Lower-limb adaptation during squatting after isolated posterior cruciate ligament injuries.

BACKGROUND While many studies point out that posterior cruciate ligament plays an important role in squatting, not many, if any, have looked into knee kinematics or kinetics for isolated posterior cruciate ligament injuries. This study explores lower-limb adaptation during squatting for asymptomatic patients with isolated chronic posterior cruciate ligament injuries. METHODS Thirteen research subjects or test participants with isolated chronic posterior cruciate ligament injuries were recruited to analyze the kinematics and kinetics on both sides of their hip, knees and ankle joints during squatting. We adopted ExpertVision™ motion analysis system and two Kistler force plates to record the three-dimensional trajectories of the reflective markers used and the ground reaction forces respectively. FINDINGS The peak vertical ground reaction force exerted on the participants, their peak support moment and the knee-joint peak extension moment exhibited at their non-involved side are significantly greater than that at their involved side. We also find that the involved side's knee joint (extension moment) exhibits a reduced percentage on the peak support moment contributed by the individual joints, while the joints of the hip and ankle signify increased percentages. INTERPRETATION In this study, the asymptomatic participants having isolated chronic posterior cruciate ligament injuries tend to shift their weight to their non-involved side, and part of their injured knee-joint load to their ipsilateral joints of the hip and ankle. The causes seem to be a habitual gravity center shift, insufficient muscle strength at the involved side, and a reduced mechanical efficiency in their extensor mechanism.

[1]  C. Harner,et al.  Neuromuscular and Biomechanical Adaptations of Patients with Isolated Deficiency of the Posterior Cruciate Ligament , 2005, The American journal of sports medicine.

[2]  N Zheng,et al.  Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. , 1998, Medicine and science in sports and exercise.

[3]  J. Perry,et al.  Functional analysis of untreated and reconstucted posterior cruciate ligament injuries , 1988, The American journal of sports medicine.

[4]  S. Hurwitz,et al.  Lower extremity compensations following anterior cruciate ligament reconstruction. , 2000, Physical therapy.

[5]  D. Hooper,et al.  Gait adaptations in patients with chronic posterior instability of the knee. , 2002, Clinical biomechanics.

[6]  R. Escamilla Knee biomechanics of the dynamic squat exercise. , 2001, Medicine and science in sports and exercise.

[7]  K.,et al.  Nonoperatively treated isolated posterior cruciate ligament injuries , 1993, The American journal of sports medicine.

[8]  T P Andriacchi,et al.  Knee biomechanics and total knee replacement. , 1986, The Journal of arthroplasty.

[9]  M. Freeman,et al.  The Effect of Posterior Cruciate Ligament Deficiency on Knee Kinematics , 2004, The American journal of sports medicine.

[10]  A. Weiler,et al.  Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[11]  M. Pandy,et al.  Determinants of cruciate-ligament loading during rehabilitation exercise. , 1998, Clinical biomechanics.

[12]  M. Schwartz,et al.  A new method for estimating joint parameters from motion data. , 2004, Journal of biomechanics.

[13]  R. B. Davis,et al.  A gait analysis data collection and reduction technique , 1991 .

[14]  J Kärrholm,et al.  Three‐dimensional knee kinematics and stability in patients with a posterior cruciate ligament tear , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[15]  K. Webster,et al.  Dynamic joint loading following hamstring and patellar tendon anterior cruciate ligament reconstruction , 2004, Knee Surgery, Sports Traumatology, Arthroscopy.

[16]  E S Growney,et al.  Comparison of Intersegmental Tibiofemoral Joint Forces and Muscle Activity During Various Closed Kinetic Chain Exercises , 1996, The American journal of sports medicine.

[17]  A. Lindstrand,et al.  Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients. , 1999, The Journal of orthopaedic and sports physical therapy.

[18]  B. Vanwanseele,et al.  Posterior cruciate ligament deficiency: biomechanical and biological consequences and the outcomes of conservative treatment. A systematic review. , 2008, Journal of science and medicine in sport.

[19]  S Toksvig-Larsen,et al.  Validation of a functional method for the estimation of hip joint centre location. , 1999, Journal of biomechanics.

[20]  F. Noyes,et al.  Posterior tibial subluxation of the posterior cruciate-deficient knee. , 1992, Clinical orthopaedics and related research.

[21]  T. Gill,et al.  In Vivo Elongation of the Anterior Cruciate Ligament and Posterior Cruciate Ligament during Knee Flexion , 2004, The American journal of sports medicine.

[22]  T. Gill,et al.  Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[23]  E. Chao,et al.  Posterior Cruciate Ligament Rupture Alters In Vitro Knee Kinematics , 2002, Clinical orthopaedics and related research.

[24]  A Leardini,et al.  Cruciate ligament forces in the human knee during rehabilitation exercises. , 2000, Clinical biomechanics.

[25]  Glenn S. Fleisig,et al.  KNEE BIOMECHANICS DURING REHABILITATION EXERCISES , 2001 .

[26]  T. Gill,et al.  In Vivo Function of the Posterior Cruciate Ligament during Weightbearing Knee Flexion , 2004, The American journal of sports medicine.

[27]  D. Winter,et al.  Overall principle of lower limb support during stance phase of gait. , 1980, Journal of biomechanics.

[28]  Thomas P Andriacchi,et al.  Mechanical loads at the knee joint during deep flexion , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[29]  G. Fleisig,et al.  A Comparison of Tibiofemoral Joint Forces and Electromyographic Activit During Open and Closed Kinetic Chain Exercises , 1996, The American journal of sports medicine.

[30]  G. Salem,et al.  Bilateral kinematic and kinetic analysis of the squat exercise after anterior cruciate ligament reconstruction. , 2003, Archives of physical medicine and rehabilitation.

[31]  M. Axe,et al.  1998 Basmajian Student Award Paper: Movement patterns after anterior cruciate ligament injury: a comparison of patients who compensate well for the injury and those who require operative stabilization. , 1998, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[32]  M. Axe,et al.  Laxity, instability, and functional outcome after ACL injury: copers versus noncopers. , 1999, Medicine and science in sports and exercise.

[33]  L. Snyder-Mackler,et al.  The Relationship Between Passive Joint Laxity and Functional Outcome After Anterior Cruciate Ligament Injury , 1997, The American journal of sports medicine.

[34]  H. Tullos,et al.  Posterior cruciate function following total knee arthroplasty. A biomechanical study. , 1994, The Journal of arthroplasty.

[35]  K. Shelbourne,et al.  The Natural History of Acute, Isolated, Nonoperatively Treated Posterior Cruciate Ligament Injuries , 1999, The American journal of sports medicine.

[36]  B. Tietjens,et al.  Long-Term Followup of the Untreated Isolated Posterior Cruciate Ligament-Deficient Knee , 1996, The American journal of sports medicine.

[37]  D. D’Lima,et al.  Anatomical Posterior Cruciate Ligament Transplantation , 2006, The American journal of sports medicine.