Frontal Plane Loading Characteristics of Medial Collateral Ligament Strain Concurrent With Anterior Cruciate Ligament Failure

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Abstract

Background: Both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force. Hypothesis: The intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion. Study Design: Controlled laboratory study. Methods: In vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized. Results: ACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P =.0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤.0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P <.0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain – maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P <.0001). Conclusion: Although significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee. Clinical Relevance: These characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.

Original languageEnglish (US)
JournalAmerican Journal of Sports Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Collateral Ligaments
Anterior Cruciate Ligament
Knee
Sports
Wounds and Injuries
Matched-Pair Analysis
Knee Injuries
Transducers
Biomechanical Phenomena
Healthy Volunteers
Rehabilitation
Extremities

Keywords

  • anterior cruciate ligament (ACL)
  • cadaveric
  • medial collateral ligament (MCL)
  • simulation
  • strain

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{12213cbe4c3b4985b97e78597acbf848,
title = "Frontal Plane Loading Characteristics of Medial Collateral Ligament Strain Concurrent With Anterior Cruciate Ligament Failure",
abstract = "Background: Both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force. Hypothesis: The intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion. Study Design: Controlled laboratory study. Methods: In vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized. Results: ACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P =.0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤.0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P <.0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain – maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P <.0001). Conclusion: Although significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee. Clinical Relevance: These characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.",
keywords = "anterior cruciate ligament (ACL), cadaveric, medial collateral ligament (MCL), simulation, strain",
author = "Nathan Schilaty and Bates, {Nathaniel A.} and Aaron Krych and Timothy Hewett",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0363546519854286",
language = "English (US)",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Frontal Plane Loading Characteristics of Medial Collateral Ligament Strain Concurrent With Anterior Cruciate Ligament Failure

AU - Schilaty, Nathan

AU - Bates, Nathaniel A.

AU - Krych, Aaron

AU - Hewett, Timothy

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force. Hypothesis: The intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion. Study Design: Controlled laboratory study. Methods: In vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized. Results: ACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P =.0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤.0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P <.0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain – maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P <.0001). Conclusion: Although significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee. Clinical Relevance: These characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.

AB - Background: Both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force. Hypothesis: The intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion. Study Design: Controlled laboratory study. Methods: In vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized. Results: ACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P =.0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤.0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P <.0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain – maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P <.0001). Conclusion: Although significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee. Clinical Relevance: These characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.

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KW - cadaveric

KW - medial collateral ligament (MCL)

KW - simulation

KW - strain

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