Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes A Prospective Study

Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Molecular Cardiovascular Biology, Cincinatti Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 05/2005; 33(4):492-501. DOI: 10.1177/0363546504269591
Source: PubMed


Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.
Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.
Cohort study; Level of evidence, 2.
There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament.
Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001) and 20% higher ground reaction force (P<.05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88.
Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes.
Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.

Download full-text


Available from: Paul Succop, Mar 11, 2014
132 Reads
  • Source
    • "The knee and hip mechanics most often associated with dynamic valgus include increased knee abduction, knee external rotation, hip adduction, and hip internal rotation (Fox et al., 2014). Based on prospective studies, however, knee abduction parameters appear most predictive of pathology (Hewett et al., 2005; Myer et al., 2015). Indeed, analyses of two large prospective landing data sets were recently conducted, looking for shared biomechanical risk factors for both ACL and PFP injury (Myer et al., 2015). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Dynamic knee valgus in females has been associated with various knee pathologies. Abnormal 3D hip and knee kinematics contribute prominently to this presentation, and these may become more aberrant with more demanding tasks. Underlying genu valgus may also accentuate such kinematics, but this effect has never been tested. Therefore, the purpose of this study was to compare 3D hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgus malalignment. We expected abnormal kinematics to become more evident in the valgus subjects as task demands increased. Methods: Eighteen healthy females with genu valgum and 18 female controls with normal alignment underwent 3D motion analysis while performing walking, running, and single-limb drop-landing trials. Sagittal, frontal, and transverse plane hip and knee kinematics were compared between groups across tasks using analyses of variance and between-group effect sizes. Findings: Group differences did not generally increase with higher forces. The valgus females demonstrated decreased hip flexion (ES=0.72-0.88) and increased knee abduction (ES=0.87-1.47) across the tasks. During running and single-limb drop landing, they showed increased knee external rotation (ES=0.69-0.73). Finally, during walking, the valgus females showed increased hip adduction (ES=0.69). Interpretation: These results suggest that females with genu valgus alignment utilize aberrant hip and knee mechanics previously associated with dynamic valgus in the literature, but that these pathomechanics do not generally worsen with rising task demands. Healthy females that present with genu valgus may be natively at elevated risk for knee pathology.
    Clinical biomechanics (Bristol, Avon) 10/2015; DOI:10.1016/j.clinbiomech.2015.10.008 · 1.97 Impact Factor
  • Source
    • "However, to-date it remains unclear how accurately one can estimate joint coordinates relative to the anatomically-correct joint positions. Motion capture systems can provide quantitative biomechanical measurements that link to risk of injury in professional athletes [3]. Specifically, computer vision offers a platform that can address some of the noted limitations of current movement assessment methods. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Motion capture systems can be used to infer skeletal joints from three-dimensional surface information for various human poses. However, to-date it remains unclear how well the estimated joint coordinates coincide with the anatomically-correct joint positions. The aim of this study was to determine the localization accuracy and localization precision of inferred joint positions using Magnetic Resonance Imaging (MRI). Color and depth information (RGB-D), and skeletal information of an athlete in static pose standing upright were acquired. A whole-body 3D tomographic scan was also recorded using a 3T MRI scanner. The deviation of the joint location was the largest for the left upper leg (4.1cm±0.2cm) and the smallest for the lower arms (0.2cm±0.01cm). The mean surface point distance averaged 2.2cm±1.3cm (left upper leg), 1.8cm±1.3cm (left lower arm), and 1.5cm±1.0cm (right lower arm). To our knowledge, this is the first attempt to use MRI as a gold standard to validate skeletal joint locations of a motion capture system. MRI provides a suitable means to validate skeletal joint localization for any motion capture system (markerless and marker based). However, advanced software solutions are required to validate and correct KinectTM skeletal joint localization in the future.
    6th International Conference on 3D Body Scanning Technologies, Lugano, Switzerland; 10/2015
    • "On the other hand, there has been a lot of debate with respect to the relationship between PFP and dynamic variables (Powers, 2003, 2010). Excessive peak knee valgus has been shown to be related to diminished hip muscle strength (Claiborne et al., 2006) and has been implicated in contributing to numerous knee injuries, including anterior cruciate ligament (ACL) injury (Hewett et al., 2005) and patellofemoral joint dysfunction (Powers, 2003). As we expected, the DKV demonstrated differences between groups with a large effect size (η 2 = 0.19) and a great part of the variance was explained by this model (F (1,52) = 10.59). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. Method: Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. Findings: Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. Interpretation: Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.
    Clinical biomechanics (Bristol, Avon) 09/2015; DOI:10.1016/j.clinbiomech.2015.09.002 · 1.97 Impact Factor
Show more