Comparison of Knee Kinematics during Anticipated and Unanticipated Landings

1. Comparison of Knee Kinematics during Anticipated and Unanticipated Landings Tony Moreno PhD CSCS School of Health Promotion and Human Performance Eastern Michigan University

2. Overview Basketball – • In general, female high school participants incur knee injury rates nearly twice as high as their male counterparts. • Anterior cruciate ligament (ACL) injuries occur at a rate of approximately 1 in 65 per participant annually. • ACL surgery rate nearly 4 times higher. Soccer – • In general, female high school participants incur knee injury rates approximately 2.5 times higher than their male counterparts. • ACL surgery rate 3 times higher Hewett et al., 2006

3. Mechanism of Injury • Incidents are typically non-contact while the athlete is: • landing from a jump or, • conducting a pivoting or sidestep cutting-type maneuver • Injury mechanism may involve: • Tibial rotation in opposition to a femoral rotation, • concurrent with a valgus (knock-kneed) stress at relatively low knee flexion angles, • while suddenly decelerating on a fixed or planted foot.

4. Statement of the Problem Unpredictable landing and cutting movements are inherent characteristics within sport, with knee joint flexion (KJF) and time to peak knee joint flexion (TKJF) often associated with increased risk of lower extremity injury. • What kinematic differences exist between anticipated and unanticipated jump landing conditions? • Do injury prevention protocols address the indeterminate movement conditions observed in practice and competition? Purpose The purpose of this study was to compare kinematic parameters of the knee during anticipated and unanticipated landing conditions among adolescent female basketball athletes performing a maximal vertical jump effort.

5. Methods • Six adolescent female AAU basketball players (13.8 ± 0.4yr.; 62.7 ± 17.87kg; 1.66 ± 0.08m). • Maximal vertical jump assessed for all participants with the use of a Vertec™ (Sports Imports, Columbus, OH). • Participants performed a maximal vertical jump, landed and immediately sprinted either left or right with an anticipated (A) and unanticipated (U) direction upon impact.

6. Methods (continued) • Kinematic data collected at 120 Hz with 8 digital cameras and EvART Version 4.2 software (Falcon, Motion Analysis Corporation, Santa Rosa, CA). • Force data sampled at 1200Hz with an AMTI LG6 force platform (Advanced Medical Technology Incorporated, Watertown, MA) synchronized with the motion capture system. • Kinetic data derived with MATLAB 7 software package (MathWorks, Nattick, MA, USA). • A paired sample t-test was performed for each dependent variable to determine if significant differences (p< 0.05) existed between the anticipated and unanticipated landing condition.

8. anticipated landing unanticipated landing

9. Mean peak knee flexion KJF (A=70.9 ± 10.2º; U=55.6 ± 12.7º)

10. Mean time to peak knee flexion TKJF (A=0.2 ± 0.06s; U= 0.17 ± 0.05s)

11. Results • Mean peak values for KJF (A=70.9 ± 10.2º; U=55.6 ± 12.7º) and TKJF (A=0.2 ± 0.06s; U= 0.17 ± 0.05s) were significantly different (p<0.05) when comparing anticipated to unanticipated landing conditions. • It is apparent subjects utilize different kinematic strategies with the unpredictable landing scenario. • Conclusion: Evaluation of anticipated and unanticipated landings may be necessary to ensure injury intervention protocols provide adequate variability and unpredictability to attenuate factors associated with lower extremity injury.

12. Neuromuscular Factors • Corrective responses via proprioceptive (sensory) feedback. • Preplanning through the Central Nervous System. • Physical training can potentially change the neuromuscular response. • Alteration of biomechanical factors may reduce the incidence or severity of injury. Hewett et al., 2006

13. Mean peak knee extensor moment on impact PKJM (A= 3.64 ± 1.07 Nm/kg; U= 5.1 ± 1.4 Nm/kg)

14. anticipated training unanticipated training

15. When comparing ACL injured subjects to controls performing similar movements with video analysis… • …injured demonstrate a hind or flatfoot disposition on impact • …non-injured exhibit greater plantar flexion on impact - …injured demonstrate less knee flexion on impact Boden, et al. (20009)

16. Future Research • Ankle joint kinematics (talar and subtalar) on landing, are significantly associated with kinematic and kinetic measures of the knee • Peak knee joint flexion • Time to peak knee joint flexion • Peak ground reaction force at impact • Eccentric knee extensor torques • Knee abduction/adduction torques • Relative loading rate at impact These biomechanical parameters are strongly associated with ACL and lower extremity injury…

17. Future Research • Select uninjured population at risk for ACL injury and currently participating in activities that include jumping and cutting. • Determine the potential influence of ankle joint motion on knee joint kinematics and kinetics, while landing from a jump task. • Perform jump task with both anticipated and unanticipated landing conditions. • Expose experimental subjects to a training intervention (anticipated and unanticipated?) that may alter proprioceptive mechanisms. • To test the hypotheses, compare pre- and post intervention biomechanical parameters within and between groups.

18. Thank You! Tony Moreno PhD CSCS School of Health Promotion and Human Performance Eastern Michigan University amoreno@emich.edu