Document Detail

Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection.
MedLine Citation:
PMID:  22387600     Owner:  NLM     Status:  In-Data-Review    
SYNOPSIS: There is a growing body of evidence documenting loads applied to the anterior cruciate ligament (ACL) for weight-bearing and non-weight-bearing exercises. ACL loading has been quantified by inverse dynamics techniques that measure anterior shear force at the tibiofemoral joint (net force primarily restrained by the ACL), ACL strain (defined as change in ACL length with respect to original length and expressed as a percentage) measured directly in vivo, and ACL tensile force estimated through mathematical modeling and computer optimization techniques. A review of the biomechanical literature indicates the following: ACL loading is generally greater with non-weight-bearing compared to weight-bearing exercises; with both types of exercises, the ACL is loaded to a greater extent between 10° to 50° of knee flexion (generally peaking between 10° and 30°) compared to 50° to 100° of knee flexion; and loads on the ACL change according to exercise technique (such as trunk position). Squatting with excessive forward movement of the knees beyond the toes and with the heels off the ground tends to increase ACL loading. Squatting and lunging with a forward trunk tilt tend to decrease ACL loading, likely due to increased hamstrings activity. During seated knee extension, ACL force decreases when the resistance pad is positioned more proximal on the anterior aspect of the lower leg, away from the ankle. The evidence reviewed as part of this manuscript provides objective data by which to rank exercises based on loading applied to the ACL. The biggest challenge in exercise selection post-ACL reconstruction is the limited knowledge of the optimal amount of stress that should be applied to the ACL graft as it goes through its initial incorporation and eventual maturation process. Clinicians may utilize this review as a guide to exercise selection and rehabilitation progression for patients post-ACL reconstruction. J Orthop Sports Phys Ther 2012;42(3):208-220. doi:10.2519/jospt.2012.3768.
Rafael F Escamilla; Toran D Macleod; Kevin E Wilk; Lonnie Paulos; James R Andrews
Publication Detail:
Type:  Journal Article     Date:  2012-02-29
Journal Detail:
Title:  The Journal of orthopaedic and sports physical therapy     Volume:  42     ISSN:  1938-1344     ISO Abbreviation:  J Orthop Sports Phys Ther     Publication Date:  2012  
Date Detail:
Created Date:  2012-03-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908150     Medline TA:  J Orthop Sports Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  208-20     Citation Subset:  IM    
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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