Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined.
Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations.
Study Design: Case series; Level of evidence, 4.
Methods: Six international experts performed visual inspection analyses of 39 videos (17 male and 22 female players) of anterior cruciate ligament injury situations from high school, college, and professional basketball games. Two predefined time points were analyzed: initial ground contact and 50 milliseconds later. The analysts were asked to assess the playing situation, player behavior, and joint kinematics.
Results: There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group median, ranged from 17 to 50 milliseconds after initial ground contact. The mean knee flexion angle was higher in female than in male players, both at initial contact (15° vs 9°, P = .034) and at 50 milliseconds later (27° vs 19°, P = .042). Valgus knee collapse occurred more frequently in female players than in male players (relative risk, 5.3; P = .002).
Conclusion: Female players landed with significantly more knee and hip flexion and had a 5.3 times higher relative risk of sustaining a valgus collapse than did male players. Movement patterns were frequently perturbed by opponents.
Clinical Relevance: Preventive programs to enhance knee control should focus on avoiding valgus motion and include distractions resembling those seen in match situations.
|1999||Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med. November–December 1999;27(6):699-706.|
|1995||Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GAM, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. November 1995;13(6):930-935.|
|2005||Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. 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 Med. April 2005;33(4):492-501.|
|1996||Hewett TE, Stroupe AL, Nance TA, Noyes FR. Plyometric training in female athletes: decreased impact forces and increased hamstring torques. Am J Sports Med. November–December 1996;24(6):765-773.|
|2005||Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med. June 2005;39(6):324-329.|
|2003||Myklebust G, Engebretsen L, Brækken IH, Skjølberg A, Olsen O-E, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. March 2003;13(2):71-78.|
|1995||Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med. December 1995;23(6):694-701.|
|2005||Krosshaug T, Bahr R. A model-based image-matching technique for three-dimensional reconstruction of human motion from uncalibrated video sequences. J Biomech. April 2005;38(4):919-929.|
|2000||Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics. June 2000;23(6):573-578.|
|2005||Krosshaug T, Andersen TE, Olsen O-EO, Myklebust G, Bahr R. Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities. Br J Sports Med. June 1, 2005;39(6):330-339.|
|2012||Fong DT-P. Kinematics analysis of five ankle inversion ligamentous sprain injury cases in tennis. In: Bradshaw EJ, Burnett A, Hume PA, eds. Proceedings of the 30th International Conference on Biomechanics in Sports. July 2-6, 2012; Melbourne, Austalia.402-405.|
|2009||Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury: abnormalities in hip and ankle kinematics. Am J Sports Med. February 2009;37(2):252-259.|
|2011||Bere T, Flørenes TW, Krosshaug T, Koga H, Nordsletten L, Irving C, Muller E, Reid RC, Senner V, Bahr R. Mechanisms of anterior cruciate ligament injury in world cup alpine skiing: a systematic video analysis of 20 cases. Am J Sports Med. July 2011;39(7):1421-1429.|
|2012||Fong DT-P, Ha SC-W, Mok K-M, Chan CW-L, Chan K-M. Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: five cases from televised tennis competitions. Am J Sports Med. November 2012;40(11):2627-2632.|
|2008||Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. June 2008;42(6):394-412.|
|2020||Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, Della Villa S. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. December 2020;54(23):1423-1432.|
|2014||Kent RW, Lievers WB, Riley PO, Frimenko RE, Crandall JR. Etiology and biomechanics of tarsometatarsal injuries in professional football players: a video analysis. Orthop J Sports Med. March 2014;2(3):2325967114525347.|
|2020||Mueske NM, Patel AR, Pace JL, Zaslow TL, VandenBerg CD, Katzel MJ, Edison BR, Wren TAL. Improvements in landing biomechanics following anterior cruciate ligament reconstruction in adolescent athletes. Sports Biomech. November 2020;19(6):738-749.|
|2016||Ha CWS. A Subject-Specific Computational Model to Investigate an Ankle Inversion Ligamentous Sprain Injury and Evaluate the Intelligent Anti-Sprain System [PhD thesis]. The Chinese University of Hong Kong; October 2016.|
|2009||Meyer EG. Biomechanical Response of the Knee to Injury Level Forces in Sports Loading Scenarios [PhD thesis]. East Lansing, MI: Michigan State University; 2009.|
|2018||Tierney G. A Biomechanical Assessment of Direct and Inertial Head Loading in Rugby Union [PhD thesis]. Dublin, Ireland: Trinity College Dublin; 2018.|
|2011||Hutchison MG. Concussions in the National Hockey League (NHL): The Video Analysis Project [PhD thesis]. University of Toronto; 2011.|
|2017||Tomescu SS. Knee Tissue Strains and Effectiveness of a Novel Functional ACL Knee Brace During Dynamic in-Vitro Loading [Master's thesis]. University of Toronto; 2017.|
|2014||Bakker R. The Effect of Sagittal Plane Mechanics on Anterior Cruciate Ligament Strain During Jump Landing [Master's thesis]. University of Waterloo; 2014.|