External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings

Bates, Nathaniel A.; Jaramillo, María Clara Mejía; Vargas, Manuela; McPherson, April L.; Schilaty, Nathan D.; Krych, Aaron J.; Hewett, Timothy E.

doi:10.1016/j.clinbiomech.2018.11.010

Cited by 22 publications

(15 citation statements)

References 66 publications

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“…This imbalance between tibial plateaus may load the ACL by producing an anterior shift of the tibial compressive load. 22 But, in contradiction to recent work of in vitro simulation of unloaded landings, 2 the final model predicted that each 1°increase in CTS reduced anterior tibial shear force by 0.06 N per body weight. Future work is needed to determine (1) if a relatively flat CTS produces an anterior shift of the tibial compressive load during landing whereas a steep CTS causes the compressive load to create out-of-plane knee motions associated with valgus collapse and (2) whether these relationships are exaggerated during weighted landings.…”

Section: Discussioncontrasting

confidence: 68%

Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load

et al. 2020

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Background: Anterior cruciate ligament (ACL) injury is a military occupational hazard that may be attributed to an individual’s knee biomechanics and joint anatomy. This study sought to determine if greater flexion when landing with load resulted in knee biomechanics thought to decrease ACL injury risk and whether knee biomechanics during landing relate to knee anatomic metrics. Hypothesis: Anatomic metrics regarding the slope and concavity of the tibial plateau will exhibit a significant relation to the increased anterior shear force on the knee and decreased knee flexion posture during landing with body-borne load. Study Design: Descriptive laboratory study. Methods: Twenty male military personnel completed a drop landing task with 3 load conditions: light (~6 kg), medium (15% body weight), and heavy (30% body weight). Participants were divided into groups based on knee flexion exhibited when landing with the heavy load (high- and low-Δflexion). Tibial slopes and depth were measured on weightbearing volumetric images of the knee obtained with a prototype cone beam computed tomography system. Knee biomechanics were submitted to a linear mixed model to evaluate the effect of landing group and load, with the anatomic metrics considered covariates. Results: Load increased peak proximal anterior tibial shear force ( P = .034), knee flexion angle ( P = .024), and moment ( P = .001) during landing. Only the high flexion group increased knee flexion ( P < .001) during weighted landings with medium and heavy loads. The low flexion group used greater knee abduction angle ( P = .030) and peak proximal anterior tibial shear force ( P = .034) when landing with load. Anatomic metrics did not differ between groups, but ratio of medial-to-lateral tibial slope and medial tibial depth predicted peak proximal anterior tibial shear force ( P = .009) and knee flexion ( P = .034) during landing, respectively. Conclusion: Increasing knee flexion is an attainable strategy to mitigate risk of ACL injury, but certain individuals may be predisposed to knee forces and biomechanics that load the ACL during weighted landings. Clinical Relevance: The ability to screen individuals for anatomic metrics that predict knee flexion may identify soldiers and athletes who require additional training to mitigate the risk of lower extremity injury.

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Section: Discussioncontrasting

confidence: 68%

Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load

et al. 2020

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“…The subsequent KAM, ATS, and ITR kinetic data from these DVJ tasks were subdivided into relative risk levels as indicated by existing literature. 8 , 13 – 15 These in vivo–based external loads were individually randomized by risk level and applied to the joint immediately before the delivery of an impulse force to the sole of the foot. After this paradigm, each specimen went through repeated-measures testing that consisted of 26 simulations, each with a unique profile of external knee kinetics.…”

Section: Methodsmentioning

confidence: 99%

Prospective Frontal Plane Angles Used to Predict ACL Strain and Identify Those at High Risk for Sports-Related ACL Injury

Bates

Myer

Hale

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Knee abduction moment during landing has been associated with anterior cruciate ligament (ACL) injury. However, accurately capturing this measurement is expensive and technically rigorous. Less complex variables that lend themselves to easier clinical integration are desirable. Purpose: To corroborate in vitro cadaveric simulation and in vivo knee abduction angles from landing tasks to allow for estimation of ACL strain in live participants during a landing task. Study Design: Descriptive laboratory study. Methods: A total of 205 female high school athletes previously underwent prospective 3-dimensional motion analysis and subsequent injury tracking. Differences in knee abduction angle between those who went on to develop ACL injury and healthy controls were assessed using Student t tests and receiver operating characteristic analysis. A total of 11 cadaveric specimens underwent mechanical impact simulation while instrumented to record ACL strain and knee abduction angle. Pearson correlation coefficients were calculated between these variables. The resultant linear regression model was used to estimate ACL strain in the 205 high school athletes based on their knee abduction angles. Results: Knee abduction angle was greater for athletes who went on to develop injury than for healthy controls ( P < .01). Knee abduction angle at initial contact predicted ACL injury status with 78% sensitivity and 83% specificity, with a threshold of 4.6° of knee abduction. ACL strain was significantly correlated with knee abduction angle during cadaveric simulation ( P < .01). Subsequent estimates of peak ACL strain in the high school athletes were greater for those who went on to injury (7.7-8.1% ± 1.5%) than for healthy controls (4.1-4.5% ± 3.6%) ( P < .01). Conclusion: Knee abduction angle exhibited comparable reliability with knee abduction moment for ACL injury risk identification. Cadaveric simulation data can be extrapolated to estimate in vivo ACL strain. Athletes who went on to ACL injury exhibited greater knee abduction and greater ACL strain than did healthy controls during landing. Clinical Relevance: These important associations between the in vivo and cadaveric environments allow clinicians to estimate peak ACL strain from observed knee abduction angles. Neuromuscular control of knee abduction angle during dynamic tasks is imperative for knee joint health. The present associations are an important step toward the establishment of a minimal clinically important difference value for ACL strain during landing.

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“…The present study did not examine the effect of PTS angle on knee biomechanics. The effect of PTS angle on biomechanics has been studied using cadaveric knees and computer simulations, 18 , 24 , 25 and there are many unknown aspects of the relationship between biomechanics and PTS angles in living subjects that need to be examined in the future.…”

Section: Discussionmentioning

confidence: 99%

Difference in sex and the effect of a dominant lower extremity in the posterior tibial slope angle in healthy Japanese subjects

Endo

Takemura

Monma

et al. 2021

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Background/objective Anterior cruciate ligament injuries are prone to re-injury, and it is crucial to prevent the primary injury. One of the anatomical risk factors for anterior cruciate ligament injury is the posterior tibial slope angle. Investigating the characteristics of healthy individuals with respect to the posterior tibial slope angle is important to elucidate the risk of developing anterior cruciate ligament injuries. The purpose of this study was to determine the characteristics related to sex and of the posterior tibial slope angle in healthy Japanese subjects, and the effect of the dominant lower extremity. Methods Sixty-two knees of 31 healthy Japanese college students (15 males and 16 females) were included in this study. Magnetic resonance images of both knee joints of the subjects were measured using a 0.3 T scanner. The medial and lateral posterior tibial slope angles were measured from the obtained magnetic resonance images. Magnetic resonance images of the knee joint of the dominant lower extremity were used to compare differences in sexes between the medial and lateral posterior tibial slope angles. Bilateral knee joint magnetic resonance images were used to compare the dominant and non-dominant lower extremities. Independent t-tests were used to compare the differences regarding sex in the medial and lateral posterior tibial slope angles and to compare the dominant and non-dominant lower extremities. Results A comparison of the mean lateral posterior tibial slope angle showed that males had a 8.8 ± 1.7° angle, while females had a 10.3 ± 2.2° angle, which was significantly greater (p = 0.047). There was no significant difference comparing the posterior tibial slope angle between the dominant and non-dominant lower extremities (p = 0.430). Conclusions From the result of this study, the lateral posterior tibial slope angle was significantly higher in the female group than in the male group. However, both the medial and lateral posterior tibial slope angles were found to be unaffected by the dominant lower extremity.

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External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings

Cited by 22 publications

References 66 publications

Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load

Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load

Prospective Frontal Plane Angles Used to Predict ACL Strain and Identify Those at High Risk for Sports-Related ACL Injury

Difference in sex and the effect of a dominant lower extremity in the posterior tibial slope angle in healthy Japanese subjects

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