Utilization of machine learning to identify lower extremity biomechanical predictors of rupture in a validated cadaveric model of ACL injury

Anterior cruciate ligament (ACL) rupture is a critical concern in sports medicine. This study presents a detailed evaluation of machine learning (ML) techniques for the prediction of anterior cruciate ligament (ACL) injuries - a critical concern in sports medicine that often entails prolonged recovery periods and significant patient burden. Leveraging the transformative potential of artificial intelligence (AI) in medical applications, our work assesses eight distinct ML models (i.e., Support Vector Machines, Decision Tree Classifiers, Random Forest, Stochastic Gradient Descent, Logistic Regression, Gradient Boosting, Ridge Regression, and Linear Discriminant Analysis). Models were trained and tested on four datasets: 53-feature (Binary) ACL Rupture Biomechanical and Demographic (ARBD/BARBD) and 13-feature (Binary) ACL Rupture Wearable (ARW/BARW) that are readily accessible in real-life scenarios. Models were evaluated under a three-class schema ’pre-rupture,’ ’trial prior to rupture,’ ’rupture’ and then reclassified into a binary ’pre-rupture’ vs. ’elevated risk.’ Our analyses reveal that early-phase force metrics, particularly those recorded at 33 milliseconds (e.g., 33ms_Fx and 33ms_Fz) with ARBD and BARBD datasets and initial-contact forces (e.g., IC_Fx, IC_Fz) over demographic variables in ARW and BARW datasets, consistently emerge as significant predictors of injury across multiple and binary models. Notably, across the ARBD and ARW datasets, the ML models achieved accuracies ranging from approximately 79% to 87%, which improved markedly to a range of 92% to 95% when reclassified into a binary classification. These findings underscore the clinical relevance of early dynamic measurements and demonstrate the robustness and generalizability of our approach.