Tibial Torsion Influences Lower Body Joint Kinematics and Kinetics in Women With Anterior Cruciate Ligament Injury During Squatting and Landing

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Abstract

External tibial torsion is an individual anatomical variation in the leg segment that alters musculoskeletal alignment which may increase risk of ACL rupture; however, the effect of external tibial torsion on lower body kinematics in healthy and ACL injured populations is underreported. The purpose of this dissertation was threefold: first to examine tibial torsion as a potential mediator of tri-planar leg rotation during a partial squat, second to compare tibial torsion angles between women with and without ACL injury; and third to investigate the influence of tibial torsion on cross-planar segmental contributions to lower body joint motion in women with and without ACL injury during squatting and landing. To accomplish these objectives, three studies were completed. Study 1: fourteen physically active men (29.4 ± 7.9 years old, 1.78 ± 0.06 m tall, 77.9 ± 9.2 kg body mass) and sixteen physically active women (25.1 ± 6.0 years old, 1.68 ± 0.07 m tall, and 63.5 ± 6.7 kg body mass) volunteered to be in the study. Each participant performed three consecutive partial squats to maximum dorsiflexion for motion analysis. External tibial torsion was significantly correlated with transverse plane leg (R² =0.459), knee (R² =0.262) and thigh (R² =0.158) angular excursions. Study 2: fifteen physically active women with ACL injury (24.6 ± 7.3 years old, 1.68 ± 0.08 m tall, and 67.6 ± 11.6 kg body mass), and fifteen physically active women without ACL injury (25.9 ± 5.9 years old, 1.69 ± 0.07 m tall, and 63.7 ± 6.0 kg body mass) volunteered to be in the study. Tibial torsion was measured using motion analysis, in the ACL injured and non-injured participants, for the left and right limbs. ACL injured women had significantly greater external tibial torsion angles (19 ± 4 degrees) compared to the healthy control participants (12 ± 4 degrees). Cohen’s effect size value (d=1.79) suggested a high practical significance. Study 3: fourteen physically active women with reconstructed unilateral ACL injury (23.2 ± 2.4 years old, 1.71 ± 0.07 m tall, and 67.3 ± 10.8 kg body mass), and thirty-four physically active women, divided in groups based on external tibial torsion, without ACL injury (23.8 ± 4.1 years old, 1.68 ± 0.05 m tall, and 64.9 ± 9.4 kg body mass) participated in a three group case-control study design. The three groups consisted of ACL injured participants, high tibial torsion control participants, and low tibial torsion control participants. Participants performed three body weight partial squats, six twofoot vertical jump landings, and six step-off box landings (three left foot lead and three right foot lead) for motion analysis. Transverse plane leg medial rotation was higher in the low torsion group than the high torsion group (d=1.06) and the ACL injured group (d=0.42). During the jump and box landings, ankle plantar flexor net joint moment was greater in the low torsion group than the high torsion group (d=1.43), and the ACL injured group (d=0.82). During the jump landings, frontal plane peak leg abduction was greater in the high torsion group compared to the low torsion group (d=0.54) and the ACL group (d=0.61). In conclusion, these data suggest there are similarities between kinematics known to be ACL injury risk factors and lower body kinematics that have been linked to individuals who demonstrate greater external tibial torsion. External tibial torsion must be considered when discussing differences in lower body motion and ACL injury for squatting and landing.

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