Article

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

ABSTRACT

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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    • "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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    • "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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