Changing sagittal plane body position during single-leg landings influences the risk of non-contact anterior cruciate ligament injury

Shimokochi, Yohei; Ambegaonkar, Jatin P.; Meyer, Eric G.; Lee, Sae Yong; Shultz, Sandra J.

doi:10.1007/s00167-012-2011-9

Cited by 106 publications

(104 citation statements)

References 35 publications

(67 reference statements)

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“…16 We defined recreationally active as being involved in physical activities for at least 30 minutes per day, 3 times per week. All participants provided written informed consent, and the study was approved by the Institutional Review Board for the Protection of Human Participants at the University of North Carolina at Greensboro.…”

Section: Participantsmentioning

confidence: 99%

“…The men landed from a greater box height because their jump capacities are often greater than those of women [21][22][23][24] and because we confirmed that recreationally active men and women could successfully perform the 3 landing styles from these box heights. After digitization procedures were performed as described previously, 16 the participants were familiarized with single-legged drop landings until they were comfortable with all styles. Next, they performed 5 single-legged landing trials onto a force plate using each of the 3 different landing styles: selfselected (SSL), body leaning forward with a more plantarflexed position at foot contact (LFL), and body upright with a flat-footed position (URL).…”

Section: Data Collectionmentioning

confidence: 99%

“…Next, they performed 5 single-legged landing trials onto a force plate using each of the 3 different landing styles: selfselected (SSL), body leaning forward with a more plantarflexed position at foot contact (LFL), and body upright with a flat-footed position (URL). 16 The examiner (Y.S.) provided the same instructions to all participants as described in a previous study.…”

Section: Data Collectionmentioning

confidence: 99%

“…11,12 In their video analysis, Krosshaug et al 15 estimated that noncontact ACL injuries occurred approximately 40 milliseconds after foot contact during landing or cutting, which closely corresponds to the time to peak GRF during single-legged landing. 16 The results of these studies collectively have indicated that sagittal-plane mechanics, including GRF direction and magnitude and sagittal-plane knee kinetics and kinematics, may greatly affect the direction and magnitude of peak tibiofemoral forces, influencing ACL loading immediately after foot contact during sharp decelerating motions.…”

mentioning

confidence: 98%

“…Therefore, the purpose of our study was to examine 2 hypothetical sagittal-plane kinematic and kinetic intersegmental links that would modulate both the magnitude and direction of GRFs and tibiofemoral forces during single-legged landings. Shimokochi et al 16 demonstrated that landing flatfooted in an upright position results in reduced shockattenuation capacity and increased peak GRF, as well as decreased time to peak GRF during single-legged landing. Contrarily, landing with the body leaning forward and landing on the toes increased shock-attenuation capacity, decreased peak GRF, and increased time to peak GRF.…”

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confidence: 99%

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Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

Shimokochi

Ambegaonkar

Meyer

2016

Journal of Athletic Training

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Context: Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown.Objective: To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing.Design: Crossover study. Setting: Laboratory.Patients or Other Participants: Twenty recreationally active participants (age ¼ 23.4 6 3.6 years, height ¼ 171.0 6 9.4 cm, mass ¼ 73.3 6 12.7 kg).Intervention(s): Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded.Main Outcome Measure(s): Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces.Results: The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles.Conclusions: Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of singlelegged landing. Therefore, improving sagittal-plane landing mechanics is important in reducing harmful magnitudes and directions of impact forces on the anterior cruciate ligament.Key Words: anterior cruciate ligament, tibial posterior slope, lower extremity biomechanics, injury prevention, landing strategy Key PointsAt the impact phase of single-legged landing, sagittal-plane kinetics and kinematics of body segments were strongly related, affecting both the magnitude and direction of the ground reaction force (GRF) and tibiofemoral forces relative to the tibia and anterior cruciate ligament injury risk. A longer time to peak GRF in single-legged landing on the toes with the body leaning forward allowed greater knee flexion, anterior tibial inclination, and shock attenuation, leading to a reduced magnitude of GRF that was more posteriorly inclined relative to the tibia and smaller tibial axial forces and posteriorly directed tibial shear forces. A shorter time to peak GRF during flat-footed landing with the body upright led to less knee flexion, anterior tibial inclination, and s...

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Section: Participantsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

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Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

Shimokochi

Ambegaonkar

Meyer

2016

Journal of Athletic Training

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Effect of sagittal plane mechanics on ACL strain during jump landing

Bakker

Tomescu

Brenneman

et al. 2016

Journal Orthopaedic Research

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ABSTRACT:The relationships between non-contact anterior cruciate ligament injuries and the underlying biomechanics are still unclear, despite large quantities of academic research. The purpose of this research was to study anterior cruciate ligament strain during jump landing by investigating its correlation with sagittal plane kinetic/kinematic parameters and by creating an empirical model to estimate the maximum strain. Whole-body kinematics and ground reaction forces were measured from seven subjects performing single leg jump landing and were used to drive a musculoskeletal model that estimated lower limb muscle forces. These muscle forces and kinematics were then applied on five instrumented cadaver knees using a dynamic knee simulator system. Correlation analysis revealed that higher ground reaction force, lower hip flexion angle and higher hip extension moment among others were correlated with higher peak strain (p < 0.05). Multivariate regression analyses revealed that intrinsic anatomic factors account for most of the variance in strain. Among the extrinsic variables, hip and trunk flexion angles significantly contributed to the strain. The empirical relationship developed in this study could be used to predict the relative strain between jumps of a participant and may be beneficial in developing training programs designed to reduce an athlete's risk of injury. Keywords: ACL; muscle force; musculoskeletal modeling; risk factor; knee injuryDespite the large quantity of research available on non-contact anterior cruciate ligament (ACL) injuries, the contributing factors and their relative contribution to the injury is still under debate. 1 This is in part due to the difficulty of measuring ACL strain in vivo 2 and inability to relate the ACL strain to the possible contributing factors. Unless the relationships between body kinematics, muscle forces and ACL strain is understood, the mechanism of ACL injury will remain unclear. Understanding the mechanics behind these injuries is crucial for injury prevention. Injuries may be prevented if screening and training programs are created for athletes who display at-risk mechanics. [3][4][5] Sagittal plane factors have been identified as important contributors to ACL injury mechanisms. [6][7][8] In addition to these extrinsic biomechanical factors, ACL strain is also dependent on a number of intrinsic anatomic factors such as tibial slope, 9,10 femoral notch width, 11 and ACL size. 12 Although these factors are known correlates with ACL strain, the relative contribution of extrinsic biomechanical and intrinsic anatomical factors is unknown.Pioneering efforts have been made to understand the relationship between knee kinematics, kinetics and ACL strain by surgically placing strain gauges on ligaments in live participants. 13 However, for ethical reasons, such approaches have not been extended to activities that are dynamic in nature. Numerical modelling approaches have been used to address this gap [14][15][16] ; however, model validation is complicated by the lack...

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