Cargando…
Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury
OBJECTIVES: Strong biomechanical and epidemiologic evidence associates knee valgus collapse with isolated non-contact ACL injury. However, the predominance of isolated non-contact anterior cruciate ligament (ACL) injuries is challenging for clinicians and researchers to explain, as the medial collat...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2013
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588925/ http://dx.doi.org/10.1177/2325967113S00032 |
_version_ | 1782392709680463872 |
---|---|
author | Quatman, Carmen E. Kiapour, Ata Demetropoulos, Constantine K. Kiapour, Ali Wordeman, Samuel Clayton Levine, Jason W. Goel, Vijay K. Hewett, Timothy E. |
author_facet | Quatman, Carmen E. Kiapour, Ata Demetropoulos, Constantine K. Kiapour, Ali Wordeman, Samuel Clayton Levine, Jason W. Goel, Vijay K. Hewett, Timothy E. |
author_sort | Quatman, Carmen E. |
collection | PubMed |
description | OBJECTIVES: Strong biomechanical and epidemiologic evidence associates knee valgus collapse with isolated non-contact ACL injury. However, the predominance of isolated non-contact anterior cruciate ligament (ACL) injuries is challenging for clinicians and researchers to explain, as the medial collateral ligament (MCL) has been reported to be the primary restraint against knee valgus. The purpose of this study was to investigate the relative ACL to MCL strain patterns during physiologic simulations of a wide range of high-risk dynamic landing scenarios. We hypothesized that both knee abduction and internal tibial rotation moments would generate a disproportionate increase in ACL strain relative to MCL strain. However, the physiologic range of knee abduction and internal tibial rotation moments that produce ACL injuries would not be of sufficient magnitude to consistently compromise MCL integrity. METHODS: A novel in sim approach was used to test our hypotheses. 17 cadaveric lower extremities (45 ± 7 years, 9 female & 8 male) were tested to simulate a broad range of landing conditions following a jump under anterior tibial shear, knee abduction and internal tibial rotation. Specimens were oriented to simulate lower extremity posture during ground strike while landing from a jump. Landing was simulated by applying an impulsive axial impact load (simulating ground reaction forces) under simulated muscle forces. ACL and MCL strains were quantified using DVRT displacement transducers arthroscopically placed across the ACL AM-bundle and sutured to the anterior/middle/posterior aspects of superficial MCL across the joint line. Specimens were tested until failure. Multiple paired and independent t-tests along with general linear models were used to investigate the changes in strain levels under each modes of loading. An extensively validated, detailed finite element model of the lower extremity was used to better interpret experimental findings. RESULTS: ACL failure was generated in 15 of 17 specimens (88%). Increased anterior tibial shear force, and knee abduction and internal tibial rotation moments resulted in significantly higher ACL: MCL strain ratios (p<0.05) compared to landing under no applied external loads. Under all modes of single- and multi-planar loading, ACL: MCL strain ratio remained greater than 1.7, and relative ACL strain was significantly higher than relative MCL strain (p<0.003, Figure 1). Relative change in ACL strain was significantly greater under combined multi-planar loading compared to ACL strain under anterior tibial shear force (p=0.016), knee abduction (p=0.018) and internal tibial rotation (p<0.0005) moments alone. CONCLUSION: The tibiofemoral frontal plane loading mechanism has become a recent topic of debate as a contributing factor to non-contact ACL injuries. Both in vivo and video analyses studies indicate that increased knee abduction is associated with increased risk for ACL injury. The current findings demonstrates that while both the ACL and MCL resist knee valgus during landing, physiological magnitudes of the applied loads that lead to high ACL strain levels and injury were not sufficient to compromise MCL integrity. Further, these findings support multi-planar knee valgus collapse as a primary mechanism of non-contact ACL injury. This enhances our understanding of the non-contact ACL injury mechanism, and provides insight that can improve current risk screening and injury prevention strategies. |
format | Online Article Text |
id | pubmed-4588925 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-45889252015-11-03 Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury Quatman, Carmen E. Kiapour, Ata Demetropoulos, Constantine K. Kiapour, Ali Wordeman, Samuel Clayton Levine, Jason W. Goel, Vijay K. Hewett, Timothy E. Orthop J Sports Med Article OBJECTIVES: Strong biomechanical and epidemiologic evidence associates knee valgus collapse with isolated non-contact ACL injury. However, the predominance of isolated non-contact anterior cruciate ligament (ACL) injuries is challenging for clinicians and researchers to explain, as the medial collateral ligament (MCL) has been reported to be the primary restraint against knee valgus. The purpose of this study was to investigate the relative ACL to MCL strain patterns during physiologic simulations of a wide range of high-risk dynamic landing scenarios. We hypothesized that both knee abduction and internal tibial rotation moments would generate a disproportionate increase in ACL strain relative to MCL strain. However, the physiologic range of knee abduction and internal tibial rotation moments that produce ACL injuries would not be of sufficient magnitude to consistently compromise MCL integrity. METHODS: A novel in sim approach was used to test our hypotheses. 17 cadaveric lower extremities (45 ± 7 years, 9 female & 8 male) were tested to simulate a broad range of landing conditions following a jump under anterior tibial shear, knee abduction and internal tibial rotation. Specimens were oriented to simulate lower extremity posture during ground strike while landing from a jump. Landing was simulated by applying an impulsive axial impact load (simulating ground reaction forces) under simulated muscle forces. ACL and MCL strains were quantified using DVRT displacement transducers arthroscopically placed across the ACL AM-bundle and sutured to the anterior/middle/posterior aspects of superficial MCL across the joint line. Specimens were tested until failure. Multiple paired and independent t-tests along with general linear models were used to investigate the changes in strain levels under each modes of loading. An extensively validated, detailed finite element model of the lower extremity was used to better interpret experimental findings. RESULTS: ACL failure was generated in 15 of 17 specimens (88%). Increased anterior tibial shear force, and knee abduction and internal tibial rotation moments resulted in significantly higher ACL: MCL strain ratios (p<0.05) compared to landing under no applied external loads. Under all modes of single- and multi-planar loading, ACL: MCL strain ratio remained greater than 1.7, and relative ACL strain was significantly higher than relative MCL strain (p<0.003, Figure 1). Relative change in ACL strain was significantly greater under combined multi-planar loading compared to ACL strain under anterior tibial shear force (p=0.016), knee abduction (p=0.018) and internal tibial rotation (p<0.0005) moments alone. CONCLUSION: The tibiofemoral frontal plane loading mechanism has become a recent topic of debate as a contributing factor to non-contact ACL injuries. Both in vivo and video analyses studies indicate that increased knee abduction is associated with increased risk for ACL injury. The current findings demonstrates that while both the ACL and MCL resist knee valgus during landing, physiological magnitudes of the applied loads that lead to high ACL strain levels and injury were not sufficient to compromise MCL integrity. Further, these findings support multi-planar knee valgus collapse as a primary mechanism of non-contact ACL injury. This enhances our understanding of the non-contact ACL injury mechanism, and provides insight that can improve current risk screening and injury prevention strategies. SAGE Publications 2013-09-20 /pmc/articles/PMC4588925/ http://dx.doi.org/10.1177/2325967113S00032 Text en © The Author(s) 2013 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. |
spellingShingle | Article Quatman, Carmen E. Kiapour, Ata Demetropoulos, Constantine K. Kiapour, Ali Wordeman, Samuel Clayton Levine, Jason W. Goel, Vijay K. Hewett, Timothy E. Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title | Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title_full | Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title_fullStr | Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title_full_unstemmed | Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title_short | Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury |
title_sort | preferential loading of the acl compared to the mcl during landing: a novel in sim approach yields the multi-planar mechanism of dynamic valgus during acl injury |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588925/ http://dx.doi.org/10.1177/2325967113S00032 |
work_keys_str_mv | AT quatmancarmene preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT kiapourata preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT demetropoulosconstantinek preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT kiapourali preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT wordemansamuelclayton preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT levinejasonw preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT goelvijayk preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury AT hewetttimothye preferentialloadingoftheaclcomparedtothemclduringlandinganovelinsimapproachyieldsthemultiplanarmechanismofdynamicvalgusduringaclinjury |