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
115 Reads
  • Source
    • "Previous investigators have utilized landings and squats to assess lower extremity biomechanics associated with ACL loading and injury risks (Ali et al., 2013; Bell et al., 2013; Hewett et al., 2005; Lyle et al., 2014; Nguyen et al., 2011; Padua, 2012; Padua et al., 2012; Stensrud et al., 2011). In the current study, the differences and correlations for five biomechanical variables were identified during a single-leg landing, a single-leg squat, a double-leg landing, and a double-leg squat. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Landing and squat tasks have been utilized to assess lower extremity biomechanics associated with anterior cruciate ligament loading and injury risks. The purpose of this study was to identify the differences and correlations in knee and hip mechanics during a single-leg landing, a single-leg squat, a double-leg landing, and a double-leg squat. Seventeen male and 17 female recreational athletes performed landings and squats when kinematic and kinetic data were collected. ANOVAs showed significant differences (p < 0.00001) for maximum knee flexion angles, maximum hip flexion angles, maximum knee abduction angles, maximum hip adduction angles, and maximum external knee abduction moments among squats and landings. For maximum knee and hip flexion angles, significant correlations (r ≥ 0.5, p ≤ 0.003) were observed between the two landings and between the two squats. For maximum knee abduction and hip adduction angles and maximum external knee abduction moments, significant correlations were mostly found between the two landings, and between the single-leg squat and landings (r ≥ 0.54, p ≤ 0.001). Individuals are likely to demonstrate different profiles of injury risks when screened using different tasks. While a double-leg landing should be considered as a priority in screening, a single-leg squat may be used as a surrogate to assess frontal plane motion and loading.
    Research in Sports Medicine An International Journal 08/2015; DOI:10.1080/15438627.2015.1076413 · 1.70 Impact Factor
  • Source
    • "Force plate instruments have become the gold standard for jumpingrelated biomechanical research during the last decades (Hatze, 1998). As such, numerous research articles have been published related to the biomechanical evaluation of vertical jumps by utilising a force platform for both performance enhancement (Gorostiaga et al., 2010, 2006; Marques & Izquierdo, 2014) and injury prevention and rehabilitation concerns (Hewett et al., 2005; Noyes et al., 2005; Oberländer et al., 2013). Briefly, as previously stated by Hatze (Hatze, 1998), two different methodologies for the "
    [Show abstract] [Hide abstract]
    ABSTRACT: Progress in micro-electromechanical systems has turned inertial sensor units (IUs) into a suitable tool for vertical jumping evaluation. 9 men and 8 women were recruited for this study. Three types of Vertical jumping tests were evaluated in order to determine if the data provided by an inertial sensor unit placed at the lumbar spine could reliably assess jumping biomechanics and to examine the validity of the inertial sensor unit compared to force plate platform recordings. Robust correlation levels of the inertial sensor unit based jumping biomechanical evaluation with respect to the force plate across the entire analyzed jumping battery were found. In this sense, significant and extremely large correlations were found when raw data of both inertial sensor unit and force plate derived normalized force-time curves were compared. Furthermore significant mainly moderate correlation levels were also found between both instruments when isolated resultant forces´ peak values of predefined jumping phases of each maneuver were analyzed. However, Bland & Altman graphical representation demonstrated a systematic error in the distribution of the data points within the mean ±1.96 SD intervals. Using inertial sensor units, several biomechanical variables such as the resultant force-time curve patterns of the three different vertical jumps analyzed were reliably measured.
    Journal of Sports Sciences 07/2015; DOI:10.1080/02640414.2015.1075057 · 2.25 Impact Factor
    • "While these previous studies have provided evidence that a link exists between an athlete's footwear traction and lower extremity non-contact injury, the mechanism as to why increased footwear traction can lead to injury remains unknown. It is generally considered that increased joint loading may lead to joint injury (Hewett et al., 2005; Sharma et al., 1998; Shin, Chaudhari, & Andriacchi, 2009; Stefanyshyn, Stergiou, Lun, Meeuwisse, & Worobets, 2006). In biomechanics research, joint loading is estimated by calculating resultant joint moments, which represent the net torque or twisting load on the joint, and joint angular impulse, which represents the cumulative loading experienced by the joint throughout the stance phase (calculated as the integral of the resultant joint moment vs. time curve). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies have linked footwear traction to lower extremity non-contact injury; however, these studies mainly focussed on rotational traction exclusively. While studies have shown that increases in traction lead to increases in joint loading, represented by joint moments, these studies failed to determine how the individual components of rotational and translational traction affect joint loading. Therefore, this study investigated how each component of traction independently affects lower extremity joint loading. Traction testing was performed using a robotic testing machine on three shoes that had independent alterations of translational and rotational traction. All testing was conducted on a sample piece of artificial turf. Kinematic and kinetic data were then collected on 10 athletes performing two cutting movements in each shoe condition. As rotational and translational traction were independently altered, decreased rotational traction led to significant decreases in transverse and frontal plane joint loading at the ankle and knee joints, while increases in translational traction led to increases in frontal plane joint loading at the ankle and knee joints. Increases in joint loading in the transverse and frontal planes are one of the possible mechanisms of lower extremity non-contact injury. Both translational and rotational traction can independently alter the joint loading.
    Journal of Sports Sciences 07/2015; DOI:10.1080/02640414.2015.1066023 · 2.25 Impact Factor
Show more