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Relationship of anterior knee laxity to knee translations during drop landings: a bi-plane fluoroscopy study

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Passive anterior knee laxity has been linked to non-contact ACL injury risk. High deceleration movements have been implicated in the non-contact ACL injury mechanism, and evidence suggests that greater anterior tibial translations (ATT) may occur in healthy knees that are lax compared to a tight knee. The purpose of this study was to determine the relationship between anterior knee laxity scores and ATT during drop landings using biplane fluoroscopy.


Sixteen healthy adults (10 women; 6 men) performed stiff drop landings (40 cm) while being filmed using a high-speed, biplane fluoroscopy system. Initial, peak and excursions for rotations and translations were calculated and regression analysis used to determine the 6DoF kinematic relationships with KT1000 scores with peak ATT occurring during the landing.


KT1000 values were (+) correlated with peak ATT values for group (r = 0.89; P < 0.0001) and both genders (males, r = 0.97; P = 0.0003; females, r = 0.93; P = < 0.0001). Regression analysis yielded a significant linear fit for the group (r 2 = 0.80; Y ATT-group = − 0.516 + 1.2 × X KT1000-group) and for each gender (females: r2 = 0.86; Y ATT-females = 0.074 + 1.2 × X KT1000-females and males: r 2 = 0.94; Y ATT-males = − 0.79 + 1.2 × X KT1000-males).


A strong relationship was observed between passive anterior knee laxity measured via KT1000 and peak ATT experienced during dynamic activity in otherwise healthy persons performing a stiff drop-landing motion.

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  1. 1.

    Blankevoort L, Huiskes R, de Lange A (1990) Helical axes of passive knee joint motions. J Biomech 23:1219–1229

  2. 2.

    Braun S, Millett PJ, Yongpravat C et al (2010) Biomechanical evaluation of shear force vectors leading to injury of the biceps reflection pulley: a biplane fluoroscopy study on cadaveric shoulders. Am J Sports Med 38:1015–1024

  3. 3.

    Daniel DM, Stone ML, Sachs R et al (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407

  4. 4.

    Davies H, Tietjens B, Van Sterkenburg M et al (2009) Anterior cruciate ligament injuries in snowboarders: a quadriceps-induced injury. Knee Surg Sports Traumatol Arthrosc 17:1048–1051

  5. 5.

    Decker MJ, Torry MR, Wyland DJ et al (2003) Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clin Biomech 18:662–669

  6. 6.

    Decoster LC, Bernier JN, Lindsay RH et al (1999) Generalized joint hypermobility and its relationship to injury patterns among NCAA Lacrosse players. J Athl Train 34:99–105

  7. 7.

    Demorat G, Weinhold P, Blackburn T et al (2004) Aggressive quadriceps loading can induce non-contact anterior cruciate ligament injury. Am J Sports Med 32:477–483

  8. 8.

    Ford KR, Myer GD, Hewett TE (2003) Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc 35:1745–1750

  9. 9.

    Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144

  10. 10.

    Hantan W, Pace M (1987) Reliability of measuring anterior laxity of the knee joint using a knee ligament arthrometer. Phys Ther 67(3):357–359

  11. 11.

    Hertel J, Dorfman J, Braham R (2004) Lower extremity malalignments and and anteriro cruciate ligment injury history. J Sports Sci Med 3:220–225

  12. 12.

    Hewett TE, Myer GD, Ford KR et al (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33:492–501

  13. 13.

    Hurschler C, Seehaus F, Emmerich J et al (2008) Accuracy of model-based RSA contour reduction in a typical clinical application. Clin Orthop Relat Res 466:1978–1986

  14. 14.

    Ishibashi Y, Rudy TW, Livesay GA et al (1997) The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy 13:177–182

  15. 15.

    Keller TS, Weisberger AM, Ray JL et al (1996) Relationship between vertical ground reaction force and speed during walking, slow jogging, and running. Clin Biomech 11:253–259

  16. 16.

    Kernozek TW, Ragan RJ (2008) Estimation of anterior cruciate ligament tension from inverse dynamics data and electromyography in females during drop landing. Clin Biomech 23:1279–1286

  17. 17.

    Kernozek TW, Torry MR HVANH et al (2005) Gender differences in frontal and sagittal plane biomechanics during drop landings. Med Sci Sports Exerc 37:1003–1012

  18. 18.

    Krosshaug T, Slauterbeck JR, Engebretsen L et al (2007) Biomechanical analysis of anterior cruciate ligament injury mechanisms: three-dimensional motion reconstruction from video sequences. Scand J Med Sci Sports 17:508–519

  19. 19.

    Li G, Kozanek M, Hosseini A et al (2009) New fluoroscopic imaging techniques for investigation of 6DOF knee kinematics during treadmill walking. J Orthop Surg Res 4:1–5. doi:10.1186/1749-1799x-1184-1186

  20. 20.

    Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13:184–188

  21. 21.

    Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee–the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 58:583–594

  22. 22.

    Miyasaka K, Daniel DM, Stone ML et al (1991) The incidence of knee ligament injuries in the general population. American J Knee Surg 4:3–8

  23. 23.

    Myer GD, Ford KR, Khoury J et al (2010) Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury. Br J Sports Med

  24. 24.

    Myers CA, Hawkins D (2010) Alterations to movement mechanics can greatly reduce anterior cruciate ligament loading without reducing performance. J Biomech 43:2657–2664

  25. 25.

    Pflum MA, Shelburne KB, Torry MR et al (2004) Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exerc 36:1949–1958

  26. 26.

    Quatman CE, Hewett TE (2009) The anterior cruciate ligament controversy: is valgus collapse a sex specific mechanism. Br J Sports Med 43(5):328–335

  27. 27.

    Rangger C, Daniel DM, Stone ML et al (1993) Diagnosis of an ACL disruption with KT-1000 arthrometer measurements. Knee Surg Sports Traumatol Arthrosc 1:60–66

  28. 28.

    Scerpella T, Stayer T, Makhuli B (1997) Ligamentous laxity and non-contact ACL tears: a gender based comparison. Orthopedics 656–660

  29. 29.

    Seehaus F, Emmerich J, Kaptein BL et al (2009) Experimental analysis of Model-Based Roentgen Stereophotogrammetric Analysis (MBRSA) on four typical prosthesis components. J Biomech Eng 131:041004-10

  30. 30.

    Tashman S, Collon D, Anderson K et al (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983

  31. 31.

    Torry MR, Shelburne KB, Peterson DS et al. (2010) Knee kinematic profiles during drop landings: a biplane fluoroscopy study. Med Sci Sports Exerc. doi:10.1249/MSS.0b013e3181f1e491

  32. 32.

    Uhorchak JM, Scoville CR, Williams GN et al (2003) Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets. Am J Sports Med 31:831–842

  33. 33.

    Wojtys EM, Huston LJ, Lindenfeld TN et al (1998) Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes [see comments]. Am J Sports Med 26:614–619

  34. 34.

    Woo SL, Hollis JM, Adams DJ et al (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19:217–225

  35. 35.

    Woo SL, Livesay GA, Engle C (1992) Biomechanics of the human anterior cruciate ligament. ACL structure and role in knee motion. Orthop Rev 21:835–842

  36. 36.

    Woodford-Rogers B, Cyphert L, Denegar CR (1994) Risk factors for anterior cruciate ligament injury in high school and college athletes. J Athl Train 29:343–346

  37. 37.

    Yu B, Garrett WE (2007) Mechanisms of non-contact ACL injuries. Br J Sports Med 41(Suppl):i47–i51

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This study was funded in part by the Steadman Philippon Research Institute and a grant from the National Institutes of Health (AR39683 to PI: Savio L-Y. Woo). The Steadman Philippon Research Institute is a 501(c)3 non-profit institution supported financially by private donations and corporate support from the following entities: Smith & Nephew Endoscopy, Arthrex, Siemens Medical Solutions USA, Saucony, OrthoRehab, Ossur Americas, Alignmed LLC and Opedix. Thank you to Medis Specials for providing the MBRSA software.

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Correspondence to Michael R. Torry.

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Torry, M.R., Myers, C., Pennington, W.W. et al. Relationship of anterior knee laxity to knee translations during drop landings: a bi-plane fluoroscopy study. Knee Surg Sports Traumatol Arthrosc 19, 653–662 (2011). https://doi.org/10.1007/s00167-010-1327-6

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  • ACL
  • Landing
  • Anterior tibial translation
  • Biomechanics