Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump.

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2021-03

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Abstract

Background

There is little in vivo data that describe the relationships between patellar tendon orientation, patellar tendon strain, and anterior cruciate ligament (ACL) strain during dynamic activities. Quantifying how the quadriceps load the ACL via the patellar tendon is important for understanding ACL injury mechanisms.

Hypothesis

We hypothesized that flexion angle, patellar tendon orientation, and patellar tendon strain influence ACL strain during a single-leg jump. Specifically, we hypothesized that patellar tendon and ACL strains would increase concurrently when the knee is positioned near extension during the jump.

Study design

Descriptive laboratory study.

Methods

Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon attachment sites of 8 male participants were generated from magnetic resonance imaging (MRI). High-speed biplanar radiographs during a single-leg jump were obtained. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones, ligament, and tendon attachment sites. Flexion angle, patellar tendon orientation, patellar tendon strain, and ACL strain were measured from the registered models. ACL and patellar tendon strains were approximated by normalizing their length at each knee position to their length at the time of MRI. Two separate bivariate linear regression models were used to assess relationships between flexion angle and patellar tendon orientation and between ACL strain and patellar tendon strain. A multivariate linear regression model was used to assess whether flexion angle and patellar tendon strain were significant predictors of ACL strain during the inflight and landing portions of the jump.

Results

Both flexion angle and patellar tendon strain were significant predictors (P < .05) of ACL strain. These results indicate that elevated ACL and patellar tendon strains were observed concurrently when the knee was positioned near extension.

Conclusion

Concurrent increases in patellar tendon and ACL strains indicate that the quadriceps load the ACL via the patellar tendon when the knee is positioned near extension.

Clinical relevance

Increased ACL strain when the knee is positioned near extension before landing may be due to quadriceps contraction. Thus, landing with unanticipated timing on an extended knee may increase vulnerability to ACL injury as a taut ligament is more likely to fail.

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Citation

Published Version (Please cite this version)

10.1177/2325967121991054

Publication Info

Englander, Zoë A, Brian C Lau, Jocelyn R Wittstein, Adam P Goode and Louis E DeFrate (2021). Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump. Orthopaedic journal of sports medicine, 9(3). p. 2325967121991054. 10.1177/2325967121991054 Retrieved from https://hdl.handle.net/10161/30091.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Lau

Brian Chei-Fai Lau

Assistant Professor of Orthopaedic Surgery
Wittstein

Jocelyn Ross Wittstein

Associate Professor of Orthopaedic Surgery
Goode

Adam Payne Goode

Professor in Orthopaedic Surgery

Dr. Goode is an Associate Professor in the Department of Orthopedic Surgery. He is a physical therapist by clinical training and epidemiologist by scientific training. His focus is on understanding the etiology of low back pain and other chronic musculoskeletal conditions and improving the delivery of care for patients with acute and chronic musculoskeletal conditions.  In his research he has published in the areas of the relationship between individual radiographic features in the lumbar spine and clinical symptoms, biomarkers and peripheral joint osteoarthritis. 

DeFrate

Louis Edwin DeFrate

Laszlo Ormandy Distinguished Professor of Orthopaedic Surgery

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