Lessons learned from the last 20 years of ACL-related in vivo-biomechanics research of the knee joint

Abstract

As a result of biomechanical research, clinicians have a better understanding of ACL injury aetiology, prevention and rehabilitation. Athletes exhibiting neuromuscular deficits predisposing them to ACL injury can be identified and enrolled into prevention programmes. Clinicians should assess ACL-reconstructed patients for excessive internal tibial rotation that may lead to poor outcomes.

Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis

“…A recent cadaveric study demonstrated agreement with the proposed injury mechanism reported from ‘in vivo’ studies; increased knee valgus and anterior tibial translation (and to a lesser extent internal tibial rotation) increase ACL strain 9. Finally, biomechanical laboratory studies have contributed to the current understanding of ACL injury factors as described in a recent literature review of the past 20 years 21. In addition to the prospective coupled biomechanical-epidemiological study discussed above,10 studies have compared the biomechanics of athletes at high risk for ACL injury to those at low risk finding that female athletes, compared to males, perform athletic tasks with patterns consistent with the ligament dominance theory 22…”

Gender difference in lower limb muscle activity during landing and rapid change of direction

“…However, if the shear load exerted by the quadriceps is greater than the shear load exerted by the hamstrings, a resultant anteriorly directed shear force may be exerted on the proximal end of the tibia, which will potentially cause anterior tibial translation and therefore is likely to increase ACL strain [24,25]. This is known as quadriceps dominance, defined as a preferential activation of the quadriceps compared to the hamstrings when providing dynamic stability of the knee joint [26], which a number of studies have found to be greater in females than males during activities associated with ACL injury [17,[27][28][29][30][31].…”

Comparison of Strength and Endurance between Open and Closed Kinematic Chain Exercises after Anterior Cruciate Ligament Reconstruction: Randomized Control Trial

“…An ACL injury typically occurs during the landing portion of a jump in ordinary sports activities and has a greater incidence in women than in men 1,2) . ACL deficiency may lead to degenerative changes such as tears of the meniscus.…”