Summary: The peak ACL strain rate increases during more demanding activities, while the maximum ACL elongation remains unchanged, which suggests the ACL strain rate, and not simply the kinematics, may be an important factor related to an athlete’s susceptibility to injury during high demand activities.

Purpose

ACL stress and failure load depend upon the strain rate. No studies have reported the ACL strain rate during different activities, which may be important for understanding ACL injury risk. The purpose of this study was to compare the peak rate of ACL elongation (i.e. the “strain rate”) during the initial impact when ACL injury is believed to occur (within 40ms after initial contact) during walking, jogging, fast running and a drop jump using dynamic biplane radiography. Based on the impact forces during each activity, it was hypothesized that the peak elongation rate would be greater during fast running and drop jump than during jogging and walking.

Methods

Data from ten young healthy adults (5 male/5 female, 27±4 years) and 19 healthy collegiate athletes (11 male/ 8 female, 20±1 years) were pooled from two previous studies. Participant’s knees were imaged during walking (1.4m/s), jogging (2.6m/s), fast running (5.0m/s) and double-legged drop jump (60cm platform). Synchronized biplane radiographs were collected at 100 images/second during walking and 150 images/second for the other activities. Subject-specific MRI-based bone models of the femur and tibia were co-registered to CT-based bone models, providing a 3D transformation between the MRI and CT models. The ACL insertion points, digitized from the MRI scans, were transformed to the CT bone using the MRI to CT transformation. The ACL length was calculated as the distance between the femoral and tibial insertion points. A validated tracking technique was used to match digitally reconstructed radiographs, created from the subject-specific CT-based bones, to the biplane images with submillimeter accuracy. ACL elongation was calculated each frame of tracked motion as the ratio of dynamic ACL length divided by resting ACL length during MRI. The peak rate of ACL elongation within the first 40ms after contact, and maximum elongation during stance, were calculated and compared among activities using a Kruskal-Wallis test and a Steel-Dwass post-hoc test, with significance set at p < 0.05.

Results

The peak rate of ACL elongation was 0.07±0.06 (range 0.01 to 0.20) %/ms for walking, 0.14±0.10 (range 0.01 to 0.37) %/ms for jogging, 0.24±0.15 (range 0.04 to 0.69) %/ms for fast running, and 0.15±0.32 (range -0.10 to 1.2) %/ms for drop jump. The peak rate of ACL elongation was greater during fast running compared to walking (p = 0.005). The maximum ACL elongation during stance was 0.3±2.9%, 1.7±3.4%, 1.1±4.0, and 1.8±3.5 during walking, jogging, fast running, and drop jump, respectively, with no differences among activities.

Conclusion

The peak ACL elongation rate increases during more demanding activities while the maximum ACL elongation remains unchanged. This suggests the ACL strain rate, and not simply the kinematics, may be an important factor related to an athlete’s susceptibility to injury during high demand activities. These findings highlight the potential significance of ACL strain rate in injury risk, injury prevention screening, and rehabilitation protocols.

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Dynamic Radiostereometry Evaluation Of Two Different Anterior Cruciate Ligament Reconstruction Techniques: Does Single Bundle Reconstruction Plus Lateral Plasty Cause Knee Over-Constraint? Abstract Presentation 4 minutes Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Piero Agostinone, MD, QATAR Gian Andrea Lucidi, MD, ITALY Erika Pinelly, MsC, ITALY Marco Bontempi, PhD, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Edoardo Monaco, MD, ITALY Edoardo Gaj, MD, ITALY Valerio Andreozzi, ITALY Alessandro Annibaldi, MD, ITALY Alessandro Carrozzo, MD, ITALY Thais Dutra Vieira, MD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE Andrea Ferretti, Prof., ITALY
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity Abstract Presentation 6 minutes Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Full-Thickness Peroneus Longus Tendon Autograft For Anterior Cruciate Ligament Reconstruction: Outcomes And Donor Site Morbidity ePoster Presentation Tarun Goyal, MBBS, MS, DNB, MCh, FRCS (Edin), INDIA Souvik Paul, MBBS, MS Orthopedics (AIIMS), DNB, MCh, Dip SICOT, INDIA Lakshmana Das Sekar, MS, DNB Orthopaedics, INDIA Arghya Kundu Choudhury, MS, MCh Joint replacement and reconstruction, INDIA
Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, QATAR Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, AUSTRALIA Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Concurrent Treatment Of A Displaced Bucket Handle And Anterior Cruciate Ligament Reconstruction: A Higher Risk Of Stiffness? Abstract Presentation 5 minutes Etienne Deroche, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE John Swan, MBBS, FRANCE Sebastien Lustig, MD, PhD, Prof., FRANCE Elvire Servien, MD, PhD, Prof., FRANCE
Quadriceps Tendon Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years Award Winner 5 minutes Armin Runer, PD MD, GERMANY Aline Suter, MD, AUSTRIA Tommaso Roberti di Sarsina, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Peter Gföller, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Robert Csapo, PhD, AUSTRIA Christian Fink, MD, Prof., AUSTRIA
Why, When and Who Fails Non-Operative Treatment of Anterior Cruciate Ligament Injury – An Exploratory Analysis of the COMPARE Trial Abstract Presentation 5 minutes Sabine van der Graaff, MD, NETHERLANDS Duncan E. Meuffels, MD, PhD, NETHERLANDS Sita Bierma-Zeinstra, MD, NETHERLANDS Eline van Es, MSc, NETHERLANDS Jan Verhaar, MD, PhD, Prof., NETHERLANDS Vincent Eggerding, MD, NETHERLANDS Max Reijman, PhD, NETHERLANDS

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In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities

In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities

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In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities

In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content