Optimizing whole-body kinematics to minimize valgus knee loading during sidestepping: implications for ACL injury risk.

The kinematic mechanisms associated with elevated externally applied valgus knee moments during non-contact sidestepping and subsequent anterior cruciate ligament (ACL) injury risk are not well understood. To address this issue, the residual reduction algorithm (RRA) in OpenSim was used to create nine subject-specific, full-body (37 degrees of freedom) torque-driven simulations of athletic males performing unplanned sidestep (UnSS) sport tasks. The RRA was used again to produce an optimized kinematic solution with reduced peak valgus knee torques during the weight acceptance phase of stance. Pre-to-post kinematic optimization, mean peak valgus knee moments were significantly reduced by 44.2 Nm (p=0.045). Nine of a possible 37 upper and lower body kinematic changes in all three planes of motion were consistently used during the RRA to decrease peak valgus knee moments. The generalized kinematic strategy used by all nine simulations to reduce peak valgus knee moments and subsequent ACL injury risk during UnSS was to redirect the whole-body center of mass medially, towards the desired direction of travel.

[1]  H. Borer.  The normal course of events , 2005 .

[2]  A. E. Patla,et al.  Online steering: coordination and control of body center of mass, head and body reorientation , 1999, Experimental Brain Research.

[3]  J. R. Scotti,et al.  Available From , 1973 .

[4]  A. Lindstrand,et al.  Soccer after anterior cruciate ligament injury--an incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players. , 1995, Acta orthopaedica Scandinavica.

[5]  A. Caraffa,et al.  In vivo anterior cruciate ligament strain behaviour during a rapid deceleration movement: case report , 2003, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  T. Hewett,et al.  Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms , 2011, The American journal of sports medicine.

[7]  Jonathan P. Walter,et al.  Decreased knee adduction moment does not guarantee decreased medial contact force during gait , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  At L Hof,et al.  Handling of impact forces in inverse dynamics. , 2006, Journal of biomechanics.

[9]  R J Johnson,et al.  The effect of weightbearing and external loading on anterior cruciate ligament strain. , 2001, Journal of biomechanics.

[10]  T. Hewett,et al.  NEUROMUSCULAR TRAINING IMPROVES PERFORMANCE AND LOWER‐EXTREMITY BIOMECHANICS IN FEMALE ATHLETES , 2005, Journal of strength and conditioning research.

[11]  T. Hewett,et al.  Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk , 2007, The American journal of sports medicine.

[12]  Antonie J van den Bogert,et al.  Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods. , 2008, Clinical biomechanics.

[13]  F.E. Zajac,et al.  An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures , 1990, IEEE Transactions on Biomedical Engineering.

[14]  D G Lloyd,et al.  Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football. , 2001, The Journal of orthopaedic and sports physical therapy.

[15]  Anthony G Schache,et al.  The effect of gait modification on the external knee adduction moment is reference frame dependent. , 2008, Clinical biomechanics.

[16]  Normal course of events amongst Swedish soccer players: an 8-year follow-up study. , 1990, British journal of sports medicine.

[17]  Jeffrey A. Reinbolt,et al.  Design of patient-specific gait modifications for knee osteoarthritis rehabilitation , 2007, IEEE Transactions on Biomedical Engineering.

[18]  T. Hewett,et al.  Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study , 2005, The American journal of sports medicine.

[19]  David G Lloyd,et al.  The effect of technique change on knee loads during sidestep cutting. , 2007, Medicine and science in sports and exercise.

[20]  Antonie J van den Bogert,et al.  Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: implications for ACL injury. , 2005, Clinical biomechanics.

[21]  Jeffrey A. Reinbolt,et al.  Simulation of human movement: applications using OpenSim , 2011 .

[22]  David G Lloyd,et al.  Training affects knee kinematics and kinetics in cutting maneuvers in sport. , 2010, Medicine and science in sports and exercise.

[23]  David G Lloyd,et al.  Repeatability of gait data using a functional hip joint centre and a mean helical knee axis. , 2003, Journal of biomechanics.

[24]  W. Dunn,et al.  Predictors of Activity Level 2 Years after Anterior Cruciate Ligament Reconstruction (ACLR) , 2010, The American journal of sports medicine.

[25]  Caroline Finch,et al.  A new framework for research leading to sports injury prevention. , 2006, Journal of science and medicine in sport.

[26]  Jeff R Houck,et al.  Comparison of frontal plane trunk kinematics and hip and knee moments during anticipated and unanticipated walking and side step cutting tasks. , 2006, Gait & posture.

[27]  Ayman Habib,et al.  OpenSim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement , 2007, IEEE Transactions on Biomedical Engineering.

[28]  S. McLean,et al.  Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. , 2004, Clinical biomechanics.

[29]  B. Boden,et al.  Mechanisms of anterior cruciate ligament injury. , 2000, Orthopedics.

[30]  Devin L Jindrich,et al.  A hypothesis for the function of braking forces during running turns. , 2006, Journal of biomechanics.

[31]  James A Ashton-Miller,et al.  The effect of an impulsive knee valgus moment on in vitro relative ACL strain during a simulated jump landing. , 2006, Clinical biomechanics.

[32]  T. Krosshaug,et al.  Mechanisms for Noncontact Anterior Cruciate Ligament Injuries , 2010, The American journal of sports medicine.

[33]  D. Lloyd,et al.  External loading of the knee joint during running and cutting maneuvers. , 2001, Medicine and science in sports and exercise.

[34]  T. Driscoll,et al.  High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model? , 2012, Scandinavian journal of medicine & science in sports.

[35]  Simon M Gianotti,et al.  Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. , 2009, Journal of science and medicine in sport.

[36]  David G Lloyd,et al.  Changing Sidestep Cutting Technique Reduces Knee Valgus Loading , 2009, The American journal of sports medicine.

[37]  K. Markolf,et al.  Combined knee loading states that generate high anterior cruciate ligament forces , 1995, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[38]  Jeffrey A. Reinbolt,et al.  Are Patient-Specific Joint and Inertial Parameters Necessary for Accurate Inverse Dynamics Analyses of Gait? , 2007, IEEE Transactions on Biomedical Engineering.

[39]  Ajay Seth,et al.  Muscle contributions to propulsion and support during running. , 2010, Journal of biomechanics.

[40]  Choongsoo S. Shin,et al.  Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. , 2011, Medicine and science in sports and exercise.

[41]  T. Hewett,et al.  Mechanisms of Anterior Cruciate Ligament Injury in Basketball , 2007, The American journal of sports medicine.

[42]  Hugh Seward,et al.  Characteristics of anterior cruciate ligament injuries in Australian football. , 2007, Journal of science and medicine in sport.

[43]  R. Cantu,et al.  Sport-Dependent Variations in Arm Position During Single-Limb Landing Influence Knee Loading: Implications for Anterior Cruciate Ligament InjuryChaudhari AM, Hearn BK, Andriacchi TP (Stanford Univ, Calif; Palo Alto Health Care System, Calif) Am J Sports Med 33:824–830, 2005§ , 2006 .

[44]  DivingWayne L. Wooten,et al.  Simulation of Human , 1996 .