Tibiofemoral Alignment: Contributing Factors to Noncontact Anterior Cruciate Ligament Injury

Boden, Barry P.; Breit, Ilan; Sheehan, Frances T.

doi:10.2106/jbjs.h.01721

Cited by 50 publications

(61 citation statements)

References 28 publications

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“…When assessed on a lateral radiograph, a high-degree measurement error can exacerbate the variability [16,26]. It remains unclear whether noncontact ACL injury is a result of a greater medial PTS, lateral PTS, or both [6,39,43]. Regardless of which plateau is associated with an injury risk, the menisci play a role in AP knee stability and may modify this stability when injured or resected [25,36].…”

Section: Introductionmentioning

confidence: 99%

Is Noncontact ACL Injury Associated with the Posterior Tibial and Meniscal Slope?

Hudek

Fuchs

Regenfelder

et al. 2011

Clinical Orthopaedics &Amp; Related Research

127

167

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Background The risk of noncontact ACL injury reportedly is increased in patients with a greater posterior tibial slope (PTS), but clinical data are inconsistent. It is unclear whether the medial and lateral PTSs have a different impact on this connection. It also is unknown whether the meniscal slope (MS) is associated with ACL injury. Patients/methods Using MRI, we compared the medial and lateral PTSs and MSs separately in 55 matched pairs of patients with isolated noncontact ACL injuries and a control group.

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Section: Introductionmentioning

confidence: 99%

Is Noncontact ACL Injury Associated with the Posterior Tibial and Meniscal Slope?

Hudek

Fuchs

Regenfelder

et al. 2011

Clinical Orthopaedics &Amp; Related Research

127

167

View full text Add to dashboard Cite

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“…When the ACL tears during a noncontact mechanism, the lower extremity typically is positioned with the foot firmly planted on the ground, knee abducted and near full extension, femur internally rotated, and tibia externally rotated. [12][13][14][15][16] In several observational studies, 12,17,18 investigators have shown that ACL injuries occur shortly after initial contact (approximately 40 milliseconds) and with a decreased knee-flexion angle.…”

mentioning

confidence: 99%

Changes in Lower Extremity Biomechanics Due to a Short-Term Fatigue Protocol

Cortés

Greska

Kollock

et al. 2013

Journal of Athletic Training

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Context: Noncontact anterior cruciate ligament injury has been reported to occur during the later stages of a game when fatigue is most likely present. Few researchers have focused on progressive changes in lower extremity biomechanics that occur throughout fatiguing.Objective: To evaluate the effects of a sequential fatigue protocol on lower extremity biomechanics during a sidestepcutting task (SS).Design: Controlled laboratory study. Setting: Laboratory.Patients or Other Participants: Eighteen uninjured female collegiate soccer players (age ¼ 19.2 6 0.9 years, height ¼ 1.66 6 0.5 m, mass ¼ 61.6 6 5.1 kg) volunteered.Intervention(s): The independent variable was fatigue level, with 3 levels (prefatigue, 50% fatigue, and 100% fatigue). Using 3-dimensional motion capture, we assessed lower extremity biomechanics during the SS. Participants alternated between a fatigue protocol that solicited different muscle groups and mimicked actual sport situations and unanticipated SS trials. The process was repeated until fatigue was attained.Main Outcome Measure(s): Dependent variables were hipand knee-flexion and abduction angles and internal moments measured at initial contact and peak stance and defined as measures obtained between 0% and 50% of stance phase.Results: Knee-flexion angle decreased from prefatigue (À178 6 58) to 50% fatigue (À168 6 68) and to 100% fatigue (À148 6 48) (F 2,34 ¼ 5.112, P ¼ .004). Knee flexion at peak stance increased from prefatigue (À52.98 6 5.68) to 50% fatigue (À56.18 6 7.28) but decreased from 50% to 100% fatigue (À50.58 6 7.18) (F 2,34 ¼ 8.282, P ¼ 001). Knee-adduction moment at peak stance increased from prefatigue (0.49 6 0.23 Nm/kgm) to 50% fatigue (0.55 6 0.25 Nm/kgm) but decreased from 50% to 100% fatigue (0.37 6 0.24) (F 2,34 ¼ 3.755, P ¼ 03). Hip-flexion angle increased from prefatigue (45.48 6 10.98) to 50% fatigue (46.28 6 11.28) but decreased from 50% to 100% fatigue (40.98 6 11.38) (F 2,34 ¼ 6.542, P ¼ .004). Hip flexion at peak stance increased from prefatigue (49.88 6 9.98) to 50% fatigue (52.98 6 12.18) but decreased from 50% to 100% fatigue (46.38 6 12.98) (F 2,34 ¼ 8.639, P ¼ 001). Hip-abduction angle at initial contact decreased from prefatigue (À13.88 6 6.68) to 50% fatigue (À9.18 6 6.58) and to 100% fatigue (À7.88 6 6.58) (F 2,34 ¼ 11.228, P , .001). Hip-adduction moment decreased from prefatigue (0.14 6 0.13 Nm/kgm) to 50% fatigue (0.08 6 0.13 Nm/kgm) and to 100% fatigue (0.06 6 0.05 Nm/kg) (F 2,34 ¼ 5.767, P ¼ .007).Conclusions: The detrimental effects of fatigue on sagittal and frontal mechanics of the hip and knee were visible at 50% of the participants' maximal fatigue and became more marked at 100% fatigue. Anterior cruciate ligament injury-prevention programs should emphasize feedback on proper mechanics throughout an entire practice and not only at the beginning of practice.Key Words: anterior cruciate ligament, knee, fatiguing, kinematics, kinetics Key PointsA progressive change in lower extremity mechanics occurred for knee-flexion angle, hip-abduction angle,...

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“…Further evidence concerns the severity of SI in G4; 22 injuries (63%) comprise serious injuries 24 , with more than 21 days of withdrawal. Among other factors predisposing to SI that are increased by age, there are biomechanical gait alterations 25 , segmental deficits of flexibility 16 and postural changes 26 , which have not been approached in this study. Therefore, the etiologic understanding of sports injuries should be conceived from a multifactorial perspective, by defining the main causal agents 27 , characterizing them according to age group.…”

Section: Discussionmentioning

confidence: 97%

“…Therefore, frequent requests at matches in the official Sub-16 and Sub-18 categories 28 , or even in training, added to the lack of fitness resulting from the nonsystematic training, could result in increased rates of injury in this age group. Nevertheless, other disorders, such as postural changes 26,29 and muscle imbalances 25 could also contribute to the occurrence of SI in teenagers.…”

Section: Discussionmentioning

confidence: 99%