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Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury
  1. Gregory D Myer1,2,3,
  2. Kevin R Ford1,2,4,
  3. Jane Khoury1,5,
  4. Paul Succop6,
  5. Timothy E Hewett1,2,4,7
  1. 1Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
  3. 3Rocky Mountain University of Health Professions, Provo, Utah, USA
  4. 4Departments of Pediatrics, University of Cincinnati, Ohio, USA
  5. 5Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, USA
  7. 7Department of Orthopaedic Surgery, College of Medicine and the Departments of Biomedical Engineering and Rehabilitation Sciences, University of Cincinnati, Ohio, USA
  1. Correspondence to Dr Gregory D Myer, Cincinnati Children's Hospital, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA; greg.myer{at}


Objective Knee abduction moment (KAM) during landing predicts non-contact anterior cruciate ligament (ACL) injury risk with high sensitivity and specificity in female athletes. The purpose of this study was to employ sensitive laboratory (lab-based) tools to determine predictive mechanisms that underlie increased KAM during landing.

Methods Female basketball and soccer players (N=744) from a single county public school district were recruited to participate in testing of anthropometrics, maturation, laxity/flexibility, strength and landing biomechanics. Linear regression was used to model KAM, and logistic regression was used to examine high (>25.25 Nm of KAM) versus low KAM as surrogate for ACL injury risk.

Results The most parsimonious model included independent predictors (β±1 SE) (1) peak knee abduction angle (1.78±0.05; p<0.001), (2) peak knee extensor moment (0.17±0.01; p<0.001), (3) knee flexion range of motion (0.15±0.03; p<0.01), (4) body mass index (BMI) Z-score (−1.67±0.36; p<0.001) and (5) tibia length (−0.50±0.14; p<0.001) and accounted for 78% of the variance in KAM during landing. The logistic regression model that employed these same variables predicted high KAM status with 85% sensitivity and 93% specificity and a C-statistic of 0.96.

Conclusions Increased knee abduction angle, quadriceps recruitment, tibia length and BMI with decreased knee flexion account for 80% of the measured variance in KAM during a drop vertical jump.

Clinical relevance Females who demonstrate increased KAM are more responsive and more likely to benefit from neuromuscular training. These findings should significantly enhance the identification of those at increased risk and facilitate neuromuscular training targeted to this important risk factor (high KAM) for ACL injury.

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  • Funding The authors would like to acknowledge funding support from National Institutes of Health Grant R01-AR049735, R01-AR055563 and R01-AR056259.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Cincinnati Children's Hospital Medical Center and Rocky Mountain University of Health Professions Institutional Review Boards.

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

  • Patient consent Obtained.