ACL Injury Mechanism in Alpine Skiing: Analysis of an Accidental ACL Rupture

Abstract

Knee injuries in alpine skiing, especially the rupture of the anterior cruciate ligament (ACL), are still the leading indication for surgical treatment. The boot-induced anterior drawer (BIAD) caused by the backward fall is one of the possible injury mechanisms. We investigated the landing of approximately 250 jumps to collect data for a computer model of the BIAD. During our experiments one test subject suffered an ACL rupture of his right knee. This accidental event was recorded on video for later 2D motion analysis. Furthermore, the muscle activity of four muscles (vastus medialis and lateralis, biceps femoris and semitendinosus) was registered for both lower extremities during this event. Seven more subjects were analyzed under identical experimental conditions, thus representing an adequate reference group. The results of the 2D motion analysis will be presented and compared to the results of the reference group. Further, the registered EMG signal of the injured subject will be illustrated and discussed in relation to a reference subject. Our observations allow the conclusion that during landing situations different kinematics besides those described for the BIAD, in combination with certain muscular conditions, may lead to an ACL rupture.

Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities

“…Still, the biggest challenge is probably how to verify that the simulated injury pattern actually resembles what is experienced in real life. This is illustrated well with the experiment of Barone et al 86 If the injury had not occurred during their BIAD experiment, chances are that a ''solution'' not present in the real world could have been found, because the observed injury kinematics differed significantly from all the other noninjury ski jump landings.…”

“…It was concluded that the maximal tendon stress was considerably greater in sporting situations than in a static setting. In the study of Barone et al, 86 kinematic input to a simulation model was collected at the landing from a jump on a ski slope. The researchers intended, from the motion obtained, to simulate the so called boot induced anterior drawer (BIAD) injury mechanism.…”

Peak ACL force during jump landing in downhill skiing is less sensitive to landing height than landing position

“…Trunk lean was defined as the angle between the global vertical axis and the trunk segment. The between-subject SD of the trunk lean angle was derived from the study of Barone et al 23 amounting to 9.2°. This variation is comparable with other jump landing studies, where the corresponding values at initial ground contact have been reported between 7.1° and 13° 24–26.…”

Correlation of axial impact forces with knee joint forces and kinematics during simulated ski-landing

“…Li et al (2006a) also reported that the ACL could restrain both anterior and medial tibial translations, and medial tibial translation was found to be closely associated with valgus joint rotation (Li et al, 2007). It has previously been reported (Barone, Senner, & Schaff, 1999;Freudiger & Friederich, 2000) that anterior tibial translation is important in most critical load cases for ACL injuries sustained during ski-landing. Furthermore, it has been demonstrated that simulated quadriceps loading in cadaveric knees induced substantial anterior tibial translation of *2 cm, which resulted in ACL failure (DeMorat, Weinhold, Blackburn, Chudik, & Garrett, 2004).…”