Int J Sports Med 2012; 33(05): 381-385
DOI: 10.1055/s-0031-1299750
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of Estimated Anterior Cruciate Ligament Tension During a Typical and Flexed Knee and Hip Drop Landing Using Sagittal Plane Knee Modeling

J. Southard
1   University of Wisconsin-La Crosse, Health Professions, La Crosse, United States
,
T. W. Kernozek
2   University of Wisconsin-La Crosse, Department of Health Professions, La Crosse, United States
,
R. Ragan
3   University of Wisconsin-La Crosse, Physics Department, La Crosse, United States
,
J. Willson
1   University of Wisconsin-La Crosse, Health Professions, La Crosse, United States
› Author Affiliations
Further Information

Publication History



accepted after revision 07 December 2011

Publication Date:
08 February 2012 (online)

Abstract

Noncontact mechanisms, such as landing from a jump, account for over 70% of all anterior cruciate ligament injuries. Increased knee and hip flexion during landing has been suggested to decrease anterior cruciate ligament tension; however, current literature utilizing knee modeling approaches has not investigated this. Our purpose was to compare estimated anterior cruciate ligament tension in females between a typical and flexed knee and hip drop landing performance. A sagittal plane knee model based on kinematic, kinetic, electromyography, and cadaveric data was used to estimate forces on the anterior cruciate ligament during a typical and flexed drop landing for 23 females. Model estimated peak anterior cruciate ligament tension decreased by 10% during the flexed landing performance (p=0.008). This was accounted for by an increase in hamstring shear force by 6% of body weight and a reduction in patellar tendon shear force and femur-tibia shear force by 3% of body weight each. Results suggest that simple verbal cues for increased knee and hip flexion during landing may be effective in reducing anterior cruciate ligament tension and potential risk of injury during landing.

 
  • References

  • 1 Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13 year review. Am J Sports Med 2005; 33: 524-531
  • 2 Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 2009; 17: 705-729
  • 3 Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med 1995; 23: 694-701
  • 4 Beynnon BD, Fleming BC, Johnson RJ, Nichols CE, Renstrom PA, Pope MH. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med 1995; 23: 24-34
  • 5 Boden BP, Dean GS, Feagin Jr JA, Garrett Jr WE. Mechanisms of anterior cruciate ligament injury. Orthop 2000; 23: 573-578
  • 6 Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg Am 1980; 62: 259-270
  • 7 Decker MJ, Torry MR, Wyland DJ, Sterett WI, Steadman JR. Gender differences in lower extremity kinematics, kinetics, and energy absorption during landing. Clin Biomech 2003; 18: 662-669
  • 8 DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. Am J Sports Med 2004; 32: 477-483
  • 9 Ford KR, Myer GD, Hewett TE. Reliability of landing 3D motion analysis: implications for longitudinal analyses. Med Sci Sports Exerc 2007; 39: 2021-2021
  • 10 Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TL, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 2000; 8: 141-150
  • 11 Harriss DJ, Atkinson G. Update – Ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
  • 12 Hashemi J, Breighner R, Jang TH, Chandrashekar N, Ekwaro-Osire S, Slauterbeck JR. Increasing pre-activation of the quadriceps muscle protects the anterior cruciate ligament during the landing phase of a jump: an in vitro simulation. Knee 2010; 17: 235-241
  • 13 Kernozek TW, Torry MR, Van Hoof H, Cowley H, Tanner S. Gender differences in frontal and sagittal plane biomechanics during drop landings. Med Sci Sports Exerc 2005; 37: 1003-1012
  • 14 Kernozek TW, Ragan RJ. Estimation of anterior curciate ligament tension from inverse dynamics data and electromyography in females during drop landing. Clin Biomech 2008; 23: 1279-1286
  • 15 Markolf KL, Neill GO, Jackson SR, McAllister DR. Effects of applied quadriceps and hamstrings muscle loads on forces in the anterior and posterior cruciate ligaments. Am J Sports Med 2004; 32: 1144-1149
  • 16 McLean SG, Su A, van den Bogert AJ. Development and validation of a 3-D model to predict knee joint loading during dynamic movement. J Biomech Eng 2003; 12: 864-874
  • 17 McLean SG, Huang X, van den Bogert AJ. Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods. Clin Biomech 2008; 23: 926-936
  • 18 Myers CA, Hawkins D. Alterations to movement mechanics can greatly reduce anterior cruciate ligament loading without reducing performance. J Biomech 2010; 43: 2657-2664
  • 19 Pflum MA, Shelburne KB, Torry MR, Decker MJ, Pandy MG. Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exerc 2004; 36: 1949-1958
  • 20 Pollard CD, Sigward SM, Powers CM. Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Clin Biomech 2010; 25: 142-146
  • 21 Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008; 42: 394-412
  • 22 Shimokochi Y, Shultz S. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Training 2008; 43: 396-408
  • 23 Shin SC, Chaudhari AM, Andriacchi TP. The influence of deceleration forces on ACL strain during single-leg landing: A simulation study. J Biomech 2007; 40: 1145-1152
  • 24 Sakane M, Livesay GA, Fox RJ, Rudy TW, Runco TJ, Woo SL. Relative contribution of the ACL, MCL, and bony contact to the anterior stability of the knee. Knee Surg Sports Traumatol Arthrosc 1999; 7: 93-97
  • 25 Torry MR, Shelburne KB, Peterson DS, Giphart JE, Krong JP, Myers C, Steadman JR, Woo SL. Knee kinematic profiles during drop landings: a biplane fluoroscopy study. Med Sci Sports Exerc 2011; 43: 533-541
  • 26 Woo SL, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: measurements of in situ force in the ACL and knee kinematics. Knee 1998; 5: 267-288
  • 27 Withrow TJ, Huston LJ, Wojtys EM, Ashton-Miller JA. Effect of varying hamstring tension on anterior cruciate ligament strain during in vitro impulsive knee flexion and compression loading. J Bone Joint Surg Am 2008; 90: 815-823
  • 28 Yu B, Garrett WE. Mechanisms of noncontact ACL injuries. Br J Sports Med 2007; 41: i47-i51