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Popper HR, Szukics PF, Feldman J, Ford E, Pontes M, McMillan S. Trends in Anterior Cruciate Ligament Injury and Recovery in Professional Snowboarders: The Extreme Sport of Snowboardcross. Cureus 2023; 15:e50683. [PMID: 38229820 PMCID: PMC10791092 DOI: 10.7759/cureus.50683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction An anterior cruciate ligament (ACL) tear is a devastating injury for athletes that is predominantly low energy and non-contact in nature. ACL tears are one of the most well-researched injuries in sports, however, scant research has been done on competitive snowboarders. Boardercross is a relatively new sport introduced to the Winter Olympics in 2006. Initially, it entailed four snowboarders racing head-to-head down a course of obstacles in a race to the finish, with the top two riders advancing to the next rounds. It has since expanded to six racers traveling up to 60 mph and jumps up to 100 feet in length in a head-to-head race to the finish. This extreme sport puts its athletes at risk for serious injury, requiring investigation. Purpose Investigate the prevalence of ACL tears in the extreme sport of boardercross, evaluate sport-specific factors that may put athletes at higher risk, and report return to sport data. Methods An expedited IRB approval was obtained. A survey was distributed to athletes via e-mail to national/regional coaches of countries with competitive boardercross teams. Professional coaches distributed the survey and secondarily distributed it to athletes. Results Sixty-six competitive snowboardcross athletes responded to the email surveys 48.5% of respondents had torn their ACL at least once in their career. Of the female respondents, 55.6% suffered at least one ACL tear, and 43.6% of male respondents suffered at least one ACL tear. 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p <0.001) tore their front leg. 100.0% of the respondent athletes returned to sport post-ACL reconstruction. Conclusion Professional boardercross racers are at a higher risk of tearing their ACL than other winter sport athletes, including alpine skiers. A predominance of ACL injuries occurred on the front leg during landing from an aerial maneuver. All respondent athletes returned to the sport after injury, with approximately half returning within six months. Although no statistical significance was achieved, the data provided trends on risk factors related to ACL injuries among snowboardcross athletes.
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Affiliation(s)
| | | | - Jenna Feldman
- Orthopaedic Surgery, Inspira Health Network, Vineland, USA
| | - Elizabeth Ford
- Orthopaedic Surgery, Inspira Health Network, Vineland, USA
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Nukuto K, Gale T, Yamamoto T, Musahl V, Anderst W. Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high-demand activities. Knee Surg Sports Traumatol Arthrosc 2023; 31:5096-5103. [PMID: 37728761 DOI: 10.1007/s00167-023-07560-3] [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: 07/18/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Bony morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury. The relationship between bony morphology, knee kinematics, and ACL elongation during high-demand activities remains unclear. The purpose of this study was to determine if bone morphology features that have been associated with ACL injury risk and knee kinematics are also predictive of ACL elongation during fast running and double-legged drop jump. METHODS Nineteen healthy athletes performed fast running and double-legged drop jump within a biplane radiography imaging system. Knee kinematics and ACL elongation were measured bilaterally after using a validated registration process to track bone motion in the radiographs and after identifying ACL attachment sites on magnetic resonance imaging (MRI). Bony morphological features of lateral posterior tibial slope (LPTS), medial tibial plateau (MTP) depth, and lateral femoral condyle anteroposterior width (LCAP)/lateral tibial plateau anteroposterior width (TPAP) were measured on MRI. Relationships between bony morphology and knee kinematics or ACL elongation were identified using multiple linear regression analysis. RESULTS No associations between bony morphology and knee kinematics or ACL elongation were observed during fast running. During double-legged drop jump, a greater range of tibiofemoral rotation was associated with a steeper LPTS (β = 0.382, p = 0.012) and a deeper MTP depth (β = 0.331, p = 0.028), and a greater range of anterior tibial translation was associated with a shallower MTP depth (β = - 0.352, p = 0.018) and a larger LCAP/ TPAP (β = 0.441, p = 0.005); however, greater ACL elongation was only associated with a deeper MTP depth (β = 0.456, p = 0.006) at toe-off. CONCLUSION These findings indicate that observed relationships between bony morphology and kinematics should not be extrapolated to imply a relationship also exists between those bone morphology features and ACL elongation during high-demand activities. These new findings deepen our understanding of the relationship between bony morphology and ACL elongation during high-demand activities. This knowledge can help identify high-risk patients for whom additional procedures during ACL reconstruction are most appropriate.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 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
| | - Tetsuya Yamamoto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 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
| | - Volker Musahl
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 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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Zamankhanpour M, Sheikhhoseini R, Letafatkar A, Piri H, Asadi Melerdi S, Abdollahi S. The effect of dual-task on jump landing kinematics and kinetics in female athletes with or without dynamic knee valgus. Sci Rep 2023; 13:14305. [PMID: 37652971 PMCID: PMC10471762 DOI: 10.1038/s41598-023-41648-7] [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: 05/03/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
It has been indicated that dual tasks may multiply the possibility of injuries due to divided attention. This study aimed to investigate the effect of dual-task on kinematics and kinetics of jump landing in female athletes with and without dynamic knee valgus. In this study, 32 recreational athletes between 18 and 30 years old were recruited and divided into with (n = 17) and without (n = 15) dynamic knee valgus groups. The 3-D positions of retroreflective markers were recorded at 200 Hz using a 8-camera Kestrel system (Motion Analysis Corporation, Santa Rosa, CA), while ground reaction forces were synchronously recorded at 1000 Hz using 2 adjacent force plates (FP4060-NC; Bertec Corporation, Columbus, OH). Kinematics and kinetics of jump landing were recorded while counting backward digits as a dual task, and also without counting backward digits as a single task. One-way repeated measures of variance were used to analyse data at the significant level of 95% (α < 0.05). The study found that the dual-task affected the angles and moments of hip, knee, and ankle joints (P < 0.05) in both groups. Additionally, the effect of the dual-task differed significantly between the two groups in the angles hip flexion (P < 0.001), knee abduction (P < 0.001), and ankle internal rotation (P = 0.001), as well as the moments hip flexion (P < 0.001), hip abduction (P = 0.011), knee flexion (P = 0.017), knee internal rotation (P < 0.001), ankle dorsiflexion (P = 0.046), ankle eversion (P < 0.001), and ankle internal rotation (P = 0.046). Athletes with dynamic knee valgus may have been less able to protect themselves during the landing and are more prone to lower extremities injuries. As a result, using kinematics and kinetics in athletes with dynamic knee valgus during landing may help identify potential mechanisms associated with risk factors of lower extremity injuries and ACL injuries as well.
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Affiliation(s)
- Mina Zamankhanpour
- Department of Corrective Exercise and Sports Injury, Faculty of Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise and Sports Injury, Faculty of Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran.
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran
| | - Hashem Piri
- Department of Corrective Exercise and Sports Injury, Faculty of Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Shakiba Asadi Melerdi
- Department of Philology, Philosophy, and Sports, Otto von Guericke University, Magdeburg, Germany
| | - Sajjad Abdollahi
- Department of Corrective Exercise and Sports Injury, Faculty of Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI: Response. Am J Sports Med 2023; 51:NP22-NP24. [PMID: 37392078 DOI: 10.1177/03635465231172184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
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Kamitani A, Hara K, Fujii Y, Yoshida S. Landing Posture in Elite Female Athletes During a Drop Vertical Jump Before and After a High-Intensity Ergometer Fatigue Protocol: A Study of 20 Japanese Women's Soccer League Players. Orthop J Sports Med 2023; 11:23259671231171859. [PMID: 37435587 PMCID: PMC10331781 DOI: 10.1177/23259671231171859] [Citation(s) in RCA: 2] [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: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background Even elite athletes, who usually show stable postural control, sometimes cannot control their posture after high-load training. This instability may contribute to anterior cruciate ligament injury. Purpose/Hypothesis The purpose of this study was to evaluate the landing posture of elite female soccer players before and after a novel high-intensity fatigue-inducing exercise protocol. We hypothesized that the landing posture will change before versus after the fatigue protocol. Study Design Descriptive laboratory study. Method The study participants were 20 female elite soccer players. All athletes performed 3 drop vertical jumps (DVJs), pedaled an ergometer 8 times with full force for 10 seconds each (fatigue protocol), and then repeated the 3 DVJs. We measured and compared the athletes' blood lactate levels before and after the fatigue protocol, as well as the hip flexion, knee flexion, and ankle dorsiflexion angles and final landing posture during the DJVs. Results Blood lactate levels increased significantly pre- to postprotocol (from 2.7 ± 1.9 to 15.0 ± 3.6 mmol/L; P < .001), while there were decreases in hip flexion angle (from 35.0° ± 11.2° to 22.4° ± 8.8°; P < .001) and ankle dorsiflexion angle (from 26.4° ± 3.9° to 20.0° ± 3.7°; P < .001). The number of athletes who could not maintain a stable DVJ final landing posture increased from 10% before the fatigue protocol to 70% after. Conclusion The elite female athletes in our study showed significant decreases in hip flexion and ankle dorsiflexion angles in the DVJ landing after a fatigue-inducing protocol. Most elite athletes were unable to maintain a stable posture on the DVJ landing after the fatigue protocol. Clinical Relevance This study advances our understanding of how elite athletes land in a fatigued state.
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Affiliation(s)
- Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Orthopaedics, Japan Community Heath Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Kunio Hara
- Department of Orthopaedics, Japan Community Heath Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shohei Yoshida
- Department of Sports Rehabilitation, Kyoto Interdisciplinary Institute of Community Medicine, Kyoto, Japan
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Brightwell BD, Samaan MA, Johnson D, Noehren B. Dynamic knee joint stiffness during bilateral lower extremity landing 6 months after ACL reconstruction. Knee 2023; 42:73-81. [PMID: 36913865 DOI: 10.1016/j.knee.2023.02.017] [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: 09/15/2022] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstructions are associated with long-term functional impairments. Improved understanding of dynamic knee joint stiffness and work may provide insights to help address these poor outcomes. Defining the relationship between knee stiffness, work and quadriceps muscle symmetry may reveal therapeutic targets. The purposes of this study were to investigate between-limb differences in knee stiffness and work during early phase landing 6-months after an ACL reconstruction. Additionally, we investigated relationships among symmetry of knee joint stiffness and work during early-phase landing and quadriceps muscle performance symmetry. METHODS Twenty-nine participants (17 M, 20.0 ± 5.3 years) were tested 6-months after ACL reconstruction. Motion capture analysis was used to assess between-limb differences in knee stiffness and work during the first 60 ms of a double-limb landing. Quadriceps peak strength and rate of torque development (RTD) were assessed with isometric dynamometry. Paired t-tests and Pearson's product moment correlations were used to determine between-limb differences of knee mechanics and correlations of symmetry respectively. FINDINGS Knee joint stiffness and work were significantly reduced (p < 0.01, p < 0.01) in the surgical limb (0.021 ± 0.01 Nm*(deg*kg*m)-1, -0.085 ± 0.06 J*(kg*m) -1) compared to the uninvolved limb (0.045 ± 0.01 Nm*(deg*kg*m)-1, -0.256 ± 0.10 J*(kg*m) -1). Greater knee stiffness (51 ± 22%) and work (35 ± 21%) symmetry were significantly associated with greater RTD symmetry (44.5 ± 19.4%) (r = 0.43, p = 0.02; r = 0.45, p = 0.01) but not peak torque symmetry (62.9 ± 16.1%) (r = 0.32, p = 0.10; r = 0.34, p = 0.10). INTERPRETATION Dynamic stiffness and energy absorption are lower in the surgical knee during landing from a jump. Therapeutic interventions that target increasing quadriceps RTD may help optimize dynamic stability and energy absorption during landing.
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Affiliation(s)
- Benjamin D Brightwell
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, United States; College of Health Sciences, University of Kentucky, Lexington, KY, United States; College of Education, University of Kentucky, Lexington, KY, United States.
| | - Michael A Samaan
- College of Education, University of Kentucky, Lexington, KY, United States; Orthopedic Surgery, University of Kentucky, Lexington, KY, United States
| | - Darren Johnson
- Orthopedic Surgery, University of Kentucky, Lexington, KY, United States
| | - Brian Noehren
- College of Health Sciences, University of Kentucky, Lexington, KY, United States; College of Education, University of Kentucky, Lexington, KY, United States; Orthopedic Surgery, University of Kentucky, Lexington, KY, United States
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Chia L, Myer GD, Hewett TE, McKay MJ, Sullivan J, Ford KR, Pappas E. Do Cutting Kinematics Change as Boys Mature? A Longitudinal Cohort Study of High-School Athletes. Clin J Sport Med 2023; 33:e8-e13. [PMID: 36367778 PMCID: PMC9991932 DOI: 10.1097/jsm.0000000000001095] [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: 06/16/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Examine longitudinal changes in trunk, hip, and knee kinematics in maturing boys during an unanticipated cutting task. DESIGN Prospective cohort study. SETTING Biomechanical laboratory. PARTICIPANTS Forty-two high-school male basketball, volleyball, and soccer athletes. ASSESSMENT OF RISK FACTORS Trunk, hip, and knee range-of-motion (RoM), peak angles, and angles at initial contact during an unanticipated 45 degrees sidestep cutting task were estimated using laboratory-based three-dimensional optoelectronic motion capture. Maturation was classified using a modified Pubertal Maturational Observational Scale (PMOS) into prepubertal, midpubertal, or postpubertal stages. MAIN OUTCOME MEASURES Trunk total RoM in frontal, sagittal, and transverse planes; peak trunk flexion, right lateral flexion and right rotation angles; hip total RoM in frontal, sagittal, and transverse planes; hip flexion angle at initial contact; peak hip flexion and adduction angles; knee total RoM in frontal, sagittal, and transverse planes; knee flexion angle at initial contact; peak knee flexion and abduction angles. RESULTS As boys matured, there was a decrease in hip sagittal-plane RoM (49.02 degrees to 43.45 degrees, Benjamini-Hochberg adjusted P = 0.027), hip flexion at initial contact (29.33 degrees to 23.08 degrees, P = 0.018), and peak hip flexion (38.66 degrees to 32.71 degrees, P = 0.046), and an increase in trunk contralateral rotation (17.47 degrees to 25.05 degrees, P = 0.027). CONCLUSIONS Maturing male athletes adopted a more erect cutting strategy that is associated with greater knee joint loading. Knee kinematic changes that increase knee joint loading were not observed in this cohort.
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Affiliation(s)
- Lionel Chia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
- Cleveland Guardians Baseball Company, Cleveland, OH, USA
| | - Gregory D. Myer
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Timothy E. Hewett
- Hewett Global Consulting, Minneapolis & Rochester, MN, USA
- The Rocky Mountain Consortium for Sports Research, Edwards, CO, USA
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
| | - Kevin R. Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Evangelos Pappas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
- The University of Wollongong, School of Medicine and Illawarra Health and Medical Research Institute, NSW, AUS
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Moon J, Koo D, Kim S, Panday SB. Effect of sprinting velocity on anterior cruciate ligament and knee load during sidestep cutting. Front Bioeng Biotechnol 2023; 11:1033590. [PMID: 36824350 PMCID: PMC9941960 DOI: 10.3389/fbioe.2023.1033590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The purpose of the study was to investigate the effect of an increase in sprinting velocity on the anterior cruciate ligament (ACL) load, knee joint load, and activation of femoral muscles using the musculoskeletal modeling approach. Fourteen high school male athletes were recruited (age: 17.4 ± 0.7 years, height: 1.75 ± 0.04 m, weight: 73.3 ± 8.94 kg), with the right foot dominant and physical activity level of about 3-4 h per day. The kinematics, kinetics, and co-contraction index (CCI) of the extensors and flexors of the right leg's femoral muscles were calculated. The anterior cruciate ligament load was estimated using the musculoskeletal modeling method. In the results, it was observed that the anterior cruciate ligament load (p < 0.017) increased as sidestep cutting velocity increased, resulting in increased adduction (p < 0.017) and the internal rotation moment of the knee joint. This was significantly higher than when sprinting at a similar velocity. The co-contraction index result, which represents the balanced activation of the femoral extensor and flexor muscles, showed a tendency of decrement with increasing sprinting velocity during sidestep cutting (p < 0.017), whereas no significant differences were observed when running at different sprinting conditions. Therefore, we postulate that factors such as knee joint shear force, extended landing posture with increasing sprinting velocity, internal rotation moment, and femoral muscle activity imbalance influence the increase of anterior cruciate ligament load during a sidestep cutting maneuver.
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Affiliation(s)
- Jeheon Moon
- Department of Physical Education, Korea National University of Education, Chungbuk, Republic ofKorea
| | - Dohoon Koo
- Department of Exercise Prescription, Jeonju University, Chonbuk, Republic ofKorea
| | - Sungmin Kim
- Institute of School Physical Education, Korea National University of Education, Chungbuk, Republic ofKorea
| | - Siddhartha Bikram Panday
- Department of Physical Education, Hanyang University, Seoul, Republic ofKorea,Department of Art and Sportainment, Hanyang University, Seoul, Republic ofKorea,*Correspondence: Siddhartha Bikram Panday,
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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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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI. Am J Sports Med 2023; 51:58-65. [PMID: 36440714 DOI: 10.1177/03635465221131551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN Descriptive laboratory study. METHODS Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kwadwo Owusu-Akyaw
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Coppock
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Aiello F, Impellizzeri FM, Brown SJ, Serner A, McCall A. Injury-Inciting Activities in Male and Female Football Players: A Systematic Review. Sports Med 2023; 53:151-176. [PMID: 36315396 PMCID: PMC9807506 DOI: 10.1007/s40279-022-01753-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A comprehensive examination of the sport-specific activities performed around the time of injury is important to hypothesise injury mechanisms, develop prevention strategies, improve management, and inform future investigations. The aim of this systematic review is to summarise the current literature describing the activities performed around the time of injury in football (soccer). METHODS A systematic search was carried out in PubMed, Web of Science, SPORTDiscus, and OpenGrey. Studies were included if participants were football players aged > 13 years old and the activities performed at the time of injury were reported together with the total number of injuries. Risk of bias was assessed using an adapted version of checklists developed for prevalence studies. The activities reported by the studies were grouped to account for inconsistent reporting, and the proportion of each injury activity was calculated. Data were not meta-analysed due to high heterogeneity of methods and classification criteria. RESULTS We included 64 studies reporting on 56,740 injuries in total. ACL injures were analysed by 12 studies, ankle/foot and knee injuries were analysed by five studies, thigh injuries were analysed by four studies, hip/groin injuries were analysed by three studies, and hamstring injuries were analysed by two studies. Five studies analysed more than one type of injury and 38 studies did not specify the type of injuries analysed. Running and kicking were the predominant activities leading to thigh and hamstring injuries. Changing direction and kicking were the predominant activities leading to hip and groin injuries and duels were the predominant activities leading to ankle injuries. Duels and pressing seem the predominant activities leading to ACL injuries, while results for other knee and general injuries were inconsistent. CONCLUSIONS A qualitative summary of the activities performed at the time of injury has been reported. The results need to be interpreted carefully due to the risk of bias observed in the included studies. If we are to meaningfully progress our knowledge in this area, it is paramount that future research uses consistent methods to record and classify injuries and activities leading up to and performed at the time of injury. REGISTRATION The protocol of this systematic review was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/U96KV ).
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Affiliation(s)
- Francesco Aiello
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Franco M Impellizzeri
- Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Sydney, Australia
| | - Susan J Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
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12
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Mancini S, Dickin DC, Hankemeier D, Ashton C, Welch J, Wang H. Effects of a soccer-specific vertical jump on lower extremity landing kinematics. SPORTS MEDICINE AND HEALTH SCIENCE 2022; 4:209-214. [PMID: 36090922 PMCID: PMC9453686 DOI: 10.1016/j.smhs.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Anterior cruciate ligament (ACL) injury frequently occurs in female soccer athletes during deceleration movements such as landings. In soccer, landings mostly occur following jumping headers. Little research has been done to determine the mechanics that follow and how they compare to standard drop vertical jumps (DVJ). The purpose of this study was to analyze differences in kinematics between the DVJ and the soccer-specific vertical jump (SSVJ) in female soccer athletes to better assess the sport-specific risk for ACL injury. A secondary aim was to compare second landings (L2) to first landings (L1). Eight female recreational soccer athletes performed DVJs and SSVJs initiated from a 31 cm height. Motion capture was performed during landings and data were analyzed using repeated-measures ANOVA. SSVJs produced less peak hip flexion (p = 0.03) and less peak knee flexion (p = 0.002) than DVJs. SSVJs also demonstrated increased ankle plantarflexion at initial contact (IC) than DVJs (p = 0.005). L2s produced less peak hip (p = 0.007) and knee flexion (p = 0.002) than L1s. SSVJs and L2s displayed a more erect landing posture than the DVJs and L1s at the hip and knee, a known ACL risk factor. The significant results between jump styles show that the SSVJ displays mechanics that are different from the DVJ. The SSVJ may be a better sport-specific screening tool for ACL injury mechanisms than the DVJ in soccer athletes as it has a more direct translation to the sport.
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13
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Englander ZA, Foody JN, Cutcliffe HC, Wittstein JR, Spritzer CE, DeFrate LE. Use of a Novel Multimodal Imaging Technique to Model In Vivo Quadriceps Force and ACL Strain During Dynamic Activity. Am J Sports Med 2022; 50:2688-2697. [PMID: 35853157 PMCID: PMC9875882 DOI: 10.1177/03635465221107085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quadriceps loading of the anterior cruciate ligament (ACL) may play a role in the noncontact mechanism of ACL injury. Musculoskeletal modeling techniques are used to estimate the intrinsic force of the quadriceps acting at the knee joint. PURPOSE/HYPOTHESIS The purpose of this paper was to develop a novel musculoskeletal model of in vivo quadriceps force during dynamic activity. We used the model to estimate quadriceps force in relation to ACL strain during a single-leg jump. We hypothesized that quadriceps loading of the ACL would reach a local maximum before initial ground contact with the knee positioned in extension. STUDY DESIGN Descriptive laboratory study. METHODS Six male participants underwent magnetic resonance imaging in addition to high-speed biplanar radiography during a single-leg jump. Three-dimensional models of the knee joint, including the femur, tibia, patellofemoral cartilage surfaces, and attachment-site footprints of the patellar tendon, quadriceps tendon, and ACL, were created from the magnetic resonance imaging scans. The bone models were registered to the biplanar radiographs, thereby reproducing the positions of the knee joint at the time of radiographic imaging. The magnitude of quadriceps force was determined for each knee position based on a 3-dimensional balance of the forces and moments of the patellar tendon and the patellofemoral cartilage contact acting on the patella. Knee kinematics and ACL strain were determined for each knee position. RESULTS A local maximum in average quadriceps force of approximately 6500 N (8.4× body weight) occurred before initial ground contact. ACL strain increased concurrently with quadriceps force when the knee was positioned in extension. CONCLUSION This novel participant-specific modeling technique provides estimates of in vivo quadriceps force during physiologic dynamic loading. A local maximum in quadriceps force before initial ground contact may tension the ACL when the knee is positioned in extension. CLINICAL RELEVANCE These data contribute to understanding noncontact ACL injury mechanisms and the potential role of quadriceps activation in these injuries.
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Affiliation(s)
- Zoë A. Englander
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Hattie C. Cutcliffe
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,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.,Address correspondence to Louis E. DeFrate, ScD, Duke University Medical Center, Room 379, Medical Sciences Research Bldg, Box 3093, Durham, NC 27710, USA ()
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14
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Rolley TL, Saunders N, Bonacci J, Keast M, Fox AS. Video Analysis of Anterior Cruciate Ligament Injury Situations in the Women's Australian Football League. SCI MED FOOTBALL 2022; 7:106-123. [PMID: 35544763 DOI: 10.1080/24733938.2022.2076897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anterior cruciate ligament (ACL) injury rates in the Women's Australian Football League (AFLW) are alarmingly high. Understanding injuries within their sporting context is important to develop effective injury prevention strategies, yet there is currently little knowledge of how ACL injuries occur to AFLW players. This study addressed the common scenarios and characteristics of ACL injuries in the AFLW. Online match and AFLW club injury reports identified 38 ACL injury cases. After excluding injuries where footage was unavailable (i.e. training, pre-season games), a video analysis of 21 match ACL injuries from the 2017-2020 AFLW seasons was performed. We examined match characteristics, and the player's movements and body postures preceding and at the estimated time of injury. Descriptive frequencies and relative proportions were determined across the assessed categories. Non-contact ACL injuries were frequently observed (n=13, 61.9%), while contact preceding the injury event (i.e. indirect contact) was also common (n=10, 47.6%). The most common game situation was direct defence (i.e. defending an opponent in possession) (n=14, 66.7%). Sidestep cutting was the most prevalent movement (n=11, 52.4%), with this commonly performed while applying defensive pressure (n=6 of 11, 54.6%). Sidestep cutting when applying defensive pressure is the most common non-contact ACL injury scenario in the AFLW. Preceding contact potentially contributing to a player's loss of balance was another prominent AFLW scenario. AFLW players may benefit from injury prevention programs emphasising appropriate sidestep cutting technique during reactive defensive scenarios, and maintenance of lower limb postures known to withstand knee loading relative to the sporting task.
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Affiliation(s)
- Tess L Rolley
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Natalie Saunders
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jason Bonacci
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Meghan Keast
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Aaron S Fox
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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15
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Choi J, Song K, Kim H, Lee SY, Park J. Effects of Unilateral Lower-extremity Joint Cooling on Movement Biomechanics during Two-legged Jumping and Landing. THE ASIAN JOURNAL OF KINESIOLOGY 2022. [DOI: 10.15758/ajk.2022.24.2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study examined the immediate effect of unilateral ankle or knee joint cooling on the low-erextremity kinematics and kinetics during two-legged jumping and landing.METHODS Twenty healthy adults randomly completed three data collection sessions for ankle or knee joint cooling, or control. For each session, participants performed two-legged countermovement jumps and lands. For joint cooling, two ice bags were directly placed to the right side and secured with a compression bandage. A three-dimensional motion analysis system (200 Hz) with two floor-embedded force platforms (2000 Hz) was employed to capture the jumping and landing. The cooling effects on kinematical (flight time, and sagittal plane joint angles) and kinetical (peak vertical ground reaction force (vGRF), impulse, and sagittal plane joint moments) variables were examined. A mixed-model analysis of variance was performed for each dependent variable (<i>p</i>≤0.0001 for all tests).RESULTS We did not observe any interactions (flight time: F<sub>2,95</sub>=0.67, <i>p</i>=0.52; joint angles: F<sub>2,209</sub>≤2.26, <i>p</i>≥0.10; peak vGRF: F<sub>2,209</sub>≤1.76, <i>p</i>≥0.20; impulse: F<sub>2,209</sub>≤2.54, <i>p</i>≥0.10; joint moments: F<sub>2,209</sub>≤4.80, <i>p</i>≥0.01 for all interactions). Regardless of condition and time (side effect), subjects showed a dominant-leg predominant movement strategy. Specifically, the right side showed a greater peak vGRF (2%), and greater ankle (7%), knee (6%), and hip (11%) joint moments, as compared with the left side during jumping. The same movement pattern was observed during landing that there was greater peak vGRF (11%) and impulse (8%), and greater ankle and knee joint moments (15%). Regardless of time and side (condition effect), subjects with ankle joint cooling showed 5% lesser ankle joint moment during jumping, compared with those who received knee joint cooling (<i>p</i>=0.0001).CONCLUSIONS A 20-min of unilateral ankle or knee joint cooling seems to neither alter vertical jump height nor change movement biomechanics during two-legged jumping and landing.
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16
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Zandiyeh P, Parola LR, Fleming BC, Beveridge JE. Wavelet analysis reveals differential lower limb muscle activity patterns long after anterior cruciate ligament reconstruction. J Biomech 2022; 133:110957. [PMID: 35114581 PMCID: PMC8893161 DOI: 10.1016/j.jbiomech.2022.110957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to test whether differences in muscle activity patterns between anterior cruciate ligament-reconstructed patients (ACLR) and healthy controls could be detected 10 to 15 years post-surgery using a machine learning classification approach. Eleven ACLR subjects and 12 healthy controls were recruited from an ongoing prospective randomized clinical trial. Surface electromyography (EMG) signals were recorded from gastrocnemius medialis and lateralis, tibialis anterior, vastus medialis, rectus femoris, biceps femoris, and semitendinosus muscles. Muscle activity was analyzed using wavelet analysis and examined within four sub-phases of the hop test, as well as an average of the task as a whole. K-nearest neighbor machine learning combined with a leave-one-out validation was used to classify the muscle activity patterns as either ACLR or Control. When muscle activity was averaged across the whole hop task, activity patterns for all muscles except the tibialis anterior were identified as being different between the study cohorts. ACLR patients demonstrated continuous muscle activities that spanned take-off, airborne, and landing hop phases versus healthy controls who displayed timed and regulated islets of muscle activities specific to each hop phase. The most striking features were 25-50% greater relative quadriceps intensity and approximately 66% diminished biceps femoris intensity in ACLR patients. The current findings are in contrast to previous work using conventional co-contraction and muscle activation onset EMG measures of the same dataset, underscoring the sensitivity and potential of the wavelet approach coupled with machine learning to reveal meaningful adaptation strategies in this at-risk population.
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Affiliation(s)
- Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, TX, USA.
| | - Lauren R. Parola
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.,Cleveland Clinic Biomedical Engineering Department, Cleveland, OH, USA.,Corresponding Author: Dr. Jillian Beveridge, Cleveland Clinic Biomedical Engineering Department, 9500 Euclid Avenue/ND20, Cleveland, OH, 44195, USA; ; P: (216) 299-3993
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17
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Nishida K, Xu C, Gale T, Anderst W, Fu F. Symmetry and sex differences in knee kinematics and ACL elongation in healthy collegiate athletes during high-impact activities revealed through dynamic biplane radiography. J Orthop Res 2022; 40:239-251. [PMID: 34387908 DOI: 10.1002/jor.25162] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/26/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to determine symmetry and sex differences in knee kinematics and anterior cruciate ligament (ACL) elongation waveforms in healthy athletes without a history of a knee injury during fast running, drop jump, and 180° internal/external rotation hops. It was hypothesized that knee abduction angle and ACL relative elongation would be greater in women than in men during all activities. Bilateral knee kinematics and ACL relative elongation were determined in 19 collegiate athletes using dynamic biplane radiography. Sex differences in kinematics and ACL relative elongation waveforms were identified using statistical parametric mapping. Average absolute side-to-side differences (SSDA ) in kinematics and ACL relative elongation waveforms were determined for each activity. Women had up to 2.3° (all p < 0.05) less knee adduction angle and had greater ACL relative elongation (max. 4.8%-9.2%; all p < 0.01) than men during all activities, in support of the hypotheses. SSDA in kinematics were 1.4 mm and 5.5° or less in all components of translation and rotation, respectively, while SSDA in ACL relative elongation was 3.6% or less across all activities. Greater ACL relative elongation across a variety of activities may make women more susceptible to ACL injury than men. This study provides valuable reference data for identifying abnormal asymmetry in knee kinematics and ACL elongation in athletes after the ACL injury. These novel results improve our understanding of ACL elongation during demanding athletic activities and may help guide the development of sex-specific risk screening metrics, return to play assessments, and rehabilitation protocols after the ACL injury.
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Affiliation(s)
- Kyohei Nishida
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caiqi Xu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Tom Gale
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie Fu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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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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19
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Hirohata K, Aizawa J, Ohmi T, Ohji S, Yagishita K. Characteristics of ground reaction force and frontal body movement during failed trials of single-leg lateral drop jump-landing task. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 26:8-14. [PMID: 34430216 PMCID: PMC8349769 DOI: 10.1016/j.asmart.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 10/31/2022]
Abstract
Background /objectives: For biomechanical studies using jump-landing tasks, many researchers set the criteria for judging success or failure of the trial. Failed trials are usually removed from the analysis. However, the kinetics and kinematics during tasks included in failed trials might be important for understanding the mechanisms and risk factors of non-contact sports injuries. However, few studies have attempted to analyze failed trials. Therefore, the main objective of this study was to investigate the characteristics associated with ground reaction force (GRF) and two-dimensional frontal body movements during a failed trial of single-leg lateral drop jump-landing. Methods Ten healthy women and 16 healthy men participated in this study. Spearman's rank correlation coefficients were calculated using the total number of failed trials and GRF data of successful trials. The association between frontal body movement and kinetics data was identified using correlation analyses. Wilcoxon signed-rank tests were performed to compare the GRF data of successful trials and failed trials of the same subject. Additionally, a two-way repeated measure analysis of variance was used to determine significant interactions of each trial and time after initial contact in the frontal body movement. Results A total of 137 trials including successful and failed trials were recorded. There were 59 failed jump trials. There was a significant negative correlation between the number of failed jump trials and the elapsed time from initial contact to peak vertical GRF (peak vGRF time) during successful trials (r = -0.427). The majority of failed trials were judged to be due to rearfoot movement patterns (rearfoot medial slip or rearfoot lateral slip). During rearfoot medial slip, we observed shorter peak vGRF time, larger trunk medial motions, and larger hip adduction movements after landing than that during successful trials. During rearfoot lateral slip, we observed larger trunk lateral motions and hip abduction movements after landing than that during successful trials. Conclusions Athletes who frequently failed during single-leg lateral drop jump-landing had poor skills absorbing jump-landing impact, which is related to various sports injuries. It is possible to identify the risk factors for sports injuries by analyzing failure patterns.
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Affiliation(s)
- Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junya Aizawa
- Department of Physical Therapy, Juntendo University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Molinaro L, Taborri J, Santospagnuolo A, Vetrano M, Vulpiani MC, Rossi S. Sensor-Based Indices for the Prediction and Monitoring of Anterior Cruciate Ligament Injury: Reliability Analysis and a Case Study in Basketball. SENSORS 2021; 21:s21165341. [PMID: 34450783 PMCID: PMC8398404 DOI: 10.3390/s21165341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
The possibility of measuring predictive factors to discriminate athletes at higher risk of anterior cruciate ligament (ACL) injury still represents an open research question. We performed an observational study with thirteen female basketball players who performed monopodalic jumps and single-leg squat tests. One of them suffered from an ACL injury after the first test session. Data gathered from twelve participants, who did not suffer from ACL injury, were used for a reliability analysis. Parameters related to leg stability, load absorption capability and leg mobility showed good-to-excellent reliability. Path length, root mean square of the acceleration and leg angle with respect to the vertical axis revealed themselves as possible predictive factors to identify athletes at higher risk. Results confirm that six months after reconstruction represents the correct time for these athletes to return to playing. Furthermore, the training of leg mobility and load absorption capability could allow athletes to reduce the probability of new injuries.
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Affiliation(s)
- Luca Molinaro
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Adriano Santospagnuolo
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
- Sports Medicine Institute CONI Rome, 00197 Rome, Italy;
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
- Correspondence: ; Tel.: +39-07-6135-7049
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22
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Nasseri A, Lloyd DG, Bryant AL, Headrick J, Sayer TA, Saxby DJ. Mechanism of Anterior Cruciate Ligament Loading during Dynamic Motor Tasks. Med Sci Sports Exerc 2021; 53:1235-1244. [PMID: 33731661 DOI: 10.1249/mss.0000000000002589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study determined anterior cruciate ligament (ACL) force and its contributors during a standardized drop-land-lateral jump task using a validated computational model. METHODS Three-dimensional whole-body kinematics, ground reaction forces, and muscle activation patterns from eight knee-spanning muscles were collected during dynamic tasks performed by healthy recreationally active females (n = 24). These data were used in a combined neuromusculoskeletal and ACL force model to determine lower limb muscle and ACL forces. RESULTS Peak ACL force (2.3 ± 0.5 bodyweight) was observed at ~14% of stance during the drop-land-lateral jump. The ACL force was primarily generated through the sagittal plane, and muscle was the dominant source of ACL loading. The main ACL antagonists (i.e., loaders) were the gastrocnemii and quadriceps, whereas the hamstrings were the main ACL agonists (i.e., supporters). CONCLUSION Combining neuromusculoskeletal and ACL force models, the roles of muscle in ACL loading and support were determined during a challenging motor task. Results highlighted the importance of the gastrocnemius in ACL loading, which could be considered more prominently in ACL injury prevention and rehabilitation programs.
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Affiliation(s)
| | | | - Adam L Bryant
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
| | | | - Timothy A Sayer
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
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Keizer MNJ, Otten E, Beijersbergen CMI, Brouwer RW, Hijmans JM. Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967121998061. [PMID: 33948445 PMCID: PMC8053773 DOI: 10.1177/2325967121998061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers. Purpose/Hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers. Study Design: Controlled laboratory study. Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained. Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing. Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment. Clinical Relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.
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Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal M I Beijersbergen
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands
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Englander ZA, Lau BC, Wittstein JR, Goode AP, DeFrate LE. Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump. Orthop J Sports Med 2021; 9:2325967121991054. [PMID: 33796591 PMCID: PMC7983247 DOI: 10.1177/2325967121991054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is little in vivo data that describe the relationships between patellar tendon orientation, patellar tendon strain, and anterior cruciate ligament (ACL) strain during dynamic activities. Quantifying how the quadriceps load the ACL via the patellar tendon is important for understanding ACL injury mechanisms. HYPOTHESIS We hypothesized that flexion angle, patellar tendon orientation, and patellar tendon strain influence ACL strain during a single-leg jump. Specifically, we hypothesized that patellar tendon and ACL strains would increase concurrently when the knee is positioned near extension during the jump. STUDY DESIGN Descriptive laboratory study. METHODS Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon attachment sites of 8 male participants were generated from magnetic resonance imaging (MRI). High-speed biplanar radiographs during a single-leg jump were obtained. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones, ligament, and tendon attachment sites. Flexion angle, patellar tendon orientation, patellar tendon strain, and ACL strain were measured from the registered models. ACL and patellar tendon strains were approximated by normalizing their length at each knee position to their length at the time of MRI. Two separate bivariate linear regression models were used to assess relationships between flexion angle and patellar tendon orientation and between ACL strain and patellar tendon strain. A multivariate linear regression model was used to assess whether flexion angle and patellar tendon strain were significant predictors of ACL strain during the inflight and landing portions of the jump. RESULTS Both flexion angle and patellar tendon strain were significant predictors (P < .05) of ACL strain. These results indicate that elevated ACL and patellar tendon strains were observed concurrently when the knee was positioned near extension. CONCLUSION Concurrent increases in patellar tendon and ACL strains indicate that the quadriceps load the ACL via the patellar tendon when the knee is positioned near extension. CLINICAL RELEVANCE Increased ACL strain when the knee is positioned near extension before landing may be due to quadriceps contraction. Thus, landing with unanticipated timing on an extended knee may increase vulnerability to ACL injury as a taut ligament is more likely to fail.
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Affiliation(s)
- Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Duke Sport Science Institute, Department of Orthopaedics, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Sport Science Institute, Department of Orthopaedics, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R. Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Sport Science Institute, Department of Orthopaedics, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Duke Sport Science Institute, Department of Orthopaedics, Duke
University School of Medicine, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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25
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Lee J, Pathak P, Panday SB, Moon J. Effect of Foot-Planting Strategy on Anterior Cruciate Ligament Loading in Women During a Direction Diversion Maneuver: A Musculoskeletal Modeling Approach. Orthop J Sports Med 2020; 8:2325967120963180. [PMID: 33283003 PMCID: PMC7686614 DOI: 10.1177/2325967120963180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Although there is a higher prevalence of noncontact anterior cruciate ligament (ACL) injuries during a direction diversion maneuver (DDM), no previous studies have reported how foot-planting strategies affect ACL loading. Purpose To investigate the effect of foot-planting strategies on ACL loading in women during a DDM task using a musculoskeletal modeling approach. Study Design Descriptive laboratory study. Methods A total of 13 female participants performed a DDM task, which involved running at 4.5 ± 0.2 m/s and turning left at 35° to 55° under a foot-planting strategy in 3 directions: neutral, toe-in, and toe-out. Kinematic and kinetic data were measured with the use of a 3-dimensional motion capture system and force platform to calculate variables such as joint angle, shear force, and moment. Anterior ACL and posterior ACL forces were extracted using musculoskeletal modeling. Results The peak anterior ACL force was significantly larger for the toe-out condition (31.29 ± 4.02 N/body weight [BW]) compared with the toe-in condition (25.43 ± 5.68 N/BW) (P = .047), with no significant difference in the neutral condition. The toe-out condition had a higher knee valgus angle (2.98° ± 4.20°; P = .041), knee shear force (10.20 ± 1.69 N/BW; P = .009), and knee internal rotation moment (-0.18 ± 0.16 N·m/BW×height; P = .012) than the toe-in and neutral conditions. Conclusion Through musculoskeletal modeling, we were able to conclude that the toe-out condition during the DDM might result in a higher risk of ACL injuries. Athletes and sports practitioners should avoid the toe-out foot-planting strategy when participating in a sporting activity. Clinical Relevance Based on these findings, medical professionals and athletic coaches can gain knowledge on how foot-planting strategy affects ACL loading. Understanding the actual cause of an ACL injury can be useful for designing preventive training programs or strategies to decrease the risk of such injuries.
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Affiliation(s)
- Jusung Lee
- Department of Sport Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Prabhat Pathak
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Siddhartha Bikram Panday
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea.,Department of Sport and Leisure Studies, Keimyung University, Daegu, Republic of Korea
| | - Jeheon Moon
- Department of Physical Education, Korea National University of Education, Cheongju, Republic of Korea.,Department of Sport Science, Korea Institute of Sport Science, Seoul, Republic of Korea
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26
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Heinrich D, van den Bogert AJ, Csapo R, Nachbauer W. A model-based approach to predict neuromuscular control patterns that minimize ACL forces during jump landing. Comput Methods Biomech Biomed Engin 2020; 24:612-622. [PMID: 33185129 DOI: 10.1080/10255842.2020.1842376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Jump landing is a common situation leading to knee injuries involving the anterior cruciate ligament (ACL) in sports. Although neuromuscular control is considered as a key injury risk factor, there is a lack of knowledge regarding optimum control strategies that reduce ACL forces during jump landing. In the present study, a musculoskeletal model-based computational approach is presented that allows identifying neuromuscular control patterns that minimize ACL forces during jump landing. The approach is demonstrated for a jump landing maneuver in downhill skiing, which is one out of three main injury mechanisms in competitive skiing.
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Affiliation(s)
- Dieter Heinrich
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Robert Csapo
- Department of Orthopedic Sports Medicine and Injury Prevention, University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Teng PSP, Leong KF, Yi Xian Phua P, Kong PW. An exploratory study of the use of ultrasound in the measurement of anterior tibial translation under gastrocnemius muscle stimulation. Res Sports Med 2020; 29:103-115. [PMID: 33118836 DOI: 10.1080/15438627.2020.1840378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gastrocnemius' role as an agonist or antagonist of the anterior cruciate ligament (ACL) is not well understood. This study explored the use of ultrasound imaging to investigate how gastrocnemius stimulation levels influenced anterior tibial translation. The gastrocnemii of 10 participants were stimulated to four different levels using electrical muscle stimulation. The quadriceps were co-activated at a fixed level. Anterior tibial translation was determined using ultrasound imaging. Intraclass correlation coefficient [ICC (2,1)] was used to assess the intra-rater reliability over two sessions. Intra-rater reliability was good at rest and under most muscle stimulation levels (ICC = 0.84 to 0.92), and moderate with the lowest (ICC = 0.71) and highest stimulation (ICC = 0.61). While anterior tibial translation was not significantly different across simulation levels, ultrasound imaging recorded the anterior movement of the tibia as the gastrocnemius was activated, thus supporting gastrocnemius' role as an antagonist of the ACL.
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Affiliation(s)
- Phillis Soek Po Teng
- Institute for Sports Research, Nanyang Technological University , Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore
| | - Kah Fai Leong
- Institute for Sports Research, Nanyang Technological University , Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore
| | - Philip Yi Xian Phua
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| | - Pui Wah Kong
- Institute for Sports Research, Nanyang Technological University , Singapore.,Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
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Techniques for In Vivo Measurement of Ligament and Tendon Strain: A Review. Ann Biomed Eng 2020; 49:7-28. [PMID: 33025317 PMCID: PMC7773624 DOI: 10.1007/s10439-020-02635-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
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29
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Englander ZA, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography: Response. J Biomech 2020; 109:109918. [PMID: 32660758 DOI: 10.1016/j.jbiomech.2020.109918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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30
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Bates NA, Schilaty ND, Ueno R, Hewett TE. Timing of Strain Response of the ACL and MCL Relative to Impulse Delivery During Simulated Landings Leading up to ACL Failure. J Appl Biomech 2020; 36:148-155. [PMID: 32320947 PMCID: PMC7764947 DOI: 10.1123/jab.2019-0308] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/08/2020] [Accepted: 02/03/2020] [Indexed: 11/18/2022]
Abstract
Anterior cruciate ligament (ACL) injury videos estimate that rupture occurs within 50 milliseconds of initial contact, but are limited by imprecise timing and nondirect data acquisition. The objective of this study was to precisely quantify the timing associated with ligament strain during simulated landing and injury events. The hypotheses tested were that the timing of peak strain following initial contact would differ between ligaments and that peak strain timing would be independent of the injury-risk profile emulated during simulated landing. A mechanical impact simulator was used to perform landing simulations based on various injury-risk profiles that were applied to each specimen in a block-randomized order. The ACL and medial collateral ligament were instrumented with strain gauges that recorded continuously. The data from 35 lower-extremity specimens were included for analysis. Analysis of variance and Kruskal-Wallis tests were used to determine the differences between timing and profiles. The mean time to peak strain was 53 (24) milliseconds for the ACL and 58 (35) milliseconds for the medial collateral ligament. The time to peak ACL strain ranged from 48 to 61 milliseconds, but the timing differences were not significant between profiles. Strain timing was independent of injury-risk profile. Noncontact ACL injuries are expected to occur between 0 and 61 milliseconds after initial contact. Both ligaments reached peak strain within the same time frame.
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31
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Keizer MNJ, Hijmans JM, Gokeler A, Benjaminse A, Otten E. Healthy subjects with lax knees use less knee flexion rather than muscle control to limit anterior tibia translation during landing. J Exp Orthop 2020; 7:32. [PMID: 32415565 PMCID: PMC7229106 DOI: 10.1186/s40634-020-00246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose It has been reported that there is no correlation between anterior tibia translation (ATT) in passive and dynamic situations. Passive ATT (ATTp) may be different to dynamic ATT (ATTd) due to muscle activation patterns. This study aimed to investigate whether muscle activation during jumping can control ATT in healthy participants. Methods ATTp of twenty-one healthy participants was measured using a KT-1000 arthrometer. All participants performed single leg hops for distance during which ATTd, knee flexion angles and knee flexion moments were measured using a 3D motion capture system. During both tests, sEMG signals were recorded. Results A negative correlation was found between ATTp and the maximal ATTd (r = − 0.47, p = 0.028). An N-Way ANOVA showed that larger semitendinosus activity was seen when ATTd was larger, while less biceps femoris activity and rectus femoris activity were seen. Moreover, larger knee extension moment, knee flexion angle and ground reaction force in the anterior-posterior direction were seen when ATTd was larger. Conclusion Participants with more ATTp showed smaller ATTd during jump landing. Muscle activation did not contribute to reduce ATTd during impact of a jump-landing at the observed knee angles. However, subjects with large ATTp landed with less knee flexion and consequently showed less ATTd. The results of this study give information on how healthy people control knee laxity during jump-landing. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands
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In vivo static and dynamic lengthening measurements of the posterior cruciate ligament at high knee flexion angles. Int J Comput Assist Radiol Surg 2019; 15:555-564. [PMID: 31863253 DOI: 10.1007/s11548-019-02107-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Rehabilitation is an important aspect of both non-operative and operative treatments of knee ligament tear. Posterior cruciate ligament (PCL) non-operative treatment consists of a step-by-step rehabilitation protocol and is well described. It goes from rest (phase I) to strengthening exercises (phase IV). More specific and high-intensity exercises such as cutting, sidestepping or jumps are, however, not described in detail, as no in vivo data exist to tell how these exercises constrain the ligaments and whether they have the same effect on all of them, in particular regarding lengthening. The goal of this study was to measure the ligament lengthening in static knee flexion based on 3D reconstructions from magnetic resonance imaging (MRI) and from motion capture and ligament simulation during dynamic exercises. METHODS The knee of nine volunteers was first imaged in a closed-bore MRI scanner at various static knee flexion angles (up to 110°), and the corresponding lengthening of the PCL and the other major knee ligaments was measured. Then, the volunteers underwent motion capture of the knee where dynamic exercises (sitting, jumping, sidestepping, etc.) were recorded. For each exercise, knee ligament elongation was simulated and evaluated. RESULTS According to the MRI scans, maximal lengthening occurred at 110° of flexion in the anterior cruciate ligament and 90° of flexion in the PCL. Daily living movements such as sitting were predicted to elongate the cruciate ligaments, whereas they shortened the collateral ligaments. More active movements such as jumping put the most constrain to cruciate ligaments. CONCLUSION This study provides interesting insights into a tailored postoperative regimen. In particular, knowing the knee ligament lengthening during dynamic exercises can help better define the last stages of the rehabilitation protocol, and hence provide a safe return to play.
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Bates NA, Schilaty ND, Krych AJ, Hewett TE. Variation in ACL and MCL Strain Before Initial Contact Is Dependent on Injury Risk Level During Simulated Landings. Orthop J Sports Med 2019; 7:2325967119884906. [PMID: 32010728 PMCID: PMC6967202 DOI: 10.1177/2325967119884906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The existent literature has well explored knee ligament kinetics and strain at and after initial contact (IC) during landing tasks. However, little is known about knee ligament biomechanics in flight before IC. Purpose To quantify and compare change in anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strain before IC relative to after IC. Study Design Descriptive laboratory study. Methods A total of 40 cadaveric specimens were analyzed after being subjected to simulated landings in a mechanical impact simulator. External joint loads of varying magnitudes were applied to mimic relative injury risk load levels from an in vivo cohort and were coupled with an impulse force to represent initial ground contact. Implanted strain gauges continually recorded ligament strain. Kruskal-Wallis tests evaluated the significance of risk level and pre- and post-IC factors, while Wilcoxon each-pair tests evaluated differences within both factors. Results Strain responses during simulated landing tasks for the ACL (P ≥ .545) and MCL (P ≥ .489) were consistent after IC regardless of the level of relative injury risk simulated in each trial. Before IC, the level of injury risk kinetics applied to a specimen differentiated strain response in the ACL (P < .001) and MCL (P < .001), as higher risk profiles produced greater changes in ligament strain. Mean baseline strain was 4.0% in the ACL and 1.0% in the MCL. Mean change in strain from the ACL ranged from 0.1% to 3.9% pre-IC and from 2.9% to 5.7% post-IC, while the MCL ranged from 0.0% to 3.0% pre-IC and from 0.9% to 1.3% post-IC. Conclusion Within each ligament, post-IC strain response lacked statistical differences among simulated risk profiles, while pre-IC response was dependent on the risk profile simulated. Individually, neither pre- nor poststrain changes were enough to induce ACL failure, but when combined over the course of a full landing task, they could lead to rupture. Clinical Relevance Prevention and rehabilitation techniques should aim to limit the presence of increased risk biomechanics in flight before landing, as impulse delivery at IC is inevitable.
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Affiliation(s)
- Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Englander ZA, Baldwin EL, Smith WA, Garrett WE, Spritzer CE, DeFrate LE. In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography. Am J Sports Med 2019; 47:3166-3172. [PMID: 31593498 PMCID: PMC7042957 DOI: 10.1177/0363546519876074] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The in vivo mechanics of the anterior cruciate ligament (ACL) and its bundles during dynamic activities are not completely understood. An improved understanding of how the ACL stabilizes the knee is likely to aid in the identification and prevention of injurious maneuvers. PURPOSE/HYPOTHESIS The purpose was to measure in vivo ACL strain during a single-legged jump through use of magnetic resonance imaging (MRI) and high-speed biplanar radiography. We hypothesized that ACL strain would increase with the knee near extension, and a peak in ACL strain would occur just before landing from the jump, potentially due to quadriceps contraction in anticipation of landing. STUDY DESIGN Descriptive laboratory study. METHODS Models of the femur, tibia, and ACL attachment sites of 8 male participants were generated from MRI scans through use of solid modeling. High-speed biplanar radiographs were obtained from these participants as they performed a single-legged jump. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the joint throughout the jump. ACL and bundle elongations were defined as the centroid to centroid distances between attachment sites for each knee position. ACL strain was defined as ACL length normalized to its length measured in the position of the knee at the time of MRI. RESULTS Peaks in ACL strain were observed before toe-off and 55 ± 35 milliseconds before initial ground contact. These peaks were associated with the knee positioned at low flexion angles. Mean ACL strain was inversely related to mean flexion angle (rho = -0.73, P < .001), such that ACL strain generally increased with knee extension throughout the jumping motion. ACL bundle lengths were significantly (rho > 0.85, P < .001) correlated with overall ACL length. CONCLUSION These findings provide insight into how landing in extension can increase the risk of ACL injury. Specifically, this study shows that peak ACL strain can occur just before landing from a single-legged jump. Thus, when an individual lands on an extended knee, the ACL is relatively taut, which may make it particularly vulnerable to injury, especially in the presence of a movement perturbation or unanticipated change in landing strategy. CLINICAL RELEVANCE This study provides a novel measurement of dynamic ACL strain during an athletic maneuver and lends insight into how landing in extension can increase the likelihood of ACL failure.
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Affiliation(s)
- Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Edward L. Baldwin
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Wyatt A.R. Smith
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | | | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Englander ZA, Garrett WE, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography. J Biomech 2019; 98:109443. [PMID: 31679755 DOI: 10.1016/j.jbiomech.2019.109443] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to measure in vivo attachment site to attachment site lengths and strains of the anterior cruciate ligament (ACL) and its bundles throughout a full cycle of treadmill gait. To obtain these measurements, models of the femur, tibia, and associated ACL attachment sites were created from magnetic resonance (MR) images in 10 healthy subjects. ACL attachment sites were subdivided into anteromedial (AM) and posterolateral (PL) bundles. High-speed biplanar radiographs were obtained as subjects ambulated at 1 m/s. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones and ACL attachment sites throughout gait. The lengths of the ACL and both bundles were estimated as straight line distances between attachment sites for each knee position. Increased attachment to attachment ACL length and strain were observed during midstance (length = 28.5 ± 2.6 mm, strain = 5 ± 4%, mean ± standard deviation), and heel strike (length = 30.5 ± 3.0 mm, strain = 12 ± 5%) when the knee was positioned at low flexion angles. Significant inverse correlations were observed between mean attachment to attachment ACL lengths and flexion (rho = -0.87, p < 0.001), as well as both bundle lengths and flexion (rho = -0.86, p < 0.001 and rho = -0.82, p < 0.001, respectively). AM and PL bundle attachment to attachment lengths were highly correlated throughout treadmill gait (rho = 0.90, p < 0.001). These data can provide valuable information to inform design criteria for ACL grafts used in reconstructive surgery, and may be useful in the design of rehabilitation and injury prevention protocols.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Davis DJ, Hinshaw TJ, Critchley ML, Dai B. Mid-flight trunk flexion and extension altered segment and lower extremity joint movements and subsequent landing mechanics. J Sci Med Sport 2019; 22:955-961. [DOI: 10.1016/j.jsams.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/09/2019] [Accepted: 03/03/2019] [Indexed: 01/13/2023]
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McBurnie AJ, DosʼSantos T, Jones PA. Biomechanical Associates of Performance and Knee Joint Loads During A 70-90° Cutting Maneuver in Subelite Soccer Players. J Strength Cond Res 2019; 35:3190-3198. [PMID: 31268990 DOI: 10.1519/jsc.0000000000003252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
McBurnie, AJ, Dos'Santos, T, Jones, PA. Biomechanical associates of performance and knee joint loads during a 70-90° cutting maneuver in subelite soccer players. J Strength Cond Res XX(X): 000-000, 2019-The aim of this study was to explore the "performance-injury risk" conflict during cutting, by examining whole-body joint kinematics and kinetics that are responsible for faster change-of-direction (COD) performance of a cutting task in soccer players, and to determine whether these factors relate to peak external multiplanar knee moments. 34 male soccer players (age: 20 ± 3.2 years; body mass: 73.5 ± 9.2 kg; height: 1.77 ± 0.06 m) were recruited to investigate the relationships between COD kinetics and kinematics with performance and multiplanar knee joint moments during cutting. Three-dimensional motion data using 10 Qualisys Oqus 7 infrared cameras (240 Hz) and ground reaction force data from 2 AMTI force platforms (1,200 Hz) were collected to analyze the penultimate foot contact and final foot contact (FFC). Pearson's or Spearman's correlations coefficients revealed performance time (PT), peak external knee abduction moment (KAM), and peak external knee rotation moment (KRM) were all significantly related (p < 0.05) to horizontal approach velocity (PT: ρ = -0.579; peak KAM: ρ = 0.414; peak KRM: R = -0.568) and FFC peak hip flexor moment (PT: ρ = 0.418; peak KAM: ρ = -0.624; peak KRM: ρ = 0.517). Performance time was also significantly (p < 0.01) associated with horizontal exit velocity (ρ = -0.451) and, notably, multiplanar knee joint loading (peak KAM: ρ = -0.590; peak KRM: ρ = 0.525; peak KFM: ρ = -0.509). Cohen's d effect sizes (d) revealed that faster performers demonstrated significantly greater (p < 0.05; d = 1.1-1.7) multiplanar knee joint loading, as well as significantly greater (p < 0.05; d = 0.9-1.2) FFC peak hip flexor moments, PFC average horizontal GRFs, and peak knee adduction angles. To conclude, mechanics associated with faster cutting performance seem to be "at odds" with lower multiplanar knee joint loads. This highlights the potential performance-injury conflict present during cutting.
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Affiliation(s)
- Alistair J McBurnie
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Greater Manchester, United Kingdom
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Dai B, Garrett WE, Gross MT, Padua DA, Queen RM, Yu B. The effect of performance demands on lower extremity biomechanics during landing and cutting tasks. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:228-234. [PMID: 31193278 PMCID: PMC6523039 DOI: 10.1016/j.jshs.2016.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/29/2016] [Accepted: 08/01/2016] [Indexed: 06/09/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries commonly occur during the early phase of landing and cutting tasks that involve sudden decelerations. The purpose of this study was to investigate the effects of jump height and jump speed on lower extremity biomechanics during a stop-jump task and the effect of cutting speed on lower extremity biomechanics during a side-cutting task. METHODS Thirty-six recreational athletes performed a stop-jump task under 3 conditions: jumping fast, jumping for maximum height, and jumping for 60% of maximum height. Participants also performed a side-cutting task under 2 conditions: cutting at maximum speed and cutting at 60% of maximum speed. Three-dimensional kinematic and kinetic data were collected. RESULTS The jumping fast condition resulted in increased peak posterior ground reaction force (PPGRF), knee extension moment at PPGRF, and knee joint stiffness and decreased knee flexion angle compared with the jumping for maximum height condition. The jumping for 60% of maximum height condition resulted in decreased knee flexion angle compared with the jumping for maximum height condition. Participants demonstrated greater PPGRF, knee extension moment at PPGRF, knee valgus angle and varus moment at PPGRF, knee joint stiffness, and knee flexion angle during the cutting at maximum speed condition compared with the cutting at 60% maximum speed condition. CONCLUSION Performing jump landing at an increased jump speed resulted in lower extremity movement patterns that have been previously associated with an increase in ACL loading. Cutting speed also affected lower extremity biomechanics. Jump speed and cutting speed need to be considered when designing ACL injury risk screening and injury prevention programs.
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Affiliation(s)
- Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82070, USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | - Michael T. Gross
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Robin M. Queen
- Kevin Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Bing Yu
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Wochatz M, Tilgner N, Mueller S, Rabe S, Eichler S, John M, Völler H, Mayer F. Reliability and validity of the Kinect V2 for the assessment of lower extremity rehabilitation exercises. Gait Posture 2019; 70:330-335. [PMID: 30947108 DOI: 10.1016/j.gaitpost.2019.03.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Besides its initial use as a video gaming system the Kinect might also be suitable to capture human movements in the clinical context. However, the system's reliability and validity to capture rehabilitation exercises is unclear. RESEARCH QUESTION The purpose of this study was to evaluate the test-retest reliability of lower extremity kinematics during squat, hip abduction and lunge exercises captured by the Kinect and to evaluate the agreement to a reference 3D camera-based motion system. METHODS Twenty-one healthy individuals performed five repetitions of each lower limb exercise on two different days. Movements were simultaneously assessed by the Kinect and the reference 3D motion system. Joint angles and positions of the lower limb were calculated for sagittal and frontal plane. For the inter-session reliability and the agreement between the two systems standard error of measurement (SEM), bias with limits of agreement (LoA) and Pearson Correlation Coefficient (r) were calculated. RESULTS Parameters indicated varying reliability for the assessed joint angles and positions and decreasing reliability with increasing task complexity. Across all exercises, measurement deviations were shown especially for small movement amplitudes. Variability was acceptable for joint angles and positions during the squat, partially acceptable during the hip abduction and predominately inacceptable during the lunge. The agreement between systems was characterized by systematic errors. Overestimations by the Kinect were apparent for hip flexion during the squat and hip abduction/adduction during the hip abduction exercise as well as for the knee positions during the lunge. Knee and hip flexion during hip abduction and lunge were underestimated by the Kinect. SIGNIFICANCE The Kinect system can reliably assess lower limb joint angles and positions during simple exercises. The validity of the system is however restricted. An application in the field of early orthopedic rehabilitation without further development of post-processing techniques seems so far limited.
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Affiliation(s)
- Monique Wochatz
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, Potsdam, Germany.
| | - Nina Tilgner
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, Potsdam, Germany
| | - Steffen Mueller
- Trier University of Applied Science, Computer Science/Therapy Science, Trier, Germany
| | - Sophie Rabe
- University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany
| | - Sarah Eichler
- University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany
| | - Michael John
- Fraunhofer Institute for Open Communication Systems, Berlin, Germany
| | - Heinz Völler
- University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany
| | - Frank Mayer
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, Potsdam, Germany
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In vivo assessment of the interaction of patellar tendon tibial shaft angle and anterior cruciate ligament elongation during flexion. J Biomech 2019; 90:123-127. [PMID: 31072596 DOI: 10.1016/j.jbiomech.2019.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/05/2019] [Accepted: 04/21/2019] [Indexed: 12/19/2022]
Abstract
A potential cause of non-contact anterior cruciate ligament (ACL) injury is landing on an extended knee. In line with this hypothesis, studies have shown that the ACL is elongated with decreasing knee flexion angle. Furthermore, at low flexion angles the patellar tendon is oriented to increase the anterior shear component of force acting on the tibia. This indicates that knee extension represents a position in which the ACL is taut, and thus may have an increased propensity for injury, particularly in the presence of excessive force acting via the patellar tendon. However, there is very little in vivo data to describe how patellar tendon orientation and ACL elongation interact during flexion. Therefore, this study measured the patellar tendon tibial shaft angle (indicative of the relative magnitude of the shear component of force acting via the patellar tendon) and ACL length in vivo as subjects performed a quasi-static lunge at varying knee flexion angles. Spearman rho rank correlations within each individual revealed that flexion angles were inversely correlated to both ACL length (rho = -0.94 ± 0.07, mean ± standard deviation, p < 0.05) and patellar tendon tibial shaft angle (rho = -0.99 ± 0.01, p < 0.05). These findings indicate that when the knee is extended, the ACL is both elongated and the patellar tendon tibial shaft angle is increased, resulting in a relative increase in anterior shear force on the tibia acting via the patellar tendon. Therefore, these data support the hypothesis that landing with the knee in extension is a high risk scenario for ACL injury.
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In vivo kinematics and ligamentous function of the knee during weight-bearing flexion: an investigation on mid-range flexion of the knee. Knee Surg Sports Traumatol Arthrosc 2019; 28:797-805. [PMID: 30972464 PMCID: PMC6786938 DOI: 10.1007/s00167-019-05499-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the in vivo femoral condyle motion and synergistic function of the ACL/PCL along the weight-bearing knee flexion. METHODS Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging technique during a single-legged lunge (0°-120°). The medial and lateral femoral condyle translation and rotation (measured using geometric center axis-GCA), and the length changes of the ACL/PCL were analyzed at: low (0°-30°), mid-range (30°-90°) and high (90°-120°) flexion of the knee. RESULTS At low flexion (0°-30°), the strains of the ACL and the posterior-medial bundle of the PCL decreased. The medial condyle showed anterior translation and lateral condyle posterior translation, accompanied with a sharp increase in external GCA rotation (internal tibial rotation). As the knee continued flexion in mid-range (30°-90°), both ACL and PCL were slack (with negative strain values). The medial condyle moved anteriorly before 60° of flexion and then posteriorly, accompanied with a slow increase of GCA rotation. As the knee flexed in high flexion (90°-120°), only the PCL had increasingly strains. Both medial and lateral condyles moved posteriorly with a rather constant GCA rotation. CONCLUSIONS The ACL and PCL were shown to play a reciprocal and synergistic role during knee flexion. Mid-range reciprocal anterior-posterior femoral translation or laxity corresponds to minimal constraints of the ACL and PCL, and may represent a natural motion character of normal knees. The data could be used as a valuable reference when managing the mid-range "instability" and enhancing high flexion capability of the knee after TKAs. LEVEL OF EVIDENCE Level IV.
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Morgan AM, O'Connor KM. Evaluation of an accelerometer to assess knee mechanics during a drop landing. J Biomech 2019; 86:125-131. [PMID: 30777341 DOI: 10.1016/j.jbiomech.2019.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/31/2022]
Abstract
Non-contact anterior cruciate ligament (ACL) injuries account for 70% of all ACL injuries, and can lead to missed time from activity for athletes and a predisposition for knee osteoarthritis. Prior research has shown that athletes who land in a stiff manner, with larger internal knee adduction and extension moments, are at greater risk for an ACL injury. A three-dimensional accelerometer placed at the tibial tuberosity may prove to be a low-cost means of assessing these risk factors. The primary purpose of this study was to compare tibial accelerations during drop landings with kinematic and kinetic risk factors for ACL injury measured with three-dimensional motion capture. The secondary purpose of this study was to compare these measures between soft and stiff landings. Participants were instructed to land bilaterally in preferred, soft, and stiff manners. Peak knee flexion decreased significantly from soft to stiff landings. Peak internal knee extension moment, peak anterior/posterior knee acceleration, and peak medial knee acceleration all increased significantly from soft to stiff landings. No associations were found between landing condition and either frontal plane knee angle at maximum vertical ground reaction force or peak internal knee adduction moment. Significant positive associations between kinetics and accelerations were found only in the sagittal plane. As such, while a three-dimensional accelerometer could discern between soft and stiff landings in both planes, it may be better suited to predict kinetic risk factors in the sagittal plane.
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Affiliation(s)
- Alexander M Morgan
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Kristian M O'Connor
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Englander ZA, Cutcliffe HC, Utturkar GM, Garrett WE, Spritzer CE, DeFrate LE. A Comparison of Knee Abduction Angles Measured by a 3D Anatomic Coordinate System Versus Videographic Analysis: Implications for Anterior Cruciate Ligament Injury. Orthop J Sports Med 2019; 7:2325967118819831. [PMID: 30729143 PMCID: PMC6350144 DOI: 10.1177/2325967118819831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Knee positions involved in noncontact anterior cruciate ligament (ACL) injury have been studied via analysis of injury videos. Positions of high ACL strain have been identified in vivo. These methods have supported different hypotheses regarding the role of knee abduction in ACL injury. Purpose/Hypothesis The purpose of this study was to compare knee abduction angles measured by 2 methods: using a 3-dimensional (3D) coordinate system based on anatomic features of the bones versus simulated 2-dimensional (2D) videographic analysis. We hypothesized that knee abduction angles measured in a 2D videographic analysis would differ from those measured from 3D bone anatomic features and that videographic knee abduction angles would depend on flexion angle and on the position of the camera relative to the patient. Study Design Descriptive laboratory study. Methods Models of the femur and tibia were created from magnetic resonance images of 8 healthy male participants. The models were positioned to match biplanar fluoroscopic images obtained as participants posed in lunges of varying flexion angles (FLAs). Knee abduction angle was calculated from the positioned models in 2 ways: (1) varus-valgus angle (VVA), defined as the angle between the long axis of the tibia and the femoral transepicondylar axis by use of a 3D anatomic coordinate system; and (2) coronal plane angle (CPA), defined as the angle between the long axis of the tibia and the long axis of the femur projected onto the tibial coronal plane to simulate a 2D videographic analysis. We then simulated how changing the position of the camera relative to the participant would affect knee abduction angles. Results During flexion, when CPA was calculated from a purely anterior or posterior view of the joint-an ideal scenario for measuring knee abduction from 2D videographic analysis-CPA was significantly different from VVA (P < .0001). CPA also varied substantially with the position of the camera relative to the participant. Conclusion How closely CPA (derived from 2D videographic analysis) relates to VVA (derived from a 3D anatomic coordinate system) depends on FLA and camera orientation. Clinical Relevance This study provides a novel comparison of knee abduction angles measured from 2D videographic analysis and those measured within a 3D anatomic coordinate system. Consideration of these findings is important when interpreting 2D videographic data regarding knee abduction angle in ACL injury.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Hattie C Cutcliffe
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - William E Garrett
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | | | - Louis E DeFrate
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Yokoyama H, Oda A, Makino M, Ishikawa T, Shikanai K, Tsukamoto T, Tsuda E. Effects of different oral instructions on kinematic and kinetic parameters during drop vertical jump. J Phys Ther Sci 2019; 31:670-674. [PMID: 31528007 PMCID: PMC6698476 DOI: 10.1589/jpts.31.670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 12/05/2022] Open
Abstract
[Purpose] This study aimed to examine the impact of changing the drop vertical jump
stance time on kinematic and kinetic parameters by ordering to high jump or quick jump for
consistent stance time and a more accurate assessment of anterior cruciate ligament injury
risk. [Participants and Methods] The participants were 20 healthy female students. The
drop vertical jump was started by instructing the participants to stand on a 30-cm
platform with both legs stationary. The task was performed while the participants were
instructed to perform high jump or quick jump. [Results] Stance time was significantly
shorter with quick jump than with high jump. Quick jump showed significantly higher knee
abduction angles at initial contact and peak vertical ground reaction force, and lower hip
flexion, knee flexion, and ankle dorsiflexion angles at the lowest point of the center of
mass. Quick jump showed a significantly higher peak vertical ground reaction force. The
knee abduction moment at initial contact was not significantly different between the 2
conditions. [Conclusion] Quick jump was better than high jump for making stance time
consistent, and the differences in kinematic and kinetic characteristics by oral
instructions should be considered when using drop vertical jump.
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Affiliation(s)
- Hiroko Yokoyama
- Department of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences: 66-1 Honcho, Hirosaki, Aomori 036-8564, Japan
- Department of Rehabilitation, Hirosaki University Hospital, Japan
| | - Atsushi Oda
- Department of Health Sciences, Hirosaki University Graduate School of Health Sciences, Japan
| | - Misato Makino
- Department of Health Sciences, Hirosaki University Graduate School of Health Sciences, Japan
| | - Takaaki Ishikawa
- Department of Health Sciences, Hirosaki University Graduate School of Health Sciences, Japan
| | | | | | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Japan
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Sutter EG, Liu B, Utturkar GM, Widmyer MR, Spritzer CE, Cutcliffe HC, Englander ZA, Goode AP, Garrett WE, DeFrate LE. Effects of Anterior Cruciate Ligament Deficiency on Tibiofemoral Cartilage Thickness and Strains in Response to Hopping. Am J Sports Med 2019; 47:96-103. [PMID: 30365903 PMCID: PMC6559720 DOI: 10.1177/0363546518802225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Changes in knee kinematics after anterior cruciate ligament (ACL) injury may alter loading of the cartilage and thus affect its homeostasis, potentially leading to the development of posttraumatic osteoarthritis. However, there are limited in vivo data to characterize local changes in cartilage thickness and strain in response to dynamic activity among patients with ACL deficiency. PURPOSE/HYPOTHESIS The purpose was to compare in vivo tibiofemoral cartilage thickness and cartilage strain resulting from dynamic activity between ACL-deficient and intact contralateral knees. It was hypothesized that ACL-deficient knees would show localized reductions in cartilage thickness and elevated cartilage strains. STUDY DESIGN Controlled laboratory study. METHODS Magnetic resonance images were obtained before and after single-legged hopping on injured and uninjured knees among 8 patients with unilateral ACL rupture. Three-dimensional models of the bones and articular surfaces were created from the pre- and postactivity scans. The pre- and postactivity models were registered to each other, and cartilage strain (defined as the normalized difference in cartilage thickness pre- and postactivity) was calculated in regions across the tibial plateau, femoral condyles, and femoral cartilage adjacent to the medial intercondylar notch. These measurements were compared between ACL-deficient and intact knees. Differences in cartilage thickness and strain between knees were tested with multiple analysis of variance models with alpha set at P < .05. RESULTS Compressive strain in the intercondylar notch was elevated in the ACL-deficient knee relative to the uninjured knee. Furthermore, cartilage in the intercondylar notch and adjacent medial tibia was significantly thinner before activity in the ACL-deficient knee versus the intact knee. In these 2 regions, thinning was significantly influenced by time since injury, with patients with more chronic ACL deficiency (>1 year since injury) experiencing greater thinning. CONCLUSION Among patients with ACL deficiency, the medial femoral condyle adjacent to the intercondylar notch in the ACL-deficient knee exhibited elevated cartilage strain and loss of cartilage thickness, particularly with longer time from injury. It is hypothesized that these changes may be related to posttraumatic osteoarthritis development. CLINICAL RELEVANCE This study suggests that altered mechanical loading is related to localized cartilage thinning after ACL injury.
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Affiliation(s)
- E. Grant Sutter
- Department of Orthopaedic Surgery, Duke University, Durham,
NC
| | - Betty Liu
- Department of Biomedical Engineering, Duke University,
Durham, NC
| | | | | | | | | | - Zoë A. Englander
- Department of Biomedical Engineering, Duke University,
Durham, NC
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University, Durham,
NC
| | | | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham,
NC,Department of Biomedical Engineering, Duke University,
Durham, NC,Department of Mechanical Engineering and Materials Science,
Duke University, Durham, NC
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Englander ZA, Martin JT, Ganapathy PK, Garrett WE, DeFrate LE. Automatic registration of MRI-based joint models to high-speed biplanar radiographs for precise quantification of in vivo anterior cruciate ligament deformation during gait. J Biomech 2018; 81:36-44. [PMID: 30249338 PMCID: PMC6434938 DOI: 10.1016/j.jbiomech.2018.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/04/2018] [Accepted: 09/08/2018] [Indexed: 11/25/2022]
Abstract
Understanding in vivo joint mechanics during dynamic activity is crucial for revealing mechanisms of injury and disease development. To this end, laboratories have utilized computed tomography (CT) to create 3-dimensional (3D) models of bone, which are then registered to high-speed biplanar radiographic data captured during movement in order to measure in vivo joint kinematics. In the present study, we describe a system for measuring dynamic joint mechanics using 3D surface models of the joint created from magnetic resonance imaging (MRI) registered to high-speed biplanar radiographs using a novel automatic registration algorithm. The use of MRI allows for modeling of both bony and soft tissue structures. Specifically, the attachment site footprints of the anterior cruciate ligament (ACL) on the femur and tibia can be modeled, allowing for measurement of dynamic ACL deformation. In the present study, we demonstrate the precision of this system by tracking the motion of a cadaveric porcine knee joint. We then utilize this system to quantify in vivo ACL deformation during gait in four healthy volunteers.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - John T Martin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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47
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Hewett TE, Schilaty ND. Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises: Letter to the Editor. Am J Sports Med 2018; 46:NP47-NP48. [PMID: 30169142 DOI: 10.1177/0363546518788319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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48
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Owusu-Akyaw KA, Kim SY, Spritzer CE, Collins AT, Englander ZA, Utturkar GM, Garrett WE, DeFrate LE. Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises: Response. Am J Sports Med 2018; 46:NP48-NP51. [PMID: 30169145 DOI: 10.1177/0363546518788316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fox AS, Bonacci J, Saunders N. The relationship between performance of a single-leg squat and leap landing task: moving towards a netball-specific anterior cruciate ligament (ACL) injury risk screening method. Sports Biomech 2018; 19:493-509. [DOI: 10.1080/14763141.2018.1498535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aaron S. Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Lower-Extremity Kinematics Differed Between a Controlled Drop-Jump and Volleyball-Takeoffs. J Appl Biomech 2018; 34:327-335. [DOI: 10.1123/jab.2017-0286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies utilizing jump-landing biomechanics to predict anterior cruciate ligament injuries have shown inconsistent findings. The purpose of this study was to quantify the differences and correlations in jump-landing kinematics between a drop-jump, a controlled volleyball-takeoff, and a simulated-game volleyball-takeoff. Seventeen female volleyball players performed these 3 tasks on a volleyball court, while 3-dimensional kinematic data were collected by 3 calibrated camcorders. Participants demonstrated significantly increased jump height, shorter stance time, increased time differences in initial contact between 2 feet, increased knee and hip flexion at initial contact and decreased peak knee and hip flexion for both left and right legs, and decreased knee–ankle distance ratio at the lowest height of midhip for the 2 volleyball-takeoffs compared with the drop-jump (P < .05, Cohen’s dz ≥ 0.8). Significant correlations were observed for all variables between the 2 volleyball-takeoffs (P < .05, ρ ≥ .6) but were not observed for most variables between the drop-jump and 2 volleyball-takeoffs. Controlled drop-jump kinematics may not represent jump-landing kinematics exhibited during volleyball competition. Jump-landing mechanics during sports-specific tasks may better represent those exhibited during sports competition and their associated risk of anterior cruciate ligament injury compared with the drop-jump.
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