Direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact

A biomechanical analysis of skiing-related anterior cruciate ligament injuries based on biomedical imaging technology

Alpine skiing is an attractive but highly risky sport, and the anterior cruciate ligament (ACL) tear is one of the most common diagnoses of skiing-related injuries. To better prevent such injuries among athletes and recreational skiers, we developed a facile and reliable biomechanical method to analyze the differences between "right" and "wrong" movements during skiing and their impacts on ACL stress loading. Unlike those conventional methods that are very difficult to implement and time-consuming, our method was developed based on inverse dynamics analyses and video capture, which were much easier to implement in the real-world setting. It is shown that, with a harmful skiing action, the knee joint's maximum reaction force significantly increases compared to nonharmful skiing actions. The peak front-and-rear force increased from 1242 N to 3105 N, and the peak axial force increased from 1023 N to 3443 N, which significantly exceeded the maximum tensile loading (2000 N) in the ACL. Our results are proven to be reliable and consistent with findings obtained with other methods. This method may substitute current complex analytical methods and be easier to apply in sports-related injury-prevention applications.

High Axial Loads While Walking Increase Anterior Tibial Translation in Intact and Anterior Cruciate Ligament-Deficient Knees

PURPOSE

To evaluate the effect of high axial loading (AL) on anterior tibial translation (ATT) according to the increase in knee flexion and the effect of valgus stress (VS) and internal rotation (IR) combined with high AL in intact and anterior cruciate ligament (ACL)-deficient knees according to the increase in knee flexion.

METHODS

We used 10 fresh-frozen, human cadaveric knees. Different loading conditions (134-N anterior drawer, 1,000-N AL, 10-Nm VS, and 5-Nm IR) were sequentially combined, and ATT was measured at 0°, 15°, 30°, 45°, and 60° of flexion in the intact and ACL-deficient knees.

RESULTS

ATT increased significantly by adding high AL in intact knees (P = .001) and ACL-deficient knees (P < .0001) according to the change in flexion angle (P < .0001). Under high AL, ATT in the ACL-deficient knees was significantly larger than that in the intact knees for all loading conditions, and it also increased gradually according to the increase in knee flexion (P = .0001). ATT increased significantly after adding IR or VS with high AL in intact knees (VS, P = .002; VS/IR, P = .03) and ACL-deficient knees (VS, P = .0004) at some of the flexion angles.

CONCLUSIONS

The added high AL increased ATT in intact and ACL-deficient knees from 0° to 60° of flexion. The effect of high AL on ATT became greater in ACL-deficient knees than in intact knees, and ATT also gradually increased according to the increase in knee flexion from 0° to 60°. In both the intact and ACL-deficient knees, ATT increased significantly after valgus stress or IR from 0° to 60°.

CLINICAL RELEVANCE

ATT during weight bearing increases stress to the ACL, which worsens with valgus stress and/or IR forces. This finding should be considered when one is studying ACL injury mechanisms, as well as prescribing rehabilitation after ACL surgery.

Relationship between jump landing kinematics and peak ACL force during a jump in downhill skiing: a simulation study

Recent data highlight that competitive skiers face a high risk of injuries especially during off-balance jump landing maneuvers in downhill skiing. The purpose of the present study was to develop a musculo-skeletal modeling and simulation approach to investigate the cause-and-effect relationship between a perturbed landing position, i.e., joint angles and trunk orientation, and the peak force in the anterior cruciate ligament (ACL) during jump landing. A two-dimensional musculo-skeletal model was developed and a baseline simulation was obtained reproducing measurement data of a reference landing movement. Based on the baseline simulation, a series of perturbed landing simulations (n = 1000) was generated. Multiple linear regression was performed to determine a relationship between peak ACL force and the perturbed landing posture. Increased backward lean, hip flexion, knee extension, and ankle dorsiflexion as well as an asymmetric position were related to higher peak ACL forces during jump landing. The orientation of the trunk of the skier was identified as the most important predictor accounting for 60% of the variance of the peak ACL force in the simulations. Teaching of tactical decisions and the inclusion of exercise regimens in ACL injury prevention programs to improve trunk control during landing motions in downhill skiing was concluded.

Variation of Anatomical and Physiological Parameters that Affect Estimates of ACL Loading During Drop Landing

BACKGROUND

Anterior cruciate ligament (ACL) loading during drop landing has been recently studied with a sagittal plane knee model developed by Kernozek and Ragan using mean anatomical and physiological parameters obtained from cadaveric and clinical data. It is unknown how estimates in ACL load may be altered due to variations in anatomical and physiological parameters used from other research.

METHODS

USING THE SAME MODEL, THESE PARAMETERS WERE SYSTEMATICALLY VARIED, INCLUDING: tibial slope, moment arms of the patellar tendon, hamstring, and gastrocnemius at the knee and ankle, patellar tendon and hamstring line of force, ACL stiffness, and nonlinear muscle activation parameters. To determine the sensitivity of the model to changes in these parameters, each was varied independently by ±5% and by ranges reported in the literature. Changes in maximum ACL load and shear force components of the patellar tendon, hamstring, and tibio-femoral contact force were calculated from drop landing data of 21 subjects.

RESULTS

The variation in ACL load during drop landing from its nominal value was largest (-100% to 176%) when extremes in reported tibial slope values were utilized. Variation in the next most important parameter, patellar tendon line of force, affected ACL load by -72% to 88%.

CONCLUSION

Variations in tibial slope and patellar tendon line of force had the greatest influence on estimated ACL loading during drop landing. Differences in these parameters between subjects may be just as important to ACL loading as the kinematic and kinetic performance differences observed in landing.

Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases

BACKGROUND

There is limited insight into the mechanisms of anterior cruciate ligament injuries in alpine skiing, particularly among professional ski racers.

PURPOSE

This study was undertaken to qualitatively describe the mechanisms of anterior cruciate ligament injury in World Cup alpine skiing.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Twenty cases of anterior cruciate ligament injuries reported through the International Ski Federation Injury Surveillance System for 3 consecutive World Cup seasons (2006-2009) were obtained on video. Seven international experts in the field of skiing biomechanics and sports medicine related to alpine skiing performed visual analyses of each case to describe the injury mechanisms in detail (skiing situation, skier behavior, biomechanical characteristics).

RESULTS

Three main categories of injury mechanisms were identified: slip-catch, landing back-weighted, and dynamic snowplow. The slip-catch mechanism accounted for half of the cases (n = 10), and all these injuries occurred during turning, without or before falling. The skier lost pressure on the outer ski, and while extending the outer knee to regain grip, the inside edge of the outer ski caught abruptly in the snow, forcing the knee into internal rotation and valgus. The same loading pattern was observed for the dynamic snowplow (n = 3). The landing back-weighted category included cases (n = 4) where the skier was out of balance backward in flight after a jump and landed on the ski tails with nearly extended knees. The suggested loading mechanism was a combination of tibiofemoral compression, boot-induced anterior drawer, and quadriceps anterior drawer.

CONCLUSION

Based on this video analysis of 20 injury situations, the main mechanism of anterior cruciate ligament injury in World Cup alpine skiing appeared to be a slip-catch situation where the outer ski catches the inside edge, forcing the outer knee into internal rotation and valgus. A similar loading pattern was observed for the dynamic snowplow. Injury prevention efforts should focus on the slip-catch mechanism and the dynamic snowplow.

The effect of choice reaction task on impact of single-leg landing

This study aimed to investigate attentional demand during single-leg landing after a jump. The experiment was set up as dual-task test. Twelve healthy male participants were instructed to make a two-leg jump with right-leg landing as softly as possible. The flight time of the jump was set to 300ms through sufficient practice. As a cognitive task, the participants were asked to push the right or left custom-made button as soon as a go-signal was presented. The timing when the go-signal presented varied from 0 to 300ms from the take-off. Catch trials in which the go-signal was not presented were randomly inserted. The results showed that the maximum vertical ground reaction force after touchdown was greater under the dual-task condition than in the single-task condition. Increase in the maximum vertical ground reaction force was consistent regardless of the timing of presenting the go-signal, and the same effect was observed in the catch trials. These results indicate that the effect of dual tasking was caused by attentional allocation to the choice reaction time task. Athletes may be exposed a large ground reaction forces during landing while performing cognitive tasks.

Effect of an anterior-sloped brace joint on anterior tibial translation and axial tibial rotation: a motion analysis study

BACKGROUND

Anterior tibial translation and axial tibial rotation are major biomechanical factors involved in anterior cruciate ligament injuries. This study sought to evaluate a brace prototype designed with an anterior-sloped joint, in terms of its efficacy in attenuating anterior tibial translation and axial tibial rotation during landing, using a motion analysis approach.

METHODS

Ten healthy male subjects performed single-leg landing tasks from a 0.6-m height with and without the brace prototype. Ground reaction force and kinematics data were obtained using a motion-capture system and force-plates. Anterior tibial translation and axial tibial rotation were determined based on tibial and femoral marker reference frames. Vertical and anterior-posterior ground reaction forces, hip, knee and ankle joint range-of-motions and angular velocities, anterior tibial translation and axial tibial rotation were compared between unbraced and braced conditions using Wilcoxon signed-rank test.

FINDINGS

We found no significant difference in peak vertical and anterior-posterior ground reaction forces (p=0.770 and p=0.332 respectively) between unbraced and braced conditions. Knee joint range-of-motion and angular velocity were lower (p=0.037 and p=0.038 respectively) for braced condition than unbraced condition. Anterior tibial translation and axial tibial rotation were reduced (p=0.027 and p=0.006 respectively) in braced condition, compared to unbraced condition.

INTERPRETATION

The anterior-sloped brace joint helps to attenuate anterior tibial translation and axial tibial rotation present in the knee joint during landing. It is necessary to test the brace prototype in a sporting population with realistic sports landing situations in order to assess its effectiveness in lowering anterior cruciate ligament injury risk.