Influence of the trunk position on knee kinematics during the single-leg landing: implications for injury prevention

Variables Associated With Knee Valgus in Male Professional Soccer Players During a Single-Leg Vertical Landing Task

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was .43 during the landing phase (P = .04) and with peak hip internal rotation was -.68 (P < .001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r = .40, P = .05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test.

Predictive simulation of single-leg landing scenarios for ACL injury risk factors evaluation

The Anterior Cruciate Ligament (ACL) rupture is a very common knee injury during sport activities. Landing after jump is one of the most prominent human body movements that can lead to such an injury. The landing-related ACL injury risk factors have been in the spotlight of research interest. Over the years, researchers and clinicians acquire knowledge about human movement during daily-life activities by organizing complex in vivo studies that feature high complexity, costs and technical and most importantly physical challenges. In an attempt to overcome these limitations, this paper introduces a computational modeling and simulation pipeline that aims to predict and identify key parameters of interest that are related to ACL injury during single-leg landings. We examined the following conditions: a) landing height, b) hip internal and external rotation, c) lumbar forward and backward leaning, d) lumbar medial and lateral bending, e) muscle forces permutations and f) effort goal weight. Identified on related research studies, we evaluated the following risk factors: vertical Ground Reaction Force (vGRF), knee joint Anterior force (AF), Medial force (MF), Compressive force (CF), Abduction moment (AbdM), Internal rotation moment (IRM), quadricep and hamstring muscle forces and Quadriceps/Hamstrings force ratio (Q/H force ratio). Our study clearly demonstrated that ACL injury is a rather complicated mechanism with many associated risk factors which are evidently correlated. Nevertheless, the results were mostly in agreement with other research studies regarding the ACL risk factors. The presented pipeline showcased promising potential of predictive simulations to evaluate different aspects of complicated phenomena, such as the ACL injury.

Effect of combining eight weeks of neuromuscular training with dual cognitive tasks on landing mechanics in futsal players with knee ligament dominance defect: a randomized controlled trial

Background

The performing of jump and landing in futsal simultaneous with divided attention is one of the most common mechanisms of non-contact anterior cruciate ligament (ACL) injury. Neuromuscular training has effectively reduced the risk of ACL injury, but the effect of neurocognitive training has received less attention. This study investigated the effect of combining 8 weeks of neuromuscular training with dual cognitive tasks on the landing mechanics of futsal players with knee ligament dominance defects.

Methods

Thirty male futsal players (mean ± SD: age: 21.86 ± 3.27 years) with knee ligament dominance defects were purposefully identified by the tuck jump test and were randomly divided into the intervention and the control group. The intervention group performed dual task (DT) training for three weekly sessions for 8 weeks and 60 min each, while the control group only did activities of daily living. During the drop vertical jump test, 2D landing kinematics in two moments of initial contact (IC) and full flexion (FF) were assessed. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (α ≤ 0.05).

Results

A significant improvement was observed in the intervention group compared to the control group for the dynamic knee valgus at IC (F1,28 = 6.33; P = 0.02, ES = 0.31) and FF (F1,28 = 13.47; P = 0.003, ES = 0.49), knee flexion at IC (F1,28 = 20.08; P = 0.001, ES = 0.41) and FF (F1,28 = 13.67; P = 0.001, ES = 0.32), ankle dorsiflexion at IC (F1,28 = 37.17; P = 0.001, ES = 0.72) and FF (F1,28 = 14.52; P = 0.002, ES = 0.50), and trunk flexion at FF (F1,28 = 20.48; P = 0.001, ES = 0.59) angles. Changes in the trunk flexion at IC (F1,28 = 0.54; P = 0.47, ES = 0.03) and trunk lateral flexion at IC (F1,28 = 0.006; P = 0.93, ES = 0.00) and FF (F1,28 = 2.44; P = 0.141, ES = 0.148) angles were not statistically significant.

Conclusions

DT training compared to the control group improved landing mechanics in futsal players with knee ligament dominance defects.

Trial registration: Current Controlled Trials using the IRCT website with ID number IRCT20210602051477N1 prospectively registered on 20/06/2021.

Using a modified vector coding technique to describe the calcaneus-shank coupling relationship during unanticipated changes of direction: theoretical implications for prophylactic ACL strategies

Shank rotation is associated with increased risk in lower limb injuries of weight-bearing sport activity. Straight-line running injury prevention research proposes a 'bottom-up' approach to minimising injury risk to the knee. This prophylactic recommendation is due to the observed distal-proximal coupling relationship between rearfoot and shank rotations. However, the coupling relationship between the calcaneus and shank is unknown in sports with high intensity decelerations, frequent changes of direction, associated with increased anterior cruciate ligament (ACL) injury risk. The aim of this study was to determine whether the movement of the calcaneus has a potential effect on the internal and external rotational movement of the shank, associated with ACL injury risk. We implemented a modified vector coding technique using segmental velocities in a local, anatomical reference frame to quantify the coupling relationship between the individual tri-planar calcaneus rotations and transverse plane shank rotations. During the loading phase, a distal-proximal coupling relationship between calcaneus eversion deceleration, abduction acceleration, and shank internal rotation deceleration was observed amongst most subjects. The distal-proximal coupling found between the calcaneus and shank justifies exploring interventions geared towards manipulating calcaneus motion to affect shank rotational movements during unanticipated change of direction tasks associated with ACL injury risk.

Sex difference in frontal plane hip moment in response to lateral trunk obliquity during single-leg landing

BACKGROUND

Lateral trunk obliquity during landing is a characteristic of anterior cruciate ligament (ACL) injuries in female athletes and affects their knee and hip kinetics and kinematics. However, it is unclear whether these effects differ between females and males. The purpose of this study was to compare the effects of lateral trunk obliquity on knee and hip kinetics and kinematics in females and males during single-leg landing.

METHODS

Eighteen female (aged 22.1 ± 1.5 years) and 18 male participants (aged 21.8 ± 1.1 years) performed single-leg landings under two conditions: (1) without any instructions about trunk position (natural) and (2) with leaning their trunks laterally 15° from the vertical line (trunk obliquity). The kinetics and kinematics of their hip and knee were analyzed using a three-dimensional motion analysis with a force plate. Two-way repeated-measures ANOVA (sex × trunk obliquity) and Bonferroni pairwise comparisons were conducted.

RESULTS

The trunk obliquity angle at initial contact was significantly greater in the trunk-obliquity landing condition than in the natural landing condition (natural 4.0 ± 2.2°, trunk-obliquity 15.1 ± 3.6°, P < 0.001) with no sex difference (95% CI - 1.2 to 2.2°, P = 0.555). The peak knee abduction moment was significantly larger in the trunk-obliquity landing condition than in the natural landing condition (trunk-obliquity, 0.09 ± 0.07 Nm/kg/m; natural, 0.04 ± 0.06 Nm/kg/m; P < 0.001), though there was no sex or interaction effect. A significant interaction between sex and landing condition was found for the peak hip abduction moment (P = 0.021). Males showed a significantly larger peak hip abduction moment in the trunk-obliquity landing condition than in the natural landing condition (95% CI 0.05 to 0.13 Nm/kg/m, P < 0.001), while females showed no difference in the peak hip abduction moment between the two landing conditions (95% CI - 0.02 to 0.06 Nm/kg/m, P = 0.355).

CONCLUSIONS

The knee abduction moment increased with a laterally inclined trunk for both female and male participants, while the hip abduction moment increased in males but not in females. It may be beneficial for females to focus on frontal plane hip joint control under lateral trunk-obliquity conditions during single-leg landing.

Reliability and Repeatability of ACL Quick Check®: A Methodology for on Field Lower Limb Joint Kinematics and Kinetics Assessment in Sport Applications

Anterior cruciate ligament (ACL) lesion represents one of the most dramatic sport injuries. Even though clinical screenings aiming at identifying subjects at risk of injuries are gaining popularity, the use of sophisticated equipment still represents a barrier towards their widespread use. This study aimed to test both reliability and repeatability of a new methodology to assess lower limb joints kinematics and kinetics directly on field with the aid of video cameras and plantar pressure insoles. Ten athletes and one case study (post ACL surgery) were assessed in a gait laboratory, while performing double leg squats, through the simultaneous acquisition of stereophotogrammetry, force plates, commercial video cameras and plantar pressure insoles. Different sources of errors were investigated and both reliability and repeatability analysis performed. Minimum and maximum RMSE values of 0.74% (right knee joint center trajectory) and 64.51%, respectively (ankle dorsi-plantarflexion moment), were detected. Excellent to good correlation was found for the majority of the measures, even though very poor and inverse between-trials correlation was found on a restricted number of trials especially for the ankle dorsi-plantarflexion moment. These findings could be used in combination with already available screening tools in order to provide more repeatable results.

Effect of lumbopelvic control on landing mechanics and lower extremity muscles' activities in female professional athletes: implications for injury prevention

Background

Lumbopelvic control (LPC) has recently been associated with function, kinesiology, and load distribution on the limb. However, poor LPC has not been studied as a risk factor for lower limb injury in sports requiring frequent jump landings. The present study investigated the effects of LPC on landing mechanics and lower limb muscle activity in professional athletes engaged in sport requiring frequent landing.

Methods

This study was conducted on 34 professional female athletes aged 18.29 ± 3.29 years with the height and body mass of 173.5 ± 7.23 cm and 66.79 ± 13.37 kg, respectively. The landing error scoring system (LESS) and ImageJ software were used to assess landing mechanics. Wireless electromyography was also used to record the activity of the gluteus medius (GMed), rectus femoris, and semitendinosus. Lumbopelvic control was evaluated using the knee lift abdominal test, bent knee fall-out, active straight leg raising, and the PRONE test using a pressure biofeedback unit. Based on the LPC tests results, the participants were divided into two groups of proper LPC (n = 17) and poor LPC (n = 17).

Results

There were significant differences between the groups with proper and poor LPC in terms of the LESS test scores (P = 0.0001), lateral trunk flexion (P = 0.0001), knee abduction (P = 0.0001), knee flexion (P = 0.001), trunk flexion (P = 0.01), and GMed muscle activity (P = 0.03). There were no significant differences in the activity of the rectus femoris and semitendinosus muscles, and ankle dorsiflexion (P > 0.05).

Conclusions

Poor lumbopelvic control affects the kinematics and activity of the lower limb muscles, and may be a risk factor for lower limb injuries, especially of the knee.

Test-retest reliability of entire time-series data from hip, knee and ankle kinematics and kinetics during one-leg hops for distance: Analyses using integrated pointwise indices

Motion capture systems enable in-depth interpretations of human movements based on data from three-dimensional joint angles and moments. Such analyses carry important bearings for evaluation of movement control during for instance hop landings among sports-active individuals from a performance perspective but also in rehabilitation. Recent statistical development allows analysis of entire time-series of angle and moment during hops using functional data analysis, but the reliability of such multifaceted data is not established. We used integrated pointwise indices (intra-class correlation, ICC; standard error of measurement, SEM) to establish the test-retest reliability of three-dimensional hip, knee and ankle angle and moment curves during landings of one-leg hop for distance (OLHD) in 23 asymptomatic individuals aged 18-28. We contrasted these findings to reliability of discrete variables extracted at specific events (initial contact, peak value). We extended the calculations of ICC and SEM to handle unbalanced situations (varying number of repetitions) to include all available data. Hip and knee angle curves proved reliable with stable ICC curves throughout the landing, with integrated ICCs ≥ 0.71 for all planes except for knee internal/external rotation (ICC = 0.57). Hip and knee moment curves and ankle angle and moments were less reliable and less stable, particularly in the first ~ 10-25% of the landing (integrated ICCs 0.44-0.57). Curve data were generally not in agreement with the results for discrete event data, thus advocating analysis of curve data which contains more information. To conclude, hip and knee angle curve data during OLHD landings can reliably be evaluated, while moment curves necessitate careful consideration.

The influence of decision making and divided attention on lower limb biomechanics associated with anterior cruciate ligament injury: a narrative review

Cognitive loads have been shown to influence anterior cruciate ligament (ACL) injury risk. Two main sources of cognitive loads that athletes experience are decision making and dividing attention between multiple tasks. The aim of this paper was to review previous studies examining the effects of decision making and divided attention on lower limb biomechanics during landing and cutting. Previous research has shown decision making to significantly influence a number of biomechanical variables associated with increased risk of ACL injury, such as reduced knee flexion at initial contact, increased knee valgus angles, increased knee extension moment and increased knee valgus moment in decision-making tasks compared to pre-planned tasks. Furthermore, dividing attention between multiple tasks has been shown to result in reduced knee flexion at initial contact, increased vertical ground reaction force, and reduced stability during landing/cutting. The changes in lower limb biomechanics observed as a result of both decision making and dividing attention are likely due to a reduced ability to anticipate ground contact and implement protective movement patterns associated with reduced ACL loading. Collectively, these findings emphasise the need for tasks that incorporate decision making and divided attention when investigating ACL injury mechanisms and developing ACL injury risk screening assessments.

Side-hops challenge knee control in the frontal and transversal plane more than hops for distance or height among ACL-reconstructed individuals

We compared knee landing mechanics with presumed relation to risk of anterior cruciate ligament (ACL) injury among three single-leg hop tests and between legs in individuals with unilateral ACL reconstruction. Thirty-four participants (>10 months' post-surgery, 23 females) performed the standardised rebound side hop (SRSH), maximal hop for distance (OLHD) and maximal vertical hop (OLVH). We calculated the following knee outcomes from motion capture and force plate data: finite helical axis inclination angles (approximates knee robustness), frontal and transversal plane angles at initial contact, peak angles of abduction and internal rotation during landing, and peak external moments of flexion, abduction and internal rotation during landing. Repeated-measures MANOVA analysis ('sex' as covariate) confirmed that SRSH induced greater angles and moments, particularly in the frontal plane, compared to OLHD and OLVH. There was between-leg asymmetry for peak knee flexion moment for males during OLHD and OLVH, and for females during SRSH. Our results advocate the SRSH over OLHD and OLVH for assessment of knee landing control to screen for movement patterns potentially related to ACL injury risk. However, clear differences in both knee kinematics and kinetics between OLHD and SRSH motivate the use of both tests to evaluate different aspects of landing control.

Increased core stability is associated with reduced knee valgus during single-leg landing tasks: Investigating lumbar spine and hip joint rotational stiffness

Knee valgus during landing has been identified as a strong correlate of ACL injury. Inappropriate trunk control during landing contributes to high knee valgus, with neuromuscular factors related to core stability postulated as the mechanism. This investigation probed the influence of trunk and hip mechanics, including joint stiffness, on knee mechanics, particularly high knee valgus. Specifically, this study quantified lumbar spine and hip joint rotational stiffness (a proxy for mechanical joint stability) during single-leg landing tasks known to be associated with injury risk, particularly in females. Kinematics, kinetics, and 24 channels of electromyography spanning the trunk and hip musculature were measured in 18 healthy female participants. Anatomically detailed EMG-driven musculoskeletal models quantified lumbar spine and hip joint rotational stiffness. The links between peak knee abduction angle and moment with lumbar spine and hip joint rotational stiffness were measured. Hip joint rotational stiffness influenced knee abduction across tasks (correlation coefficient ranging from -0.48 to -0.70, p < 0.05) to reduce valgus deviation. Similarly, transverse plane hip joint rotational stiffness during landings reduced knee abduction moment (R = -0.50, P = 0.03; R = -0.49, P = 0.04), and lumbar spine joint rotational stiffness reduced knee abduction angle and moment but did not consistently reach statistical significance. The control system uses stiffness to control motion. This study demonstrates the importance of proximal (lumbar spine and hip) joint rotational stiffness (i.e. core control stability) during single-leg landing to prevent knee abduction motion. Instantaneous core stability is achieved with the coordinated activation and stiffness of both trunk and hip muscles.