Hip Adduction, Not Hip Internal Rotation, Dictates Knee Motion Related to ACL Injury During Cutting Maneuvers

Myer, Gregory D.; Imwalle, Lauren E.; Ford, Kevin R.; Hewett, Timothy E.

doi:10.1249/00005768-200605001-01059

Cited by 2 publications

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“…Hip abduction strength was increased in a group of female athletes after TNMT. Recent investigations indicate an association of hip abduction strength with dynamic valgus alignments that increase ACL injury risk 9 22 – 25. Padua et al examined the relationship between hip strength quantified with a hand-held dynamometer and joint kinematics during a drop-jump task in males and female athletes 24.…”

Section: Discussionmentioning

confidence: 99%

“…Female athletes also showed decreased power and increased valgus knee motion during jumping and landing as they matured 5 6. Mature female athletes who showed decreased hip abduction control were also more likely to show increased knee valgus angle during a dynamic cutting task 9. Based on these data, it can be hypothesised that after the onset of puberty and the initiation of peak height velocity, the increased tibia and femur lever length, with increased body mass and height of the centre of mass, lead to decreased “core stability” or control of trunk motion during dynamic tasks in the absence of increases in strength and recruitment of the musculature at the hip 7 10.…”

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A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength

et al. 2008

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Objective-The objective was to determine the effect of trunk focused neuromuscular training (TNMT) on hip and knee strength. The hypothesis was that TNMT would increase standing isokinetic hip abduction, but not knee flexion/extension, strength.Methods-21 high-school female volleyball players (14 TMNT, mean age 15.4 (1.4) years, weight 170.5 (5.0) cm, height 64.1 (8.5) kg and 7 controls, mean age 16.0 (1.7) years, height 173.4 (10.0) cm, weight 63.9 (5.3) kg; p>0.05) were recruited to participate in this study. The 14 TNMT subjects participated in a TNMT protocol (twice weekly) over a 10 week period in addition to their standard once-weekly off-season strength training. Standing isokinetic hip abduction strength and seated knee flexion/extension strength were measured before and after TNMT.Results-A significant interaction of group and time was observed. The TNMT group increased isokinetic hip abduction strength approximately 15% (13.5% in the dominant leg: mean (SD) 46.6 (10.1) to 52.9 (11.4) foot-pounds and 17.1% in the non-dominant leg: 46.1 (10.4) to 54.0 (10.7) foot-pounds; p=0.01). There was no difference in the control group in pre-test versus post-test measures. Post-test results also indicated no effect of TNMT on isokinetic knee extension (p=0.57) or knee flexion (p=0.57) strength.Conclusions-Ten weeks of TNMT increased standing hip abduction strength in female athletes. Increased hip abduction strength and recruitment may improve the ability of female athletes to increase control of lower limb alignment and decrease knee loads resulting from increased trunk displacement during sports activities. Female athletes are currently reported to be 4-6 times more likely to sustain a sport-related non-contact anterior cruciate ligament (ACL) injury than are male athletes. 1-3 Altered neuromuscular trunk and hip control strategies during the execution of sports movements may result in lower limb joint mechanics (motions and loads) that increase the risk of ACL injury in female athletes. Hip abduction strength and control may be the critical modulator between altered trunk control and ultimate lower limb knee loads responsible for ACL rupture.During peak growth velocity of both height and mass, the tibia and femur grow at rapid rates in pubertal athletes of both sexes. 4 Rapid growth of the two longest levers in the human body initiates height increases and increased height of the centre of mass, making muscular control of trunk more challenging. In addition, increased body mass and longer joint levers leads to the development of greater joint forces and moments that are more difficult to balance and dampen at the lower limb joints during high-velocity manoeuvres. [5][6][7] Brent et al used a longitudinal study approach to determine that in a population of 11-22-year-old athletes, male athletes increased their relative hip abduction strength at a significantly greater rate than did female athletes. 8 Female athletes also showed decreased power and increased valgus knee motion during jumping and landing as...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength

et al. 2008

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“…26 This association between frontal plane knee torque and increased ligament loading, which was initially defined through motion analysis, has since been affirmed in a multitude of in vitro , in situ , and in sim models. 27–29 In addition, 3D motion analysis has identified that decreased knee flexion, 30 increased hip adduction, 31–33 and greater trunk instability 34–37 when landing from a jump are all related to abnormal loading at the knee and potentially increased ACL injury-risk. Many of these specific factors identified in 3D models can be generalized in 2D motion analyses that are more cost effective to the clinical environment.…”

Section: Introductionmentioning

confidence: 99%

Motion Analysis and the Anterior Cruciate Ligament: Classification of Injury Risk

Bates

Hewett

2015

J Knee Surg

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More than 55% of all athletic injuries are incurred on the lower extremity, 1-4 while damage specific to the knee accounts for approximately 15% of all athletic injuries. 5 Overall, 43% of these knee injuries are classified as strains or sprains, which makes them the third most prevalent form of lower extremity injury with a rate of 102 incidents per 100,000 athletes per year. 6 Of these knee injuries, it is estimated that 45% involve internal knee trauma, and 49% of those entail anterior cruciate ligament (ACL) rupture, 7 as 1 in 3,000 persons are likely to suffer an ACL disruption each year. 8 However, ACL injury is a sex-specific event, as females are 2 to 10 times more likely to suffer ACL disruption than their male counterparts, 9-14 which produces an incidence rate of 1 ACL tear in every 50 to 70 female athletes per year. 15 These high incidence rates of ACL rupture lead to an estimated 250,000 ACL tears and 127,000 ACL reconstructions (ACLR) annually in the United States. 16,17 With conservative repair estimates ranging from $5,000 to $44,000 per ACLR depending on the type of repair and severity of injury, 13,18-20 the annual medical expense of ACL injury treatments in the United States alone may exceed $2 billion. Worldwide, it is estimated that the annual incidence of ACL tears could reach as high as 2 million patients, 21 which would exponentially increase these costs. Unfortunately, despite the expense associated with ACLR, surgical repair has not been found to significantly reduce the longterm outlook of knee osteoarthritis compared with nonoperative rehabilitation. 22,23 As many as 86% of patients demonstrated early onset osteoarthritis following ACLR and 75% report degradation in knee quality of life within 20 years postsurgery. [23][24][25] For these reasons, the focus on treating ACL injuries may be best served through identification and treatment of modifiable injury risk factors that may prevent ruptures before they happen.Two-and three-dimensional (2D and 3D) motion analysis systems have been used in vivo to identify, classify, and associate biomechanical risk factors with the likelihood of Keywords ► anterior cruciate ligament injury ► injury risk classification ► motion capture ► motion analysis ► neuromuscular training AbstractAnterior cruciate ligament (ACL) injuries are common, catastrophic events that incur large expense and lead to degradation of the knee. As such, various motion capture techniques have been applied to identify athletes who are at increased risk for suffering ACL injuries. The objective of this clinical commentary was to synthesize information related to how motion capture analyses contribute to the identification of risk factors that may predict relative injury risk within a population. Individuals employ both active and passive mechanisms to constrain knee joint articulation during motion. There is strong evidence to indicate that athletes who consistently classify as high-risk loaders during landing suffer from combined joint stability deficits in both the active a...

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Hip Adduction, Not Hip Internal Rotation, Dictates Knee Motion Related to ACL Injury During Cutting Maneuvers

Cited by 2 publications

References 0 publications

A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength

A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength

Motion Analysis and the Anterior Cruciate Ligament: Classification of Injury Risk

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