The findings from this review lend support to ACL injury prevention programs designed to prevent unopposed excessive quadriceps force and frontal-plane or transverse-plane (or both) moments to the knee and to encourage increased knee flexion angle during sudden deceleration and acceleration tasks.

ABSTRACT:We examined sex differences in general joint laxity (GJL), and anterior-posterior displacement (ANT-POST), varus-valgus rotation (VR-VL), and internal-external rotation (INT-EXT) knee laxities, and determined whether greater ANT and GJL predicted greater VR-VL and INT-EXT. Twenty subjects were measured for GJL, and scored on a scale of 0-9. ANT and POST were measured using a standard knee arthrometer at 133 N. VR-VL and INT-EXT were measured using a custom joint laxity testing device, defined as the angular displacements (deg) of the tibia relative to the femur produced by 0-10 Nm of varus-valgus torques, and 0-5 Nm of internalexternal torques, respectively. INT-EXT were measured during both non-weight-bearing (NWB) and weight-bearing (WB ¼ 40% body weight) conditions while VR-VL were measured NWB. All laxity measures were greater for females compared to males except for POST. ANT and GJL positively predicted 62.5% of the variance in VR-VL and 41.8% of the variance in WB INT-EXT. ANT was the sole predictor of INT-EXT in NWB, explaining 42.3% of the variance. These findings suggest that subjects who score higher on clinical measures of GJL and ANT are also likely to have greater VR-VL and INT-EXT knee laxities. ß

ABSTRACT:We examined the capabilities of the Vermont Knee Laxity Device (VKLD) in measuring varus (VR)-valgus (VL) and internal (INT)-external (EXT) rotational laxities by quantifying measurement consistency and absolute measurement error (N ¼ 10). Based on the expected measurement error, we then examined side-to-side differences (N ¼ 20). For all measures, the knee was flexed 208, the thigh securely fixed, and counterweights applied to the thigh and shank to create an initial zero shear and compressive load across the tibiofemoral joint. A 10-Nm torque was applied to the knee for VL and VR during non-weight-bearing, and a 5-Nm torque was applied for INT and EXT during non-weight-bearing and weight-bearing conditions. Position sensors measured angular displacements (deg). Except for INT during weight bearing, measurement consistency was good to excellent (range, 0.68-0.96), with absolute measurement errors generally less than 28 for VR-VL and 3-48 for INT-EXT. Although side-to-side differences were observed, they did not exceed absolute measurement errors. The VKLD yields reliable measures of VR-VL and INT-EXT laxities, with sufficient measurement precision to yield clinically relevant differences. ß

Leaning forward while landing appears to protect the ACL by increasing the shock absorption capacity and knee flexion angles and decreasing anterior shear force due to the knee joint compression force and quadriceps muscle activation. Conversely, landing upright appears to be ACL harmful by increasing the post-impact force of landing and quadriceps muscle activity while decreasing knee flexion angles, all of which lead to a greater tibial anterior shear force and ACL loading. ACL injury prevention programmes should include exercise regimens to improve sagittal plane body position control during landing motions.

Background-Torsional joint stiffness is thought to play in role in the observed sex bias in noncontact ACL injury rates.