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Prediction and prevention of musculoskeletal injury: a paradigm shift in methodology
  1. C E Quatman1,2,
  2. C C Quatman1,3,
  3. T E Hewett1,4,5,6
  1. 1
    The Cincinnati Children’s Hospital Medical Center and Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
  2. 2
    Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Engineering Center for Orthopaedic Research Excellence, Toledo, Ohio, USA
  3. 3
    Department of Physical Therapy, University of Toledo, Toledo, Ohio, USA
  4. 4
    Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  5. 5
    Department of Biomedical Engineering and Rehabilitation Sciences, College of Engineering, Cincinnati, Ohio, USA
  6. 6
    Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr C Quatman, The Sports Medicine Biodynamics Center and Human Performance Laboratory, 3333 Burnet Avenue, Cincinnati, OH 45206, USA; carmen.quatman{at}


Traditional methods employed to study musculoskeletal injury mechanisms and joint biomechanics utilise in vivo or in vitro techniques. The advent of new technology and improved methods has also given rise to in silico (computer modelling) techniques. Under the current research paradigm, in vivo, in vitro and in silico methods independently provide information regarding the mechanisms and prevention of musculoskeletal injury. However, individually, each of these methods has multiple, inherent limitations and is likely to provide incomplete answers about multifactorial, complex injury conditions. The purpose of this treatise is to review current methods used to study, understand, and prevent musculoskeletal injury and to develop new conceptual-methodological frameworks that may help create a paradigm shift in musculoskeletal injury prevention research. We term the fusion of these three techniques in simulacra amalgama, or simply in sim, meaning a “union of models done on the likeness of phenomena.” Anterior cruciate ligament (ACL) injury will be employed as a model example for the utility and applicability of the proposed, synthesised approach. Shifting the current experimental paradigm to incorporate a multifaceted, multidisciplinary, integration of in vivo, in vitro and in silico methods into the proposed in sim approaches may provide a platform for a more comprehensive understanding of the relationships between complex joint biomechanics and observed injury mechanisms.

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  • Funding The authors would like to acknowledge funding from the National Institutes of Health Grants R01-AR049735, R01-AR05563 and R01-AR056259. The authors also 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.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.