Change-of-Direction Biomechanics: Is What’s Best for Anterior Cruciate Ligament Injury Prevention Also Best for Performance?

Abstract

Change-of-direction maneuvers (e.g., side-step cutting) are an important aspect of performance in multi-directional sports, but these maneuvers are also associated with anterior cruciate ligament (ACL) injury. Despite this, the impact of biomechanics on ACL injury risk and performance is often examined in isolation. The purpose of this review was to examine the alignment between biomechanical recommendations for ACL injury prevention and performance with regard to change-of-direction maneuvers. Several studies linking change-of-direction biomechanics to both ACL injury risk and performance were examined. A degree of overlap was identified between biomechanical strategies that could both reduce ACL injury risk and enhance performance during change-of-direction maneuvers. A fore-foot footfall pattern along with trunk rotation and lateral flexion in the intended cutting direction were identified as biomechanical strategies that could both reduce potentially hazardous knee joint moments and enhance change-of-direction speed. Minimizing knee valgus during change-of-direction maneuvers may also reduce ACL injury risk, with this biomechanical strategy found to have no impact on performance. Certain biomechanical strategies proposed to reduce ACL injury risk were linked to reduced change-of-direction performance. A narrow foot placement and "soft" landings with greater knee flexion were identified as ACL injury prevention strategies that could have a negative impact on performance. The findings of this review emphasize the need to consider both ACL injury risk and performance when examining the biomechanics of change-of-direction maneuvers.

Dynamic knee control and movement strategies in athletes and non‐athletes in side hops: Implications for knee injury

“…In sports in which considerable loads are placed on the knee joint, athletes struggle with demands of keeping joint mobility while still maintaining joint stability. This constitutes a challenge since sports performance and biomechanical risk factors for injury are closely related . Previous statements therefore recommend athletes to regularly train for and learn proper movement techniques (reduce knee motion in the frontal and transversal planes), while simultaneously improving agility and speed during dynamically challenging tasks .…”

“…This constitutes a challenge since sports performance and biomechanical risk factors for injury are closely related . Previous statements therefore recommend athletes to regularly train for and learn proper movement techniques (reduce knee motion in the frontal and transversal planes), while simultaneously improving agility and speed during dynamically challenging tasks . Indeed, such training has proven successful in decreasing injury occurrence and improving lower limb landing mechanics (injury prevention perspective) .…”

“…7 Previous statements therefore recommend athletes to regularly train for and learn proper movement techniques (reduce knee motion in the frontal and transversal planes), while simultaneously improving agility and speed during dynamically challenging tasks. 6,7 Indeed, such training has proven successful in decreasing injury occurrence 29,30 and improving lower limb landing mechanics (injury prevention perspective). 31,32 We calculated a quantified measure of dynamic knee robustness based on FHA inclination angles relative to the knee flexion-extension axis during consecutive motion intervals of 10°.…”

“…Such dynamic knee stability is maintained during dynamically challenging tasks when frontal and transversal plane motions are minimal. 6,7 These movements have indeed shown to decrease the strain placed on the ACL, [8][9][10] with obvious implications for injury prevention.…”

Acute effects of the Prevent injury and Enhance Performance warm-up on potential reinjury risk factors associated with unanticipated jump landings: Study protocol for a crossover randomized controlled trial in individuals cleared for return to sports after anterior cruciate ligament reconstruction.

“…This may help address the persistent challenges posed by modi able reinjury risk factors [4]through preventive training and performance enhancing approaches. [5][6][7] Since primary ACL injury prevention training programmes have been successful at reducing the risk of ACL injuries. [8] The transfer of such primary programmes to secondary injury prevention may be promising.…”