Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury

Abstract

Background The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation. Hypothesis An aggressive quadriceps contraction can injure the ACL. Methods The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen freshfrozen knees were potted in a jig held in 20 ° of flexion while a 4500 N quadriceps contraction was simulated. Knee kinematics were recorded. A KT-1000 arthrometer and a simulated active quadriceps test assessed anterior displacement. Statistics were performed using paired t tests and 1-way analysis of variance. Results Kinematics revealed the following mean values: anterior displacement, 19.5 mm; valgus, 2.3 °; and internal rotation, 5.5 °. Mean KT-1000 and active quadriceps test differences were 4.0 mm and 2.7 mm, respectively (statistically significant P = .002 and P = .002). Six knees showed gross ACL injury at the femoral insertion. Based on ACL injury, KT-1000 differences were statistically significant (P = .029). Conclusions Aggressive quadriceps loading, with the knee in slight flexion, produces significant anterior tibial translation and ACL injury. This suggests that the quadriceps is the intrinsic force in noncontact ACL injuries, producing a model for further investigation.