Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

Kim, Sophia Y.; Spritzer, Charles E.; Collins, Amber T.; Englander, Zoë A.; Utturkar, Gangadhar M.; Garrett, William E.; DeFrate, Louis E.

doi:10.1177/0363546518764681

Cited by 55 publications

(93 citation statements)

References 63 publications

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“…The combination of increased ACL strain and knee extension during the period before landing has important implications for understanding noncontact ACL injury. Specifically, ACL injuries commonly occur with the knee relatively extended (<30° of flexion) 24,30,43,45,52 during landing or cutting motions. The findings of the present study and others 9,48 suggest that landing with an extended knee increases vulnerability of the ACL, potentially due to increased quadriceps activity in anticipation of landing.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography

et al. 2019

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Background: The in vivo mechanics of the anterior cruciate ligament (ACL) and its bundles during dynamic activities are not completely understood. An improved understanding of how the ACL stabilizes the knee is likely to aid in the identification and prevention of injurious maneuvers. Purpose/Hypothesis: The purpose was to measure in vivo ACL strain during a single-legged jump through use of magnetic resonance imaging (MRI) and high-speed biplanar radiography. We hypothesized that ACL strain would increase with the knee near extension, and a peak in ACL strain would occur just before landing from the jump, potentially due to quadriceps contraction in anticipation of landing. Study Design: Descriptive laboratory study. Methods: Models of the femur, tibia, and ACL attachment sites of 8 male participants were generated from MRI scans through use of solid modeling. High-speed biplanar radiographs were obtained from these participants as they performed a single-legged jump. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the joint throughout the jump. ACL and bundle elongations were defined as the centroid to centroid distances between attachment sites for each knee position. ACL strain was defined as ACL length normalized to its length measured in the position of the knee at the time of MRI. Results: Peaks in ACL strain were observed before toe-off and 55 ± 35 milliseconds before initial ground contact. These peaks were associated with the knee positioned at low flexion angles. Mean ACL strain was inversely related to mean flexion angle (rho = −0.73, P < .001), such that ACL strain generally increased with knee extension throughout the jumping motion. ACL bundle lengths were significantly (rho > 0.85, P < .001) correlated with overall ACL length. Conclusion: These findings provide insight into how landing in extension can increase the risk of ACL injury. Specifically, this study shows that peak ACL strain can occur just before landing from a single-legged jump. Thus, when an individual lands on an extended knee, the ACL is relatively taut, which may make it particularly vulnerable to injury, especially in the presence of a movement perturbation or unanticipated change in landing strategy. Clinical Relevance: This study provides a novel measurement of dynamic ACL strain during an athletic maneuver and lends insight into how landing in extension can increase the likelihood of ACL failure.

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Section: Discussionmentioning

confidence: 99%

In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography

et al. 2019

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“…Owusu-Akyaw et al reported that there was no significant difference in the knee positions near the time of an ACL rupture with regard to knee flexion, valgus, internal tibial rotation, or anterior tibial translation between sexes in their study using MRI three-dimensional model in 30 cases (15 males and 15 females). [32]…”

Section: Discussionmentioning

confidence: 99%

MRI comparison of injury mechanism and anatomical factors between sexes in non-contact anterior cruciate ligament injuries

et al. 2019

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Non-contact anterior cruciate ligament (ACL) rupture is mostly caused by a pivot shift mechanism including valgus collapse and internal tibial rotation. In female athletes, the incidence of ACL rupture has been reported to be significantly higher than in their male counterparts. However, to date, there have been limited reports and controversy regarding sex differences underlying injury mechanisms of ACL and severity of injury. In this study, we hypothesized that 1) in patients with non-contact ACL rupture, the incidence and severity of pivot shift injury, which are determined by injury pattern on MRI, would be significantly higher in females, and 2) anatomical factors associated with pivot shift injury would be significantly associated with female sex. A total of 148 primary ACL ruptures (145 patients) caused by non-contact injury mechanisms were included in this study. Among them, 41 knees (41 patients) were female and 107 knees (104 patients) were male. The status of the osseous lesions, lateral and medial tibial slope, depth of the medial tibial plateau, collateral ligaments, and menisci were assessed by MRI and compared between sexes. The severity of osseous lesions at the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle were comparable between sexes. There were no significant differences between sexes in the location of tibial contusions (p = 0.21), femoral contusions (p = 0.23), or meniscus tears (p = 0.189). Lateral tibial slope was found to be significantly larger in females (8.95° vs. 6.82°; p<0.0001; odds ratio = 1.464), and medial tibial depth was significantly shallower in females (1.80mm vs. 2.41mm; p<0.0001; odds ratio = 0.145). In conclusion, females showed greater lateral tibial slope and shallower medial tibial depth compared to males, however it did not affect the sex differences in injury pattern.

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“…37,38 The mechanistic studies presented by Dr DeFrate indicated that a relatively extended knee at foot contact may be a high-risk position due to the relatively larger ACL strain values in this position. [39][40][41] Research on primary risk assessment presented at the ACL Research Retreat VIII focused on structural and neurologic risk factors. This summary is therefore limited to those areas.…”

Section: Primary Risk Assessmentmentioning

confidence: 99%

Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14–16, 2019, Greensboro, NC

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et al. 2019

Journal of Athletic Training

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Carolina at Chapel Hill T he Anterior Cruciate Ligament (ACL) Research Retreat VIII was held March 14-16, 2019, in Greensboro, North Carolina. The retreat brought together clinicians and researchers to present and discuss research advances in ACL injury risk, outcomes, and prevention. Prior retreats (2001-2012) 1-6 largely focused on advances in primary injury risk-factor identification and prevention (ie, preventing the initial trauma). Despite our improved understanding of ACL injury risk and the success of primary prevention efforts, ACL injuries continue to occur and lead to short-term and long-term consequences that have substantial effects on joint health and quality of life for years to come. To address these additional challenges, the ACL Research Retreat expanded in scope to include secondary ACL injury risk and prevention in 2015 7 and the short-term and long-term sequelae of early-onset osteoarthritis that results from the initial trauma (herein, posttraumatic osteoarthritis or PTOA) in 2019. The ACL Research Retreat VIII therefore considered ACL injury risk and prevention along a continuum that includes primary, secondary, and tertiary risk identification and prevention strategies as described by Palmieri-Smith et al (Table 1). 8 To illustrate this continuum, consider a soccer team comprising 13-year-old girls. We know the ACL injury risk increases dramatically from ages 13 to 16, 9-11 such that girls have a 2 to 4 times greater risk than similarly trained males. 12,13 Thus, our first goal for this age group, especially 970 Volume 54 Number

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Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

Abstract: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.

Cited by 55 publications

References 63 publications

In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography

In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography

MRI comparison of injury mechanism and anatomical factors between sexes in non-contact anterior cruciate ligament injuries

Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14–16, 2019, Greensboro, NC

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