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Purpose: To investigate the landing strategies used after discontinuing and continuing the use of a functional knee brace (FKB) while performing a drop jump. Methods: Following published methodology and power analysis, 23 uninjured male athletes, mean age of 19.4 ± 3.0 years, performed seven tests, during three test conditions (nonbraced, braced and removed brace or continued brace use), over 6 days of 12 testing sessions (S) for a total of 38.5 h. Each subject was provided with a custom‐fitted FKB. This study focuses on the single leg drop jump kinetics during S12 when subjects were randomly selected to remove the FKB after 17.5 h or continued use of FKB. The time to peak vertical ground reaction forces (PVGRF) and PVGRF were recorded on landing in eight trials. Results: After brace removal, a significantly shorter mean time to PVGRF was recorded (9.4 ± 22.9 msec (3.9%), p = 0.005, 95% confidence interval (95% CI): −168.1, 36.1), while continued brace use required a nonsignificant (n.s.) longer mean duration to achieve PVGRF (19.4 ± 53.6 msec (8.9%), n.s., 95% CI: −49.7, 73.4). No significant mean PVGRF difference was found in brace removal (25.3 ± 65.8 N) and continued brace use (25.1 ± 23.0 N). Conclusion: Removal of FKB after 17.5 h of use led to a significantly shorter time to achieve PVGRF, while continued brace use for 21 h required a longer duration to achieve PVGRF, suggesting faster and slower knee joint loading, respectively. Understanding the concerns associated with the use of FKB and the kinetics of the knee joint will assist clinicians in counselling athletes about the risks and benefits of using an FKB. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury. Purpose: To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI. Results: A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P =.030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle [LFC] + lateral tibial plateau [LTP]) bone bruises (82.1% vs 48.6%, P <.001) and a lower rate of combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau [MTP]) bone bruises (39.7% vs 66.2%, P <.001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P =.003) and posteriorly located MTP bruises (66.2% vs 52.6%, P =.047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 [95% CI, 1.147-19.433], P =.032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 [95% CI, 0.144-0.762], P =.009) compared with those with noncontact injuries. Conclusion: Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long‐term quality of life. Before the onset of this study, understanding the mechanism of ACL injury was limited. Thus, the primary focus of this manuscript is to describe our multi‐faceted approach to uncovering the mechanism of noncontact ACL injury (NC‐ACLI) with the goal of developing preventive strategies. The initial qualitative analysis of ACL injury events revealed most (70%) injuries involve minimal to no contact and occurr during landing or deceleration maneuvers in team sports with a minor perturbation before the injury that may disrupt the neuromuscular system leading to poor body dynamics. A series of quantitative videotape studies demonstrated differences in leg and trunk positions at the time of NC‐ACLI in comparison to control subjects. Analysis of the faulty dynamics provoking NC‐ACLI, especially the flat‐footed landing component, supports the theory that an axial compressive force is the critical factor responsible for NC‐ACLI. Our magnetic resonance imaging study demonstrated the NC‐ACLI position was associated with a higher tibial slope, and joint contact occurring on the flat, anterior portion of the lateral femoral condyle versus the round, posterior aspect. Both anatomic conditions favor sliding (pivot shift) over rolling in the presence of an axial compressive force. Subsequent cadaveric studies supported axial compressive forces as the primary component of NC‐ACLI. Both a strong eccentric quadriceps contraction and knee abduction moments may increase the compressive force at the joint thereby lowering the axial threshold to injury. This manuscript summarizes the NC‐ACLI mechanism portion of the 2021 OREF Clinical Research Award. [ABSTRACT FROM AUTHOR]

Proximal anterior tibia shear force is a direct loading mechanism of the anterior cruciate ligament (ACL) and is a contributor to ACL strain during injury. Measurement of this force during competition may provide insight into risk factors for ACL injury. Accelerometers may be capable of measuring tibial acceleration during competition. The purpose of this study was to examine the relationship between acceleration measured by a tibia-mounted accelerometer and proximal anterior tibia shear force as measured through inverse dynamics and peak posterior ground reaction forces during two leg stop-jump tasks. Nineteen healthy male subjects performed stop-jump tasks across increasing jump distances. Correlation coefficients were calculated to determine if a relationship exists between accelerometer data and proximal anterior tibia shear force and peak posterior ground reaction force. An analysis of variance was performed to compare these variables across jump distance. Significant correlations were observed between accelerometer data and peak posterior ground reaction force, but none between accelerometer data and proximal anterior tibia shear force. All variables except peak proximal anterior tibia shear force increased significantly as jump distance increased. Overall, results of this study provide initial, positive support for the use of accelerometers as a useful tool for future injury prevention research. [ABSTRACT FROM AUTHOR]

While many anterior cruciate ligament (ACL) prevention programs have been published, few have achieved significant reductions in injury rates and improvements in athletic performance indices; both of which may increase compliance and motivation of athletes to participate. A supervised neuromuscular retraining program (18 sessions) was developed, aimed at achieving both of these objectives. The changes in neuromuscular indices were measured after training in 1000 female athletes aged 13–18 years, and the noncontact ACL injury rate in 700 of these trained athletes was compared with that of 1120 control athletes. There were significant improvements in the drop-jump test, (p < 0.0001, effect size [ES] 0.97), the single-leg triple crossover hop (p < 0.0001, ES 0.47), the t-test (p < 0.0001, ES 0.64), the multi-stage fitness test (p < 0.0001, ES 0.57), hamstring strength (p < 0.0001), and quadriceps strength (p < 0.01). The trained athletes had a significant reduction in the noncontact ACL injury incidence rate compared with the controls (1 ACL injury in 36,724 athlete-exposures [0.03] and 13 ACL injuries in 61,244 exposures [0.21], respectively, p = 0.03). The neuromuscular retraining program was effective in reducing noncontact ACL injury rate and improving athletic performance indicators.

Abstract: This work presents a finite element analysis of anterior cruciate ligament (ACL) impingement against the intercondylar notch during tibial external rotation and abduction, as a mechanism of noncontact ACL injuries. Experimentally, ACL impingement was measured in a cadaveric knee in terms of impingement contact pressure and six degrees-of-freedom tibiofemoral kinematics. Three-dimensional geometries of the ACL, femur and tibia were incorporated into the finite element model of the individual knee specimen. A fiber-reinforced model was adopted, which accounts for the anisotropy, large deformation, nonlinearity and incompressibility of the ACL. With boundary conditions specified based on the experimental tibiofemoral kinematics, the finite element analysis showed that impingement between the ligament and the lateral wall of intercondylar notch could occur when qthe knee at 45° was externally rotated at 29.1° and abducted at 10.0°. Strong contact pressure and tensile stress occurred at the impinging and nonimpinging sides of the ligament, respectively. The impingement force and contact area estimated from the model matched their counterparts from the corresponding cadaver experiment. The modeling and experimental approach provides a useful tool to characterize potential ACL impingement on a knee-specific basis, which may help elucidate the ACL injury mechanism and develop more effective treatments. [Copyright &y& Elsevier]