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Effects of and Response to Mechanical Loading on the Knee

Sports Medicine volume 52, pages 201–235 (2022)Cite this article

Abstract

Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient’s response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.

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Authors and Affiliations

  1. Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA

    David S. Logerstedt

  2. School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia

    Jay R. Ebert

  3. Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia

    Jay R. Ebert

  4. Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia

    Jay R. Ebert

  5. Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA

    Toran D. MacLeod

  6. Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA

    Bryan C. Heiderscheit

  7. Gabbett Performance Solutions, Brisbane, QLD, Australia

    Tim J. Gabbett

  8. Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia

    Tim J. Gabbett

  9. Department of Physical Therapy, Arcadia University, Glenside, PA, USA

    Brian J. Eckenrode

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David S. Logerstedt, Jay R. Ebert, Toran D. MacLeod, Bryan C. Heiderscheit, Tim J. Gabbett, and Brian J. Eckenrode declare that they have no conflict of interest relevant to the content of this review.

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DSL: concept, layout, writing, editing manuscript and tables; JRE: layout, writing, editing manuscript and tables; TJG: writing, editing manuscript, figures, and tables; TDM, BCH, BJE: writing, editing manuscript and tables. All authors read and approved the final manuscript.

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Logerstedt, D.S., Ebert, J.R., MacLeod, T.D. et al. Effects of and Response to Mechanical Loading on the Knee. Sports Med 52, 201–235 (2022). https://doi.org/10.1007/s40279-021-01579-7

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