b'Reducing the Load in Knee InjuriesAs the role of research within the Department of Orthopaedics continues to grow in stature, one area of intense interest lies in understanding the mechanisms at work in the most common sports-related injuries, specifically in the knee.Li-Qun Larry Zhang,PhD, Professor of Physical Therapy & Rehabilitation Science and Orthopaedics, is applying his background in bioengineering toshed new light on the causes and rehabilitation treatments of such sports- related injuries.I have been doing kneeSEEKING BETTERwe investigate the underlying investigations for many years,REHABILITATION OPTIONS mechanisms, he explains. For says Dr. Zhang. In the human knee,In the gym or rehabilitationexample, why does an ACL injury the major motion is in flexiondepartment, almost all the kneeoccur in a particular direction in and extension, but there are fewinjury protocols and devicesa specific patient? The goal is be injuries associated with this motion,address larger knee [flexion andable to develop more targeted which Dr. Zhang describes as on- tension] motion, Dr. Zhang says.treatments.axis. Most injuries occur whenTreadmills, elliptical machines, stepThe hamstring muscle, for example, the knee is forced to respond toand stair climbers all stress on-axisis used to flex the knee, primarily off-axis motion, such as a suddentraining. However, we now knowalong the major sagittal axis. twisting motion, a rapid change inthat most injuries are related toHowever, in an off-axis injury, the direction, or an incorrect landingoff-axis motion, he notes. So,medial and lateral sides of that from a jump, all of which play anfirst, we need better ways to assesshamstrings play opposite roles: all-too-painful part of such sportsthe mechanisms related to thisone twists the knee medially; the as soccer, football, and basketball.off-axis loading and furthermore,other twists it laterally, which The knee is the bodys largest andto develop rehabilitationhas opposite actions on loading among its most stressed joints,interventions based on theseor unloading the ACL. We have vital for movement and vulnerablemechanisms. shown that, perhaps we should to injury. With an estimated 2.5In their research, Dr. Zhang and hisnot treat the whole hamstrings as million sports-related knee injuriescolleagues try to understand thea single unit, he says. Perhaps annually, it is also is the mostcauses of injuries to the anteriorthe medial and lateral hamstrings commonly injured joint by manycruciate ligament (ACL), one ofneed to be treated differently and groups of athletes. When youthe major ligaments in the kneeselectively. load it too much or in the wrongand the most commonly injured. direction, injury will occur, heTo better understand the many explains. ways this common injury occurs, 26CONNECTING WITH QUALITY: A Renewed Focus on Value-Based Care'