Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms

Departments of Physiology and Cell Biology, Sports Medicine Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 04/2011; 39(8):1706-13. DOI: 10.1177/0363546511400980
Source: PubMed


Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/
(1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains.
Descriptive laboratory study.
Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons.
Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°.
The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations.
Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury.

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    • "stance) (Fleming et al., 2001) and when valgus knee moments are combined with anterior tibial translations, ACL strain is significantly elevated (Markolf et al., 1995; Withrow et al., 2006). These are similar to the loading patterns needed to increase ACL strain and/or reach injurious loading thresholds in-silico (McLean et al., 2004; McLean et al., 2008; Quatman et al., 2011; Shin et al., 2011). Reducing valgus knee loading during sport tasks like sidestepping is therefore considered an appropriate countermeasure to reduce ACL injury risk. "
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