Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique.

Markolf, K L; Gorek, J F; Kabo, J M; Shapiro, M S

doi:10.2106/00004623-199072040-00014

Cited by 610Knee injuries and reconstruction techniquesLower Extremity Biomechanics and PathologiesTendon Structure and Treatment

Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique.

Markolf, K L, Gorek, J F, Kabo, J M, Shapiro, M S·1990·The Journal of Bone & Joint Surgery

DOI 10.2106/00004623-199072040-00014

Open this paper in CoChat — free account

Abstract

A new technique was used to measure the resultant forces in the anterior cruciate ligament during a series of loading experiments on seventeen fresh-frozen cadaver specimens. The base of the ligament's tibial attachment was mechanically isolated with a coring cutter, and a specially designed load-transducer was fixed to the bone-plug that contained the ligament's tibial insertion so that the resultant forces were directly measured by the load-cell. Although the magnitudes of values for forces varied considerably between specimens for a given test condition, the patterns of loading with respect to direction of loading and the angle of flexion of the knee were remarkably consistent. Passive extension of the knee generated forces in the ligament only during the last 10 degrees of extension; at 5 degrees of hyperextension, the forces ranged from fifty to 240 newtons (mean, 118 newtons). When a 200-newton pull of the quadriceps tendon was applied to extend a knee slowly against tibial resistance, however, the force in the ligament increased at all angles of flexion of the knee. Internal tibial torque always generated greater forces in the ligament than did external tibial torque; higher forces were recorded as the knee was extended. The greatest forces (133 to 370 newtons) were generated when ten newton-meters of internal tibial torque was applied to a hyperextended knee. Fifteen newton-meters of applied varus moment generated forces of ninety-four to 177 newtons at full extension; fifteen newton-meters of applied valgus moment generated a mean force of fifty-six newtons, which remained unchanged with flexion of the knee. The force during straight anterior translation of the tibia was approximately equal to the anterior force applied to the tibia. The application of 925 newtons of tibiofemoral contact force reduced the mean force in the ligament that was generated by 200 newtons of anterior pull on the tibia by 36 per cent at full extension and 46 per cent at 20 degrees of flexion.

Integrity signals

Registry

Crossref · 10.2106/00004623-199072040-00014

Cites

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

This approach is limited to ex vivo applications.
“This approach is limited to ex vivo applications.”
From Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels (2021) · cites this paper as [5]
A technique involving isolation of the tibial attachment of the cruciate ligament by creating a bone plug and attaching a load sensor has been proposed to measure native ACL force in cadaveric knees.
“investigators have proposed a technique involving the isolation of the tibial attachment of the cruciate ligament by creating a bone plug and attaching a load sensor to measure the native ACL force in cadaveric knees [5, 6].”
From Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels (2021) · cites this paper as [5]
Passive flexion-extension motions do not load the ACL.
“studies demonstrated that passive flexion–extension motions do not load the ACL [5, 30]”
From Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels (2021) · cites this paper as [5]

Sorted by citations

Combined knee loading states that generate high anterior cruciate ligament forces
Markolf, K. L., Burchfield, D. M., Shapiro, M. M., Shepard, M. F., Finerman, G. A. M., & Slauterbeck, J. L. (1995) · Journal of Orthopaedic Research® · doi:10.1002/jor.1100130618 · Cited by 1,038 · see citing works
Self-citation
Mechanisms for Noncontact Anterior Cruciate Ligament Injuries
Koga, H., Nakamae, A., Shima, Y., Iwasa, J., Myklebust, G., Engebretsen, L., Bahr, R., & Krosshaug, T. (2010) · The American Journal of Sports Medicine · doi:10.1177/0363546510373570 · Cited by 941 · see citing works
“Although the quadriceps effect at different knee flexion angles seems to vary considerably between studies, they agree in that the anterior shear component will be large at such a low angle.(9,21) However, some limitations must be kept in mind when interpreting the results from the present study.”
Result
Prevention of non‐contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors
Alentorn‐Geli, E., Myer, G. D., Silvers, H. J., Samitier, G., Romero, D., Lázaro-Haro, C., & Cugat, R. (2009) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-009-0813-1 · Cited by 893 · see citing works
Treatment of Anterior Cruciate Ligament Injuries, Part I
Beynnon, B. D., Johnson, R. J., Abate, J. A., Fleming, B. C., & Nichols, C. E. (2005) · The American Journal of Sports Medicine · doi:10.1177/0363546505279913 · Cited by 638 · see citing works
“It is well documented that the ACL is strained when the quadriceps are contracted with the knee near extension (between full extension and 50° of flexion).(90,178) The line of action for the quadriceps muscle, and its effect on the tibia, is dictated by the orientation of the patellar tendon.”
Background
The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL
Li, G., Rudy, T. W., Sakane, M., Kanamori, A., Ma, C. B., & Woo, S. L. (1999) · Journal of Biomechanics · doi:10.1016/s0021-9290(98)00181-x · Cited by 581 · see citing works
In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads
Sakane, M., Fox, R. J., Glen, S. L. W., Livesay, A., Li, G., & Fu, F. H. (1997) · Journal of Orthopaedic Research® · doi:10.1002/jor.1100150219 · Cited by 558 · see citing works
Squatting Kinematics and Kinetics and Their Application to Exercise Performance
Schoenfeld, B. J. (2010) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e3181bac2d7 · Cited by 545 · see citing works
Mechanisms of Noncontact Anterior Cruciate Ligament Injury
Shimokochi, Y., & Shultz, S. J. (2008) · Journal of Athletic Training · doi:10.4085/1062-6050-43.4.396 · Cited by 472 · see citing works
Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo
Beynnon, B. D., Fleming, B. C., Johnson, R. J., Nichols, C. E., Renström, P. A. F. H., & Pope, M. H. (1995) · The American Journal of Sports Medicine · doi:10.1177/036354659502300105 · Cited by 471 · see citing works
Biomechanics of knee ligaments: injury, healing, and repair
Woo, S. L., Abramowitch, S. D., Kilger, R. H. P., & Liang, R. (2005) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2004.10.025 · Cited by 424 · see citing works
“…(]]]]) ]]]–]]] 11 the forces in ligaments and ligament grafts, i.e. buckle transducers, implantable transducers, transducers at ligament insertion sites, linkage systems, cutting studies, etc. (Butler et al., 1980; Holden et al., 1994; Hollis et al., 1991; Lewis et al., 1982; Markolf et al., 1990).”
Background
Anterior cruciate ligament strain in-vivo: A review of previous work
Beynnon, B. D., & Fleming, B. C. (1998) · Journal of Biomechanics · doi:10.1016/s0021-9290(98)00044-x · Cited by 399 · see citing works
Anterior Cruciate Ligament Graft Fixation
Steiner, M. E., Hecker, A. T., Brown, C. H., & Hayes, W. C. (1994) · The American Journal of Sports Medicine · doi:10.1177/036354659402200215 · Cited by 399 · see citing works
Anterior Cruciate Ligament Reconstruction
Aglietti, P., Giron, F., Buzzi, R., Biddau, F., & Sasso, F. (2004) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-200410000-00004 · Cited by 385 · see citing works
The effect of weightbearing and external loading on anterior cruciate ligament strain
Fleming, B. C., Renström, P. A. F. H., Beynnon, B. D., et al. (2001) · Journal of Biomechanics · doi:10.1016/s0021-9290(00)00154-8 · Cited by 383 · see citing works
Stiff Landings Are Associated With Increased ACL Injury Risk in Young Female Basketball and Floorball Players
Leppänen, M., Pasanen, K., Kujala, U. M., Vasankari, T. J., Kannus, P., Äyrämö, S., Krosshaug, T., Bahr, R., Avela, J., Perttunen, J., et al. (2016) · The American Journal of Sports Medicine · doi:10.1177/0363546516665810 · Cited by 372 · see citing works
The Effect of Angle and Velocity on Change of Direction Biomechanics: An Angle-Velocity Trade-Off
Dos’Santos, T., THOMAS, C. R., Comfort, P., & Jones, P. A. (2018) · Sports Medicine · doi:10.1007/s40279-018-0968-3 · Cited by 364 · see citing works
Varying Femoral Tunnels between the Anatomical Footprint and Isometric Positions
Musahl, V., Plakseychuk, A. Y., Vanscyoc, A., et al. (2005) · The American Journal of Sports Medicine · doi:10.1177/0363546504271747 · Cited by 332 · see citing works
“Various devices and methods have been applied to measure the force and strain in the ACL and ACL replacement grafts.(1,5,20) With the use of these devices, valuable information on forces and strains experienced by the ligaments has been obtained.”
Method
Osteoarthritis in patients with anterior cruciate ligament rupture: A review of risk factors
Louboutin, H., Debarge, R., Richou, J., et al. (2008) · The Knee · doi:10.1016/j.knee.2008.11.004 · Cited by 329 · see citing works
“ATT is responsible for an overlapping of the posterior horn of the medial meniscus by the medial femoral condyle on the tibia and leads to a medial meniscal injury [35].”
Background
The Vertical Drop Jump Is a Poor Screening Test for ACL Injuries in Female Elite Soccer and Handball Players
Krosshaug, T., Steffen, K., Kristianslund, E. K., Nilstad, A., Mok, K.-M., Myklebust, G., Andersen, T. E., Holme, I., Engebretsen, L., & Bahr, R. (2016) · The American Journal of Sports Medicine · doi:10.1177/0363546515625048 · Cited by 317 · see citing works
Characteristics of anterior cruciate ligament injuries in Australian football
Wilkie, J. C., Lloyd, D. G., Buttfield, A., et al. (2006) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2006.05.015 · Cited by 304 · see citing works
Risk Factors for Anterior Cruciate Ligament Injury
Smith, H. C., Vacek, P. M., Johnson, R. J., Slauterbeck, J. R., Hashemi, J., Shultz, S. J., & Beynnon, B. D. (2011) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738111428281 · Cited by 299 · see citing works
Biomechanics of Knee Ligaments
Woo, S. L., Debski, R. E., Withrow, J. D., et al. (1999) · The American Journal of Sports Medicine · doi:10.1177/03635465990270042301 · Cited by 293 · see citing works
“One study used a load cell attached to the tibial insertion of the ACL for measurement of the resultant forces in the ligament during testing.(42,43) The ACL was found to be loaded under both internal and external tibial rotation between full extension and 45° of flexion.”
Method
Effect of posterior tibial slope on knee biomechanics during functional activity
Shelburne, K. B., Kim, H., Sterett, W. I., & Pandy, M. G. (2010) · Journal of Orthopaedic Research® · doi:10.1002/jor.21242 · Cited by 295 · see citing works
Tibial attachment area of the anterior cruciate ligament in the extended knee position
Stäubli, H. ‐., & Rauschning, W. (1994) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/bf01467915 · Cited by 281 · see citing works
The influence of gender on knee kinematics, kinetics and muscle activation patterns during side-step cutting
Sigward, S. M., & Powers, C. M. (2006) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2005.08.001 · Cited by 272 · see citing works
“Data from in vitro studies appear to be consistent with observed mechanisms of ACL injury demonstrating that the ACL is loaded in these positions (Durselen et al., 1995; Markolf et al., 1990, 1995).”
BackgroundResultInfluential
The Strain Behavior of the Anterior Cruciate Ligament During Squatting and Active Flexion-Extension
Beynnon, B. D., Johnson, R. J., Fleming, B. C., Stankewich, C. J., Renström, P. A. F. H., & Nichols, C. E. (1997) · The American Journal of Sports Medicine · doi:10.1177/036354659702500616 · Cited by 270 · see citing works
Changing Sidestep Cutting Technique Reduces Knee Valgus Loading
Dempsey, A. R., Lloyd, D. G., Elliott, B. C., Steele, J. R., & Munro, B. J. (2009) · The American Journal of Sports Medicine · doi:10.1177/0363546509334373 · Cited by 271 · see citing works
Open Versus Closed Chain Kinetic Exercises After Anterior Cruciate Ligament Reconstruction
Bynum, E. B., Barrack, R. L., & Alexander, A. H. (1995) · The American Journal of Sports Medicine · doi:10.1177/036354659502300405 · Cited by 260 · see citing works
The Relationship between the Angle of the Tibial Tunnel in the Coronal Plane and Loss of Flexion and Anterior Laxity after Anterior Cruciate Ligament Reconstruction
Howell, S. M., Gittins, M. E., Gottlieb, J. E., Traina, S. M., & Zoellner, T. M. (2001) · The American Journal of Sports Medicine · doi:10.1177/03635465010290050801 · Cited by 251 · see citing works
“Free placement of the femoral tunnel may be clinically important because the placement of the femoral tunnel determines the tensile force in the graft.(1,10,11,14) A femoral tunnel positioned too anteriorly or distally causes abnormal increases in graft tension with flexion that may result in graft failure, loss of fi…”
Background
Computational Modeling of Ligament Mechanics
Weiss, J. A., & Gardiner, J. C. (2001) · Critical Reviews in Biomedical Engineering · doi:10.1615/critrevbiomedeng.v29.i3.20 · Cited by 243 · see citing works
Finite element analysis of human knee joint in varus-valgus
Bendjaballah, M. Z., Shirazi-Adl, A., & Zukor, D. J. (1997) · Clinical Biomechanics · doi:10.1016/s0268-0033(97)00072-7 · Cited by 243 · see citing works
Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques
Scheffler, S. U., Südkamp, N. P., Göckenjan, A., Hoffmann, R. F. G., & Weiler, A. (2002) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1053/jars.2002.30609 · Cited by 240 · see citing works
Dependence of cruciate-ligament loading on muscle forces and external load
Pandy, M. G., & Shelburne, K. B. (1997) · Journal of Biomechanics · doi:10.1016/s0021-9290(97)00070-5 · Cited by 234 · see citing works
The Use of a Universal Force-Moment Sensor to Determine In-Situ Forces in Ligaments: A New Methodology
Fujie, H., Livesay, G. A., Woo, S. L., Kashiwaguchi, S., & Blomstrom, G. L. (1995) · Journal of Biomechanical Engineering · doi:10.1115/1.2792266 · Cited by 233 · see citing works
Electromyographic and Kinematic Analysis of Cutting Maneuvers
Colby, S. M., FRANCISCO, A. C., Yu, B., Kirkendall, D. T., Finch, M., & Garrett, W. E. J. (2000) · The American Journal of Sports Medicine · doi:10.1177/03635465000280021501 · Cited by 233 · see citing works
Effects of Applied Quadriceps and Hamstrings Muscle Loads on Forces in the Anterior and Posterior Cruciate Ligaments
Markolf, K. L., O'Neill, G., Jackson, S. R., & McAllister, D. R. (2004) · The American Journal of Sports Medicine · doi:10.1177/0363546503262198 · Cited by 229 · see citing works
“Details of load cell installation and bench testing can be found in our prior publications.(10,11,14,15) A modification to this test apparatus was made that allowed application of muscle loads as the knee was passively extended under the above tibial loading conditions.”
BackgroundMethodSelf-citation
From conventional sensors to fibre optic sensors for strain and force measurements in biomechanics applications: A review
Roriz, P., Carvalho, L., Frazão, O., Santos, J. L., & Simöes, J. A. (2014) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2014.01.054 · Cited by 228 · see citing works
“Providing only localized measurements of strain they make it difficult to correlate strain with the total force in the ligament or tendon (Markolf et al., 1990).”
Background
The effects of single-leg landing technique on ACL loading
Laughlin, W. A., Weinhandl, J. T., Kernozek, T. W., Cobb, S. C., Keenan, K. G., & O’Connor, K. M. (2011) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2011.04.010 · Cited by 222 · see citing works
“To gain a more complete understanding of the effects of sagittal plane knee motion on loading of the ACL during dynamic activities, authors have conducted a number of in vitro (Markolf et al., 1990; Markolf et al., 1995; Withrow et al., 2006), in vivo (Cerulli et al.”
Background
Mechanisms of anterior cruciate ligament injury in world cup alpine skiing: a systematic video analysis of 20 cases
Bere, T., Flørenes, T., Krosshaug, T., Koga, H., Nordsletten, L., Irving, C., Muller, E., Reid, R., Senner, V., & Bahr, R. (2011) · British Journal of Sports Medicine · doi:10.1177/0363546511405147 · Cited by 219 · see citing works
“This is supported by findings from in vitro and in vivo studies.(12,18,32,33,38) Hame et al(18) investigated the strain generated in the ACL with application of tibial torque at different knee flexion angles in a cadaveric study.”
Result
Strain in the anteromedial bundle of the anterior cruciate ligament under combination loading
Berns, G. S., Hull, M. L., & Patterson, H. A. (1992) · Journal of Orthopaedic Research® · doi:10.1002/jor.1100100203 · Cited by 219 · see citing works
The Effect of Joint-Compressive Load and Quadriceps Muscle Force on Knee Motion in the Intact and Anterior Cruciate Ligament-Sectioned Knee
Torzilli, P. A., Deng, X., & Warren, R. F. (1994) · The American Journal of Sports Medicine · doi:10.1177/036354659402200117 · Cited by 218 · see citing works
Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament Reconstruction
Yasuda, K., Tsujino, J., Tanabe, Y., & Kaneda, K. (1997) · The American Journal of Sports Medicine · doi:10.1177/036354659702500120 · Cited by 213 · see citing works
Gender Differences in Leg Stiffness and Stiffness Recruitment Strategy During Two-Legged Hopping
Padua, D. A., Carcia, C. R., Arnold, B. L., et al. (2005) · Journal of Motor Behavior · doi:10.3200/jmbr.37.2.111-126 · Cited by 210 · see citing works
“…tibial shear forces that cause anterior translation of the tibia with respect to the femur, placing increased forces and strain on the ACL (Beynnon et al., 1995; Durselen et al., 1995; Fleming et al., 2001; Hirokawa et al., 1992; Li et al., 1999; K. L. Markolf et al., 1990; Renstrom et al., 1986).”
A ‘Plane’ Explanation of Anterior Cruciate Ligament Injury Mechanisms
Quatman, C. E., Quatman‐Yates, C. C., & Hewett, T. E. (2010) · Sports Medicine · doi:10.2165/11534950-000000000-00000 · Cited by 209 · see citing works
Cruciate ligament forces in the human knee during rehabilitation exercises
Toutoungi, D. E., Lu, T., Leardini, A., Catani, F., & O'Connor, J. J. (2000) · Clinical Biomechanics · doi:10.1016/s0268-0033(99)00063-7 · Cited by 204 · see citing works
Direct in vitro measurement of forces in the cruciate ligaments. Part I
Wascher, D. C., Markolf, K. L., Shapiro, M. S., & Finerman, G. A. M. (1993) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-199303000-00009 · Cited by 200 · see citing works
Self-citation
Hamstring tendon fixation using interference screws: a biomechanical study in calf tibial bone
Weiler, A., Hoffmann, R., Stähelin, A. C., et al. (1998) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/s0749-8063(98)70117-3 · Cited by 201 · see citing works
A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions
Shelburne, K. B., & Pandy, M. G. (1997) · Journal of Biomechanics · doi:10.1016/s0021-9290(96)00119-4 · Cited by 201 · see citing works
In vivo kinematics of the ACL during weight‐bearing knee flexion
Li, G., DeFrate, L. E., Rubash, H. E., & Gill, T. J. (2004) · Journal of Orthopaedic Research® · doi:10.1016/j.orthres.2004.08.006 · Cited by 196 · see citing works
The gastrocnemius muscle is an antagonist of the anterior cruciate ligament
Fleming, B. C., Renström, P. A. F. H., Ohlén, G., Johnson, R. J., Peura, G. D., Beynnon, B. D., & Badger, G. J. (2001) · Journal of Orthopaedic Research® · doi:10.1016/s0736-0266(01)00057-2 · Cited by 194 · see citing works
Force Measurements on the Fibular Collateral Ligament, Popliteofibular Ligament, and popliteus Tendon to Applied Loads
LaPrade, R. F., Tso, A., & Wentorf, F. A. (2004) · The American Journal of Sports Medicine · doi:10.1177/0363546503262694 · Cited by 195 · see citing works
EFFECT OF THE ANGLE OF THE FEMORAL AND TIBIAL TUNNELS IN THE CORONAL PLANE AND INCREMENTAL EXCISION OF THE POSTERIOR CRUCIATE LIGAMENT ON TENSION OF AN ANTERIOR CRUCIATE LIGAMENT GRAFT
SIMMONS, R., Howell, S. M., & Hull, M. L. (2003) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-200306000-00006 · Cited by 186 · see citing works
Predictors of proximal tibia anterior shear force during a vertical stop‐jump
Sell, T. C., Ferris, C. M., Abt, J. P., Tsai, Y., Myers, J. B., Fu, F. H., & Lephart, S. M. (2007) · Journal of Orthopaedic Research® · doi:10.1002/jor.20459 · Cited by 182 · see citing works
In Vivo Measurement of Ligament/Tendon Strains and Forces: A Review
Fleming, B. C., & Beynnon, B. D. (2004) · Annals of Biomedical Engineering · doi:10.1023/b:abme.0000017542.75080.86 · Cited by 175 · see citing works
Anatomy and biomechanics of the anterior cruciate ligament
Dienst, M., Burks, R. T., & Greis, P. E. (2002) · Orthopedic Clinics of North America · doi:10.1016/s0030-5898(02)00010-x · Cited by 175 · see citing works
“Measurements in cadavers [50,64] and in vivo [65] revealed that the strain levels for the AMB and PLB were at or below zero between 10 and 110 of passive flexion.”
BackgroundInfluential
Loading characteristics of females exhibiting excessive valgus moments during cutting
Sigward, S. M., & Powers, C. M. (2007) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2007.04.003 · Cited by 174 · see citing works
“with in vitro (Markolf et al., 1990) and modeling studies (Bendjaballah et al.”
Method
Direct measurement of strain in the posterolateral bundle of the anterior cruciate ligament
Bach, J. M., Hull, M. L., & Patterson, H. A. (1997) · Journal of Biomechanics · doi:10.1016/s0021-9290(96)00132-7 · Cited by 172 · see citing works
Native Knee Laxities at 0°, 45°, and 90° of Flexion and Their Relationship to the Goal of the Gap-Balancing Alignment Method of Total Knee Arthroplasty
Roth, J. D., Howell, S. M., & Hull, M. L. (2015) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.n.01256 · Cited by 170 · see citing works
The Effect of a Nonanatomic Repair of the Meniscal Horn Attachment on Meniscal Tension: A Biomechanical Study
Stärke, C., Kopf, S., Gröbel, K., et al. (2010) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2009.08.013 · Cited by 166 · see citing works
A quantitative analysis of valgus torque on the ACL: A human cadaveric study
Fukuda, Y., Woo, S. L., Loh, J. C., Tsuda, E., Tang, P., McMahon, P. J., & Debski, R. E. (2003) · Journal of Orthopaedic Research® · doi:10.1016/s0736-0266(03)00084-6 · Cited by 166 · see citing works
Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading
Withrow, T. J., Huston, L. J., Wojtys, E. M., & Ashton‐Miller, J. A. (2008) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.f.01352 · Cited by 159 · see citing works
Varus Alignment Leads to Increased Forces in the Anterior Cruciate Ligament
van de Pol, G. J., Arnold, M. P., Verdonschot, N. J. J., et al. (2008) · The American Journal of Sports Medicine · doi:10.1177/0363546508326715 · Cited by 157 · see citing works
“In the extended knee, however, varus can produce increased ACL strain.(16,17) A combination of external forces in the nonweightbearing knee was also studied by Markolf et al,(15) showing that the most dangerous loading conditions for the ACL are anterior tibial force plus a valgus moment in the extended knee.”
BackgroundMethodInfluential
Determination of thein situ forces and force distribution within the human anterior cruciate ligament
Livesay, G. A., Fujie, H., Kashiwaguchi, S., et al. (1995) · Annals of Biomedical Engineering · doi:10.1007/bf02584446 · Cited by 156 · see citing works
“Our study shows that the magnitude of in situ ACL forces are dependent on the magnitude of the extemally applied load, not only on knee orientation as found by previous investigators (24,25,2830).”
Result
Biology and Biomechanics of the Anterior Cruciate Ligament
Smith, B. A., Livesay, G. A., & Woo, S. L. (1993) · Clinics in Sports Medicine · doi:10.1016/s0278-5919(20)30380-x · Cited by 152 · see citing works
Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing
Taylor, K. A., Terry, M. E., Utturkar, G. M., Spritzer, C. E., Queen, R. M., Irribarra, L. A., Garrett, W. E. J., & DeFrate, L. E. (2010) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2010.10.028 · Cited by 150 · see citing works
“Many previous studies have examined ACL loading in cadavers (Draganich and Vahey, 1990; Markolf et al., 1990; Woo et al., 1991; Li et al., 1999; Kanamori et al., 2000; DeMorat et al., 2004).”
Background
Determination of the in situ loads on the human anterior cruciate ligament
Takai, S., Woo, S. L., Livesay, G. A., Adams, D. J., & Fu, F. H. (1993) · Journal of Orthopaedic Research® · doi:10.1002/jor.1100110511 · Cited by 149 · see citing works
“(21) found that the in situ load on the whole ACL was 207 N with 200 N of”
BackgroundMethod
Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft
Markolf, K. L., Hame, S. L., Hunter, D. M., et al. (2002) · Journal of Orthopaedic Research® · doi:10.1016/s0736-0266(02)00035-9 · Cited by 149 · see citing works
Self-citation
Physiological alterations of maximal voluntary quadriceps activation by changes of knee joint angle
Becker, R., & Awiszus, F. (2001) · Muscle & Nerve · doi:10.1002/mus.1053 · Cited by 149 · see citing works
“Besides the modulation attributable to muscle length changes alone, joint angle changes are inevitably coupled to tension changes of knee joint ligaments.(19) Knee joint ligament tension changes in turn are known to modulate the g innervation of muscle spindles.”
Background
Cruciate coupling and screw-home mechanism in passive knee joint during extension–flexion
Moglo, K. E., & Shirazi-Adl, A. (2004) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2004.05.033 · Cited by 148 · see citing works
Rationale for Training Programs to Reduce Anterior Cruciate Ligament Injuries in Australian Football
Lloyd, D. G. (2001) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2001.31.11.645 · Cited by 146 · see citing works
Fatigue alters lower extremity kinematics during a single‐leg stop‐jump task
Benjaminse, A., Habu, A., Sell, T. C., et al. (2007) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-007-0432-7 · Cited by 146 · see citing works
Muscle Force Contributions to Anterior Cruciate Ligament Loading
Maniar, N., Cole, M. H., Bryant, A. L., & Opar, D. A. (2022) · Sports Medicine · doi:10.1007/s40279-022-01674-3 · Cited by 147 · see citing works
Knee Mechanics During Planned and Unplanned Sidestepping: A Systematic Review and Meta-Analysis
Brown, S. R., Brughelli, M., & Hume, P. A. (2014) · Sports Medicine · doi:10.1007/s40279-014-0225-3 · Cited by 141 · see citing works
“coronal plane (abduction/adduction) and transverse plane (internal/external rotation) are believed to increase stress and the possibility for injury to the ACL compared with sagittal plane motion alone [9, 13, 15, 16].”
Background
Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part II
Markolf, K. L., Burchfield, D. M., Shapiro, M. M., et al. (1996) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-199611000-00014 · Cited by 141 · see citing works
Self-citation
Comparison of Initial Fixation Strength Between Biodegradable and Metallic Interference Screws and a Press-Fit Fixation Technique in a Porcine Model
Seil, R., Rupp, S., Krauss, P. W., et al. (1998) · The American Journal of Sports Medicine · doi:10.1177/03635465980260061301 · Cited by 136 · see citing works
“In accelerated rehabilitation, resultant forces in the graft up to 200 N (full active extension against gravity) are possible.(3,4,10,16) In several previous investigations, graft fixation with metal interference screws proved to be strong enough with respect to maximal strength during one loading cycle until failure.”
Background
Influence of Age, Sex, Technique, and Exercise Program on Movement Patterns after an Anterior Cruciate Ligament Injury Prevention Program in Youth Soccer Players
DiStefano, L. J., Padua, D. A., DiStefano, M. J., & Marshall, S. W. (2009) · The American Journal of Sports Medicine · doi:10.1177/0363546508327542 · Cited by 133 · see citing works
“It is during this combined loading state of excessive tibial rotation and knee valgus that researchers have described the ACL to be at greatest risk of injury.(5,44) All previous research investigating injury prevention exercise interventions has used a “one-size-fits-all” (generalized) approach to exercise prescripti…”
BackgroundInfluential
Finite Element Model of the Knee for Investigation of Injury Mechanisms: Development and Validation
Kiapour, A., Kiapour, A. M., Kaul, V., Quatman, C. E., Wordeman, S. C., Hewett, T. E., Demetropoulos, C. K., & Goel, V. K. (2013) · Journal of Biomechanical Engineering · doi:10.1115/1.4025692 · Cited by 135 · see citing works
“Previous studies have demonstrated that these regional measurements are valid representations of overall tissue behavior [89].”
Background
Anterior-Posterior and Rotatory Stability of Single and Double-Bundle Anterior Cruciate Ligament Reconstructions
Markolf, K. L., Park, S., Jackson, S. R., & McAllister, D. R. (2009) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.g.01215 · Cited by 132 · see citing works
Self-citation
The Effect of Direction and Reaction on the Neuromuscular and Biomechanical Characteristics of the Knee during Tasks that Simulate the Noncontact Anterior Cruciate Ligament Injury Mechanism
Sell, T. C., Ferris, C. M., Abt, J. P., Tsai, Y.-S., Myers, J. B., Fu, F. H., & Lephart, S. M. (2005) · The American Journal of Sports Medicine · doi:10.1177/0363546505278696 · Cited by 129 · see citing works
Biomechanics and anterior cruciate ligament reconstruction
Woo, S. L., Wu, C., Dede, Ö., et al. (2006) · Journal of Orthopaedic Surgery and Research · doi:10.1186/1749-799x-1-2 · Cited by 129 · see citing works
“Discovery of tools for biomechanical studies of the ACL and ACL grafts There have been many tools, including buckle transducers, load cells, strain gauges, and so on, designed to measure the forces within the ACL when a load is applied to the knee [14-19].”
Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading
Brown, C. H., Wilson, D. R., Hecker, A. T., & Ferragamo, M. (2004) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2004.06.032 · Cited by 129 · see citing works
Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: A porcine study
Li, G., Rudy, T. W., Allen, C. R., et al. (1998) · Journal of Orthopaedic Research® · doi:10.1002/jor.1100160121 · Cited by 124 · see citing works
Hip extension, knee flexion paradox: A new mechanism for non-contact ACL injury
Hashemi, J., Breighner, R. E., Chandrashekar, N., Hardy, D. M., Chaudhari, A. M. W., Shultz, S. J., Slauterbeck, J. R., & Beynnon, B. D. (2010) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2010.11.013 · Cited by 122 · see citing works
“…1995 and Demorat et al., 2004), (ii) axial compressive load mechanism (Li et al., 1998 and Meyer and Haut, 2005), (iii) hyperextension mechanism (Markolf et al., 1990 and Boden et al., 2000), (iv) valgus collapse mechanism—owing either to pure abduction of the distal tibia relative to the…”
Background
The Strain Behavior of the Anterior Cruciate Ligament During Bicycling
Fleming, B. C., Beynnon, B. D., Renström, P. A. F. H., et al. (1998) · The American Journal of Sports Medicine · doi:10.1177/03635465980260010301 · Cited by 121 · see citing works
“Markolf et al.(30) have proven that varusvalgus moments at the knee will load (and therefore strain) the ACL.”
Background
Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part I
Markolf, K. L., Burchfield, D. M., Shapiro, M. M., Davis, B. R., Finerman, G. A. M., & Slauterbeck, J. L. (1996) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-199611000-00013 · Cited by 118 · see citing works
Self-citation
Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports
Weiss, K. J., & Whatman, C. S. (2015) · Sports Medicine · doi:10.1007/s40279-015-0353-4 · Cited by 118 · see citing works
“During dynamic knee abduction, the medial collateral ligament, medial patellofemoral ligament, and ACL are strained as a result of trying to prevent this excessive abduction movement [46, 47].”
Background
Fixation strength of a biodegradable interference screw and a press‐fit technique in anterior cruciate ligament reconstruction with a BPTB graft
Rupp, S., Krauss, P. W., & Fritsch, E. W. (1997) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/s0749-8063(97)90210-3 · Cited by 119 · see citing works
Muscle Activation During Side-Step Cutting Maneuvers in Male and Female Soccer Athletes
Hanson, A. M., Padua, D. A., Blackburn, J. T., Prentice, W. E., & Hirth, C. J. (2008) · Journal of Athletic Training · doi:10.4085/1062-6050-43.2.133 · Cited by 119 · see citing works
Determinants of cruciate-ligament loading during rehabilitation exercise
Shelburne, K. B., & Pandy, M. G. (1998) · Clinical Biomechanics · doi:10.1016/s0268-0033(98)00094-1 · Cited by 118 · see citing works
Neuromuscular Biomechanical Modeling to Understand Knee Ligament Loading
Lloyd, D. G., Buchanan, T. S., & Besier, T. F. (2005) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000176676.49584.ba · Cited by 118 · see citing works
Comparison of Endoscopic and Two‐Incision Techniques for Reconstructing a Torn Anterior Cruciate Ligament Using Hamstring Tendons
Howell, S. M., & Deutsch, M. L. (1999) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1053/ar.1999.v15.015059 · Cited by 115 · see citing works
“Because the placement of the femoral tunnel determines graft tension (1-4) and positioning of the femoral tunnel is constrained by the tibial tunnel with the endoscopic technique (5, 6) knee stability may be worse compared to the two-incision technique in which the femoral tunnel is positioned independently from the t…”
Background
Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing
Lipps, D. B., Oh, Y. K., Ashton‐Miller, J. A., & Wojtys, E. M. (2011) · The American Journal of Sports Medicine · doi:10.1177/0363546511422325 · Cited by 115 · see citing works
Biomechanical Comparison of 2 Anterior Cruciate Ligament Graft Preparation Techniques for Tibial Fixation
Mayr, R., Heinrichs, C. H., Eichinger, M., et al. (2015) · The American Journal of Sports Medicine · doi:10.1177/0363546515574062 · Cited by 113 · see citing works
“These loads simulate the reported forces occurring in the ACL during terminal passive extension of the knee.(21) Subsequently, a load-tofailure test at 50 mm/min was carried out.”
Biomechanical Comparison of Single- and Double-Leg Jump Landings in the Sagittal and Frontal Plane
Taylor, J. B., Ford, K. R., Nguyen, A., & Shultz, S. J. (2016) · Orthopaedic Journal of Sports Medicine · doi:10.1177/2325967116655158 · Cited by 111 · see citing works
“internal rotation at shallow knee flexion angles.(9,27,29) As such, lower extremity biomechanics, including shallow hip and knee flexion, and components of dynamic valgus collapse (hip adduction/internal rotation, knee abduction/ internal rotation/external rotation) have been studied prospectively to identify specific…”
THREE-DIMENSIONAL MORPHOLOGY AND KINEMATICS OF THE DISTAL PART OF THE FEMUR VIEWED IN VIRTUAL REALITY
Eckhoff, D. G., Bach, J. M., Spitzer, V. M., et al. (2003) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-200300004-00012 · Cited by 112 · see citing works
Quadriceps and Hamstrings Coactivation During Common Therapeutic Exercises
Begalle, R. L., DiStefano, L. J., Blackburn, J. T., et al. (2012) · Journal of Athletic Training · doi:10.4085/1062-6050-47.4.01 · Cited by 110 · see citing works
Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict?
Dos’Santos, T., THOMAS, C. R., McBurnie, A. J., Comfort, P., & Jones, P. A. (2021) · Sports Medicine · doi:10.1007/s40279-021-01448-3 · Cited by 115 · see citing works
A Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Posterior Cruciate Ligament Reconstruction Techniques
McAllister, D. R., Markolf, K. L., Oakes, D. A., et al. (2002) · The American Journal of Sports Medicine · doi:10.1177/03635465020300030201 · Cited by 108 · see citing works
“A cylindrical block of bone containing the femoral origin of the PCL was mechanically isolated and attached to a custom-designed load cell mounted on the femur to record resultant force in the ligament.(15,21) Anteroposterior testing was repeated with the PCL load cell in place; these laxity values were used as the re…”
MethodSelf-citation
Estimation of anterior cruciate ligament tension from inverse dynamics data and electromyography in females during drop landing
Kernozek, T. W., & Ragan, R. J. (2008) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2008.08.001 · Cited by 106 · see citing works
Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics
Yamaguchi, K. T., Cheung, E. C., Markolf, K. L., et al. (2017) · The American Journal of Sports Medicine · doi:10.1177/0363546517736767 · Cited by 105 · see citing works
Self-citation

Absence of the ligament of head of femur in the human hip joint.
Ck, T., & Wc, W. (1990) · PubMed · Cited by 15 · see citing works
Evaluation of anterior oblique ligament tension at the elbow joint angle—a cadaver study
Matsuura, Y., Takamura, T., Sugiura, S., et al. (2020) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2020.05.033 · Cited by 5 · see citing works
Patellar ligament reconstruction using allograft patellar ligament: a case report.
Cushing, M. V., Lundy, D. W., Jg, K., et al. (1999) · PubMed · Cited by 3 · see citing works
The gross and histologic anatomy of the ligaments of the capitohamate joint
Ritt, M. J. P. F., Berger, R. A., & Kauer, J. M. G. (1996) · The Journal Of Hand Surgery · doi:10.1016/s0363-5023(96)80310-8 · Cited by 37 · see citing works
Prevalence and morphometric characteristics of the anterolateral ligament of the knee in a sample of Colombian human cadaversand morphometric characteristics of the anterolateral ligament of the knee in a sample of Colombian human cadavers
Cruz-Buitrago, D., & Blanco, Y. Q. (2021) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v69n4.80734

Authors: Markolf, K. L., Gorek, J. F., Kabo, J. M., & Shapiro, M. S.
Affiliations: University of California, Los Angeles (US)
ORCID: Markolf, K L
Venue: The Journal of Bone & Joint Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1990-04
Volume: 72
Issue: 4
Pages: 557-567
ISSN: 0021-9355 (ISSN-L)
DOI: 10.2106/00004623-199072040-00014
OpenAlex: W181468102
Cited by: 610
References: 0
Citations by year: 2026: 8 · 2025: 8 · 2024: 9 · 2023: 15 · 2022: 11 · 2021: 24 · 2020: 15 · 2019: 22 · 2018: 22 · 2017: 20 · 2016: 32 · 2015: 17 · 2014: 20 · 2013: 21 · 2012: 20
FWCI: 11.77
Type: journal article
Language: en
Open access: closed
Locations: Journal of Bone and Joint Surgery (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01ar037037-03)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01-AR37037)
Topics: Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
Keywords: anterior cruciate ligament, tibial attachment, knee hyperextension, tibiofemoral contact forces, anterior tibial translation, knee flexion angle
MeSH terms: Aged, Biomechanical Phenomena, Humans, Knee Joint, Ligaments, Articular, Middle Aged, Movement, In Vitro Techniques

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique.

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cited by

Related

Record

About these checks