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Injury to the lower extremity during an automotive crash is a significant problem. While the introduction of safety features (i.e. seat belts, air bags) has significantly reduced fatalities, lower extremity injury now occurs more frequently, probably for a variety of reasons. Lower extremity trauma is currently based on a bone fracture criterion derived from human cadaver impact experiments. These impact experiments, conducted in the 1960's and 70's, typically used a rigid impact interface to deliver a blunt insult to the 90° flexed knee. The resulting criterion states that 10 kN is the maximum load allowed at the knee during an automotive crash when certifying new automobiles using anthropomorphic dummies. However, clinical studies suggest that subfracture loading can cause osteochondral microdamage which can progress to a chronic and debilitating joint disease.

Knee bolsters on the lower instrument panel have been designed to control occupant kinematics during sudden deceleration. However, a wide variability in car occupant anthropometry and choice of seating posture indicates that lower-extremity contacts with the impingement bolster could predominantly load the flexed leg through the knee (acting through the femur) or through the tibia (acting through the knee joint). Potential injuries associated with these types of primary loading may vary significantly and an understanding of potential trauma mechanisms is important for proper occupant restraint.

Lower extremity injuries are a frequent outcome of automotive accidents. While the lower extremity injury criterion is based on fracture of bone, most injuries are of less severity. Recent studies suggest microscopic, occult fractures that have been shown to be precursors of gross bone fractures, may occur in the kneecap (patella) for impacts with rigid and deformable interfaces due to excessive levels of patello-femoral contact pressure. One method of reducing this contact pressure for a 90° flexed knee is to provide a parallel pathway for knee impact loads into the tibial tuberosity. Yet, blunt loads onto the tibial tuberosity can cause posterior drawer motion of the tibia, leading to injury or rupture of the posterior cruciate ligament (PCL). Recently studies have shown that axial loads in the tibia, which are measured during blunt loading on the knee in typical automobile crashes, can induce anterior drawer motion of the tibia and possibly help unload the PCL.