Cutting Mechanics: Relation to Performance

and Anterior Cruciate Ligament Injury Risk

KATHRYN L. HAVENS and SUSAN M. SIGWARD
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA

ABSTRACT
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HAVENS, K. L., and S. M. SIGWARD. Cutting Mechanics: Relation to Performance and Anterior Cruciate Ligament Injury Risk. Med.
Sci. Sports Exerc., Vol. 47, No. 4, pp. 818–824, 2015. Purpose: Quick changes of direction during running (cutting) are necessary for
successful performance of many sports but are associated with noncontact anterior cruciate ligament (ACL) injuries. Currently, it is not known
how biomechanics associated with fast performance of cutting tasks relate to the mechanics associated with increased risk for injury. Without
this knowledge, the technique emphasized in injury prevention programs may be at odds with the demands of cutting tasks. The purposes of
this study were to 1) identify whole body and/or joint mechanics that are related to completion times of 45- and 90- cuts and, from these
variables, 2) determine which variables are predictors of performance (i.e., completion time) and/or ACL injury risk (i.e., peak knee
adductor moment). Methods: Whole body and joint biomechanics were analyzed during the execution of two sidestep cutting maneuvers
(to 45- and 90-) in 25 healthy experienced soccer players. Pearson correlation coefficients and stepwise multiple regression were used to
analyze relations between variables. Results: The variables predictive of 45- cut performance included hip extensor moment and hip
sagittal plane power generation as well as medial–lateral center-of-mass to center-of-pressure separation distance. This separation dis-
tance was also predictive of peak knee adductor moment. During the 90- cut, medial–lateral ground reaction force impulse and hip frontal
plane power generation were predictive of performance whereas hip internal rotation and knee extensor moment were predictive of peak
knee adductor moment. Conclusions: These relations have important implications for ACL injury prevention programs. Although
restricting frontal and transverse plane movement has been emphasized in many programs, these movement recommendations may not
be appropriate for cutting tasks performed at greater angles. Key Words: TURNING, KINEMATICS, KNEE, AGILITY, PREVENTION

R
unning change-of-direction (cutting) maneuvers are
essential for successful participation and perfor-
mance in many sports but are unfortunately associ-
ated with noncontact anterior cruciate ligament (ACL) injury
(5,9,22). Research has identified lower extremity movement
patterns, particularly knee valgus (adductor) loading, thought
to place individuals at risk for injury during cutting (20,36).
However, less is known about the mechanics necessary for
optimal performance of cutting tasks to different directions
or how they relate to injury risk. This is needed to develop
training programs that reduce the risk for ACL injury but do
not diminish change-of-direction performance.
Athletes’ success in many sports relies on their ability to
quickly change direction—to be agile. During a soccer game,
players make many turns/swerves to different directions, with
APPLIED SCIENCES
an average of 727 turns/swerves mostly to 90- or less (3,4). The
role of agility in distinguishing among levels of sports partici-
pation, identifying talent, and influencing player selection in
teams underscores its importance in sports. Agility has been
shown to be the most important indicator of talent in soccer
(35) and is also a vital determinant of player selection in youth
soccer teams (12) and the National Football League (25).
To change direction, individuals must decelerate in the
original direction and redirect their body into the intended
direction (15). Whole body center of mass (COM) position
and horizontal ground reaction force (GRF) variables indi-
cate that deceleration and translation of the body increase
with increased cut angle (16,18). However, these subtasks
are accomplished through different joint patterns, of both the
lower extremity and trunk, when cuts are made to 45- and

90- (17). Thus, different mechanics are likely related to

faster performance of cuts to different angles. Evaluation of
both whole body and joint kinematics and kinetics in rela-
Address for correspondence: Kathryn L. Havens, Ph.D., Division of
Biokinesiology and Physical Therapy, University of Southern California, 1540 tion to task performance is essential to understand how
Alcazar St., CHP 155, Los Angeles, CA 90089; E-mail: khavens@usc.edu. training programs potentially affect performance.
Submitted for publication March 2014. Frontal plane knee mechanics are considered important
Accepted for publication August 2014. factors in ACL injuries. Questionnaires and video analyses
0195-9131/15/4704-0818/0 have described medial collapse of the knee as a component
MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ of noncontact ACL injuries during cutting and landing ma-
Copyright Ó 2014 by the American College of Sports Medicine neuvers (5,9,31). This mechanism is supported by in vitro
DOI: 10.1249/MSS.0000000000000470 (24), in vivo (2), and computer simulation studies (7,26,28)

818

Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
showing that large knee adductor (valgus) moments increase
loading of the ACL. In addition, knee adductor moment
during a drop-land task was shown to predict ACL injury
risk in a prospective study (20). While the mechanism of
frontal plane loading during landing and change-of-direction
tasks is thought to differ, increased knee valgus load during
cutting is considered a risk factor for noncontact ACL injury
(26,31).
Greater knee adductor moments during cutting are asso-
ciated with joint positions at initial contact including in-
creased abduction and internal rotation angles (27,36) and
trunk lean (21) as well as greater peak lateral forces (36). In
hopes of mitigating these biomechanical risk factors, injury
prevention programs discourage frontal and transverse plane
movement of the lower extremity and trunk and encourage
sagittal plane motion during dynamic tasks (10,23,29). Al-
though these strategies have been reported to improve per-
formance of jumping tasks (30), it is unclear whether they
are also beneficial to performance of cutting movements. In
fact, Vescovi et al. (37) showed that participation in an ACL
injury prevention program diminished agility performance.
Because athletes are driven by performance, they are un-
likely to adopt movement patterns that decrease the risk for
injury if they do not result in effective performance.
It is currently unclear whether the mechanics that are
necessary for performance of cutting tasks are at odds with
those that are emphasized in prevention programs. This
study aims to fill this gap in the current understanding of the
injury risk–cutting performance relation by 1) identifying
whole body and joint kinematics and kinetics that are related
to good performance (i.e., fast completion times (CT)) of
45- and 90- cuts and, from these variables, 2) determining
which variables predict performance and/or ACL injury risk
(i.e., peak knee adductor moment). On the basis of previous
research from our laboratory demonstrating differences in
mechanics between cutting tasks, we propose that different
mechanics will be related to cutting performance for 45- and
90- cuts. On the basis of what is known regarding poten-
tially injurious knee mechanics, we hypothesize that the
mechanics related to performance will also be related to
peak knee adductor moment.
METHODS
Participants. Twenty-five healthy soccer players (12 females)
participated in this study (mean age, 22.4 T 3.9 yr; height,
1.74 T 0.1 m; mass, 70.9 T 9.3 kg; years of soccer experience,
16.7 T 4.4 yr). A power analysis determined that with
25 subjects, the study is adequately powered to detect corre-
lations with an alpha of 0.05 and 85% power. Athletes
were considered experienced, high-level soccer players
(division I–III in college, semiprofessional, and professional).
Twenty-two participants reported that they were right limb
dominant when asked which foot they would kick a ball with.
All subjects were healthy and had no complaints associ-
ated with lower extremity injuries. Subjects were excluded
CUTTING PERFORMANCE AND INJURY RISK
Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
from the study if they had 1) history of lower extremity
surgery, 2) lower extremity injury preventing them from
participating in sport (93 wk) in the last 6 months, or 3) any
physical, cognitive, or other condition that would impair
their ability to perform the tasks in this study. Before par-
ticipation, the testing procedures were explained to the
subjects and an informed consent was obtained, as approved
by the investigational review board at the University of
Southern California Health Science Campus.
Instrumentation. Three-dimensional motion analysis
was performed using a marker-based, 11-camera digital
motion capturing system (Qualisys, Gothenburg, Sweden) at
250 Hz. GRF data were obtained at 1500 Hz using a 1.20 
0.60 m2 force platforms (AMTI, Newton, MA) embedded
into the floor surface. Kinematic and kinetic data were col-
lected synchronously using the motion capture software
(Qualisys Track Manager, version 2.6). Reflective markers
(25-mm spheres) placed on specific bony landmarks were
used to define body segments in three-dimensional space.
Laser timing gates (Brower IRD-T175; Brower Timing
Systems, Draper, UT) were used to determine the time to
complete the tasks.
Procedures. All testing took place at the Human Per-
formance Laboratory at the University of Southern California
located within the Competitive Athlete Training Zone. Par-
ticipants wore their own running/athletic shoes. Tracking
marker clusters mounted on semirigid plastic plates were se-
cured to nylon/lycra bands on the subjects’ arms, forearms,
thighs, shanks, and shoes. Using a full body marker set, re-
flective markers were placed over 45 anatomical landmarks,
including the following: end of the second toes, first and fifth
metatarsal heads, medial and lateral malleoli, medial and lat-
eral epicondyles of the femurs, greater trochanters, posterior
superior iliac spines, iliac crests, L5–S1 junction, anterior and
posterior glenohumeral joints, greater tubercles of the humerus,
acromions, lateral and medial humeral epicondyles, radial
and ulnar styloid processes, third metacarpal heads, clavicle,
cervical process of C7, and the anterior, posterior, right, and
left sides of the head. After a static calibration trial, tracking
markers remained on the subject.
Before testing, subjects completed a 15-min warm-up and
were given time to stretch. Next, subjects were instructed to
run 7.5 m as fast as possible, plant their dominant foot, and
change direction away from their plant foot at 45- (CUT45) or
90- (CUT90) and continue running as fast as possible for
APPLIED SCIENCES
7.5 m (Fig. 1). Cutting angles were marked on the floor with
tape. Laser timing gates were placed at the end of the path on
either side of this line at approximately 35- and 55- for the 45-
cut and at approximately 80- and 100- for the 90- cut. Cut
order was counterbalanced between subjects to prevent effects
related to testing order. Trials were accepted if the subject’s
task CT was within a T2.5% interval of the average CT for that
task and if their foot fully contacted the force platform.
To determine whether the cutting tasks (CUT45 and
CUT90) analyzed for this study were representative of the
subjects’ agility performance, subjects also completed an
Medicine & Science in Sports & Exercised 819

FIGURE 1—Experimental setup for right foot-dominant subjects. The
open arrow indicates the original direction of progression.
agility T-test as fast as possible (Fig. 2). The T-test was
performed outside the biomechanics laboratory on artificial
turf and was chosen because it is a reliable (33) and fre-
quently used assessment of agility performance (6). It in-
volved forward run, side shuffle, and back pedal
movements, with four changes of direction over a 40-yd
distance (Fig. 2). Trials were accepted only if subjects
touched each cone and faced forward the entire time.
Data analysis. The Qualisys Tracking Manager was
used to reconstruct the three-dimensional marker co-
ordinates. The Visual3D software (version 4.8; C-Motion,
Inc., Rockville, MD) was used to process the raw coordinate
and force data and compute segmental kinematics and
kinetics. Force data and coordinate data were low-pass–
filtered on the basis of a residual analysis (38) using a fourth-
order zero-lag Butterworth filter with 200- and 12-Hz cutoff
frequencies, respectively. The local coordinate systems of
the body segments were derived from the standing calibra-
tion trial. Lower and upper extremity segments and the
thorax were modeled as frustra of cones, whereas the pelvis
was modeled as a cylinder and the head, as a sphere. The
APPLIED SCIENCES
whole body COM position was calculated as the weighted
average of the COM positions of each of the 15 modeled
segments (11). Joint kinematics were calculated by deter-
mining the transformation from the triad of markers to the
position and orientation of each segment determined from
the standing calibration trial. Euler angles with the following
order of rotations were used to calculate joint kinematics:
flexion (+)/extension (j), abduction (+)/adduction (j), and
internal (+)/external (j) rotation. Three-dimensional net
joint moments were calculated using inverse dynamics
equations and were reported as internal net joint moments.
820 Official Journal of the American College of Sports Medicine
Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Joint power was calculated as the product of joint moment
and angular velocity. All kinetic data were normalized to
body mass. Data obtained from Visual3D were exported and
analyzed using a customized MATLAB program (version
R2011b; The MathWorks, Natick, MA). Foot contact events
were defined using a 30-N vertical force threshold.
CT for the cutting tasks and agility T-test was recorded
from laser timing gates to the nearest one-hundredth of a
second. For the agility T-test, the fastest completion time-out
of three trials performed was used for analysis.
Dependent variables included peak posterior and medial
GRF, braking and medial–lateral (ML) GRF impulse (GRI),
and peak posterior and ML distance between the COM and
center of pressure (COP). Horizontal GRF and the distance
between the COM and COP were rotated to align with the
anatomical reference frame similar to that of Glaister et al. (14).
Joint variables were analyzed during the deceleration phase,
defined as the time from initial contact with the force plate to
maximal knee flexion. This generally occurred at 50% of
stance and has been used in previous studies to define the
deceleration phase (8,21). The deceleration phase was of
particular interest because noncontact ACL injuries often oc-
cur during this period of stance (5). Dependent joint variables
included peak knee adductor moment and kinematics at initial
contact and peak net joint moments and average power over
the deceleration phase. In particular, the ankle, knee, and hip
in the sagittal plane, hip in the frontal and transverse planes,
and trunk in the frontal plane (relative to global vertical: trunk
lean) were assessed. For all variables, the average of four
trials for each subject for each task was used for analysis.
FIGURE 2—Layout of the agility T-test. Subjects started behind laser
timing gates at point A. They ran through the timing gates to point B
and touched a 9-inch cone with their hand. They side-shuffled left and
touched the cone at C. Next, they shuffled right and touched the cone at
D, then shuffled left back to B. After touching the cone at B a second
time, they back-pedaled through the timing gates at A.
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 Statistical analysis. The two cutting tasks were ana- TABLE 2. Regression statistics for CT and knee adductor moment for CUT45 and CUT90 tasks.
lyzed separately. Pearson product moment correlations was R2 Change P Value
used (> e 0.05) to determine whether cutting task CT was Completion time
CUT45
representative of agility performance. Pearson product mo- Hip sagittal power (WIkgj1) 0.23 0.016
ment correlations (> e 0.05) were also used to determine the Hip extensor moment (NImIkgj1) 0.38 G0.001
ML COM–COP separation (mImj1) 0.12 0.006
relation between cutting task CT and the biomechanical Total 0.73 G0.001
dependent variables of interest. To determine the best pre- CUT90
dictors of CT during the cutting tasks, the biomechanical Hip frontal power (WIkgj1) 0.34 0.002
ML GRI (NIsINj1) 0.28 0.001
variables that were correlated with CT (with > G 0.075) were Total 0.62 G0.001
considered in a stepwise multiple linear regression model Knee adductor moment
CUT45
(entry and removal thresholds, P e 0.05 and P e 0.10, re- ML COM–COP separation (mImj1) 0.22 0.017
spectively). To determine whether the biomechanical vari- CUT90
ables significantly correlated with CT were also predictive Knee extensor moment (NImIkgj1) 0.17 0.041
Hip rotation angle (-) 0.25 0.005
of peak knee adductor moment, these variables were con- Total 0.42 0.002
sidered in a second stepwise multiple linear regression
model (> e 0.05). Statistical analyses were performed using
the PASW software (version 18; SPSS, Inc., Chicago, IL). power entered the model first, explaining 23% of the variance
(P = 0.016), followed by peak hip extensor moment,
explaining an additional 38% of the variance in CT (P G
0.001). ML COM–COP separation was the last predictor to
RESULTS
enter the model, explaining an additional 12% of variance in
Average (T SD) CT measurements were 10.07 T 0.69 s for CT (P = 0.006).
the agility T-test, 2.69 T 0.23 s for CUT45, and 3.25 T 0.22 s When the four variables that were correlated with CUT45
for CUT90. CT for the agility T-test was significantly cor- CT were considered in a stepwise multiple regression with
related with the CT of both CUT45 (r = 0.816, P G 0.001) peak knee adductor moment as the independent variable,
and CUT90 (r = 0.788, P G 0.001). Smaller (faster) times for ML COM–COP separation distance was the only predictor,
the T-test were associated with faster times for the cutting explaining 22% of the variance (r = 0.472, P = 0.017) (Table 2).
tasks. These significant positive correlations allowed us to Larger ML distances between the COM and COP were as-
confidently use the cutting tasks to represent subjects’ sociated with greater knee adductor moments.
change-of-direction performance abilities. CUT90. CT of CUT90 was significantly correlated with
Average (T SD) peak knee adductor moment was j1.07 T ML GRI, hip rotation angle at initial contact, hip frontal
0.99 NImIkgj1 for CUT45 and j1.83 T 0.77 NImIkgj1 for plane power, and peak knee sagittal plane moment (P G 0.05)
CUT90. (Table 1). Faster CT was associated with greater ML GRI,
CUT45. CT for CUT45 was significantly correlated with greater internal rotation angles, greater power generation,
hip power generation in the sagittal plane and peak ankle and greater knee extensor moments. When these variables
plantarflexor moment (P G 0.05) (Table 1). Better perfor- were considered in a stepwise multiple regression, ML GRI
mance (i.e., shorter CT) was associated with greater hip and hip frontal plane power generation were the only pre-
power generation and greater plantarflexor moments. dictors of CT, explaining 62% of the variance (r = 0.790,
Shorter CT was also associated with greater hip extensor P G 0.001). Hip frontal plane power entered the model first,
moment and larger peak ML COM–COP separation distance explaining 34% of the variance in knee adductor moment
(P G 0.075) (Table 1). When these four variables were con- (P = 0.002), followed by ML GRI, explaining an additional
sidered in a stepwise multiple regression, hip sagittal power 28% of the variance (P = 0.001) (Table 2).
generation, hip extensor moment, and ML COM–COP sepa- When the variables that were significantly correlated with
ration entered the model and together explained 73% of the CUT90 CT were considered in a stepwise multiple regression
variance in CT (r = 0.854, P G 0.001) (Table 2). Hip sagittal model with peak knee adductor moment as the independent
APPLIED SCIENCES
TABLE 1. Variables correlated with CT: descriptive and correlation statistics for CUT45 and CUT90 tasks.
Completion Time
Average T SD Range Correlation Coefficient P Value
CUT45
ML COM–COP separation (mImj1) 0.26 T 0.02 0.22 to 0.30 j0.387 0.056
Hip extensor moment (NImIkgj1) j4.65 T 1.41 j8.47 to j2.75 0.393 0.052
Hip sagittal power (WIkgj1) 6.66 T 3.50 0.76 to 13.75 j0.475 0.016
Ankle plantarflexor moment (NImIkgj1) j3.04 T 0.53 j1.73 to j4.11 0.450 0.024
CUT90
ML GRI (NIsINj1) 0.21 T 0.03 0.13 to 0.26 j0.489 0.013
Hip rotation angle (-) 10.14 T 7.89 j3.74 to 23.53 j0.471 0.018
Hip frontal power (WIkgj1) 0.37 T 0.99 j1.44 to 2.30 j0.586 0.002
Knee extensor moment (NImIkgj1) j3.06 T 0.61 j4.33 to j1.98 0.499 0.024

CUTTING PERFORMANCE AND INJURY RISK Medicine & Science in Sports & Exercised 821

Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 variable, peak knee extensor moment and hip internal rotation
angles at initial contact were the best predictors, explaining
42% of the variance (r = 0.651, P = 0.002). Peak knee ex-
tensor moments entered the model first and explained 17% of
the variance (P = 0.041). Hip internal rotation angle at initial
contact explained an additional 25% of the variance in peak
knee adductor moment (P = 0.005) (Table 2). Greater knee
adductor moments were associated with greater knee extensor
moments and less hip internal rotation.
DISCUSSION
This study aimed to determine whether the mechanics that
are related to performance of athletic cutting tasks (i.e., fast
CT) are also related to potentially injurious frontal plane
knee loading. The variables that predicted faster cutting
performance differed between cutting tasks performed to 45-
and 90-. This is not surprising because differences in whole
body and joint mechanical variables have been observed
among change-of-direction tasks performed to different an-
gles (17,18,32,40). Primarily, sagittal plane mechanics pre-
dicted performance of the CUT45 task, whereas frontal
plane mechanics predicted performance of CUT90. Of the
variables that predicted performance, few were also predic-
tive of potentially injurious knee joint loading.
Hip mechanics in the sagittal plane were related to CT of the
CUT45 task. Greater hip extensor moments and power gen-
eration at the hip were associated with faster CT and together
explained 61% of the variance in CT. The hip extensors gen-
erate power during deceleration of 45- cuts, and similar re-
lations have been noted between hip extensor joint power and
muscle activity and straight running speed (1). Greater ML
COM–COP separation distance was also found to be associ-
ated with faster performance of CUT45, explaining an addi-
tional 12% of the variance in CT. This ML distance indicates
that the COM is separated from COP toward the cut direction,
which may allow for acceleration and momentum generation
toward the new direction (39). Although ankle plantarflexor
moments were correlated with CT, they did not enter the
prediction model. This may be because the ankle plantarflexors
act to absorb energy during deceleration and the peak moment
occurred at the end of the deceleration phase. Their contribu-
tion to performance may have been larger had the entire stance
phase been considered.
APPLIED SCIENCES
Of the variables that correlated with CUT45 CT, only ML
COM–COP separation distance was found to predict peak
knee adductor moment. A more medial whole body position
with respect to the foot can contribute to a larger valgus
moment at the knee by positioning the COP more lateral to
the COM of the body and the tibia. This could create a large
moment arm, the perpendicular distance from the axis of
rotation to the force, for the vertical GRF about the knee
joint, similar to the relation between knee valgus and hip
abduction angle demonstrated previously (36). This was the
only variable that predicted both performance and injury
822 Official Journal of the American College of Sports Medicine
Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
risk, but it only explained a small amount of the variance for
both CT and knee loading.
Medial GRI and frontal plane hip power were the only
predictors of CUT90 CT. Increases in GRI can be accom-
plished by increasing GRF magnitude and/or time of force
application (stance time). The relation between increased
medial GRI and faster CT is not surprising, as a larger medial
GRF over a longer stance time is necessary to accomplish the
greater redirection demands of CUT90 (18). Frontal plane
hip power also predicted CUT90 CT. During deceleration of
CUT90, frontal plane power generation at the hip is ob-
served as the hip adducts into a less abducted position,
concurrent with increasing trunk lean into the cut. Together,
these mechanics are thought to allow for greater trunk lean
during the CUT90 task (17). The inclusion of power gen-
eration of the hip adductors into the prediction model sug-
gests that this may be important for faster performance.
Larger knee extensor moments and greater hip internal
rotation angles were correlated with faster CT during CUT90
but did not enter the regression equation. The knee extensors
play an important role in deceleration during CUT90, which
may allow for more rapid transition to redirection (17).
Greater internal rotation at the hip may be indicative of a
pre-positioning of the limb into the direction of the cut.
When the variables that were significantly correlated to
CUT90 CT were considered, hip internal rotation at initial
contact and peak knee extensor moment were found to be
significant predictors of peak knee adductor moment. It is
not clear how larger knee extensor moments relate to greater
frontal plane loading at the knee but may reflect greater
overall loading at the knee during CUT90. Smaller degrees
of hip internal rotation at initial contact were related to larger
peak knee adductor moments. This relation is in contrast to
that found for CT, suggesting that more hip internal rotation
during CUT90 is beneficial for both performance and knee
loading. This relation is also in contrast to previous studies
that found that larger degrees of hip internal rotation are
related to greater peak knee adductor moments during cuts
performed to 45- (27,36). This suggests that the relation
between hip internal rotation and knee loading differs during
cuts performed at different angles.
These data suggest that current injury prevention recom-
mendations may be applicable to good technique for cutting to
45-. These programs emphasize increased sagittal plane mo-
tion (13,19,23,29) and discourage frontal and transverse plane
motion of the lower extremity and trunk (10,23,29). ML
separation between the COM and COP predicted knee load-
ing during CUT45. Because this distance likely results from a
combination of trunk and lower extremity positioning, limit-
ing these motions may result in decreased frontal plane
loading of the knee during CUT45. The extent to which these
frontal plane recommendations would influence performance
is not clear, considering that separation distance explained
only 12% of the variance in CT. In the sagittal plane, increased
engagement of the hip may be advantageous, as sagittal plane
hip mechanics predicted performance but not injury risk.
http://www.acsm-msse.org
Furthermore, previous studies suggest that increasing hip
sagittal engagement may decrease knee adductor moments by
reducing frontal and transverse plane motions of the hip (34).
The implications of the current technique training on
performance and injury risk during CUT90 are less clear.
Interestingly, the ML variables predictive of CUT90 per-
formance, hip frontal plane power generation, and ML GRI
were not predictive of knee adductor moment. This was not
expected because frontal plane mechanics are related to knee
adductor moments during cuts to smaller angles (21,36). In
the transverse plane, limiting lower extremity motion may
result in smaller degrees of hip internal rotation. Less hip
rotation was shown here to be associated with decreased
performance and increased knee loading for CUT90. This
suggests that injury prevention programs that discourage
frontal and transverse plane movements of the lower ex-
tremity may limit performance and may not decrease risk for
injury during a 90- cutting task.
This novel study analyzed the relations between cutting
performance and whole body and joint biomechanics. Al-
though these data provide some insight into the relation
REFERENCES
1. Belli A, Kyröläinen H, Komi PV. Moment and power of lower
limb joints in running. Int J Sports Med. 2002;23(2):136–41.
2. Beynnon BD, Fleming BC, Johnson RJ, Nichols CE, Renström
PA, Pope MH. Anterior cruciate ligament strain behavior during
rehabilitation exercises in vivo. Am J Sports Med. 1995;23(1):
24–34.
3. Bloomfield J, Polman R, O’Donoghue P. Physical demands of
different positions in FA Premier League soccer. J Sport Sci Med.
2007;6(1):63–70.
4. Bloomfield J, Polman R, O’Donoghue P. Turning movements
performed during FA Premier League soccer matches. J Sport Sci
Med. 2007;6(10 Suppl):9.
5. Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of
anterior cruciate ligament injury. Orthopedics. 2000;23(6):573–8.
6. Brughelli M, Cronin J, Levin G, Chaouachi A. Understanding
change of direction ability in sport: a review of resistance training
studies. Sports Med. 2008;38(12):1045–63.
7. Chaudhari AM, Andriacchi TP. The mechanical consequences of
dynamic frontal plane limb alignment for non-contact ACL injury.
J Biomech. 2006;39(2):330–8.
8. Chaudhari AM, Hearn BK, Andriacchi TP. Sport-dependent vari-
ations in arm position during single-limb landing influence knee
loading: implications for anterior cruciate ligament injury. Am J
Sports Med. 2005;33(6):824–30.
9. Cochrane JL, Lloyd DG, Buttfield A, Seward H, McGivern J.
Characteristics of anterior cruciate ligament injuries in Australian
football. J Sci Med Sport. 2007;10(2):96–104.
10. Dempsey AR, Lloyd DG, Elliott BC, Steele JR, Munro BJ, Russo KA.
The effect of technique change on knee loads during sidestep cutting.
Med Sci Sports Exerc. 2007;39(10):1765–73.
11. Dempster WT. Space Requirements of the Seated Operator. Geo-
metrical, Kinematic, and Mechanical Aspects of the Body with
Special Reference to the Limbs. Wright Air Development Center
Technical Report. Wright-Patterson Air Force Base (OH): Wright
Air Development Center. 1955;55–159:1–254.
12. Gil S, Ruiz F, Irazusta A, Gil J, Irazusta J. Selection of young
soccer players in terms of anthropometric and physiological fac-
tors. J Sports Med Phys Fit. 2007;47(1):25–32.
CUTTING PERFORMANCE AND INJURY RISK
Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
between cutting mechanics related to performance and in-
jury risk, caution must be taken before applying these data to
injury prevention training. These predictors were assessed in
highly trained, healthy athletes during preplanned cutting
tasks. It is not known whether similar results would be found
in other athlete populations or under different task condi-
tions. Moreover, interpretation of these data may be limited
by the use of skin markers and by allowing subjects to use
their own footwear. To relate performance variables to knee
adductor moments and injury risk, only the deceleration
phase of stance was considered. It is likely that whole body
or joint mechanics associated with the second half of stance
(i.e., the propulsion phase) could provide additional insight
into cutting performance. Future research should consider
the entire stance phase and possibly the mechanics of the
approach steps before the cut’s execution.
This study was not funded by any institution.
The authors declare no conflicts of interest related to this study.
The results of the present study do not constitute endorsement by
the American College of Sports Medicine.
13. Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized
controlled trial to prevent noncontact anterior cruciate ligament
injury in female collegiate soccer players. Am J Sports Med.
2008;36(8):1476–83.
14. Glaister BC, Orendurff MS, Schoen JA, Klute GK. Rotating hor-
izontal ground reaction forces to the body path of progression.
J Biomech. 2007;40(15):3527–32.
15. Hase K, Stein RB. Turning strategies during human walking.
J Neurophysiol. 1999;81(6):2914–22.
16. Havens K, Sigward S. Whole body posture for running change of
direction tasks. In: Proceedings of the American Society of Biome-
chanics Annual Conference. September 4–7, 2013; Omaha (NE);
2013. p. 31.
17. Havens K, Sigward S. Joint and segmental mechanics differ be-
tween cutting maneuvers in skilled athletes. Gait Posture. 41(1):33–8.
18. Havens K, Sigward S. Whole body mechanics differ among run-
ning and cutting maneuvers in skilled athletes. Gait Posture. 2014,
http://dx.doi.org/10.1016/j.gaitpost.2014.07.022.
19. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect
of neuromuscular training on the incidence of knee injury in fe-
male athletes. A prospective study. Am J Sports Med. 1999;27(6):
699–706.
20. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of
neuromuscular control and valgus loading of the knee predict an-
terior cruciate ligament injury risk in female athletes: a prospective
APPLIED SCIENCES
study. Am J Sports Med. 2005;33(4):492–501.
21. Jamison ST, Pan XL, Chaudhari AM. Knee moments during run-
to-cut maneuvers are associated with lateral trunk positioning.
J Biomech. 2012;45(11):1881–5.
22. Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of
anterior cruciate ligament injury in basketball: video analysis of
39 cases. Am J Sports Med. 2007;35(3):359–67.
23. Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of
a neuromuscular and proprioceptive training program in preventing
anterior cruciate ligament injuries in female athletes: 2-year follow-up.
Am J Sports Med. 2005;33(7):1003–10.
24. Markolf KL, Burchfield DI, Shapiro MM, Shepard ME, Finerman GA,
Slauterbeck JL. Combined knee loading states that generate high
anterior cruciate ligament forces. J Orthop Res. 1995;13(6):930–5.
Medicine & Science in Sports & Exercised 823
 25. McGee KJ, Burkett LN. The National Football League combine: a
reliable predictor of draft status? J Strength Cond Res. 2003;17(1):
6–11.
26. McLean SG, Huang X, Su A, van den Bogert AJ. Sagittal plane
biomechanics cannot injure the ACL during sidestep cutting. Clin
Biomech (Bristol, Avon). 2004;19(8):828–38.
27. McLean SG, Huang XM, van den Bogert AJ. Association between
lower extremity posture at contact and peak knee valgus moment
during sidestepping: implications for ACL injury. Clin Biomech
(Bristol, Avon). 2005;20(8):863–70.
28. McLean SG, Huang X, van den Bogert AJ. Investigating isolated
neuromuscular control contributions to non-contact anterior cru-
ciate ligament injury risk via computer simulation methods. Clin
Biomech (Bristol, Avon). 2008;23(7):926–36.
29. Myer GD, Ford KR, McLean SG, Hewett TE. The effects of
plyometric versus dynamic stabilization and balance training on
lower extremity biomechanics. Am J Sports Med. 2006;34(3):
445–55.
30. Myer GD, Ford KR, Palumbo JP, Hewett TE. Neuromuscular
training improves performance and lower-extremity biomechanics
in female athletes. J Strength Cond Res. 2005;19(1):51–60.
31. Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury
mechanisms for anterior cruciate ligament injuries in team hand-
ball: a systematic video analysis. Am J Sports Med. 2004;32(4):
1002–12.
APPLIED SCIENCES
824 Official Journal of the American College of Sports Medicine
Copyright © 2015 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
32. Patla AE, Adkin A, Ballard T. Online steering: coordination and
control of body center of mass, head and body reorientation. Exp
Brain Res. 1999;129(4):629–34.
33. Pauole K, Madole K, Garhammer J, Lacourse M, Rozenek R.
Reliability and validity of the T-test as a measure of agility, leg
power, and leg speed in college-aged men and women. J Strength
Cond Res. 2000;14(4):443–50.
34. Pollard CD, Sigward SM, Powers CM. Gender differences in hip
joint kinematics and kinetics during side-step cutting maneuver.
Clin J Sport Med. 2007;17(1):38–42.
35. Reilly T, Williams AM, Nevill A, Franks A. A multidisciplinary
approach to talent identification in soccer. J Sports Sci. 2000;18(9):
695–702.
36. Sigward SM, Powers CM. Loading characteristics of females
exhibiting excessive valgus moments during cutting. Clin Biomech
(Bristol, Avon). 2007;22(7):827–33.
37. Vescovi JD, VanHeest JL. Effects of an anterior cruciate ligament
injury prevention program on performance in adolescent female
soccer players. Scand J Med Sci Sports. 2010;20(3):394–402.
38. Winter D. Biomechanics and Motor Control of Human Movement.
Hoboken (NJ): John Wiley & Sons, Inc.; 2005.
39. Winter DA. Human balance and posture control during standing
and walking. Gait Posture. 1995;3(4):193–214.
40. Xu DL, Carlton LG, Rosengren KS. Anticipatory postural adjust-
ments for altering direction during walking. J Mot Behav. 2004;36(3):
316–26.
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