Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict?

Abstract

Background Most cutting biomechanical studies investigate performance and knee joint load determinants independently. This is surprising because cutting is an important action linked to performance and non-contact anterior cruciate ligament (ACL) injuries. The aim of this study was to investigate the relationship between cutting biomechanics and cutting performance (completion time, ground contact time [GCT], exit velocity) and surrogates of non-contact ACL injury risk (knee abduction [KAM] and internal rotation [KIRM] moments) during 90° cutting. Design Mixed, cross-sectional study following an associative design. 61 males from multidirectional sports performed six 90° pre-planned cutting trials, whereby lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional (3D) motion and ground reaction force analysis over the penultimate (PFC) and final foot contact (FFC). Pearson’s and Spearman’s correlations were used to explore the relationships between biomechanical variables and cutting performance and injury risk variables. Stepwise regression analysis was also performed. Results Faster cutting performance was associated (p ≤ 0.05) with greater centre of mass (COM) velocities at key instances of the cut (r or ρ = 0.533–0.752), greater peak and mean propulsive forces (r or ρ = 0.449–0.651), shorter FFC GCTs (r or ρ = 0.569–0.581), greater FFC and PFC braking forces (r = 0.430–0.551), smaller hip and knee flexion range of motion (r or ρ = 0.406–0.670), greater knee flexion moments (KFMs) (r = 0.482), and greater internal foot progression angles (r = − 0.411). Stepwise multiple regression analysis revealed that exit velocity, peak resultant propulsive force, PFC mean horizontal braking force, and initial foot progression angle together could explain 64% (r = 0.801, adjusted 61.6%, p = 0.048) of the variation in completion time. Greater peak KAMs were associated with greater COM velocities at key instances of the cut (r or ρ = − 0.491 to − 0.551), greater peak knee abduction angles (KAA) (r = − 0.468), and greater FFC braking forces (r = 0.434–0.497). Incidentally, faster completion times were associated with greater peak KAMs (r = − 0.412) and KIRMs (r = 0.539). Stepwise multiple regression analysis revealed that FFC mean vertical braking force and peak KAA together could explain 43% (r = 0.652, adjusted 40.6%, p < 0.001) of the variation peak KAM. Conclusion Techniques and mechanics associated with faster cutting (i.e. faster COM velocities, greater FFC braking forces in short GCTs, greater KFMs, smaller hip and knee flexion, and greater internal foot progression angles) are in direct conflict with safer cutting mechanics (i.e. reduced knee joint loading, thus ACL injury risk), and support the “performance-injury conflict” concept during cutting. Practitioners should be conscious of this conflict when instructing cutting techniques to optimise performance while minimising knee joint loading, and should, therefore, ensure that their athletes have the physical capacity (i.e. neuromuscular control, co-contraction, and rapid force production) to tolerate and support the knee joint loading during cutting.

Biomechanical and Neuromuscular Performance Requirements of Horizontal Deceleration: A Review with Implications for Random Intermittent Multi-Directional Sports

“…both feet in contact with the ground). Accordingly, an ability to produce greater deceleration in the steps prior to severe COD manoeuvres could be a deceleration strategy that not only enhances COD performance [21,22,62], but also reduces knee joint loads, which in turn could reduce ACL injury risk factors as they are commonly associated with turning during the final foot contact of COD manoeuvres [63][64][65][66][67].…”

Alternatives to common approaches for training change of direction performance: a scoping review

“…Variables strongly associated with a faster change of direction time included greater centre of mass velocity at final foot contact (r = – 0.75) and exit from the direction change (r = – 0.73) [ 21 ], angle of resultant peak force (r = – 0.77) [ 22 ], mean (r = 0.77) and peak (r = 0.74) horizontal to vertical propulsive ground reaction force ratio at final foot contact [ 22 ], mean horizontal to vertical propulsive ground reaction force ratio at penultimate foot contact (r = 0.79) [ 22 ], shorter ground contact time at final foot contact (r = 0.75) [ 20 ], eccentric knee extensor moment (r = – 0.75) [ 34 ], and maximum ankle power (r = 0.77) [ 40 ]. Variables moderately associated with change of direction performance included mean and/or peak horizontal propulsive force (r = 0.54 to 0.61) [ 20 – 22 ], shorter ground contact time (r = 0.53 to 0.65) [ 21 , 40 , 50 ], ankle plantar flexor moment (r = 0.45 to 0.65) [ 30 , 40 ] and knee flexor moment (r = – 0.54 to 0.51) [ 34 , 41 ]. Several other variables were moderately related to change of direction performance, but only in one study (Table 1 ).…”

A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading

“…The performance-injury conflict is largely debated in the sports medicine community. A recent investigation by Dos’Santos et al highlighted that the most performant players adopt less safe biomechanical patterns in sport-specific movements [ 17 ]. The authors advocated the need for a broader consciousness on performance-injury conflict and for preventative screenings.…”