Key Challenges Confronting Biomechanist Aiming to Predict ACL Injury Mechanisms

Abstract

Even though everyone is predisposed to anterior cruciate ligament (ACL) injuries, the highest incidences of non-contact ACL injuries are seen among athletes. There is a significant amount of in-vivo and in- vitro studies, musculoskeletal and computational modeling studies, as well as other related study approaches aimed at improving our understanding of ACL injury mechanisms. Despite all these efforts, there is still no clear understanding of non-contact ACL injury mechanisms. Consequently, there is no clear consensus that identified risk factors implicated to cause ACL injuries. The objective of this study is to provide insights as to why the mechanisms of ACL injury during non-contact events remain unknown. This study has found several key challenges which, among many, include the lack of material properties of some of the human tissues, shortcomings in problem definition, wide inter- and intra-subject variability, and also limitations of the existing study approaches. In addition, the lack of test standards and specifications in the field of biomechanics continues to hinder constructive dialogue among researchers. In order to predict the ACL injury mechanisms, new approaches or coupled approaches, as well as, benchmarks are needed. Until this can be done, our ability to identify, develop, and improve prevention and training strategies to mitigate the risk of ACL injuries, is limited.