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. 2025 Jul 6;17(7):e87390.
doi: 10.7759/cureus.87390. eCollection 2025 Jul.

Biomechanical Changes in the Lower Limb After a Quadriceps Fatigue Task in Association With Dynamic Knee Valgus

Makoto Asaeda  1   2 , Yukio Mikami  1 , Akihiro Matsumoto  1 , Takeya Araki  1 , Kiyo Ueda  1 , Noriaki Maeda  3 , Tomoya Onishi  2 , Hideyuki Ito  2 , So Miyahara  2 , Atsuo Nakamae  4 , Nobuo Adachi  4
Affiliations

Biomechanical Changes in the Lower Limb After a Quadriceps Fatigue Task in Association With Dynamic Knee Valgus

Makoto Asaeda et al. Cureus. .

Abstract

Objectives: Dynamic knee valgus (DKV), characterized by knee abduction and external rotation, has been associated with anterior cruciate ligament (ACL) injury, but the predictive accuracy of DKV for ACL injury remains unclear.

Methods: This controlled laboratory study examined fatigue effects on lower limb biomechanics and electromyography (EMG) during jump landing in healthy men. Participants were categorized into induced (n=11) and non-induced (n=8) DKV groups based on changes in knee abduction moment after a fatigue task.

Results: Compared to the non-induced DKV group, the induced group exhibited a significantly reduced hip flexion angle (p=0.030), lower vertical ground reaction force (p=0.040), and decreased quadriceps peak EMG amplitude (p=0.008), along with a significant increase in hip internal rotation moment (p=0.001). Receiver operating characteristic analysis revealed that hip internal rotation moment had the highest discriminative power for classifying DKV occurrence, with an area under the curve (AUC) of 0.994 (95% CI: 0.960-1.000), followed by hip adduction moment (AUC = 0.896) and quadriceps peak amplitude (AUC = 0.883).

Conclusions: Findings suggest that DKV occurrence after fatigue is associated with altered quadriceps activity and hip rotation mechanics. These insights may inform ACL injury prevention strategies.

Keywords: anterior cruciate ligament; electromyography; fatigue; knee valgus; lower limb biomechanics.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Research Ethics Committee of Takarazuka University of Medical and Health Care issued approval 2009251. This study was approved by the Institutional Research Ethics Committee (the Institutional Research Ethics Committee of Takarazuka University of Medical and Health Care: Approval No.: 2009251) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Receiver operating characteristic analysis with the parameters showing significant differences between the two groups.
A: Changes in vertical GRF, B: Changes in hip flexion angle, C; Changes in hip adduction moment, D: Changes in hip internal moment, E: Quadriceps peak amplitude after fatigue task AUC, area under the curve; CI, confidence interval; GRF, ground reaction force; SD, standard deviation
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References

    1. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball. Koga H, Nakamae A, Shima Y, et al. Am J Sports Med. 2010;38:2218–2225. - PubMed
    1. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Hewett TE, Myer GD, Ford KR, et al. Am J Sports Med. 2005;33:492–501. - PubMed
    1. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. Cronström A, Creaby MW, Ageberg E. BMC Musculoskelet Disord. 2020;21:563. - PMC - PubMed
    1. Revised approach to the role of fatigue in anterior cruciate ligament injury prevention: a systematic review with meta-analyses. Benjaminse A, Webster KE, Kimp A, Meijer M, Gokeler A. Sports Med. 2019;49:565–586. - PMC - PubMed
    1. Effect of fatigue protocols on lower limb neuromuscular function and implications for anterior cruciate ligament injury prevention training: a systematic review. Barber-Westin SD, Noyes FR. Am J Sports Med. 2017;45:3388–3396. - PubMed

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