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The Journal of Bone and Joint Surgery, Vol 66, Issue 5 725-734, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament
ES Grood, WJ Suntay, FR Noyes and DL Butler
We conducted this study to determine the effective moment arm of the knee
extensor mechanism and the conditions under which the anterior cruciate
ligament is loaded during knee-extension exercises. The moment arm was
calculated from measurement of the quadriceps force required to extend the
knee with and without resistive weights placed at the foot, the leg weight,
and the location of its center of gravity. Changes in three-dimensional
joint motion after the anterior cruciate ligament was removed were
considered to be an indication that the ligament was loaded. The quadriceps
force rose during the initial phase of knee extension and remained nearly
constant at an average value of 177 newtons between 50 and 15 degrees. With
extension past 15 degrees it rose rapidly, reaching an average of 350
newtons at zero degrees of extension, and continued to increase with
hyperextension. The addition of thirty-one newtons (seven pounds) at the
foot approximately doubled the quadriceps force that was required to extend
the knee. The effective moment arm of the extensor mechanism increased with
knee extension, peaked at approximately 20 degrees, and rapidly decreased
with further extension. No change was found in the quadriceps force or its
effective moment arm when the anterior cruciate ligament was sectioned
except in hyperextension, where the quadriceps force decreased in two of
five specimens. There was, however, an increased anterior tibial
displacement in the range of 30 degrees to full extension, suggesting that
the anterior cruciate ligament is loaded in that flexion arc. Clinical
Relevance: This study demonstrates that very large quadriceps forces are
required to accomplish the last 15 degrees of extension during leg-raising
exercises, typically twice those required to reach 30 degrees of flexion.
The large forces that are required to obtain full extension explain why an
extensor lag occurs with quadriceps weakness even though a full passive
range of motion is possible. Since thirty-one newtons (seven pounds) of
resistive weight added at the foot approximately doubles the quadriceps
forces required to extend the leg alone, using such weights can produce
very large quadriceps forces and concurrent patellofemoral and tibiofemoral
contact forces. Because the quadriceps force increases little as the leg is
extended from 50 to 15 degrees, in patients with patellofemoral chondroses
for whom a full range of joint motion is not desired, quadriceps exercises
can be limited to the amount of extension without decreasing quadriceps
force.(ABSTRACT TRUNCATED AT 400 WORDS)
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