scholarly journals Ankle-Dorsiflexion Range of Motion and Landing Biomechanics

2011 ◽  
Vol 46 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Chun-Man Fong ◽  
J. Troy Blackburn ◽  
Marc F. Norcross ◽  
Melanie McGrath ◽  
Darin A. Padua
Keyword(s):  
Range Of Motion ◽  
Knee Flexion ◽  
Injury Risk ◽  
Acl Injury ◽  
Ankle Dorsiflexion ◽  
Ground Reaction Forces ◽  
Knee Valgus ◽  
Landing Biomechanics ◽  
Reaction Forces ◽  
Acl Injury Risk

Abstract Context: A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion displacement and greater ground reaction forces, and greater ground reaction forces are associated with greater knee-valgus displacement. Additionally, restricted dorsiflexion range of motion (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Because large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. However, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics. Objective: To evaluate relationships between dorsiflexion ROM and landing biomechanics. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Thirty-five healthy, physically active volunteers. Intervention(s): Passive dorsiflexion ROM was assessed under extended-knee and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture system interfaced with a force plate. Main Outcome Measure(s): Dorsiflexion ROM was measured in degrees using goniometry. Knee-flexion and knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable. Results: Significant correlations were noted between extended-knee dorsiflexion ROM and knee-flexion displacement (r  =  0.464, P  =  .029) and vertical (r  =  −0.411, P  =  .014) and posterior (r  =  −0.412, P  =  .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus displacement were nonsignificant. Conclusions: Greater dorsiflexion ROM was associated with greater knee-flexion displacement and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and limiting the forces the lower extremity must absorb. These findings suggest that clinical techniques to increase plantar-flexor extensibility and dorsiflexion ROM may be important additions to ACL injury-prevention programs.

Examination of the Feasibility of a 2-Dimensional Portable Assessment of Knee Joint Stability: A Pilot Study

2020 ◽  
Vol 36 (6) ◽  
pp. 381-389
Author(s):  
Ryan Zerega ◽  
Carolyn Killelea ◽  
Justin Losciale ◽  
Mallory Faherty ◽  
Timothy Sell
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Initial Contact ◽  
Ground Reaction Forces ◽  
Joint Stability ◽  
Reaction Forces ◽  
Acl Injury Risk

Rupture of the anterior cruciate ligament (ACL) remains extremely common, with over 250,000 injuries annually. Currently, clinical tests have poor utility to accurately screen for ACL injury risk in athletes. In this study, the position of a knee marker was tracked in 2-dimensional planes to predict biomechanical variables associated with ACL injury risk. Three-dimensional kinematics and ground reaction forces were collected during bilateral, single-leg stop-jump tasks for 44 healthy male military personnel. Knee marker position data were extracted to construct 2-dimensional 95% prediction ellipses in each anatomical plane. Knee marker variables included: ellipse areas, major/minor axes lengths, orientation of ellipse axes, absolute ranges of knee position, and medial knee collapse. These variables were then used as predictor variables in stepwise multiple linear regression analyses for 7 biomechanical variables associated with ACL injury risk. Knee flexion excursion, normalized peak vertical ground reaction forces, and knee flexion angle at initial contact were the response variables that generated the highest adjusted R2 values: .71, .37, and .31, respectively. The results of this study provide initial support for the hypothesis that tracking a single marker during 2-dimensional analysis can accurately reflect the information gathered from 3-dimensional motion analysis during a task assessing knee joint stability.

Preliminary Evaluation of Knee Kinetics in Female Athletes on Hormonal Contraceptives

2019 ◽  
Vol 41 (02) ◽  
pp. 113-118
Author(s):  
Gabrielle Gilmer ◽  
Gretchen D. Oliver
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Acl Injury ◽  
Hormonal Contraceptives ◽  
Preliminary Evaluation ◽  
Knee Valgus ◽  
Time Points ◽  
Acl Injury Risk

AbstractRecently, an emphasis has been placed on understanding how ovarian sex hormones and hormonal contraceptives affect risk for anterior cruciate ligament (ACL) injury. The literature presents large discrepancies in whether or not hormonal contraceptives affect ACL injury risk; therefore, the purpose of this study was to evaluate whether vertical ground reaction force (GRF) and knee valgus force are different between athletes who do and do not use hormonal contraceptives. Twenty-two female athletes volunteered to participate and were divided into two groups based on their answers to a health history questionnaire: those who use hormonal contraceptives and those who do not. Participants performed a drop vertical jump (DVJ) and single leg crossover dropdown (SCD) at two different time points in their menstrual cycle (pre-ovulatory phase and mid-luteal phase). Kinetic data were collected at 1000 Hz. Independent samples t-tests revealed no significant differences between groups in vertical GRF and knee valgus force at both time points. Findings from this study suggest that hormonal contraceptives do not elicit detectable changes in vertical GRF and knee valgus force. Ultimately, this calls for further studies on the relationship between hormones and ACL injury risk and physicians to consider hormonal screening in addition to neuromuscular and biomechanical screening.

Concurrent Tactile Feedback Provided by a Simple Device Increased Knee Flexion and Decreased Impact Ground Reaction Forces During Landing

2016 ◽  
Vol 32 (3) ◽  
pp. 248-253 ◽  
Author(s):  
Boyi Dai ◽  
Mitchell L. Stephenson ◽  
Samantha M. Ellis ◽  
Michael R. Donohue ◽  
Xiaopeng Ning ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Low Cost ◽  
Cruciate Ligament ◽  
Tactile Feedback ◽  
Simple Device ◽  
Ground Reaction Forces ◽  
Knee Valgus ◽  
Peak Knee ◽  
Reaction Forces ◽  
Anterior Cruciate

Increased knee flexion and decreased knee valgus angles and decreased impact ground reaction forces (GRF) are associated with decreased anterior cruciate ligament (ACL) loading during landing. The purpose of this study was to determine the effect of tactile feedback provided by a simple device on knee flexion and valgus angles and impact GRF during landing. Kinematic and kinetic data were collected when 28 participants performed baseline, training, and evaluation jump-landing trials. During the training trials, the device was placed on participants’ shanks so that participants received tactile feedback when they reached a peak knee flexion angle of a minimum of 100°. During the evaluation trials, participants were instructed to maintain the movement patterns as they learned from the training trials. Participants demonstrated significantly (P < .008) increased peak knee flexion angles, knee flexion range of motion during early landing (first 100 ms of landing) and stance time, decreased impact posterior and vertical GRF during early landing and jump height, and similar knee valgus angles during the evaluation trials compared with the baseline trials. Immediately following training with tactile feedback, participants demonstrated landing patterns associated with decreased ACL loading. This device may have advantages in application because it provides low-cost, independent, and real-time feedback.

A Finite Element Analysis of a Subject Specific Single-Leg Drop Landing at Varied Heights

2011 ◽  
Author(s):  
Chi-Yin Tse ◽  
Hamid Nayeb-Hashemi ◽  
Ashkan Vaziri ◽  
Paul K. Canavan
Keyword(s):  
Knee Flexion ◽  
Reaction Force ◽  
Acl Injury ◽  
Ground Reaction Forces ◽  
Vertical Ground Reaction Force ◽  
Element Analysis ◽  
Drop Landing ◽  
Subject Specific ◽  
Reaction Forces ◽  
Vertical Ground

The pathomechanics of knee anterior cruciate ligament (ACL) injury related to the female athlete is of high interest due to the high incidence of injury compared to males participating in the same sport. The mechanisms of ACL injury are still not completely understood, but it is known that single-leg landings, stopping and cutting at high velocity are some of the non-contact mechanisms that are causing these injuries. This study analyzed a subject specific analysis of a single-leg drop landing that was performed by a female subject at 60%, 80% and 100% of her maximum vertical jump. The femur, tibia, articular cartilage, and menisci were modeled as 3-D structures and the data collected from the motion analysis was used to obtain the knee joint contact stresses in finite element analysis (FEA). The four major ligaments of the knee were modeled as non-linear springs. Material properties of previously published studies were used to define the soft tissue structures. The articular cartilage was defined as isotropic elastic and the menisci were defined as transverse isotropic elastic. Two different styles of single-leg landings were compared to one another, resembling landing from a basketball rebound. The first landing style, single-leg arms up (SLAU), produced larger knee flexion angles at peak ground reaction forces, while single-leg arms across (SLAX) landings produced higher peak vertical ground reaction forces along with lower knee flexion angles. The mean peak vertical ground reaction force was 2.9–3.5 bodyweight for SLAU landings, while they were 3.0–3.8 for SLAX landings. The time to peak vertical ground reaction force with SLAU landings were 69 ms (60%), 60 ms (80%), and 55 ms (100%); SLAX landings were 61 ms (60%), 61 ms (80%), and 51 ms (100%).

scholarly journals Expert Versus Novice Interrater Reliability and Criterion Validity of the Landing Error Scoring System

2010 ◽  
Vol 19 (1) ◽  
pp. 41-56 ◽  
Author(s):  
James Onate ◽  
Nelson Cortes ◽  
Cailee Welch ◽  
Bonnie Van Lunen
Keyword(s):  
Range Of Motion ◽  
Scoring System ◽  
Knee Flexion ◽  
Interrater Reliability ◽  
Assessment Tool ◽  
Outcome Measurement ◽  
Acl Injury ◽  
Initial Contact ◽  
Knee Valgus ◽  
Trunk Flexion

Context:A clinical assessment tool that would allow for efficient large-group screening is needed to identify individuals potentially at risk for anterior cruciate ligament (ACL) injury.Objective:To assess the criterion validity of a jumplanding assessment tool compared with 3-dimensional (3D) motion analysis and evaluate interrater reliability across an expert vs novice rater using the Landing Error Scoring System (LESS).Design:Validity protocol.Setting:Controlled, laboratory.Participants:Nineteen female (age 19.58 ± .84 y, height 1.67 ± .05 m, mass 63.66 ± 10.11 kg) college soccer athletes volunteered.Main Outcome Measurement:Interrater reliability between expert rater (5 y LESS experience) vs novice rater (no LESS experience). LESS scores across 13 items and total score. 3D lower extremity kinematics were reduced to dichotomous values to match LESS items.Interventions:Participants performed drop-box landings from a 30-cm height with standard video-camera and 3D kinematic assessment.Results:Intrarater item reliability, assessed by kappa correlation, between novice and experienced LESS raters ranged from moderate to excellent (κ = .459–.875). Overall LESS score, assessed by intraclass correlation coefficient, was excellent (ICC2,1 = .835, P < .001). Statistically significant phi correlation (P < .05) was found between rater and 3D scores for knee-valgus range of motion; however, percent agreement between expert rater and 3D scores revealed excellent agreement (range of 84–100%) for ankle flexion at initial contact, knee-flexion range of motion, trunk flexion at maximum knee flexion, and foot position at initial contact for both external and internal rotation of tibia. Moderate agreement was found between rater and 3D scores for trunk flexion at initial contact, stance width less than shoulder width, knee valgus at initial contact, and knee-valgus range of motion.Conclusions:Our findings support moderate to excellent validity and excellent expert vs novice interrater reliability of the LESS to accurately assess 3D kinematic motion patterns. Future research should evaluate the efficacy of the LESS to assess individuals at risk for ACL injury.

scholarly journals Lower Extremity Energy Absorption and Biomechanics During Landing, Part I: Sagittal-Plane Energy Absorption Analyses

2013 ◽  
Vol 48 (6) ◽  
pp. 748-756 ◽  
Author(s):  
Marc F. Norcross ◽  
Michael D. Lewek ◽  
Darin A. Padua ◽  
Sandra J. Shultz ◽  
Paul S. Weinhold ◽  
...  
Keyword(s):  
Energy Absorption ◽  
Injury Risk ◽  
Sagittal Plane ◽  
Frontal Plane ◽  
Acl Injury ◽  
Knee Extension ◽  
Landing Biomechanics ◽  
Anterior Tibial ◽  
Acl Injury Risk ◽  
Risk Potential

Context: Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. Objective: To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. Intervention(s): We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Main Outcome Measure(s): Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to compare male and female representation in the high and low groups. Results: The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P &lt; .05) and low (P &lt; .05) groups and greater anterior tibial shear force than the low group (P &lt; .05). No other group differences were noted. Women were not represented more than men in the high group (χ2 = 1.20, P = .27). Conclusions: Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

scholarly journals RELIABILITY OF A NEW LANDING ERROR SCORING SYSTEM: THE LESS-RMC

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Ryan S. Wexler ◽  
Sean Higinbotham ◽  
Danny Blake ◽  
Carlie Harrison ◽  
Justin Hollenbeck ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Scoring System ◽  
Injury Risk ◽  
Knee Injury ◽  
Assessment Tool ◽  
Acl Injury ◽  
Knee Valgus ◽  
Jump Landing ◽  
Acl Injury Risk ◽  
The Mean

BACKGROUND Several biomechanical deficits have been shown to increase non-contact knee injury risk of the anterior cruciate ligament (ACL). The Landing Error Scoring System (LESS) is a clinical assessment tool that has been successfully used to predict the individuals that are at a high risk for injury and evaluate changes in landing technique after participation in a neuromuscular preventive training program. The LESS-RT is a shortened version of the LESS and is a method to score landing technique without the use of video. The current study proposes a new tool for the evaluation of landing technique and ACL injury risk that blends the LESS and LESS-RT protocols but emphasizes the movement features that contribute to high knee valgus moments including movement asymmetry. The LESS-RMC (Rocky Mountain Consortium) consists of evaluating 11 comprehensive landing errors that are related to ACL injury risk. Consolidating questions pertaining to the opposite ends of joint motion such as “toe in” and “toe out” into “maximum foot rotation position” and adding a global asymmetry score were performed to reduce the time demands for evaluation yet capture the salient factors of the LESS; whereas the penalty for knee valgus severity was pulled from the LESS-RT but implemented for both knees in the new LESS-RMC to ultimately stratify knee injury risk during the jump landing task. The purpose of this study was to determine the reliability of the new LESS-RMC assessment tool. METHODS Thirty-seven, elite female soccer athletes (13.2 +/- 0.4 y) performed three drop-jumps from a height of 30 cm. Front and side views of the landing were recorded with digital video cameras. Movement quality was rated by 4 researchers evaluating 17 components of the landing with the LESS and a modified, 11 component version of the LESS (LESS-RMC). The 4 raters were novel to the evaluation of both scoring systems. Each rater was trained how to score each test and was instructed to evaluate the landing trials from the first 10 participants. After a group video review and discussion, the raters repeated the scoring procedures for the same 10 participants 48 hours after the original review. After another 48 hours, the raters evaluated the landing trials for all 37 participants (111 trials). Inter-rater reliability of the LESS and LESS-RMC were determined using the ICC (3,1) equations and the output from a two-way ANOVA (SPSS, version 25). RESULTS The mean LESS score was 6.45 +/- 0.55 (rater 1, 6.42; rater 2, 7.15; rater 3, 5.79; rater 4, 6.45). The ICC agreement between raters of scoring the LESS was .389 whereas the ICC agreement for the mean of the four raters was .718. The ICC for scoring consistency was .382 and Cronbach’s a was .735. The mean LESS-RMC score was 6.19 +/- 0.74 (rater 1, 5.65; rater 2, 6.99; rater 3, 5.48; rater 4, 6.64). The ICC agreement of scoring the LESS-RMC was .585 whereas the ICC agreement for the mean of the four raters was .849. The ICC for scoring consistency was .574 and Cronbach’s a was .884. CONCLUSION On average, the raters scored the LESS and the LESS-RMC with moderate reliability across the group of athletes. The LESS-RMC was scored with greater reliability than the LESS for this group of relatively novice raters. This is likely due to the simplification of the overall protocol in terms of quantity of questions, the ability of a novel rater to understand scenarios which elicit specific scores and the clear separation of body segments (e.g. hip and trunk flexion). In conjunction with this, it was reported by the raters that LESS-RMC was less redundant and more effective at assessing crucial aspects of a jump landing pattern. Overall, LESS RMC was objectively and subjectively more reliable and easier to use than the LESS for the four raters involved in this study. It is concluded that the LESS-RMC is a quick, easy and reliable clinical assessment tool that may be used to stratify individuals who may be at risk for ACL injury.

scholarly journals Stiff Landings Are Associated With Increased ACL Injury Risk in Young Female Basketball and Floorball Players

2016 ◽  
Vol 45 (2) ◽  
pp. 386-393 ◽  
Author(s):  
Mari Leppänen ◽  
Kati Pasanen ◽  
Urho M. Kujala ◽  
Tommi Vasankari ◽  
Pekka Kannus ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Injury Risk ◽  
Acl Injury ◽  
Young Female ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Acl Injuries ◽  
Increased Risk ◽  
Peak Knee ◽  
Acl Injury Risk

Background: Few prospective studies have investigated the biomechanical risk factors of anterior cruciate ligament (ACL) injury. Purpose: To investigate the relationship between biomechanical characteristics of vertical drop jump (VDJ) performance and the risk of ACL injury in young female basketball and floorball players. Study Design: Cohort study; Level of evidence, 3. Methods: At baseline, a total of 171 female basketball and floorball players (age range, 12-21 years) participated in a VDJ test using 3-dimensional motion analysis. The following biomechanical variables were analyzed: (1) knee valgus angle at initial contact (IC), (2) peak knee abduction moment, (3) knee flexion angle at IC, (4) peak knee flexion angle, (5) peak vertical ground-reaction force (vGRF), and (6) medial knee displacement. All new ACL injuries, as well as match and training exposure, were then recorded for 1 to 3 years. Cox regression models were used to calculate hazard ratios (HRs) and 95% CIs. Results: Fifteen new ACL injuries occurred during the study period (0.2 injuries/1000 player-hours). Of the 6 factors considered, lower peak knee flexion angle (HR for each 10° increase in knee flexion angle, 0.55; 95% CI, 0.34-0.88) and higher peak vGRF (HR for each 100-N increase in vGRF, 1.26; 95% CI, 1.09-1.45) were the only factors associated with increased risk of ACL injury. A receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.6 for peak knee flexion and 0.7 for vGRF, indicating a failed-to-fair combined sensitivity and specificity of the test. Conclusions: Stiff landings, with less knee flexion and greater vGRF, in a VDJ test were associated with increased risk of ACL injury among young female basketball and floorball players. However, although 2 factors (decreased peak knee flexion and increased vGRF) had significant associations with ACL injury risk, the ROC curve analyses revealed that these variables cannot be used for screening of athletes.

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