Common lower limb postures have been found when noncontact anterior cruciate ligament (ACL) injuries occur during sidestep cutting tasks. These same postures have been linked to knee loadings known to stress the ACL.
Hypothesis
Whole body technique modification would reduce knee loading.
Study Design
Controlled laboratory study.
Methods
Experienced team sport athletes were recruited for whole body sidestep cutting technique modification. Before and after a 6-week technique modification training, participants performed sidestep cutting tasks while ground-reaction force and motion data were collected. A kinematic and inverse dynamics model was used to calculate 3-dimensional knee loading during sidestep cutting.
Results
At initial foot contact, the participants placed their stance foot closer to the body’s midline and held their torso more upright, in line with the aims of the technique modification training. This was accompanied by significantly lower peak valgus moments in the weight acceptance phase of stance. Both postural changes were correlated with the change in peak valgus moment.
Conclusion
Whole body sidestep cutting technique modification resulted in reduced knee loading.
Clinical Relevance
Implementation of whole body technique modification may produce effective ACL injury prevention programs in sports involving sidestep cutting.
ArendtEAgelJDickRW. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train1999;34(2):86–92.
2.
BesierTFLloydDGAcklandTRCochraneJL. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc2001;33(7):1176–1181.
3.
BesierTFLloydDGCochraneJLAcklandTR. External loading of the knee joint during running and cutting maneuvers. Med Sci Sports Exerc2001;33(7):1168–1175.
4.
BesierTFSturnieksDLAldersonJALloydDG. Repeatability of gait data using a functional hip joint centre and a mean helical knee axis. J Biomech2003;36(8):1159–1168.
5.
BeynnonBDEttlingerCFJohnsonRJHewettTEShultzSJGriffinLY. Epidemiology and mechanisms of ACL injury in alpine skiing. Understanding and Preventing Noncontact ACL Injuries. Champaign: Human Kinetics; 2007:183–188.
6.
BodenBPDeanGSFeaginJAJrGarrettWEJr. Mechanisms of anterior cruciate ligament injury. Orthopedics2000;23(6):573–578.
7.
CaraffaACerulliGProjettiMAisaGRizzoA. Prevention of anterior cruciate ligament injuries in soccer: a prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc1996;4(1):19–21.
8.
ChaudhariAMHearnBKAndriacchiTP. Sport-dependent variations in arm position during single-limb landing influence knee loading: implications for anterior cruciate ligament injury. Am J Sports Med2005;33(6):824–830.
9.
CochraneJLLloydDGButtfieldASewardHMcGivernJ. Characteristics of anterior cruciate ligament injures in Australian Football. J Sci Med Sport2007;10(2):96–104.
10.
de LevaP. Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J Biomech1996;29(9):1223–1230.
11.
DelayBSSmolinskiRJWindWMBowmanDS. Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopedic Society for Sports Medicine. Am J Knee Surg2001;14:85–91.
12.
DempseyARLloydDGElliottBCSteeleJRMunroBJRussoKA. The effect of technique change on knee loads during sidestep cutting. Med Sci Sports Exerc2007;39(10):1765–1773.
13.
EttlingerCFJohnsonRJShealyJE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med1995;23(5):531–537.
14.
GriffinLYAlbohmMJArendtEA. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II Meeting, January 2006. Am J Sports Med2005;34(9):1512–1523.
15.
HameSLOakesDAMarkolfKL. Injury to the anterior cruciate ligament during alpine skiing: a biomechanical analysis of tibial torque and knee flexion angle. Am J Sports Med2002;30(4):537–540.
16.
HautalaRMConnJH. A test of Magill’s closed-to-open continuum for skill development. Percept Mot Skills1993;77:219–226.
17.
HenningCEMaehlumSNilssonSRenstromP. Injury prevention of the anterior cruciate ligament. Update on Sports Medicine. Soria Moria, Oslo, Norway: Danish and Norwegian Sports Medicine Associations and the Swedish Society of Sports Medicine; 1986.
18.
HewettTELindenfeldTNRiccobeneJVNoyesFR. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med1999;27(6):699–706.
19.
HewettTEMyerGDFordKRHewettTEShultzSJGriffinLY. Theories on how neuromuscular intervention programs may influence ACL injury rates: the biomechanical effects of plyometric, balance, strength and feedback training. Understanding and Preventing Noncontact ACL Injuries. Champaign: Human Kinetics; 2007:75–90.
20.
HewettTEMyerGDFordKR. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med2005;33(4):492–501.
21.
HouckJRDuncanADeHavenKE. Comparison of frontal plane trunk kinematics and hip and knee moments during anticipated and unanticipated walking and side step cutting tasks. Gait Posture2006;24(3):314–322.
22.
IrelandML. The female ACL: why is it more prone to injury?. Orthop Clin North Am2002;33(4):637–651.
23.
KadabaMPRamakrishnanHKWoottenMEGaineyJGortonGCochranGVB. Repeatability of kinematic, kinetic and electromyographic data in normal adult gait. J Orthop Res1989;7(6):849–860.
24.
KrosshaugTNakamaeABodenBP. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med2007;35(3):359–367.
25.
LloydDG. Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football. J Orthop Sports Phys Ther2001;31(11):645–654.
26.
LloydDGAldersonJAElliottBE. An upper limb kinematic model of the examination of cricket bowling: a case study of Mutiah Muralitharan. J Sports Sci2000;18:975–982.
27.
LloydDGBuchananTSBesierTF. Neuromuscular biomechanical modeling to understand knee ligament loading. Med Sci Sports Exerc2005;37(11):1939–1947.
28.
LohmanderLSEnglundPMDahlLLRoosEM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med2007;35(10):1756–1769.
29.
MagillRA. Motor Learning: Concepts and Applications. 6th ed. New York: McGraw-Hill; 2001.
30.
MarkolfKLBurchfieldDMShapiroMMShepardMFFinermanGASlauterbeckJL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res1995;13(6):930–935.
31.
MarkolfKLGorekJFKaboJMShapiroMS. Direct measurement of resultant forces in the anterior cruciate ligament: an in vitro study performed with a new experimental technique. J Bone Joint Surg Am1990;72(4):557–567.
32.
McGinleyJLBakerRWolfeRMorrisME. The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture2009;29(3):360–369.
33.
McLeanSGAndrishJTvan den BogertAJGarrettWEJrYuB. Letter to the editor & authors’ response. Am J Sports Med2005;33(7):1106–1107.
34.
McLeanSGHuangXSuAVan Den BogertAJ. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech2004;19(8):828–838.
35.
McLeanSGHuangXvan den BogertAJ. Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: implications for ACL injury. Clin Biomech2005;20(8):863–870.
36.
MyklebustGEngebretsenLBraekkenIHSkjolbergAOlsenOEBahrR. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med2003;13(2):71–78.
37.
OlsenOEMyklebustGEngebretsenLBahrR. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med2004;32(4):1002–1012.
38.
OlsenOEMyklebustGEngebretsenLHolmeIBahrR. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ2005;330(7489):449.
39.
RenstromPALjungqvistAArendtEA. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med2008;42:394–412.
40.
SigwardSMPowersCM. Loading characteristics of females exhibiting excessive valgus moments during cutting. Clin Biomech2007;22(7):827–833.
41.
SilversHJMandelbaumBR. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med2007;41(suppl1):i52–59.
42.
van den BogertAJMcLeanSGYuBChappellJJGarrettWEJr. Letter to the editor & authors’ response. Am J Sports Med.2006;34(2):312-a–315.
43.
WithrowTJHustonLJWojtysEMAshton-MillerJA. The effect of an impulsive knee valgus moment on in vitro relative ACL strain during a simulated jump landing. Clin Biomech2006;21(9):977–983.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
