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)