Knee Joint Contact Forces during High-Risk Dynamic Tasks: 90° Change of Direction and Deceleration Movements

Abstract

Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was developed to estimate the total, medial, and lateral TFCF developed during vigorous activities. Thirty-one competitive soccer players performing deceleration and 90° sidestepping tasks were assessed via 3D motion analysis by using a marker-based optoelectronic system and TFCF were assessed via OpenSim software. Statistical parametric mapping was used to investigate the effect of frontal plane alignment, compartment laterality, and varus-valgus genu on TFCF. Further, in consideration of specific risk factors, sex influence was also assessed. A strong correlation (R = 0.71 ÷ 0.98, p < 0.001) was found between modification of compartmental forces and changes in frontal plane alignment. Medial and lateral TFCF were similar throughout most of the tasks with the exception of the initial phase, where the lateral compartment had to withstand to higher loadings (1.5 ÷ 3 BW higher, p = 0.010). Significant sex differences emerged in the late phase of the deceleration task. A comprehensive view of factors influencing the mediolateral distribution of TFCF would benefit knee injury prevention and rehabilitation in sport activities.

Keywords: anterior cruciate ligament; cut maneuver; deceleration; football; knee compartmental contact forces; musculoskeletal modeling; return to sport; sport injury.

Figure 1

(A) Representation of the neutral knee model: hip, knee, and ankle joint centers are aligned along a straight line. (B) Representation of the aligned knee model (varus knees in the example above): hip, knee, and ankle joint centers are not aligned along a straight line.

Figure 2

Linear correlations between valgus−varus alignment and mean force changes for medial and lateral tibiofemoral contact forces (TFCF) during sidestepping (top row) and deceleration (bottom row). Change (Δmean) is intended as the difference between task average forces measured by the aligned model with respect to the neutral model. Every dot represents one individual case.

Figure 3

Linear correlations between valgus−varus alignment and peak force change for medial and lateral tibiofemoral contact forces (TFCF) during sidestepping (top row) and deceleration (bottom row). Change (Δmean) is intended as the difference between peak forces measured by the aligned model with respect to the neutral model. Every dot represents one individual case.

Figure 4

Sidestepping TFCF (normalized to body weight and represented as mean and standard deviation) of all individuals across the task stance in both the neutral (red) and aligned (blue) knee models. The left column represents total TFCF, the middle column represents medial TFCF, and the right column represents lateral TFCF. The central row highlights the differences between the means (neutral−aligned). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences.

Figure 5

Deceleration TFCF (normalized to body weight and represented as mean and standard deviation) of all individuals across the task stance in both the neutral (red) and aligned (blue) knee models. The left column represents total TFCF, the middle column represents medial TFCF, and the right column represents lateral TFCF. The central row highlights the differences between the means (neutral−aligned). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences.

Figure 6

Total (red), medial (magenta), and lateral (cyan) sidestepping TFCF (normalized to body weight and represented as mean and standard deviation) across the task stance. The green line represents differences between means for the medial and lateral forces (medial−lateral). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences between compartmental forces.

Figure 7

Total (red), medial (magenta), and lateral (cyan) deceleration TFCF (normalized to body weight and represented as mean and standard deviation) across the task stance. The green line represents differences between means for the medial and lateral forces (medial−lateral). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences between compartmental forces.

Figure 8

Sidestepping TFCF (normalized to body weight and represented as mean and standard deviation) across the task stance for both the male (blue) and female (magenta) groups. The left column represents total TFCF, the middle column represents medial TFCF, and the right column represents lateral TFCF. The central row highlights the differences between the means (male−female). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences.

Figure 9

Deceleration TFCF (normalized to body weight and represented as mean and standard deviation) across the task stance in both the male (blue) and female (magenta) groups. The left column represents total TFCF, the middle column represents medial TFCF, and the right column represents lateral TFCF. The central row highlights the differences between the means (male−female). Grey areas with corresponding p-values from SPM graphs indicate significant and clinically relevant differences.