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Wu X, Chen J, Ye Z, Dong S, Xie G, Zhao S, Xu C, Li Z, Xu J, Zhao J. Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability. Am J Sports Med 2024; 52:936-947. [PMID: 38349070 DOI: 10.1177/03635465241226976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons' attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. PURPOSE (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. RESULTS The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. CONCLUSION In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.
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Affiliation(s)
- Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lima Y, Gouttebarge V, Bayraktar B. What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries. Res Sports Med 2024:1-11. [PMID: 38414221 DOI: 10.1080/15438627.2024.2324257] [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: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.
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Affiliation(s)
- Yavuz Lima
- Cerrahpasa Faculty of Medicine, Sports Medicine Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vincent Gouttebarge
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Section Sports Medicine, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, Netherlands
| | - Bülent Bayraktar
- Sports Medicine Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
- Turkish Football Federation, Medical Board, Istanbul, Turkey
- Acıbadem Sports/FIFA Medical Centre of Excellence Consultant, Istanbul, Turkey
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Mohr M, Federolf P, Heinrich D, Nitschke M, Raschner C, Scharbert J, Koelewijn AD. An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk. Sci Rep 2024; 14:3115. [PMID: 38326644 PMCID: PMC10850483 DOI: 10.1038/s41598-024-53640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant 'training x group' interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.
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Affiliation(s)
- M Mohr
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - P Federolf
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - D Heinrich
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - M Nitschke
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - C Raschner
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - J Scharbert
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - A D Koelewijn
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Vianna M, Metsavaht L, Guadagnin E, Franciozi CE, Luzo M, Tannure M, Leporace G. Variables Associated With Knee Valgus in Male Professional Soccer Players During a Single-Leg Vertical Landing Task. J Appl Biomech 2024; 40:9-13. [PMID: 37775099 DOI: 10.1123/jab.2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 10/01/2023]
Abstract
Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was .43 during the landing phase (P = .04) and with peak hip internal rotation was -.68 (P < .001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r = .40, P = .05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test.
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Affiliation(s)
- Matheus Vianna
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo Metsavaht
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Eliane Guadagnin
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Carlos Eduardo Franciozi
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcus Luzo
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Gustavo Leporace
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
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Song Y, Li L, Layer J, Hughes G, Smith D, Wilson M, Zhu Q, Dai B. Falling decreased anterior cruciate ligament loading variables during single-leg landings after mid-flight external trunk perturbation. J Electromyogr Kinesiol 2024; 74:102849. [PMID: 38061150 DOI: 10.1016/j.jelekin.2023.102849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 01/29/2024] Open
Abstract
Mid-flight external upper-trunk perturbation is associated with increased anterior cruciate ligament (ACL) injury risk during landing. This study aimed to assess the effect of natural, soft, and falling landing techniques on knee mechanics and vertical ground reaction forces (VGRF) during single-leg landings with/without mid-flight medial-lateral external upper-trunk pushing perturbation. Twenty-eight participants performed single-leg landings using the three landing techniques with/without mid-flight pushing perturbation. The perturbation was created by a customized apparatus releasing a slam ball and pushing the participants near the peak jump height at the upper trunk. Perturbation resulted in significantly greater lateral trunk bending angles, knee flexion angles at initial contact, peak knee abduction angles, and peak knee adduction moments compared to no perturbation. The falling condition significantly demonstrated the greatest lateral trunk bending angles, knee flexion angles, and peak knee external rotation moments and the smallest peak knee abduction angles, peak VGRF, and peak knee extension moments compared to natural/soft landings regardless of perturbation conditions. Mid-flight external perturbation resulted in variables associated with greater ACL loading during single-leg landings. Falling demonstrated variables associated with smaller ACL loading, particularly for perturbation conditions. Incorporating falling techniques into jump-landing training programs may guide players to safely fall on the ground when perturbation occurs. Falling provides an alternative strategy to potentially decrease indirect contact ACL injury risk when the sports environment allows.
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Affiliation(s)
- Yu Song
- Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Jacob Layer
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Gerwyn Hughes
- Department of Kinesiology, University of San Francisco, San Francisco, CA 94117, USA
| | - Derek Smith
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Margaret Wilson
- Department of Theatre and Dance, University of Wyoming, Laramie, WY 82071, USA
| | - Qin Zhu
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA.
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Cross J, Kung SM, Welch N. Assessing the reliability of biomechanical variables during a horizontal deceleration task in healthy adults. J Sports Sci 2024; 42:263-269. [PMID: 38484285 DOI: 10.1080/02640414.2024.2327874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/01/2024] [Indexed: 04/23/2024]
Abstract
Horizontal deceleration technique is an underpinning factor to musculoskeletal injury risk and performance in multidirectional sport. This study primarily assessed within- and between-session reliability of biomechanical and performance-based aspects of a horizontal deceleration technique and secondarily investigated the effects of limb dominance on reliability. Fifteen participants completed four horizontal decelerations on each leg during test and retest sessions. A three-dimensional motion analysis system was used to collect kinetic and kinematic data. Completion time, ground contact time, rate of horizontal deceleration, minimum centre of mass height, peak eccentric force, impulse ratio, touchdown distance, sagittal plane foot and knee angles at initial contact, maximum sagittal plane thorax angle, and maximum knee flexion moment were assessed. Coefficients of variation (COV) and intraclass correlation coefficients (ICC) were used to assess within- and between-session reliability, respectively. Seven variables showed "great" within-session reliability bilaterally (COV ≤9.13%). ICC scores were 'excellent' (≥0.91; n = 4), or 'good' (0.76-0.89; n = 7), bilaterally. Limb dominance affected five variables; three were more reliable for the dominant leg. This horizontal deceleration task was reliable for most variables, with little effect of limb dominance on reliability. This deceleration task may be reliably used to assess and track changes in deceleration technique in healthy adults.
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Affiliation(s)
- Joshua Cross
- Sports Medicine Department, UPMC Sports Surgery Clinic, Dublin, Ireland
| | - Stacey M Kung
- Sports Medicine Department, UPMC Sports Surgery Clinic, Dublin, Ireland
| | - Neil Welch
- Sports Medicine Department, UPMC Sports Surgery Clinic, Dublin, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Högberg J, Piussi R, Wernbom M, Della Villa F, Simonsson R, Samuelsson K, Thomeé R, Hamrin Senorski EH. No Association Between Hamstrings-to-Quadriceps Strength Ratio and Second ACL Injuries After Accounting for Prognostic Factors: A Cohort Study of 574 Patients After ACL-Reconstruction. SPORTS MEDICINE - OPEN 2024; 10:7. [PMID: 38212594 PMCID: PMC10784243 DOI: 10.1186/s40798-023-00670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The stress on the anterior cruciate ligament (ACL) induced by the quadriceps can be attenuated by activation of the hamstrings by exerting an opposing torque to the anterior translation of tibia. Consequently, considering the ratio between strength of the hamstrings-to-quadriceps (HQ-ratio) may be of value to reduce the odds of second ACL injuries. The objective was therefore to evaluate (1) the association between HQ-ratio and the occurrence of a second ACL injury in patients after ACL-reconstruction within 2 years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL reconstruction. METHODS Patients who had undergone primary ACL reconstruction and participated in knee-strenuous activity preinjury were included. Demographics, the occurrence of a second ACL injury, and muscle strength test results before returning to preinjury sport level were extracted from a rehabilitation registry. The endpoint was set at a second ACL injury or 2 years after return to preinjury sport level. A multivariable logistic regression was used to analyze the association between the HQ-ratio and a second ACL injury. RESULTS A total of 574 patients (50.0% female) with a mean age of 24.0 ± 9.4 years at primary ACL reconstruction were included. In the univariable logistic regression analysis, the odds of sustaining a second ACL injury decreased by 3% for every 1% increase in the HQ-ratio (OR 0.97 [95% CI 0.95-1.00], p = 0.025). After adjusting for the time from reconstruction to return to preinjury sport level, sex, preinjury sport level, graft choice, age, and body mass index, the results were no longer significant (OR 0.98 [95% CI 0.95-1.01], p = 0.16). Females had a higher HQ-ratio compared with males for both the ACL-reconstructed and uninjured side (3.7% [95% CI 5.7; 1.8%], p = 0.0002 and 3.3% [95% CI 4.6; 2.1], p < 0.001, respectively). CONCLUSION The HQ-ratio did not significantly affect the odds for sustaining a second ACL injury upon return to preinjury sports level after primary ACL reconstruction. Females had a significant higher HQ-ratio than males for both the ACL reconstructed and uninjured side.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- The Rydberg Laboratory for Applied Sciences, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Eric Hamrin Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
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Schaefer LV, Dech S, Carnarius F, Rönnert F, Bittmann FN, Becker R. Adaptive Force of hamstring muscles is reduced in patients with knee osteoarthritis compared to asymptomatic controls. BMC Musculoskelet Disord 2024; 25:34. [PMID: 38178020 PMCID: PMC10768123 DOI: 10.1186/s12891-023-07133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Quadriceps strength deficits are known for patients with knee osteoarthritis (OA), whereas findings on hamstrings are less clear. The Adaptive Force (AF) as a special neuromuscular function has never been investigated in OA before. The maximal adaptive holding capacity (max. isometric AF; AFisomax) has been considered to be especially vulnerable to disruptive stimuli (e.g., nociception). It was hypothesized that affected limbs of OA patients would show clear deficits in AFisomax. METHODS AF parameters and the maximal voluntary isometric contraction (MVIC) of hamstrings were assessed bilaterally comparing 20 patients with knee OA (ART) vs. controls (CON). AF was measured by a pneumatically driven device. Participants were instructed to maintain a static position despite an increasing load of the device. After reaching AFisomax, the hamstrings merged into eccentric action whereby the force increased further to the maximum (AFmax). MVIC was recorded before and after AF trials. Mixed ANOVA was used to identify differences between and within ART and CON (comparing 1st and 2nd measured sides). RESULTS AFisomax and the torque development per degree of yielding were significantly lower only for the more affected side of ART vs. CON (p ≤ 0.001). The percentage difference of AFisomax amounted to - 40%. For the less affected side it was - 24% (p = 0.219). MVIC and AFmax were significantly lower for ART vs. CON for both sides (p ≤ 0.001). Differences of MVIC between ART vs. CON amounted to - 27% for the more, and - 30% for the less affected side; for AFmax it was - 34% and - 32%, respectively. CONCLUSION The results suggest that strength deficits of hamstrings are present in patients with knee OA possibly attributable to nociception, generally lower physical activity/relief of lower extremities or fear-avoidance. However, the more affected side of OA patients seems to show further specific impairments regarding neuromuscular control reflected by the significantly reduced adaptive holding capacity and torque development during adaptive eccentric action. It is assumed that those parameters could reflect possible inhibitory nociceptive effects more sensitive than maximal strengths as MVIC and AFmax. Their role should be further investigated to get more specific insights into these aspects of neuromuscular control in OA patients. The approach is relevant for diagnostics also in terms of severity and prevention.
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Affiliation(s)
- Laura V Schaefer
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany.
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany.
| | - Silas Dech
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Friederike Carnarius
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Florian Rönnert
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Frank N Bittmann
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Roland Becker
- Department of Orthopedics and Traumatology, University Hospital Brandenburg, Brandenburg an der Havel, Berlin, Germany
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Jadidi S, Lee AD, Pierko EJ, Choi H, Jones NS. Non-operative Management of Acute Knee Injuries. Curr Rev Musculoskelet Med 2024; 17:1-13. [PMID: 38095838 PMCID: PMC10767052 DOI: 10.1007/s12178-023-09875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach. RECENT FINDINGS Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1 year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.
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Affiliation(s)
- Shaheen Jadidi
- Department of Orthopedics, Edward-Elmhurst Health, Naperville, IL, USA
| | - Aaron D Lee
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Eliza J Pierko
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Haemi Choi
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Nathaniel S Jones
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA.
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Siegel DN, Ogle MM, Wilson C, Scholes O, Prow A, Mannen EM. How do babies roll? Identifying the coordinated movements of infant rolling through video compared to laboratory techniques. Technol Health Care 2024; 32:2527-2539. [PMID: 38251079 PMCID: PMC11222302 DOI: 10.3233/thc-231281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Rolling is an important developmental milestone for infants where identifying the coordinated movement patterns could facilitate the early identification of motor development delays. Current methods for identifying coordinated movements of rolling are limited to a laboratory setting and not feasible for clinicians. OBJECTIVE To develop video-based methods in which six coordinated movements, previously defined through motion capture, can be identified through video alone. METHODS Forty-five videos of sixteen healthy infants achieving a roll were used to develop the video-based methodology and twenty-four videos had corresponding motion capture data used for validation. Four raters comprised of researchers and a clinician identified rolling coordination using the new video-based methods. A Fleiss' Kappa statistical test determined the inter- and intra-rater reliability of agreement for the new methodology and compared it to motion capture. RESULTS The comparison of the motion capture and video-based methods resulted in substantial agreement. The video-based methods inter- and intra-rater reliability were substantial and almost perfect, respectively. CONCLUSIONS We developed reliable methodology to accurately identify the coordinated movements of infant rolling using only 2D video. This methodology will allow researchers to reliably define coordinated movements of infants through video alone and may assist clinicians in identifying possible motor development delays and disorders.
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Affiliation(s)
- Danielle N. Siegel
- Biomedical Engineering Doctoral Program, Boise State University, Boise, ID, USA
| | - Melissa M. Ogle
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID, USA
| | - Christopher Wilson
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID, USA
| | - Olivia Scholes
- Idaho College of Osteopathic Medicine, Meridian, ID, USA
| | - Abby Prow
- Idaho College of Osteopathic Medicine, Meridian, ID, USA
| | - Erin M. Mannen
- Biomedical Engineering Doctoral Program, Boise State University, Boise, ID, USA
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID, USA
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Hoenig T, Rahlf L, Wilke J, Krauß I, Dalos D, Willwacher S, Mai P, Hollander K, Fohrmann D, Krosshaug T, Gronwald T. Appraising the Methodological Quality of Sports Injury Video Analysis Studies: The QA-SIVAS Scale. Sports Med 2024; 54:203-211. [PMID: 37632664 PMCID: PMC10799118 DOI: 10.1007/s40279-023-01907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Video analysis (VA) is commonly used in the assessment of sports injuries and has received considerable research interest. Until now, no tool has been available for the assessment of study quality. Therefore, the objective of this study was to develop and evaluate a valid instrument that reliably assesses the methodological quality of VA studies. METHODS The Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) scale was developed using a modified Delphi approach including expert consensus and pilot testing. Reliability was examined through intraclass correlation coefficient (ICC3,1) and free-marginal kappa statistics by three independent raters. Construct validity was investigated by comparing QA-SIVAS with expert ratings by using Kendall's tau analysis. Rating time was studied by applying the scale to 21 studies and computing the mean time for rating per study article. RESULTS The QA-SIVAS scale consists of an 18-item checklist addressing the study design, data source, conduct, report, and discussion of VA studies in sports injury research. Inter- and intra-rater reliability were excellent with ICCs > 0.97. Expert ratings revealed a high construct validity (0.71; p < 0.001). Mean rating time was 10 ± 2 min per article. CONCLUSION QA-SIVAS is a reliable and valid instrument that can be easily applied to sports injury research. Future studies in the field of VA should adhere to standardized methodological criteria and strict quality guidelines.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lina Rahlf
- Department of Exercise Physiology, Institute of Sports Science, Europa-Universität Flensburg, Flensburg, Germany
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Inga Krauß
- Department of Sports Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Dimitris Dalos
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- UKE Athleticum, Center for Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | - Patrick Mai
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Dominik Fohrmann
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Tron Krosshaug
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany.
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Mofateh R, Kiani Haft Lang M, Orakifar N, Goharpey S. Response to "Comment on: Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study". J Sport Rehabil 2024; 33:3-4. [PMID: 37939702 DOI: 10.1123/jsr.2023-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Razieh Mofateh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Kiani Haft Lang
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Orakifar
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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63
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Wen C, Zhang Y, Xu X. Examining the Distribution of Bone Bruise Patterns in Contact and Noncontact Acute Anterior Cruciate Ligament Injuries: Letter to the Editor. Am J Sports Med 2023; 51:NP59. [PMID: 38031751 DOI: 10.1177/03635465231198496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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Della Villa F, Massa B, Bortolami A, Nanni G, Olmo J, Buckthorpe M. Injury mechanisms and situational patterns of severe lower limb muscle injuries in male professional football (soccer) players: a systematic video analysis study on 103 cases. Br J Sports Med 2023; 57:1550-1558. [PMID: 37898508 DOI: 10.1136/bjsports-2023-106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE The objective of this study is to describe the mechanism of injury and situational patterns (based on ball possession and playing action leading to injury) of severe (lay-off time >28 days) lower limb muscle injuries in professional male football (soccer) players during match play. METHODS Players experiencing a severe muscle injury of the lower limb during Italian first (Serie A) division male football matches over three consecutive seasons (2018-2021) were identified. Video footage was obtained and three raters independently categorised injury mechanism and situational patterns using a standardised checklist. Injury epidemiology (month), timing of injuries within the match and location of injuries on the pitch were also examined. RESULTS We identified 121 lower limb severe muscle injuries. Videos of sufficient quality were available for 103 (85%) cases, including 61 (60%) hamstring, 17 (16%) calf, 16 (15%) adductor and 9 (9%) quadricep muscle injuries. Nearly two-thirds of injuries involved the dominant/kicking leg (n=65, 63%). Eighty-five (83%) injuries were non-contact and 18 (17%) indirect contact. Four main situational patterns were identified and accounted for 88% of injuries: (1) running/acceleration (n=35, 34%); (2) closed kinetic chain stretching (n=21, 20%); (3) open kinetic chain stretching (n=19, 18%) and (4) kicking (n=16, 16%), with differences between muscle groups. 71% of injuries occurred in the first half of the match (p<0.01), with a gradual increase through the first half. CONCLUSION Most severe muscle injuries during football matches were non-contact and occurred in the first half during running/acceleration, open and closed kinetic chain stretching, or kicking.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Bruno Massa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Antonio Bortolami
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gianni Nanni
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Jesus Olmo
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
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Fältström A, Kvist J, Hägglund M. Are We Jumping to the Wrong Conclusions? Longer Jumps and More Hops in Female Football Players Who Went on to Sustain a Primary or Secondary ACL Injury Compared to Those Who Did Not. SPORTS MEDICINE - OPEN 2023; 9:105. [PMID: 37947959 PMCID: PMC10638330 DOI: 10.1186/s40798-023-00656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Different functional performance tests are used to assess patients in the clinic and before return to sport (RTS), where the rehabilitation goal is to reach good strength and jumping ability. A limb symmetry index of ≥ 90% is a common target in rehabilitation before RTS. The aim of this short communication is to use data from our 2-year prospective cohort study on female football players, either with or without an anterior cruciate ligament (ACL) reconstruction, to discuss whether hop performance in 3 commonly used hop tests can inform safe football participation, that is, with a low risk for ACL injury or reinjury. METHOD At baseline, 117 active female football players (mean age ± standard deviation, 20 ± 2 years) were included 19 ± 9 months after ACL reconstruction as well as 119 matched female knee-healthy players (age 19 ± 3 years). All players performed a single hop for distance test, 5-jump test and side hop test at baseline and were then prospectively followed for 2 years. Twenty-eight (24%) players sustained a second ACL injury and 8 (7%) sustained a primary ACL injury. RESULTS Longer jumps in the 5-jump test (922 cm vs. 865 cm, Cohen's d = - 0.60) and more hops in the side hop test for both limbs (41-42 hops vs. 33-36 hops, d = - 0.43 to - 0.60) were seen in players who sustained a second ACL injury compared with those who did not. Longer jumps in the single hop for distance test (both limbs) (139-140 cm vs. 124-125 cm, d = - 0.38 to - 0.44), in the 5-jump test (975 cm vs. 903 cm, d = -0.42) and more hops in the side hop test (both limbs) (48-49 hops vs. 37-38 hops, d = - 0.38 to - 0.47) were seen in players who sustained a primary ACL injury compared with those who did not. CONCLUSIONS The average hop performance, i.e. longer jumps or more hops, was greater in players who went on to sustain a primary or secondary ACL injury compared to those who did not over a two-year follow-up period. Even though hop tests are not used in isolation to evaluate readiness to RTS, their interpretation needs consideration in the decision-making process of returning to pivoting sports.
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Affiliation(s)
- Anne Fältström
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
- Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, 551 85, Jönköping, Sweden.
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Bertozzi F, Fischer PD, Hutchison KA, Zago M, Sforza C, Monfort SM. Associations Between Cognitive Function and ACL Injury-Related Biomechanics: A Systematic Review. Sports Health 2023; 15:855-866. [PMID: 36680310 PMCID: PMC10606969 DOI: 10.1177/19417381221146557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
CONTEXT Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements? OBJECTIVE To evaluate the association between cognitive function and biomechanics related to ACL injuries during cognitively challenging sports movements. DATA SOURCES PubMed (MEDLINE), Web of Science, Scopus, and SciELO databases were searched; additional hand searching was also conducted. STUDY SELECTION The following inclusion criteria had to be met: participants completed (1) a neurocognitive test, (2) a cognitively challenging sport-related task involving lower limbs, and (3) a biomechanical analysis. The following criteria determined exclusion from the review: studies involving participants with (1) recent or current musculoskeletal injuries; (2) recent or current concussion; (3) ACL surgical reconstruction, reviews of the literature, commentary or opinion articles, and case studies. STUDY DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement and registered at the International Prospective Register of Systematic Reviews (PROSPERO). LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Two of authors independently extracted data and assessed the methodological quality of the articles with the Downs and Black and ROBINS-I checklists, to assess methodological quality and risk of bias, respectively. RESULTS Six studies with different methodologies and confounding factors were included in this review. Of these 6 studies, 3 were ranked as high-quality, 3 demonstrated a low risk of bias, 2 a moderate risk, and 1 a severe risk. Five studies found a cognitive-motor relationship, with worse cognitive performance associated with increased injury risk, with 1 study reporting the opposite directionality for 1 variable. One study did not identify any interaction between cognitive function and biomechanical outcomes. CONCLUSION Worse cognitive performance is associated with an increased injury risk profile during cognitively challenging movements.
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Affiliation(s)
- Filippo Bertozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
- E4Sport Laboratory, Politecnico di Milano, Milan, Italy
| | - Patrick D. Fischer
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana
| | | | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Scott M. Monfort
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana
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Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med 2023; 57:1395-1399. [PMID: 37648410 DOI: 10.1136/bjsports-2023-107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation. METHODS NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively. RESULTS Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5). CONCLUSION Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.
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Affiliation(s)
- Vikram S Gill
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sayi P Boddu
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Almeida GPL, Albano TR, Rodrigues CAS, Tavares MLA, de Paula Lima PO. _Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2023; 31:5087-5095. [PMID: 37728760 DOI: 10.1007/s00167-023-07559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the combinations of variables that comprise the biopsychosocial model domains to identify clinical profiles of risk and protection of second anterior cruciate ligament injury. METHODS One hundred and forty-five patients for return-to-sport testing after anterior cruciate ligament (ACL) reconstruction (ACLR) were contacted, and 97 were deemed eligible. All were evaluated between 6 and 24 months and followed up for 2 years. Participants answered the International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), performed the postural stability assessment using the Biodex Balance System, and assessed muscle strength at 60° and 300°/s on the isokinetic dynamometer. Personal factors (age, gender, body mass index), body structures (graft type and concomitant injuries), and environmental factors (time between surgery and evaluation) were also collected. The participants were asked about the occurrence of a second ACL injury and return to sport after 2 years of follow-up. Classification and regression tree (CART) analysis was used to determine predictors of a second ACL injury. The receiver operating characteristic (ROC) curve was performed to verify the accuracy of the CART analysis, in addition to the sensitivity, specificity, and relative risk (RR) of the model. RESULTS Of the initial 97 participants, 88 (89.8%) responded to follow-up and 14 (15.9%) had a second ACL injury (11 graft ruptures and three contralateral ACL). CART analysis identified the following variables as predictors of second ACL injury: return to sport, hamstring strength symmetry at 300°/s, ACL-RSI score, hamstrings/quadriceps ratio at 60°/s, and body mass index (BMI). CART correctly identified 9 (64.3%) of the 14 participants who were reinjured and 71 (95.9%) of the 74 participants who were not. The total correct classification was 90.9%. The area under the ROC curve was 0.88 (95% CI 0.72-0.99; p < 0.001), and the model showed a sensitivity of 75% (95% CI 42.8-94.5), specificity of 93.4% (95% CI 85.3-97.8), and RR of 15.9 (95% CI 4.9-51.4; p < 0.0001). CONCLUSION The combination of hamstring strength symmetry, hamstring/quadriceps ratio (body functions); return to sport (activity and participation); psychological readiness; and BMI (personal factors) could identify three clinical risk profiles for a second ACL injury with good accuracy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil.
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Thamyla Rocha Albano
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Larissa Azevedo Tavares
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
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Westheim F, Gløersen Ø, Harper D, Laugsand H, Eriksrud O. Reliability of phase-specific outcome measurements in change-of-direction tests using a motorized resistance device. Front Sports Act Living 2023; 5:1212414. [PMID: 37936876 PMCID: PMC10626501 DOI: 10.3389/fspor.2023.1212414] [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: 04/26/2023] [Accepted: 08/30/2023] [Indexed: 11/09/2023] Open
Abstract
This study aims to determine test-retest reliability of phase-specific information during initial acceleration, deceleration, and re-acceleration phases of different change-of-direction (CoD) tests using a motorized resistance device (MRD). A total of 21 participants (16 males and five females, with mean age of 22.3 ± 3.9 years, body mass of 75.2 ± 6.9 kg, height of 177.9 ± 6.8 cm) completed the modified 505 (m505), 10-0-5, and 15-0-5 CoD tests on four different test sessions while exposed to an external load (3 kg) provided by the MRD. Outcome variables included overall and phase-specific kinetic (force, power, and impulse) and kinematic (time, distance, velocity, and acceleration/deceleration) data during the initial acceleration, deceleration, and re-acceleration phases. The deceleration and re-acceleration phases were further divided into two subphases, namely, early and late subphases, using 50% of maximum velocity. Reliability was assessed using an intraclass correlation coefficient (ICC), coefficient of variation (CV), typical error (TE), and minimal detectable change (MDC). Good to excellent ICC values (>0.75) and acceptable (<10%) to good (<5%) CV values were observed for most outcome measurements. Specifically, 80.1% (822 out of 1,026) of all variables showed good or better relative reliability (i.e., ICC ≥ 0.75), while 97.0% (995 out of 1,026) of all variables showed acceptable or better absolute reliability (i.e., CV < 10%). In conclusion, the present study demonstrates that the MRD can obtain reliable phase-specific outcome measurements across different CoD tests, providing coaches and researchers with new opportunities to advance our understanding of CoD ability and inform more advanced CoD training prescriptions.
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Affiliation(s)
- Frederic Westheim
- Biomechanics Laboratory, Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Øyvind Gløersen
- Biomechanics Laboratory, Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Damian Harper
- School of Sport and Health Sciences, Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom
| | - Håkon Laugsand
- Biomechanics Laboratory, Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ola Eriksrud
- Biomechanics Laboratory, Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Saito T, Matsumura N, Kawamoto S, Doi N, Aoyama T, Nagai-Tanima M. Analyses of actions which cause anterior cruciate ligament injuries in the national basketball association players: YouTube-based video analyses. BMC Sports Sci Med Rehabil 2023; 15:130. [PMID: 37828552 PMCID: PMC10571282 DOI: 10.1186/s13102-023-00747-8] [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: 08/22/2022] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are among the most common injuries in the National Basketball Association (NBA), and it is important to investigate the actual nature of the injury because it can impair a player's performance after returning to the game. Although the moment of injury has been investigated, the details of the movements and circumstances leading to injury in basketball games are unknown. This study aimed to clarify the actions leading to ACL injuries and to investigate their characteristics, based on YouTube video analyses of the NBA players. METHODS Players with ACL injuries in the NBA were identified through web-based research over 10 seasons (2011/2012-2021/2022, through October 2021), with 29 recorded videos of ACL injuries in the NBA. Actions were categorized based on basketball-specific gestures, and determined whether the player was in contact with an opponent or not and, if so, the location of the contact was analyzed focusing on two time points: at the injury frame (IF) and one step before the injury frame (IF-1). The "injury leg" timing was counted for each of the first and second steps after ball possession. RESULTS The majority (68.2%) of ACL injury occurred during the 2 steps phase (only two steps can proceed after ball retention in basketball, so we defined them as two steps) in the offense action, and most notably during the first step (80.0%). 73.3% of players who were injured during the 2 steps phase got contact to an area other than the knee (Indirect contact) at the IF-1, with 81.8% of contact being located in the upper body contralateral to the respective knee injury. The probability of players with ACL injuries during the 2 steps at the IF-1 who got Indirect contact was statistically significantly greater than those who got no contact with other players (p = 0.042). CONCLUSIONS We argue that including pre-injury play and contact falls into the novelty category. Through YouTube-based video analyses, this study revealed that ACL injuries tend to be characterized by specific types of actions, the timing of contact, and the location of contact in NBA players.
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Affiliation(s)
- Takanobu Saito
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Natsuki Matsumura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Shinichi Kawamoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Naoki Doi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Tomoki Aoyama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Momoko Nagai-Tanima
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan.
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71
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Shibata S, Takemura M, Miyakawa S. Kinematics, Kinetics and Muscle Activity Analysis during Single-leg Drop-jump Landing Followed by an Unanticipated Task: Focusing on Differences in Neurocognitive Function. Int J Sports Phys Ther 2023; 18:1085-1093. [PMID: 37795316 PMCID: PMC10547070 DOI: 10.26603/001c.86124] [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: 01/19/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Lower neurocognitive function is a risk factor for anterior cruciate ligament (ACL) injury. However, the mechanism by which lower neurocognitive function increases the risk of ACL injury remains unclear. Purpose To clarify the effect of differences in neurocognitive function on landing mechanics during a single-leg drop-jump landing motion followed by an unanticipated task. Study Design Cross-sectional study. Methods Fifteen collegiate female athletes were recruited (20.1 ± 1.3 years, 166.6 ± 7.3 cm, 60.6 ± 6.9 kg) and were divided into two groups (the high-performance (HP) group and the lower-performance (LP) group) using the median Symbol Digit Modalities Test (SDMT) score. Three-dimensional motion analysis was employed for the analysis during the experimental task of a single-leg drop-jump followed by an unanticipated landing task from a 30-cm high box. Joint angular changes of the trunk, pelvis, hip, and knee were calculated within the interval from initial contact (IC) to 40ms. Knee and hip moments were calculated as the maximum values within the interval from IC to 40ms. Surface electromyography data from key muscles were analyzed 50ms before and after IC. Independent t-tests were used to compare the effects of different neurocognitive function on the measurement items. Statistical significance was set at p < 0.05. Results The SDMT score was significantly higher in HP group (HP: 77.9 ± 5.5; LP: 66.0 ± 3.4; p < 0.001). The LP group had a significantly greater trunk rotation angular change to the stance leg side (HP: 0.4 ± 0.8; LP: 1.2 ± 0.4; p = 0.020). There were no significant differences between the two groups in terms of joint moments, and muscle activities. Conclusion Differences in neurocognitive function by SDMT were found to be related to differences in motor strategies of the trunk in the horizontal plane. Although trunk motion in the sagittal and frontal planes during single-leg drop-jump landing increases the ACL injury risk by affecting knee joint motion, the effect of trunk motion in the horizontal plane remains unclear. Level of Evidence 3© The Authors.
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72
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Jokela A, Mechó S, Pasta G, Pleshkov P, García-Romero-Pérez A, Mazzoni S, Kosola J, Vittadini F, Yanguas J, Pruna R, Valle X, Lempainen L. Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings. Clin J Sport Med 2023; 33:475-482. [PMID: 36853900 PMCID: PMC10467807 DOI: 10.1097/jsm.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/01/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To describe injury mechanisms and magnetic resonance imaging (MRI) findings in acute rectus femoris (RF) injuries of soccer players using a systematic video analysis. DESIGN Descriptive case series study of consecutive RF injuries from November 2017 to July 2022. SETTING Two specialized sports medicine hospitals. PARTICIPANTS Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after a RF injury, with an available video footage of the injury and a positive finding on an MRI. INDEPENDENT VARIABLES Rectus femoris injury mechanisms (specific scoring based on standardized models) in relation to RF muscle injury MRI findings. MAIN OUTCOME MEASURES Rectus femoris injury mechanism (playing situation, player/opponent behavior, movement, and biomechanics), location of injury in MRI. RESULTS Twenty videos of RF injuries in 19 professional male soccer players were analyzed. Three different injury mechanisms were seen: kicking (80%), sprinting (10%), and change of direction (10%). Isolated single-tendon injuries were found in 60% of the injuries. Of the kicking injuries, 62.5% included complete tendon ruptures, whereas both running injuries and none of the change of direction injuries were complete ruptures. The direct tendon was involved in 33% of the isolated injuries, and the common tendon was affected in all combined injuries. CONCLUSIONS Rectus femoris injuries typically occur during kicking among football players. Most of the RF injuries involve a complete rupture of at least one tendon. Kicking injuries can also affect the supporting leg, and sprinting can cause a complete tendon rupture, whereas change of direction seems not to lead to complete ruptures.
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Affiliation(s)
- Aleksi Jokela
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Sandra Mechó
- FC Barcelona, Medical Department, Barcelona, Spain
| | | | | | - Alvaro García-Romero-Pérez
- Watford FC, Injury Prevention and Rehabilitation Department, Watford, England
- Physiotherapy Department, Universidad Camilo José Cela, Madrid, Spain
| | | | - Jussi Kosola
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
- Department of Orthopaedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | | | | | - Ricard Pruna
- FC Barcelona, Medical Department, Barcelona, Spain
| | - Xavier Valle
- FC Barcelona, Medical Department, Barcelona, Spain
| | - Lasse Lempainen
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
- FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland; and
- Ripoll y De Prado, FIFA Medical Centre of Excellence, Madrid, Spain
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73
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Di Paolo S, Grassi A, Bragonzoni L, Zaffagnini S, Della Villa F. Foot rotation and pelvic angle correlate with knee abduction moment during 180° lateral cut in football players. Knee 2023; 43:81-88. [PMID: 37295045 DOI: 10.1016/j.knee.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/12/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lateral movements are challenging for 2D video-analysis and are therefore often omitted in functional tests for Anterior Cruciate Ligament (ACL) injury risk assessment. The purpose of the present study was to investigate the association between frontal and transverse plane angles obtained from 2D video-analysis and knee abduction moment (KAM) from gold standard 3D motion capture in a 180° lateral cut task. The hypothesis was that 2D angles other than the knee joint effectively explain variations in KAM. METHODS Thirty-four healthy football players (age 22.8 ± 4.1 years) performed a series of 180° lateral cut (lateral shuffles) tasks. The peak KAM was collected through a 3D motion capture system. A 2D video-analysis movement assessment identified frontal and transverse plane joint kinematics: foot projection angle (FPA), Frontal Plane Knee Projection Angle (FPKPA), Pelvis tilt angle (PA), and Trunk tilt angle (TA). A forward stepwise regression model was used to assess significant 2D predictors of KAM (p < 0.05). RESULTS FPA and PA were the only significant predictors (R2-ajdusted = 9.2%, p < 0.001), with external foot rotation and contralateral pelvic drop associated with higher KAM. Based on the regression model, the "High FPA & PA group" was defined and showed higher KAM than the rest of the cohort (p = 0.012, ES = 0.71). CONCLUSIONS The external foot rotation and the contralateral pelvic drop from 2D video-analysis were associated with higher peak KAM during the 180° lateral cut. A qualitative assessment of the 180° lateral cut could offer precious insights on ACL injury risk mitigation. LEVEL OF EVIDENCE Descriptive Laboratory Study.
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, Bologna, Italy.
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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74
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Di Paolo S, Grassi A, Tosarelli F, Crepaldi M, Bragonzoni L, Zaffagnini S, Della Villa F. Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players. Int J Sports Phys Ther 2023; 18:887-897. [PMID: 37547837 PMCID: PMC10399106 DOI: 10.26603/001c.84308] [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: 04/20/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis. Study Design Prospective cohort study. Methods Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered. Results Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 - 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 - 0.042), ankle eversion, and contralateral pelvic drop (p<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45). Conclusions Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it. Level of Evidence 3©The Author(s).
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Affiliation(s)
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic Istituto Ortopedico Rizzoli
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75
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Farinelli L, Csapo R, Meena A, Abermann E, Hoser C, Fink C. Concomitant Injuries Associated With ACL Rupture in Elite Professional Alpine Ski Racers and Soccer Players: A Comparative Study With Propensity Score Matching Analysis. Orthop J Sports Med 2023; 11:23259671231192127. [PMID: 37655251 PMCID: PMC10467387 DOI: 10.1177/23259671231192127] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/03/2023] [Indexed: 09/02/2023] Open
Abstract
Background For elite professional soccer players and alpine skiers, injuries associated with anterior cruciate ligament (ACL) rupture, such as meniscal, cartilage, or collateral ligament lesions, could result in a delayed return to sport compared with isolated ACL injury. Purpose/Hypothesis The purpose of the study was to provide a detailed description of associated injuries at the time of primary ACL reconstruction in elite soccer players and alpine skiers. It was hypothesized that soccer players and skiers would present different typical injury patterns due to different injury mechanisms. Study Design Cohort study; Level of evidence, 3. Methods Surgical reports and arthroscopic images of elite professional soccer players and alpine skiers who underwent primary ACL reconstruction at a single institution between January 2010 and June 2022 were analyzed retrospectively. The presence and location of multiligamentous injury, meniscal tears, and chondral lesions were compared between the athlete groups. A propensity score matching analysis with 1:1 ratio was performed between skiers and soccer players to limit the effect of selection bias. Results Included were ACL reconstruction data representative of 37 soccer players and 44 alpine skiers. Meniscal pathology was found in 32 (86%) soccer players and 30 (68%) skiers. Chondral injuries were reported in 11 (30%) soccer players and 15 (34%) skiers. Results of the propensity score matching analysis in 15 pairs of soccer players and skiers indicated that soccer players had a significantly higher rate of medial meniscal injuries (73% vs 27%; P = .03) and lateral posterior root tears (33% vs 0%; P = .04) compared with skiers. Conclusion A higher prevalence of combined chondral and meniscal injuries versus isolated ACL injuries was observed in both groups of athletes. Professional soccer players were characterized by higher prevalence of medial meniscal tears and lateral posterior root lesions compared with professional alpine skiers.
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Affiliation(s)
- Luca Farinelli
- Department of Clinical and Molecular Sciences, Clinical Orthopaedics, Ancona, Italy
| | - Robert Csapo
- Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Amit Meena
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
| | - Elisabeth Abermann
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
| | - Christian Hoser
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
| | - Christian Fink
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
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Jorge PB, Jorge RB, de Oliveira DE, Helito CP, da Silva LNM, Sato FT, Brito DS, Possebom I. Magnetic resonance imaging of the knee anteromedial quadrant. BMC Musculoskelet Disord 2023; 24:596. [PMID: 37475015 PMCID: PMC10357810 DOI: 10.1186/s12891-023-06732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the possibility of characterizing an extra-articular thickening in the knee anteromedial quadrant in routine MRI scans. MATERIALS AND METHODS Firstly, in a pilot study, for a better understanding of this extra-articular thickening trajectory in MRI, polytetrafluoroethylene (PTFE) tubes were attached to the ligament structure topography in two dissected pieces. Afterward, 100 knee MRI studies were randomly selected from our database, and 97 met the inclusion criteria. Two musculoskeletal radiologists interpreted the exams separately. Both had previously studied the ligament in the cadaveric knee MRI with the PTFE tube. RESULTS The intraobserver and interobserver agreement for the ligament identification was calculated using Cohen's Kappa coefficient. The first radiologist identified the structure in 41 of the 97 scans (42.2%), and the second radiologist in 38 scans (39.2%). The interobserver agreement was substantial, with a Kappa of 0.68 and an agreement of 84.5%. The results suggest that this extra-articular thickening, recently called Anterior Oblique Ligament (AOL) in the literature, is a structure that can be frequently visualized on MRI scans with a high level of interobserver agreement in a relatively large number of exams. CONCLUSION Therefore, this study indicates that MRI is a promising method for evaluating this anteromedial thickening, and it may be used for future studies of the Anterior Oblique Ligament.
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Affiliation(s)
- Pedro Baches Jorge
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
| | | | | | - Camilo Partezani Helito
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Igor Possebom
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Pillay L, Janse van Rensburg DC, Ramkilawon G, Maas M, Orhant E, Rantanen J, Salo J, Kerkhoffs G, Gouttebarge V. Determination of the Prevalence of Knee and Hip Clinical Osteoarthritis in the Active Professional Male Footballer and Its Association with Pain, Function, Injury and Surgery. Sports (Basel) 2023; 11:136. [PMID: 37505623 PMCID: PMC10385669 DOI: 10.3390/sports11070136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To comment on and explore (1) the prevalence of clinical knee and hip osteoarthritis (OA); (2) the association between pain or function and clinical knee or hip OA; (3) the association between injury or surgery and clinical knee or hip OA. METHODS Participants were recruited from FIFPRO members. A total of 101 footballers consented to answer (1) a developed questionnaire, (2) patient-reported outcome measures, and (3) be evaluated by their team physician for clinical knee or hip OA. RESULTS Of the 53% evaluated for clinical knee and hip OA, a prevalence of 9.43% and 7.55% of knee and hip OA, respectively, was found. There was a significant and strong association between knee (p = 0.033; Cramers v Value = 0.523) and hip pain (p = 0.005; Cramers v Value = 0.602) and clinical OA. A significant association existed between Hip dysfunction and Osteoarthritis Outcome short form Scores and clinical OA of the hip (p = 0.036). The odds of clinical knee OA were 1.5 and 4.5 times more after one or more injuries or surgeries, respectively. There was no association between playing position and clinical OA. CONCLUSION There is a low prevalence of a clinical knee or hip OA in the active professional male footballer. Pain may be a valid symptom to predict or monitor knee or hip OA. Validated assessment tools should be utilised to identify a negative effect on function. The odds of developing clinical OA in the knee with the number of injuries or surgeries. The hip presents with earlier clinical signs of OA compared to the knee.
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Affiliation(s)
- Lervasen Pillay
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Dina C. Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Gopika Ramkilawon
- Department of Statistics, University of Pretoria, Pretoria 0028, South Africa
| | - Mario Maas
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
| | - Emmanuel Orhant
- French Football Federation (FFF), Clairefontaine Medical Centre, FIFA Medical Center of Excellence, 93216 Clairefontaine, France
| | - Jussi Rantanen
- Orthopaedics and Sports Clinic, Mehilainen NEO Hospital, 20520 Turku, Finland
| | - Jari Salo
- Sports Hospital Mehilainen, 41400 Helsinki, Finland
| | - Gino Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
- Football Players Worldwide (FIFPRO), 2132 Hoofddorp, The Netherlands
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Solie BS, Eggleston GG, Schwery NA, Doney CP, Kiely MT, Larson CM. Clinic and Home-Based Exercise with Blood Flow Restriction Resolves Thigh Muscle Atrophy after Anterior Cruciate Ligament Reconstruction with the Bone-Patellar Tendon-Bone Autograft: A Case Report. Healthcare (Basel) 2023; 11:1885. [PMID: 37444719 DOI: 10.3390/healthcare11131885] [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: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) results in thigh muscle atrophy. Of the various interventions proposed to mitigate thigh muscle atrophy, exercise with blood flow restriction (BFR) appears safe and effective. Some literature suggests daily exposure to exercise with BFR may be indicated during the early phase of ACLR rehabilitation; this case report outlines the methodology utilized to prescribe clinic- and home-based BFR within an outpatient rehabilitation program. A 15-year-old male soccer player suffered a left knee injury involving the anterior cruciate ligament and both menisci. He underwent ACLR and completed exercise with BFR as part of his clinic- and home-based rehabilitation program, which included practical blood flow restriction during home-based rehabilitation. After 16 weeks of rehabilitation, surgical limb thigh girth values were objectively larger than the non-surgical limb (surgical, 52.25 cm; non-surgical 50 cm), as well as the multi-frequency bioelectrical impedance analysis of his lower-extremity lean body mass (surgical limb, 10.37 kg; non-surgical limb, 10.02 kg). The findings of this case report suggest that the inclusion of clinic- and home-based BFR within an outpatient rehabilitation program may be indicated to resolve thigh muscle atrophy early after ACLR.
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Affiliation(s)
- Braidy S Solie
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Nicole A Schwery
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Michael T Kiely
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
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Nijmeijer EM, Elferink-Gemser MT, McCrory S, Cortes N, Benjaminse A. How to improve movement execution in sidestep cutting? Involve me and I will learn. Hum Mov Sci 2023; 90:103115. [PMID: 37329711 DOI: 10.1016/j.humov.2023.103115] [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: 06/03/2022] [Revised: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Providing choices, i.e., autonomy, to athletes during practice increases intrinsic motivation and positively influences the motor learning process. The effects of autonomy on the timing of feedback (self-controlled timing of feedback) when optimizing the movement execution of sidestep cutting (SSC), a task that is highly related with ACL injury risk, are unknown. The aim of this study was to investigate the effect of self-controlled timing of video and EF-feedback on movement execution of SSC in team sport athletes. Thirty healthy ball team sport athletes (22.9 ± 1.7 years, 185.5 ± 7.2 cm, 79.3 ± 9.2 kg) were recruited from local sports clubs. Participants were alternately assigned to the self-control (SC) or the yoked (YK) group based on arrival and performed five anticipated and five unanticipated 45° SSC trials as pre-, immediate-post and one-week retention test. Movement execution was measured with the Cutting Movement Assessment Score (CMAS). Training consisted of three randomized 45° SSC conditions: one anticipated and two unanticipated conditions. All participants received expert video instructions and were instructed to 'try to do your best in copying the movement of the expert'. The SC group was allowed to request feedback whenever they wanted during training. The feedback consisted of 1) CMAS score, 2) posterior and sagittal videos of the last trial and 3) an external focus verbal cue on how to improve their execution. The participants were told to lower their score and they knew the lower the score, the better. The YK group received feedback after the same trial on which their matched participant in the SC group had requested feedback. Data of twenty-two participants (50% in SC group) was analyzed. Pre-test and training CMAS scores between groups were equal (p > 0.05). In the anticipated condition, the SC group (1.7 ± 0.9) had better CMAS scores than the YK group (2.4 ± 1.1) at the retention test (p < 0.001). Additionally, in the anticipated condition, the SC group showed improved movement execution during immediate-post (2.0 ± 1.1) compared to pre-test (3.0 ± 1.0), which was maintained during retention (p < 0.001). The YK group also improved in the anticipated condition during immediate-post (1.8 ± 1.1) compared to pre-test (2.6 ± 1.0) (p < 0.001) but showed decreased movement execution during retention compared to immediate-post test (p = 0.001). In conclusion, self-controlled timing of feedback resulted in better learning and greater improvements in movement execution compared to the control group in the anticipated condition. Self-controlled timing of feedback seems beneficial in optimizing movement execution in SSC and is advised to be implemented in ACL injury prevention programs.
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Affiliation(s)
- Eline M Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Marije T Elferink-Gemser
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Stuart McCrory
- Sports Medicine, Assessment, Research & Testing (SMART) Laboratory, School of Kinesiology, George Mason University, 9100 Freedom Center Blvd, Manassas, VA 20110, USA.
| | - Nelson Cortes
- School of Sport, Rehabilitation, and Exercise Science, University of Essex, Colchester CO4 3WA, United Kingdom of Great Britain and Northern Ireland; Department of Bioengineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
| | - Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; School of Sport Studies, Hanze University of Applied Sciences, Zernikeplein 17, 9747 AS Groningen, The Netherlands.
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80
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Ross AG, McKay MJ, Pappas E, Peek K. Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data. J Sci Med Sport 2023:S1440-2440(23)00129-9. [PMID: 37349252 DOI: 10.1016/j.jsams.2023.06.003] [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: 01/03/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. DESIGN Descriptive epidemiological study. METHODS Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals. RESULTS Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. CONCLUSIONS Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.
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Affiliation(s)
- Andrew G Ross
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Marnee J McKay
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Evangelos Pappas
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Faculty of Science, Medicine and Health, Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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81
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Jorge PB, Horita MM, de Oliveira e Silva M, Marinho de Gusmão Canuto S, Helito CP, Escudeiro de Oliveira D. Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus' Anterior Half Grafts. Arthrosc Tech 2023; 12:e861-e866. [PMID: 37424635 PMCID: PMC10323729 DOI: 10.1016/j.eats.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/12/2023] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
Anterior cruciate ligament injuries are common in high school and college with an estimated 120,000 cases per year in the United States. Most sports injuries occur without direct contact, and knee valgus with external rotation of the foot is the most common movement. This movement may be related to the injury of the anterior oblique ligament located in the anteromedial quadrant of the knee. This technical note presents anterior cruciate ligament reconstruction with extraarticular anteromedial reinforcement using hamstring and the anterior half of the peroneus longus grafts.
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Affiliation(s)
- Pedro Baches Jorge
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Melanie Mayumi Horita
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Marconde de Oliveira e Silva
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Camilo Partezani Helito
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diego Escudeiro de Oliveira
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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82
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Choi NH, Lee DM, Victoroff BN. Bone Morphological Characteristics as Risk Factors for Anterior Cruciate Ligament Injury: Comparison Between Contact and Noncontact Injury. Orthop J Sports Med 2023; 11:23259671231179757. [PMID: 37384238 PMCID: PMC10293527 DOI: 10.1177/23259671231179757] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 06/30/2023] Open
Abstract
Background Altered bone morphologies are considered risk factors for noncontact anterior cruciate ligament (ACL) injuries. Purpose/Hypothesis This study aimed to investigate bone morphological characteristics as risk factors for ACL tears in contact injuries and compare these factors with those for noncontact ACL injuries. We hypothesized that altered bone morphologies would also be risk factors for contact ACL injury. Study Design Cross-sectional study; Level of evidence, 3. Methods Enrolled were patients who underwent primary ACL reconstructions between January 2000 and December 2021 within 6 weeks after injury. Patients in the ACL group were classified according to injury mechanism (contact vs noncontact). During the same period, a control group of patients matched by age, height, and body mass index to the ACL group was selected. The lateral femoral condylar ratio (LFCR), notch width index (NWI), and lateral posterior tibial slope (PTS) were measured. Measured parameters were compared between the control, contact, and noncontact groups using analysis of variance. Results There were 86 patients in the control group, 102 patients in the contact ACL group, and 105 patients in the noncontact ACL group. The demographic characteristics of the 3 groups did not differ significantly. The contact group had significantly higher LFCRs and lower NWIs compared with the control group (P < .001 and P = .001, respectively). The noncontact group had significantly higher LFCRs and PTSs and lower NWIs compared with the control group (P = .031; P < .001; and P < .001, respectively). The noncontact group had significantly higher PTSs and lower NWIs compared with the contact group (P = .003 and P =.014, respectively). In the contact group, the LFCR, PTS, and NWI were significant risk factors for ACL tears (odds ratio [OR], 1.25 [P < .001]; OR, 1.16 [P = .008]; and OR, 1.27 [P = .001], respectively), and in the noncontact group, the PTS and NWI were significant risk factors for ACL tears (OR, 1.20 [P < .001]; OR, 1.59 [P < .001], respectively). Conclusion Altered bone morphological characteristics of the knee were found to be risk factors for ACL tears in contact injuries as well as noncontact injuries. Altered morphology has a more significant effect in noncontact ACL injuries.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Dong-Min Lee
- Department of Orthopedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Republic of Korea
| | - Brian N. Victoroff
- Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
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83
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Chijimatsu M, Ishida T, Yamanaka M, Taniguchi S, Ueno R, Ikuta R, Samukawa M, Ino T, Kasahara S, Tohyama H. Subsequent Jumping Increases the Knee and Hip Abduction Moment, Trunk Lateral Tilt, and Trunk Rotation Motion During Single-Leg Landing in Female Individuals. J Appl Biomech 2023:1-7. [PMID: 37225171 DOI: 10.1123/jab.2022-0305] [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: 12/08/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
Single-leg landings with or without subsequent jumping are frequently used to evaluate landing biomechanics. The purpose of this study was to investigate the effects of subsequent jumping on the external knee abduction moment and trunk and hip biomechanics during single-leg landing. Thirty young adult female participants performed a single-leg drop vertical jumping (SDVJ; landing with subsequent jumping) and single-leg drop landing (SDL; landing without subsequent jumping). Trunk, hip, and knee biomechanics were evaluated using a 3-dimensional motion analysis system. The peak knee abduction moment was significantly larger during SDVJ than during SDL (SDVJ 0.08 [0.10] N·m·kg-1·m-1, SDL 0.05 [0.10] N·m·kg-1·m-1, P = .002). The trunk lateral tilt and rotation angles toward the support-leg side and external hip abduction moment were significantly larger during SDVJ than during SDL (P < .05). The difference in the peak hip abduction moment between SDVJ and SDL predicted the difference in the peak knee abduction moment (P = .003, R2 = .252). Landing tasks with subsequent jumping would have advantages for evaluating trunk and hip control as well as knee abduction moment. In particular, evaluating hip abduction moment may be important because of its association with the knee abduction moment.
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Affiliation(s)
- Masato Chijimatsu
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki,Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Masanori Yamanaka
- Faculty of Health Sciences, Hokkaido Chitose College of Rehabilitation, Chitose,Japan
| | | | - Ryo Ueno
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Ryohei Ikuta
- Hachioji Sports Orthopedic Clinic, Hachioji,Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo,Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo,Japan
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84
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Grodman LH, Beaulieu ML, Ashton-Miller JA, Wojtys EM. Levels of ACL-straining activities increased in the six months prior to non-contact ACL injury in a retrospective survey: evidence consistent with ACL fatigue failure. Front Physiol 2023; 14:1166980. [PMID: 37215179 PMCID: PMC10198379 DOI: 10.3389/fphys.2023.1166980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Recent evidence has emerged suggesting that a non-contact anterior cruciate ligament (ACL) tear can result from repetitive submaximal loading of the ligament. In other words, when the intensity of ACL-straining athletic activities is increased too rapidly, microdamage can accumulate in the ligament beyond the rate at which it can be repaired, thereby leading to material fatigue in the ligament and its eventual failure. The objective of this survey-based exploratory study was to retrospectively determine whether the levels of various athletic activities performed by ACL-injured patients significantly changed during the 6 months before injury. Methods: Forty-eight ACL-injured patients completed a survey to characterize their participation in various activities (weightlifting, sport-specific drills, running, jumping, cutting, pivoting/twisting, and decelerating) at three timepoints (1 week, 3 months, 6 months) prior to ACL injury. Activity scores, which summarized the frequency and intensity of each activity, were calculated for each patient at each time interval. A series of linear mixed-effects regression models was used to test whether there was a significant change in levels of the various activities in the 6-month period leading up to ACL injury. Results: Patients who sustained a non-contact ACL injury markedly increased their sport-specific drills activity levels in the time leading up to injury (p = 0.098), while those patients who sustained a contact ACL injury exhibited no change in this activity during the same time period (p = 0.829). Levels of running, jumping, cutting, pivoting/twisting, and decelerating increased for non-contact ACL-injured patients but decreased for contact ACL-injured patients, though not significantly (p values > 0.10). Weightlifting activity significantly decreased leading up to injury among contact ACL-injured patients (p = 0.002). Discussion: We conclude that levels of ACL-straining athletic activities or maneuvers in non-contact ACL-injured patients markedly increased in the 6 months leading up to their injury, providing evidence that changing levels of certain activities or maneuvers may play a role in ACL injury risk. This warrants further investigation of the hypothesis that too rapid an increase in activities or maneuvers known to place large loads on the ACL can cause microdamage to accumulate in the ligament, thereby leading to failure.
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Affiliation(s)
- Louis H. Grodman
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Mélanie L. Beaulieu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, United States
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85
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Jokela A, Valle X, Kosola J, Rodas G, Til L, Burova M, Pleshkov P, Andersson H, Pasta G, Manetti P, Lupón G, Pruna R, García-Romero-Pérez A, Lempainen L. Mechanisms of Hamstring Injury in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings. Clin J Sport Med 2023; 33:217-224. [PMID: 36730099 PMCID: PMC10128906 DOI: 10.1097/jsm.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis. DESIGN Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022. SETTING Two specialized sports medicine hospitals. PARTICIPANTS Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI. INDEPENDENT VARIABLES Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings. MAIN OUTCOME MEASURES Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location. RESULTS Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretch-type (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion <45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries. CONCLUSIONS According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.
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Affiliation(s)
- Aleksi Jokela
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Xavier Valle
- FC Barcelona, Medical Department, Barcelona, Spain
- Department de Cirurgia de la Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jussi Kosola
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland;
| | - Gil Rodas
- FC Barcelona, Medical Department, Barcelona, Spain
| | - Lluís Til
- Human Performance Department SL Benfica, Lisbon, Portugal
| | | | | | | | | | | | | | - Ricard Pruna
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Alvaro García-Romero-Pérez
- Watford FC, Injury Prevention and Rehabilitation Department, Watford, United Kingdom
- Physiotherapy Department, Universidad Camilo José Cela, Madrid, Spain; and
| | - Lasse Lempainen
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland;
- FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland and Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland.
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86
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Georgoulis JD, Melissaridou D, Patras K, Megaloikonomos PD, Trikoupis I, Savvidou OD, Papagelopoulos PJ. Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies. J Exp Orthop 2023; 10:43. [PMID: 37058177 PMCID: PMC10105000 DOI: 10.1186/s40634-023-00603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear. METHODS A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed. RESULTS Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients. CONCLUSION This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jim D Georgoulis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece.
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Patras
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Trikoupis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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87
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Simonson R, Piussi R, Högberg J, Senorski C, Thomeé R, Samuelsson K, Senorski EH. Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231157386. [PMID: 37152619 PMCID: PMC10155024 DOI: 10.1177/23259671231157386] [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: 11/15/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. Purpose To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. Results A total of 835 patients (46% women), with a mean age of 23.9 ± 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index ≥90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Conclusion Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.
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Affiliation(s)
- Rebecca Simonson
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
- Rebecca Simonsson, PT, MSc,
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of
Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden,
Sahlgrenska Sports Medicine Center. Box 455, SE-405 30, Gothenburg, Sweden
() (Twitter:
@BeccaSimonson2)
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Department of Orthopaedics, Institute
of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
- Department of Orthopaedics, Sahlgrenska
University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
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Hoenig T, Gronwald T, Hollander K, Klein C, Frosch KH, Ueblacker P, Rolvien T. Video analysis of Achilles tendon ruptures in professional male football (soccer) reveals underlying injury patterns and provides strategies for injury prevention. Knee Surg Sports Traumatol Arthrosc 2023; 31:2236-2245. [PMID: 36977780 PMCID: PMC10183418 DOI: 10.1007/s00167-023-07384-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE In professional football (soccer), Achilles tendon ruptures are severe injuries. Video analysis promotes a better understanding of the underlying situational and biomechanical patterns, and provides a roadmap for future research to improve the management and prevention of Achilles tendon ruptures. The purpose of this study was to identify injury patterns contributing to acute Achilles tendon ruptures in professional male football players. METHODS Professional male football players with an acute Achilles tendon rupture were identified using an online database. For every in-competition injury, the corresponding football match was detected. Video footage of the injury was accessed using Wyscout.com or publicly available video databases. Situational patterns and injury biomechanics of the injury frame were independently analysed by two reviewers using a standardised checklist and a motion analysis software. Finally, consensus was reached to describe the main injury patterns of Achilles tendon ruptures in professional male football players. RESULTS The search identified video footage of 80 Achilles tendon ruptures in 78 players. Most injuries (94%) occurred through indirect or non-contact mechanisms. The kinematic analysis revealed characteristic joint positions at the time of injury consisting of hip extension, knee extension, ankle dorsiflexion, foot abduction, and foot pronation in most cases. The underlying direction of movement was from flexion to extension (knee) and from plantarflexion to dorsiflexion (ankle). Player actions identified as main injury patterns were stepping back (26%), landing (20%), running/sprinting (18%), jumping (13%), and starting (10%). CONCLUSION Most Achilles tendon ruptures in professional male football players are closed-chain indirect or non-contact injuries. Sudden loading to the plantarflexor musculotendinous unit remains to be the main component for most cases. By achieving a better understanding of underlying injury mechanisms, this study provides new strategies for the prevention of Achilles tendon ruptures. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Christian Klein
- Department of Sports Injury Prevention, VBG, German Statutory Accident Insurance for the Administrative Sector, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Peter Ueblacker
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- FC Bayern München Football Club, Munich, Germany
- Orthopaedics and Sports Medicine Practice, Munich, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
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89
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Chia L, Myer GD, Hewett TE, McKay MJ, Sullivan J, Ford KR, Pappas E. Do Cutting Kinematics Change as Boys Mature? A Longitudinal Cohort Study of High-School Athletes. Clin J Sport Med 2023; 33:e8-e13. [PMID: 36367778 PMCID: PMC9991932 DOI: 10.1097/jsm.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Examine longitudinal changes in trunk, hip, and knee kinematics in maturing boys during an unanticipated cutting task. DESIGN Prospective cohort study. SETTING Biomechanical laboratory. PARTICIPANTS Forty-two high-school male basketball, volleyball, and soccer athletes. ASSESSMENT OF RISK FACTORS Trunk, hip, and knee range-of-motion (RoM), peak angles, and angles at initial contact during an unanticipated 45 degrees sidestep cutting task were estimated using laboratory-based three-dimensional optoelectronic motion capture. Maturation was classified using a modified Pubertal Maturational Observational Scale (PMOS) into prepubertal, midpubertal, or postpubertal stages. MAIN OUTCOME MEASURES Trunk total RoM in frontal, sagittal, and transverse planes; peak trunk flexion, right lateral flexion and right rotation angles; hip total RoM in frontal, sagittal, and transverse planes; hip flexion angle at initial contact; peak hip flexion and adduction angles; knee total RoM in frontal, sagittal, and transverse planes; knee flexion angle at initial contact; peak knee flexion and abduction angles. RESULTS As boys matured, there was a decrease in hip sagittal-plane RoM (49.02 degrees to 43.45 degrees, Benjamini-Hochberg adjusted P = 0.027), hip flexion at initial contact (29.33 degrees to 23.08 degrees, P = 0.018), and peak hip flexion (38.66 degrees to 32.71 degrees, P = 0.046), and an increase in trunk contralateral rotation (17.47 degrees to 25.05 degrees, P = 0.027). CONCLUSIONS Maturing male athletes adopted a more erect cutting strategy that is associated with greater knee joint loading. Knee kinematic changes that increase knee joint loading were not observed in this cohort.
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Affiliation(s)
- Lionel Chia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
- Cleveland Guardians Baseball Company, Cleveland, OH, USA
| | - Gregory D. Myer
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Timothy E. Hewett
- Hewett Global Consulting, Minneapolis & Rochester, MN, USA
- The Rocky Mountain Consortium for Sports Research, Edwards, CO, USA
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
| | - Kevin R. Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Evangelos Pappas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AUS
- The University of Wollongong, School of Medicine and Illawarra Health and Medical Research Institute, NSW, AUS
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90
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Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, Orantes-González E, Heredia-Jimenez J, Lucha-López MO, Hidalgo-García C, Tricás-Moreno JM. Diagnostics Using the Change-of-Direction and Acceleration Test (CODAT) of the Biomechanical Patterns Associated with Knee Injury in Female Futsal Players: A Cross-Sectional Analytical Study. Diagnostics (Basel) 2023; 13:diagnostics13050928. [PMID: 36900071 PMCID: PMC10000524 DOI: 10.3390/diagnostics13050928] [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: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant limb in the whole group, using the same test. A cross-sectional study was performed in 16 female futsal players allocated into two groups: eight females with a previous knee injury, i.e., affected by the valgus collapse mechanism without surgical intervention, and eight with no previous injury. The evaluation protocol included the change-of-direction and acceleration test (CODAT). One registration was made for each lower limb, i.e., the dominant (the preferred kicking limb) and non-dominant limb. A 3D motion capture system (Qualisys AB, Göteborg, Sweden) was used to analyze the kinematics. The Cohen's d effect sizes between the groups demonstrated a strong effect size towards more physiological positions in the non-injured group in the following kinematics in the dominant limb: hip adduction (Cohen's d = 0.82), hip internal rotation (Cohen's d = 0.88), and ipsilateral pelvis rotation (Cohen's d = 1.06). The t-test for the dominant and non-dominant limb in the whole group showed the following differences in knee valgus: dominant limb (9.02 ± 7.31 degrees) and non-dominant limb (1.27 ± 9.05 degrees) (p = 0.049). Conclusions: The players with no previous history of knee injury had a more physiological position for avoiding the valgus collapse mechanism in the hip adduction and internal rotation, and in the pelvis rotation in the dominant limb. All the players showed more knee valgus in the dominant limb, which is the limb at greater risk of injury.
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Affiliation(s)
- Loreto Ferrández-Laliena
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Lucía Vicente-Pina
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Rocío Sánchez-Rodríguez
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Eva Orantes-González
- Department of Sports and Computer Science, Faculty of Physical Education and Sports, University of Pablo de Olavide, 41013 Sevilla, Spain
| | - José Heredia-Jimenez
- Department of Physical Education and Sports, Faculty of Education, Economy & Technology, University of Granada, 51001 Ceuta, Spain
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
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91
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Schaefer LV, Carnarius F, Dech S, Bittmann FN. Repeated measurements of Adaptive Force: Maximal holding capacity differs from other maximal strength parameters and preliminary characteristics for non-professional strength vs. endurance athletes. Front Physiol 2023; 14:1020954. [PMID: 36909246 PMCID: PMC9992808 DOI: 10.3389/fphys.2023.1020954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
The Adaptive Force (AF) reflects the neuromuscular capacity to adapt to external loads during holding muscle actions and is similar to motions in real life and sports. The maximal isometric AF (AFisomax) was considered to be the most relevant parameter and was assumed to have major importance regarding injury mechanisms and the development of musculoskeletal pain. The aim of this study was to investigate the behavior of different torque parameters over the course of 30 repeated maximal AF trials. In addition, maximal holding vs. maximal pushing isometric muscle actions were compared. A side consideration was the behavior of torques in the course of repeated AF actions when comparing strength and endurance athletes. The elbow flexors of n = 12 males (six strength/six endurance athletes, non-professionals) were measured 30 times (120 s rest) using a pneumatic device. Maximal voluntary isometric contraction (MVIC) was measured pre and post. MVIC, AFisomax, and AFmax (maximal torque of one AF measurement) were evaluated regarding different considerations and statistical tests. AFmax and AFisomax declined in the course of 30 trials [slope regression (mean ± standard deviation): AFmax = -0.323 ± 0.263; AFisomax = -0.45 ± 0.45]. The decline from start to end amounted to -12.8% ± 8.3% (p < 0.001) for AFmax and -25.41% ± 26.40% (p < 0.001) for AFisomax. AF parameters declined more in strength vs. endurance athletes. Thereby, strength athletes showed a rather stable decline for AFmax and a plateau formation for AFisomax after 15 trials. In contrast, endurance athletes reduced their AFmax, especially after the first five trials, and remained on a rather similar level for AFisomax. The maximum of AFisomax of all 30 trials amounted 67.67% ± 13.60% of MVIC (p < 0.001, n = 12), supporting the hypothesis of two types of isometric muscle action (holding vs. pushing). The findings provided the first data on the behavior of torque parameters after repeated isometric-eccentric actions and revealed further insights into neuromuscular control strategies. Additionally, they highlight the importance of investigating AF parameters in athletes based on the different behaviors compared to MVIC. This is assumed to be especially relevant regarding injury mechanisms.
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Affiliation(s)
- Laura V. Schaefer
- Neuromechanics Laboratory, Regulative Physiology and Prevention, Department Sports and Health Sciences, University Potsdam, Potsdam, Germany
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92
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Chaaban CR, Turner JA, Padua DA. Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction. Front Sports Act Living 2023; 4:1089882. [PMID: 36873910 PMCID: PMC9975395 DOI: 10.3389/fspor.2022.1089882] [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: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients "think" (add a secondary cognitive task) outside the "box" (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete's ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes' biomechanics and performance.
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Affiliation(s)
- Courtney R. Chaaban
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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93
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Di Paolo S, Nijmeijer EM, Bragonzoni L, Gokeler A, Benjaminse A. Definition of High-Risk Motion Patterns for Female ACL Injury Based on Football-Specific Field Data: A Wearable Sensors Plus Data Mining Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23042176. [PMID: 36850776 PMCID: PMC9961558 DOI: 10.3390/s23042176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 05/30/2023]
Abstract
The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitch during football-specific exercises (F-EX) and games (F-GAME). Knee joint moments were collected in the laboratory and grouped using hierarchical agglomerative clustering. The clusters were used to investigate the kinematics collected on field through wearable sensors. Three clusters emerged: Cluster 1 presented the lowest knee moments; Cluster 2 presented high knee extension but low knee abduction and rotation moments; Cluster 3 presented the highest knee abduction, extension, and external rotation moments. In F-EX, greater knee abduction angles were found in Cluster 2 and 3 compared to Cluster 1 (p = 0.007). Cluster 2 showed the lowest knee and hip flexion angles (p < 0.013). Cluster 3 showed the greatest hip external rotation angles (p = 0.006). In F-GAME, Cluster 3 presented the greatest knee external rotation and lowest knee flexion angles (p = 0.003). Clinically relevant differences towards ACL injury identified in the laboratory reflected at-risk patterns only in part when cutting on the field: in the field, low-risk players exhibited similar kinematic patterns as the high-risk players. Therefore, in-lab injury risk screening may lack ecological validity.
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Eline M. Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Alli Gokeler
- Exercise and Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, 33098 Paderborn, Germany
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
| | - Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- School of Sport Studies, Hanze University Groningen, 9747 AS Groningen, The Netherlands
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94
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Astur DC, Margato GF, Zobiole A, Pires D, Funchal LFZ, Jimenez AE, Freitas EV, Cohen M. The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07331-0. [PMID: 36779987 DOI: 10.1007/s00167-023-07331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. METHODS A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. RESULTS Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). CONCLUSION A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Diego Costa Astur
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil.
| | - Gabriel Furlan Margato
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Alexandre Zobiole
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Diego Pires
- Real Instituto de Ortopedia, Recife, PE, Brazil
| | | | | | | | - Moises Cohen
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
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95
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Foody JN, Bradley PX, Spritzer CE, Wittstein JR, DeFrate LE, Englander ZA. Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes. Am J Sports Med 2023; 51:422-428. [PMID: 36625427 DOI: 10.1177/03635465221141876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. PURPOSE/HYPOTHESIS The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. STUDY DESIGN Descriptive laboratory study. METHODS Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. RESULTS Mean ACL strain increased with decreasing knee flexion angle (ρ = -0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, -0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = -0.01; P = .9). CONCLUSION ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. CLINICAL RELEVANCE These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.
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Affiliation(s)
- Jacqueline N Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Patrick X Bradley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | | | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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96
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Knee Joint Contact Forces during High-Risk Dynamic Tasks: 90° Change of Direction and Deceleration Movements. Bioengineering (Basel) 2023; 10:bioengineering10020179. [PMID: 36829673 PMCID: PMC9952676 DOI: 10.3390/bioengineering10020179] [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: 01/12/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was developed to estimate the total, medial, and lateral TFCF developed during vigorous activities. Thirty-one competitive soccer players performing deceleration and 90° sidestepping tasks were assessed via 3D motion analysis by using a marker-based optoelectronic system and TFCF were assessed via OpenSim software. Statistical parametric mapping was used to investigate the effect of frontal plane alignment, compartment laterality, and varus-valgus genu on TFCF. Further, in consideration of specific risk factors, sex influence was also assessed. A strong correlation (R = 0.71 ÷ 0.98, p < 0.001) was found between modification of compartmental forces and changes in frontal plane alignment. Medial and lateral TFCF were similar throughout most of the tasks with the exception of the initial phase, where the lateral compartment had to withstand to higher loadings (1.5 ÷ 3 BW higher, p = 0.010). Significant sex differences emerged in the late phase of the deceleration task. A comprehensive view of factors influencing the mediolateral distribution of TFCF would benefit knee injury prevention and rehabilitation in sport activities.
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97
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Högberg J, Piussi R, Simonson R, Sundberg A, Broman D, Samuelsson K, Thomeé R, Hamrin Senorski E. Is absolute or relative knee flexor strength related to patient-reported outcomes in patients treated with ACL reconstruction with a hamstring tendon autograft? An analysis of eccentric Nordic hamstring strength and seated concentric isokinetic strength. Knee 2023; 41:161-170. [PMID: 36702050 DOI: 10.1016/j.knee.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/10/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is a need for better understanding of how knee flexor strength influence patient-reported outcomes (PROs) after anterior cruciate ligament (ACL) reconstruction. Our aim was to investigate the relationship between the eccentric NordBord test and the seated concentric Biodex test with PROs, during the first year of rehabilitation after ACL reconstruction with hamstring tendon (HT) autograft. METHODS Patients with an index ACL reconstruction with an HT autograft participating in a rehabilitation registry were screened for inclusion. Outcomes of interest were the correlation between absolute (N/kg or Nm/kg) and relative (limb symmetry index) knee flexor strength measured in the NordBord and Biodex with the results of PROs. The significance level was set at p < 0.05 and Pearson's correlation coefficient was used. RESULTS 137 patients were included (47% women) with a mean age of 24.8 ± 8.4 years. There were non-significant and weak correlations between relative strength for all PROs. Significant and weak correlations between absolute strength in the Biodex with the Knee Self-Efficacy Scale18 (K-SES18) present at 4 and 8 months, and for the ACL-Return to Sport after Injury scale (ACL-RSI) at 12 months was observed, accounting for 8.4-15.7% of the variance. Significant and weak correlations between absolute strength in the Nordbord with the Knee injury and Osteoarthritis Outcome Scale subscale Sports and Recreation at 4 months, the K-SES18 present and the ACL-RSI at 8 months were observed, accounting for 9.4-14.4% of the variance. CONCLUSION Absolute knee flexor strength relative to bodyweight for both the Biodex and NordBord test appeared to have a stronger relationship with perceived knee function than relative knee flexor strength, although the observed correlations were weak.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; GHP Orthocenter, Arvid Wallgrens backe 4A, SE-413 46 Gothenburg, Sweden
| | - Daniel Broman
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
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98
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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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99
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Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the 'ACL registry in German Football'. Knee Surg Sports Traumatol Arthrosc 2023; 31:133-141. [PMID: 35819462 PMCID: PMC9859836 DOI: 10.1007/s00167-022-07062-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE ACL injuries are one of the most severe injuries in football, but medical consequences and performance outcomes after return to competition are only rarely investigated. Aim of this study was to analyse the time of return to competition (RTC) in German professional, semi-professional and amateur football. Also, this investigation highlights the rate of career ending and performance outcome after RTC in different playing levels by the measurement of playing level, performed matches and played minutes. METHODS Database of this investigation is the 'ACL registry in German Football' with prospectively collected injury data. Between 2014 and 2018, four seasons in professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the return to competition period and performance parameters. Data were collected for three subsequent seasons after injury and compared with the pre-injury and injury season. Data collection was performed using standardized methods. RESULTS A total of 607 ACL injuries were registered during the 4-year period with a mean RTC time of 337.1 day (SD: 183). After primary ACL ruptures, the fastest RTC was found in professional football (247.3 days), while in semi-professional (333.5 d; p < 0.0001) and amateur football (376.2 d; p < 0.0001) a prolonged absence was detected. Re-ruptures occurred in 17.8% (n = 108) and showed similar trend with fastest RTC in professionals (289.9 days; p = 0.002). Within the first three seasons after injury, 92 players (36.7%) in semi-professional and 24 (20%) in professionals had to end their career. Keeping the level of play was only possible for 48 (47.5%) of professionals, while only 47 (29.6%) of semi-professionals and 43 (28.1%) of amateurs were able to. Only in professional football, no significant difference could be seen in the played minutes and games after 2 years compared to the pre-injury season. CONCLUSION Lower playing levels and re-ruptures are the main factors for a prolonged return to competition after ACL rupture in German football. Significant reduction in playing level and a high rate of career endings were found for all levels of play. However, only professional players were able to regain their playing minutes and games 2 years after injury, while lower classed athletes did not reach the same amount within 3 years. LEVEL OF EVIDENCE Level III.
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100
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The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns. Knee Surg Sports Traumatol Arthrosc 2023; 31:121-132. [PMID: 35691962 PMCID: PMC9859865 DOI: 10.1007/s00167-022-07002-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To analyze the MRI features, in particular bone bruises pattern, of Anterior Cruciate Ligament (ACL) injured footballers, and to correlate them with the characteristics of injury mechanism and situation obtained from direct video footage. METHODS Nineteen professional football (soccer) players that sustained ACL injury while playing during an official match of First League Championship were included in the study. The video of injury was obtained from the Television broadcast. Knee Magnetic Resonance (MRI) was obtained within 7 days from the injury. BB and meniscal lesions were analyzed on MRI, while a video-analysis of mechanisms of ACL injury and injury dynamic were assessed from the videos. RESULTS The most commonly involved Bone Bruise areas in the knee were the Posterior Lateral Tibial Plateau (LTp) in 16 cases (84%) and the Central Lateral Femoral Condyle (LFc) in 11 cases (58%). Three patients (16%) had bone bruise in the Posterior Medial Tibial Plateau (MTp) while none (0%) had bone bruise in the Medial Femoral Condyle. Based on the bone bruise pattern, 11 (58%) had simultaneous LFc and LTp and were defined "Typical" while 8 (42%) had other locations or no bone bruise and were defined "Atypical". 9 out of 11 injuries (82%) of athletes with "Typical" pattern occurred with a "Pivoting" action", in contrast to only 1 case (12%) in those with "Atypical" bone bruise pattern (p = 0.0055). The most common situational mechanism pattern on video analysis was "pressing" (n = 7) accounting for the 47% of the "indirect" ACL injuries. In terms of movement pattern, ten injuries (52%) occurred during a "Pivoting" movement (7 pressing, 1 dribbling, 1 tackled, 1 goalkeeping), whereas the remaining were classified as "Planting" in four cases, "Direct Blow" in four cases and "Landing". CONCLUSION A well-defined and consistent bone bruise pattern involving the posterior tibial plateau and central femoral condyle of lateral compartment is present in footballers that sustained non-contact and indirect ACL injuries during pivoting with sudden change of direction/deceleration, while heterogeneous patterns were present in those with direct contact or injury mechanisms involving high horizontal velocity. LEVEL OF EVIDENCE Level IV.
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