Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting : a systematic review and technical framework

Donelon, TA; Dos’Santos, T; Pitchers, G; Brown, M; Jones, PA

Abstract

Background: Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation. Methods: Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical determinants”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis. Results: The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs. Conclusion: Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a mid-foot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC).

Citation

Donelon, T., Dos’Santos, T., Pitchers, G., Brown, M., & Jones, P. (2020). Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting : a systematic review and technical framework. Sports Medicine - Open, 6(1), 53. https://doi.org/10.1186/s40798-020-00276-5

• Journal Article Type: Article
• Acceptance Date: Sep 2, 2020
• Online Publication Date: Nov 2, 2020
• Publication Date: Nov 2, 2020
• Deposit Date: Nov 4, 2020
• Publicly Available Date: Nov 4, 2020
• Journal: Sports Medicine - Open
• Print ISSN: 2199-1170
• Electronic ISSN: 2198-9761
• Publisher: Springer Verlag
• Volume: 6
• Issue: 1
• Pages: 53
• DOI: https://doi.org/10.1186/s40798-020-00276-5
• Publisher URL: https://doi.org/10.1186/s40798-020-00276-5
• Related Public URLs: http://www.sportsmedicine-open.com/
• Additional Information: Additional Information : ** From Springer Nature via Jisc Publications Router ** Licence for this article: https://creativecommons.org/licenses/by/4.0/ **Journal IDs: pissn 2199-1170; eissn 2198-9761 **Article IDs: publisher-id: s40798-020-00276-5; manuscript: 276 **History: collection 12-2020; published_online 02-11-2020; online 02-11-2020; accepted 02-09-2020; registration 02-09-2020; submitted 20-12-2019