A ‘Plane’ Explanation of Anterior Cruciate Ligament Injury Mechanisms

Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA.
Sports Medicine (Impact Factor: 5.04). 09/2010; 40(9):729-46. DOI: 10.2165/11534950-000000000-00000
Source: PubMed


Although intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) injury have been explored extensively, the factors surrounding the inciting event and the biomechanical mechanisms underlying ACL injury remain elusive. This systematic review summarizes all the relevant data and clarifies the strengths and weaknesses of the literature regarding ACL injury mechanisms. The hypothesis is that most ACL injuries do not occur via solely sagittal, frontal or transverse plane mechanisms. Electronic database literature searches of PubMed MEDLINE (1966-2008), CINAHL (1982-2008) and SportDiscus (1985-2008) were used for the systematic review to identify any studies in the literature that examined ACL injury mechanisms. Methodological approaches that describe and evaluate ACL injury mechanisms included athlete interviews, arthroscopic studies, clinical imaging and physical exam tests, video analysis, cadaveric studies, laboratory tests (motion analysis, electromyography) and mathematical modelling studies. One hundred and ninety-eight studies associated with ACL injury mechanisms were identified and provided evidence regarding plane of injury, with evidence supporting sagittal, frontal and/or transverse plane mechanisms of injury. Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury.

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    • "Whilst three-dimensional (3D) measurements are considered the gold standard in assessing complex movement patterns, two-dimensional (2D) video analysis may be a useful alternative to screen athletes in clinical practice [3] [4] [5] [6]. Despite the increasing evidence that knee injuries may be caused by multi-planar mechanisms [7] [8] [9], and the suggestions to assess multi-segmental and multi-planar movement quality to identify those athletes with highest injury risk [8] [10], most studies using 2D video analysis only focused on the frontal plane [3] [4] [5] [6]. Only a limited number of studies [11] [12] have performed sagittal plane movement analysis during athletic screening tests. "
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    ABSTRACT: Background: Less optimal sagittal plane movement patterns are believed to increase knee injury risk in female athletes. To facilitate clinical screening with a user-friendly method, the purpose of the present study was to examine the temporal relationships between two-dimensional measured sagittal plane kinematics and three-dimensional joint moments during the double-leg drop vertical jump (DVJ) and single-leg DVJ (SLDVJ). Methods: Fifty injury-free female athletes were tested. Maximal excursions of hip flexion, knee flexion and ankle dorsiflexion were measured through two-dimensional video analysis. Three-dimensional motion and ground reaction forces were recorded to calculate external hip flexion, knee flexion and knee abduction moments during the entire stance phase of DVJ and SLDVJ. One-dimensional statistical parametric mapping was used to examine relationships between peak two-dimensional kinematic variables and three-dimensional moment profiles. Results: Hip flexion was significantly related to the hip and knee flexion moment for both tests and knee abduction moment for DVJ during the time frames corresponding with highest three-dimensional moments, while knee flexion was significantly related to the hip flexion moment during these time frames. No significant relationships were found for ankle dorsiflexion with any of the joint moments. Conclusions: Two-dimensional measured sagittal plane hip flexion angles at the deepest landing position were associated with peak joint moments of the hip and knee during DVJ and SLDVJ, while the amount of knee flexion was only associated with the hip flexion moment. Assessment of knee injury risk with two-dimensional video analysis could benefit from measuring maximal hip flexion, more so than knee flexion.
    Full-text · Article · Dec 2014 · The Knee
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    • "Wikstrom et al stated that assessing only the forward jump-landing maneuver did not fully evaluate the factors of lower extremity injury [10]. Investigating knee joint loading during various scenarios may better describe the risk of ACL injury [11]. Therefore, purpose of the study was to measure knee valgus angle during unilateral jump-landing in different directions. "
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    ABSTRACT: Excessive knee valgus during landing tasks is a contributing factor to knee injuries. Most studies have examined lower extremity biomechanics during the forward direction of a jump-landing task. Athletes perform many movements in the air and land in multi-directions. Therefore, the purpose of this study was to assess the peak knee valgus angle (PKVA) during one leg jump-landing in various directions. Eighteen male basketball and volleyball athletes participated in the study. Participants performed one leg jump-landing tests from a 30 cm height platform in four directions. Knee valgus motion was measured using Vicon™ motion system. The data were analyzed with repeated measures ANOVA. Direction significantly (P<0.001) influenced the PKVA during landing. Significantly higher PKVA was observed for the lateral (8.8°±4.7°) direction as compared to forward (5.8°±4.6°) direction (P<0.05). The PKVA in 30° diagonal (7.5°±4.6°) and 60° diagonal (7.7°±5.7°) directions was higher than in the forward direction (P<0.05). One leg jump-landing in lateral and diagonal directions results in a higher PKVA compared to landing in a forward direction and could lead to a higher risk of knee injury.
    Full-text · Article · Sep 2013 · Asian Journal of Sports Medicine
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    • "This is of particular interest as the magnitude of this variable is dependent on frontal-and transverse-plane mechanics, both at the hip and knee. It is well accepted that the mechanism of ACL injuries is multi-planar (Quatman et al., 2010). Our second hypothesis that a double-leg landing training program would decrease frontal-plane knee mechanics of double-leg landings, but not those of single-leg landings could not be accepted. "
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    ABSTRACT: Excessive knee abduction loading is a contributing factor to anterior cruciate ligament (ACL) injury risk. The purpose of this study was to determine whether a double-leg landing training program with real-time visual feedback improves frontal-plane mechanics during double- and single-leg landings. Knee abduction angles and moments and vertical ground reaction forces (GRF) of 21 recreationally active women were quantified for double- and single-leg landings before and after the training program. This program consisted of two sessions of double-leg jump landings with real-time visual feedback on knee abduction moments for the experimental group and without real-time feedback for the control group. No significant differences were found between training groups. In comparison with pre-training data, peak knee abduction moments decreased 12% post-training for both double- and single-leg landings; whereas peak vertical GRF decreased 8% post-training for double-leg landings only, irrespective of training group. Real-time feedback on knee abduction moments, therefore, did not significantly improve frontal-plane knee mechanics during landings. The effect of the training program on knee abduction moments, however, transferred from the double-leg landings (simple task) to single-leg landings (more complex task). Consequently, ACL injury prevention efforts may not need to focus on complex tasks during which injury occurs.
    Full-text · Article · Jan 2013 · Scandinavian Journal of Medicine and Science in Sports
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