Effect of Foot-Planting Strategy on Anterior Cruciate Ligament Loading in Women During a Direction Diversion Maneuver: A Musculoskeletal Modeling Approach

Jusung Lee; Prabhat Pathak; Siddhartha Bikram Panday; Jeheon Moon

doi:10.1177/2325967120963180

Effect of Foot-Planting Strategy on Anterior Cruciate Ligament Loading in Women During a Direction Diversion Maneuver: A Musculoskeletal Modeling Approach

Orthop J Sports Med. 2020 Nov 19;8(11):2325967120963180. doi: 10.1177/2325967120963180. eCollection 2020 Nov.

Authors

Jusung Lee¹, Prabhat Pathak², Siddhartha Bikram Panday^{2

3}, Jeheon Moon^{4

5}

Affiliations

¹ Department of Sport Science, Kangwon National University, Chuncheon, Republic of Korea.
² Department of Physical Education, Seoul National University, Seoul, Republic of Korea.
³ Department of Sport and Leisure Studies, Keimyung University, Daegu, Republic of Korea.
⁴ Department of Physical Education, Korea National University of Education, Cheongju, Republic of Korea.
⁵ Department of Sport Science, Korea Institute of Sport Science, Seoul, Republic of Korea.

Abstract

Background: Although there is a higher prevalence of noncontact anterior cruciate ligament (ACL) injuries during a direction diversion maneuver (DDM), no previous studies have reported how foot-planting strategies affect ACL loading.

Purpose: To investigate the effect of foot-planting strategies on ACL loading in women during a DDM task using a musculoskeletal modeling approach.

Study design: Descriptive laboratory study.

Methods: A total of 13 female participants performed a DDM task, which involved running at 4.5 ± 0.2 m/s and turning left at 35° to 55° under a foot-planting strategy in 3 directions: neutral, toe-in, and toe-out. Kinematic and kinetic data were measured with the use of a 3-dimensional motion capture system and force platform to calculate variables such as joint angle, shear force, and moment. Anterior ACL and posterior ACL forces were extracted using musculoskeletal modeling.

Results: The peak anterior ACL force was significantly larger for the toe-out condition (31.29 ± 4.02 N/body weight [BW]) compared with the toe-in condition (25.43 ± 5.68 N/BW) (P = .047), with no significant difference in the neutral condition. The toe-out condition had a higher knee valgus angle (2.98° ± 4.20°; P = .041), knee shear force (10.20 ± 1.69 N/BW; P = .009), and knee internal rotation moment (-0.18 ± 0.16 N·m/BW×height; P = .012) than the toe-in and neutral conditions.

Conclusion: Through musculoskeletal modeling, we were able to conclude that the toe-out condition during the DDM might result in a higher risk of ACL injuries. Athletes and sports practitioners should avoid the toe-out foot-planting strategy when participating in a sporting activity.

Clinical relevance: Based on these findings, medical professionals and athletic coaches can gain knowledge on how foot-planting strategy affects ACL loading. Understanding the actual cause of an ACL injury can be useful for designing preventive training programs or strategies to decrease the risk of such injuries.

Keywords: anterior cruciate ligament; foot-planting strategy; kinematics; kinetics; musculoskeletal modeling.