Effects of Quadriceps and Hamstrings Ratio on ACL Strain During Landing Activities

2012 ◽  
Author(s):  
Carmen E. Quatman ◽  
Ata M. Kiapour ◽  
Ali Kiapour ◽  
Jason W. Levine ◽  
Samuel C. Wordeman ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
The United States ◽  
Implant Design ◽  
Reconstruction Technique ◽  
Fe Model ◽  
Acl Injuries

Over 100,000 anterior cruciate ligament (ACL) injuries occur annually in the United States [1]. Of these, 70% are classified as non-contact, many of which occur subsequent to a landing from a jump [2]. While most agree that quadriceps (Q) and hamstrings (H) have a significant contribution in knee biomechanics, the role of quadriceps and hamstrings muscle loads and their ratio (Q/H) in ACL injury remains controversial. Understanding muscle recruitment in high risk activities may improve our knowledge of ACL injury mechanisms. Such insight may improve current prevention strategies to decrease the risk of ACL injury and damage to secondary anatomical structures, all of which may in turn minimize associated posttraumatic knee osteoarthritis. As in vivo quantification of muscle loads remains challenging, especially under dynamic conditions, validated finite element (FE) models of the knee can be used to characterize the role of muscle loads in ACL injury. FE analysis has provided considerable insight into knee joint biomechanics, including ligament function, ligament reconstruction technique and implant design. This study utilized a validated FE model of the knee joint to study the effects of quadriceps to hamstrings ratio (Q/H) on ACL strain during a simulated landing from a jump. We hypothesized that both the ratio and magnitude of muscle loads are critical determinants of ACL loading. Further, a threshold may be reached as the magnitude of quadriceps load exceeds hamstrings load.

Detailed Cadaveric Simulation of Landing Reveals Timing Sequence of Multi-Planar Knee Kinematics: Implications for ACL Injury

2013 ◽  
Author(s):  
A. M. Kiapour ◽  
C. E. Quatman ◽  
V. K. Goel ◽  
S. C. Wordeman ◽  
T. E. Hewett ◽  
...  
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Acl Injury ◽  
The United States ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Acl Injuries ◽  
Cadaveric Simulation ◽  
Tibial Translation

Over 120,000 anterior cruciate ligament (ACL) injuries occur annually in the United States, mainly affecting the young athletic population. Non-contact injuries are reported to be the predominant mechanism of ACL injury (>70% of ACL injuries), which often occur during landing with high ground reaction forces, muscle forces and segmental inertia. An improved understanding of the mechanisms underlying non-contact ACL injury and inciting events can be used to improve current prevention strategies and decrease the risk of early-onset osteoarthritis. Previous biomechanical and video analysis studies have demonstrated that anterior tibial translation (ATT), knee valgus and internal tibial rotation (ITR) are associated with non-contact ACL injuries [1–3]. While the effects of these factors on ACL injury risk have been extensively studied, there is still controversy and debate about the timing in which these motions occur and reach maximum values during a jump landing task. The current study aimed to investigate interactions between tibio-femoral joint kinematics and ACL strain through a detailed cadaveric simulation of the knee biomechanical response during landing from a jump. For this purpose, instrumented cadaveric limbs were used to simulate bi-pedal landing following a jump utilizing a novel testing apparatus.

scholarly journals Validation of Noncontact Anterior Cruciate Ligament Tears Produced by a Mechanical Impact Simulator Against the Clinical Presentation of Injury

2018 ◽  
Vol 46 (9) ◽  
pp. 2113-2121 ◽  
Author(s):  
Nathaniel A. Bates ◽  
Nathan D. Schilaty ◽  
Christopher V. Nagelli ◽  
Aaron J. Krych ◽  
Timothy E. Hewett
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Rotation ◽  
Peak Strain ◽  
Injury Patterns ◽  
Acl Injuries ◽  
Mechanical Impact ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are catastrophic events that affect athletic careers and lead to long-term degenerative knee changes. As injuries are believed to occur within the first 50 milliseconds after initial contact during a rapid deceleration task, impact simulators that rapidly deliver impulse loads to cadaveric specimens have been developed. However, no impactor has reproducibly and reliably created ACL injures in a distribution that mimics clinical observation. Purpose: To better understand ACL injury patterns through a cadaveric investigation that applied in vivo–measured external loads to the knee during simulated landings. Study Design: Controlled laboratory study. Methods: A novel mechanical impact simulator reproduced kinetics from in vivo–recorded drop landing tasks on 45 cadaveric knees. Specimens were exposed to a randomized order of variable knee abduction moment, anterior tibial shear, and internal tibial rotation loads before the introduction of an impulse load at the foot. This process was repeated until a hard or soft tissue injury was induced on the joint. Injuries were assessed by an orthopaedic surgeon, and ligament strain was recorded by implanted strain gauges. Results: The mechanical impact simulator induced ACL injuries in 87% of specimens, with medial collateral ligament (MCL) injuries in 31%. ACL tear locations were 71% femoral side, 21% midsubstance, and 9% tibial side. Peak strain before failure for ACL-injured specimens was 15.3% ± 8.7% for the ACL and 5.1% ± 5.6% for the MCL ( P < .001). Conclusion: The ACL injuries induced by the mechanical impact simulator in the present study have provided clinically relevant in vitro representations of in vivo ACL injury patterns as cited in the literature. Additionally, current ligament strains corroborate the literature to support disproportionate loading of the ACL relative to the MCL during athletic tasks. Clinical Relevance: These findings indicate that the mechanical impact simulator is an appropriate model for examining independent mechanical variables, treatment techniques, and preventive interventions during athletic tasks leading up to and including an ACL injury. Accordingly, this system can be utilized to further parse out contributing factors to an ACL injury as well as assess the shortcomings of ACL reconstruction techniques in a dynamic, simulated environment that is better representative of in vivo injury scenarios.

Quadriceps Control: A Key Factor in Coping With Anterior Cruciate Ligament Deficiency

2003 ◽  
Author(s):  
Glenn N. Williams ◽  
Peter J. Barrance ◽  
Lynn Snyder-Mackler ◽  
Thomas S. Buchanan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Activity Patterns ◽  
Neuromuscular Control ◽  
Acl Injury ◽  
The United States ◽  
Circular Statistics ◽  
Return To Sports ◽  
Acl Injuries ◽  
Anterior Cruciate

Approximately 250,000 anterior cruciate ligament (ACL) injuries occur in the United States each year. Most people cannot return to sports after an ACL injury without surgical intervention (Non-copers), but some can (Copers). Recent research suggests that the ability to cope with ACL injury is most likely related to neuromuscular function. The purpose of this study was to evaluate the neuromuscular control strategies of ACL deficient (ACL-D) Non-copers, ACL-D Copers, and people with uninjured knees using an established target-matching protocol, electromyography (EMG) of 10 muscles acting at the knee, and circular statistics methods. Thirty-two people (12 Non-Copers, 8 Copers, and 12 people without a history of knee injury) volunteered to participate in the study. The ACL-D subjects demonstrated diminished neuromuscular control when their muscle activity patterns were compared to those of the uninjured subjects. The key difference between the Copers and Non-copers was that Copers demonstrated better quadriceps control than the Non-copers. This study may have important implications for the treatment of people who sustain ACL injuries.

Development of a Failure Locus for a 3-Dimensional Anterior Crutiate Ligament: A Finite Element Analysis

2011 ◽  
Author(s):  
A. Orsi ◽  
N. H. Yang ◽  
A. Vaziri ◽  
P. K. Canavan ◽  
H. N. Hashemi
Keyword(s):  
Finite Element ◽  
Knee Joint ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Joint Orientation ◽  
Element Analysis ◽  
3 Dimensional ◽  
Failure Locus

This study investigated movement combinations which may cause injury to the anterior cruciate ligament (ACL). A 3-Dimensional finite element knee joint model, including bones and ligament bundles, was developed. Bone was modeled as rigid, and a transversely isotropic material was applied to the ligament structures. This study incorporates a novel approach for developing bundle specific prestrain within the ligament structures. The bundles were stretched from their zero load lengths to their reference lengths, producing a strain field mimicking in vivo conditions at full knee extension. A failure locus was created by performing multiple knee joint motion combination simulations until ligament failure. The locus shows which movement combinations of internal/external femoral rotation and varus/valgus angle cause failure within the ACL bundles at 25° of knee flexion. The 3D model provided improved accuracy for locating bundle ruptures. By monitoring stresses and strains within the ligament bundles during knee joint orientation simulations, ruptures were virtually diagnosed. The relationship between knee joint orientation and ligament rupture provides a spectrum for the propensity of ACL injury. The results highlight femoral external rotation relative to the tibia as an important factor related to ACL injury. The results also show the posterolateral bundle to be more susceptible to rupture than the anteromedial bundle. These results have various clinical applications. In sports where ACL injuries are prevalent, training programs can be adapted to address the avoidance of harmful knee orientations. Monitoring bundle rupture locations also increases insight for practitioners in identifying more precise injury mechanisms.

scholarly journals In Vitro Functional Verification of a Novel Laxity Measurement Stress Radiography Device

2018 ◽  
Author(s):  
Giancarlo L. Beukes ◽  
Sarthak Patnaik ◽  
Sudesh Sivarasu
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
The United States ◽  
Functional Verification ◽  
Collateral Ligament ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Rapid Deceleration

The human knee is a hinge joint, primarily facilitating locomotion. Knee joint instability, due to ligament injuries (anterior cruciate ligament [ACL], posterior cruciate ligament [PCL], medial collateral ligament [MCL] and lateral collateral ligament [LCL]), is a result of direct or indirect trauma, non-anatomical stresses during pivoting movements about the knee, imbalanced landing during jumping and rapid deceleration during high intensity locomotion [1]. Biomechanical indications of an unstable knee joint include decreased joint integrity, hyper laxity, abrupt locking and catching combined with clicking noises during locomotion. Approximately, two hundred and fifty thousand ACL injuries occur in the United States of America, annually [2].

scholarly journals MR imaging of anterio cruciate ligament injuries

2017 ◽  
Vol 5 (11) ◽  
pp. 4980
Author(s):  
Nilesh H. Chaudhari ◽  
Rounak R. Bagga ◽  
Zoya M. Patni
Keyword(s):  
Mr Imaging ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Associated Injuries ◽  
Acl Injuries ◽  
Partial Tear ◽  
Magnetic Resonance Imaging Mri

Background: Of all the ligaments of the knee joint the Anterior cruciate ligament (ACL) is the most commonly injured. It is an important pillar of the ligament stabilization of knee joint preventing anterior translation of Tibia over Fibula. Magnetic resonance imaging (MRI) is an excellent modality providing fine-resolution and multiplanar imaging without any radiation, for detection and evaluation of ACL injury with the associated injuries to other ligaments of the knee join. The purpose of the work was to study the role of MRI in classifying the ACL injuries.Methods: MRI Knee of 162 patients with ACL injuries was studied. All the MR imaging scans were performed on 1.5-T MR system (Siemens magnetom Essenza).Results: A total of 162 patients were studied in which majority of them i.e. 43 patients had interstitial sprain, 38 patients had complete tear, 33 patients had mucoid degeneration, 27 had partial tear and 14 had high grade partial tear, however 7 patients had normal ACL. There were associated injuries to the other ligaments of the knee joint along with ACL injury, medial meniscus tear being the most common and was seen in 39.50% followed by lateral meniscus tear in 9.87%, MCL tear in 6.79%, LCL tear in 1.85% and PCL tear in 2.46 %.Conclusions: MRI is a good modality for classifying ACL injury and evaluation of injuries to the associated ligaments.

Anterior Cruciate Ligament (ACL) Injury: A Literature Review

2017 ◽  
Author(s):  
Jazmin Aguilar ◽  
James Yang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
The United States ◽  
Acl Injuries ◽  
Highly Active ◽  
Preventative Measures ◽  
Active Lifestyles ◽  
Anterior Cruciate ◽  
Injury Research

Anterior Cruciate Ligament (ACL) injuries occur often in competitive sports such as soccer, basketball, football, and more. Athletes of all ages are at risk of experiencing this injury due to living highly active lifestyles. ACL injuries account for over $500 million in total medial cost in the United States, with about 150,000 annual occurrences of injury. Much research over this knee injury has been conducted as early as 1850, but confirmation of definite mechanisms of ACL injury have proved to be a difficult endeavor due to conflicting results found from experiments. Solving this problem could lead to implementation of preventative measures to help reduce to number of victims that undergo ACL injuries. The intention of this paper is to review the state-of-the-art of ACL injury research, including possible mechanisms of injury and the experimental methods used to analyze ACL performance.

scholarly journals Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1035
Author(s):  
Eva-Maria Winkelmeyer ◽  
Justus Schock ◽  
Lena Marie Wollschläger ◽  
Philipp Schad ◽  
Marc Sebastian Huppertz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Joint Stability ◽  
Anatomic Landmarks ◽  
Human Knee Joint ◽  
Custom Made ◽  
Tibial Translation

While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.

Measuring Strain Distributions in the Anterior Cruciate Ligament Using Ultrasound

2010 ◽  
Author(s):  
Amy Cochran ◽  
Yingxin Gao ◽  
Ursula Krotscheck ◽  
Margret Thompson ◽  
James Stouffer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Strategies ◽  
Acl Injury ◽  
Physiological Factors ◽  
Detailed Understanding ◽  
Prevention And Treatment ◽  
Anterior Cruciate ◽  
Tissue Motion

Optimal prevention and treatment strategies of anterior cruciate ligament (ACL) injury can be realized with a detailed understanding of how physiological factors impact the ACL. A noninvasive, in vivo method that assesses the ACL’s mechanical integrity is needed to help clarify this multi-factorial pathophysiology. We investigated the use of the noninvasive, in vivo technique, ultrasound strain elastography (USE) (1), to distinguish between normal and injured ACLs. USE is used as a diagnostic tool in oncological (2), hepatic (3), and cardiovascular (4) applications. This technique uses ultrasonic RF data to track tissue motion in order to estimate strain within the tissue.

Experiences of returning to elite alpine skiing after ACL injury and ACL reconstruction

2014 ◽  
Vol 26 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Birgitta Nordahl ◽  
Rita Sjöström ◽  
Maria Westin ◽  
Suzanne Werner ◽  
Marie Alricsson
Keyword(s):  
High School Students ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Alpine Skiing ◽  
Structured Interviews ◽  
School Students ◽  
Physical Ability ◽  
Acl Injuries ◽  
Elite Level ◽  
Passive Strategies

Abstract Aim: To explore the experiences of alpine skiing at the elite level after anterior cruciate ligament (ACL) injury and reconstruction. Design: A qualitative approach where semi-structured interviews were conducted, and an analysis of the manifest content was performed. Participants: Five ski high school students, two male and three female skiers, who had suffered ACL injuries and undergone ACL reconstructions. Results: Seven categories were identified. The participants described their perceived opportunities with regard to returning to alpine skiing after ACL injury and reconstruction as something positive to do with self-belief, being mentally and physically prepared, regaining confidence in their own ability, being given time and using active strategies. In contrast, perceived barriers to a return to elite alpine skiing gave rise to negative feelings, for example, fear, disheartenment, a total lack of or ambivalent confidence in their own ability and the use of passive strategies. Conclusion: The two male skiers returned to alpine skiing. They reported confidence in their own ability, active strategies and support on all levels, as well as enhanced physical ability. The female skiers did not return to their pre-injury level of competitive alpine skiing. They stated a lack of support on all levels, deterioration in their physical ability and two out of three reported passive strategies and no or ambivalent confidence in their own ability. The most important factors were family support, support on all levels, access to a physiotherapist and time given.

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