The Influence of Neuromuscular Factors on Anterior Cruciate Ligament Loading in Response to External Force Perturbations

The purpose of this dissertation was to determine the influence of neuromuscular factors on anterior cruciate ligament (ACL) loading during sidestep cutting. Twenty recreationally active females completed a series of randomly cued sidestep cutting tasks followed by a hamstrings fatigue protocol and an additional set of anticipated sidestep cutting trials. Participant-specific musculoskeletal models were generated to estimate muscle excitations and ACL loading during the cutting tasks. Simulated perturbations were applied to the ground reaction forces (GRF) and forward dynamics analyses were run using with no corrective mechanism. This approach allowed the model to deviate from the experimentally measured kinematic data as a result of the perturbations. ACL loading during anticipated sidestep cutting is largely due to sagittal plane loading which results from a complex interaction of the anteroposterior shear forces at the knee. ACL loading increased when the sidestep cut was unanticipated and when hamstrings strength was reduced suggesting that the risk of injury is potentially increased in such situations.

Anteroposterior GRF perturbations had the greatest effect on ACL loading. These perturbations resulted in increased knee flexion which positioned the quadriceps at a near optimal length. This also shortened the hamstrings such that their maximum force production was significantly reduced causing peak ACL loading to increase. GRF perturbations had similar effects regardless of cutting condition. As the muscles in the model were not allowed to reflexively respond to the perturbations, intrinsic muscle properties and passive dynamics of the body's segments might have reduced the effect of unexpected loading conditions. Furthermore, it appears that initial joint kinematics are essential to effectively modulating ACL loading.

Neuromuscular intervention programs should focus on balancing the strength of the hamstring and quadriceps muscle strength as this appears to reduce ACL loading. These intervention programs should also include training elements based on visual and mechanical stimuli as this may improve the muscular support of the external loads, thus reducing the potential loading of the ACL. However, whether or not these neuromuscular changes map over into performance of the sporting tasks remains to be seen.

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Year

Entry

1996

Piazza SJ, Delp SL. The influence of muscles on knee flexion during the swing phase of gait. J Biomech. June 1996;29(6):723-733.

2001

Anderson FC, Pandy MG. Dynamic optimization of human walking. J Biomech Eng. October 2001;123(5):381-390.

2004

Olsen O-E, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. June 2004;32(4):1002-1012.

1975

Seireg A, Arvikar RJ. The prediction of muscular load sharing and joint forces in the lower extremities during walking. J Biomech. March 1975;8(2):89-102.

2001

Piazza SJ, Delp SL. Three-dimensional dynamic simulation of total knee replacement motion during a step-up task. J Biomech Eng. December 2001;123(6):599-606.