Non-knee-spanning muscles contribute to tibiofemoral shear as well as valgus and rotational joint reaction moments during unanticipated sidestep cutting

Anterior cruciate ligament (ACL) injuries are a burdensome condition due to potential surgical requirements and increased risk of long term debilitation. Previous studies indicate that muscle forces play an important role in the development of ligamentous loading, yet these studies have typically used cadaveric models considering only the knee-spanning quadriceps, hamstrings and gastrocnemius muscle groups. Using a musculoskeletal modelling approach, we investigated how lower-limb muscles produce and oppose key tibiofemoral reaction forces and moments during the weight acceptance phase of unanticipated sidestep cutting. Muscles capable of opposing (or controlling the magnitude of) the anterior shear force and the external valgus moment at the knee are thought to be have the greatest potential for protecting the anterior cruciate ligament from injury. We found the best muscles for generating posterior shear to be the soleus, biceps femoris long head and medial hamstrings, providing up to 173N, 111N and 77N of force directly opposing the anterior shear force. The valgus moment was primarily opposed by the gluteus medius, gluteus maximus and piriformis, with these muscles providing contributions of up to 32 Nm, 19 Nm and 21 Nm towards a knee varus moment, respectively. Our findings highlight key muscle targets for ACL preventative and rehabilitative interventions.