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

Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States
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.

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Available from: Paul Succop, Mar 11, 2014
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    • "As expected, when landing on an everted surface in contrast to the neutral one, the tibia was forced to move more medially in the frontal plane resulting in an increased knee abduction moment. Clinically, this result may be linked to ACL injury risk (Hewett et al. 2005; Smith et al. 2012). Furthermore, Markolf et al. (1995) reported that the abduction moment significantly increases ACL loading only when it is combined with a high anterior tibial force. "
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    ABSTRACT: Knee and hip alignment and knee moments during landing are considered risk factors for knee injuries while ankle bracing has been demonstrated to alter landing kinematics and kinetics at these joints. The aim of this study was to investigate whether a semi-rigid ankle brace has an effect on knee and hip kinematics and kinetics during landing on uneven surfaces. Seventeen recreational athletes performed a landing task on a randomly inclined platform with and without an ankle brace. Three different surface alignments were generated: everted, neutral, and inverted. Ground reaction forces (GRF), kinematics, and brace reaction forces were measured. Two independent variables were tested: the brace factor (braced and non-braced) and the inclination factor (everted, neutral, and inverted). Seven separate 2 × 3 repeated measures MANOVAs were employed to compare GRF, knee, and hip initial angles and range of motion (ROM), knee, and hip forces and moments. Participants landed with a more flexed knee and hip during the brace condition, followed by a knee ROM reduction. No differences were observed for the kinetic variables. Landing on the inverted surface resulted in increased peak magnitudes of the vertical and the mediolateral GRF compared to landing on the neutral surface. Landing on the everted surface caused higher knee and hip abduction moments during early contact. Results confirm that ankle bracing may affect the kinematics of the whole lower extremity with no effect on knee or hip loading. Landing on uneven surfaces may increase injury risk, but no adverse effects were shown for wearing the brace.
    Full-text · Article · Jan 2016
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    • "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). "
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    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.
    Full-text · Article · Oct 2015 · Clinical biomechanics (Bristol, Avon)
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    • "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. "
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    Full-text · Conference Paper · Oct 2015
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