ACL Injury Mechanism is Related to Articular Pressure Distribution: A Cadaveric and Finite Element Investigation

2012 ◽  
Author(s):  
Ata M. Kiapour ◽  
Constantine K. Demetropoulos ◽  
Ali Kiapour ◽  
Carmen E. Quatman ◽  
Jason W. Levine ◽  
...  
Keyword(s):  
Finite Element ◽  
Pressure Distribution ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
High Rate ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Injury Mechanisms ◽  
Anterior Cruciate

Acute anterior cruciate ligament (ACL) injury can be devastating, and often results in clinical sequelae that include meniscal tears, chondral lesions and osteoarthritis. Various bone bruise patterns of the femur or tibia, and bone contusions of the lateral tibial plateau have been associated in more than 80% of partial or complete ACL ruptures [1]. As quantification of articular cartilage pressure distribution under high-rate loading conditions remains challenging, validated finite element (FE) models of the knee can be used to characterize the effects of different loading parameters on tibiofemoral (TF) joint pressure distribution. This study combines high-rate cadaveric experiments with FE analysis to simulate ACL injuries and associated bone bruise patterns following landing from a jump. We hypothesized that a potential relationship exists between ACL injury mechanisms and resultant tibial plateau bone bruise patterns. This relationship may enhance our understanding of ACL injury mechanisms, which may provide insight to improve current prevention strategies that aim to decrease the risk of ACL injury and damage to secondary anatomical structures. All of this may in turn minimize associated posttraumatic knee osteoarthritis.

scholarly journals Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You’re asking the wrong question

2020 ◽  
Vol 6 (1) ◽  
pp. e000778 ◽  
Author(s):  
Aaron Fox ◽  
Jason Bonacci ◽  
Samantha Hoffmann ◽  
Sophia Nimphius ◽  
Natalie Saunders
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Early Years ◽  
High Rate ◽  
Acl Injuries ◽  
Sports Science ◽  
Australian Football ◽  
Women And Girls ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women’s Australian Football League (AFLW), eliciting headlines of a ‘knee crisis’ surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football (AF) as being dangerous predominantly due to female biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of women and girls in the sport. We propose that an approach addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of women in AF, and question how to address inequities for the benefit of the athletes.

scholarly journals An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging

2021 ◽  
pp. 036354652110171
Author(s):  
Lukas Willinger ◽  
Kiron K. Athwal ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Acl Transection

Background: Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. Purpose: To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone–patellar tendon–bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). Results: The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT ( P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test ( P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. Conclusion: This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. Clinical Relevance: This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.

Failure Locus of the Anterior Cruciate Ligament Disruption at 25° Knee Flexion: 3D Finite Element Analysis

2010 ◽  
Author(s):  
Andrew Homyk ◽  
Paul K. Canavan ◽  
Alexander Orsi ◽  
Story Wibby ◽  
Nicholas Yang ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Element Analysis ◽  
Acl Injuries ◽  
Fea Model ◽  
Failure Locus ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) disruption is a common injury that is detrimental to an athlete’s quality of life. Determining the mechanisms that cause ACL injury is important in order to develop proper interventions. This study was conducted to provide insight into the specific knee orientations associated with ACL injuries. A failure locus for the ACL was developed by simulating multiple loading scenarios using a 3-D finite element analysis (FEA) model of the knee. The results indicated varus and valgus were more dominant to the ACL injury compared to femoral rotation. The order of MCL failure, ACL failure, and maximum meniscus stress was also determined with respect to time during loading. The results of this study could be used to develop training programs focused on the avoidance of the described combination of movements, which may lead to ACL injury.

scholarly journals Barriers to Predicting the Mechanisms and Risk Factors of Non-Contact Anterior Cruciate Ligament Injury

2010 ◽  
Vol 4 (1) ◽  
pp. 178-189 ◽  
Author(s):  
Nicholas Ali ◽  
Gholamreza Rouhi
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Contributing Factors ◽  
Acl Injuries ◽  
Hand Search ◽  
Injury Mechanisms ◽  
Anterior Cruciate

High incidences of non-contact anterior cruciate ligament (ACL) injury, frequent requirements for ACL reconstruction, and limited understanding of ACL mechanics have engendered considerable interest in quantifying the ACL loading mechanisms. Although some progress has been made to better understand non-contact ACL injuries, information on how and why non-contact ACL injuries occur is still largely unavailable. In other words, research is yet to yield consensus on injury mechanisms and risk factors. Biomechanics, video analysis, and related study approaches have elucidated to some extent how ACL injuries occur. However, these approaches are limited because they provide estimates, rather than precise measurements of knee - and more specifically ACL - kinematics at the time of injury. These study approaches are also limited in their inability to simultaneously capture many of the contributing factors to injury. This paper aims at elucidating and summarizing the key challenges that confound our understanding in predicting the mechanisms and subsequently identifying risk factors of non-contact ACL injury. This work also appraise the methodological rigor of existing study approaches, review testing protocols employed in published studies, as well as presents a possible coupled approach to better understand injury mechanisms and risk factors of non-contact ACL injury. Three comprehensive electronic databases and hand search of journal papers, covering numerous full text published English articles were utilized to find studies on the association between ACL and injury mechanisms, ACL and risk factors, as well as, ACL and investigative approaches. This review unveils that new research modalities and/or coupled research methods are required to better understand how and why the ACL gets injured. Only by achieving a better understanding of ACL loading mechanisms and the associated contributing factors, one will be able to develop robust prevention strategies and exercise regimens to mitigate non-contact ACL injuries.

scholarly journals Comparison Between Soccer and Basketball of Bone Bruise and Meniscal Injury Patterns in Anterior Cruciate Ligament Injuries

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199584
Author(s):  
Huijuan Shi ◽  
Li Ding ◽  
Yanfang Jiang ◽  
Haocheng Zhang ◽  
Shuang Ren ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Lateral Side ◽  
Bone Bruise ◽  
Meniscal Injury ◽  
Injury Patterns ◽  
Acl Injuries ◽  
Medial Side ◽  
Bone Bruises ◽  
Injury Mechanisms ◽  
Anterior Cruciate

Background: The varying effectiveness of anterior cruciate ligament (ACL) injury prevention programs between soccer and basketball may be due to differences in sport-specific injury mechanisms. Bone bruise patterns may provide information regarding injury mechanisms. Purpose: To compare bone bruise and meniscal injury patterns for ACL injuries sustained in soccer versus basketball. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Clinical notes, operative reports, and magnetic resonance imaging scans were reviewed for patients who sustained a noncontact ACL rupture while playing soccer or basketball between August 2016 and August 2018. The presence, location, and signal intensity of bone bruises on the tibia and femur were documented, and patterns were classified according to the location of the bone bruise in the lateral-medial direction. The meniscal and bone bruise injury patterns and the specific bone bruise locations were compared between the soccer and basketball groups. Results: Overall, 138 patients were included (56 with soccer-related and 82 with basketball-related ACL injury). No significant difference between the groups was observed in bone bruise patterns ( P = .743) or meniscal injury patterns ( P = .952). Bone bruise on the lateral side only of both the femur and the tibia was the most common pattern in both soccer (41.9%) and basketball (47.0%) groups; the most common meniscal injury type was an isolated lateral meniscal injury in both soccer (50.0%) and basketball (45.0%) groups. For patients with bone bruises on both the lateral and the medial sides of both the femur and the tibia (BF+BT), the bone bruise signal intensity on the lateral side of the femur ( P < .001) and tibia ( P = .009) was significantly higher than that on the medial side for both groups. The bone bruises on the lateral side of the femur ( P < .001) and tibia ( P = .002) were significantly more anterior than those on the medial side for patients with the BF+BT pattern. Conclusion: No significant differences in bone bruise location or meniscal injury type were detected when comparing ACL injuries sustained during soccer versus basketball. The study results suggest a similar biomechanical loading pattern for ACL injuries in these sports.

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

2021 ◽  
pp. 194173812110295
Author(s):  
Patrick Ward ◽  
Peter Chang ◽  
Logan Radtke ◽  
Robert H. Brophy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Study Design: Clinical review. Level of Evidence: Level 4. Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. Strength of Recommendation Taxonomy: 2.

scholarly journals No Association Between Risk of Anterior Cruciate Ligament Rupture and Selected Candidate Collagen Gene Variants in Female Elite Athletes From High-Risk Team Sports

2018 ◽  
Vol 47 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Einar Andreas Sivertsen ◽  
Kari Bente Foss Haug ◽  
Eirik Klami Kristianslund ◽  
Anne-Marie Siebke Trøseid ◽  
Jari Parkkari ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Elite Athletes ◽  
Cruciate Ligament ◽  
Team Sports ◽  
Acl Injury ◽  
Acl Rupture ◽  
Acl Injuries ◽  
Genes Encoding ◽  
Anterior Cruciate

Background: Several single-nucleotide variants (SNVs) in collagen genes have been reported as predisposing factors for anterior cruciate ligament (ACL) tears. However, the evidence is conflicting and does not support a clear association between genetic variants and risk of ACL ruptures. Purpose: To assess the association of previously identified candidate SNVs in genes encoding for collagen and the risk of ACL injury in a population of elite female athletes from high-risk team sports. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 851 female Norwegian and Finnish elite athletes from team sports were included from 2007 to 2011. ACL injuries acquired before inclusion in the cohort were registered by interview. The participants were followed prospectively through 2015 to record new complete ACL injuries. Six selected SNVs were genotyped ( COL1A1: rs1800012, rs1107946; COL3A1: rs1800255; COL5A1: rs12722, rs13946; COL12A1: rs970547). Results: No associations were found between ACL rupture and the SNVs tested. Conclusion: The study does not support a role of the 6 selected SNVs in genes encoding for collagen proteins as risk factors for ACL injury. Clinical Relevance: Genetic profiling to identify athletes at high risk for ACL rupture is not yet feasible.

scholarly journals Should females play Australian football? You’re asking the wrong question…

2020 ◽  
Author(s):  
Aaron Fox ◽  
Jason Bonacci ◽  
Samantha Hoffmann ◽  
Sophia Nimphius ◽  
Natalie Saunders
Keyword(s):  
Gender Stereotypes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Early Years ◽  
High Rate ◽  
Sociocultural Factors ◽  
Acl Injuries ◽  
Sports Science ◽  
Australian Football League ◽  
Australian Football

Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women’s Australian Football League (AFLW) – eliciting headlines of a “knee crisis” surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football as being dangerous for females due to their biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of females in the sport. We propose that that a framework addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of female Australian football, and question how to address inequities for the benefit of the athletes.

scholarly journals Anterior Cruciate ligament injuries of the knee:

2018 ◽  
Vol 30 (1) ◽  
pp. 1-6
Author(s):  
G Linde Strauss ◽  
D Janse van Rensburg ◽  
C Grant ◽  
A Jansen van Rensburg ◽  
M Velleman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Mechanism Of Injury ◽  
Mri Scan ◽  
Chi Square ◽  
Valgus Stress ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate

Abstract Background and problem statement Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries. Aim To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries. Methods This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified. Results MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury. Conclusion Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public.  Key words Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.

scholarly journals The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

2015 ◽  
Vol 50 (6) ◽  
pp. 589-595 ◽  
Author(s):  
Darin A. Padua ◽  
Lindsay J. DiStefano ◽  
Anthony I. Beutler ◽  
Sarah J. de la Motte ◽  
Michael J. DiStefano ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Screening Tool ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Receiver Operator Characteristic ◽  
Acl Injuries ◽  
Youth Soccer ◽  
Jump Landing ◽  
Anterior Cruciate

Context Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics. Objective To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population. Design Cohort study. Setting Field-based functional movement screening performed at soccer practice facilities. Patients or Other Participants A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age. Intervention(s) Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up). Main Outcome Measure(s) Landings were scored for “errors” in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed. Results Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = −2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%. Conclusions Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.

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