Susan M. Sigward

Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments

BACKGROUND It has been proposed that female athletes who limit knee and hip flexion during athletic tasks rely more on the passive restraints in the frontal plane to deceleration their body center of mass. This biomechanical pattern is thought to increase the risk for anterior cruciate ligament injury. To date, the relationship between sagittal plane kinematics and frontal plane knee motion and moments has not been explored. METHODS Subjects consisted of 58 female club soccer players (age range: 11-20 years) with no history of knee injury. Kinematics, ground reaction forces, and surface electromyography were collected while each subject performed a drop landing task. Subjects were divided into two groups based on combined sagittal plane knee and hip flexion angles during the deceleration phase of landing (high flexion and low flexion). FINDINGS Subjects in the low flexion group demonstrated increased knee valgus angles (P=0.02, effect size 0.27), increased knee adductor moments (P=0.03, effect size 0.24), decreased energy absorption at the knee and hip (P=0.02, effect size 0.25; and P<0.001, effect size 0.59), and increased vastus lateralis EMG when compared to subjects in the high flexion group (P=0.005, effect size 0.35). INTERPRETATION Female athletes with limited sagittal plane motion during landing exhibit a biomechanical profile that may put these individuals at greater risk for anterior cruciate ligament injury.

The influence of in-season injury prevention training on lower-extremity kinematics during landing in female soccer players.

ObjectiveTo examine the influence of in-season injury prevention training on hip and knee kinematics during a landing task. DesignLongitudinal pre-post intervention study. SettingTesting sessions were conducted in a biomechanics research laboratory. ParticipantsEighteen female soccer players between the ages of 14 and 17 participated in this study. All subjects were healthy with no current complaints of lower extremity injury. InterventionsTesting sessions were conducted prior to and following a season of soccer practice combined with injury prevention training. Main Outcome MeasurementsDuring each testing session three-dimensional kinematics were collected while each subject performed a drop landing task. Peak hip and knee joint angles were measured during the early deceleration phase of landing and compared between pre- and post-training using paired t-tests. ResultsFollowing a season of soccer practice combined with injury prevention training, females demonstrated significantly less hip internal rotation (7.1° vs. 1.9°; P=0.01) and significantly greater hip abduction (−4.9° vs. −7.7°; P=0.02). No differences in knee valgus or knee flexion angles were found post-season. ConclusionsFemale soccer players exhibited significant changes in hip kinematics during a landing task following in-season injury prevention training. Our results support the premise that a season of soccer practice combined with injury prevention training is effective in altering lower extremity motions that may play a role in predisposing females to ACL injury.

Gender differences in hip joint kinematics and kinetics during side-step cutting maneuver.

Objective:Based on the recent suggestion that proximal hip control may be related to a predisposition to anterior cruciate ligament injury, our purpose was to identify gender differences in hip mechanics between female athletes who previously demonstrated greater knee valgus moments and their male counterparts. Design:Descriptive laboratory study. Setting:Testing was conducted in a biomechanics research laboratory. Participants:Thirty collegiate soccer players (15 women and 15 men) participated in this study. All subjects were healthy with no current complaints of lower extremity injury. Main Outcome Measurements:Three-dimensional hip joint kinematics and kinetics were collected while subjects performed a side-step cutting maneuver. Gender differences in hip mechanics were compared using independent sample t tests. Results:Compared with male athletes, female athletes demonstrated significantly greater hip internal rotation and decreased hip flexion. In addition, female athletes demonstrated significantly greater hip adductor moments as well as decreased hip extensor moments. Conclusion:Overall, it appeared that female athletes moved into greater hip internal rotation and used less sagittal plane hip motion during the early deceleration phase of the cutting maneuver. The findings of this investigation support the premise that altered hip kinematics and kinetics may influence loading at the knee. Future studies are needed to further explore the impact of these differences on knee loading and to ascertain the underlying causes.

Predictors of Frontal Plane Knee Excursion During a Drop Land in Young Female Soccer Players

STUDY DESIGN Controlled laboratory study using a cross-sectional, single testing session. OBJECTIVE To determine the association between frontal plane knee excursion during a drop land task and measures of hip strength, and ankle and hip range of motion. BACKGROUND Assessment of frontal plane knee excursion during a drop land task has been advocated as a means to screen for potentially injurious lower extremity movement patterns. Accordingly, an understanding of the physical characteristics associated with the magnitude of frontal plane knee excursion could assist clinicians in developing interventions and prevention strategies to minimize injury risk. METHODS AND MEASURES Thirty-nine female high school soccer players (mean +/- SD age, 15.5 +/- 1.0 years; height, 162.2 +/- 5.3 cm; body mass, 56.8 +/- 6.7 kg) participated. Isometric hip muscle strength as well as ankle and hip range of motion measurements were obtained using standard clinical procedures and a handheld dynamometer. Frontal plane knee excursion was assessed using a 6-camera motion analysis system during a drop land task. Using 3-dimensional coordinate data, maximum frontal plane knee excursion was defined as the difference between the distances of right and left lateral knee markers at initial contact and maximum knee flexion during the deceleration phase of landing. Independent variables found to be significantly correlated with frontal plane knee excursion were then entered into a stepwise multiple regression procedure to determine the best set of predictors of this motion. RESULTS Hip external rotation range of motion and ankle dorsiflexion range of motion were found to be negatively correlated with frontal plane knee excursion (r=-0.40, P=.005 and r=-0.27, P=.05, respectively). Together they accounted for 27% of the variance in frontal plane knee excursion (r=0.52, P=.03). No relationships between measures of hip strength and frontal plane knee excursion were found. CONCLUSIONS Frontal plane knee excursion during a drop land task was partially attributed to available range of motion at the hip and ankle. These results suggest that range of motion of the joints proximal and distal to the knee should be considered when evaluating individuals who present with excessive frontal plane knee excursion during this task. Given that the relationship between range of motion and frontal plane knee excursion was small, other factors, including learned motor patterns, should be considered.

ACL Research Retreat V: An Update on ACL Injury Risk and Prevention, March 25–27, 2010, Greensboro, NC

It has been well recognized that multiple factors, whether individually or in combination, contribute to noncontact anterior cruciate ligament (ACL) injury. The ongoing mission of the ACL Research Retreat is to bring clinicians and researchers together to present and discuss the most recent advances in ACL injury epidemiology, risk factor identification, and injury-risk screening and prevention strategies and to identify future research directives. The sixth retreat held March 22–24, 2012, in Greensboro, North Carolina, was attended by more than 70 clinicians and researchers, including representatives from Canada, Iceland, Japan, The Netherlands, Norway, and South Africa. The meeting featured keynote presentations and discussion forums by expert scientists in ACL injury risk and prevention and 34 podium and poster presentations by attendees. Keynotes delivered by Ajit Chaudhari, PhD (The Ohio State University), Malcolm Collins, PhD (Medical Research Council and University of Cape Town, South Africa), and Tron Krosshaug, PhD (Oslo Sports Trauma Research Center, Norway) described their ongoing work related to proximal trunk control and lower extremity biomechanics, genetic risk factors associated with ACL injury, and methodologic approaches to understanding ACL loading mechanisms, respectively. Discussion forums led by Jennifer Hootman, PhD, ATC, FNATA, FACSM (Centers for Disease Control and Prevention) and Scott McLean, PhD (University of Michigan), focused on strategies for implementing injury-prevention programs in community settings and took a critical look at the strengths and limitations of motion-capture systems and how we might continue to refine our research approaches to increase the relevance and influence of our biomechanical research, respectively. Podium and poster presentations were organized into thematic sessions of anatomical, genetic, and hormone risk factors; the role of body position in ACL injury risk; pubertal and sex differences in lower extremity biomechanics; injury-risk screening and prevention; and methodologic considerations in risk factor research. Substantial time was provided for group discussion throughout the conference. From these discussions, the 2010 consensus statement1 was updated to reflect recent advances in the field and to chart new directions for future research. Following is the updated consensus statement. The presentation abstracts organized by topic and presentation order appear online at http://nata.publisher.ingentaconnect.com/content/nata/jat.

The influence of sex and maturation on landing biomechanics: implications for anterior cruciate ligament injury

During landing and cutting, females exhibit greater frontal plane moments at the knee (internal knee adductor moments or external knee abduction moments) and favor the use of the knee extensors over the hip extensors to attenuate impact forces when compared with males. However, it is not known when this biomechanical profile emerges. The purpose of this study was to compare landing biomechanics between sexes across maturation levels. One hundred and nineteen male and female soccer players (9–22 years) participated. Subjects were grouped based on maturational development. Lower extremity kinematics and kinetics were obtained during a drop‐land task. Dependent variables included the average internal knee adductor moment and sagittal plane knee/hip moment and energy absorption ratios during the deceleration phase of landing. When averaged across maturation levels, females demonstrated greater internal knee adductor moments (0.06±0.03 vs 0.01±0.02 N m/kg m; P<0.005), knee/hip extensor moment ratios (2.0±0.1 vs 1.4±0.1 N m/kg m; P<0.001) and knee/hip energy absorption ratios (2.9±0.1 vs 1.96±0.1 N m/kg m; P<0.001) compared with males. Higher knee adductor moments combined with disproportionate use of knee extensors relative to hip extensors observed in females reflect a biomechanical pattern that increases anterior cruciate ligament loading. This biomechanical strategy already was established in pre‐pubertal female athletes.

Effects of Fatigue and Recovery on Knee Mechanics during Side-Step Cutting

INTRODUCTION Changes in knee mechanics immediately after a fatiguing bout of exercise are thought to place an individual at a greater risk for anterior cruciate ligament (ACL) injury. However, the recovery time required to restore normal knee kinetics and kinematics after fatigue has not been established. PURPOSE The purpose of this study was to examine knee mechanics during side-step cutting immediately after a fatigue protocol and after 20 and 40 min of rest. METHODS Knee kinematics (eight-camera system Vicon 612; Oxford Metrics, Oxford, United Kingdom) and kinetics (AMTI force platform; AMTI, Newton, MA) of 15 female recreational athletes were recorded during a side-step cutting task. Data were obtained at four different time points: 1) before a fatigue protocol, 2) immediately after the fatigue protocol, 3) 20 min after the fatigue protocol, and 4) 40 min after the fatigue protocol. Peak knee joint angles and knee joint moments in the sagittal, frontal, and transverse planes were identified during the deceleration phase of the cutting task. One-way ANOVA with repeated measures were used to compare variables among the four time points. RESULTS Peak internal knee adductor moments (external knee valgus moments) and peak knee internal rotation angles were significantly greater after fatigue and remained elevated at 20 and 40 min after fatigue. Peak knee abduction (valgus) angles immediately after the fatigue protocol were significantly greater but returned to prefatigue levels after 20 min of rest. The fatigue protocol had no influence on any other of the variables examined. CONCLUSIONS Fatigue resulted in changes in knee mechanics that are thought to be associated with ACL injury. Forty minutes of recovery was not sufficient in restoring knee mechanics to prefatigue levels.

Influence of sex and maturation on knee mechanics during side-step cutting.

INTRODUCTION Females have been reported to have a three to five times greater incidence of noncontact anterior cruciate ligament injury when compared with their male counterparts. Previous research suggests that physical maturation is one factor that is associated with the development of potentially injurious lower extremity biomechanics in female athletes. PURPOSE The studys purpose was to determine whether lower extremity biomechanics differ between male and female soccer athletes during a cutting maneuver across different stages of maturational development. METHODS One hundred fifty-six soccer players (76 males and 80 females) between the ages of 9 and 23 yr participated. Subjects were classified on the basis of maturation as prepubertal, pubertal, postpubertal, or young adult. Lower extremity kinematics, kinetics, and ground reaction forces (GRFs) were obtained during a 45° side-step cutting maneuver. Differences between sex and maturation were assessed for peak knee valgus angle, knee adductor moments, and GRFs (vertical, posterior, and lateral) during weight acceptance using a two-factor ANCOVA (controlling for approach velocity). RESULTS No sex × maturation interactions were found for any variable of interest. On average, females exhibited greater knee abduction and adductor moments than males. Prepubertal athletes demonstrated greater knee adductor moments and GRFs than all other groups. CONCLUSIONS Biomechanical differences between males and females were evident across all stages of maturation. On average, less mature athletes exhibit biomechanical patterns during cutting that may place them at greater risk for injury than their more mature counterparts.

Altered Dynamic Postural Control during Step Turning in Persons with Early-Stage Parkinson’s Disease

Persons with early-stage Parkinsons disease (EPD) do not typically experience marked functional deficits but may have difficulty with turning tasks. Studies evaluating turning have focused on individuals in advanced stages of the disease. The purpose of this study was to compare postural control strategies adopted during turning in persons with EPD to those used by healthy control (HC) subjects. Fifteen persons with EPD, diagnosed within 3 years, and 10 HC participated. Participants walked 4 meters and then turned 90°. Dynamic postural control was quantified as the distance between the center of pressure (COP) and the extrapolated center of mass (eCOM). Individuals with EPD demonstrated significantly shorter COP-eCOM distances compared to HC. These findings suggest that dynamic postural control during turning is altered even in the early stages of PD.

Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait

BACKGROUND Restrictions in range of ankle dorsiflexion (DF) motion can persist following ankle injuries. Ankle DF is necessary during terminal stance of gait, and its restricted range may affect knee joint kinematics and kinetics. The purpose of this study was to investigate the acute influence of varied levels of restricted ankle DF on knee joint sagittal and frontal plane kinematics and kinetics during gait. METHODS Thirty healthy volunteers walked with a custom-designed ankle brace that restricted ankle DF. Kinematics and kinetics were collected using a 7-camera motion analysis system and two force plates. Ankle dorsiflexion was restricted in 10-degree increments, allowing for four conditions: Free, light (LR), moderate (MR) and severe restriction (SR). Knee angles and moments were measured during terminal stance. RESULTS Real peak ankle DF for Free, LR, MR, and SR were 13.7±4.8°, 11.6±5.0°, 7.5±5.3°, and 4.2±7.2°, respectively. Peak knee extension angles under the same conditions were -6.7±6.7°, -5.4±6.4°, -2.5±7.5°, and 0.6±7.8°, respectively, and the peak knee varus moment was 0.48±0.17 Nm/kg, 0.47±0.17 Nm/kg, 0.53±0.20 Nm/kg, and 0.57±0.20 Nm/kg. The knee varus moment was significantly increased from MR condition with an 8-degree restriction in ankle DF. CONCLUSION Knee joint kinematics and kinetics in the sagittal and frontal planes were affected by reduced ankle DF during terminal stance of gait. Differences were observed with restriction in ankle DF range of approximately 8°. LEVEL OF EVIDENCE level III.