Computer simulation of landing movement in downhill skiing: anterior cruciate ligament injuries

Anterior cruciate ligament (ACL) injuries typically occur in high-speed downhill skiing during the landing phase following a jump. A direct dynamics simulation model was developed which allows investigation of possible ACL injury mechanisms without the need to use actual skiers in a potentially dangerous environment. The model included multibody dynamics, muscle dynamics and a model for ski-snow interaction. The model's ability to reproduce an actual landing movement was investigated by minimizing the differences between measured and stimulated landing movements as a function of constant muscle stimulation levels. The remaining difference was mainly due to noise in the measurements. A small balance disturbance was induced to simulate an injury condition. This disturbance caused the modeled skier to fall slightly backwards. A recovery attempt was made by maximal activation of the quadriceps and iliopsoas muscles. Peak resultant shear force at the knee joint in ACL direction was substantially higher in the injury simulation (1001 N) when compared to the simulated normal landing movement (589 N). Taking into account quadriceps contraction and orientation of the ACL with respect to tibial plateau, peak ACL force during the injury simulation was estimated to be 1350 N, which is within the range of failure loads for this ligament. The external forces were mainly (75%) responsible for this loading. The contribution of the fully activated quadriceps muscles was only 25%. It was concluded that the model could reproduce a typical landing movement and is therefore considered to be sufficiently realistic. Second, the simulation results suggest that external forces are the main cause for ACL injuries during landing movements in downhill skiing.