Relative Strain in the Anterior Cruciate Ligament and Medial Collateral Ligament during Simulated Jump Landing and Sidestep Cutting Tasks: Implications for Injury Risk

Nathaniel A. Bates, Rebecca J. Nesbitt, Jason T. Shearn, Gregory D. Myer, Timothy Hewett

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries. Hypothesis/Purpose: The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. Study Design: Controlled laboratory study. Methods: A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. Results: During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P <.01). The isolated ACL expressed greater peak anterior force (4.8% vs 0.3% body weight; P <.01), medial force (1.6% vs 0.4% body weight; P <.01), flexion torque (8.4 vs 0.4 N·m; P <.01), abduction torque (2.6 vs 0.3 N·m; P <.01), and adduction torque (0.5 vs 0.0 N·m; P =.03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. Conclusion: During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. Clinical Relevance: Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to injury. An enhanced understanding of joint loading during in vivo tasks may provide insight that enhances the efficacy of injury prevention protocols.

Original languageEnglish (US)
Pages (from-to)2259-2269
Number of pages11
JournalAmerican Journal of Sports Medicine
Volume43
Issue number9
DOIs
StatePublished - Sep 3 2015

Fingerprint

Collateral Ligaments
Anterior Cruciate Ligament
Wounds and Injuries
Knee
Sports
Torque
Rupture
Body Weight
Robotics
Knee Joint
Ligaments
Biomechanical Phenomena
Joints

Keywords

  • anterior cruciate ligament injury
  • athletic tasks
  • cadaveric simulation
  • knee biomechanics
  • medial collateral ligament

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Relative Strain in the Anterior Cruciate Ligament and Medial Collateral Ligament during Simulated Jump Landing and Sidestep Cutting Tasks : Implications for Injury Risk. / Bates, Nathaniel A.; Nesbitt, Rebecca J.; Shearn, Jason T.; Myer, Gregory D.; Hewett, Timothy.

In: American Journal of Sports Medicine, Vol. 43, No. 9, 03.09.2015, p. 2259-2269.

Research output: Contribution to journalArticle

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abstract = "Background: The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20{\%} to 40{\%} of ACL injuries. Hypothesis/Purpose: The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. Study Design: Controlled laboratory study. Methods: A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. Results: During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1{\%} vs 0.4{\%}; P <.01). The isolated ACL expressed greater peak anterior force (4.8{\%} vs 0.3{\%} body weight; P <.01), medial force (1.6{\%} vs 0.4{\%} body weight; P <.01), flexion torque (8.4 vs 0.4 N·m; P <.01), abduction torque (2.6 vs 0.3 N·m; P <.01), and adduction torque (0.5 vs 0.0 N·m; P =.03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. Conclusion: During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. Clinical Relevance: Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to injury. An enhanced understanding of joint loading during in vivo tasks may provide insight that enhances the efficacy of injury prevention protocols.",
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N2 - Background: The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries. Hypothesis/Purpose: The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. Study Design: Controlled laboratory study. Methods: A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. Results: During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P <.01). The isolated ACL expressed greater peak anterior force (4.8% vs 0.3% body weight; P <.01), medial force (1.6% vs 0.4% body weight; P <.01), flexion torque (8.4 vs 0.4 N·m; P <.01), abduction torque (2.6 vs 0.3 N·m; P <.01), and adduction torque (0.5 vs 0.0 N·m; P =.03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. Conclusion: During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. Clinical Relevance: Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to injury. An enhanced understanding of joint loading during in vivo tasks may provide insight that enhances the efficacy of injury prevention protocols.

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