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A ‘Plane’ Explanation of Anterior Cruciate Ligament Injury Mechanisms

A Systematic Review

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Abstract

Although intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) injury have been explored extensively, the factors surrounding the inciting event and the biomechanical mechanisms underlying ACL injury remain elusive. This systematic review summarizes all the relevant data and clarifies the strengths and weaknesses of the literature regarding ACL injury mechanisms. The hypothesis is that most ACL injuries do not occur via solely sagittal, frontal or transverse plane mechanisms. Electronic database literature searches of PubMed MEDLINE (1966–2008), CINAHL (1982–2008) and SportDiscus® (1985–2008) were used for the systematic review to identify any studies in the literature that examined ACL injury mechanisms. Methodological approaches that describe and evaluate ACL injury mechanisms included athlete interviews, arthroscopic studies, clinical imaging and physical exam tests, video analysis, cadaveric studies, laboratory tests (motion analysis, electromyography) and mathematical modelling studies. One hundred and ninety-eight studies associated with ACL injury mechanisms were identified and provided evidence regarding plane of injury, with evidence supporting sagittal, frontal and/or transverse plane mechanisms of injury. Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury.

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Acknowledgements

The authors acknowledge funding support from the University of Toledo, College of Medicine Pre-Doctoral Fellowship, the American College of Sports Medicine Foundation, Plus One Active Research Grant on Wellness Using Internet Technology, and the National Institutes of Health Grants R01-AR049735, RO1-AR05563 and R01-AR056259. The authors thank Vijay Goel, Dean Demetropoulos, Kevin Ford, Keith Kenter and Greg Myer for their discussions about the topic covered in this review.

The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA

    Carmen E. Quatman, Catherine C. Quatman-Yates &  Timothy E. Hewett PhD

  2. University of Toledo, Engineering Center for Orthopaedic Research Excellence, College of Engineering, University of Toledo, Toledo, Ohio, USA

    Carmen E. Quatman

  3. Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, Ohio, 45229, USA

    Catherine C. Quatman-Yates

  4. Division of Molecular Cardiovascular Biology, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio, USA

    Timothy E. Hewett PhD

  5. Departments of Pediatrics, Orthopaedic Surgery and College of Allied Health Sciences, Department of Rehabilitation Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

    Timothy E. Hewett PhD

  6. Sports Medicine Center, Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA

    Timothy E. Hewett PhD

Authors
  1. Carmen E. Quatman
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  2. Catherine C. Quatman-Yates
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  3. Timothy E. Hewett PhD
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Corresponding author

Correspondence to Timothy E. Hewett PhD.

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Quatman, C.E., Quatman-Yates, C.C. & Hewett, T.E. A ‘Plane’ Explanation of Anterior Cruciate Ligament Injury Mechanisms. Sports Med 40, 729–746 (2010). https://doi.org/10.2165/11534950-000000000-00000

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  • DOI: https://doi.org/10.2165/11534950-000000000-00000

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