Int J Sports Med 2021; 42(03): 264-269
DOI: 10.1055/a-1128-6995
Orthopedics & Biomechanics

Effect of Hamstring-to-quadriceps Ratio on Knee Forces in Females During Landing

Becky L. Heinert
1   Sports Medicine Department, Gundersen Lutheran Health System Inc, La Crosse, United States
,
Tia Collins
2   Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, United States
,
Carly Tehan
2   Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, United States
,
Robert Ragan
3   Department of Physics, University of Wisconsin-La Crosse, La Crosse, United States
,
Thomas W Kernozek
2   Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, United States
› Author Affiliations
Funding: Funding to support this work was recieved from the Office of Graduate Studies at the University of Wisconsin-La Crosse and the Gundersen Medical Foundation within the Gundersen Health System.

Abstract

ACL injuries in the athletic population are a common occurrence with over 70% associated with non-contact mechanisms. The hamstring to quadriceps ratio is a widely used clinical measure to assess an athlete’s readiness to return to sport; however, its relationship to knee forces and ACL tension during landing is unknown. Baseline isokinetic testing was completed on 100 college-aged females. Subjects with strength ratios 0.4 (n=20) and those with ratios of 0.6 (n=20) returned for an assessment of their drop landing. A sagittal plane knee model determined the low ratio group demonstrated 16.6% larger ligament shear (p=0.000), a 26% increase in tibiofemoral shear force (p=0.026) and a 6% increase vertical force between the femur and tibial plateau (p=0.026) compared to the high hamstring ratio group within 100 ms upon impact. The lower ratio group also demonstrated 9.5% greater maximal quadriceps (p=0.028) force during landing. These findings suggest that the hamstring to quadriceps ratio may be related to knee forces and ACL loading during landing. This metric may augment clinical decision making regarding an athlete’s readiness to return to sport or relative risk for re-injury.



Publication History

Received: 22 October 2019

Accepted: 16 February 2020

Article published online:
06 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Renström PA. Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: Recent evidence and a personal reflection. Br J Sports Med 2013; 47: 367-372
  • 2 Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2012; 42: 750-759
  • 3 Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train 1999; 34: 86-92
  • 4 Ardern CL, Taylor NF, Feller JA. et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48: 1543-1552
  • 5 Withrow TJ, Huston LJ, Wojtys EM. et al. Effect of varying hamstring tension on anterior cruciate ligament strain during in vitro impulsive knee flexion and compression loading. J Bone Joint Surg Am 2008; 90: 815-823
  • 6 Solomonow M, Baratta R, Zhou BH. et al. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med 1987; 15: 207-213
  • 7 Draganich LF, Reider B, Ling M. et al. An in vitro study of an intraarticular and extraarticular reconstruction in the anterior cruciate ligament deficient knee. Am J Sports Med 1990; 18: 262-266
  • 8 Baratta R, Solomonow M, Zhou BH. et al. Muscular coactivation. The role of the antagonist musculature in maintaining knee stability. Am J Sports Med 1988; 16: 113-122
  • 9 Aagaard P, Simonsen EB, Andersen JL. et al. Neural inhibition during maximal eccentric and concentric quadriceps contraction: Effects of resistance training. J Appl Physiol (1985) 2000; 89: 2249-2257
  • 10 Myer GD, Ford KR, Divine JG. et al. Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete: A case report. J Athl Train 2009; 44: 101-109
  • 11 Ford KR, Myer GD, Schmitt LC. et al. Preferential quadriceps activation in female athletes with incremental increases in landing intensity. J Appl Biomech 2011; 27: 215-222
  • 12 Ellman MB, Sherman SL, Forsythe B. et al. Return to play following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 2015; 23: 283-296
  • 13 Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am 2004; 86: 1601-1608
  • 14 Hewett TE, Stroupe AL, Nance TA. et al. Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med 1996; 24: 765-773
  • 15 Cowling EJ, Steele JR. Is lower limb muscle synchrony during landing affected by gender? Implications for variations in ACL injury rates. J Electromyogr Kinesiol 2001; 11: 263-268
  • 16 Malinzak RA, Colby SM, Kirkendall DT. et al. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech (Bristol, Avon) 2001; 16: 438-445
  • 17 Paterno MV, Ford KR, Myer GD. et al. Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clin J Sport Med 2007; 17: 258-262
  • 18 Hughes G. A review of recent perspectives on biomechanical risk factors associated with anterior cruciate ligament injury. Res Sports Med 2014; 22: 193-212
  • 19 Myers CA, Torry MR, Peterson DS. et al. Measurements of tibiofemoral kinematics during soft and stiff drop landings using biplane fluoroscopy. Am J Sports Med 2011; 39: 1714-1722
  • 20 Kyritsis P, Bahr R, Landreau P. et al. Infographic. Avoid ACL graft rupture. Meet discharge criteria. Br J Sports Med 2016; 50: 952
  • 21 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
  • 22 Coombs R, Cochrane T. Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons. Int J Sports Med 2001; 22: 618-622
  • 23 Dauty M, Menu P, Fouasson-Chailloux A. Cutoffs of isokinetic strength ratio and hamstring strain prediction in professional soccer players. Scand J Med Sci Sports 2018; 28: 276-281
  • 24 van Dyk N, Bahr R, Whiteley R. et al. Hamstring and quadriceps isokinetic strength deficits are weak risk factors for hamstring strain injuries: a 4-year cohort study. Am J Sports Med 2016; 44: 1789-1795
  • 25 Steffen K, Nilstad A, Kristianslund EK. et al. Association between lower extremity muscle strength and noncontact ACL injuries. Med Sci Sports Exerc 2016; 48: 2082-2089
  • 26 van Melick N, Meddeler BM, Hoogeboom TJ. et al. How to determine leg dominance: The agreement between self-reported and observed performance in healthy adults. PloS One 2017; 12: e0189876
  • 27 Dunnam LO, Hunter GR, Williams BP. et al. Bridging The Gap–Research: Comprehensive evaluation of the University of Alabama at Birmingham women’s volleyball training program. Strength Cond J 1988; 10: 43-53
  • 28 van den Bogert AJ, Geijtenbeek T, Even-Zohar O. et al. A real-time system for biomechanical analysis of human movement and muscle function. Med Biol Eng Comput 2013; 51: 1069-1077
  • 29 Roewer BD, Ford KR, Myer GD. et al. The “impact” of force filtering cut-off frequency on the peak knee abduction moment during landing: Artefact or “artifiction”?. Br J Sports Med 2014; 48: 464-468
  • 30 Bell AL, Pedersen DR, Brand RA. A comparison of the accuracy of several hip center location prediction methods. J Biomech 1990; 23: 617-621
  • 31 Kernozek TW, Ragan RJ. Estimation of anterior cruciate ligament tension from inverse dynamics data and electromyography in females during drop landing. Clin Biomech 2008; 23: 1279-1286
  • 32 Giffin JR, Vogrin TM, Zantop T. et al. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 2004; 32: 376-382
  • 33 Herzog W, Read LJ. Lines of action and moment arms of the major force-carrying structures crossing the human knee joint. J Anat 1993; 182 ( Pt 2) 213-230
  • 34 Li G, Rudy TW, Sakane M. et al. The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. J Biomech 1999; 32: 395-400
  • 35 Pflum MA, Shelburne KB, Torry MR. et al. Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exerc 2004; 36: 1949-1958
  • 36 Shin CS, Chaudhari AM, Dyrby CO. et al. The patella ligament insertion angle influences quadriceps usage during walking of anterior cruciate ligament deficient patients. J Orthop Res 2007; 25: 1643-1650
  • 37 Laughlin WA, Weinhandl JT, Kernozek TW. et al. The effects of single-leg landing technique on ACL loading. J Biomech 2011; 44: 1845-1851
  • 38 Markolf KL, O’Neill G, Jackson SR. et al. Effects of applied quadriceps and hamstrings muscle loads on forces in the anterior and posterior cruciate ligaments. Am J Sports Med 2004; 32: 1144-1149
  • 39 Samaan MA, Hoch MC, Ringleb SI. et al. Isolated hamstrings fatigue alters hip and knee joint coordination during a cutting maneuver. J Appl Biomech 2015; 31: 102-110
  • 40 Southard J, Kernozek TW, Ragan R. et al. Comparison of estimated anterior cruciate ligament tension during a typical and flexed knee and hip drop landing using sagittal plane knee modeling. Int J Sports Med 2012; 33: 381-385
  • 41 McNair PJ, Prapavessis H, Callender K. Decreasing landing forces: Effect of instruction. Br J Sports Med 2000; 34: 293-296
  • 42 Withrow TJ, Huston LJ, Wojtys EM. et al. The relationship between quadriceps muscle force, knee flexion, and anterior cruciate ligament strain in an in vitro simulated jump landing. Am J Sports Med 2006; 34: 269-274