Influence of ground reaction force perturbations on anterior cruciate ligament loading during sidestep cutting

Anterior cruciate ligament (ACL) injury risk is likely increased under unexpected loading conditions. Such situations may arise from mid-air contact with another athlete, or misjudgments in landing height, stride length or surface compliance resulting in an unbalanced landing and unexpected changes in the ground reaction forces (GRFs). The purpose this study was to identify how GRF perturbations influence ACL loading during sidestep cutting. Muscle-actuated simulations of sidestep cutting were generated and analyzed for 20 subjects. Perturbations of 20, 40 and 60% of the nominal value were applied to the posterior, vertical, and medial GRF. Open-loop, forward dynamics simulations were run with no feedback or correction mechanism which allowed deviations from the experimentally measured kinematics as a result of the GRF perturbations. Posterior and vertical GRF perturbations significantly increased ACL loading, although the change was more pronounced with posterior perturbations. These changes were primarily due to the sagittal plane component of ACL loading regardless of perturbation direction. Peak ACL loading occurred almost immediately after initial ground contact, and was thus predicated on initial joint configuration. The results of this study give merit to including knee flexion angle at initial ground contact in the evolving neuromuscular training modalities aimed at preventing non-contact ACL injury.