{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:15:09Z","timestamp":1791314109230,"version":"4.3.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"DJO"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The ligaments and soft tissue capsular structures of the knee joint that provide a resisting force to prevent abnormal knee hyperextension have not been determined. This knowledge is required for the diagnosis and treatment of knee hyperextension abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine the resisting moment of knee ligament and capsular structures that resist knee hyperextension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>The combined posteromedial and posterolateral capsular structures function to provide a major restraint to prevent abnormal knee hyperextension. The anterior and posterior cruciate ligaments resist knee hyperextension but function as secondary restraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Descriptive laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A 6 degrees of freedom robotic system determined intact laxity limits in 24 cadaveric knees from 0\u00b0 to 100\u00b0 of knee flexion for anteroposterior limits at \u00b1135 N, abduction-adduction limits at \u00b17 N\u00b7m, and external-internal limits at \u00b15 N\u00b7m. One loading method (n = 14 knees) used a static loading sequence with knee hyperextension to 27-N\u00b7m torque while maintaining all other degrees of freedom at zero load during sequential soft tissue cutting. The second method (n = 10 knees) used a cyclic loading sequence to decrease viscoelastic effects with soft tissue cutting at 0\u00b0 of extension, followed by knee hyperextension to 27-N\u00b7m torque and cycled back to 0\u00b0. Selective soft tissue cuttings were performed of the following: oblique popliteal ligament, fabellofibular ligament, posterolateral capsule, posteromedial capsule with posterior oblique ligament, cruciate ligaments, lateral collateral ligament, popliteus, anterolateral ligament and iliotibial band, and superficial plus deep medial collateral ligaments. The sequential loss in the restraining moment with sectioning provides the function of that structure in resisting knee hyperextension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The median resisting force to knee hyperextension, in descending order, was the posteromedial capsule and posterior oblique ligament (21.7%), posterorolateral ligament and fabellofibular ligament (17.1%), anterior and posterior cruciate ligaments (13% and 12.9%, respectively), superior and deep medial collateral ligament (9.6%), oblique popliteal ligament (7.7%), and lateral collateral ligament (5.4%). The combined posterior capsular structures provided 54.7% and the anterior and posterior cruciate ligaments 25.3% of the total resisting moment to prevent knee hyperextension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Diagnosis of abnormal knee hyperextension involves a combination of multiple ligament and soft tissue structures without 1 primary restraint. The posteromedial and posterolateral capsular structures provided the major resisting moment to prevent knee hyperextension. The cruciate ligaments produced a lesser resisting moment to knee hyperextension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This is the first study to comprehensively measure all of the knee ligaments and capsular structures providing a resisting moment to abnormal knee hyperextension. These data are required for diagnostic and treatment strategies on the pathomechanics of abnormal knee hyperextension in patients after injury or developmental cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231155203","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T08:54:34Z","timestamp":1677142474000},"page":"1146-1154","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Functional Interaction of the Cruciate Ligaments, Posteromedial and Posterolateral Capsule, Oblique Popliteal Ligament, and Other Structures in Preventing Abnormal Knee Hyperextension"],"prefix":"10.1177","volume":"51","author":[{"given":"Frank R.","family":"Noyes","sequence":"first","affiliation":[{"name":"Cincinnati SportsMedicine Research and Education Foundation, Noyes Knee Institute, Mercy Health\u2013Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Clark","sequence":"additional","affiliation":[{"name":"Cincinnati SportsMedicine Research and Education Foundation, Noyes Knee Institute, Mercy Health\u2013Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Nolan","sequence":"additional","affiliation":[{"name":"Burkardt Consulting Center, Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Johnson","sequence":"additional","affiliation":[{"name":"OrthoUtah Bone and Joint Specialists, Logan, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"1565","article-title":"Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning","volume":"89","author":"Austin J","year":"2007","unstructured":"Austin J, Phornphutkul C, Wojtys E. Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning. J Bone Surg Am. 2007;89:1565-1574.","journal-title":"J Bone Surg Am"},{"issue":"3","key":"e_1_3_3_3_2","first-page":"211","article-title":"Experimental capsulo-ligamentar lesions of the knee during passive hyperextension. Biomechanical aspects. A lesional evaluation and consequences. Article in French","volume":"81","author":"Bizot P","year":"1995","unstructured":"Bizot P, Meunier A, Christel P, Witvoet J. Experimental capsulo-ligamentar lesions of the knee during passive hyperextension. Biomechanical aspects. A lesional evaluation and consequences. Article in French. Rev Chir Orthop Reparatrice Appar Mot. 1995;81(3):211-220.","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198062020-00013"},{"issue":"8","key":"e_1_3_3_5_2","first-page":"232596712094411","article-title":"Treatment for symptomatic genu recurvatum: a systematic review","volume":"8","author":"Dean RS","year":"2020","unstructured":"Dean RS, Graden NR, Kahat DH, DePhillipo NN, LaPrade RF. Treatment for symptomatic genu recurvatum: a systematic review. J Orthop Sports Phys Ther. 2020;8(8):2325967120944113.","journal-title":"J Orthop Sports Phys Ther"},{"key":"e_1_3_3_6_2","unstructured":"Drillis R Contini R. Body Segment Parameters. Technical report 1166.03. Research Division School of Engineering and Science New York University; 1966."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200301000-00010"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507308189"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.12.009"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.CC.M.00264"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198163080-00007"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198870010-00014"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138397"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659402200317"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.04.081"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.08.034"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(96)90002-7"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200709000-00016"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507311096"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200704000-00009"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1998.27.5.361"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1248172"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509348742"},{"key":"e_1_3_3_24_2","volume-title":"Noyes\u2019 Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes","author":"Noyes FR","year":"2017","unstructured":"Noyes FR. Noyes\u2019 Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes. 2nd ed. Elsevier Health Sciences; 2017.","edition":"2"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659602400107"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453678909149284"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00199"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.09.047"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.04.023"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/57.5.609"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1053\/ar.1999.v15.0150481"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100216"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep42698"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231155203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03635465231155203","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231155203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:50:41Z","timestamp":1777369841000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03635465231155203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1177\/03635465231155203"],"URL":"https:\/\/doi.org\/10.1177\/03635465231155203","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}