Valgus Plus Internal Rotation Moments Increase Anterior Cruciate Ligament Strain More Than Either Alone

Article · August 2011with299 Reads
DOI: 10.1249/MSS.0b013e31820f8395 · Source: PubMed
Abstract
To test the influence of combined knee valgus and internal tibial rotation moment on anterior cruciate ligament (ACL) strain during single-leg landing. We tested the following hypotheses: the combination of the valgus and internal rotation moments observed during single-leg landing produces a higher ACL strain than either moment applied individually, the combined rotational moments at the physiological levels observed could theoretically increase strain in the ACL high enough to rupture the ACL, and the location of the peak contact force was at the posterior-lateral side for combined loading. The study was conducted by applying in vivo human loading data to a validated simulation model of the three-dimensional dynamic knee joint to predict ACL strains. The peak ACL strain increased nonlinearly when either applied valgus moment or internal rotation moment was increased in the model. When the two rotational moments were applied individually, neither caused ACL strain >0.077. However, when applied in combination, the two rotational moments had a much larger effect, and the predicted peak ACL strain increased up to 0.105. During landing, the peak contact force occurred at the posterior-lateral side of the tibial cartilage in the model when the combined maximum valgus moment and tibial internal rotation moments were applied. Combined knee valgus and internal rotation moments increases ACL strain more than either alone. The combination of a valgus and internal rotational moment at magnitudes that occurs in vivo during landing can cause ACL strains that may be high enough to cause ACL rupture. This predicted high ACL strain and the contact force location suggest that combined valgus and internal tibial rotational moments during single-leg landing are relevant to ACL injuries.
  • ...Prevention requires the identification, understanding and modification of risk factors ( Finch, 2006) with much research focussing on investigating modifiable biomechanical risk factors. Cadaveric studies demonstrate that combined (internal) knee extensor ( Weinhandl et al., 2013), adductor and especially, external rotator moments ( Markolf et al., 1995;Oh, Lipps, Ashton-Miller, & Wojtys, 2012;Shin, Chaudhari, & Andriacchi, 2011) increase ACL strain. Proposed biomechanical risk factors for non-contact ACL injury include reduced trunk kinematic control ( Hewett, Ford, Hoogenboom, & Myer, 2010;Hewett, Torg, & Boden, 2009;Zazulak, Hewett, Reeves, Goldberg, & Cholewicki, 2007), less hip and knee flexion angles ( Leppanen et al., 2017), larger ground reaction forces (GRFs) ( Leppanen et al., 2017), greater (internal) knee adductor moment and valgus angle ( Hewett et al., 2005), greater hip adduction and internal rotation (Alentorn Geli et al., 2009) and asymmetrical lower limb biomechanics ( Hewett et al., 2010;Paterno et al., 2010). ...
  • ...Further studies investigating the effects of different exercise protocols on the biomechanics of the crossover cutting manoeuvre should be investigated. We hypothesized that the biomechanical risk factors (such as increased knee valgus angle (Hewett et al., 2005Hewett et al., , 2005), internal varus (Hewett et al., 2005), extensor (Markolf et al., 1995), and external rotator moments (Oh et al., 2012;Shin et al., 2011), and altered trunk kinematics (Jamison et al., 2012;Shimokochi et al., 2013)) proposed to increase ACL loading would be greater during the performance of unanticipated cutting manoeuvres post-HIIP. The results of the current study do not support this hypothesis as no interaction was observed which is consistent with previous research (Collins et al., 2016;Khalid et al., 2015). ...
  • ...In regard to knee fl exion, sagittal plane loading in isolation cannot cause ACL injury [23], and the ACL is unloaded above 50° of fl exion [14,24]. With sagittal plan loading unable to cause ACL injury, multiple biomechanical reports have determined that dynamic valgus collapse (combined or coupled motion) of the knee is a major contributor to ACL rupture as this motion rapidly loads the ACL and increases knee abduction moment (Figure 1) [12,19,25,26]. the joint structures during motion, a dynamic valgus collapse (coupled knee abduction, internal rotation, and anterior tibial translation) of the knee can be avoided, sparing the ACL from a traumatic rupture [22]. Multiple reports have demonstrated that preventive interventions employing biofeedback, clinician feedback, and neuromuscular training can successfully reduce the incidence of ACL injury by targeting the above mentioned mechanisms [27][28][29][30][31][32]. ...
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