Sports Medicine

, Volume 40, Issue 9, pp 729–746

A ‘Plane’ Explanation of Anterior Cruciate Ligament Injury Mechanisms

A Systematic Review
  • Carmen E. Quatman
  • Catherine C. Quatman-Yates
  • Timothy E. Hewett
Review Article

DOI: 10.2165/11534950-000000000-00000

Cite this article as:
Quatman, C.E., Quatman-Yates, C.C. & Hewett, T.E. Sports Med (2010) 40: 729. doi:10.2165/11534950-000000000-00000


Although intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) injury have been explored extensively, the factors surrounding the inciting event and the biomechanical mechanisms underlying ACL injury remain elusive. This systematic review summarizes all the relevant data and clarifies the strengths and weaknesses of the literature regarding ACL injury mechanisms. The hypothesis is that most ACL injuries do not occur via solely sagittal, frontal or transverse plane mechanisms. Electronic database literature searches of PubMed MEDLINE (1966–2008), CINAHL (1982–2008) and SportDiscus® (1985–2008) were used for the systematic review to identify any studies in the literature that examined ACL injury mechanisms. Methodological approaches that describe and evaluate ACL injury mechanisms included athlete interviews, arthroscopic studies, clinical imaging and physical exam tests, video analysis, cadaveric studies, laboratory tests (motion analysis, electromyography) and mathematical modelling studies. One hundred and ninety-eight studies associated with ACL injury mechanisms were identified and provided evidence regarding plane of injury, with evidence supporting sagittal, frontal and/or transverse plane mechanisms of injury. Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury.

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Carmen E. Quatman
    • 1
    • 2
  • Catherine C. Quatman-Yates
    • 1
    • 3
  • Timothy E. Hewett
    • 1
    • 4
    • 5
    • 6
  1. 1.Cincinnati Children’s Hospital Research FoundationSports Medicine Biodynamics Center and Human Performance LaboratoryCincinnatiUSA
  2. 2.University of Toledo, Engineering Center for Orthopaedic Research Excellence, College of Engineering, University of ToledoToledoUSA
  3. 3.Division of Occupational Therapy and Physical TherapyCincinnati Children’s HospitalCincinnatiUSA
  4. 4.Division of Molecular Cardiovascular BiologyCincinnati Children’s Hospital Research FoundationCincinnatiUSA
  5. 5.Departments of Pediatrics, Orthopaedic Surgery and College of Allied Health Sciences, Department of Rehabilitation SciencesUniversity of Cincinnati College of MedicineCincinnatiUSA
  6. 6.Sports Medicine Center, Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical EngineeringThe Ohio State UniversityColumbusUSA