TitleNormalization influences knee abduction moment results: Could it influence ACL-injury research, too?
Publication TypeJournal Article
Year of Publication2016
AuthorsNorcross, MF, Johnson, S, Pollard, CD, Chang, EWook, Hoffman, MA
JournalJournal of Science and Medicine in Sport
Date PublishedJan-10-2016
ISSN14402440
Abstract

Objectives

Normalization of joint moments to reduce anthropometric influences prior to making group comparisons is a widely-accepted practice. However, a seminal prospective study reported greater non-normalized knee abduction moment (KAM) in nine females who subsequently sustained an ACL injury. It is not clear if this finding may have been influenced by the fact that the ACL-injured females were on average 3.6 cm taller and 2.4 kg heavier than uninjured females.

Design

Cross-sectional

Methods

Peak KAM was identified in thirty-six females completing jump landings. A custom software program randomly divided participants into two groups that were compared on: 1) non-normalized KAM, 2) KAM normalized to body mass, and 3) KAM normalized to body height times weight a total of 500,000 times and the results categorically coded for statistical significance (α≤0.05). For the 10,591 iterations in which one group was 3–4 cm taller and 2–3 kg heavier, the agreement between results obtained using non-normalized versus normalized data were assessed using non-parametric analyses.

Results

Despite moderate-strong agreement between the results obtained using non-normalized and normalized data (Κ = 0.614-0.744), a significant effect of normalization on the interpretation of group differences in peak KAM was identified (p<0.001). In 30.4-41.9% of the cases in which non-normalized KAM was deemed significantly different between groups, no group differences were identified when using normalized KAM.

Conclusions

While it is unlikely the magnitude of the difference in non-normalized KAM identified prospectively in ACL-injured females was attributable solely to anthropometric differences, caution should be exercised when evaluating research findings reporting non-normalized KAM.

URLhttp://www.sciencedirect.com/science/article/pii/S1440244016302213
DOI10.1016/j.jsams.2016.10.005
Short TitleJournal of Science and Medicine in Sport