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Della Villa F, Di Paolo S, Crepaldi M, Santin P, Menditto I, Pirli Capitani L, Boldrini L, Ciampone L, Vassura G, Bortolami A, Bosi AN, Grassi A, Zaffagnini S. Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713875 DOI: 10.1002/ksa.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. METHODS One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). RESULTS A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95th percentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MS and total score (p < 0.01). CONCLUSION Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Crepaldi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Piefrancesco Santin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Ilaria Menditto
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Luca Pirli Capitani
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Lorenzo Boldrini
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Luca Ciampone
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gabriele Vassura
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Antonio Bortolami
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Andrea Nicolò Bosi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Schilaty ND, Bates NA. Commentary on "The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes". JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:373-375. [PMID: 38043909 PMCID: PMC11117014 DOI: 10.1016/j.jshs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL 33620, USA; Department of Medical Engineering, University of South Florida, Tampa, FL 33620, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL 33620, USA.
| | - Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Ishida T, Koshino Y, Yamanaka M, Ueno R, Taniguchi S, Ino T, Kasahara S, Samukawa M, Tohyama H. Larger hip external rotation motion is associated with larger knee abduction and internal rotation motions during a drop vertical jump. Sports Biomech 2024; 23:640-654. [PMID: 33663352 DOI: 10.1080/14763141.2021.1881151] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023]
Abstract
Associations among hip motions, knee abduction and internal rotation motion during a drop vertical jump (DVJ), which increases the risk of anterior cruciate ligament injury, remain unclear. The purpose of this study was to examine associations among knee abduction, internal rotation and hip joint motions during a DVJ. Fifty-seven young female participants performed a DVJ from a 30-cm height. Hip and knee kinematics and kinetics were analysed using a three-dimensional motion analysis system and force plates. Multiple regression analysis showed that peak knee abduction angle was negatively associated with knee internal rotation and hip internal rotation excursions from initial contact (IC) to peak knee flexion, and positively associated with peak knee abduction moment (R2 = 0.465, P< 0.001). Peak knee internal rotation angle was negatively associated with the hip flexion excursion from IC to peak knee flexion and peak hip adduction moment (R2 = 0.194, P= 0.001). In addition, hip internal rotation excursion was negatively associated with knee abduction and internal rotation excursion from IC to 50 ms after IC. To avoid a large knee abduction and internal rotation motion during jump-landing training, it might be beneficial to provide landing instructions to avoid a large hip external rotation motion.
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Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Ryo Ueno
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Rao H, Bakker R, McLachlin S, Chandrashekar N. Computational study of extrinsic factors affecting ACL strain during single-leg jump landing. BMC Musculoskelet Disord 2024; 25:318. [PMID: 38654258 PMCID: PMC11036765 DOI: 10.1186/s12891-024-07372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain. METHODS 3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen's ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants. RESULTS The maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05). CONCLUSIONS Soft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.
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Affiliation(s)
- Harish Rao
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ryan Bakker
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Naveen Chandrashekar
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Wheatley MGA, Pearle AD, Shamritsky DZ, Hirth JM, Nawabi DH, Wickiewicz TL, Beynnon BD, Imhauser CW. Statistical shape analysis and computational modeling reveal novel relationships between tibiofemoral bony geometry and knee mechanics in young, female athletes. J Biomech 2024; 167:112030. [PMID: 38583375 DOI: 10.1016/j.jbiomech.2024.112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
Young female athletes participating in sports requiring rapid changes of direction are at heightened risk of suffering traumatic knee injury, especially noncontact rupture of the anterior cruciate ligament (ACL). Clinical studies have revealed that geometric features of the tibiofemoral joint are associated with increased risk of suffering noncontact ACL injury. However, the relationship between three-dimensional (3D) tibiofemoral geometry and knee mechanics in young female athletes is not well understood. We developed a statistically augmented computational modeling workflow to determine relationships between 3D geometry of the knee and tibiofemoral kinematics and ACL force in response to an applied loading sequence of compression, valgus, and anterior force, which is known to load the ACL. This workflow included 3D characterization of tibiofemoral bony geometry via principal component analysis and multibody dynamics models incorporating subject-specific knee geometries. A combination of geometric features of both the tibia and the femur that spanned all three anatomical planes was related to increased ACL force and to increased kinematic coupling (i.e., anterior, medial, and distal tibial translations and internal tibial rotation) in response to the applied loads. In contrast, a uniplanar measure of tibiofemoral geometry that is associated with ACL injury risk, sagittal plane slope of the lateral tibial plateau subchondral bone, was not related to ACL force. Thus, our workflow may aid in developing mechanics-based ACL injury screening tools for young, active females based on a unique combination of bony geometric features that are related to increased ACL loading.
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Affiliation(s)
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David Z Shamritsky
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Jacob M Hirth
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
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6
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Ekdahl M, Ulman S, Butler L. Relationship of Knee Abduction Moment to Trunk and Lower Extremity Segment Acceleration during Sport-Specific Movements. SENSORS (BASEL, SWITZERLAND) 2024; 24:1454. [PMID: 38474989 DOI: 10.3390/s24051454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
The knee abduction moment (KAM) has been identified as a significant predictor of anterior cruciate ligament (ACL) injury risk; however, the cost and time demands associated with collecting three-dimensional (3D) kinetic data have prompted the need for alternative solutions. Wearable inertial measurement units (IMUs) have been explored as a potential solution for quantitative on-field assessment of injury risk. Most previous work has focused on angular velocity data, which are highly susceptible to bias and noise relative to acceleration data. The purpose of this pilot study was to assess the relationship between KAM and body segment acceleration during sport-specific movements. Three functional tasks were selected to analyze peak KAM using optical motion capture and force plates as well as peak triaxial segment accelerations using IMUs. Moderate correlations with peak KAM were observed for peak shank acceleration during single-leg hop; peak trunk, thigh, and shank accelerations during a deceleration task; and peak trunk, pelvis, and shank accelerations during a 45° cut. These findings provide preliminary support for the use of wearable IMUs to identify peak KAM during athletic tasks.
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Affiliation(s)
| | - Sophia Ulman
- Scottish Rite for Children, Frisco, TX 75034, USA
- Department of Orthopaed Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lauren Butler
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL 33199, USA
- Nicklaus Children's Hospital, Miami, FL 33155, USA
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Mohr M, Federolf P, Heinrich D, Nitschke M, Raschner C, Scharbert J, Koelewijn AD. An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk. Sci Rep 2024; 14:3115. [PMID: 38326644 PMCID: PMC10850483 DOI: 10.1038/s41598-024-53640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant 'training x group' interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.
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Affiliation(s)
- M Mohr
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - P Federolf
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - D Heinrich
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - M Nitschke
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - C Raschner
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - J Scharbert
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - A D Koelewijn
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Hobayan CGP, Bates NA, Heyniger J, Alzouhayli K, Piscitani F, Haider CR, Felton C, Groth AT, Martin KD. Stability of One-Step Spray-on Splint for Lower Extremity Fractures During Splinting, MEDEVAC, and Impact. Mil Med 2024:usae001. [PMID: 38294066 DOI: 10.1093/milmed/usae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/26/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Military transport can induce whole-body vibrations, and combat almost always involves high impact between lower extremities and the ground. Therefore, robust splinting technology is necessary for lower extremity fractures in these settings. Our team compared a novel one-step spray-on foam splint (FastCast) to the current military standard structured aluminum malleable (SAM) splint. MATERIALS AND METHODS Ten cadaveric specimens were subjected to complete tibia/fibula osteotomy. Specimens were fitted with custom accelerometer and gyroscope sensors superior and inferior to the fracture line. Each specimen underwent fracture and splinting from a standard of care SAM splint and an experimental FastCast spray foam splint in a randomized order. Each specimen was manually transported to an ambulance and then released from a 1 meter height to simulate impact. The custom sensors recorded accelerations and rotations throughout each event. Repeated-measures Friedman tests were used to assess differences between splint method within each event and between sensors within each splint method. RESULTS During splinting, overall summation of change and difference of change between sensors for accelerations and rotations were greater for SAM splints than FastCast across all axes (P ≤ 0.03). During transport, the range of acceleration along the linear superior/inferior axis was greater for SAM splint than FastCast (P = 0.02), as was the range of rotation along the transverse plane (P < 0.01). On impact, the summation of change observed was greater for SAM splint than FastCast with respect to acceleration and rotation on the posterior/anterior and superior/inferior axes (P ≤ 0.03), and the cumulative difference between superior and inferior sensors was greater for SAM than FastCast with respect to anterior-axis rotation (P < 0.05). CONCLUSION FastCast maintains stabilization of fractured lower extremities during transport and impacts to a significantly greater extent than SAM splints. Therefore, FastCast can potentially reduce the risk of fracture complications following physical stressors associated with combat and extraction.
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Affiliation(s)
- C Grace P Hobayan
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Nathaniel A Bates
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - John Heyniger
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kenan Alzouhayli
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Franco Piscitani
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - Clifton R Haider
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Christopher Felton
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Adam T Groth
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - Kevin D Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
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Behnam YA, Anantha Krishnan A, Wilson H, Clary CW. Simultaneous Evaluation of Tibiofemoral and Patellofemoral Mechanics in Total Knee Arthroplasty: A Combined Experimental and Computational Approach. J Biomech Eng 2024; 146:011007. [PMID: 37916893 DOI: 10.1115/1.4063950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
Contemporary total knee arthroplasty (TKA) has not fully restored natural patellofemoral (P-F) mechanics across the patient population. Previous experimental simulations have been limited in their ability to create dynamic, unconstrained, muscle-driven P-F articulation while simultaneously controlling tibiofemoral (T-F) contact mechanics. The purpose of this study was to develop a novel experimental simulation and validate a corresponding finite element model to evaluate T-F and P-F mechanics. A commercially available wear simulator was retrofitted with custom fixturing to evaluate whole-knee TKA mechanics with varying patella heights during a simulated deep knee bend. A corresponding dynamic finite element model was developed to validate kinematic and kinetic predictions against experimental measurements. Patella alta reduced P-F reaction forces in early and midflexion, corresponding with an increase in T-F forces that indicated an increase in extensor mechanism efficiency. Due to reduced wrapping of the extensor mechanism in deeper flexion for the alta condition, peak P-F forces in flexion increased from 101% to 135% of the applied quadriceps load for the baja and alta conditions, respectively. Strong agreement was observed between the experiment and model predictions with root-mean-square errors (RMSE) for P-F kinematics ranging from 0.8 deg to 3.3 deg and 0.7 mm to 1.4 mm. RMSE for P-F forces ranged from 7.4 N to 53.6 N. By simultaneously controlling dynamic, physiological loading of the T-F and P-F joint, this novel experimental simulation and validated model will be a valuable tool for investigation of future TKA designs and surgical techniques.
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Affiliation(s)
- Yashar A Behnam
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Ahilan Anantha Krishnan
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Hayden Wilson
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Chadd W Clary
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
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Di Paolo S, Grassi A, Tosarelli F, Crepaldi M, Bragonzoni L, Zaffagnini S, Della Villa F. Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players. Int J Sports Phys Ther 2023; 18:887-897. [PMID: 37547837 PMCID: PMC10399106 DOI: 10.26603/001c.84308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis. Study Design Prospective cohort study. Methods Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered. Results Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 - 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 - 0.042), ankle eversion, and contralateral pelvic drop (p<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45). Conclusions Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it. Level of Evidence 3©The Author(s).
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Affiliation(s)
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic Istituto Ortopedico Rizzoli
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Sadeqi S, Norte GE, Murray A, Erbulut DU, Goel VK. Effect of Whole Body Parameters on Knee Joint Biomechanics: Implications for ACL Injury Prevention During Single-Leg Landings. Am J Sports Med 2023; 51:2098-2109. [PMID: 37259968 DOI: 10.1177/03635465231174899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous studies have examined the effect of whole body (WB) parameters on anterior cruciate ligament (ACL) strain and loads, as well as knee joint kinetics and kinematics. However, articular cartilage damage occurs in relation to ACL failure, and the effect of WB parameters on ACL strain and articular cartilage biomechanics during dynamic tasks is unclear. PURPOSES (1) To investigate the effect of WB parameters on ACL strain, as well as articular cartilage stress and contact force, during a single-leg cross drop (SLCD) and single-leg drop (SLD). (2) To identify WB parameters predictive of high ACL strain during these tasks. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional motion analysis data from 14 physically active men and women were recorded during an SLCD and SLD. OpenSim was used to obtain their kinematics, kinetics, and muscle forces for the WB model. Using these data in kinetically driven finite element simulations of the knee joint produced outputs of ACL strains and articular cartilage stresses and contact forces. Spearman correlation coefficients were used to assess relationships between WB parameters and ACL strain and cartilage biomechanics. Moreover, receiver operating characteristic curve analyses and multivariate binary logistic regressions were used to find the WB parameters that could discriminate high from low ACL strain trials. RESULTS Correlations showed that more lumbar rotation away from the stance limb at peak ACL strain had the strongest overall association (ρ = 0.877) with peak ACL strain. Higher knee anterior shear force (ρ = 0.895) and lower gluteus maximus muscle force (ρ = 0.89) at peak ACL strain demonstrated the strongest associations with peak articular cartilage stress or contact force in ≥1 of the analyzed tasks. The regression model that used muscle forces to predict high ACL strain trials during the dominant limb SLD yielded the highest accuracy (93.5%), sensitivity (0.881), and specificity (0.952) among all regression models. CONCLUSION WB parameters that were most consistently associated with and predictive of high ACL strain and poor articular cartilage biomechanics during the SLCD and SLD tasks included greater knee abduction angle at initial contact and higher anterior shear force at peak ACL strain, as well as lower gracilis, gluteus maximus, and medial gastrocnemius muscle forces. CLINICAL RELEVANCE Knowledge of which landing postures create a high risk for ACL or cartilage injury may help reduce injuries in athletes by avoiding those postures and practicing the tasks with reduced high-risk motions, as well as by strengthening the muscles that protect the knee during single-leg landings.
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Affiliation(s)
- Sara Sadeqi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Amanda Murray
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Deniz U Erbulut
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
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12
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Razu SS, Jahandar H, Zhu A, Berube EE, Manzi JE, Pearle AD, Nawabi DH, Wickiewicz TL, Santner TJ, Imhauser CW. Bayesian Calibration of Computational Knee Models to Estimate Subject-Specific Ligament Properties, Tibiofemoral Kinematics, and Anterior Cruciate Ligament Force With Uncertainty Quantification. J Biomech Eng 2023; 145:071003. [PMID: 36826392 PMCID: PMC10782874 DOI: 10.1115/1.4056968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023]
Abstract
High-grade knee laxity is associated with early anterior cruciate ligament (ACL) graft failure, poor function, and compromised clinical outcome. Yet, the specific ligaments and ligament properties driving knee laxity remain poorly understood. We described a Bayesian calibration methodology for predicting unknown ligament properties in a computational knee model. Then, we applied the method to estimate unknown ligament properties with uncertainty bounds using tibiofemoral kinematics and ACL force measurements from two cadaver knees that spanned a range of laxities; these knees were tested using a robotic manipulator. The unknown ligament properties were from the Bayesian set of plausible ligament properties, as specified by their posterior distribution. Finally, we developed a calibrated predictor of tibiofemoral kinematics and ACL force with their own uncertainty bounds. The calibrated predictor was developed by first collecting the posterior draws of the kinematics and ACL force that are induced by the posterior draws of the ligament properties and model parameters. Bayesian calibration identified unique ligament slack lengths for the two knee models and produced ACL force and kinematic predictions that were closer to the corresponding in vitro measurement than those from a standard optimization technique. This Bayesian framework quantifies uncertainty in both ligament properties and model outputs; an important step towards developing subject-specific computational models to improve treatment for ACL injury.
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Affiliation(s)
- Swithin S. Razu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew Zhu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Erin E. Berube
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Joseph E. Manzi
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew D. Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | - Danyal H. Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | | | - Thomas J. Santner
- Department of Statistics, The Ohio State University, Columbus, OH 43210-1247
| | - Carl W. Imhauser
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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13
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Chijimatsu M, Ishida T, Yamanaka M, Taniguchi S, Ueno R, Ikuta R, Samukawa M, Ino T, Kasahara S, Tohyama H. Subsequent Jumping Increases the Knee and Hip Abduction Moment, Trunk Lateral Tilt, and Trunk Rotation Motion During Single-Leg Landing in Female Individuals. J Appl Biomech 2023:1-7. [PMID: 37225171 DOI: 10.1123/jab.2022-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
Single-leg landings with or without subsequent jumping are frequently used to evaluate landing biomechanics. The purpose of this study was to investigate the effects of subsequent jumping on the external knee abduction moment and trunk and hip biomechanics during single-leg landing. Thirty young adult female participants performed a single-leg drop vertical jumping (SDVJ; landing with subsequent jumping) and single-leg drop landing (SDL; landing without subsequent jumping). Trunk, hip, and knee biomechanics were evaluated using a 3-dimensional motion analysis system. The peak knee abduction moment was significantly larger during SDVJ than during SDL (SDVJ 0.08 [0.10] N·m·kg-1·m-1, SDL 0.05 [0.10] N·m·kg-1·m-1, P = .002). The trunk lateral tilt and rotation angles toward the support-leg side and external hip abduction moment were significantly larger during SDVJ than during SDL (P < .05). The difference in the peak hip abduction moment between SDVJ and SDL predicted the difference in the peak knee abduction moment (P = .003, R2 = .252). Landing tasks with subsequent jumping would have advantages for evaluating trunk and hip control as well as knee abduction moment. In particular, evaluating hip abduction moment may be important because of its association with the knee abduction moment.
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Affiliation(s)
- Masato Chijimatsu
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki,Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Masanori Yamanaka
- Faculty of Health Sciences, Hokkaido Chitose College of Rehabilitation, Chitose,Japan
| | | | - Ryo Ueno
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Ryohei Ikuta
- Hachioji Sports Orthopedic Clinic, Hachioji,Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo,Japan
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14
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Nishino K, Suzuki H, Tanaka M, Kikumoto T, Omori G. single-leg medial drop landing with trunk lean includes improper body mechanics related to anterior cruciate ligament injury risk: A comparison of body mechanics between successful trials and failed trials in the drop landing test among female basketball athletes. Clin Biomech (Bristol, Avon) 2023; 104:105942. [PMID: 36933396 DOI: 10.1016/j.clinbiomech.2023.105942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Improper body mechanics during landing is a typical risk factor of anterior cruciate ligament injury. Drop landing test is used to evaluate landing mechanics by observing not only successful trials but also failed trials. Leaning of the trunk, which is frequently observed during failed trials, may lead to improper body mechanics related to anterior cruciate ligament injury. This study aimed to elucidate the mechanisms of landing with trunk lean that may underlie the risks of anterior cruciate ligament injury by comparing body mechanics between failed and successful trials. METHODS Participants were 72 female basketball athletes. The athletic task was single-leg medial drop landing, and the body mechanics was recorded by a motion capture system and force plate. Participants fixed the landing pose for ≥3 s in successful trials but failed to do so in failed trials. FINDINGS Failed trials included the large lean of trunk. There were significant changes in thoracic and pelvic leans at initial contact in failed trials with medial trunk lean (p < 0.05). Kinematics and kinetics during the landing phase in failed trials were associated with the risks of anterior cruciate ligament injury. INTERPRETATION These findings suggest that landing mechanics with trunk lean involves many biomechanical factors related to anterior cruciate ligament injury and demonstrates the inappropriate pose of trunk from the dropping phase. Exercise programs aimed at the landing manoeuver without trunk lean may contribute to reduce the risks of anterior cruciate ligament injury in female basketball athletes.
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Affiliation(s)
- Katsutoshi Nishino
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata 950-0933, Japan.
| | - Hidetomo Suzuki
- J.F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo 194-0624, Japan
| | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata 950-0933, Japan
| | - Takanori Kikumoto
- Department of Rehabilitation, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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15
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Saxby DJ, Catelli DS, Lloyd DG, Sawacha Z. Editorial: The role of biomechanics in anterior cruciate ligament injuries prevention. Front Sports Act Living 2023; 5:1134969. [PMID: 36969959 PMCID: PMC10034354 DOI: 10.3389/fspor.2023.1134969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Danilo S. Catelli
- Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - David G. Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Zimi Sawacha
- Department of Information Engineering, University of Padua, Padua, Veneto, Italy
- Department of Medicine, University of Padua, Padua, Veneto, Italy
- Correspondence: Zimi Sawacha
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16
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Miyamoto D, Saito A, Kimoto M, Terui Y, Okada K. Relationship between the knee valgus moment and the hip abductor and adductor activity during single-leg landing. Phys Ther Sport 2023; 61:129-134. [PMID: 37023591 DOI: 10.1016/j.ptsp.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To reveal the relationship between the knee valgus moment (KVM) and the hip abductor and adductor activity during single-leg landing. DESIGN A cross-sectional study. SETTING Laboratory-based, between April 2020 and May 2021. PARTICIPANTS Thirty female collegiate athletes. MAIN OUTCOME MEASURES KVM, hip adduction angle, hip internal rotation angle, knee valgus angle (KVA), gluteus medius muscle activity, adductor longus muscle activity, adductor longus to gluteus medius activity ratio (ADD/GMED), and vertical component of the ground reaction force (vGRF). RESULTS Stepwise multiple regression analysis was performed. KVM was significantly positively associated with KVA (β = 0.613, p < 0.001), vGRF (β = 0.367, p = 0.010), and ADD/GMED (β = 0.289, p = 0.038). CONCLUSIONS Increased KVA, vGRF, and ADD/GMED were the independent factors that contributed to increased KVM during single-leg landing, and only ADD/GMED was found among the muscle activity values. The relative muscle activity of the gluteus medius and adductor longus, rather than those of the gluteus medius or adductor longus alone, may be useful in preventing anterior cruciate ligament injury during single-leg landing.
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17
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Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, Orantes-González E, Heredia-Jimenez J, Lucha-López MO, Hidalgo-García C, Tricás-Moreno JM. Diagnostics Using the Change-of-Direction and Acceleration Test (CODAT) of the Biomechanical Patterns Associated with Knee Injury in Female Futsal Players: A Cross-Sectional Analytical Study. Diagnostics (Basel) 2023; 13:diagnostics13050928. [PMID: 36900071 PMCID: PMC10000524 DOI: 10.3390/diagnostics13050928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant limb in the whole group, using the same test. A cross-sectional study was performed in 16 female futsal players allocated into two groups: eight females with a previous knee injury, i.e., affected by the valgus collapse mechanism without surgical intervention, and eight with no previous injury. The evaluation protocol included the change-of-direction and acceleration test (CODAT). One registration was made for each lower limb, i.e., the dominant (the preferred kicking limb) and non-dominant limb. A 3D motion capture system (Qualisys AB, Göteborg, Sweden) was used to analyze the kinematics. The Cohen's d effect sizes between the groups demonstrated a strong effect size towards more physiological positions in the non-injured group in the following kinematics in the dominant limb: hip adduction (Cohen's d = 0.82), hip internal rotation (Cohen's d = 0.88), and ipsilateral pelvis rotation (Cohen's d = 1.06). The t-test for the dominant and non-dominant limb in the whole group showed the following differences in knee valgus: dominant limb (9.02 ± 7.31 degrees) and non-dominant limb (1.27 ± 9.05 degrees) (p = 0.049). Conclusions: The players with no previous history of knee injury had a more physiological position for avoiding the valgus collapse mechanism in the hip adduction and internal rotation, and in the pelvis rotation in the dominant limb. All the players showed more knee valgus in the dominant limb, which is the limb at greater risk of injury.
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Affiliation(s)
- Loreto Ferrández-Laliena
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Lucía Vicente-Pina
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Rocío Sánchez-Rodríguez
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Eva Orantes-González
- Department of Sports and Computer Science, Faculty of Physical Education and Sports, University of Pablo de Olavide, 41013 Sevilla, Spain
| | - José Heredia-Jimenez
- Department of Physical Education and Sports, Faculty of Education, Economy & Technology, University of Granada, 51001 Ceuta, Spain
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
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18
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Die Apple-Bite-Fraktur – wann und wie versorgen? ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Foody JN, Bradley PX, Spritzer CE, Wittstein JR, DeFrate LE, Englander ZA. Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes. Am J Sports Med 2023; 51:422-428. [PMID: 36625427 DOI: 10.1177/03635465221141876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. PURPOSE/HYPOTHESIS The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. STUDY DESIGN Descriptive laboratory study. METHODS Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. RESULTS Mean ACL strain increased with decreasing knee flexion angle (ρ = -0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, -0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = -0.01; P = .9). CONCLUSION ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. CLINICAL RELEVANCE These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.
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Affiliation(s)
- Jacqueline N Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Patrick X Bradley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | | | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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20
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Wakabayashi K, Ogasawara I, Suzuki Y, Nakata K, Nomura T. Exploring pre-impact landing kinematics associated with increase and decrease in the anterior cruciate ligament injury risk. J Biomech 2022; 145:111382. [PMID: 36446310 DOI: 10.1016/j.jbiomech.2022.111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to explore the single-legged landing kinematics that could lead to increase or decrease in the risk of anterior cruciate ligament (ACL) injury. Immediate pre-impact kinematics at the single-legged landing from 33 healthy young female handball players were evaluated. Thereafter, two-year follow-up for ACL injury incidence was conducted, in which six new ACL injuries in non-dominant leg were registered. The evaluation of pre-impact kinematics across participants was performed first by the principal component analysis to decompose them into the kinematic components (KCs), and then by the linear discrimination analysis (LDA) for a set of KC-scores to obtain important KCs for discriminating injured and non-injured legs. The result of LDA showed that the combination of second major KC (knee flexion/extension angle and angular velocity) and some minor KCs such as torso medial/lateral leaning accurately discriminated the injured and non-injured legs with the error rate of 12.5%. To examine the mechanisms of this discriminative ability, we generated hypothetical pre-impact kinematics in the subspaces spanned by eigenvectors of multiple KCs, and examined relationships between pre-impact kinematics and the corresponding knee valgus torque predicted by the motion-equation-based model. The result showed that the second major KC and the minor KCs representing torso medial/lateral leaning and/or hip adduction/abduction angle, which contributed in LDA to discriminating injured legs, also significantly affected the frontal-plane knee loading patterns. These findings suggested that KC-based postural characterization of the pre-impact landing kinematics and the motion-equation-based knee stress quantification possibly explain the future ACL injury risks of female athletes.
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Affiliation(s)
- Kaito Wakabayashi
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Issei Ogasawara
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan.
| | - Yasuyuki Suzuki
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Ken Nakata
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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21
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Tanaka T, Gale T, Nishida K, Xu C, Fu F, Anderst W. Posterior tibial slope and meniscal slope correlate with in vivo tibial internal rotation during running and drop jump. Knee Surg Sports Traumatol Arthrosc 2022; 31:2366-2373. [PMID: 36115904 DOI: 10.1007/s00167-022-07163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between tibial bony and meniscus anatomy and knee kinematics during in vivo, high-impact activities remains unclear. This study aimed to determine if the posterior tibial slope (PTS) and meniscal slope (MS) are associated with in vivo anterior-posterior translation and internal tibia rotation during running and double-leg drop jumps in healthy knees. METHODS Nineteen collegiate athletes performed fast running at 5.0 m/s on an instrumented treadmill and double-leg drop jump from a 60 cm platform while biplane radiographs of the knee were acquired at 150 Hz. Tibiofemoral kinematics were determined using a validated model-based tracking process. Medial and lateral PTS and MS were measured using magnetic resonance imaging (MRI). RESULTS In fast running, more internal tibia rotation was associated with greater PTS (ρ = 0.336, P = 0.039) and MS (ρ = 0.405, P = 0.012) in the medial knee compartment. In the double-leg drop jump, more internal tibia rotation was associated with greater PTS (ρ = 0.431, P = 0.007) and MS (ρ = 0.323, P = 0.005) in the medial knee compartment, as well as a greater PTS in the lateral knee compartment (ρ = 0.445, P = 0.005). CONCLUSION These findings suggest that the medial and lateral PTS and medial MS are associated with the amount of knee rotation during high-impact activities. These in vivo findings improve our understanding of ACL injury risk by linking bone and meniscus morphology to dynamic kinematics.
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Affiliation(s)
- Toshikazu Tanaka
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Kyohei Nishida
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Caiqi Xu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Freddie Fu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.
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22
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Lambert C, Riesterer J, Mauch M, Lambert M, Paul J, Ritzmann R. Modified defense reaction reduces biomechanical and myoelectrical ACL injury risk factors in elite Judo. J Sports Sci 2022; 40:1325-1335. [PMID: 35616597 DOI: 10.1080/02640414.2022.2080160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In judo, an anterior cruciate ligament (ACL) injury is the most severe injury an athlete could experience. Most ACL ruptures occur when defending against an osoto-gari attack. This study aims to identify ACL risk factors during osoto-gari defence and implement a modified osoto-gari defence reaction, which is assumed to improve myoelectric patterns and ameliorate critical biomechanical risk factors for ACL injuries. Twenty-six elite judokas were enrolled in the cross-over trial (female: 6; male: 20). 3D kinematics and force dynamometrics were combined with electromyographical recordings to assess the effects of the common and the modified osoto-gari defence reaction. Compared to the common osoto-gari defence reaction (maximal knee flexion: 29 ± 12°; maximal valgus: 10 ± 5°; maximal valgus moment: 58 ± 17 Nm; peak internal rotation: 9 ± 5°), the modified osoto-gari defence reaction showed significantly reduced knee angles (31 ± 10° p < 0.05; 1 ± 0° p < 0.05; 31 ± 9 Nm p < 0.05; 3 ± 0° p < 0.05). The myoelectric activity of the hamstring increased (+5±% to +27±%, p < 0.05) in the modified compared to common defence reaction. The modified osoto-gari defence reaction reduced critical biomechanical risk factors and increased hamstring myoelectric activity. We recommend the implementation of the modified osoto-gari defence reaction in judo practice and seek to evaluate its long-term effectiveness in decreasing ACL injury incidences in elite judo.
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Affiliation(s)
- Christophe Lambert
- Department of Functional Diagnostics, Rennbahnklinik, Muttenz, Switzerland.,Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | - Janine Riesterer
- Department of Functional Diagnostics, Rennbahnklinik, Muttenz, Switzerland
| | - Marlene Mauch
- Department of Functional Diagnostics, Rennbahnklinik, Muttenz, Switzerland
| | - Maxime Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | - Jochen Paul
- Department of Functional Diagnostics, Rennbahnklinik, Muttenz, Switzerland
| | - Ramona Ritzmann
- Department of Functional Diagnostics, Rennbahnklinik, Muttenz, Switzerland
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23
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Taniguchi S, Ishida T, Yamanaka M, Ueno R, Ikuta R, Chijimatsu M, Samukawa M, Koshino Y, Kasahara S, Tohyama H. Sex difference in frontal plane hip moment in response to lateral trunk obliquity during single-leg landing. BMC Sports Sci Med Rehabil 2022; 14:70. [PMID: 35428336 PMCID: PMC9013173 DOI: 10.1186/s13102-022-00460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lateral trunk obliquity during landing is a characteristic of anterior cruciate ligament (ACL) injuries in female athletes and affects their knee and hip kinetics and kinematics. However, it is unclear whether these effects differ between females and males. The purpose of this study was to compare the effects of lateral trunk obliquity on knee and hip kinetics and kinematics in females and males during single-leg landing. METHODS Eighteen female (aged 22.1 ± 1.5 years) and 18 male participants (aged 21.8 ± 1.1 years) performed single-leg landings under two conditions: (1) without any instructions about trunk position (natural) and (2) with leaning their trunks laterally 15° from the vertical line (trunk obliquity). The kinetics and kinematics of their hip and knee were analyzed using a three-dimensional motion analysis with a force plate. Two-way repeated-measures ANOVA (sex × trunk obliquity) and Bonferroni pairwise comparisons were conducted. RESULTS The trunk obliquity angle at initial contact was significantly greater in the trunk-obliquity landing condition than in the natural landing condition (natural 4.0 ± 2.2°, trunk-obliquity 15.1 ± 3.6°, P < 0.001) with no sex difference (95% CI - 1.2 to 2.2°, P = 0.555). The peak knee abduction moment was significantly larger in the trunk-obliquity landing condition than in the natural landing condition (trunk-obliquity, 0.09 ± 0.07 Nm/kg/m; natural, 0.04 ± 0.06 Nm/kg/m; P < 0.001), though there was no sex or interaction effect. A significant interaction between sex and landing condition was found for the peak hip abduction moment (P = 0.021). Males showed a significantly larger peak hip abduction moment in the trunk-obliquity landing condition than in the natural landing condition (95% CI 0.05 to 0.13 Nm/kg/m, P < 0.001), while females showed no difference in the peak hip abduction moment between the two landing conditions (95% CI - 0.02 to 0.06 Nm/kg/m, P = 0.355). CONCLUSIONS The knee abduction moment increased with a laterally inclined trunk for both female and male participants, while the hip abduction moment increased in males but not in females. It may be beneficial for females to focus on frontal plane hip joint control under lateral trunk-obliquity conditions during single-leg landing.
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Affiliation(s)
- Shohei Taniguchi
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.,Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Ryo Ueno
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Ryohei Ikuta
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Masato Chijimatsu
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.,Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan
| | - Satoshi Kasahara
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
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24
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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25
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Ueno R, Navacchia A, Schilaty ND, Myer GD, Hewett TE, Bates NA. Hamstrings Contraction Regulates the Magnitude and Timing of the Peak ACL Loading During the Drop Vertical Jump in Female Athletes. Orthop J Sports Med 2021; 9:23259671211034487. [PMID: 34604430 PMCID: PMC8485303 DOI: 10.1177/23259671211034487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury reduction training has focused on lower body strengthening and landing stabilization. In vitro studies have shown that quadriceps forces increase ACL strain, and hamstring forces decrease ACL strain. However, the magnitude of the effect of the quadriceps and hamstrings forces on ACL loading and its timing during in vivo landings remains unclear. Purpose To investigate the effect and timing of knee muscle forces on ACL loading during landing. Study Design Descriptive laboratory study. Methods A total of 13 young female athletes performed drop vertical jump trials, and their movements were recorded with 3-dimensional motion capture. Lower limb joint motion and muscle forces were estimated with OpenSim and applied to a musculoskeletal finite element (FE) model to estimate ACL loading during landings. The FE simulations were performed with 5 different conditions that included/excluded kinematics, ground-reaction force (GRF), and muscle forces. Results Simulation of landing kinematics without GRF or muscle forces yielded an estimated median ACL strain and force of 5.1% and 282.6 N. Addition of GRF to kinematic simulations increased ACL strain and force to 6.8% and 418.4 N (P < .05). Addition of quadriceps force to kinematics + GRF simulations nonsignificantly increased ACL strain and force to 7.2% and 478.5 N. Addition of hamstrings force to kinematics + GRF simulations decreased ACL strain and force to 2.6% and 171.4 N (P < .001). Addition of all muscles to kinematics + GRF simulations decreased ACL strain and force to 3.3% and 195.1 N (P < .001). With hamstrings force, ACL loading decreased from initial contact (time of peak: 1-18 milliseconds) while ACL loading without hamstrings force peaked at 47 to 98 milliseconds after initial contact (P = .024-.001). The knee flexion angle increased from 20.9° to 73.1° within 100 milliseconds after initial contact. Conclusion Hamstrings activation had greater effect relative to GRF and quadriceps activation on ACL loading, which significantly decreased and regulated the magnitude and timing of ACL loading during in vivo landings. Clinical Relevance Clinical training should focus on strategies that influence increased hamstrings activation during landing to reduce ACL loads.
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Affiliation(s)
- Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Alessandro Navacchia
- Smith & Nephew, San Clemente, California, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Smith & Nephew, San Clemente, California, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, Georgia, USA.,Emory Sports Medicine Center, Atlanta, Georgia, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Timothy E Hewett
- Hewett Global Consulting, Rochester, Minnesota, USA.,The Rocky Mountain Consortium for Sports Research, Edwards, Colorado, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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26
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Sigurðsson HB, Karlsson J, Snyder‐Mackler L, Briem K. Kinematics observed during ACL injury are associated with large early peak knee abduction moments during a change of direction task in healthy adolescents. J Orthop Res 2021; 39:2281-2290. [PMID: 33280158 PMCID: PMC8179932 DOI: 10.1002/jor.24942] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/14/2020] [Accepted: 12/03/2020] [Indexed: 02/04/2023]
Abstract
Cluster analysis of knee abduction moment waveforms may be useful to examine biomechanical data. The aim of this study was to analyze if the knee abduction moment waveform of early peaks, consistent with anterior cruciate ligament injury mechanisms, was associated with foot-trunk distance, knee kinematics, and heel strike landing posture, all of which have been observed during anterior cruciate ligament injuries. One hundred and seventy-seven adolescent athletes performed cutting maneuvers, marker-based motion capture collected kinetic and marker data and an 8-segment musculoskeletal model was constructed. Knee abduction moment waveforms were clustered as either a large early peak, or not a large early peak using a two-step process with Euclidean distances and the Ward-d2 cluster method. Mediolateral distance between foot and trunk was associated with the large early peak waveform with an odds ratio (95% confidence interval) of 3.4 (2.7-4.4). Knee flexion angle at initial contact and knee flexion excursion had odds ratios of 1.9 (1.6-2.4) and 1.6 (1.3-2.0). Knee abduction excursions had an odds ratio of 1.8 (1.1-2.4) and 1.8 (1.4-2.4), respectively. Heel strike landings and anteroposterior distance between foot and trunk were not associated with the large early peak waveform with odds ratios of 1.2 (0.9-1.7) and 1.1 (0.8-1.3), respectively. The knee abduction moment waveform is associated with several kinematic variables observed during ACL injury. The results support intervention programs that can modify these kinematics and thus reduce early stance phase knee abduction moments.
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Affiliation(s)
- Haraldur B. Sigurðsson
- Research Centre for Movement SciencesUniversity of IcelandReykjavíkIceland,Department of Physical TherapyUniversity of IcelandReykjavíkIceland
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Institute of Clinical SciencesGothenborg UniversityGothenburgSweden
| | | | - Kristín Briem
- Research Centre for Movement SciencesUniversity of IcelandReykjavíkIceland,Department of Physical TherapyUniversity of IcelandReykjavíkIceland
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27
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Nasseri A, Lloyd DG, Minahan C, Sayer TA, Paterson K, Vertullo CJ, Bryant AL, Saxby DJ. Effects of Pubertal Maturation on ACL Forces During a Landing Task in Females. Am J Sports Med 2021; 49:3322-3334. [PMID: 34494904 DOI: 10.1177/03635465211038332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rates of anterior cruciate ligament (ACL) rupture in young people have increased by >70% over the past two decades. Adolescent and young adult females are at higher risk of ACL injury as compared with their prepubertal counterparts. PURPOSE To determine ACL loading during a standardized drop-land-lateral jump in females at different stages of pubertal maturation. STUDY DESIGN Controlled laboratory study. METHODS On the basis of the Tanner classification system, 19 pre-, 19 early-/mid-, and 24 late-/postpubertal females performed a standardized drop-land-lateral jump while 3-dimensional body motion, ground-reaction forces, and surface electromyography data were acquired. These data were used to model external biomechanics, lower limb muscle forces, and knee contact forces, which were subsequently used in a validated computational model to estimate ACL loading. Statistical parametric mapping analysis of variance was used to compare ACL force and its causal contributors among the 3 pubertal maturation groups during stance phase of the task. RESULTS When compared with pre- and early-/midpubertal females, late-/postpubertal females had significantly higher ACL force with mean differences of 471 and 356 N during the first 30% and 48% to 85% of stance, and 343 and 274 N during the first 24% and 59% to 81% of stance, respectively, which overlapped peaks in ACL force. At the point of peak ACL force, contributions from sagittal and transverse plane loading mechanisms to ACL force were higher in late-/postpubertal compared with pre- and early-/midpubertal groups (medium effect sizes from 0.44 to 0.77). No differences were found between pre- and early-/midpubertal groups in ACL force or its contributors. CONCLUSION The highest ACL forces were observed in late-/postpubertal females, consistent with recently reported rises of ACL injury rates in females aged 15 to 19 years. It is important to quantify ACL force and its contributors during dynamic tasks to advance our understanding of the loading mechanism and thereby provide guidance to injury prevention. CLINICAL RELEVANCE Growth of ACL volume plateaus around 10 years of age, before pubertal maturation, meaning that a late-/postpubertal female could have an ACL of similar size to their less mature counterparts. However, late-/postpubertal females have higher body mass requiring higher muscle forces to accelerate the body during dynamic tasks, which may increase ACL loading. Thus, if greater forces develop in these females, in part because of their increased body mass, these higher forces will be applied to an ACL that is not proportionally larger. This may partially explain the higher rates of ACL injury in late-/postpubertal females.
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Affiliation(s)
- Azadeh Nasseri
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - David G Lloyd
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Clare Minahan
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Timothy A Sayer
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Kade Paterson
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | | | - Adam L Bryant
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - David J Saxby
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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28
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Lloyd D. The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries. Sports Biomech 2021:1-29. [PMID: 34496728 DOI: 10.1080/14763141.2021.1959947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.
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Affiliation(s)
- David Lloyd
- School of Health Sciences and Social Work, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), in the Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Griffith University, Australia
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29
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Willinger L, Athwal KK, Williams A, Amis AA. An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging. Am J Sports Med 2021; 49:2387-2395. [PMID: 34115540 PMCID: PMC8283191 DOI: 10.1177/03635465211017145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. PURPOSE To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone-patellar tendon-bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). RESULTS The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT (P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test (P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. CONCLUSION This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. CLINICAL RELEVANCE This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.
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Affiliation(s)
- Lukas Willinger
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Orthopaedic Surgery Department, Technical University of Munich, Munich, Germany
| | - Kiron K. Athwal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andy Williams
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Fortius Clinic, London, UK
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Andrew A. Amis, FREng, DSc(Eng), Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK ()
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30
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Schilaty ND, Martin RK, Ueno R, Rigamonti L, Bates NA. Mechanics of cadaveric anterior cruciate ligament reconstructions during simulated jump landing tasks: Lessons learned from a pilot investigation. Clin Biomech (Bristol, Avon) 2021; 86:105372. [PMID: 34052693 PMCID: PMC8278414 DOI: 10.1016/j.clinbiomech.2021.105372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Around half of anterior cruciate ligament (ACL) injuries are treated through reconstruction, but the literature lacks mechanical investigation of reconstructions in a dynamic athletic task and rupture environment. The current objective was to ascertain the feasibility of investigating ACL reconstructions in a rupture environment during simulated landing tasks in a validated mechanical impact simulator. METHODS Four cadaveric lower extremities were subjected to simulated landing in a mechanical impact simulator. External joint loads that mimicked magnitudes recorded from an in vivo population were applied to each joint in a stepwise manner. Simulations were repeated until ACL failure was achieved. Repeated measures design was used to test each specimen in the native ACL and hamstrings, quadriceps, and patellar tendon reconstructed states. FINDINGS ACL injuries were generated in 100% of specimens. Graft substance damage occurred in 58% of ACLRs, and in 75% of bone tendon bone grafts. Bone tendon bone and quadriceps grafts survived greater simulated loading than hamstrings grafts, but smaller simulated loading than the native ACL. Median peak strain prior to failure was 20.3% (11.6, 24.5) for the native ACL and 17.4% (9.5, 23.3) across all graft types. INTERPRETATION The simulator was a viable construct for mechanical examination of ACLR grafts in rupture environments. Post-surgery, ACL reconstruction complexes are weaker than the native ACL when subjected to equivalent loading. Bone tendon bone grafts most closely resembled the native ligament and provided the most consistently relevant rupture results. This model advocated reconstruction graft capacity to sustain forces generated from immediate gait and weightbearing during rehabilitation from an ACL injury.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Orthopedic Surgery, CentraCare, Saint Cloud, MN, USA
| | - Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.
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31
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Mojaddarasil M, Sadigh MJ. On the impact force analysis of two-leg landing with a flexed knee. Comput Methods Biomech Biomed Engin 2021; 24:1862-1875. [PMID: 34027762 DOI: 10.1080/10255842.2021.1925257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article looks into the effects of the initial knee flexion angle at the contact time on the peak of the impulsive lower limb forces during landing, and how these effects are related to muscular activities. The impact dynamics of drop landing is studied via a musculoskeletal model with eight Hill-type lower-limb muscles. A method is proposed for the representation of two landing strategies: landing with high and low joint stiffness. Then, in each landing strategy, the effect of the initial knee flexion angle on the peak ground reaction force (GRF), the peak knee ligaments force and the peak tibiofemoral contact force is investigated by considering different initial contact postures. It is observed that while landing with a flexed knee decreases the peak GRF in both landing strategies, it decreases the peak tibiofemoral and knee ligaments forces only in landing with low joint stiffness. Specifically, by increasing the initial knee flexion from 0° to 70°, the peak tibiofemoral and knee ligaments forces decrease monotonically by 54% and 82%, in landing with low joint stiffness. For high joint stiffness, however, as the initial knee flexion increases from 10° to 70°, the peak tibiofemoral force is seen to increase monotonically by 42% and the peak knee ligaments force is seen to have a non-monotonic behavior, first decreasing by 42%, and then, increasing by 250%. These results can be considered in training landing strategies to reduce the risk of knee injury.
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Affiliation(s)
- Marzieh Mojaddarasil
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
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Ueno R, Navacchia A, Schilaty ND, Myer GD, Hewett TE, Bates NA. Anterior Cruciate Ligament Loading Increases With Pivot-Shift Mechanism During Asymmetrical Drop Vertical Jump in Female Athletes. Orthop J Sports Med 2021; 9:2325967121989095. [PMID: 34235227 PMCID: PMC8226378 DOI: 10.1177/2325967121989095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Frontal plane trunk lean with a side-to-side difference in lower extremity
kinematics during landing increases unilateral knee abduction moment and
consequently anterior cruciate ligament (ACL) injury risk. However, the
biomechanical features of landing with higher ACL loading are still unknown.
Validated musculoskeletal modeling offers the potential to quantify ACL
strain and force during a landing task. Purpose: To investigate ACL loading during a landing and assess the association
between ACL loading and biomechanical factors of individual landing
strategies. Study Design: Descriptive laboratory study. Methods: Thirteen young female athletes performed drop vertical jump trials, and their
movements were recorded with 3-dimensional motion capture.
Electromyography-informed optimization was performed to estimate lower limb
muscle forces with an OpenSim musculoskeletal model. A whole-body
musculoskeletal finite element model was developed. The joint motion and
muscle forces obtained from the OpenSim simulations were applied to the
musculoskeletal finite element model to estimate ACL loading during
participants’ simulated landings with physiologic knee mechanics. Kinematic,
muscle force, and ground-reaction force waveforms associated with high ACL
strain trials were reconstructed via principal component analysis and
logistic regression analysis, which were used to predict trials with high
ACL strain. Results: The median (interquartile range) values of peak ACL strain and force during
the drop vertical jump were 3.3% (–1.9% to 5.1%) and 195.1 N (53.9 to 336.9
N), respectively. Four principal components significantly predicted high ACL
strain trials, with 100% sensitivity, 78% specificity, and an area of 0.91
under the receiver operating characteristic curve (P <
.001). High ACL strain trials were associated with (1) knee motions that
included larger knee abduction, internal tibial rotation, and anterior
tibial translation and (2) motion that included greater vertical and lateral
ground-reaction forces, lower gluteus medius force, larger lateral pelvic
tilt, and increased hip adduction. Conclusion: ACL loads were higher with a pivot-shift mechanism during a simulated landing
with asymmetry in the frontal plane. Specifically, knee abduction can create
compression on the posterior slope of the lateral tibial plateau, which
induces anterior tibial translation and internal tibial rotation. Clinical Relevance: Athletes are encouraged to perform interventional and preventive training to
improve symmetry during landing.
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Affiliation(s)
- Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Alessandro Navacchia
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria.,Smith & Nephew, San Clemente, California, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Timothy E Hewett
- Hewett Global Consulting, Rochester Minnesota, USA.,The Rocky Mountain Consortium for Sports Research, Edwards, Colorado, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:783-792. [PMID: 32350577 DOI: 10.1007/s00167-020-06014-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 04/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To elucidate whether sagittal graft tunnel affects the signal intensity in anatomical ACL reconstruction (ACLR) and to clarify the prevalence of intercondylar roof impingement. It was hypothesized that if the tunnel apertures are located within the anatomical footprint of ACL, tunnel position would not affect the signal intensity. METHODS A total of 132 patients who underwent anatomical double-bundle ACLR (DB-ACLR) using hamstring autograft were recruited. Tunnel position was determined by the quadrant method on three-dimensional computed tomography; the femoral tunnel position was defined as "high and low" or "deep and shallow", while that of the tibial side was defined as "anterior and posterior" or "medial and lateral". Subjects were divided into three groups according to the tertile of % deep-shallow. The signal intensity was evaluated by the region of interest value of the antero-medial bundle (AMB) and postero-lateral bundle on magnetic resonance imaging at 12 months after reconstruction. Linear regression analysis was conducted to elucidate the relationship between the percentage position of each tunnel and the graft signal intensity. RESULTS In the shallow tertile group, AMB signal intensity increased in the anterior position of the tibial tunnel (β = - 0.34; P = 0.025). In the intermediate and deep tertile groups, the tunnel position did not correlate with the signal intensity. CONCLUSIONS A more anterior tibial tunnel position increases AMB signal intensity in shallower femoral tunnel. Conversely, this correlation is attenuated for deeper femoral tunnels. Surgeons should pay attention to sagittal femoral tunnel position to create a more anterior tibial tunnel position. LEVEL OF EVIDENCE Level III.
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Landing instructions focused on pelvic and trunk lateral tilt decrease the knee abduction moment during a single-leg drop vertical jump. Phys Ther Sport 2020; 46:226-233. [DOI: 10.1016/j.ptsp.2020.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 12/17/2022]
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Keizer MNJ, Hijmans JM, Gokeler A, Otten E, Brouwer RW. Sagittal knee kinematics in relation with the posterior tibia slope during jump landing after an anterior cruciate ligament reconstruction. J Exp Orthop 2020; 7:69. [PMID: 32959098 PMCID: PMC7505908 DOI: 10.1186/s40634-020-00289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose An increased posterior tibia plateau angle is associated with increased risk for anterior cruciate ligament injury and re-rupture after reconstruction. The aims of this study were to determine whether the tibia plateau angle correlates with dynamic anterior tibia translation (ATT) after an anterior cruciate ligament reconstruction and whether the tibia plateau angle correlates with aspects of knee kinematics and kinetics during jump landing. Methods Thirty-seven patients after anterior cruciate ligament reconstruction with autograft hamstring tendon were included. Knee flexion angle and knee extension moment during single leg hops for distance were determined using a motion capture system and the dynamic ATT with its embedded method. The medial and lateral posterior tibia plateau angle were measured using MRI. Moreover, passive ATT was measured using the KT-1000 arthrometer. Results A weak negative correlation was found between the maximal dynamic ATT and the medial tibia plateau angle (p = 0.028, r = − 0.36) and between the maximal knee flexion angle and the lateral tibia plateau angle (p = 0.025, r = − 0.37) during landing. Patients with a smaller lateral tibia plateau angle show larger maximal knee flexion angle during landing than the patients with larger lateral tibia plateau angle. Also, the lateral tibia plateau angle is associated the amount of with muscle activity. Conclusion The posterior medical tibia plateau angle is associated with dynamic ATT. The maximal knee flexion angle and muscle activity are associated with the posterior lateral tibia plateau angle. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Egbert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
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Effects of second-generation and indoor sports surfaces on knee joint kinetics and kinematics during 45° and 180° cutting manoeuvres, and exploration using statistical parametric mapping and Bayesian analyses. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2020; 21:563. [PMID: 32819327 PMCID: PMC7441716 DOI: 10.1186/s12891-020-03552-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. METHODS Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. RESULTS Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: - 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: - 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: - 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: - 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. CONCLUSION Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Schilaty ND, Bates NA, Kruisselbrink S, Krych AJ, Hewett TE. Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome From Biomechanical Variables. Am J Sports Med 2020; 48:2447-2455. [PMID: 32693617 PMCID: PMC7566284 DOI: 10.1177/0363546520939946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The most commonly damaged structures of the knee are the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and menisci. Given that these injuries present as either isolated or concomitant, it follows that these events are driven by specific mechanics versus coincidence. This study was designed to investigate the multiplanar mechanisms and determine the important biomechanical and demographic factors that contribute to classification of the injury outcome. HYPOTHESIS Linear discriminant analysis (LDA) would accurately classify each injury type generated by the mechanical impact simulator based on biomechanical input variables (ie, ligament strain and knee kinetics). STUDY DESIGN Controlled laboratory study. METHODS In vivo kinetics and kinematics of 42 healthy, athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain and knee kinetics during a simulated landing task. Uniaxial and multiaxial load cells and implanted strain sensors were used to collect mechanical data for analysis. LDA was used to determine the ability to classify injury outcome by demographic and biomechanical input variables. RESULTS From LDA, a 5-factor model (Entropy R2 = 0.26) demonstrated an area under the receiver operating characteristic curve (AUC) for all 5 injury outcomes (ACL, MCL, ACL+MCL, ACL+MCL+meniscus, ACL+meniscus) of 0.74 or higher, with "good" prediction for 4 of 5 injury classifications. A 10-factor model (Entropy R2 = 0.66) improved the AUC to 0.86 or higher, with "excellent" prediction for 5 injury classifications. The 15-factor model (Entropy R2 = 0.85), produced 94.1% accuracy with the AUC 0.98 or higher for all 5 injury classifications. CONCLUSION Use of LDA accurately predicted the outcome of knee injury from kinetic data from cadaveric simulations with the use of a mechanical impact simulator at 25° of knee flexion. Thus, with clinically relevant kinetics, it is possible to determine clinical risk of injury and also the likely presentation of singular or concomitant knee injury. CLINICAL RELEVANCE LDA demonstrates that injury outcomes are largely characterized by specific mechanics that can distinguish ACL, MCL, and medial meniscal injury. Furthermore, as the mechanics of injury are better understood, improved interventional prehabilitation can be designed to reduce these injuries.
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Affiliation(s)
- Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | - Timothy E. Hewett
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
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Schilaty ND, Bates NA, Ueno R, Hewett TE. Filtration Selection and Data Consilience: Distinguishing Signal from Artefact with Mechanical Impact Simulator Data. Ann Biomed Eng 2020; 49:334-344. [PMID: 32632532 DOI: 10.1007/s10439-020-02562-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
A large variety of data filtration techniques exist in biomechanics literature. Data filtration is both an 'art' and a 'science' to eliminate noise and retain true signal to draw conclusions that will direct future hypotheses, experimentation, and technology development. Thus, data consilience is paramount, but is dependent on filtration methodologies. In this study, we utilized ligament strain, vertical ground reaction force, and kinetic data from cadaveric impact simulations to assess data from four different filters (12 vs. 50 Hz low-pass; forward vs. zero lag). We hypothesized that 50 Hz filtered data would demonstrate larger peak magnitudes, but exhibit consilience of waveforms and statistical significance as compared to 12 Hz filtered data. Results demonstrated high data consilience for matched pair t test correlations of peak ACL strain (≥ 0.97), MCL strain (≥ 0.93) and vertical ground reaction force (≥ 0.98). Kinetics had a larger range of correlation (0.06-0.96) that was dependent on both external load application and direction of motion monitored. Coefficients of multiple correlation demonstrated high data consilience for zero lag filtered data. With respect to in vitro mechanical data, selection of low-pass filter cutoff frequency will influence both the magnitudes of discrete and waveform data. Dependent on the data type (i.e., strain and ground reaction forces), this will not likely significantly alter conclusions of statistical significance previously reported in the literature with high consilience of matched pair t-test correlations and coefficients of multiple correlation demonstrated. However, rotational kinetics are more sensitive to filtration selection and could be suspect to errors, especially at lower magnitudes.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA.
- Biomechanics Laboratories, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Biomechanics Laboratories, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
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Ueno R, Navacchia A, DiCesare CA, Ford KR, Myer GD, Ishida T, Tohyama H, Hewett TE. Knee abduction moment is predicted by lower gluteus medius force and larger vertical and lateral ground reaction forces during drop vertical jump in female athletes. J Biomech 2020; 103:109669. [PMID: 32019678 DOI: 10.1016/j.jbiomech.2020.109669] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
Prospective knee abduction moments measured during the drop vertical jump task identify those at increased risk for anterior cruciate ligament injury. The purpose of this study was to determine which muscle forces and frontal plane biomechanical features contribute to large knee abduction moments. Thirteen young female athletes performed three drop vertical jump trials. Subject-specific musculoskeletal models and electromyography-informed simulations were developed to calculate the frontal plane biomechanics and lower limb muscle forces. The relationships between knee abduction moment and frontal plane biomechanics were examined. Knee abduction moment was positively correlated to vertical (R = 0.522, P < 0.001) and lateral ground reaction forces (R = 0.395, P = 0.016), hip adduction angle (R = 0.358, P < 0.023) and lateral pelvic tilt (R = 0.311, P = 0.061). A multiple regression showed that knee abduction moment was predicted by reduced gluteus medius force and increased vertical and lateral ground reaction forces (P < 0.001, R2 = 0.640). Hip adduction is indicative of lateral pelvic shift during landing. The coupled hip adduction and lateral pelvic tilt were associated to the increased vertical and lateral ground reaction forces, propagating into higher knee abduction moments. These biomechanical features are associated with ACL injury and may be limited in a landing with increased activation of the gluteus medius. Targeted neuromuscular training to control the frontal pelvic and hip motion may help to avoid injurious ground reaction forces and consequent knee abduction moment and ACL injury risk.
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Affiliation(s)
- Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Departments of Pediatrics and Orthopedic Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Timothy E Hewett
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA
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Ueno R, Navacchia A, Bates NA, Schilaty ND, Krych AJ, Hewett TE. Analysis of Internal Knee Forces Allows for the Prediction of Rupture Events in a Clinically Relevant Model of Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2020; 8:2325967119893758. [PMID: 31976347 PMCID: PMC6958658 DOI: 10.1177/2325967119893758] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 01/12/2023] Open
Abstract
Background: A recently developed mechanical impact simulator induced an anterior cruciate ligament (ACL) rupture via the application of a combination of inverse dynamics–based knee abduction moment (KAM), anterior tibial shear force (ATS), and internal tibial rotation moment with impulsive compression in a cohort of cadaveric limbs. However, there remains an opportunity to further define the interaction of internal forces and moments at the knee and their respective influence on injury events. Purpose: To identify the influence of internal knee loads on an ACL injury event using a cadaveric impact simulator. Study Design: Controlled laboratory study. Methods: Drop-landing simulations were performed and analyzed on 30 fresh-frozen cadaveric knees with a validated mechanical impact simulator. Internal forces and moments at the knee joint center were calculated using data from a 6-axis load cell recorded on the femur during testing. Kinetic data from a total of 1083 trials that included 30 ACL injury trials were used as inputs for principal component (PC) analysis to identify the most critical features of loading waveforms. Logistic regression analysis with a stepwise selection was used to select the PCs that predicted an ACL injury. Injurious waveforms were reconstructed with selected PCs in logistic regression analysis. Results: A total of 3 PCs were selected in logistic regression analysis that developed a significant model (P < .001). The external loading of KAM was highly correlated with PC1 (ρ < –0.8; P < .001), which explained the majority (>69%) of the injurious waveforms reconstructed with the 3 selected PCs. The injurious waveforms demonstrated a larger internal knee adduction moment and lateral tibial force. After the ACL was ruptured, decreased posterior tibial force was observed in injury trials. Conclusion: These findings give us a better understanding of ACL injury mechanisms using 6-axis kinetics from an in vitro simulator. An ACL rupture was correlated with an internal knee adduction moment (external KAM) and was augmented by ATS and lateral tibial force induced by an impact, which distorted the ACL insertion orientation. Clinical Relevance: The ACL injury mechanism explained in this study may help target injury prevention programs to decrease injurious knee loading (KAM, ATS, and lateral tibial force) during landing tasks.
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Affiliation(s)
- Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessandro Navacchia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
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EMG-Informed Musculoskeletal Modeling to Estimate Realistic Knee Anterior Shear Force During Drop Vertical Jump in Female Athletes. Ann Biomed Eng 2019; 47:2416-2430. [PMID: 31290036 DOI: 10.1007/s10439-019-02318-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
The anterior cruciate ligament is the primary structural restraint to tibial anterior shear force. The anterior force occurring at the knee during landing contributes to anterior cruciate ligament injury risk, but it cannot be directly measured experimentally. The objective of this study was to develop electromyography-informed musculoskeletal simulations of the drop vertical jump motor task and assess the contribution of knee muscle forces to tibial anterior shear force. In this cross-sectional study, musculoskeletal simulations were used to estimate the muscle forces of thirteen female athletes performing a drop vertical jump using an electromyography-informed method. Muscle activation and knee loads that resulted from these simulations were compared to the results obtained with the more common approach of minimization of muscle effort (optimization-based method). Quadriceps-hamstrings and quadriceps-gastrocnemius co-contractions were progressively increased and their contribution to anterior shear force was quantified. The electromyography-informed method produced co-contraction indexes more consistent with electromyography data than the optimization-based method. The muscles that presented the largest contribution to peak anterior shear force were the gastrocnemii, likely from their wrapping around the posterior aspect of the tibia. The quadriceps-hamstring co-contraction provided a protective effect on the ACL and reduced peak anterior shear force by 292 N with a co-contraction index increase of 25% from baseline (31%), whereas a quadriceps-gastrocnemius co-contraction index of 61% increased peak anterior shear force by 797 N compared to baseline (42%). An increase in gastrocnemius contraction, which might be required to protect the ankle from the impact with the ground, produced a large quadriceps-gastrocnemius co-activation, increasing peak anterior shear force. A better understanding of each muscle's contribution to anterior shear force and, consequently, anterior cruciate ligament tension may inform subject-specific injury prevention programs and rehabilitation protocols.
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