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Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech 2023; 22:1-29. [PMID: 33957846 PMCID: PMC9097243 DOI: 10.1080/14763141.2021.1916578] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/08/2021] [Indexed: 01/26/2023]
Abstract
This review identifies the three-dimensional knee loads that have the highest risk of injuring the anterior cruciate ligament (ACL) in the athlete. It is the combination of the muscular resistance to a large knee flexion moment, an external reaction force generating knee compression, an internal tibial torque, and a knee abduction moment during a single-leg athletic manoeuvre such as landing from a jump, abruptly changing direction, or rapidly decelerating that results in the greatest ACL loads. While there is consensus that an anterior tibial shear force is the primary ACL loading mechanism, controversy exists regarding the secondary order of importance of transverse-plane and frontal-plane loading in ACL injury scenarios. Large knee compression forces combined with a posteriorly and inferiorly sloped tibial plateau, especially the lateral plateau-an important ACL injury risk factor-causes anterior tibial translation and internal tibial rotation, which increases ACL loading. Furthermore, while the ACL can fail under a single supramaximal loading cycle, recent evidence shows that it can also fail following repeated submaximal loading cycles due to microdamage accumulating in the ligament with each cycle. This challenges the existing dogma that non-contact ACL injuries are predominantly due to a single manoeuvre that catastrophically overloads the ACL.
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Affiliation(s)
- Mélanie L. Beaulieu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Quadriceps Function and Athletic Performance in Highly Trained Female Athletes. J Sport Rehabil 2023; 32:63-69. [PMID: 35926849 DOI: 10.1123/jsr.2021-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Quadriceps strength is considered a key contributor to performance in various athletic tasks. Yet, past research has reported conflicting results based on population, with little data available in highly trained female athletes. DESIGN Cross-sectional. METHOD To examine how athletic performance relates to quadriceps strength and neural function, we measured the quadriceps maximum voluntary isometric contraction force (MVIC) and rate of force development over 0 to 50 ms (rate of force development [RFD]0-50ms), and various performance measures in 34 highly trained female athletes. RESULTS Stepwise multiple regression analysis revealed that the quadriceps variables explained 16 of 21 performance variables (R2 = .08-.36, P ≤ .10). Squat performance related to RFD0-50ms alone (R2 = .17-.20, P < .05; βRFD = 0.41 to 0.45, P < .05) but only MVIC explained the variance in sprinting and vertical jump performance (R2 = .08-.34, P ≤ .10; βMVIC = -0.51 to 0.58, P ≤ .10). The broad jump model included both parameters and their interaction (R2 = .20, P = .08; βRFD = 0.06, P = .76; βMVIC = -0.39, P = .03; βRFD×MVIC = -0.24, P = .10). CONCLUSION The contribution of the quadriceps MVIC or RFD0-50ms varies in size and nature depending on the task or leg dominance. While quadriceps are significant contributors to performance, because our models leave most of the variance in performance unexplained, rehabilitation and performance professionals should refrain from interpreting peak athletic performance as a reflection of knee-extensors function in highly trained female athletes.
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI. Am J Sports Med 2023; 51:58-65. [PMID: 36440714 DOI: 10.1177/03635465221131551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN Descriptive laboratory study. METHODS Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kwadwo Owusu-Akyaw
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Coppock
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Different patient and activity-related characteristics result in different injury profiles for patients with anterior cruciate ligament and posterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2023; 31:308-315. [PMID: 36029316 PMCID: PMC9859844 DOI: 10.1007/s00167-022-07131-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/17/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare patient characteristics including patient sex, age, body mass index (BMI), activities at the time of injury and injury profiles in patients with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. METHODS Data were obtained from the Swedish National Knee Ligament Registry. Two study groups were created: (1) index ACL reconstruction (ACL group) and (2) index PCL reconstruction (PCL group). Between-group differences were investigated using Fisher's exact test and Fisher's non-parametric permutation test for dichotomous variables and continuous variables, respectively. RESULTS Of 39,010 patients, 38,904 were ACL injuries. A larger proportion of patients with combined injuries to the PCL, meniscus and cartilage were female, aged > 25 years and with a BMI of > 35 kg/m2 compared with patients with combined injuries to the ACL, meniscus and cartilage. An isolated ACL injury was more commonly found in males, while all other injury profiles of ACL, including combined injuries with meniscus, cartilage and collateral ligament injuries, were more frequently observed in females. The PCL injuries were sustained either during pivoting sports, non-pivoting sports or were traffic-related. CONCLUSION Different patient characteristics (BMI, age and sex), and activities at the time of injury (sport- versus traffic-related activities), resulted in distinct injury profiles for the ACL and PCL groups. These findings provide valuable information of the way specific injury patterns of cruciate ligament injuries occur, and subsequently may help clinicians with the diagnostic process of ACL and PCL injuries. LEVEL OF EVIDENCE III.
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Hart DA. Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle? Front Physiol 2023; 14:1127689. [PMID: 37113695 PMCID: PMC10126777 DOI: 10.3389/fphys.2023.1127689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.
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Mayer C, Rühlemann A, Busch A, Jäger M. Measures of Knee Capability in Handball Players Differ by Age: A Cross Sectional Study. Sports Med Int Open 2022; 6:E60-E68. [PMID: 36575730 PMCID: PMC9790767 DOI: 10.1055/a-1926-0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022] Open
Abstract
The return to sport after knee injury is challenging. This is burdensome for sports with a high incidence of injuries, such as team handball. Various tests guide decision making, but often the athlete's preinjury performance of these measures remains unknown. Moreover, objective return-to-sport criteria of a matching population are missing. The purpose of this study was to evaluate objective measures of knee capability in handball depending on players' age. Two hundred sixty-one handball players performed a functional test battery designed to evaluate knee capability after an anterior cruciate ligament injury: two- and one-legged stability analysis, jumps, speed tests, and agility assessments. For age-specific evaluation, athletes were divided into three age groups (16-19; 20-29;≥30 years). Male players showed differences in two and one-legged jumping height (p<0.02) as well as power per body weight (p<0.01) between age groups. Young female players reached better results in two-and one-legged stability. Besides the quick feet test, results of females did not differ between age groups. Functional knee stability in healthy handball players is partly influenced by age, and females show better results in stability and male athletes in power measurements. This aspect should be considered for return to sports testing and underlines the importance of performance measures in athletic testing.
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Affiliation(s)
- Constantin Mayer
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Correspondence Dr. Constantin
Mayer St Marien-Hospital Mülheim an der
RuhrOrthopedics and
TraumatologyKaiserstrasse
5045468
MülheimGermany+49
208 305 2202
| | - Alina Rühlemann
- Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
| | - Andre Busch
- Orthopedics and Traumatology, katholische Kliniken Philippusstift
Essen, Essen, Germany
| | - Marcus Jäger
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
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Toyooka S, Tsukada K, Yasui Y, Saho Y, Okawa Y, Ando S, Nakagawa T, Kawano H, Miyamoto W. Association of medial arch support of foot orthoses with knee valgus angle at initial contact during cutting maneuvers in female athletes: a controlled laboratory study. BMC Sports Sci Med Rehabil 2022; 14:214. [PMID: 36536460 PMCID: PMC9762016 DOI: 10.1186/s13102-022-00608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The effect of medial arch support foot orthoses on kinematics and kinetics of the knee joint has remained unknown. METHODS Sixteen female collegiate-level athletes volunteered to participate. Participants were asked to perform a 30° sidestep cut using orthoses of 3 different medial arch heights, comprising of the following: (1) "low," a full flat foot orthosis without arch support, (2) "mid," a commercially available foot orthosis with general height arch support, and (3) "high," a foot orthosis with double the commercially available height for arch support to observe the effect on the knee when overcorrected. Kinematics and kinetics of the knee joint were collected by a markerless motion capture system with 2 force plates and compared between orthosis types using linear regression analysis, assuming a correlation between the measurements of the same cases in the error term. RESULTS The knee valgus angle at initial contact was 2.3 ± 5.2 degrees for "low" medial arch support height, 2.1 ± 5.8 degrees for "mid," and 0.4 ± 6.6 degrees for "high". Increased arch support height significantly decreased the knee valgus angle at initial contact (p = 0.002). Other kinematic and kinetic measurements did not differ between groups. CONCLUSIONS The valgus angle of the knee at initial contact was decreased by the height of the medial arch support provided by foot orthosis during cutting manoeuvres. Increasing the arch support height may decrease knee valgus angle at initial contact. Medial arch support of foot orthosis may be effective in risk reduction of ACL injury. Clinical trial registration numbers and date of registration: UMIN000046071, 15/11/2021.
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Affiliation(s)
- Seikai Toyooka
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Keisuke Tsukada
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Youich Yasui
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Yasuaki Saho
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan ,grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuaki Okawa
- grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Shuji Ando
- grid.143643.70000 0001 0660 6861Tokyo University of Science, Tokyo, Japan
| | - Takumi Nakagawa
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Wataru Miyamoto
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
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Examining the Effects of Mirror Therapy on Psychological Readiness and Perception of Pain in ACL-Injured Female Football Players. J Funct Morphol Kinesiol 2022; 7:jfmk7040113. [PMID: 36547659 PMCID: PMC9788338 DOI: 10.3390/jfmk7040113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Virtual reality-guided imagery (VRGI) and mirror therapy (MT) have been used in isolation to treat patients suffering from different injuries. However, no attempts have been made to understand the effects of combined VRGI and MT added to conventional physical therapy, and no information exists regarding perceptual responses to these rehabilitation strategies in female football players. Thus, this study aimed to examine the effect of MT added to conventional rehabilitation on psychological readiness and perception of pain in ACL-injured female football players. Thirty ACL-injured female football players competing in the 2nd and 3rd Italian tier who underwent an ACL rehabilitation program from the same clinic participated in this study. Players were randomly distributed in an MT group (n = 15) and a CON group (n = 15). All participants reported their perception of pain on a VAS before and after the interventions and their psychological readiness to return to sport after ACL injury and reconstruction surgery on the ACL-RSI scale after the intervention. An independent-sample t-test was performed to assess between-group differences in post-intervention ACL-RSI, and a further independent-sample t-test to assume non-significant differences between VAS values before the intervention. A two-way repeated-measures analysis of variance was used to test the null hypothesis of no different change in VAS over time between groups. After the intervention, the MT group perceived largely greater psychological readiness (p < 0.01). MT and CON groups experienced a large reduction in VAS after the intervention (p < 0.001). However, a small time × group interaction was observed (p = 0.023). MT reported a greater perception of the psychological readiness of the soccer players and a lower perception of pain than those who performed conventional therapy.
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Wakabayashi K, Ogasawara I, Suzuki Y, Nakata K, Nomura T. Exploring pre-impact landing kinematics associated with increase and decrease in the anterior cruciate ligament injury risk. J Biomech 2022; 145:111382. [PMID: 36446310 DOI: 10.1016/j.jbiomech.2022.111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to explore the single-legged landing kinematics that could lead to increase or decrease in the risk of anterior cruciate ligament (ACL) injury. Immediate pre-impact kinematics at the single-legged landing from 33 healthy young female handball players were evaluated. Thereafter, two-year follow-up for ACL injury incidence was conducted, in which six new ACL injuries in non-dominant leg were registered. The evaluation of pre-impact kinematics across participants was performed first by the principal component analysis to decompose them into the kinematic components (KCs), and then by the linear discrimination analysis (LDA) for a set of KC-scores to obtain important KCs for discriminating injured and non-injured legs. The result of LDA showed that the combination of second major KC (knee flexion/extension angle and angular velocity) and some minor KCs such as torso medial/lateral leaning accurately discriminated the injured and non-injured legs with the error rate of 12.5%. To examine the mechanisms of this discriminative ability, we generated hypothetical pre-impact kinematics in the subspaces spanned by eigenvectors of multiple KCs, and examined relationships between pre-impact kinematics and the corresponding knee valgus torque predicted by the motion-equation-based model. The result showed that the second major KC and the minor KCs representing torso medial/lateral leaning and/or hip adduction/abduction angle, which contributed in LDA to discriminating injured legs, also significantly affected the frontal-plane knee loading patterns. These findings suggested that KC-based postural characterization of the pre-impact landing kinematics and the motion-equation-based knee stress quantification possibly explain the future ACL injury risks of female athletes.
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Affiliation(s)
- Kaito Wakabayashi
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Issei Ogasawara
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan.
| | - Yasuyuki Suzuki
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Ken Nakata
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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Mason J, Kniewasser C, Hollander K, Zech A. Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:139. [DOI: 10.1186/s40798-022-00530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Background
Ankle sprains remain prevalent across most team sports. However, despite divergent ankle sprain injury rates in male and female athletes, little is known about potential sex-specific risk factors for ankle sprain.
Objective
To systematically investigate the sex-specific risk factors for ankle sprain.
Methods
Combinations of the key terms were entered into PubMed, Web of Science, Embase and Cochrane Library databases, and prospective studies reporting ankle sprain risk factors in males or females were included for meta-analysis.
Results
Sixteen studies were eligible for inclusion, for a total of 3636 athletes (735 female) and 576 ankle sprains (117 female). Out of 21 prognostic factors, previous ankle sprain injury (odds ratio = 2.74, P < .001), higher body mass index (SMD = 0.50, P < 0.001), higher weight (SMD = 0.24, P = 0.02), lower isometric hip abduction strength (SMD = − 0.52, P < 0.0001) and lower dynamic balance performance (SMD = − 0.48 to − 0.22, P < 0.001–0.04) were identified as risk factors in male athletes. In female athletes, out of 18 factors eligible for meta-analysis, only lower concentric dorsiflexion strength was identified as a risk factor (SMD = − 0.48, P = 0.005).
Conclusion
This meta-analysis provides novel evidence for different risk factor profiles for ankle sprain injuries between female and male athletes. Further studies, particularly in female athletes, are needed to strengthen the evidence.
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Aslani H, Bonakdar S, Gorji M, Gholipour M. Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction. Adv Biomed Res 2022; 11:102. [PMID: 36660760 PMCID: PMC9843597 DOI: 10.4103/abr.abr_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/07/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
Background As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.
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Affiliation(s)
- Hamidreza Aslani
- Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran
| | - Sona Bonakdar
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Gorji
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Gholipour
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,Address for correspondence: Dr. Morteza Gholipour, Clinical Research Development Unit, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
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Mai P, Bill K, Glöckler K, Claramunt-Molet M, Bartsch J, Eggerud M, Tidemann Pedersen A, Sæland F, Bergh Moss R, Mausehund L, Willwacher S, Kersting UG, Eriksrud O, Krosshaug T. Unanticipated fake-and-cut maneuvers do not increase knee abduction moments in sport-specific tasks: Implication for ACL injury prevention and risk screening. Front Sports Act Living 2022; 4:983888. [DOI: 10.3389/fspor.2022.983888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Non-contact anterior cruciate ligament injuries typically occur during cutting maneuvers and are associated with high peak knee abduction moments (KAM) within early stance. To screen athletes for injury risk or quantify the efficacy of prevention programs, it may be necessary to design tasks that mimic game situations. Thus, this study compared KAMs and ranking consistency of female handball players in three sport-specific fake-and-cut tasks of increasing complexity. The biomechanics of female handball players (n = 51, mean ± SD: 66.9 ± 7.8 kg, 1.74 ± 0.06 m, 19.2 ± 3.4 years) were recorded with a 3D motion capture system and force plates during three standardized fake-and-cut tasks. Task 1 was designed as a simple pre-planned cut, task 2 included catching a ball before a pre-planned cut in front of a static defender, and task 3 was designed as an unanticipated cut with three dynamic defenders involved. Inverse dynamics were used to calculate peak KAM within the first 100 ms of stance. KAM was decomposed into the frontal plane knee joint moment arm and resultant ground reaction force. RANOVAs (α ≤ 0.05) were used to reveal differences in the KAM magnitudes, moment arm, and resultant ground reaction force for the three tasks. Spearman's rank correlations were calculated to test the ranking consistency of the athletes' KAMs. There was a significant task main effect on KAM (p = 0.02; ηp2 = 0.13). The KAM in the two complex tasks was significantly higher (task 2: 1.73 Nm/kg; task 3: 1.64 Nm/kg) than the KAM in the simplest task (task 1: 1.52 Nm/kg). The ranking of the peak KAM was consistent regardless of the task complexity. Comparing tasks 1 and 2, an increase in KAM resulted from an increased frontal plane moment arm. Comparing tasks 1 and 3, higher KAM in task 3 resulted from an interplay between both moment arm and the resultant ground reaction force. In contrast to previous studies, unanticipated cutting maneuvers did not produce the highest KAMs. These findings indicate that the players have developed an automated sport-specific cutting technique that is utilized in both pre-planned and unanticipated fake-and-cut tasks.
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AKGÜN AS, TEKCAN A. Assessment Of Femoral Notch Morphology In Male Patients With Anterior Cruciate Ligament Injury: An MRI Study. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1069144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The objective of the present study was to evaluate the femoral notch type, notch width index (NWI), notch angle (NA) and α angle in patients with ACL injury and compare with nonathletic male population using magnetic resonance imaging (MRI).
Methods: 79 patients with complete ACL tear and 80 patients as control group (aged 19-43 years) who had knee MRI were evaluated. NWI, NA measurements and notch shape were evaluated on axial fat-saturated proton-weighted sequences. Femoral notch shape was classified as A, U and W types.
Results: A statistically significant association was found between notch type, NWI, NA and ACL injury (p
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Al Attar WSA, Bakhsh JM, Khaledi EH, Ghulam H, Sanders RH. Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials. J Physiother 2022; 68:255-261. [PMID: 36244964 DOI: 10.1016/j.jphys.2022.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
QUESTION Do injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament (ACL) injuries in sport? DESIGN Systematic review of (cluster) randomised trials with meta-analysis. PARTICIPANTS Sporting participants of any age, sex or competition level. INTERVENTIONS The experimental intervention was an injury prevention program that included plyometric exercises. The control intervention was the usual warm-up program, which did not include plyometric exercises. OUTCOME MEASURES Exposure-based ACL injury rates. RESULTS The initial search yielded 7,302 articles, of which nine met the inclusion criteria. All nine articles reported cluster randomised trials, providing data on 14,394 participants. The pooled results showed that injury prevention programs that include plyometric exercises reduce the risk of ACL injury by 60% per 1,000 hours of exposure compared with the control group, with an injury risk ratio (IRR) of 0.40 (95% CI 0.26 to 0.63). Data from subgroups of these trials estimated that this preventative effect may be stronger in males (IRR 0.21, 95% CI 0.07 to 0.62) and weaker in females (IRR 0.51, 95% CI 0.30 to 0.87), albeit with less precise estimates. Subgroup analysis also suggested a stronger effect on non-contact ACL injuries (IRR 0.34, 95% CI 0.18 to 0.65), whereas the effect on contact ACL injuries remained uncertain (IRR 0.59, 95% CI 0.15 to 2.30). CONCLUSIONS Injury prevention programs that incorporate plyometric exercises substantially decrease the risk of ACL injuries more than warm-up programs that do not include plyometric exercises. The preventive effect appears to be stronger among males and in the prevention of ACL injuries that do not involve contact with another player. PROSPERO CRD42020196982.
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Affiliation(s)
- Wesam Saleh A Al Attar
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia; Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Jumana M Bakhsh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | - Ehdaa H Khaledi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia; Department of Physical Therapy, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hussain Ghulam
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Ross H Sanders
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia
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Edison BR, Pandya N, Patel NM, Carter CW. Sex and Gender Differences in Pediatric Knee Injuries. Clin Sports Med 2022; 41:769-787. [DOI: 10.1016/j.csm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bill K, Mai P, Willwacher S, Krosshaug T, Kersting UG. Athletes with high knee abduction moments show increased vertical center of mass excursions and knee valgus angles across sport-specific fake-and-cut tasks of different complexities. Front Sports Act Living 2022; 4:983889. [PMID: 36225972 PMCID: PMC9548628 DOI: 10.3389/fspor.2022.983889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Young female handball players represent a high-risk population for anterior cruciate ligament (ACL) injuries. While the external knee abduction moment (KAM) is known to be a risk factor, it is unclear how cutting technique affects KAMs in sport-specific cutting maneuvers. Further, the effect of added game specificity (e.g., catching a ball or faking defenders) on KAMs and cutting technique remains unknown. Therefore, this study aimed: (i) to test if athletes grouped into different clusters of peak KAMs produced during three sport-specific fake-and-cut tasks of different complexities differ in cutting technique, and (ii) to test whether technique variables change with task complexity. Fifty-one female handball players (67.0 ± 7.7 kg, 1.70 ± 0.06 m, 19.2 ± 3.4 years) were recruited. Athletes performed at least five successful handball-specific sidestep cuts of three different complexities ranging from simple pre-planned fake-and-cut maneuvers to catching a ball and performing an unanticipated fake-and-cut maneuver with dynamic defenders. A k-means cluster algorithm with squared Euclidean distance metric was applied to the KAMs of all three tasks. The optimal cluster number of koptimal = 2 was calculated using the average silhouette width. Statistical differences in technique variables between the two clusters and the tasks were analyzed using repeated-measures ANOVAs (task complexity) with nested groupings (clusters). KAMs differed by 64.5%, on average, between clusters. When pooling all tasks, athletes with high KAMs showed 3.4° more knee valgus, 16.9% higher downward and 8.4% higher resultant velocity at initial ground contact, and 20.5% higher vertical ground reaction forces at peak KAM. Unlike most other variables, knee valgus angle was not affected by task complexity, likely due to it being part of inherent movement strategies and partly determined by anatomy. Since the high KAM cluster showed higher vertical center of mass excursions and knee valgus angles in all tasks, it is likely that this is part of an automated motor program developed over the players' careers. Based on these results, reducing knee valgus and downward velocity bears the potential to mitigate knee joint loading and therefore ACL injury risk.
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Affiliation(s)
- Kevin Bill
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
- *Correspondence: Kevin Bill
| | - Patrick Mai
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
- Department of Mechanical and Process Engineering, Offenburg University, Offenburg, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
- Department of Mechanical and Process Engineering, Offenburg University, Offenburg, Germany
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Uwe G. Kersting
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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Campón Chekroun A, Velázquez-Saornil J, Guillén Vicente I, Sánchez Milá Z, Rodríguez-Sanz D, Romero-Morales C, Fernandez-Jaén T, Garrido González JI, Sánchez-Garrido MÁ, Guillén García P. Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children. World J Orthop 2022; 13:777-790. [PMID: 36189335 PMCID: PMC9516626 DOI: 10.5312/wjo.v13.i9.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.
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Affiliation(s)
| | | | - Isabel Guillén Vicente
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | - Zacarías Sánchez Milá
- Department of Physiotherapy, Universidad Católica de Ávila, Ávila 05005, Ávila, Spain
| | - David Rodríguez-Sanz
- Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid 28040, Madrid, Spain
| | - Carlos Romero-Morales
- Department of Physical Therapy, Universidad Europea de Madrid, Madrid 28023, Madrid, Spain
| | - Tomas Fernandez-Jaén
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | | | | | - Pedro Guillén García
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
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Mancini S, Dickin DC, Hankemeier D, Ashton C, Welch J, Wang H. Effects of a soccer-specific vertical jump on lower extremity landing kinematics. SPORTS MEDICINE AND HEALTH SCIENCE 2022; 4:209-214. [PMID: 36090922 PMCID: PMC9453686 DOI: 10.1016/j.smhs.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Anterior cruciate ligament (ACL) injury frequently occurs in female soccer athletes during deceleration movements such as landings. In soccer, landings mostly occur following jumping headers. Little research has been done to determine the mechanics that follow and how they compare to standard drop vertical jumps (DVJ). The purpose of this study was to analyze differences in kinematics between the DVJ and the soccer-specific vertical jump (SSVJ) in female soccer athletes to better assess the sport-specific risk for ACL injury. A secondary aim was to compare second landings (L2) to first landings (L1). Eight female recreational soccer athletes performed DVJs and SSVJs initiated from a 31 cm height. Motion capture was performed during landings and data were analyzed using repeated-measures ANOVA. SSVJs produced less peak hip flexion (p = 0.03) and less peak knee flexion (p = 0.002) than DVJs. SSVJs also demonstrated increased ankle plantarflexion at initial contact (IC) than DVJs (p = 0.005). L2s produced less peak hip (p = 0.007) and knee flexion (p = 0.002) than L1s. SSVJs and L2s displayed a more erect landing posture than the DVJs and L1s at the hip and knee, a known ACL risk factor. The significant results between jump styles show that the SSVJ displays mechanics that are different from the DVJ. The SSVJ may be a better sport-specific screening tool for ACL injury mechanisms than the DVJ in soccer athletes as it has a more direct translation to the sport.
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Howe D, Cone SG, Piedrahita JA, Spang JT, Fisher MB. Age- and Sex-Specific Joint Biomechanics in Response to Partial and Complete Anterior Cruciate Ligament Injury in the Porcine Model. J Athl Train 2022; 57:978-989. [PMID: 34964874 PMCID: PMC9842119 DOI: 10.4085/1062-6050-565-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed, but few guidelines and very limited data exist regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. OBJECTIVE To evaluate the effects of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS We studied 60 male and female Yorkshire crossbreed pigs aged 1.5, 3, 4.5, 6, and 18 months (n = 6 pigs per age per sex). MAIN OUTCOME MEASURE(S) Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. Loading of the soft tissues in the stifle joint was measured under each condition. RESULTS Anterior-posterior joint laxity increased by 13% to 50% (P < .05) after anteromedial bundle transection and 75% to 178% (P < .05) after ACL transection. Destabilization after anteromedial bundle transection increased with age (P < .05) and was greater in late female than late male adolescents (P < .05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. The MCL contribution was larger and the medial meniscus contribution was smaller in male versus female specimens. CONCLUSIONS Partial ACL transection resulted in moderate increases in joint laxity, with the remaining bundle performing the primary ACL function. Destabilization due to partial ACL transection (anteromedial bundle) was largest in late adolescent joints, indicating that operative treatment should be considered in active, late-adolescent patients with this injury. Increased forces on the MCL and medial meniscus after ACL transection suggested that rehabilitation protocols may need to focus on protecting these tissues.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Mechanical Engineering, University of Wisconsin, Madison
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
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Myofascial and Movement Tests after Anterior Cruciate Ligament Reconstruction. J Hum Kinet 2022; 83:67-75. [PMID: 36157956 PMCID: PMC9465765 DOI: 10.2478/hukin-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Functional evaluation after anterior cruciate ligament reconstruction is one of the key points involved in decision making about the return of patients to full and unrestricted physical activity. The objective of the present study was to verify whether myofascial chain NEURAC® and Functional Movement Screen (FMS™) tests can be used to detect functional differences between the operated and the non-operated extremity in patients after anterior cruciate ligament reconstruction. A total of 83 young and physically active recreational athletes (mean age: 26.9 ± 9.7 years) who underwent primary single-bundle anterior cruciate ligament reconstruction using an autogenous semitendinosus-gracilis tendon graft were evaluated between the 3rd and the 4th month after surgery. Subjects received a similar, standardised rehabilitation programme. Two experienced raters, blinded to the objective of this study, were involved in functional outcome data collection using myofascial NEURAC® and Functional Movement Screen tests. Only two of the NEURAC® tests showed significant differences in the results between the operated and the non-operated extremity: the supine bridging (mean 2.92 vs. 3.51 points, p < 0.001) and prone bridging (mean 2.76 vs. 3.67 points, p < 0.001) tests. Additionally, the summary score of all NEURAC® tests significantly differed between extremities (mean 12.08 for the operated vs. 13.67 points for the non-operated extremity, p < 0.001). Myofascial tests (supine and prone bridging) in comparison with a battery of Functional Movement Screen tests seem to be more effective in detecting functional differences between the operated and the non-operated extremity at the early stage of recovery after anterior cruciate ligament reconstruction.
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Howe D, Cone SG, Piedrahita JA, Collins B, Fordham LA, Griffith EH, Spang JT, Fisher MB. Sex-specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model. J Orthop Res 2022; 40:1853-1864. [PMID: 34751996 PMCID: PMC9081289 DOI: 10.1002/jor.25207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 02/04/2023]
Abstract
Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross-sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Molecular Biomedical Sciences, North Carolina State University; Raleigh, NC 27695
| | - Bruce Collins
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Animal Science, North Carolina State University; Raleigh, NC 27695
| | - Lynn A. Fordham
- Department of Radiology, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University; Raleigh, NC 27695
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599,Corresponding Author Contact: Address: 4130 Engineering Building III, 911 Oval Drive, CB 7115, Raleigh, NC, 27695, Telephone: 919-515-5242, Fax: 919-513-3814,
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Rider D, Gowd AK, Torres LF, Kaplin LW, Waterman BR. Rates of Anterior Cruciate Ligament Rerupture in Adolescent Patients with and without Patella Alta. J Knee Surg 2022. [PMID: 35798345 DOI: 10.1055/s-0042-1749608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study was to compare rates of anterior cruciate ligament (ACL) failure among adolescent patients to evaluate patella alta as a high-risk variable. Demographic and surgical data were retrospectively queried for patients ≤18 years of age with primary ACL reconstruction performed at a single academic center between 2011 and 2016 and minimum of 2-year clinical surveillance. Patellar height indices, including Caton-Deschamps index (CDI) and Insall-Salvati index (ISI), were retrospectively calculated from preoperative imaging to assess the presence of patella alta. Failure was defined as (1) ACL graft rerupture, (2) Lachman's grade 2 + , (3) presence of pivot shift, and (4) side-to-side difference of 3 mm on KT-1000 arthrometer. A total of 184 patients (84 females and 100 males) and 192 knees were identified, with an average age of 16.2 ± 1.8 years. Of these, 30 (15.63%) experienced ACL failure. Male sex was the only significant risk factor for rerupture (p = 0.026). The mean CDI was 1.06 ± 0.17 and mean ISI was 1.04 ± 0.15. Of the 49 knees that met criteria for patella alta on radiographic evaluation, rerupture occurred in seven (14.29%). Patella alta was not a significant risk factor for ACL failure among adolescent patients (p = 0.359 and 0.277). Only male sex was associated with increased rates of ACL failure. Age, graft selection technique, fixation construct, and presence of patella alta were not risk factors for reinjury. This study is a therapeutic case series and reflects level of evidence IV.
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Affiliation(s)
- Danielle Rider
- Department of Orthopedic Surgery, Wake Forest School of Medicine Ringgold Standard Institution, Bowman Gray Center for Medical Education, Winston-Salem, North Carolina
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest School of Medicine Ringgold Standard Institution, Winston-Salem, North Carolina
| | - LeeAnne F Torres
- Department of Orthopaedic Surgery, Wake Forest School of Medicine Ringgold Standard Institution, Winston-Salem, North Carolina
| | - Lisa W Kaplin
- Department of Orthopaedic Surgery, Orthopaedic Surgery and Rehabilitation Associates, Rockledge, Pennsylvania
| | - Brian R Waterman
- Department of Orthopaedics, William Beaumont Army Medical Center, El Paso, Texas
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Brooks T, Dendy D. Implementing an Injury Prevention and Performance Enhancement Program During a Softball Season for Young Female Athletes. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li M, Bai H, Zhang F, Zhou Y, Lin Q, Zhou Q, Feng Q, Zhang L. Automatic segmentation model of intercondylar fossa based on deep learning: a novel and effective assessment method for the notch volume. BMC Musculoskelet Disord 2022; 23:426. [PMID: 35524293 PMCID: PMC9074347 DOI: 10.1186/s12891-022-05378-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Notch volume is associated with anterior cruciate ligament (ACL) injury. Manual tracking of intercondylar notch on MR images is time-consuming and laborious. Deep learning has become a powerful tool for processing medical images. This study aims to develop an MRI segmentation model of intercondylar fossa based on deep learning to automatically measure notch volume, and explore its correlation with ACL injury. Methods The MRI data of 363 subjects (311 males and 52 females) with ACL injuries incurred during non-contact sports and 232 subjects (147 males and 85 females) with intact ACL were retrospectively analyzed. Each layer of intercondylar fossa was manually traced by radiologists on axial MR images. Notch volume was then calculated. We constructed an automatic segmentation system based on the architecture of Res-UNet for intercondylar fossa and used dice similarity coefficient (DSC) to compare the performance of segmentation systems by different networks. Unpaired t-test was performed to determine differences in notch volume between ACL-injured and intact groups, and between males and females. Results The DSCs of intercondylar fossa based on different networks were all more than 0.90, and Res-UNet showed the best performance. The notch volume was significantly lower in the ACL-injured group than in the control group (6.12 ± 1.34 cm3 vs. 6.95 ± 1.75 cm3, P < 0.001). Females had lower notch volume than males (5.41 ± 1.30 cm3 vs. 6.76 ± 1.51 cm3, P < 0.001). Males and females who had ACL injuries had smaller notch than those with intact ACL (p < 0.001 and p < 0.005). Men had larger notches than women, regardless of the ACL injuries (p < 0.001). Conclusion Using a deep neural network to segment intercondylar fossa automatically provides a technical support for the clinical prediction and prevention of ACL injury and re-injury after surgery.
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Affiliation(s)
- Mifang Li
- Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Department of Medical Imaging, Longgang Central Hospital of Shenzhen, 6082 Longgang Avenue, Longgang District, Shenzhen, 518116, Guangdong province, China.,Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong province, China
| | - Hanhua Bai
- Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Department of Biomedical Engineering, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China
| | - Feiyuan Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong province, China
| | - Yujia Zhou
- Department of Biomedical Engineering, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China
| | - Qiuyu Lin
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong province, China
| | - Quan Zhou
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong province, China.
| | - Qianjin Feng
- Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China. .,Department of Biomedical Engineering, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China. .,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China. .,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China.
| | - Lingyan Zhang
- Southern Medical University, 1838 shatai Road, Baiyun District, Guangzhou, 510515, Guangdong province, China. .,Department of Medical Imaging, Longgang Central Hospital of Shenzhen, 6082 Longgang Avenue, Longgang District, Shenzhen, 518116, Guangdong province, China.
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75
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Mattu AT, Ghali B, Linton V, Zheng A, Pike I. Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084648. [PMID: 35457516 PMCID: PMC9027388 DOI: 10.3390/ijerph19084648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.
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Affiliation(s)
- Anmol T. Mattu
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Brianna Ghali
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Vanessa Linton
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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76
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Morris JL, McEwen P, Letson HL, Dobson GP. Anterior Cruciate Ligament Reconstruction Surgery: Creating a Permissive Healing Phenotype in Military Personnel and Civilians for Faster Recovery. Mil Med 2022; 187:1310-1317. [PMID: 35389483 PMCID: PMC9617292 DOI: 10.1093/milmed/usac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Anterior cruciate ligament (ACL) rupture in military personnel and civilians can be a devastating injury. A service member is 10 times more likely to suffer an ACL injury than their civilian counterparts, and despite successful surgical stabilization, 4%-35% will develop arthrofibrosis, over 50% will not return to full active duty, and up to 50% will develop post-traumatic osteoarthritis (PTOA) within 15 years. Equally concerning, woman are 2 to 8 times more likely to experience ACL injuries than men, which represents a major knowledge gap. Materials and Methods A comprehensive literature search was performed in December 2021 using structured search terms related to prevalence, risk factors, disease progression, and treatment of ACL injury and reconstruction. The literature search was conducted independently by two researchers using PubMed, Cochrane, and Embase databases, with inclusion of articles with military, civilian, and sex relevance, and exclusion of most papers with a publication date greater than 10 years. The resources used for the review reflect the most current data, knowledge, and recommendations associated with research and clinical findings from reliable international sources. Results Currently, there is no effective system-based drug therapy that creates a “permissive environment” to reduce synovial and cartilage stress after ACL injury and reconstruction and prevent secondary complications. We argue that progress in this area has been hampered by researchers and clinicians failing to recognize that (1) an ACL injury is a system’s failure that affects the whole joint, (2) the early molecular events define and perpetuate different injury phenotypes, (3) male and female responses may be different and have a molecular basis, (4) the female phenotype continues to be under-represented in basic and clinical research, and (5) the variable outcomes may be perpetuated by the trauma of surgery itself. The early molecular events after ACL injury are characterized by an overexpression of joint inflammation, immune dysfunction, and trauma-induced synovial stress. We are developing an upstream adenosine, lidocaine, and magnesium therapy to blunt these early molecular events and expedite healing with less arthrofibrosis and early PTOA complications. Conclusions ACL injuries continue to be a major concern among military personnel and civilians and represent a significant loss in command readiness and quality of life. The lack of predictability in outcomes after ACL repair or reconstruction underscores the need for new joint protection therapies. The male–female disparity requires urgent investigation.
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Affiliation(s)
- Jodie L Morris
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, QLD 4812, Australia
| | - Hayley L Letson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Geoffrey P Dobson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
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Ajdaroski M, Ashton-Miller JA, Baek SY, Shahshahani PM, Esquivel AO. Testing a Quaternion Conversion Method to Determine Human Three-Dimensional Tibiofemoral Angles During an In Vitro Simulated Jump Landing. J Biomech Eng 2022; 144:1120497. [PMID: 34549272 DOI: 10.1115/1.4052496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Indexed: 11/08/2022]
Abstract
Lower limb joint kinematics have been measured in laboratory settings using fixed camera-based motion capture systems; however, recently inertial measurement units (IMUs) have been developed as an alternative. The purpose of this study was to test a quaternion conversion (QC) method for calculating the three orthogonal knee angles during the high velocities associated with a jump landing using commercially available IMUs. Nine cadaveric knee specimens were instrumented with APDM Opal IMUs to measure knee kinematics in one-legged 3-4× bodyweight simulated jump landings, four of which were used in establishing the parameters (training) for the new method and five for validation (testing). We compared the angles obtained from the QC method to those obtained from a commercially available sensor and algorithm (APDM Opal) with those calculated from an active marker motion capture system. Results showed a significant difference between both IMU methods and the motion capture data in the majority of orthogonal angles (p < 0.01), though the differences between the QC method and Certus system in the testing set for flexion and rotation angles were smaller than the APDM Opal algorithm, indicating an improvement. Additionally, in all three directions, both the limits of agreement and root-mean-square error between the QC method and the motion capture system were smaller than between the commercial algorithm and the motion capture.
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Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan-Ann Arbor, 3443 GGB (George G. Brown Laboratory), 2350 Hayward Street, Ann Arbor, MI 48109
| | - So Young Baek
- Department of Mechanical Engineering, University of Michigan-Ann Arbor, 3443 GGB (George G. Brown Laboratory), 2350 Hayward Street, Ann Arbor, MI 48109
| | - Payam Mirshams Shahshahani
- Department of Mechanical Engineering, University of Michigan-Ann Arbor, 3443 GGB (George G. Brown Laboratory), 2350 Hayward Street, Ann Arbor, MI 48109
| | - Amanda O Esquivel
- Department of Mechanical Engineering, University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
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78
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Karlström J, Wiklund M, Tengman E. Disrupted knee - disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury. BMC Musculoskelet Disord 2022; 23:290. [PMID: 35346145 PMCID: PMC8961924 DOI: 10.1186/s12891-022-05252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals’ experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury. Methods Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19–41 years) with an ACL rupture 2–25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis. Results The results consisted of one overarching theme: ‘A strenuous process towards regaining balance’ which built on three categories ‘Disrupted knee’, ‘Disrupted me’ and ‘Moving forward with new insights’. The overarching theme captures the participants’ experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically ‘disrupted knee’, as well as facing mental challenges, identity challenges and a ‘disrupted me’. By gradual acceptance and re-orientation they were moving forward with new insights – although still struggling with the consequences of the injury. Conclusions Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual ‘disruptions’ and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted.
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Affiliation(s)
- Josefin Karlström
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden. .,Umeå School of Sport Sciences, Umeå University, Umeå, 90187, Sweden.
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79
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Uno Y, Ogasawara I, Konda S, Wakabayashi K, Miyakawa M, Nambo M, Umegaki K, Cheng H, Hashizume K, Nakata K. Effect of the foot-strike pattern on the sagittal plane knee kinetics and kinematics during the early phase of cutting movements. J Biomech 2022; 136:111056. [DOI: 10.1016/j.jbiomech.2022.111056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/28/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
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80
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Kano T, Kokubun T, Murata K, Oka Y, Ozone K, Arakawa K, Morishita Y, Takayanagi K, Kanemura N. Influence of the site of injury on the spontaneous healing response in a rat model of total rupture of the anterior cruciate ligament. Connect Tissue Res 2022; 63:138-150. [PMID: 33588658 DOI: 10.1080/03008207.2021.1889529] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM The healing ability of the anterior cruciate ligament (ACL) injury is very poor; however, it has recently been shown to undergo self-healing with conservative treatments. In this study, we evaluated the influence of the site of injury on the healing process after complete transverse tear of ACL using a rat model. MATERIALS AND METHODS A total of 58 skeletally mature Wistar rats were randomly assigned to various ACL injury groups: controlled abnormal movement-mid-portion (CAM-MP), controlled abnormal movement-femoral side (CAM-FS), ACL transection-mid-portion (ACLT-MP), or ACL transection-femoral side (ACLT-FS) injury groups. The ACL was completely transected in the mid-portion in the ACLT-MP and CAM-MP groups, and on the femoral side in the ACLT-FS and CAM-FS groups. Both CAM groups underwent extra-articular braking to control for abnormal tibial translation. The animals were allowed full cage activity until sacrifice postoperatively for histological and biomechanical assessment. RESULTS Significant differences were found in the ratios of residual ligament lengths between the CAM-MP and CAM-FS groups, demonstrating the validity of each model. Spontaneous healing of the injured ACL was observed in the CAM-MP and CAM-FS groups but not in the ACLT-MP and ACLT-FS groups. The mechanical strength of the healing ACL did not differ between the CAM-MP and CAM-FS groups 8 weeks after injury; however, the former had better mechanical strength than the latter 12 weeks after the injury. CONCLUSION ACL injuries in the mid-portion and on the femoral side may be treated with conservative therapy for spontaneous healing.
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Affiliation(s)
- Takuma Kano
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan.,Department of Rehabilitation, Soka Orthopedics Internal Medicine, Soka, Japan.,Department of Rehabilitation, Yatsuka Orthopedics Internal Medicine, Soka, Japan
| | - Takanori Kokubun
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Yuichiro Oka
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kaichi Ozone
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kohei Arakawa
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Yuri Morishita
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kiyomi Takayanagi
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
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81
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Duchene Y, Gauchard GC, Mornieux G. Influence of sidestepping expertise and core stability on knee joint loading during change of direction. J Sports Sci 2022; 40:959-967. [PMID: 35191363 DOI: 10.1080/02640414.2022.2042980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aims of this study were twofold: first, to compare core stability and knee joint loading between sidestepping experts and nonexperts; secondly, to determine core predictors of knee joint loading. Thirteen handball male players (experts) and 14 karatekas (nonexperts) performed six unanticipated 45° sidestepping manoeuvers, while trunk and pelvis 3D kinematics as well as ground reaction forces were measured, and peak knee abduction moment (PKAM) was determined. Student t-tests enabled a comparison of both groups and a linear mixed model approach was used to identify PKAM predictors. Sidestepping experts demonstrated significantly lower pelvis rotation towards the new movement direction at the initial contact than nonexperts (4.9° vs. 10.8°) and higher PKAM (0.539 vs. 0.321 Nm/kg-bwt). Trunk medial lean, trunk axial rotation and pelvis anterior tilt at the initial contact predicted PKAM, while trunk axial rotation, pelvis medial lean and posterior ground reaction force predicted PKAM during the weight acceptance phase. Despite higher PKAM, handball players might not be at a higher risk of anterior cruciate ligament injury as the knee joint loading remained at a relatively low level during this sidestepping task. Core stability, in its three dimensions, is a key determinant of knee joint loading.
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Affiliation(s)
- Youri Duchene
- Université de Lorraine, Faculty of Sport Sciences, Nancy, France
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82
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Belcher S, Whatman C, Brughelli M. A systematic video analysis of 21 anterior cruciate ligament injuries in elite netball players during games. Sports Biomech 2022:1-18. [PMID: 35129089 DOI: 10.1080/14763141.2022.2034928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 01/14/2023]
Abstract
This systematic video analysis of 21 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games, describes the situation, movement pattern and player behaviour, providing insight regarding the injury mechanism. Seventeen of the ACL injuries occurred from jump-landing actions and only two from cutting manoeuvres. A common scenario was identified for 11 players. In this scenario, players were decelerating rapidly after jumping to receive a high pass, utilising a double-footed landing with a wide base of support (WBOS). Deceleration appeared to be applied predominantly via the injured leg with the knee extended and foot planted. Often the players appeared unbalanced on landing leaning too far back. ACL injury risk was possibly exacerbated by the players head turning away from the injured side. A further compressive knee moment may have been placed on the lateral aspect of the knee by bringing the ball from a high position to a low position at the estimated time of injury. Players may benefit from landing technique training programmes that encourage shoulder-width foot landings, with ≥30° knee flexion, a small amount of plantar-flexion and good balance. Incorporating challenges to players balance and ability to cope with perturbations may also be beneficial. Training programmes should include instruction on securing the ball in a stable above pelvis-level position after receiving a pass and bringing their whole body around during landing into the direction of their next pass, rather than simply turning their head to look.
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Affiliation(s)
- Suzanne Belcher
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- NetballSmart New Zealand, Auckland, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Matt Brughelli
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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83
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Familial Predisposition to Anterior Cruciate Ligament Injury: A Systematic Review with Meta-analysis. Sports Med 2022; 52:2657-2668. [PMID: 35829993 PMCID: PMC9585006 DOI: 10.1007/s40279-022-01711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Having a family history of anterior cruciate ligament (ACL) injury has been investigated in the literature but few studies have focused on this factor specifically or reported their outcomes by sex. OBJECTIVE We aimed to systematically review family history as a risk factor for sustaining a primary ACL injury and the impact it has on ACL graft rupture or contralateral ACL injury in male and female individuals. METHODS A literature search was completed in seven databases from inception until March 2021 to investigate primary and subsequent ACL injuries in those with a family history of ACL injury. Articles were screened by prespecified inclusion criteria, and the methodological quality of each study was determined. Study results were combined using an odds ratio (OR) meta-analysis. Subgroup analysis was also completed by sex for primary ACL injury, as well as by graft rupture and contralateral ACL injury for subsequent ACL injuries. RESULTS Twelve studies were acquired for systematic review and meta-analysis. Four studies that investigated primary ACL injury, seven that investigated ACL graft and/or contralateral ACL ruptures and one study that investigated both primary and subsequent ACL injury. Having a family history of ACL injury increased the odds of injury across all outcomes. Those with a family history had a 2.5 times greater odds for sustaining a primary ACL injury (OR 2.53 [95% confidence interval [CI] 1.96-3.28, p < 0.001)]. There was no significant difference of injury odds for primary ACL injury when analysed by sex. Family history of ACL injury was found to increase the odds of subsequent ACL injury by 2.38 (95% CI 1.64-3.46, p < 0.001) and was significant for both graft ruptures (OR 1.80 [95% CI 1.20-2.71, p = 0.005]) and contralateral ACL injuries (OR 2.28 [95% CI 1.28-4.04, p = 0.005]). When compared directly, the odds of sustaining a graft rupture versus a contralateral ACL injury were similar for those with a family history. Outcomes were not frequently reported by sex for subsequent ACL injuries. CONCLUSIONS Having a family history of ACL injury more than doubles the odds of sustaining a primary or subsequent ACL injury. However, if a family history of ACL injury is present, the sex of the athlete does not increase the risk for primary injury nor is there a difference in the risk for a subsequent graft rupture compared to a contralateral ACL injury. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42020186472.
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84
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Kuntze G, Nettel-Aguirre A, Lorenzen KN, Küpper J, Ronsky JL, Whittaker JL, Emery CA. Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211058105. [PMID: 34917690 PMCID: PMC8669131 DOI: 10.1177/23259671211058105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies. Purpose To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport-related ACLR and uninjured peers of a similar age, sex, and sport. Study Design Cross-sectional study. Level of evidence III. Methods Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects. Results Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = -0.04 deg/% [95% CI, -0.07 to -0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = -0.2° [95% CI, -0.3° to -0.0°]; P = .014) and hip flexion (β = -0.1° [95% CI, -0.2° to -0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = -0.34 BW [95% CI, -0.61 to -0.07 BW]; P = .014) (pushoff: β = -0.20 BW [95% CI, -0.32 to -0.08 BW]; P = .001). Conclusion Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges. Clinical Relevance It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport-related ACLR.
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Affiliation(s)
- Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kristin N Lorenzen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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85
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Second Generation of Tissue-Engineered Ligament Substitutes for Torn ACL Replacement: Adaptations for Clinical Applications. Bioengineering (Basel) 2021; 8:bioengineering8120206. [PMID: 34940359 PMCID: PMC8698634 DOI: 10.3390/bioengineering8120206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) of the knee joint is one of the strongest ligaments of the body and is often the target of traumatic injuries. Unfortunately, its healing potential is limited, and the surgical options for its replacement are frequently associated with clinical issues. A bioengineered ACL (bACL) was developed using a collagen matrix, seeded with autologous cells and successfully grafted and integrated into goat knee joints. We hypothesize that, in order to reduce the cost and simplify the model, an acellular bACL can be used as a substitute for a torn ACL, and bone plugs can be replaced by endobuttons to fix the bACL in situ. First, acellular bACLs were successfully grafted in the goat model with 18% recovery of ultimate tensile strength 6 months after implantation (94 N/mm2 vs. 520). Second, a bACL with endobuttons was produced and tested in an exvivo bovine knee model. The natural collagen scaffold of the bACL contributes to supporting host cell migration, growth and differentiation in situ post-implantation. Bone plugs were replaced by endobuttons to design a second generation of bACLs that offer more versatility as biocompatible grafts for torn ACL replacement in humans. A robust collagen bACL will allow solving therapeutic issues currently encountered by orthopedic surgeons such as donor-site morbidity, graft failure and post-traumatic osteoarthritis.
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86
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Jones HSR, Moore IS, King E, Stiles VH, Laudani L, McCarthy-Ryan M, McFadden C, Daniels KAJ. Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 2021; 32:612-621. [PMID: 34797936 DOI: 10.1111/sms.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
Abstract
There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs = 0.728, p < 0.001), knee (rs = 0.638, p < 0.001) and hip (rs = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs = 0.10, p = 0.104), knee (rs = 0.106, p = 0.166) and hip (rs = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.
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Affiliation(s)
- Holly S R Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Enda King
- Sports Surgery Clinic, Dublin, Ireland
| | | | - Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Molly McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Ciarán McFadden
- Sports Surgery Clinic, Dublin, Ireland.,Sport and Exercise Science Research Centre, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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87
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Shams F, Hadadnezhad M, Letafatkar A, Hogg J. Valgus Control Feedback and Taping Improves the Effects of Plyometric Exercises in Women With Dynamic Knee Valgus. Sports Health 2021; 14:747-757. [PMID: 34651505 DOI: 10.1177/19417381211049805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Female athletes are more predisposed to anterior cruciate ligament (ACL) injuries in comparison with their male counterparts. Research on ACL injury prevention strategies has demonstrated beneficial effects of plyometric exercises and feedback (FB) during the exercises. FB has resulted in reductions in vertical ground-reaction force and kinematic risk factors associated with ACL injury. Furthermore, taping (TP) may draw attention to the restriction created by the tape and serve as real-time biofeedback. The additional influence of FB and TP on plyometric exercises has not been determined. HYPOTHESIS FB and TP interventions delivered during plyometric exercises would result in positive changes in biomechanics and muscle onset in female athletes displaying dynamic knee valgus. DESIGN Controlled trial. SETTING University research laboratory. LEVEL OF EVIDENCE Level 2. METHODS Forty-eight active female athletes were divided into 3 groups: control (n = 16), plyometric training with FB (n = 16), and plyometric training with TP (n = 16). The 2 experimental groups performed a 6-week exercise program with either FB or TP. The control group continued its regular team schedule. Knee joint position sense, landing error scoring system (LESS), and the onset of muscle activation (the point at which muscle activation exceeds 3 standard deviations over baseline and continued above this threshold for at least 25 ms) before landing for the rectus femoris, vastus medialis, vastus lateralis, gluteus medius, semitendinosus, and biceps femoris during pre- and posttests were measured. RESULTS The vastus lateralis onset later in the TP group compared with the FB group (d [95% CI] = 0.64 [0.35-0.82], P = 0.01). Joint position sense accuracy improved only in the TP group (d = -0.63, P = 0.001). Both the FB (d = -0.85, P = 0.001), and TP (d = -0.82, P = 0.001) groups improved in LESS scores. CONCLUSION The results of the present study showed that plyometric exercises with FB or TP affect LESS and the onset of the vastus lateralis in active uninjured women with dynamic knee valgus, while TP improves joint position sense. Therefore, when more accurate joint position sense is desired, practitioners may use plyometric with TP. If an improved LESS score is desired, plyometrics with either TP or FB are acceptable. CLINICAL RELEVANCE Our findings indicate that female athletes may benefit more when completing a plyometric training program with a TP versus an FB. Trainers, coaches, and clinicians should consider utilizing instructions that promote an external focus when implementing plyometric training programs with male athletes.
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Affiliation(s)
- Fereshteh Shams
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Malihe Hadadnezhad
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Jennifer Hogg
- Graduate Athletic Training Program, Health & Human Performance Department, University of Tennessee Chattanooga, Chattanooga, Tennessee
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88
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Estimation of vertical ground reaction force parameters during athletic tasks using 2D video. Gait Posture 2021; 90:483-488. [PMID: 34624702 DOI: 10.1016/j.gaitpost.2021.09.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Given that elevated vertical ground reaction forces (vGRF) have been reported to contribute to various lower-extremity injuries, there is a need for a practical method to characterize movement behavior that is representative of elevated impact forces. RESEARCH QUESTION Can images obtained from 2D video be used to predict vGRF parameters during athletic tasks? Specifically, we sought to determine whether the 2D thigh angle obtained at peak knee flexion could be used to predict the peak vGRF and vGRF impulse during single limb and double limb landings and movements that involve a change of direction. METHODS 2D sagittal plane video and vGRFs were obtained simultaneously from 39 participants (15 males and 24 females) during 5 athletic tasks (drop jump, lateral shuffle, deceleration, triple hop, side-step-cut). Linear regression analysis was performed to determine if the 2D thigh angle at peak knee flexion predicted the first peak of the vGRF and vGRF impulse during the deceleration phase of each task. RESULTS The 2D thigh angle predicted the peak vGRF for all tasks except cutting (R2 = 0.17 to 0.47, all p < 0.01). However, the 2D thigh angle predicted the vGRF impulse for all 5 tasks (R2 = 0.13 to 0.39, all p < 0.025). SIGNIFICANCE An increased 2D thigh angle (which is representative of increased hip and knee flexion) was able to predict lower peak vGRFs and vGRF impulse during athletic tasks. The 2D thigh angle is a potential clinical method to characterize movement behavior that may expose individuals to high impact forces.
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89
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Akgün AS, Agirman M. Associations between Anterior Cruciate Ligament Injuries and Patella Alta and Trochlear Dysplasia in Adults Using Magnetic Resonance Imaging. J Knee Surg 2021; 34:1220-1226. [PMID: 32131095 DOI: 10.1055/s-0040-1702198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to research the associations between anterior cruciate ligament (ACL) injuries and patella alta and trochlear dysplasia in adult patients using magnetic resonance imaging (MRI). This retrospective study included 221 adult patients: 110 with acute complete noncontact ACL tears and 111 without ACL injuries who underwent knee MRI procedures between May 2016 and July 2018. After the ACL injuries were verified using the sagittal proton density images, the patellar height and patellar tendon length were measured on the sagittal T1-weighted images, and the Insall-Salvati ratio (ISR) was calculated. In the axial proton density MRI scans, according to the Dejour and Le Coultre classification of trochlear dysplasia, the knees were classified as normal or as types A, B, C, or D. The patellar length was not significantly different between the patient and control groups (41.5 ± 3.3 vs. 41.0 ± 2.9 mm, respectively). An increased patellar tendon length (46.1 ± 3.9 vs. 44.5 ± 3.4 mm, respectively) and an increased ISR (1.11 ± 0.08 vs. 1.08 ± 0.06, respectively) were measured in the patient group (with the ACL tears). In the group with the ACL tears, the rate of trochlear dysplasia was higher (15.45%) than that in the healthy group (4.5%). Of the 17 trochlear dysplasia patients in the ACL group, 11 were type A (10%), 2 were type B (1.82%), 3 were type C (2.73%), and 1 was type D (0.91%). Results showed increased patellar tendon lengths, ISRs, and trochlear dysplasia in the patients with the ACL injuries when compared with the healthy control group. Although the causative relationship has not yet been clearly elucidated, one should keep in mind that these variations may be risk factors for ACL tears.
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Affiliation(s)
- Ayşe Serap Akgün
- Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Agirman
- Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey
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90
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Costa MQ, Murray MM, Sieker JT, Karamchedu NP, Proffen BL, Fleming BC. Peripheral shift in the viable chondrocyte population of the medial femoral condyle after anterior cruciate ligament injury in the porcine knee. PLoS One 2021; 16:e0256765. [PMID: 34437631 PMCID: PMC8389427 DOI: 10.1371/journal.pone.0256765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022] Open
Abstract
Anterior cruciate ligament injuries result in posttraumatic osteoarthritis in the medial compartment of the knee, even after surgical treatment. How the chondrocyte distribution within the articular cartilage changes early in this process is currently unknown. The study objective was to investigate the chondrocyte distribution within the medial femoral condyle after an anterior cruciate ligament transection in a preclinical model. Forty-two adolescent Yucatan minipigs were allocated to receive unilateral anterior cruciate ligament surgery (n = 36) or no surgery (n = 6). Central coronal sections of the medial femoral condyle were obtained at 1- and 4 weeks after surgery, and the chondrocyte distribution was measured via whole slide imaging and a cell counting batch processing tool utilized in ImageJ. Ki-67 immunohistochemistry was performed to identify proliferating cells. Empty lacunae, karyolysis, karyorrhexis, and pyknosis were used to identify areas of irreversible cell injury. The mean area of irreversible cell injury was 0% in the intact controls, 13.4% (95% confidence interval: 6.4, 20.3) at 1-week post-injury and 19.3% (9.7, 28.9) at 4 weeks post-injury (p < .015). These areas occurred closest to the femoral intra-articular notch. The remaining areas containing viable chondrocytes had Ki-67-positive cells (p < .02) and increased cell density in the middle (p < .03) and deep zones (p = .001). For the entire section, the total chondrocyte number did not change significantly post-operatively; however, the density of cells in the peripheral regions of the medial femoral condyle increased significantly at 1- and 4 weeks post-injury relative to the intact control groups (p = .032 and .004, respectively). These data demonstrate a peripheral shift in the viable chondrocyte population of the medial femoral condyle after anterior cruciate ligament injury and further suggest that chondrocytes with the capacity to proliferate are not confined to one particular cartilage layer.
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Affiliation(s)
- Meggin Q. Costa
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, United States of America
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jakob T. Sieker
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, United States of America
| | - Benedikt L. Proffen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, United States of America
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91
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Unilateral versus Bilateral Landing after Spike Jumps in Male and Female Volleyball: A Systematic Review. Symmetry (Basel) 2021. [DOI: 10.3390/sym13081505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The spike is a key action in volleyball, and the landing technique and its asymmetries are commonly associated with an increased risk of injury. Objectives: The aim of this systematic review was to assess how male and female volleyball players land (i.e., unilaterally, or bilaterally) after spike jumps in matches and analytical settings (field or laboratory). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed, with eligibility criteria defined according to participants, interventions, comparators, study design (PICOS): (p) healthy indoor volleyball players of any sex, age group, or competitive level; (i) exposure to landing after spike actions during official matches AND/OR simulated 6 vs. 6 games AND/OR analytical training conditions AND/OR laboratorial experiments; (c) not mandatory; (o) data on landing mechanics after spike actions, including reporting of whether the landing was unilateral or bilateral; (s) no restrictions imposed on study design. Searches were performed in seven electronic databases (Cochrane Library, EBSCO, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science) on 23 April 2021. Results: Automated searches provided 420 results. Removal of 119 duplicates resulted in 301 records being screened for titles and abstracts. A total of 25 studies were eligible for full-text analysis. Of these, eight studies were deemed eligible for inclusion in the review. Studies showed that (i) attackers landed asymmetrically 68% of the times (61% left leg, 7% right leg); (ii) bilateral asymmetries were observed for the hip, knee, and ankle joints; (iii) bilateral asymmetries were observed even when players were instructed to land evenly on two feet; (iv) landing contact of the leg opposite to the hitting arm preceded the contact of the homolateral leg. One match analysis study showed that men landed more often on the left (31.5%) or right foot (8.5%) than women (23.7% and 1.6%). Conclusions: Studies analyzing spike landing showed a prevalence of unilateral landings (mostly the left leg first, for right-handed players) in men and women but more prevalently in men. Registration INPLASY202140104, DOI: 10.37766/inplasy2021.4.0104.
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92
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Zago M, David S, Bertozzi F, Brunetti C, Gatti A, Salaorni F, Tarabini M, Galvani C, Sforza C, Galli M. Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention. Front Bioeng Biotechnol 2021; 9:666841. [PMID: 34291039 PMCID: PMC8287513 DOI: 10.3389/fbioe.2021.666841] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background The etiology of Anterior Cruciate Ligament (ACL) injury in women football results from the interaction of several extrinsic and intrinsic risk factors. Extrinsic factors change dynamically, also due to fatigue. However, existing biomechanical findings concerning the impact of fatigue on the risk of ACL injuries remains inconsistent. We hypothesized that fatigue induced by acute workload in short and intense game periods, might in either of two ways: by pushing lower limbs mechanics toward a pattern close to injury mechanism, or alternatively by inducing opposed protective compensatory adjustments. Aim In this study, we aimed at assessing the extent to which fatigue impact on joints kinematics and kinetics while performing repeated changes of direction (CoDs) in the light of the ACL risk factors. Methods This was an observational, cross-sectional associative study. Twenty female players (age: 20-31 years, 1st-2nd Italian division) performed a continuous shuttle run test (5-m) involving repeated 180°-CoDs until exhaustion. During the whole test, 3D kinematics and ground reaction forces were used to compute lower limb joints angles and internal moments. Measures of exercise internal load were: peak post-exercise blood lactate concentration, heart rate (HR) and perceived exertion. Continuous linear correlations between kinematics/kinetics waveforms (during the ground contact phase of the pivoting limb) and the number of consecutive CoD were computed during the exercise using a Statistical Parametric Mapping (SPM) approach. Results The test lasted 153 ± 72 s, with a rate of 14 ± 2 CoDs/min. Participants reached 95% of maximum HR and a peak lactate concentration of 11.2 ± 2.8 mmol/L. Exercise duration was inversely related to lactate concentration (r = -0.517, p < 0.01), while neither%HR max nor [La-] b nor RPE were correlated with test duration before exhaustion (p > 0.05). Alterations in lower limb kinematics were found in 100%, and in lower limb kinetics in 85% of the players. The most common kinematic pattern was a concurrent progressive reduction in hip and knee flexion angle at initial contact (10 players); 5 of them also showed a significantly more adducted hip. Knee extension moment decreased in 8, knee valgus moment increased in 5 players. A subset of participants showed a drift of pivoting limb kinematics that matches the known ACL injury mechanism; other players displayed less definite or even opposed behaviors. Discussion Players exhibited different strategies to cope with repeated CoDs, ranging from protective to potentially dangerous behaviors. While the latter was not a univocal effect, it reinforces the importance of individual biomechanical assessment when coping with fatigue.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy.,E4Sport Laboratory, Politecnico di Milano, Lecco, Italy
| | - Sina David
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Filippo Bertozzi
- Dipartimento di Scienze Biomediche per la Salute, Politecnico di Milano, Milan, Italy
| | - Claudia Brunetti
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Alice Gatti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Francesca Salaorni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Marco Tarabini
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy.,E4Sport Laboratory, Politecnico di Milano, Lecco, Italy
| | - Christel Galvani
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Politecnico di Milano, Milan, Italy
| | - Manuela Galli
- E4Sport Laboratory, Politecnico di Milano, Lecco, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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93
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Hart DA, Martin CR, Scott M, Shrive NG. The instrumented sheep knee to elucidate insights into osteoarthritis development and progression: A sensitive and reproducible platform for integrated research efforts. Clin Biomech (Bristol, Avon) 2021; 87:105404. [PMID: 34171651 DOI: 10.1016/j.clinbiomech.2021.105404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis of the knee is a very common condition that has been difficult to treat. The majority of cases are considered idiopathic. Much research effort remains focused on biology rather than the biomechanics of such joints. Some new methods were developed and validated to better appreciate the subtleties of the biomechanical integrity of joints, and how changes in biomechanics can contribute to osteoarthritis. METHODS Over the past 15 years our lab has enhanced the sensitivity of the assessment of knee biomechanics of an instrumented, trained large animal model (sheep) of osteoarthritis and integrated the findings with biological and histological assessments. These new methods include gait analysis before and after injury followed by robotic validation post-sacrifice, and more recently using Fibre Bragg Grating sensors to detect alterations in cartilage stresses. RESULTS A review of the findings obtained with this model are presented. The findings indicate that sheep, like humans, exhibit individual characteristics. They also indicate that joint kinetics, rather than kinematics may better define the alterations induced by injury. With the addition of Fibre Bragg Grating sensors, it has been possible to measure with good accuracy, alterations to cartilage stresses following a controlled knee injury. INTERPRETATION Using this model as Proof of Concept, this sheep system can now be viewed as a sensitive platform to address many questions related to risk for development of idiopathic osteoarthritis of the human knee, the efficacy of potential interventions to correct biomechanical disruptions, and how joint biomechanics and biology are integrated during aging.
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Affiliation(s)
- David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
| | - C Ryan Martin
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Section of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Michael Scott
- Department of Veterinary Clinical & Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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94
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Zheng C, Han H, Cao Y. Arthroscopically Assisted Cannulated Screw Fixation for Treating Type III Tibial Intercondylar Eminence Fractures: A Short-Term Retrospective Controlled Study. Front Surg 2021; 8:639270. [PMID: 34239891 PMCID: PMC8259787 DOI: 10.3389/fsurg.2021.639270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study presents the clinical results from 22 children who underwent minimally invasive arthroscopically assisted screw fixation for the treatment of intercondylar eminence fractures. Methods: We retrospectively analyzed the clinical data of 22 children (aged 7.5 to 13.5 years) with type III tibial intercondylar eminence fractures who were treated in our department from March 2007 to September 2019. According to the type of operation, the patients were divided into two groups: group A (n = 12) received arthroscopically assisted cannulated screw fixation, and group B (n = 10) received open reduction and cannulated screw internal fixation. Radiography scans, Lysholm scores, International Knee Documentation Committee (IKDC) 2,000 subjective scores, Tegner scores, range of motion (ROM) of the knee, the anterior drawer test (ADT), the Lachman test, and the pivot-shift test were used to evaluate the clinical efficacy. Results: All 22 children were evaluated over a 12 to 58 month follow-up period (mean: 27.5 months). At the final exam, group A was significantly superior to group B in Lysholm scores (93.33 ± 3.55 vs. 86.20 ± 4.52), IKDC scores (92.06 ± 3.55 vs. 86.07 ± 5.81), and Tegner scores (7.75 ± 0.87 vs. 6.40 ± 0.52) and presented shorter operative times (25.42 ± 3.97 vs. 35.00 ± 5.27). The differences were statistically significant (P < 0.05). All the incisions healed primarily. No complications, such as fracture fragment displacement, delayed epiphyseal growth, or knee joint dysfunction, were observed. The drawer test, Lachman test, and pivot-shift test were negative for all patients. Conclusions: Arthroscopically assisted cannulated screw fixation is effective and safe for the treatment of tibial intercondylar eminence fractures, providing excellent stability and quick recovery of joint function.
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Affiliation(s)
- Chao Zheng
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huanli Han
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yujiang Cao
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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95
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Bram JT, Magee LC, Mehta NN, Patel NM, Ganley TJ. Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1962-1972. [PMID: 33090889 DOI: 10.1177/0363546520959619] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries among adolescent athletes is steadily increasing. Identification of the highest risk sports for ACL injuries by sex and competitive setting (ie, practice vs match) is important for targeting injury prevention programs. PURPOSE To identify the risk of ACL injuries in adolescent athletes by sport, sex, and setting across a variety of common US and international sports. STUDY DESIGN Meta-analysis. METHODS Essentially, 3 online databases (PubMed, Embase, and Cochrane Library) were searched for all studies of ACL injuries per athlete-exposure (AE) or hours of exposure in adolescent athletes. Injuries were then pooled and incidence rates (IRs) reported per 1000 AEs or hours of exposure, with the relative risk (RR) of injuries calculated for sex-comparable sports. IRs per competitive setting (match vs practice) were also calculated. RESULTS A total of 1235 ACL injuries over 17,824,251 AEs were identified (IR, 0.069 [95% CI, 0.065-0.074]), with 586 of these injuries in girls across 6,986,683 AEs (IR, 0.084 [95% CI, 0.077-0.091]) versus 649 injuries in boys over 10,837,568 AEs (IR, 0.060 [95% CI, 0.055-0.065]). Girls had a higher overall rate of ACL injuries (RR, 1.40 [95% CI, 1.25-1.57]), with the most disproportionate risk observed in basketball (RR, 4.14 [95% CI, 2.98-5.76]). The risk of ACL injuries by sex was highest in girls' soccer (IR, 0.166 [95% CI, 0.146-0.189]) and boys' football (IR, 0.101 [95% CI, 0.092-0.111]). ACL injuries were over 8 (RR, 8.54 [95% CI, 6.46-11.30]) and 6 (RR, 6.85 [95% CI, 5.52-8.49]) times more likely to occur in a match versus a practice setting for female and male athletes, respectively. CONCLUSION The risk of ACL injuries overall approached nearly 1 per 10,000 AEs for female athletes, who were almost 1.5 times as likely as male athletes to suffer an ACL injury across all adolescent sports. A multisport female athlete was estimated to have a nearly 10% risk of ACL injuries over her entire high school or secondary school career. Specifically, male and female adolescents playing soccer, basketball, lacrosse, and football appeared at particular risk of injuries, a finding that can be used to target an injury intervention.
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Affiliation(s)
- Joshua T Bram
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lacey C Magee
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nishank N Mehta
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeraj M Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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96
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Lucarno S, Zago M, Buckthorpe M, Grassi A, Tosarelli F, Smith R, Della Villa F. Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Female Soccer Players. Am J Sports Med 2021; 49:1794-1802. [PMID: 33989090 DOI: 10.1177/03635465211008169] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Female soccer players are particularly susceptible to anterior cruciate ligament (ACL) injuries, accounting for 16% to 43% of the injury burden during the season. Despite the advancements in injury prevention programs, the rate of ACL injuries continues to rise. PURPOSE To provide a comprehensive description of the mechanisms, situational pattern, and biomechanics of ACL injuries in women's soccer. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified 57 consecutive ACL injuries that occurred in matches of 6 top female leagues across 3 seasons (2017-2020). A total of 35 (61%) injury videos were analyzed for the mechanism and situational pattern, while biomechanical analysis was possible in 29 cases. Three independent reviewers evaluated each video. The distribution of ACL injuries according to month, timing within the match, and field location at the time of injury was also reported. RESULTS In the 35 injury videos, there were 19 (54%) noncontact injuries, 12 (34%) indirect contact injuries, and 4 (11%) direct contact injuries. We identified 3 main situations in players who suffered a noncontact/indirect contact injury: (1) pressing and tackling (n = 18), (2) regaining balance after kicking (n = 7), and (3) being tackled (n = 4). Biomechanical analysis indicated multiplanar mechanisms with frequent knee valgus loading (88%). Additionally, 64% of injuries occurred in the first half of matches and most frequently within the first 30 minutes. CONCLUSION Female athletes showed remarkable similarities with elite male players in terms of the ACL mechanism and situational pattern of injury, and 88% of injuries involved no direct contact to the knee, with noncontact injuries being highly prevalent. Injuries occurred during 3 main situations, with accompanying alterations in multiplanar biomechanics. Interventions aimed at reducing ACL injuries in women's soccer should consider high-intensity defensive play at the beginning of a match. Instruction in the 3 main situations should be applied alongside appropriate neuromuscular training interventions.
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Affiliation(s)
| | - Matteo Zago
- Department of Mechanics, Politecnico di Milano, Milan, Italy.,E4Sport Laboratory, Politecnico di Milano, Lecco, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, Istituto Ortopedico Rizzoli, FIFA Medical Center of Excellence, Bologna, Italy
| | - Filippo Tosarelli
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
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97
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Marmura H, Getgood AMJ, Spindler KP, Kattan MW, Briskin I, Bryant DM. Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1777-1785. [PMID: 33945339 DOI: 10.1177/03635465211010798] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstructions (ACLRs) fail at an alarmingly high rate in young active individuals. The Multicenter Orthopaedic Outcomes Network (MOON) knee group has developed an autograft risk calculator that uses patient characteristics and lifestyle to predict the probability of graft rupture if the surgeon uses a hamstring tendon (HT) or a bone-patellar tendon-bone (BPTB) graft to reconstruct the ligament. If validated, this risk calculator can be used during the shared decision-making process to make optimal ACLR autograft choices and reduce rupture rates. The STABILITY 1 randomized clinical trial offers a large, rigorously collected data set of similar young active patients who received HT autograft with or without lateral extra-articular tenodesis (LET) for ACLR. PURPOSE/HYPOTHESIS The purpose was to validate the ACLR graft rupture risk calculator in a large external data set and to investigate the utility of BPTB and LET for ACLR. We hypothesized that the risk calculator would maintain adequate discriminative ability and calibration in the external STABILITY 1 data set when compared with the initial MOON development data set. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 1. METHODS The model predictors for the risk calculator include age, sex, body mass index, sport played at the time of injury, Marx Activity Score, preoperative knee laxity, and graft type. The STABILITY 1 trial data set was used for external validation. Discriminative ability, calibration, and diagnostic test validity of the model were assessed. Finally, predictor strength in the initial and validation samples was compared. RESULTS The model showed acceptable discriminative ability (area under the curve = 0.73), calibration (Brier score = 0.07), and specificity (85.3%) to detect patients who will experience a graft rupture. Age, high-grade preoperative knee laxity, and graft type were significant predictors of graft rupture in young active patients. BPTB and the addition of LET to HT were protective against graft rupture versus HT autograft alone. CONCLUSION The MOON risk calculator is a valid predictor of ACLR graft rupture and is appropriate for clinical practice. This study provides evidence supporting the idea that isolated HT autografts should be avoided for young active patients undergoing ACLR. REGISTRATION NCT00463099 (MOON); NCT02018354 (STABILITY 1) (ClinicalTrials.gov identifiers).
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Isaac Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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98
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Kumar R, Kalra M, Garg AK, Choudhary R, Venishetty N, Verma S, Kumar A. Clinical Reliability of Adjustable Femoral Cortical Suspensory Fixation in Anterior Cruciate Ligament Reconstruction and Correlation of Clinical Outcomes With Demographic and Perioperative Factors. Cureus 2021; 13:e15345. [PMID: 34235023 PMCID: PMC8243633 DOI: 10.7759/cureus.15345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective The primary goal of anterior cruciate ligament reconstruction (ACLR) is to protect the initial graft fixation against heavy loads encountered during the rehabilitation phase. The purpose of this study was to evaluate the functional outcomes (Lysholm score) and laxity [anterior tibial translation (ATT), anterior drawer test, Lachman test, and pivot shift test] of ACLR with adjustable-loop femoral cortical suspensory fixation (CSF) and tibial interferences crew fixation. Methods This study included 100 patients who underwent primary ACL reconstruction using quadruple hamstring grafts secured with TightRope® (Arthrex Inc, Naples, FL) femoral fixation and an interference screw on the tibial end. Six patients were excluded from the final analysis (four lost to follow-up, one suffered re-injury, and one had septic arthritis). The remaining 94 patients were evaluated for laxity and functional outcomes preoperatively, as well as at one, six, and 12 months postoperatively. Regression analysis was performed to determine the association between outcomes and 11 independent variables. This was designed as a prospective cohort study (level of evidence: II). Results The mean age of the participants was 28.46 ± 7.01 years. The median preoperative Lysholm knee score of 49 (mean ± SD: 48.2 ± 5.42) improved to 93 (92.7 ± 2.1) at six months and 98 (97.6 ± 2.1) at the one-year follow-up. The improvement was found to be statistically significant (p<0.01). The median ATT was 10 mm preoperatively, which decreased to 2 mm at one month, remained the same at six months, and rose to 3 mm at the one-year follow-up. ATT was found significantly reduced at one month postoperatively (p<.001) and did not show any significant further changes at subsequent follow-ups (p>0.05). Multiple linear regression revealed that one-year postoperative ATT (Rolimeter, Aircast Europa, Stephanskirchen, Germany) was independent of all demographic and perioperative variables tested. Conclusion Quadrupled hamstring graft ACLR with adjustable-loop fixation showed excellent subjective and objective outcomes with no residual laxity or failure of graft over mid-term follow-up. Postoperative laxity was not correlated with graft and tunnel dimensions.
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Affiliation(s)
- Ramesh Kumar
- Orthopaedics and Trauma, Pushpawati Singhania Research Institute, New Delhi, IND
| | - Mukesh Kalra
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
| | - Ankit Kumar Garg
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | | | | | - Shilp Verma
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | - Ankush Kumar
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
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99
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Tseng HJ, Lo HL, Lin YC, Liu WC, Lin SY, Chou PH, Lu CC. Analyze the Differential Rates of Anterior Cruciate Ligament Injuries Between Men and Women by Biomechanical Study of Single-Leg Landing in Badminton. Indian J Orthop 2021; 55:409-417. [PMID: 34306555 PMCID: PMC8275743 DOI: 10.1007/s43465-021-00421-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND In female badminton players, certain landings are associated with injury to the anterior cruciate ligament (ACL). However, the kinematic and kinetic changes of the landing leg and the effects of risky posture on ACL injuries among female vs male badminton players are still unknown. We hypothesized that female players land with a significantly higher knee valgus angle and moment compared to male players during single-leg landings in badminton. METHODS Ten male and ten female badminton players were enrolled in this study. In the laboratory, these subjects performed back-stepping to the backhand side with a concurrent overhead stroke, a single-leg landing on the force plate, and a return to the starting position. The kinematic data in the stance phase were normalized ranging from 0% as initial contact to 100% as toe-off; and 0% as initial contact to 100% as maximum knee flexion in the impact phase. RESULTS The knee valgus angle in female players was significantly higher in initial contact (5.06° ± 6.83° vs - 5.10° ± 4.30, p = .001) and maximal knee valgus angle (7.58° ± 9.54° vs - 3.93° ± 4.22°, p = .004) compared to male players. The knee valgus moment was significantly higher in male players than female players ( - 0.09 ± 0.12 vs 0.03 ± 0.10 N∙m/kg, p = .032) in initial contact during the impact phase. During landings, female badminton players had lower hip flexion angles, greater knee valgus angles, and greater ankle dorsiflexion angles. CONCLUSION Female badminton players presented higher knee valgus angles but smaller knee valgus moments compared with male players during backward single-leg landings. The concomitant kinematic and kinetic changes of the hip, knee, and ankle joints also can play an important role in the higher incidence of ACL injury in female athletes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00421-6.
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Affiliation(s)
- Hsiang-Jui Tseng
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Siaogang Dist, No. 482, Shanming Rd, Kaohsiung, Taiwan ,grid.412027.20000 0004 0620 9374Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hon-Lok Lo
- grid.412027.20000 0004 0620 9374Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Lin
- grid.412027.20000 0004 0620 9374Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Chih Liu
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Siaogang Dist, No. 482, Shanming Rd, Kaohsiung, Taiwan
| | - Sung-Yen Lin
- grid.412027.20000 0004 0620 9374Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hsi Chou
- grid.412027.20000 0004 0620 9374Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Siaogang Dist, No. 482, Shanming Rd, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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100
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Lambert C, Lambert M, Ellermann A, Wafaisade A, Buse C, Peters N, Centner C, Klinspon E. Development of a modified cross-over hop test to reduce measurement errors in return-to-competition testing. SPORTVERLETZUNG-SPORTSCHADEN 2021; 36:92-99. [PMID: 34010963 DOI: 10.1055/a-1349-5605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONTEXT Hop tests play an important role in the rehabilitation process after injuries. A comparison of the jumping distances of both extremities allows for an evaluation of the injured limb. In the conventional cross-over hop test for distance, the jump width (medial vs. lateral) that the athlete has to cross during the jump is not standardised and therefore highly variable. This affects the absolute jump length in each jump series. HYPOTHESIS Modifying the test may reduce the jump length variance between test series of an athlete as well as the test-dependent variations in the cross-over hop for distance. METHODS N = 47 athletes from the German and French national Judo youth teams were included in the study (age: 15.3 years ± 13-17). A modified version of the cross-over hop for distance was developed with a cross-over width of 50 cm and a fixed landing zone of 10 cm. The jump lengths of the conventional test and the modified test were documented. The change in jump length variations of the two sexes were compared. RESULTS The mean value of the coefficient of variation decreased significantly from 4.09 % to 2.83 % (p < 0.01) due to the test modification. This resulted in an absolute improvement in accuracy of 1.26 % and a relative improvement of 30.8 %. A comparison of the limb symmetry index between the conventional and the modified cross-over hop for distance revealed no significant differences. CONCLUSION The modified cross-over hop for distance showed a significantly lower variation in jump lengths compared with the conventional cross-over hop for distance. As a result, more accurate statements can be made regarding the patient's return-to-competition progress.
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Affiliation(s)
- Christophe Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Universität Witten/Herdecke
| | - Maxime Lambert
- University of Witten/Herdecke, Universität Witten/Herdecke
| | | | | | | | | | - Christoph Centner
- University of Freiburg im Breisgau, Albert-Ludwigs-Universität Freiburg
| | - Erich Klinspon
- RWTH University Aachen Centre of Process Engineering, Rheinisch-Westfälische Technische Hochschule Aachen, Aachener Verfahrenstechnik
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