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DOI: 10.1055/s-0041-1728735
Lesiones del ligamento cruzado anterior en esquiadores: Conceptos actuales
Article in several languages: español | English![](https://www.thieme-connect.de/media/10.1055-s-00033425/202101/lookinside/thumbnails/10-1055-s-0041-1728735_2000028_es-1.jpg)
Resumen
El esquí es un deporte individual con una tasa de lesiones de 1,84 por 1.000 días esquiador en la población general. Las roturas del ligamento cruzado anterior (LCA) son algunas de las más comunes, llegando a una tasa de 5 por cada 100 esquiadores por temporada a nivel competitivo, debido a la gran exigencia a la que se encuentran sometidas las rodillas. Lo anterior presenta un desafío para el traumatólogo a la hora de plantear un manejo. Se realizó una revisión de la literatura respecto de los mecanismos de lesión, tratamiento, prevención, rehabilitación y uso de órtesis en el retorno deportivo. Se describen los mecanismos clásicos de lesión en esquiadores amateurs y competitivos. La mayoría de las lesiones de LCA son de resolución quirúrgica, en que la recomendación de reconstrucción debe ser con injerto autólogo de hueso-tendón patelar-hueso, salvo en los pacientes mayores o en pacientes con fisis abierta, en los que se recomienda el uso de injerto autólogo de semitendinoso-gracilis. La prevención y rehabilitación se basan en mejorar la fuerza y el control neuromuscular de los estabilizadores dinámicos de la rodilla implementándose programas específicos, evaluación del gesto deportivo, y pruebas de control neuromuscular. Se recomienda el uso de órtesis funcionales adecuadas en los pacientes sometidos a reconstrucción del LCA. Las lesiones de LCA en esquiadores de nivel competitivo son habituales, de manejo específico y multidisciplinario. La elección del injerto y del tipo de rehabilitación son fundamentales en el retorno deportivo del esquiador. Nivel de evidencia: V.
Palabras Clave
esquí - lesiones de rodilla - ligamento cruzado anterior - tratamiento - prevención - órtesis de rodillaPublication History
Received: 10 July 2020
Accepted: 21 January 2021
Article published online:
02 June 2021
© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referencias
- 1 Asociación de Centros de Esquí de Chile A.G. Memoria ACESKI 2017. Revisado el 7 de Julio 2020. https://aceski.cl/wp-content/uploads/2018/05/Memoria-ACESKI-2017.pdf
- 2 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40 (03) 193-201
- 3 Vidal A, Barahona M, Rojas JT, Santorcuato M, Aguirre S. Evolution of Injury Rates in Skiers and Snowboarders from a Single Ski Resort: A 23 Years Overview. EC Orthopaedics 2018; 9 (04) 182-186
- 4 The FIS Injury Surveillance System. Oslo Sports Trauma Research Center. https://assets.fis-ski.com/image/upload/v1559053066/fis-prod/assets/FIS_ISS_report_2018-19.pdf
- 5 Flørenes TW, Bere T, Nordsletten L, Heir S, Bahr R. Injuries among male and female World Cup alpine skiers. Br J Sports Med 2009; 43 (13) 973-978
- 6 Soligard T, Palmer D, Steffen K. et al. Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries. Br J Sports Med 2019; 53 (17) 1085-1092
- 7 Hägglund M, Waldén M, Ekstrand J. Injuries among male and female elite football players. Scand J Med Sci Sports 2009; 19 (06) 819-827
- 8 Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med 1995; 23 (05) 531-537
- 9 Bere T, Flørenes TW, Krosshaug T, Nordsletten L, Bahr R. Events leading to anterior cruciate ligament injury in World Cup Alpine Skiing: a systematic video analysis of 20 cases. Br J Sports Med 2011; 45 (16) 1294-1302
- 10 Bottoni CR, Smith EL, Shaha J. et al. Autograft vs allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a mini- mum 10-year follow-up. Am J Sports Med 2015; 43 (10) 2501-2509
- 11 Maletis GB, Chen J, Inacio MCS, Love RM, Funahashi TT. Increased Risk of Revision After Anterior Cruciate Ligament Reconstruction With Soft Tissue Allografts Compared With Autografts: Graft Processing and Time Make a Difference. Am J Sports Med 2017; 45 (08) 1837-1844
- 12 Baratta R, Solomonow M, Zhou BH, Letson D, Chuinard R, D'Ambrosia R. Muscular coactivation. The role of the antagonist musculature in maintaining knee stability. Am J Sports Med 1988; 16 (02) 113-122
- 13 MacWilliams BA, Wilson DR, DesJardins JD, Romero J, Chao EY. Hamstrings cocontraction reduces internal rotation, anterior translation, and anterior cruciate ligament load in weight-bearing flexion. J Orthop Res 1999; 17 (06) 817-822
- 14 Behrens M, Mau-Moeller A, Wassermann F, Plewka A, Bader R, Bruhn S. Repetitive jumping and sprinting until exhaustion alters hamstring reflex responses and tibial translation in males and females. J Orthop Res 2015; 33 (11) 1687-1692
- 15 Berg HE, Eiken O, Tesch PA. Involvement of eccentric muscle actions in giant slalom racing. Med Sci Sports Exerc 1995; 27 (12) 1666-1670
- 16 Hintermeister RA, O'Connor DD, Dillman CJ, Suplizio CL, Lange GW, Steadman JR. Muscle activity in slalom and giant slalom skiing. Med Sci Sports Exerc 1995; 27 (03) 315-322
- 17 Neumayr G, Hoertnagl H, Pfister R, Koller A, Eibl G, Raas E. Physical and physiological factors associated with success in professional alpine skiing. Int J Sports Med 2003; 24 (08) 571-575
- 18 Turnbull JR, Kilding AE, Keogh JWL. Physiology of alpine skiing. Scand J Med Sci Sports 2009; 19 (02) 146-155
- 19 Ristanis S, Tsepis E, Giotis D, Stergiou N, Cerulli G, Georgoulis AD. Electromechanical delay of the knee flexor muscles is impaired after harvesting hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 2009; 37 (11) 2179-2186
- 20 Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 2000; 32 (08) 1472-1479
- 21 Jordan MJ, Aagaard P, Herzog W. Rapid hamstrings/quadriceps strength in ACL-reconstructed elite Alpine ski racers. Med Sci Sports Exerc 2015; 47 (01) 109-119
- 22 Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 1991; 19 (05) 478-484
- 23 Aglietti P, Buzzi R, Zaccherotti G, De Biase P. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 1994; 22 (02) 211-217 , discussion 217–218
- 24 Oates KM, Van Eenenaam DP, Briggs K, Homa K, Sterett WI. Comparative injury rates of uninjured, anterior cruciate ligament-deficient, and reconstructed knees in a skiing population. Am J Sports Med 1999; 27 (05) 606-610
- 25 Ekeland A, Engebretsen L, Fenstad AM, Heir S. Similar risk of ACL graft revision for alpine skiers, football and handball players: the graft revision rate is influenced by age and graft choice. Br J Sports Med 2020; 54 (01) 33-37
- 26 van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med 1992; 14 (02) 82-99
- 27 Spörri J, Kröll J, Gilgien M, Müller E. How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here?. Sports Med 2017; 47 (04) 599-614 DOI: 10.1007/s40279-016-0601-2.
- 28 Kröll J, Spörri J, Steenstrup SE, Schwameder H, Müller E, Bahr R. How can we prove that a preventive measure in elite sport is effective when the prevalence of the injury (eg, ACL tear in alpine ski racing) is low? A case for surrogate outcomes. Br J Sports Med 2017; 51 (23) 1644-1645
- 29 Donnell-Fink LA, Klara K, Collins JE. et al. Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a metaanalysis. PLoS One 2015; 10 (12) e0144063
- 30 Ardern CL, Ekås G, Grindem H. et al; International Olympic Committee Pediatric ACL Injury Consensus Group. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2018; 6 (03) 2325967118759953
- 31 Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res 2016; 34 (11) 1843-1855
- 32 Fort-Vanmeerhaeghe A, Romero-Rodriguez D, Lloyd RS, Kushner A, Myer GD. Integrative Neuromuscular Training in Youth Athletes. Part II. Strength Condit J 2016; 38 (04) 9-27
- 33 Kokmeyer D, Wahoff M, Mymern M. Suggestions from the field for return-to-sport rehabilitation following anterior cruciate ligament reconstruction: alpine skiing. J Orthop Sports Phys Ther 2012; 42 (04) 313-325
- 34 Hewett TE, Myer GD, Ford KR. et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33 (04) 492-501
- 35 Westin M, Harringe ML, Engström B, Alricsson M, Werner S. Risk Factors for Anterior Cruciate Ligament Injury in Competitive Adolescent Alpine Skiers. Orthop J Sports Med 2018; 6 (04) 2325967118766830
- 36 Garrison JC, Shanley E, Thigpen C, Geary R, Osler M, Delgiorno J. The reliability of the vail sport test™ as a measure of physical performance following anterior cruciate ligament reconstruction. Int J Sports Phys Ther 2012; 7 (01) 20-30
- 37 Oslo Sports Trauma Research Center. Skadefri. Revisado el 7 de Julio 2020 http://www.fittoplay.org/
- 38 Spitzenpfeil P. Development and first evaluation of a novel preventive knee brace for alipine ski racing. Erich Muller, Stefan Lindinger, Thomas Stöggl, editors. Science and Skiing Volume VI, Meyer and Meyer (UK) Ltd; 2015: 297-207
- 39 Németh G, Lamontagne M, Tho KS, Eriksson E. Electromyographic activity in expert downhill skiers using functional knee braces after anterior cruciate ligament injuries. Am J Sports Med 1997; 25 (05) 635-641
- 40 Sterett WI, Briggs KK, Farley T, Steadman JR. Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study. Am J Sports Med 2006; 34 (10) 1581-1585
- 41 Negrin R, Uribe-Echevarria B, Reyes N. Do Knee Braces Prevent Ski Knee Injuries?. Asian J Sports Med 2017; 8 (04) e58678