Effect of Foot-Planting Strategy on Anterior Cruciate Ligament Loading in Women During a Direction Diversion Maneuver: A Musculoskeletal Modeling Approach

Abstract

Background:,Although there is a higher prevalence of noncontact anterior cruciate ligament (ACL) injuries during a direction diversion maneuver (DDM), no previous studies have reported how foot-planting strategies affect ACL loading.,Purpose:,To investigate the effect of foot-planting strategies on ACL loading in women during a DDM task using a musculoskeletal modeling approach.,Study Design:,Descriptive laboratory study.,Methods:,A total of 13 female participants performed a DDM task, which involved running at 4.5 +/- 0.2 m/s and turning left at 35 degrees to 55 degrees under a foot-planting strategy in 3 directions: neutral, toe-in, and toe-out. Kinematic and kinetic data were measured with the use of a 3-dimensional motion capture system and force platform to calculate variables such as joint angle, shear force, and moment. Anterior ACL and posterior ACL forces were extracted using musculoskeletal modeling.,Results:,The peak anterior ACL force was significantly larger for the toe-out condition (31.29 +/- 4.02 N/body weight [BW]) compared with the toe-in condition (25.43 +/- 5.68 N/BW) (P = .047), with no significant difference in the neutral condition. The toe-out condition had a higher knee valgus angle (2.98 degrees +/- 4.20 degrees; P = .041), knee shear force (10.20 +/- 1.69 N/BW; P = .009), and knee internal rotation moment (-0.18 +/- 0.16 N center dot m/BWxheight; P = .012) than the toe-in and neutral conditions.,Conclusion:,Through musculoskeletal modeling, we were able to conclude that the toe-out condition during the DDM might result in a higher risk of ACL injuries. Athletes and sports practitioners should avoid the toe-out foot-planting strategy when participating in a sporting activity.,