Anterior Cruciate Ligament Loading Increases With Pivot-Shift Mechanism During Asymmetrical Drop Vertical Jump in Female Athletes

Ryo Ueno, Alessandro Navacchia, Nathan D Schilaty, Gregory D Myer, Timothy E Hewett, Nathaniel A Bates, Ryo Ueno, Alessandro Navacchia, Nathan D Schilaty, Gregory D Myer, Timothy E Hewett, Nathaniel A Bates

Abstract

Background: Frontal plane trunk lean with a side-to-side difference in lower extremity kinematics during landing increases unilateral knee abduction moment and consequently anterior cruciate ligament (ACL) injury risk. However, the biomechanical features of landing with higher ACL loading are still unknown. Validated musculoskeletal modeling offers the potential to quantify ACL strain and force during a landing task.

Purpose: To investigate ACL loading during a landing and assess the association between ACL loading and biomechanical factors of individual landing strategies.

Study design: Descriptive laboratory study.

Methods: Thirteen young female athletes performed drop vertical jump trials, and their movements were recorded with 3-dimensional motion capture. Electromyography-informed optimization was performed to estimate lower limb muscle forces with an OpenSim musculoskeletal model. A whole-body musculoskeletal finite element model was developed. The joint motion and muscle forces obtained from the OpenSim simulations were applied to the musculoskeletal finite element model to estimate ACL loading during participants' simulated landings with physiologic knee mechanics. Kinematic, muscle force, and ground-reaction force waveforms associated with high ACL strain trials were reconstructed via principal component analysis and logistic regression analysis, which were used to predict trials with high ACL strain.

Results: The median (interquartile range) values of peak ACL strain and force during the drop vertical jump were 3.3% (-1.9% to 5.1%) and 195.1 N (53.9 to 336.9 N), respectively. Four principal components significantly predicted high ACL strain trials, with 100% sensitivity, 78% specificity, and an area of 0.91 under the receiver operating characteristic curve (P < .001). High ACL strain trials were associated with (1) knee motions that included larger knee abduction, internal tibial rotation, and anterior tibial translation and (2) motion that included greater vertical and lateral ground-reaction forces, lower gluteus medius force, larger lateral pelvic tilt, and increased hip adduction.

Conclusion: ACL loads were higher with a pivot-shift mechanism during a simulated landing with asymmetry in the frontal plane. Specifically, knee abduction can create compression on the posterior slope of the lateral tibial plateau, which induces anterior tibial translation and internal tibial rotation.

Clinical relevance: Athletes are encouraged to perform interventional and preventive training to improve symmetry during landing.

Keywords: ACL; finite element; knee; landing; strain.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: The authors acknowledge funding from the National Institutes of Health (grants R01AR049735, R01AR056259, R01AR055563, K12HD065987, and L30AR070273). A.N. is an employee of Smith & Nephew. G.D.M. has received royalties from Human Kinetics and Wolters Kluwer and has a patent pending. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
Work flow of the computational modeling to estimate ligament loading during the drop vertical jump, in which individual landing strategies were maintained. Joint motion and muscle forces were estimated using electromyography-informed optimization in OpenSim simulation. Joint motion was inputted to first finite element (FE) simulation to simulate the same landing and obtain nodal coordinates of knee and ankle joint center positions. To simulate more physiologic knee joint mechanics, the joint center position was kinematically driven, and muscle forces from OpenSim simulation were applied in the second FE simulation. Black arrows on the joint center indicate kinematically driven degrees of freedom (DOF). Inferosuperior DOF on the ankle joint were unconstrained to apply vertical ground-reaction force (GRF), whereas rotation on the transverse plane was kinematically driven to track toe direction. The pelvis was kinematically driven with 6 DOF motion according to OpenSim simulation. This allows hip internal/external rotation as well as knee abduction/adduction and 3 DOF translations to be unconstrained and dependent on muscle force, joint contact force, and GRF for physiologic simulation.
Figure 2.
Figure 2.
Median, interquartile range, and representative trials of (A) high and low ACL strain and (B) ACL force. Time zero indicates time of the initial contact to the ground. ACL, anterior cruciate ligament.
Figure 3.
Figure 3.
ROC curve of the 4 principal components that predicted high anterior cruciate ligament strain trials with 100% sensitivity, 78% specificity, and an area of 0.91 under the ROC curve. ROC, receiver operating characteristic.
Figure 4.
Figure 4.
Mean (thin), high ACL strain (thick), and low ACL strain (dashed) waveforms of (A) knee flexion, (B) knee abduction, (C) knee external rotation, (D) lateral tibial translation, (E) anterior tibial translation, and (F) inferior tibial translation reconstructed from the 4 principal components that significantly predicted high ACL strain trials. Time zero indicates initial contact to the ground. ACL, anterior cruciate ligament.
Figure 5.
Figure 5.
Mean (thin), high ACL strain (thick), and low ACL strain (dashed) waveforms of (A) lateral pelvic tilt, (B) hip adduction, (C) hip internal rotation, (D) vertical ground-reaction force (GRF), (E) lateral GRF, and (F) gluteus medius force  (from fiber 2; see Appendix for all 3 fibers) reconstructed from the 4 principal components that significantly predicted high ACL strain trials. Time zero indicates initial contact to the ground. ACL, anterior cruciate ligament.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8226378/bin/10.1177_2325967121989095-fig6.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8226378/bin/10.1177_2325967121989095-fig7.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8226378/bin/10.1177_2325967121989095-fig8.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8226378/bin/10.1177_2325967121989095-fig9.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8226378/bin/10.1177_2325967121989095-fig10.jpg

References

    1. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39(3):538–543.
    1. Bates NA, Mejia Jaramillo MC, Vargas M, et al. External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings. Clin Biomech (Bristol, Avon). 2019;61:84–94.
    1. Bates NA, Myer GD, Hale RF, Schilaty ND, Hewett TE. Prospective frontal plane angles used to predict ACL strain and identify those at high risk for sports-related ACL injury. Orthop J Sports Med. 2020;8(10):2325967120957646
    1. Bates NA, Schilaty ND, Krych AJ, Hewett TE. Influence of relative injury risk profiles on anterior cruciate ligament and medial collateral ligament strain during simulated landing leading to a noncontact injury event. Clin Biomech (Bristol, Avon). 2019;69:44–51.
    1. Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Multiplanar loading of the knee and its influence on anterior cruciate ligament and medial collateral ligament strain during simulated landings and noncontact tears. Am J Sports Med. 2019;47(8):1844–1853.
    1. Bates NA, Schilaty ND, Ueno R, Hewett TE. Timing of strain response of the ACL and MCL relative to impulse delivery during simulated landings leading up to ACL failure. J Appl Biomech. Published online April 22, 2020. doi:10.1123/jab.2019-0308
    1. Boden BP, Dean GS, Feagin JA, Garrett WE. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23(6):573–578.
    1. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2006;87(11):1428–1435.
    1. Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS. Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech. 1992;25(5):511–518.
    1. Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943–2950.
    1. Cram JR, Kasman GS, Holtz J. Introduction to Surface Electromyography. Aspen Publishers; 1998.
    1. Englander ZA, Baldwin EL, Smith WAR, Garrett WE, Spritzer CE, DeFrate LE. In vivo anterior cruciate ligament deformation during a single-legged jump measured by magnetic resonance imaging and high-speed biplanar radiography. Am J Sports Med. 2019;47(13):3166–3172.
    1. Englander ZA, Garrett WE, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography. J Biomech. 2020;98:109443.
    1. Fleming BC, Renstrom PA, Beynnon BD, et al. The effect of weightbearing and external loading on anterior cruciate ligament strain. J Biomech. 2001;34(2):163–170.
    1. Ford KR, Myer GD, Schmitt LC, Uhl TL, Hewett TE. Preferential quadriceps activation in female athletes with incremental increases in landing intensity. J Appl Biomech. 2011;27(3):215–222.
    1. Fujie H, Otsubo H, Fukano S, et al. Mechanical functions of the three bundles consisting of the human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2011;19(suppl_1):47–53.
    1. Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34(9):1512–1532.
    1. Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105(2):136–144.
    1. Groote FD, Pipeleers G, Jonkers I, et al. A physiology based inverse dynamic analysis of human gait: potential and perspectives. Comput Methods Biomech Biomed Engin. 2009;12(5):563–574.
    1. Halloran JP, Ackermann M, Erdemir A, van den Bogert AJ. Concurrent musculoskeletal dynamics and finite element analysis predicts altered gait patterns to reduce foot tissue loading. J Biomech. 2010;43(14):2810–2815.
    1. Hewett TE, Bates NA. Preventive biomechanics: a paradigm shift with a translational approach to injury prevention. Am J Sports Med. 2017;45(11):2654–2664.
    1. Hewett TE, Ford KR, Xu YY, Khoury J, Myer GD. Effectiveness of neuromuscular training based on the neuromuscular risk profile. Am J Sports Med. 2017;45(9):2142–2147.
    1. Hewett TE, Ford KR, Xu YY, Khoury J, Myer GD. Utilization of ACL injury biomechanical and neuromuscular risk profile analysis to determine the effectiveness of neuromuscular training. Am J Sports Med. 2016;44(12):3146–3151.
    1. Hewett TE, Myer GD. The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury. Exerc Sport Sci Rev. 2011;39(4):161–166.
    1. Hewett TE, Myer GD, Ford KR, 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. Am J Sports Med. 2005;33(4):492–501.
    1. Hume DR, Navacchia A, Ali AA, Shelburne KB. The interaction of muscle moment arm, knee laxity, and torque in a multi-scale musculoskeletal model of the lower limb. J Biomech. 2018;76:173–180.
    1. Hume DR, Navacchia A, Rullkoetter PJ, Shelburne KB. A lower extremity model for muscle-driven simulation of activity using explicit finite element modeling. J Biomech. 2019;84:153–160.
    1. Jackson DA. Stopping rules in principal components analysis: a comparison of heuristical and statistical approaches. Ecology. 1993;74(8):2204–2214.
    1. Kanamori A, Woo SL, Ma CB, et al. The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: a human cadaveric study using robotic technology. Arthroscopy. 2000;16(6):633–639.
    1. Kiapour AM, Quatman CE, Goel VK, Wordeman SC, Hewett TE, Demetropoulos CK. Timing sequence of multi-planar knee kinematics revealed by physiologic cadaveric simulation of landing: implications for ACL injury mechanism. Clin Biomech (Bristol, Avon). 2014;29(1):75–82.
    1. Koga H, Nakamae A, Shima Y, et al. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball. Am J Sports Med. 2010;38(11):2218–2225.
    1. Laughlin WA, Weinhandl JT, Kernozek TW, Cobb SC, Keenan KG, O’Connor KM. The effects of single-leg landing technique on ACL loading. J Biomech. 2011;44(10):1845–1851.
    1. Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. 1995;13(6):930–935.
    1. Martelli S, Calvetti D, Somersalo E, Viceconti M. Stochastic modelling of muscle recruitment during activity. Interface Focus. 2015;5(2):20140094.
    1. Matsumoto H. Mechanism of the pivot shift. J Bone Joint Surg Br. 1990;72(5):816–821.
    1. Mokhtarzadeh H, Ewing K, Janssen I, Yeow C-H, Brown N, Lee PVS. The effect of leg dominance and landing height on ACL loading among female athletes. J Biomech. 2017;60:181–187.
    1. Mokhtarzadeh H, Yeow CH, Hong Goh JC, Oetomo D, Malekipour F, Lee PV-S. Contributions of the soleus and gastrocnemius muscles to the anterior cruciate ligament loading during single-leg landing. J Biomech. 2013;46(11):1913–1920.
    1. Naghibi H, Mazzoli V, Gijsbertse K, et al. A noninvasive MRI based approach to estimate the mechanical properties of human knee ligaments. J Mech Behav Biomed Mater. 2019;93:43–51.
    1. Navacchia A, Bates NA, Schilaty ND, Krych AJ, Hewett TE. Knee abduction and internal rotation moments increase ACL force during landing through the posterior slope of the tibia. J Orthop Res. 2019;37(8):1730–1742.
    1. Navacchia A, Hume DR, Rullkoetter PJ, Shelburne KB. A computationally efficient strategy to estimate muscle forces in a finite element musculoskeletal model of the lower limb. J Biomech. 2019;84:94–102.
    1. Navacchia A, Ueno R, Ford KR, DiCesare CA, Myer GD, Hewett TE. EMG-informed musculoskeletal modeling to estimate realistic knee anterior shear force during drop vertical jump in female athletes. Ann Biomed Eng. 2019;47(12):2416–2430.
    1. Omi Y, Sugimoto D, Kuriyama S, et al. Effect of hip-focused injury prevention training for anterior cruciate ligament injury reduction in female basketball players: a 12-year prospective intervention study. Am J Sports Med. 2018;46(4):852–861.
    1. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):1567–1573.
    1. Rajagopal A, Dembia CL, DeMers MS, Delp DD, Hicks JL, Delp SL. Full-body musculoskeletal model for muscle-driven simulation of human gait. IEEE Trans Biomed Eng. 2016;63(10):2068–2079.
    1. Sartori M, Llyod DG, Farina D. Neural data-driven musculoskeletal modeling for personalized neurorehabilitation technologies. IEEE Trans Biomed Eng. 2016;63(5):879–893.
    1. Schilaty ND, Bates NA, Krych AJ, Hewett TE. Frontal plane loading characteristics of medial collateral ligament strain concurrent with anterior cruciate ligament failure. Am J Sports Med. 2019;47(9):2143–2150.
    1. Schilaty ND, Bates NA, Nagelli C, Krych AJ, Hewett TE. Sex-based differences in knee kinetics with anterior cruciate ligament strain on cadaveric impact simulations. Orthop J Sports Med. 2018;6(3):2325967118761037.
    1. Sugimoto D, Myer GD, Foss KDB, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. Br J Sports Med. 2015;49(5):282–289.
    1. Ueno R, Ishida T, Yamanaka M, et al. Quadriceps force and anterior tibial force occur obviously later than vertical ground reaction force: a simulation study. BMC Musculoskelet Disord. 2017;18(1):467.
    1. Ueno R, Navacchia A, Bates NA, Schilaty ND, Krych AJ, Hewett TE. Analysis of internal knee forces allows for the prediction of rupture events in a clinically relevant model of anterior cruciate ligament injuries. Orthop J Sports Med. 2020;8(1):2325967119893758.
    1. Ueno R, Navacchia A, DiCesare CA, et al. Knee abduction moment is predicted by lower gluteus medius force and larger vertical and lateral ground reaction forces during drop vertical jump in female athletes. J Biomech. 2020;103:109669.
    1. Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217–225.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi