Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies

Abstract

Background: To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. Methods: Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. Results: Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff:-1.68, 95%CI: − 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff:-2.17, 95%CI: − 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff:-3.25, 95%CI: − 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff::-0.19, 95%CI: − 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI:-26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. Conclusion: Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.

Kiss goodbye to the ‘kissing knees’: no association between frontal plane inward knee motion and risk of future non-contact ACL injury in elite female athletes

“…Although we included an overhead target for the VDJ test, the result did not deviate from the recent meta-analysis of Cronström et al (2020). We found only minor, nonsignificant, differences in group means, and all effect sizes were smaller than 0.3, suggesting that even if we would have identified statistically significant differences, these would likely be of minor importance.…”

“…Several prospective cohort studies have investigated whether a vertical drop jump (VDJ) can be used for screening purposes. Although a recent meta-analysis (Cronström et al, 2020) documents that frontal plane kinematics cannot be used to screen for ACL injury risk, it is worth noting that the initial study identifying knee valgus as a risk factor included an overhead target (Hewett et al, 2005), whereas later studies that failed to identify the same factors have not (Krosshaug et al, 2016;Leppanen et al, 2017;Smith et al, 2012). A previous study comparing vertical drop jumps with and without an overhead target concluded that using an overhead target can improve jump height and significantly alter knee biomechanics (Mok et al, 2017).…”

A Statistical Model for Prediction of Lower Limb Injury of Active Sportsperson

“…And this result also supports the finding of the present study. Many research evidence suggested the difference of knee kinematics between healthy and injured subjects and highlighted the importance of medical application of knee joint kinematics to classify injury among different populations [30,31] however, the association between altered knee kinematics and lower limb injury seems to be conflicting according to Cronström et al [32]. The result of the comparative descriptive statistics about toe out angle is supported by the results of Rosenbaum [33] and Simpson & Jiang [34].…”

Machine Learning-Based Estimation of Ground Reaction Forces and Knee Joint Kinetics from Inertial Sensors While Performing a Vertical Drop Jump

“…The VDJ is usually part of a training program to enhance performance and neuromuscular readiness, and it has been widely used as clinical test for injury-risk screening purpose for Anterior Cruciate Ligament (ACL) non-contact injury assessment and evaluation of training interventions [1,[3][4][5], while the evidence of its capability of predicting future injuries is still scarce [6][7][8][9][10][11].…”