Statistical modelling of knee valgus during a continuous jump test

Landing with the knee in a valgus position is recognized as a risk factor for anterior cruciate ligament (ACL) injury. Using linear and non-linear regression analyses, the purpose of this study was to examine the correlation between two-dimensional (2D) knee valgus and three-dimensional (3D) knee kinematics measured during a jump landing task. Twenty-eight female collegiate athletes participated. All participants were required to perform a continuous jump test. The average maximum angles of abduction and internal tibial rotation during landing were measured using the Point Cluster Technique. Average peak knee valgus angle was measured using a 2D approach. Linear and non-linear regression analyses between 2D valgus and 3D knee abduction, and between 2D valgus and 3D internal tibial rotation, were performed. The R ² value between 2D valgus and 3D knee abduction was significantly different from zero and had a moderate correlation for all models, whereas the R ² value between 2D valgus and 3D internal tibial rotation was not significantly different from zero. The 2D approach could be used to screen a specific group of individuals for risk of ACL injury; however, using frontal plane 2D analysis of valgus motion to evaluate internal tibial rotation is not advised.     

Correlation of axial impact forces with knee joint forces and kinematics during simulated ski-landing

Anterior cruciate ligament (ACL) rupture, during ski-landing, is caused by excessive knee joint forces and kinematics, like anterior tibial translation, internal tibial rotation, and valgus rotation. It is not well understood how these forces/kinematics are directly related to ski-landing impact. In the present study, we applied simulated ski-landing impact to knee specimens, and examined joint force/kinematic responses and their correlations with impact force. Ten human cadaveric knees were subjected to axial impact loading at 70° of flexion to simulate ski-landing impact. Impact was repeated with incremental magnitude until ACL failure. Axial impact forces, anterior-posterior and medial-lateral tibial forces were measured using a tri-axial load cell. Anterior-posterior tibial translation, internal-external tibial rotation, and valgus-varus rotation were determined using a motion-capture system. We found positive correlations of axial impact force with anterior tibial force, medial tibial force, anterior tibial translation, internal tibial rotation, and valgus joint rotation. Axial impact forces were more strongly correlated with anterior tibial forces (R(2) = 0.937 ± 0.050), anterior tibial translation (R(2) = 0.916 ± 0.059), and internal tibial rotation (R(2) = 0.831 ± 0.141) than medial tibial force (R(2) = 0.677 ± 0.193) and valgus joint rotation (R(2) = 0.630+0.271). During ski-landing, these joint forces/kinematics can synergistically act to increase ACL injury risk, whereby the failure mechanism would be dominated by anterior tibial forces, anterior tibial translation, and internal tibial rotation.     

Relationship between three-dimensional kinematics of knee and trunk motion during shuttle run cutting

Female athletes are considered to exhibit knee and trunk motion that is characteristic of anterior cruciate ligament (ACL) injury. The aim of this study was to examine the in vivo motion of the trunk and knee during a cutting manoeuvre and determine the relationship between them. All participants (10 male and 10 female college athletes) performed a shuttle run cutting task with the left limb. Trunk inclination (forward and lateral) and knee joint angles (flexion/extension, abduction/adduction, and internal/external tibial rotation) were calculated. Differences between the sexes and associations between knee motion and trunk inclination were examined. An increase in trunk forward inclination was strongly correlated with an increase in knee flexion angle and moderately correlated with a decrease in the excursion of internal tibial rotation. An increase in right trunk lateral inclination was moderately correlated with an increase in excursion of internal tibial rotation. The results also showed differences between the sexes in trunk forward inclination, lateral inclination, and knee flexion angle, but no such differences in knee abduction or internal tibial rotation. Trunk inclination is related to knee flexion and excursion of internal tibial rotation. Female athletes demonstrate a low trunk forward inclination and knee flexion angle, a posture that resembles that of ACL injury.     

The relationship between performance of a single-leg squat and leap landing task: moving towards a netball-specific anterior cruciate ligament (ACL) injury risk screening method

ABSTRACT

Field-based screening methods have a limited capacity to identify high-risk postures during netball-specific landings associated with anterior cruciate ligament (ACL) injuries. This study determined the biomechanical relationship between a single-leg squat and netball-specific leap landing, to examine the utility of including a single-leg squat within netball-specific ACL injury risk screening. Thirty-two female netballers performed single-leg squat and netball-specific leap landing tasks, during which three-dimensional (3D) kinematic/kinetic data were collected. One-dimensional statistical parametric mapping examined relationships between kinematics from the single-leg squat, and the 3D joint rotation and moment data from leap landings. Participants displaying reduced hip external rotation, reduced knee flexion, and greater knee abduction and knee internal rotation angles during the single-leg squat exhibited these same biomechanical characteristics during the leap landing (p < 0.001). Greater ankle dorsiflexion during the single-leg squat was associated with greater knee flexion during landing (p < 0.001). Ankle eversion during the single-leg squat was associated with frontal and transverse plane knee biomechanics during landing (p < 0.001). Biomechanics from the single-leg squat were associated with landing strategies linked to ACL loading or injury risk, and thus may be a useful movement screen for identifying netball players who exhibit biomechanical deficits during landing.     

Relationship between three-dimensional kinematics of knee and trunk motion during shuttle run cutting

Abstract

Female athletes are considered to exhibit knee and trunk motion that is characteristic of anterior cruciate ligament (ACL) injury. The aim of this study was to examine the in vivo motion of the trunk and knee during a cutting manoeuvre and determine the relationship between them. All participants (10 male and 10 female college athletes) performed a shuttle run cutting task with the left limb. Trunk inclination (forward and lateral) and knee joint angles (flexion/extension, abduction/adduction, and internal/external tibial rotation) were calculated. Differences between the sexes and associations between knee motion and trunk inclination were examined. An increase in trunk forward inclination was strongly correlated with an increase in knee flexion angle and moderately correlated with a decrease in the excursion of internal tibial rotation. An increase in right trunk lateral inclination was moderately correlated with an increase in excursion of internal tibial rotation. The results also showed differences between the sexes in trunk forward inclination, lateral inclination, and knee flexion angle, but no such differences in knee abduction or internal tibial rotation. Trunk inclination is related to knee flexion and excursion of internal tibial rotation. Female athletes demonstrate a low trunk forward inclination and knee flexion angle, a posture that resembles that of ACL injury.     

Correlation of axial impact forces with knee joint forces and kinematics during simulated ski-landing

Abstract

Anterior cruciate ligament (ACL) rupture, during ski-landing, is caused by excessive knee joint forces and kinematics, like anterior tibial translation, internal tibial rotation, and valgus rotation. It is not well understood how these forces/kinematics are directly related to ski-landing impact. In the present study, we applied simulated ski-landing impact to knee specimens, and examined joint force/kinematic responses and their correlations with impact force. Ten human cadaveric knees were subjected to axial impact loading at 70° of flexion to simulate ski-landing impact. Impact was repeated with incremental magnitude until ACL failure. Axial impact forces, anterior-posterior and medial-lateral tibial forces were measured using a tri-axial load cell. Anterior-posterior tibial translation, internal-external tibial rotation, and valgus-varus rotation were determined using a motion-capture system. We found positive correlations of axial impact force with anterior tibial force, medial tibial force, anterior tibial translation, internal tibial rotation, and valgus joint rotation. Axial impact forces were more strongly correlated with anterior tibial forces (R ² = 0.937 ± 0.050), anterior tibial translation (R ² = 0.916 ± 0.059), and internal tibial rotation (R ² = 0.831 ± 0.141) than medial tibial force (R ² = 0.677 ± 0.193) and valgus joint rotation (R ² = 0.630+0.271). During ski-landing, these joint forces/kinematics can synergistically act to increase ACL injury risk, whereby the failure mechanism would be dominated by anterior tibial forces, anterior tibial translation, and internal tibial rotation.     

The effects of an unanticipated side-cut on lower extremity kinematics and ground reaction forces during a drop landing

Unanticipated direction to cut after landing may alter the lower extremity landing biomechanics when performing landing motions. These alterations may potentially increase the risk of ACL injury. The purpose of this study was to determine if an unanticipated side-cut affects lower extremity landing biomechanics in females. Eighteen recreational female athletes participated in two blocks of testing: the first block of testing consisted of three acceptable trials of anticipated dominant limb and non-dominant limb 45-degree diagonal cutting after landing, which were performed in a counterbalanced order. The second block of testing consisted of three acceptable trials of unanticipated dominant limb and non-dominant limb diagonal cutting after landing. Data analysis mainly focused on the dominant limb landing biomechanics. Unanticipated side-cut landing, compared (paired t-test, p < 0.05) to the anticipated landings, resulted in less hip abduction and tibial internal rotation angle at initial contact (IC) and a lower maximum ankle inversion angle and a greater maximum knee abduction angle, and knee and hip displacement. Also, greater posterior GRF and a longer time to peak medial GRF were exhibited. These outcomes indicate that athletes may adapt their landing mechanics to land unsafely when encountering an unanticipated event.     

Mid-flight lateral trunk bending increased ipsilateral leg loading during landing: a center of mass analysis

Increased lateral trunk bending to the injured side has been observed when ACL injuries occur. The purpose was to quantify the effect of mid-flight lateral trunk bending on center of mass (COM) positions and subsequent landing mechanics during a jump-landing task. Forty-one recreational athletes performed a jump-landing task with or without mid-flight lateral trunk bending. When the left and right trunk bending conditions were compared with the no trunk bending condition, participants moved the COM of the upper body to the bending direction, while the COM of the pelvis, ipsilateral leg, and contralateral leg moved away from the bending direction relative to the whole body COM. Participants demonstrated increased peak vertical ground reaction forces (VGRF) and knee valgus and internal rotation angles at peak VGRF for the ipsilateral leg, but decreased peak VGRF and knee internal rotation angles at peak VGRF and increased knee varus angles at peak VGRF for the contralateral leg. Mid-flight lateral trunk resulted in an asymmetric landing pattern associated with increased ACL loading for the ipsilateral leg. The findings may help to understand altered trunk motion during ACL injury events and the discrepancy in ACL injuries related to limb dominance in badminton and volleyball.     

Sport-specific biomechanical responses to an ACL injury prevention programme: A randomised controlled trial

Anterior cruciate ligament (ACL) injury prevention programmes have not been as successful at reducing injury rates in women’s basketball as in soccer. This randomised controlled trial (ClinicalTrials.gov #NCT02530333) compared biomechanical adaptations in basketball and soccer players during jump-landing activities after an ACL injury prevention programme. Eighty-seven athletes were cluster randomised into intervention (6-week programme) and control groups. Three-dimensional biomechanical analyses of drop vertical jump (DVJ), double- (SAG-DL) and single-leg (SAG-SL) sagittal, and double- (FRONT-DL) and single-leg (FRONT-SL) frontal plane jump landing tasks were tested before and after the intervention. Peak angles, excursions, and joint moments were analysed using two-way MANCOVAs of post-test scores while controlling for pre-test scores. During SAG-SL the basketball intervention group exhibited increased peak knee abduction angles (p = .004) and excursions (p = .003) compared to the basketball control group (p = .01) and soccer intervention group (p = .01). During FRONT-SL, the basketball intervention group exhibited greater knee flexion excursion after training than the control group (p = .01), but not the soccer intervention group (p = .11). Although women’s soccer players exhibit greater improvements in knee abduction kinematics than basketball players, these athletes largely exhibit similar biomechanical adaptations to ACL injury prevention programmes.     

Gender differences in lower limb frontal plane kinematics during landing

The aim of this study was to investigate gender differences in knee valgus angle and inter-knee and inter-ankle distances in university volleyball players when performing opposed block jump landings. Six female and six male university volleyball players performed three dynamic trials each for which they were instructed to jump up and block a volleyball suspended above a net set at the height of a standard volleyball net as it was spiked against them by an opposing player. Knee valgus/varus, inter-knee distance, and inter-ankle distance (absolute and relative to height) were determined during landing using three-dimensional motion analysis. Females displayed significantly greater maximum valgus angle and range of motion than males. This may increase the risk of ligament strain in females compared with males. Minimum absolute inter-knee distance was significantly smaller, and absolute and relative inter-knee displacement during landing significantly greater, in females than males. Both absolute and relative inter-ankle displacement during landing was significantly greater in males than females. These findings suggest that the gender difference in the valgus angle of the knee during two-footed landing is influenced by gender differences in the linear movement of the ankles as well as the knees. Coaches should therefore develop training programmes to focus on movement of both the knee and ankle joints in the frontal plane in order to reduce the knee valgus angle during landing, which in turn may reduce the risk of non-contact anterior cruciate ligament injury.     

Effect of gender on trunk and pelvis control during lateral movements with perturbed landing

In lateral reactive movements, core stability may influence knee and hip joint kinematics and kinetics. Insufficient core stabilisation is discussed as a major risk factor for anterior cruciate ligament (ACL) injuries. Due to the higher probability of ACL injuries in women, this study concentrates on how gender influences trunk, pelvis and leg kinematics during lateral reactive jumps (LRJs). Perturbations were investigated in 12 men and 12 women performing LRJs under three different landing conditions: a movable landing platform was programmed to slide, resist or counteract upon landing. Potential group effects on three-dimensional trunk, pelvic, hip and knee kinematics were analysed for initial contact (IC) and the time of peak pelvic medial tilt (PPT). Regardless of landing conditions, the joint excursions in the entire lower limb joints were gender-specific. Women exhibited higher trunk left axial rotation at PPT (women: 4.0 ± 7.5°, men: ?3.1 ± 8.2°; p = 0.011) and higher hip external rotation at both IC and PPT (p < 0.01). But women demonstrated higher knee abduction compared to men. Men demonstrated more medial pelvic tilt at IC and especially PPT (men: –5.8 ± 4.9°, women: 0.3 ± 6.3°; p = 0.015). Strategies for maintaining trunk, pelvis and lower limb alignment during lateral reactive movements were gender-specific; the trunk and hip rotations displayed by the women were associated with the higher knee abduction amplitudes and therefore might reflect a movement strategy which is associated with higher injury risk. However, training interventions are needed to fully understand how gender-specific core stability strategies are related to performance and knee injury.     

Gender differences in lower limb frontal plane kinematics during landing

The aim of this study was to investigate gender differences in knee valgus angle and inter-knee and inter-ankle distances in university volleyball players when performing opposed block jump landings. Six female and six male university volleyball players performed three dynamic trials each for which they were instructed to jump up and block a volleyball suspended above a net set at the height of a standard volleyball net as it was spiked against them by an opposing player. Knee valgus/varus, inter-knee distance, and inter-ankle distance (absolute and relative to height) were determined during landing using three-dimensional motion analysis. Females displayed significantly greater maximum valgus angle and range of motion than males. This may increase the risk of ligament strain in females compared with males. Minimum absolute inter-knee distance was significantly smaller, and absolute and relative inter-knee displacement during landing significantly greater, in females than males. Both absolute and relative inter-ankle displacement during landing was significantly greater in males than females. These findings suggest that the gender difference in the valgus angle of the knee during two-footed landing is influenced by gender differences in the linear movement of the ankles as well as the knees. Coaches should therefore develop training programmes to focus on movement of both the knee and ankle joints in the frontal plane in order to reduce the knee valgus angle during landing, which in turn may reduce the risk of non-contact anterior cruciate ligament injury.     

Frontal plane comparison between drop jump and vertical jump: implications for the assessment of ACL risk of injury

The potential to use the vertical jump (VJ) to assess both athletic performance and risk of anterior cruciate ligament (ACL) injury could have widespread clinical implications since VJ is broadly used in high school, university, and professional sport settings. Although drop jump (DJ) and VJ observationally exhibit similar lower extremity mechanics, the extent to which VJ can also be used as screening tool for ACL injury risk has not been assessed. This study evaluated whether individuals exhibit similar knee joint frontal plane kinematic and kinetic patterns when performing VJs compared with DJs. Twenty-eight female collegiate athletes performed DJs and VJs. Paired t-tests indicated that peak knee valgus angles did not differ significantly between tasks (p = 0.419); however, peak knee internal adductor moments were significantly larger during the DJ vs. VJ (p < 0.001). Pearson correlations between the DJ and VJ revealed strong correlations for knee valgus angles (r = 0.93, p < 0.001) and for internal knee adductor moments (r = 0.82, p < 0.001). Our results provide grounds for investigating whether frontal plane knee mechanics during VJ can predict ACL injuries and thus can be used as an effective tool for the assessment of risk of ACL injury in female athletes.     

Lower leg and foot contributions to turnout in female pre-professional dancers: A 3D kinematic analysis

Turnout is a central element of classical ballet which involves sustained external rotation of the lower limbs during dance movements. Lower leg and foot compensation mechanisms which are often used to increase turnout have been attributed to the high incidence of lower limb injury in dancers. Evaluation of dancers’ leg posture is needed to provide insight into the lower limb kinematic strategies used to achieve turnout. The primary purpose of this study was to use 3D kinematic analyses to determine the lower leg and foot compensations that are incorporated by female university dancers to accentuate their turnout. Active and passive external tibiofemoral rotation (TFR) was also measured. A moderate-strong negative relationship was observed between hip external rotation (HER) and foot abduction in the three first position conditions. A moderate negative relationship was found between passive TFR and foot abduction in all first position conditions. Our findings suggest dancers are more likely to pronate, than rotate the knee to compensate for limited HER. Dancers with a limited capacity to pronate may force additional rotation via the knee. Ongoing research would benefit from more in-depth analyses of the foot/ankle complex using a multi-segment foot model.     

乒乓球运动员膝关节损伤机制研究——对3种常用步法的膝关节负荷特征分析

目的:了解不同性别乒乓球运动员完成并步、跳步、跨步3种常用步法时膝关节的负荷特征,并探析乒乓球运动员膝关节的损伤机制。方法:对乒乓球男、女各10名运动员完成3种常用步法动作时的下肢运动学、动力学数据进行采集和处理,并运用方差分析法比较不同性别、不同技术之间的差异。结果:受试者在完成3种步法过程中,膝关节屈角大致范围在20°~60°。当地面反作用力最大时,女运动员比男运动员表现出更小的外展角(P<0.05),跳步比并步和跨步表现出更小的外展角(P<0.05);在三维受力方面,膝关节受到垂直方向上的力最大,水平向后和向左的力次之,未表现出显著的性别差异和技术差异;在三维力矩方面,膝关节受到的伸膝力矩较大,也未表现出显著的性别差异和技术差异。结论:膝关节屈曲状态下,较大的地面反作用力和膝关节外展角易导致乒乓球运动员前交叉韧带损伤,女运动员的损伤风险小于男运动员,跳步的损伤风险小于并步和跨步;水平向后和向左的力易造成乒乓球运动员软骨和半月板损伤;过大的伸膝力矩易导致乒乓球运动员髌腱末端病和髌骨软化。     

Knee loading patterns in a simulated netball landing task

Abstract

The knee is a common site of injury in netball players. In this study, 10 high-performance netball players underwent a biomechanical assessment of their single leg landing technique whilst receiving a pass. Three-dimensional video and ground reaction force data were recorded using a motion analysis system. Net internal knee joint moments were calculated using a rigid body analysis and inverse dynamics. The kinematics of the support leg and front-on video footage was used to investigate whether players adhered to guidelines on safe and effective landing strategies. Results indicated that for most players the internal valgus moment was the largest frontal plane knee moment during the landing phase. This may reflect a relatively greater need to resist varus knee excursion or may be related to the kinematics of the hip. For 6 of the 10 players the rapid change to an internal knee valgus moment coincided with hip adduction. Since an increase in the magnitude of the internal valgus moment may increase the compressive forces in the medial compartment of the knee, further work should be undertaken to determine if a neuromuscular training intervention to improve the strength of the hip musculature may be beneficial for these players. A large relative excursion of the knee compared to the hip may indicate that these players had a greater reliance on the more distal segments of the lower extremity for the attenuation of the ground reaction forces. This information may be used to better understand potential knee injury mechanisms in netball players.     

The effects of mid-flight whole-body and trunk rotation on landing mechanics: implications for anterior cruciate ligament injuries

ABSTRACT

The purpose was to quantify the effects of mid-flight whole-body and trunk rotation on knee mechanics in a double-leg landing. Eighteen male and 20 female participants completed a jump-landing-jump task in five conditions: no rotation, testing leg ipsilateral or contralateral (WBRC) to the whole-body rotation direction, and testing leg ipsilateral (TRI) or contralateral to the trunk rotation direction. The WBRC and TRI conditions demonstrated decreased knee flexion and increased knee abduction angles at initial contact (2.6 > Cohen’s dz > 0.3) and increased peak vertical ground reaction forces and knee adduction moments during the 100 ms after landing (1.7 > Cohen’s dz > 0.3). The TRI condition also showed the greatest knee internal rotation angles at initial contact and peak knee abduction and internal rotation angles and peak knee extension moments during the 100 ms after landing (2.0 > Cohen’s dz > 0.5). Whole-body rotation increased contralateral knee loading because of its primary role in decelerating medial-lateral velocities. Trunk rotation resulted in the greatest knee loading for the ipsilateral knee due to weight shifting and mechanical coupling between the trunk and lower extremities. These findings may help understand altered trunk motion in anterior cruciate ligament injuries.     

膝关节损伤对排球运动员急停纵跳的影响

目的:对辽宁省排球队女运动员下肢急停纵跳落地时的力矩和最大关节角度进行研究,以期对有膝关节损伤的排球运动员进行科学训练提供参考。方法:以14名辽宁省排球队女运动员为研究对象,将运动员分为两组,其中无伤组8人,损伤组6人,采用三维测力平台和红外光电运动捕捉系统,记录受试者在完成急停纵跳动作落地时的髋关节、膝关节、踝关节的力矩以及最大关节角度数据。结果:在急停纵跳落地时,损伤膝关节的旋转、收展力矩大于无伤组,屈伸力矩小于无伤组,损伤组的髋关节的屈伸、收展、旋转力矩均大于无伤组;损伤组的踝关节旋转力矩小于无伤组,收展力矩和屈伸力矩大于无伤组。损伤组的踝关节在屈伸、收展和旋转时的最大关节角度大于无伤组;损伤组的膝关节在屈伸和收展时的最大关节角度大于无伤组,旋转时小于无伤组;损伤的髋关节屈伸和收展时的最大关节角度大于无伤组,髋关节旋转时的最大关节角度左侧小于无伤组,右侧大于无伤组。结论:膝关节损伤的运动员完成急停纵跳动作落地时,通过代偿性改变增大髋关节力矩、增加膝关节旋转和收展力矩,增大踝关节收展和屈伸力矩,增加膝关节和髋关节在屈伸和收展时活动角度,增加膝关节屈伸和收展时活动角度来完成动作。     

The effects of opposition and gender on knee kinematics and ground reaction force during landing from volleyball block jumps

The aim of this study was to examine the effect of opposition and gender on knee kinematics and ground reaction force during landing from a volleyball block jump. Six female and six male university volleyball players performed two landing tasks: (a) an unopposed and (b) an opposed volleyball block jump and landing. A 12-camera motion analysis system (120 Hz) was used to record knee kinematics, and a force platform (600 Hz) was used to record ground reaction force during landing. The results showed a significant effect for level of opposition in peak normalized ground reaction force (p = .04), knee flexion at ground contact (p = .003), maximum knee flexion (p = .001), and knee flexion range of motion (p = .003). There was a significant effect for gender in maximum knee flexion (p = .01), knee flexion range of motion (p = .001), maximum knee valgus angle (p = .001), and knee valgus range of motion (p = .001). The changes in landing biomechanics as a result of opposition suggest future research on landing mechanics should examine opposed exercises, because opposition may significantly alter neuromuscular responses.