BIOMECHANICAL RISK FACTORS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Research purpose. While biomechanics plays a crucial role in anterior cruciate ligament (ACL) injury risk, the specific influence of certain biomechanical factors on ACL injury occurrence remains uncertain. This study aims to comprehensively investigate and analyze the biomechanical risk factors associated with ACL injuries of the knee joint through a systematic and meta-analysis. 

Materials and methods. Using the PRISMA Protocols Statement relevant literature was systematically searched on PubMed, MEDLINE, Scopus, Web of Science, CNKI, and Wanfang Data using the following terms: ACL biomechanical factors, knee joint, ACL injury mechanisms, knee biomechanics, and ligament injuries. After title/abstract screening and full-text review, 11 articles (n=41) met all inclusion criteria and were included in the analysis. Through effect size analysis, several biomechanical factors were associated to ACL injury risk. 

Results. It was found that ACL injury risk is linked to a positive association with peak external hip flexion moment and a substantial reduction in stance phase peak external knee. Factors like pelvic drop angle and trunk tilt angle show the significance of upper body mechanics in ACL injury prevention. In addition, women tend to exhibit weaker hip and knee extensors, contributing to instability during landing and cutting maneuvers, increasing the risk of ACL. 

Conclusions. This systematic review and meta-analysis of biomechanical risk factors associated with ACL injuries across various contexts provides valuable insights into the intricate interplay of factors that contribute to ACL injury susceptibility. The findings highlight the significance of hip adduction, hamstring strength, and knee valgus during landing and cutting maneuvers in increasing the risk of ACL injuries, particularly in women.

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