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Neira A, Silvestre R, Debandi A, Darras D, Cristi-Sánchez I, Barra I, Peñailillo L, De La Fuente C. Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match? Front Bioeng Biotechnol 2022; 10:903131. [PMID: 35935511 PMCID: PMC9354053 DOI: 10.3389/fbioe.2022.903131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Fatigue induced by soccer playing increases physical efforts, which might alter the transverse knee stability, a known factor that promotes knee injuries, particularly anterior cruciate ligament injury. Thereby, primarily, we aimed to determine whether rotatory knee stability decreases immediately following a competitive soccer match in amateur players. Furthermore, we assessed the role of the preferred and non-preferred limbs to kick a ball in rotatory knee stability and the correlation between performance parameters and rotatory knee stability. We hypothesized that the knee stability decreases immediately after a competitive soccer match in amateur players. Eight healthy amateur soccer players (aged 27.2 ± 4.7 years and with body mass index of 23.8 ± 1.2 kg m−2) were included immediately before and after a competitive soccer match. The rotatory knee stability was assessed in the preferred and non-preferred limbs through the acceleration and jerk of the pivot shift maneuver and by the internal knee rotation of a pivoting landing task. Two-way repeated-measures ANOVA for factors time (before and after the soccer match) and limb (preferred and non-preferred) and multiple comparisons were performed using α = 5%. There was a statistical significance for the main factor time in the acceleration (5.04 vs. 6.90 ms−2, Δ = 1.86 ms−2, p = 0.020, η2 = 0.331) and jerk (18.46 vs. 32.10 ms−2, Δ = 13.64 ms−2, p = 0.004, η2 = 0.456) of the pivot shift maneuver. Rotatory stability decreases following a competitive soccer match in amateur soccer players under fatigue. Both the acceleration and jerk during the pivot shift maneuver is increased without significant internal knee rotation changes during the pivoting landing task.
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Affiliation(s)
- Alejandro Neira
- Escuela Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- *Correspondence: Alejandro Neira,
| | - Rony Silvestre
- Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aníbal Debandi
- Traumatología, Clínica MEDS, Santiago, Chile
- Servicio Traumatologéa, Hospital Clénico Universidad de Chile, Santiago, Chile
| | | | - Iver Cristi-Sánchez
- Laboratorio de Neuromecánica Aplicada, Escuela de Kinesiología, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Ignacio Barra
- Escuela Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Luis Peñailillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Carlos De La Fuente
- Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Campus Uruguaiana, Uruguaiana, Brazil
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Malige A, Baghdadi S, Hast MW, Schmidt EC, Shea KG, Ganley TJ. Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: A systematic review. Clin Biomech (Bristol, Avon) 2022; 95:105636. [PMID: 35428007 DOI: 10.1016/j.clinbiomech.2022.105636] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions. Studies were excluded if performed on both skeletally immature and mature or non-human grafts, or if the grafts were tested after fixation in a cadaveric knee. For each graft, failure load, stiffness, Young's modulus, maximum stress, and maximum strain were recorded. FINDINGS Twenty-six articles were included. Most studies reported equal or increased biomechanical failure load and stiffness of their tested bone-patellar tendon-bone, hamstring, quadriceps, peroneus longus, tibialis anterior and posterior, Achilles, tensor fascia lata, and iliotibial band grafts compared to the native ACL. All recorded biomechanical properties had similar values between graft types. INTERPRETATION Most grafts used for ACL reconstruction are biomechanically superior to the native ACL. Utilizing a proper graft, combined with a standard surgical technique and a rigorous rehabilitation before and after surgery, will improve outcomes of ACL reconstruction.
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Affiliation(s)
- Ajith Malige
- St. Luke's University Health Network, Department of Orthopaedic Surgery, 801 Ostrum Street, Bethlehem, PA 18015, USA.
| | - Soroush Baghdadi
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Michael W Hast
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Elaine C Schmidt
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Kevin G Shea
- Stanford University Department of Orthopaedic Surgery 450 Broadway, Redwood City, CA 94063, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Caracciolo G, Yáñez R, Silvestre R, De la Fuente C, Zamorano H, Ossio A, Strömbäck L, Abusleme S, P Carpes F. Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury. J Exp Orthop 2021; 8:80. [PMID: 34561730 PMCID: PMC8463650 DOI: 10.1186/s40634-021-00396-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/27/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose The knee stiffness acquired following an Anterior Cruciate Ligament (ACL) injury might affect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor effects of spinal anesthesia could favor the identification of rotatory knee deficiencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without. Methods Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1 ± 13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys’ tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha = 5%). Results We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12 ± 1.56 m.s− 2 vs. 2.73 ± 1.19 m.s− 2, p < 0.001), and compared to the non-injured leg (5.12 ± 1.56 m.s− 2 vs. 3.45 ± 1.35 m.s− 2, p < 0.001). There was a presence of significant interaction between leg and anesthesia conditions (p < 0.001). Conclusions The pivot-shift maneuver performed under anesthesia identifies better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stiffness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.
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Affiliation(s)
- Gastón Caracciolo
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Roberto Yáñez
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Rony Silvestre
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Carlos De la Fuente
- Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile.,Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, 97500-970, Brazil.,Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, RM, 7820436, Chile
| | - Héctor Zamorano
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Alejandra Ossio
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Lars Strömbäck
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Sebastian Abusleme
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, 97500-970, Brazil.
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Milandri G, Sivarasu S. A Randomized Controlled Trial of Eccentric Versus Concentric Cycling for Anterior Cruciate Ligament Reconstruction Rehabilitation. Am J Sports Med 2021; 49:626-636. [PMID: 33555943 DOI: 10.1177/0363546520987566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent strength and biomechanical deviations remain after anterior cruciate ligament reconstruction (ACLR). Eccentric training may reduce these and associated reinjury or osteoarthritis risks. HYPOTHESIS For male patients who have undergone ACLR, eccentric training is more effective than concentric training at improving knee flexion angle and other biomechanical deviations, as well as strength and patient-reported outcomes, using a matched perceived exertion dose. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 26 men, 10-16 weeks after hamstring tendon graft ACLR, were randomized to an eccentric training group or a concentric control group. Both groups trained 3 times a week for 8 weeks using the same isokinetic cycle ergometer in a matched studio environment. Exercise dose was matched in training frequency, time, progression, and intensity using a target rating of perceived exertion. Baseline and follow-up testing included questionnaires, dynamometer strength testing, and walk/run gait analysis. RESULTS Eccentric training increased knee (+2.1°; P = .022) and hip (+2.1°; P = .010) flexion angles more than concentric training but not more than the minimal clinically important difference of 3°. Very large asymmetries in baseline knee abduction moment (walk, -0.10 N·m/kg/m; run, -0.54 N·m/kg/m) had not changed in either group by follow-up. Knee valgus angle effects were mixed. Tibial rotation angle increased in both groups, but concentric training was more effective at promoting symmetry (P < .001). Both groups had similar increases in affected limb quadriceps strength and knee flexion moments during walk/run gait (by 20% to 33%). Hamstring strength increased in the eccentric group (+15.4%) but not the concentric group. Eccentric group limb forces were 33% to 70% higher than those of the concentric group, with a lower heart rate. Both groups had low pain scores throughout. CONCLUSION For rehabilitation after ACLR, progressive eccentric cycle training was not more clinically effective than concentric training at a matched perceived intensity dose in male patients. This can guide exercise prescription for reducing gait and strength deviations of these patients. REGISTRATION PACTR201602001449365 (Pan African Clinical Trials Registry), NHREC 4344 (South African).
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Affiliation(s)
- Giovanni Milandri
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Correlation Analysis of Magnetic Resonance Imaging-Based Graft Maturity and Outcomes After Anterior Cruciate Ligament Reconstruction Using International Knee Documentation Committee Score. Am J Phys Med Rehabil 2019; 98:387-391. [DOI: 10.1097/phm.0000000000001106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Borton ZM, Yasen SK, Mumith A, Wilson AJ. Mid-bundle positioning of the femoral socket increases graft rupture in anatomic single bundle anterior cruciate ligament reconstruction. Knee 2018; 25:1122-1128. [PMID: 30224151 DOI: 10.1016/j.knee.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomic anterior cruciate ligament (ACL) reconstructions are superior to non-anatomic graft placements with regard to controlling rotational laxity. Different techniques of anatomic single-bundle reconstruction exist. The femoral tunnel may be placed in a mid-bundle position (MB) or within the anteromedial bundle footprint (AM) with no definitive consensus as to the preferred position. Our institution, reflecting trends in surgical practice, has experience with both techniques. METHODS Interrogation of our prospectively maintained database yielded all primary ACL reconstructions performed using the anatomic TransLateral single-bundle all-inside technique. A two year minimum follow-up was set. The failure rate of the MB and AM cohorts was compared as a primary outcome. Patient-reported outcomes across cohorts at several time-points were analysed as a secondary outcome. RESULTS Two hundred and seventy-nine primary ACL reconstructions were identified at a median follow-up of 49 months. MB positioning was utilised in 113 cases (40.5%) and AM positioning in 166 (59.5%). There were significantly more failures in the MB cohort (p = 0.029). Logistic regression revealed mid-bundle femoral positioning was associated with greater than fourfold increase in graft failure (odds ratio 4.14, p = 0.039). CONCLUSION Data from this case series suggests that amongst anatomic single-bundle ACL reconstructions, grafts with a mid-bundle femoral tunnel are more than four times more likely to fail versus those with a femoral tunnel placed four millimetres deeper within the anteromedial bundle footprint.
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Affiliation(s)
- Zakk M Borton
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter Road, Derby, United Kingdom.
| | - Sam K Yasen
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester SO22 4NR, United Kingdom
| | - Aadil Mumith
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom
| | - Adrian J Wilson
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester SO22 4NR, United Kingdom
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Pincheira PA, Silvestre R, Armijo-Olivo S, Guzman-Venegas R. Ankle perturbation generates bilateral alteration of knee muscle onset times after unilateral anterior cruciate ligament reconstruction. PeerJ 2018; 6:e5310. [PMID: 30083454 PMCID: PMC6074771 DOI: 10.7717/peerj.5310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to compare muscle activation onset times of knee muscles between the involved and uninvolved knee of patients with unilateral anterior cruciate ligament reconstruction (ACLR), and the uninjured knees of healthy subjects after a controlled perturbation at the ankle level. METHODS Fifty male amateur soccer players, 25 with unilateral ACLR using semitendinosus-gracilis graft (age = 28.36 ± 7.87 years; time after surgery = 9 ± 3 months) and 25 uninjured control subjects (age = 24.16 ± 2.67 years) participated in the study. Two destabilizing platforms (one for each limb) generated a controlled perturbation at the ankle of each participant (30°of inversion, 10°plantarflexion simultaneously) in a weight bearing condition. The muscle activation onset times of semitendinosus (ST) and vastus medialis (VM) was detected through an electromyographic (EMG) analysis to assess the neuromuscular function of knee muscles. RESULTS Subjects with ACLR had significant delays in EMG onset in the involved (VM = 99.9 ± 30 ms; ST = 101.7 ± 28 ms) and uninvolved knee (VM = 100.4 ± 26 ms; ST = 104.7 ± 28 ms) when compared with the healthy subjects (VM = 69.1 ± 9 ms; ST = 74.6 ± 9 ms). However, no difference was found between involved and uninvolved knee of the ACLR group. DISCUSSION The results show a bilateral alteration of knee muscles in EMG onset after a unilateral ACLR, responses that can be elicited with an ankle perturbation. This suggests an alteration in the central processing of proprioceptive information and/or central nervous system re-organization that may affect neuromuscular control of knee muscles in the involved and uninvolved lower limbs.
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Affiliation(s)
- Patricio A. Pincheira
- Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clinica Meds, Santiago, Chile
| | - Susan Armijo-Olivo
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Rodrigo Guzman-Venegas
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
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8
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The assessment of movement health in clinical practice: A multidimensional perspective. Phys Ther Sport 2018; 32:282-292. [DOI: 10.1016/j.ptsp.2018.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/07/2017] [Accepted: 04/10/2018] [Indexed: 12/11/2022]
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9
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Multi-plane, multi-joint lower extremity support moments during a rapid deceleration task: Implications for knee loading. Hum Mov Sci 2018; 58:155-164. [DOI: 10.1016/j.humov.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
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10
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Mokhtarzadeh H, Ewing K, Janssen I, Yeow CH, Brown N, Lee PVS. The effect of leg dominance and landing height on ACL loading among female athletes. J Biomech 2017; 60:181-187. [PMID: 28712544 DOI: 10.1016/j.jbiomech.2017.06.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 06/04/2017] [Accepted: 06/20/2017] [Indexed: 11/19/2022]
Abstract
Female athletes are more prone to anterior cruciate ligament (ACL) injury. A neuromuscular imbalance called leg dominance may provide a biomechanical explanation. Therefore, the purpose of this study was to compare the side-to-side lower limb differences in movement patterns, muscle forces and ACL forces during a single-leg drop-landing task from two different heights. We hypothesized that there will be significant differences in lower limb movement patterns (kinematics), muscle forces and ACL loading between the dominant and non-dominant limbs. Further, we hypothesized that significant differences between limbs will be present when participants land from a greater drop-landing height. Eight recreational female participants performed dominant and non-dominant single-leg drop landings from 30 to 60cm. OpenSim software was used to develop participant-specific musculoskeletal models and to calculate muscle forces. We also predicted ACL loading using our previously established method. There were no significant differences between dominant and non-dominant leg landing except in ankle dorsiflexion and GMED muscle forces at peak GRF. Landing from a greater height resulted in significant differences among most kinetics and kinematics variables and ACL forces. Minimal differences in lower-limb muscle forces and ACL loading between the dominant and non-dominant legs during single-leg landing may suggest similar risk of injury across limbs in this cohort. Further research is required to confirm whether limb dominance may play an important role in the higher incidence of ACL injury in female athletes with larger and sport-specific cohorts.
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Affiliation(s)
- Hossein Mokhtarzadeh
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Australia; Department of Orthopedic Surgery, Harvard Medical School, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, United States
| | - Katie Ewing
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Australia
| | - Ina Janssen
- AIS Movement Science, Australian Institute of Sport, Canberra, Australia
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Nicholas Brown
- AIS Movement Science, Australian Institute of Sport, Canberra, Australia
| | - Peter Vee Sin Lee
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Australia.
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van der List JP, Mintz DN, DiFelice GS. The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging. Orthop J Sports Med 2017; 5:2325967117709966. [PMID: 28680889 PMCID: PMC5484434 DOI: 10.1177/2325967117709966] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for different types of midsubstance tears. Currently, the incidence of these different tear types is unknown. Purpose: To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types. Study Design: Case series; Level of evidence, 4. Methods: A retrospective search in an institutional radiographic database was performed for patients who underwent knee MRI at our institution between June 2014 and June 2016. Patients younger than 18 years and those with reports of chronic tears, partial tears, multiligamentous injuries, were excluded. Tear types were graded as proximal avulsion (distal remnant length >90% of total ligament length, type I), proximal (75%-90%, type II), midsubstance (25%-75%, type III), distal (10%-25%, type IV), and distal avulsion (<10%, type V). An orthopaedic surgeon, a radiologist, and a research fellow graded the tear type on 30 MRIs to determine reliability, and the research fellow graded all MRIs. Inter- and intraobserver reliability were measured using kappa statistics. Results: A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001). Conclusion: This classification system was reliable in assessing tear location in acute ACL injuries. Type I tears were seen in 16%, type II in 27%, and type III in 52% of patients in our cohort. These data suggest that there may be greater potential application for ACL preservation techniques.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Gregory S DiFelice
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Bates NA, McPherson AL, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. Robotic simulation of identical athletic-task kinematics on cadaveric limbs exhibits a lack of differences in knee mechanics between contralateral pairs. J Biomech 2017; 53:36-44. [PMID: 28062120 DOI: 10.1016/j.jbiomech.2016.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 01/12/2023]
Abstract
Limb asymmetry is a known factor for increased ACL injury risk. These asymmetries are normally observed during in vivo testing. Prior studies have developed in vitro testing methodologies driven by in vivo kinematics to investigate knee mechanics relative to ACL injury. The objective of this study was to determine if mechanical side-to-side asymmetries persist in contralateral pairs during in vitro simulation testing. In vivo kinematics were recorded for male and female drop vertical jump and sidestep cutting tasks. The recorded kinematics were used to robotically simulate the motions on 7 contralateral pairs of cadaveric lower extremities specimens. ACL and MCL force, torque, and strains were recorded and analyzed for differences between contralateral pairs. There was a general lack of mechanical differences between limb sides. Adduction peak torque for the male sidestep cut movement was significantly different between limb sides (p=0.04). However, this is consistent with ACL injury mechanics in that movement in the frontal plane (abduction/adduction) increases injury risk and it is possible loading differences in this plane may have resulted from tolerances within the setup process. The findings of this study indicate that contralateral knee joints were representative of each other during biomechanical in vitro tests. In future cadaveric robotic simulations, contralateral limbs can be used interchangeably. In addition, direct comparisons of the structural behaviors of isolated conditions for contralateral knee joints can be performed.
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Affiliation(s)
- Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - April L McPherson
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA; Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH, USA
| | - Rebecca J Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D Myer
- Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA; Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Departments of Orthopedics, Physical Medicine and Rehabilitation and Physiology & Biomedical Engineering, Mayo Clinic, Rochester and Minneapolis, MN..
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13
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Reliability of Zebris Motion Analysis System in Healthy Athletes and Athletes with Anterior Cruciate Ligament Reconstruction. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.42040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Oberhofer K, Hosseini Nasab SH, Schütz P, Postolka B, Snedeker JG, Taylor WR, List R. The influence of muscle-tendon forces on ACL loading during jump landing: a systematic review. Muscles Ligaments Tendons J 2017; 7:125-135. [PMID: 28717620 PMCID: PMC5505580 DOI: 10.11138/mltj/2017.7.1.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The goal of this review is to summarise and discuss the reported influence of muscle-tendon forces on anterior cruciate ligament (ACL) loading during the jump-landing task by means of biomechanical analyses of the healthy knee. METHODS A systematic review of the literature was conducted using different combinations of the terms "knee", "ligament", "load", "tension ", "length", "strain", "elongation" and "lengthening". 26 original articles (n=16 in vitro studies; n=10 in situ studies) were identified which complied with all inclusion/exclusion criteria. RESULTS No apparent trend was found between ACL loading and the ratio between hamstrings and quadriceps muscle-tendon forces prior to or during landing. Four in vitro studies reported reduced peak ACL strain if the quadriceps force was increased; while one in vitro study and one in situ study reported reduced ACL loading if the hamstrings force was increased. A meta-analysis of the reported results was not possible because of the heterogeneity of the confounding factors. CONCLUSION The reported results suggest that increased hip flexion during landing may help in reducing ACL strain by lengthening the hamstrings, and thus increasing its passive resistance to stretch. Furthermore, it appears that increased tensile stiffness of the quadriceps may help in stabilising the knee joint during landing, and thus protecting the passive soft-tissue structures from overloading. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
| | | | | | | | - Jess G. Snedeker
- Institute for Biomechanics, ETH Zürich, Switzerland
- University Hospital Balgrist, Zürich, Switzerland
| | | | - Renate List
- Institute for Biomechanics, ETH Zürich, Switzerland
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15
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Hu C, Huang Q, Yu L, Zhou Y, Gu R, Ye M, Ge M, Xu Y, Liu J. Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction. J Phys Ther Sci 2016; 28:2196-8. [PMID: 27630396 PMCID: PMC5011560 DOI: 10.1589/jpts.28.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the long-term interventions effects of
robot-assisted therapy rehabilitation on functional activity levels after anterior
cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6
males and 2 females) who received anterior cruciate ligament reconstruction. The subjects
participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test,
10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus
lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee
joint were evaluated before and after the intervention. [Results] The average value of the
of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor
strength of the knee joint isokinetic movement increased significantly, and the time of
the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that
walking ability and muscle strength can be improved by robotic walking training as a
long-term intervention.
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Affiliation(s)
- Chunying Hu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Qiuchen Huang
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Lili Yu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Yue Zhou
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Rui Gu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Orthopedic and Orthopedic Rehabilitation China Rehabilitation Research Center, China
| | - Miao Ye
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Meng Ge
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Yanfeng Xu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Jianfeng Liu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
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16
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Moewis P, Duda GN, Jung T, Heller MO, Boeth H, Kaptein B, Taylor WR. The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction. PLoS One 2016; 11:e0159600. [PMID: 27467744 PMCID: PMC4965218 DOI: 10.1371/journal.pone.0159600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 01/15/2023] Open
Abstract
While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.
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Affiliation(s)
- Philippe Moewis
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Georg N. Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Jung
- Knee Surgery and Sports Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus O. Heller
- Bioengineering Research Group, University of Southhampton, Southhampton, United Kingdom
| | - Heide Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bart Kaptein
- Department of Orthopaedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - William R. Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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17
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Ismail SA, Button K, Simic M, Van Deursen R, Pappas E. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2016; 35:68-80. [PMID: 27132248 DOI: 10.1016/j.clinbiomech.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. METHODS We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. FINDINGS We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). INTERPRETATION No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population.
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Affiliation(s)
- Shiek Abdullah Ismail
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Milena Simic
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robert Van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Bedi A, Warren RF, Wojtys EM, Oh YK, Ashton-Miller JA, Oltean H, Kelly BT. Restriction in hip internal rotation is associated with an increased risk of ACL injury. Knee Surg Sports Traumatol Arthrosc 2016; 24:2024-31. [PMID: 25209211 PMCID: PMC6388720 DOI: 10.1007/s00167-014-3299-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Evidence suggests that femoroacetabular impingement (FAI) in athletes may increase the risk of anterior cruciate ligament (ACL) injury. This study correlates ACL injury with hip range of motion in a consecutive series of elite, contact athletes and tests the hypothesis that a restriction in the available hip axial rotation in a dynamic in silico model of a simulated pivot landing would increase ACL strain and the risk of ACL rupture. METHODS Three hundred and twenty-four football athletes attending the 2012 NFL National Invitational Camp were examined. Hip range of internal rotation was measured and correlated with a history of ACL injury and surgical repair. An in silico biomechanical model was used to study the effect of FAI on the peak relative ACL strain developed during a simulated pivot landing. RESULTS The in vivo results demonstrated that a reduction in internal rotation of the left hip was associated with a statistically significant increased odds of ACL injury in the ipsilateral or contralateral knee (OR 0.95, p = 0.0001 and p < 0.0001, respectively). A post-estimation calculation of odds ratio for ACL injury based on deficiency in hip internal rotation demonstrated that a 30-degree reduction in left hip internal rotation was associated with 4.06 and 5.29 times greater odds of ACL injury in the ipsilateral and contralateral limbs, respectively. The in silico model demonstrated that FAI systematically increased the peak ACL strain predicted during the pivot landing. CONCLUSION FAI may be associated with ACL injury because of the increased resistance to femoral internal axial rotation during a dynamic maneuver such as a pivot landing. This insight may lead to better interventions to prevent ACL injury and improved understanding of ACL reconstruction failure. LEVEL OF EVIDENCE Cohort study, Level IV.
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Affiliation(s)
- Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI, 48106, USA.
| | - Russell F. Warren
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
| | - You Keun Oh
- Departments of Mechanical and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - James A. Ashton-Miller
- Departments of Mechanical and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hanna Oltean
- Department of Orthopaedic Surgery, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
| | - Bryan T. Kelly
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA
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19
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Shi D, Li N, Wang Y, Jiang S, Lin J, Zhu W. Gait modification strategies in trunk over right stance phase in patients with right anterior cruciate ligament deficiency. Gait Posture 2016; 46:63-8. [PMID: 27131179 DOI: 10.1016/j.gaitpost.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 02/02/2023]
Abstract
This study aimed to investigate the gait modification strategies of trunk over right stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Thirty-six patients with right chronic ACL-D were recruited, as well as 36 controls. A 3D optical video motion capture system was used during gait and stair ambulation. Kinematic variables of the trunk and kinematic and kinetic variables of the knee were calculated. Patients with chronic right ACL-D exhibited many significant abnormalities compared with controls. Trunk rotation with right shoulder trailing over the right stance phase was lower in all five motion patterns (P<0.05). Compared with controls, trunk posterior lean was higher from descending stairs to walking when the knee sagittal plane moment ended (P<0.01). Trunk lateral flexion to the left was higher when ascending stairs at the start of right knee coronal plane moment (P=0.01), when descending stairs at the maximal knee coronal plane moment (P<0.01), and when descending stairs at the end of the knee coronal plane moment (P=0.03). Trunk rotation with right shoulder forward was higher at the minimal knee transverse plane moment (P<0.01) and when the knee transverse plane moment ended (P<0.01); during walking, trunk rotation with right shoulder trailing was lower at other knee moments during other walking patterns (all P<0.01). In conclusion, gait modification strategies of the trunk were apparent in patients with ACL-D. These results provide new insights about diagnosis and rehabilitation of chronic ACL-D (better use of walking and stair tasks as part of a rehabilitation program).
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Affiliation(s)
- Dongliang Shi
- Department of Pediatric Orthopedic, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China
| | - Nannan Li
- Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yubin Wang
- Department of Pediatric Orthopedic, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China
| | - Shuyun Jiang
- Gait Analysis Laboratory, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai 200437, China
| | - Jianping Lin
- Department of Orthopedic, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
| | - Wenhui Zhu
- Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China.
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20
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Abstract
Anterior cruciate ligament (ACL) injuries are common, catastrophic events that incur large expense and lead to degradation of the knee. As such, various motion capture techniques have been applied to identify athletes who are at increased risk for suffering ACL injuries. The objective of this clinical commentary was to synthesize information related to how motion capture analyses contribute to the identification of risk factors that may predict relative injury risk within a population. Individuals employ both active and passive mechanisms to constrain knee joint articulation during motion. There is strong evidence to indicate that athletes who consistently classify as high-risk loaders during landing suffer from combined joint stability deficits in both the active and passive knee restraints. Implementation of prophylactic neuromuscular interventions and biofeedback can effectively compensate for some of the deficiencies that result from poor control of the active knee stabilizers and reduce the incidence of ACL injuries.
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Affiliation(s)
- Nathaniel A. Bates
- The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy E. Hewett
- The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, and Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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21
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Dingenen B, Malfait B, Nijs S, Peers KHE, Vereecken S, Verschueren SMP, Staes FF. Can two-dimensional video analysis during single-leg drop vertical jumps help identify non-contact knee injury risk? A one-year prospective study. Clin Biomech (Bristol, Avon) 2015; 30:781-7. [PMID: 26144662 DOI: 10.1016/j.clinbiomech.2015.06.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/08/2015] [Accepted: 06/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies showed that the amount of hip flexion and the combination of knee valgus and lateral trunk motion, measured with two-dimensional video analysis, were related to three-dimensional measured knee joint moments during single-leg drop vertical jumps, but it remains unclear whether these measurements can be used to identify non-contact knee injury risk. METHODS Fifty injury-free female athletes participated in the study. Two-dimensional video analysis was used to measure hip flexion, knee valgus and lateral trunk motion angles during single-leg drop vertical jumps. Time loss non-contact knee injuries were registered during a one-year follow-up. Independent t-tests and receiver operating characteristic analysis were used to analyze the predictive ability of the two-dimensional angles. FINDINGS Seven participants sustained a time loss non-contact knee injury. Hip flexion was not significantly different between groups (P>.05). The combination of knee valgus and lateral trunk motion was significantly smaller in the injured (P=.036) and non-injured legs (P=.009) of the future injured group compared with the respective matched leg of the non-injured group. The receiver operating characteristic analysis showed a significant discriminative accuracy between groups for the combination of knee valgus and lateral trunk motion of the uninjured leg of the future injured group with the matched leg of the non-injured group (area under curve=0.803; P=.012). INTERPRETATION The measurement of a combination of increased knee valgus and ipsilateral trunk motion during the single-leg drop vertical jump with two-dimensional video analysis can be used to help identify female athletes with increased non-contact knee injury risk.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Bart Malfait
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Stefaan Nijs
- Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
| | - Koen H E Peers
- Physical Medicine and Rehabilitation, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Styn Vereecken
- Physical Medicine and Rehabilitation, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Sabine M P Verschueren
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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Fernández-Jaén T, López-Alcorocho JM, Rodriguez-Iñigo E, Castellán F, Hernández JC, Guillén-García P. The Importance of the Intercondylar Notch in Anterior Cruciate Ligament Tears. Orthop J Sports Med 2015; 3:2325967115597882. [PMID: 26535388 PMCID: PMC4622305 DOI: 10.1177/2325967115597882] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The factors associated with anterior cruciate ligament (ACL) tears are not completely clear. Some studies have shown that patients with a narrow intercondylar notch have a predisposition for ACL tears. Purpose To determine the relationship between the α angle and intercondylar notch width measurements and ACL tears. Study Design Case-control study; Level of evidence, 3. Methods A total of 530 patients (308 with ACL rupture, 222 with healthy ACLs) were included in this study. The α angle and intercondylar width were measured from magnetic resonance images (MRIs). Binary logistic regression analysis was performed to determine the influence of the variables on ACL status (normal or torn). Odds ratios (ORs) and their respective 95% CIs were also calculated. Results No significant differences in patient age and the affected knee were found between patients with normal or torn ACLs. The mean α angle was higher in patients with a torn ACL than in those with an intact one (57.5° ± 5.5° vs 56.2° ± 4.5°; P = .009). Intercondylar width was significantly lower in patients with a torn ACL than in those with an intact one (18.2 ± 3.1 vs 19.5 ± 3.6 mm; P < .001). A highly significant difference between men and women was found for mean intercondylar notch width (19.3 ± 3.3 vs 17.4 ± 3.1 mm; P < .001). In a logistic regression model, sex, intercondylar width, and α angle were statistically significant when adjusted for age. Conclusion Study results suggest that the ACL tears are associated with a narrow intercondylar notch and a high α angle, and that tears occur more frequently in men than in women. Clinical Relevance The model proposed in this study could be used by the physician in the medical office as a tool to identify the risk factors that may predispose a patient for a potential ACL tear.
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Affiliation(s)
- Tomás Fernández-Jaén
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Cátedra de Traumatología del Deporte, Facultad de Medicina, Universidad Católica de Murcia, Murcia, Spain
| | | | | | - Fabián Castellán
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Departamento de Traumatología, Hospital Universitario Reina Fabiola, Córdoba, Argentina
| | | | - Pedro Guillén-García
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Cátedra de Traumatología del Deporte, Facultad de Medicina, Universidad Católica de Murcia, Murcia, Spain
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23
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Hughes G, Dally N. Gender difference in lower limb muscle activity during landing and rapid change of direction. Sci Sports 2015. [DOI: 10.1016/j.scispo.2015.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Bates NA, Myer GD, Shearn JT, Hewett TE. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2015; 30:1-13. [PMID: 25547070 PMCID: PMC4298459 DOI: 10.1016/j.clinbiomech.2014.12.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA,The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory D. Myer
- Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Department Orthopaedic Surgery, College of Medicine, University of Cincinnati, OH, USA,Athletic Training Division, School of Allied Medical Professions, The Ohio State University, Columbus, OH, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA,The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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25
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Pappas E, Nightingale EJ, Simic M, Ford KR, Hewett TE, Myer GD. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. Br J Sports Med 2014; 49:673-80. [PMID: 25492646 DOI: 10.1136/bjsports-2014-093796] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. DESIGN The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. RESULTS Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p ≤ 0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. CONCLUSIONS The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes.
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Affiliation(s)
- Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center of Ioannina, School of Medicine, Ioannina, Greece
| | - Elizabeth J Nightingale
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Milena Simic
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Kevin R Ford
- Department of Physical Therapy, School of Health Sciences, High Point University, High Point, North Carolina, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Timothy E Hewett
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Departments of Physiology & Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering OSU Sports Medicine, The Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA
| | - Gregory D Myer
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Departments of Physiology & Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering OSU Sports Medicine, The Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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Towards understanding knee joint laxity: Errors in non-invasive assessment of joint rotation can be corrected. Med Eng Phys 2014; 36:889-95. [DOI: 10.1016/j.medengphy.2014.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 03/06/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022]
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Orishimo KF, Liederbach M, Kremenic IJ, Hagins M, Pappas E. Comparison of landing biomechanics between male and female dancers and athletes, part 1: Influence of sex on risk of anterior cruciate ligament injury. Am J Sports Med 2014; 42:1082-8. [PMID: 24590005 DOI: 10.1177/0363546514523928] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries among dancers is much lower than among team sport athletes, and no clear disparity between sexes has been reported in the dance population. Although numerous studies have observed differences in landing biomechanics of the lower extremity between male and female team sport athletes, there is currently little research examining the landing biomechanics of male and female dancers and none comparing athletes to dancers. Comparing the landing biomechanics within these populations may help explain the lower overall ACL injury rates and lack of sex disparity. HYPOTHESIS The purpose was to compare the effects of sex and group (dancer vs team sport athlete) on single-legged drop-landing biomechanics. The primary hypothesis was that female dancers would perform a drop-landing task without demonstrating typical sex-related risk factors associated with ACL injuries. A secondary hypothesis was that female team sport athletes would display typical ACL risk factors during the same task. STUDY DESIGN Controlled laboratory study. METHODS Kinematics and kinetics were recorded as 40 elite modern and ballet dancers (20 men and 20 women) and 40 team sport athletes (20 men and 20 women) performed single-legged drop landings from a 30-cm platform. Joint kinematics and kinetics were compared between groups and sexes with a group-by-sex multivariate analysis of variance (MANOVA) followed by pairwise t tests. RESULTS Dancers of both sexes and male team sport athletes landed similarly in terms of frontal-plane knee alignment, whereas female team sport athletes landed with a significantly greater peak knee valgus (P = .007). Female dancers were found to have a lower hip adduction torque than those of the other 3 groups (P = .003). Dancers (male and female) exhibited a lower trunk side flexion (P = .002) and lower trunk forward flexion (P = .032) compared with team sport athletes. CONCLUSION In executing a 30-cm drop landing, female team sport athletes displayed a greater knee valgus than did the other 3 groups. Dancers exhibited better trunk stability than did athletes. CLINICAL RELEVANCE These biomechanical findings may provide insight into the cause of the epidemiological differences in ACL injuries between dancers and athletes and the lack of a sex disparity within dancers.
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Affiliation(s)
- Karl F Orishimo
- Karl F. Orishimo, MS, Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 100 East 77th Street, 2nd Floor, New York, NY 10075, USA.
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Lee H, Petrofsky JS, Daher N, Berk L, Laymon M, Khowailed IA. Anterior cruciate ligament elasticity and force for flexion during the menstrual cycle. Med Sci Monit 2013; 19:1080-8. [PMID: 24287619 PMCID: PMC3862144 DOI: 10.12659/msm.889393] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background A high occurrence of knee injuries have been observed in women during the menstrual cycle (MC). As a result, numerous studies have been conducted regarding knee ligament elasticity during the MC. Some researchers believe that since estrogen receptor b exists in ligaments and tendons in the knee, estrogen may modulate towards a state of laxity. However, increased tissue temperature also observed during the MC can predispose ligament and tendon laxness. Therefore, the purpose of this study was to assess in women the relationship between Estradiol (E2) serum concentrations and tissue temperature during the MC and their combined effect on knee laxity. Material/Methods Ten non-athletic young healthy females, 18 to 30 years of age participated in the study. E2 serum concentrations, anterior cruciate ligament (ACL) elasticity, and force to flex the knee (FFK), knee flexion-extension hysteresis (KFEH) were assessed both at ambient temperature (22°C) and after 38°C warming. Testing was performed multiple times during the participant’s MC, for one full MC. Results ACL elasticity was significantly higher (P<0.01) and FFK and KFEH were significantly lower (p<0.05) during ovulation when E2 levels were highest. ACL elasticity was still higher during ovulation after warming to 38°C. But, the effects of MC on FFK and KFEH were reduced by tissue warming. Conclusions ACL elasticity, FFK, and KFEH was affected not only by E2 but also tissue temperature. However, E2 had more impact on ACL elasticity while tissue temperature had more impact on FFK and KFEH at 38°C warming.
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Affiliation(s)
- Haneul Lee
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, USA
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Petrofsky JS, Laymon M, Lee H. Effect of heat and cold on tendon flexibility and force to flex the human knee. Med Sci Monit 2013; 19:661-7. [PMID: 23933600 PMCID: PMC3747018 DOI: 10.12659/msm.889145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is commonly believed in medicine that using heat will increase the distensability and flexibility of soft tissue. If true, increased flexibility would be a positive factor to reduce injuries in sports. However, cold should have the opposite effect and is often used to treat sports injuries. This study was accomplished to quantify the effect of heat and cold on the force needed to flex the knee and laxness of the anterior and posterior cruciate ligaments. MATERIAL AND METHODS The present study examined 20 male and female subjects to determine if heat would increase extensibility of the anterior and posterior cruciate ligaments of the knee and reduce the force needed to flex the knee. Cold exposure was examined to see if it would have the opposite effect. There were 4 experiments in the series: The first was a room temperature series; the second was a series where cold was applied with an ice pack for 20 minutes; in the third, hydrocollator heat packs were applied for 20 minutes; and in the fourth, ThermaCare heat wraps were applied for 4 hours on the quadriceps and knee. Tendon extensibility was measured with a KT2000. The force for flexing the knee was measured by passive movement being applied (CPM) to the knee through 30° and the force required to move the leg was measured. RESULTS The results show that the anterior and posterior cruciate ligament flexibility increased and the force needed to move the knee decreased with heat by about 25% compared to cold application. CONCLUSIONS Heat is beneficial in increasing muscle and ligament flexibility and may help reduce athletic injuries, but cold treatment may have the opposite effect.
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Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 2013. [PMID: 23203338 DOI: 10.1007/s00167-012-2323-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach. METHODS Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects. RESULTS All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p ≤ 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p ≤ 0.05) and better performance in the timed lateral movement functional tests at 3 and 6 months (p ≤ 0.05). No other comparisons were significant (n.s). CONCLUSIONS Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol. LEVEL OF EVIDENCE Therapeutic study, Level II.
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MacLeod TD, Manal K, Silbernagel KG, Snyder-Mackler L, Buchanan TS. Characteristics of human knee muscle coordination during isometric contractions in a standing posture: the effect of limb task. J Electromyogr Kinesiol 2013; 23:1398-405. [PMID: 23790392 DOI: 10.1016/j.jelekin.2013.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/22/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022] Open
Abstract
Different functional roles for the hands have been demonstrated, however leg control is not as well understood. The purpose of the present study was to evaluate bilateral knee neuromuscular control to determine if the limb receiving greater attention would have more well-tuned control compared to an unattended limb. Surface electrodes were placed on seven muscles of each limb, before standing on two force platforms. Visual feedback was given of the forces and moments of the "focus limb," but not the "unattended limb." Static isometric forces were matched with their focus limb, requiring their unattended limb to push in the opposite direction, using a combination of forward-backward-medial-lateral shear forces while muscle activity was collected bilaterally. There was a significant main effect for limb task (p = 0.02), with the medial hamstrings being more specific (p = 0.001) while performing the unattended limb and the lateral hamstring being more well-tuned (p = 0.007) while performing the focus limb task. The focus limb's medial and lateral gastrocnemius were principally active in the forwards direction, but only the unattended limb's lateral gastrocnemius was active in the backwards direction. Findings suggest unique neuromuscular control strategies are used for the legs depending on limb task.
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Affiliation(s)
- Toran D MacLeod
- University of Delaware, Delaware Rehabilitation Institute, 126 Spencer, 130 Academy Street, Newark, DE 19711, USA
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Abstract
The purposes of this article are to discuss key factors for assessing joint function, to present some recent findings, and to address the future directions for evaluating the function of the anterior cruciate ligament-injured/reconstructed knees. Well-designed studies, using state-of-the art tools to assess knee kinematics under in vivo, dynamic, high-loading conditions, are necessary to evaluate the relative performance of different procedures for restoring normal joint motion.
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Kang H, Jung J, Yu J. Comparison of Strength and Endurance between Open and Closed Kinematic Chain Exercises after Anterior Cruciate Ligament Reconstruction: Randomized Control Trial. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University
| | - Jaeho Yu
- Department of Physical Therapy, Kangwon National University
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