Model Prediction of Anterior Cruciate Ligament Force during Drop-Landings

Pflum, Mary A.; Shelburne, Kevin B.; Torry, Michael R.; Decker, Michael J.; Pandy, Marcus G.

doi:10.1249/01.mss.0000145467.79916.46

Cited by 177 publications

(215 citation statements)

References 31 publications

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“…A large posterior tibial slope for example, viewed to occur more frequently in women (Brandon et al, 2006), will likely promote increases in anteriorly directed tibial loads, and further orient the ACL such that a greater portion of this load is transferred along the ligament (Li et al, 2006;Petersen and Zantop, 2007). Expanding cur rent models to incorporate an anatomically relevant knee joint (Pflum et al, 2004;Shelburne et al, 2004) capable of accommodating subject-based variations in knee anato mies and laxities would provide immediate insights into individual predispositions to ACL injury based on joint and tissue biomechanical vulnerabilities.…”

Section: Discussionmentioning

confidence: 99%

Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods

McLean¹,

Huang²,

Bogert³

2008

Clinical Biomechanics

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Section: Discussionmentioning

confidence: 99%

Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods

McLean¹,

Huang²,

Bogert³

2008

Clinical Biomechanics

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“…Furthermore, the direction of peak GRF relative to the tibia in the sagittal plane has been reported to substantially affect the amount of net proximal tibial anterior shear forces immediately after the foot contact of landing. 11,12 In their video analysis, Krosshaug et al 15 estimated that noncontact ACL injuries occurred approximately 40 milliseconds after foot contact during landing or cutting, which closely corresponds to the time to peak GRF during single-legged landing. 16 The results of these studies collectively have indicated that sagittal-plane mechanics, including GRF direction and magnitude and sagittal-plane knee kinetics and kinematics, may greatly affect the direction and magnitude of peak tibiofemoral forces, influencing ACL loading immediately after foot contact during sharp decelerating motions.…”

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confidence: 99%

“…4,8 Proximal tibial anterior shear forces are thought to be the primary cause of ACL injury because they directly load the ACL, especially at shallow knee-flexion angles. 3,9 Investigators [10][11][12] have shown that the ground reaction forces (GRFs) that athletes incur right after foot contact in sharp decelerating motions greatly affect the magnitude of proximal tibial anterior shear forces and ACL loading. Authors 13,14 of in vivo studies who measured the amount of ACL strain during landing tasks demonstrated that the timing of peak ACL strain coincides with the peak GRF that occurs immediately after the foot contact of landing.…”

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confidence: 99%

“…Given that GRFs are the largest external forces on the body, particularly immediately after foot contact, researchers 18 have implied that incurring a large GRF that is parallel to the longitudinal axis of the tibia increases the risk of ACL injuries. However, during normal double-legged landing, authors 11,20 of simulation studies reported that GRFs were directed posteriorly to the tibia, and these deceleration forces pushed the tibia posteriorly and reduced the ACL strain. Overall, ACL injury is most likely to occur when one incurs excessive GRFs that are directed parallel or more anteriorly inclined relative to the tibia immediately after the foot contact of landing, whereas small GRFs that are posteriorly inclined relative to the tibia should protect against ACL injury.…”

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confidence: 99%

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Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

Shimokochi

Ambegaonkar

Meyer

2016

Journal of Athletic Training

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Context: Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown.Objective: To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing.Design: Crossover study. Setting: Laboratory.Patients or Other Participants: Twenty recreationally active participants (age ¼ 23.4 6 3.6 years, height ¼ 171.0 6 9.4 cm, mass ¼ 73.3 6 12.7 kg).Intervention(s): Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded.Main Outcome Measure(s): Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces.Results: The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles.Conclusions: Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of singlelegged landing. Therefore, improving sagittal-plane landing mechanics is important in reducing harmful magnitudes and directions of impact forces on the anterior cruciate ligament.Key Words: anterior cruciate ligament, tibial posterior slope, lower extremity biomechanics, injury prevention, landing strategy Key PointsAt the impact phase of single-legged landing, sagittal-plane kinetics and kinematics of body segments were strongly related, affecting both the magnitude and direction of the ground reaction force (GRF) and tibiofemoral forces relative to the tibia and anterior cruciate ligament injury risk. A longer time to peak GRF in single-legged landing on the toes with the body leaning forward allowed greater knee flexion, anterior tibial inclination, and shock attenuation, leading to a reduced magnitude of GRF that was more posteriorly inclined relative to the tibia and smaller tibial axial forces and posteriorly directed tibial shear forces. A shorter time to peak GRF during flat-footed landing with the body upright led to less knee flexion, anterior tibial inclination, and s...

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“…[5][6][7] Recently, computer simulations of ACL loading mechanisms have enhanced our understanding of the loading combination most likely to facilitate an ACL injury mechanism. [8][9][10][11][12][13] Even though cadaver-based and computer-simulation-based research has greatly improved our understanding of ACL injury mechanisms, this research does not identify prospective risk factors. Thus, we still have a very limited understanding of prospective risk factors for ACL injury because injury mechanisms and prospective risk factors, although related, are not identical.…”

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confidence: 99%

Executing a Collaborative Prospective Risk-Factor Study: Findings, Successes, and Challenges

Padua

2010

Journal of Athletic Training

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M oderate evidence 1 demonstrates that injury-prevention training programs can substantially reduce the risk of anterior cruciate ligament (ACL) injury in athletes. Yet the current literature [2][3][4] contains both positive and negative results for ACL injury prevention. Researchers must identify the prospective risk factors for noncontact/indirect-contact ACL injury to ultimately improve the effectiveness of existing ACL injury-prevention programs. PROSPECTIVE RISK FACTORS VERSUS MECHANISMS OF INJURYA critical distinction needs to be made when describing prospective risk factors for ACL injury. This involves differentiating between ACL injury mechanisms and prospective risk factors. An ACL injury mechanism can be defined as the combinations of joint forces, moments, and movements that cause failure of the ACL and occur at the time of injury. However, ACL injury prospective risk factors are variables that are useful for screening purposes. Also, prospective risk factors for ACL injury are not necessarily the same as mechanisms of ACL injury or loading. Prospective risk factors are variables that can be identified years before an ACL injury mechanism is experienced. Therefore, prospective risk factors for ACL injury can be defined as those variables (eg, signature movement patterns, age, sex, injury history) that identify individuals who will later experience an ACL injury mechanism.Risk factors and injury mechanisms are related in 2 ways. First, risk factors may work in a synergistic manner to raise the probability that a certain individual is exposed to high-risk biomechanical forces that create injury mechanisms. For example, knee laxity and poor neuromuscular control of the hamstrings muscles are independent risk factors that might interact to increase the probability of an injury mechanism occurring. Second, risk factors might be ''proxies'' or ''markers'' for unknown factors that predispose an individual to injury mechanisms; for example, sex may be a proxy for poor neuromuscular control in high school-aged athletes.Improving our understanding of mechanisms for ACL injury has been accomplished through cadaver-based and computer-simulation research. Cadaver-based research has provided insight into how internal and external loads at the knee may facilitate stress and strain on the ACL. [5][6][7] Recently, computer simulations of ACL loading mechanisms have enhanced our understanding of the loading combination most likely to facilitate an ACL injury mechanism. 8-13 Even though cadaver-based and computer-simulation-based research has greatly improved our understanding of ACL injury mechanisms, this research does not identify prospective risk factors. Thus, we still have a very limited understanding of prospective risk factors for ACL injury because injury mechanisms and prospective risk factors, although related, are not identical.The prospective cohort design is considered the strongest method for identifying prospective risk factors for ACL injury. 14 This design requires testing of participants before they ...

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Model Prediction of Anterior Cruciate Ligament Force during Drop-Landings

Abstract: The pattern of ACL force in drop-landing cannot be explained by the anterior pull of the quadriceps force alone.

Cited by 177 publications

References 31 publications

Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods

Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

Executing a Collaborative Prospective Risk-Factor Study: Findings, Successes, and Challenges

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