The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee, with female athletes sustaining ACL injuries at a 2-8 fold greater rate compared to male athletes. An ACL injury can be devastating and significantly increases the athlete's risk for osteoarthritis long term. While many advances have been made in terms of surgical and rehabilitation treatments for ACL injured patients, long term outcome studies show that these patients are at a high risk for developing knee osteoarthritis 10-15 years after ACL injury regardless of the treatment. Currently, the mechanism of non-contact ACL injury is not well understood. In order to design successful ACL injury prevention programs and address the high rates of ACL injuries in the female athlete population, a better understanding of the non-contact ACL injury mechanism must be established. Both biomechanical data and video analyses indicate that increased abduction loads in the lower extremities may be associated with increased ACL strain and risk of injury. However, the medial collateral ligament (MCL) is considered to be the primary restraint against abduction stress in the knee joint. Clinicians and biomechanists are unable to explain why ACL ruptures without MCL injuries are significantly more common than combined ACL/MCL injuries. We hypothesize that coupled abduction and anterior knee joint loads near full knee extension will lead to disproportional increases in ACL strain relative to MCL strain and lead to ACL failure loads without concomitant MCL failure loads in female athletes. We propose to use a unique blend of the current methods used to investigate ACL injury mechanisms in order to gain an in depth understanding of knee ligament biomechanics during high knee loading conditions. Specifically, we aim to determine the mechanical responses of the ACL and MCL to loads using cadaveric testing, computer mathematical modeling, and three-dimensional motion analysis. Identifying ACL injury mechanisms may help us develop ACL injury prevention programs that would allow many athletes to receive the health benefits of sports participation and avoid the long term sequelae of disability associated with knee osteoarthritis.

Public Health Relevance

An anterior cruciate ligament (ACL) injury can be devastating and places an athlete at a high risk of developing osteoarthritis long term. Unfortunately, surgical intervention does not change the odds of developing knee osteoarthritis after injury. We utilize biomechanical methods to identify mechanisms of ACL injury in order to develop effective interventions to prevent ACL injury.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
Project #
Application #
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Panagis, James S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Cincinnati Children's Hospital Medical Center
United States
Zip Code
Bates, Nathaniel A; Schilaty, Nathan D; Nagelli, Christopher V et al. (2017) Novel mechanical impact simulator designed to generate clinically relevant anterior cruciate ligament ruptures. Clin Biomech (Bristol, Avon) 44:36-44
Schilaty, Nathan D; Nagelli, Christopher; Bates, Nathaniel A et al. (2017) Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database. Orthop J Sports Med 5:2325967117724196
Hewett, Timothy E; Webster, Kate E; Hurd, Wendy J (2017) Systematic Selection of Key Logistic Regression Variables for Risk Prediction Analyses: A Five-Factor Maximum Model. Clin J Sport Med :
Sugimoto, Dai; Mattacola, Carl G; Bush, Heather M et al. (2017) Preventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates. J Athl Train 52:58-64
Schilaty, Nathan D; Bates, Nathaniel A; Sanders, Thomas L et al. (2017) Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale. Am J Sports Med 45:1567-1573
Bates, Nathaniel A; McPherson, April L; Nesbitt, Rebecca J et al. (2017) Robotic simulation of identical athletic-task kinematics on cadaveric limbs exhibits a lack of differences in knee mechanics between contralateral pairs. J Biomech 53:36-44
Nagelli, Christopher V; Hewett, Timothy E (2017) Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Sports Med 47:221-232
Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J et al. (2017) How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard. Ann Musculoskelet Med 1:008-12
Schilaty, Nathan D; Bates, Nathaniel A; Hewett, Timothy E (2017) Effect of sagittal plane mechanics on ACL strain during jump landing. J Orthop Res 35:1171-1172
Willigenburg, Nienke; Hewett, Timothy E (2017) Performance on the Functional Movement Screen Is Related to Hop Performance But Not to Hip and Knee Strength in Collegiate Football Players. Clin J Sport Med 27:119-126

Showing the most recent 10 out of 124 publications