ACL Injury

Changes in Gait Biomechanics Between Level and Downhill Walking Do Not Differ Between Those With Anterior Cruciate Ligament Reconstruction and Controls

Conflicting evidence exists regarding the presence of aberrant gait biomechanics more than one-year following anterior cruciate ligament reconstruction (ACLR). Overground walking may not elucidate differences in those further removed from surgery due to the unexacting nature of the task. Quadriceps dysfunction is common post-ACLR and contributes to aberrant gait biomechanics, thus downhill walking may exacerbate differences as this task places greater demands on the quadriceps. Purpose: To compare gait biomechanics between individuals with ACLR and healthy controls during level and downhill walking conditions. Methods: 24 individuals more than 1-year removed from ACLR and 24 healthy controls completed both level and downhill (10 degree grade) gait biomechanics assessments on an instrumented split-belt treadmill at their preferred walking speed. Peak variables were evaluated over the first 50% of stance including the vertical ground reaction force, internal knee extension and abduction moments and knee flexion angle. Moments were normalized to %body weight*height (%BW*Ht) and vGRF was normalized to %body weight. Dependent variables were compared across groups and conditions via two-way repeated measures ANCOVAs controlling for gait speed. Results: There were no significant condition*group interaction effects nor group main effects for any outcomes. However, there were significant condition increases in knee extension moment (P=0.020) and knee flexion angle (P=0.018) from level to downhill. Conclusions: Downhill walking necessitates larger knee extension moments and knee flexion angle compared to level gait. Our results suggest that changes in gait biomechanics between level and downhill conditions do not differ between individuals with ACLR >1 year post-reconstruction and controls.
Listed In: Biomechanics, Gait, Orthopedic Research

Does Type of Unanticipated Stimulus Alter Knee Mechanics During Dynamic Tasks?

Noncontact ACL injuries occur during movements that involve sudden decelerations and changes in direction due to combined sagittal and frontal plane knee loading. Previous studies have shown altered knee mechanics when decision-making is involved, which may better simulate game-like scenarios in a lab setting. The purpose of this study was to determine how two unanticipated stimuli alter knee biomechanics during a dynamic task. Eight females and eight males, all recreationally-active, participated. Participants completed two unanticipated 45-degree cutting conditions (visual stimulus (VS); human defensive opponent (DO)). For the VS condition, a custom computer program presented one of three visual stimuli in a random order. For the DO condition, a research assistant attempted to “block” the participant’s running path with a defensive move, using the same three random-order tasks as in VS. For both conditions, participants had a reaction time range of 400-500 milliseconds. Separate 2×2 mixed-model repeated measures ANOVAs (condition×sex) were performed, with an alpha level of .05. Results showed a significant condition main effect for knee extension moments, which were greater in DO compared to VS (p=.009). Significant interactions were present for peak knee flexion angles and peak knee adduction moments. Females had greater flexion angles (p=.001) and adduction moments (p=.030) in VS compared to DO. Women had less knee flexion and more adduction moment in VS, possibly suggesting this stimulus amplifies ACL injury risk factors in females. A human defender increased sagittal plane loading in a manner that may better represent loading in game situations.
Listed In: Biomechanics, Sports Science

Anticipation alters lower-limb biomechanics during drop-jump landings

ACL injury mechanisms are commonly determined from evidence gathered during highly controlled lab-based activities. However, many non-contact ACL ruptures occur following a reaction to an external stimulus, when athletes are unable to pre-plan their movement strategy1. The purpose of this study was to determine if unanticipated drop-jump landing altered lower-limb biomechanics. Ten participants performed two counter-balanced single-leg drop-jump landing conditions (anticipated and unanticipated). Unanticipated landings were conducted by randomly displaying either a left or right arrow immediately following jump takeoff. The visual cue was triggered by the participant making contact with a force platform, set at a threshold of 10N. Three-dimensional kinematic and kinetic data for the ankle, knee and hip were time-normalized over the jumping and landing phase and with-in participant averaged over the successful trials. Paired sample t-tests, using Statistical Parametric Mapping, evaluated between condition differences over the jumping and landing phases (α = 0.05). Participants landed with significantly greater hip abduction (p=0.004) during the unanticipated condition over the entire landing phase (0-100%). Participants also landed with significantly less hip external rotation (p=0.048) over the final 17% of the landing phase. Although no differences were identified at the knee joint, participants landed with greater hip abduction and less external rotation when the movement was unaticipated. Given that proximal factors play a contributing role towards controling knee mechanics, the altered hip position could be a compensatory strategy to limit knee abduction and reduce ACL injury risk during unanticipated tasks2. 1. Olsen et al. AJSM 2004;32(4):1002-1012 2. Powers JOSPT 2010;40(2):42-51
Listed In: Biomechanics

Hinged ankle braces do not alter knee mechanics during sidestep cutting

Lateral ankle sprains, caused by rapid ankle inversion, and noncontact anterior cruciate ligament (ACL) knee injuries, caused by excessive knee loading, are among the most common lower extremity injuries that occur during dynamic tasks, such as cutting. Ankle braces are commonly used to prevent lateral ankle sprains by reducing ankle inversion. There is limited and conflicting research about how an ankle brace affects other joints, such as the knee, during cutting movements. It is also not known if sex differences exist during a cutting task when an ankle brace is present. The purpose of this study was to determine the effects of an Ultra Zoom® hinged ankle brace and sex on ankle and knee biomechancis during a cutting maneuver. Eighteen recreationally active adults completed sidestep cutting trials with and without an Ultra Zoom® ankle brace. Three-dimensional ankle and knee kinematics and GRF were collected. Separate 2×2 (sex × brace) repeated measures ANOVAs were used. Results indicated the brace reduced frontal plane ankle kinematics and had no effect on knee kinematics. Additionally, females demonstrated decreased knee flexion compared to males. An ankle brace during a cutting maneuver restricted frontal plane ankle movement. Furthermore, the only significant changes in knee mechanics were due to sex differences, which has been well documented. These findings indicate that the use of an Ultra Zoom® hinge brace is suitable for sports, reduces the risk of lateral ankle injuries, and does not alter knee mechanics, and therefore may not increase the risk of ACL injury.
Listed In: Biomechanics, Sports Science

Increased Role of the Secondary Passive Stabilizers Following Complete but Not Partial Loss of Anterior Cruciate Ligament Function During Post-Natal Growth

Robotic testing was performed with a 6-degree of freedom load cell in order to analyze functional contributions of the soft tissues in the knee under physiologically relevant loading conditions. Age groups ranging from 1.5 months to 18 months, porcine equivalent to early youth through late adolescent human ages, were studied. Complete ACL transection resulted in increased APTT and VVR across all ages (p<0.05), while injury to the AM bundle did not affect APTT or VVR. Additionally, increasing age resulted in decreased APTT normalized to the tibial plateau (p<0.05) and an average 19° decrease in VVR across states from 0 to 18 months of age (p<0.05). The ACL was the primary restraint against anterior drawer in the intact knee state [75-111%]. Following AM bundle dissection, the PL bundle carried the vast majority of the anterior load regardless of age [66-112%]. Following complete ACL transection, the MCL and medial meniscus carried most of the force across ages under anterior drawer. The LCL contributed increasing resistance to varus torque across states with age, as did the MCL under valgus torque.
Listed In: Biomechanical Engineering, Biomechanics, Orthopedic Research, Sports Science

Bilateral assessment of cartilage with UTE-T2* quantitative MRI and associations with knee center of rotation following anterior cruciate ligament reconstruction

Purpose: Anterior cruciate ligament (ACL) tear greatly increases the risk of knee osteoarthritis (OA), even when patients undergo ACL reconstruction surgery (ACLR). Changes to walking kinematics following ACLR have been suggested to play a role in this degenerative path to post-traumatic OA by shifting the location of repetitive joint contact loads that occur during walking to regions of cartilage not conditioned for altered loads. Recent work has shown that changes to the average knee center of rotation during walking (KCOR) between 2 and 4 years after ACLR are associated with long term changes in patient reported outcomes at 8 years. Changes to KCOR result in changes to contact patterns between the femur and the tibial plateau. However, it is unknown if changes to this kinematic measure are reflected by changes to cartilage as early as 2 years after surgery. Ultrashort TE-enhanced T2* (UTE-T2*) mapping has been shown to be sensitive to subsurface changes occurring in deep articular cartilage early after ACL injury and over 2 years after ACLR that were not detectable by standard morphological MRI. Thus, the purpose of this study was to test the hypothesis that side to side differences in KCOR correlate with side to side differences in UTE-T2* quantitative MRI (qMRI) in the central weight bearing regions of the medial and lateral tibial plateaus at 2 years following ACLR. Methods: Thirty-five human participants (18F, Age: 33.8±10.5 yrs, BMI: 24.1±3.3) with a history of unilateral ACL reconstruction (2.19±0.22 yrs post-surgery) and no other history of serious lower limb injury received bilateral examinations on a 3T MRI scanner. UTE-T2* maps were calculated via mono-exponential fitting on a series of T2*-weighted MR images acquired at eight TEs (32μs -16 ms, non-uniform echo spacing) using a radial out 3D cones acquisition. All subjects completed bilateral gait analysis. Medial-lateral (ML) and anterior-posterior (AP) coordinates of average KCOR during stance of walking were calculated for both knees. Side to side differences in KCOR were tested for correlations with side to side differences in mean full thickness UTE-T2* quantitative values in the central weight bearing regions of the medial and lateral tibial plateau using Pearson correlation coefficients. Results: There was a distribution in UTE-T2* values, with some subjects having higher UTE-T2* and some lower in the ACLR knee relative to the contralateral knee. A significant correlation (R=0.407, p=0.015, Figure 1A) was observed between UTE-T2* and the ML KCOR with a more lateral KCOR corresponding to higher values of UTE-T2* for the medial tibia. Similarly, for the lateral tibia, a lower UTE-T2* was correlated with a more posterior KCOR (R=0.363, p=0.032, Figure 1B). Significant correlations were not observed for UTE-T2* in the lateral tibia with the ML position of KCOR or for UTE-T2* in the medial tibia with the AP position of KCOR. Conclusions: The results of this study support the hypothesis that side to side differences in mean full thickness UTE-T2* qMRI correlate with side to side differences in knee kinematics at 2 years after ACLR. The finding that a more lateral KCOR in the ACLR knee correlates with UTE T2* values in the medial tibia that were higher than the contralateral side suggests that this kinematic change, which has been previously shown to result in more relative motion between the femur and tibia in the medial compartment, could be affecting subsurface matrix integrity, inducing changes detectable by UTE-T2* mapping. Additionally, the finding that a more posterior KCOR in the ACLR knee correlated with UTE-T2* values in the lateral tibia that were lower than the contralateral knee further suggests that the UTE-T2* metric may reflect early changes in cartilage health. When interpreted within the context of prior work showing that a posterior shift in KCOR from 2 to 4 years post-surgery correlated with improved clinical outcomes at 8 years, the observed lower UTE-T2* with a more posterior KCOR, which is reflective of improved quadriceps recruitment, suggests positive cartilage matrix properties. In spite of the limitations of this cross-sectional and exploratory study, and the difficulty accounting for changes in the contralateral knee, these results support future studies of the relationship between UTE-T2* and KCOR to provide new insight into predicting the risk for OA after ACLR.
Listed In: Biomechanical Engineering, Biomechanics, Gait, Mechanical Engineering, Orthopedic Research, Sports Science