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Apseloff NA, Hughes JD, Devitt BM, Musahl V. Primary Anterior Cruciate Ligament Injury: Extrinsic and Intrinsic Risk Factors. J Am Acad Orthop Surg 2024:00124635-990000000-01101. [PMID: 39312886 DOI: 10.5435/jaaos-d-24-00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries continue to increase in incidence despite extensive research into prevention strategies. Many extrinsic and intrinsic risk factors for sustaining ACL injuries have been identified and continue to be investigated. Extrinsic risk factors for ACL injury relate to the athlete's environment, such as the shoe-surface interaction, weather conditions, and sport played. Intrinsic risk factors relate to the athlete's sex, hormones, knee anatomy, landing and pivoting biomechanics, and neuromuscular control. Recent research has highlighted the role of the bony morphology of the proximal tibia and distal femur on primary ACL injury risk, as well as the risk for ACL graft failure. Sex differences in bony and ligamentous morphology of the knee, neuromuscular control, and hormonal factors, such as serum relaxin levels and variations within the menstrual cycle, have been correlated with a higher risk of noncontact primary ACL injuries in female athletes compared with male athletes.
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Affiliation(s)
- Nicholas A Apseloff
- From the Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA (Apseloff, Hughes, Musahl), and the Dublin City University, School of Health and Human Performance and Sports Surgery Clinic, Dublin, Ireland (Devitt)
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Yunoki S, Kishimoto M, Mandai Y, Hiraoka Y, Kondo E. High-speed spinning of collagen microfibers comprising aligned fibrils for creating artificial tendons. Biomed Mater 2024; 19:045010. [PMID: 38729187 DOI: 10.1088/1748-605x/ad49f6] [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: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 05/12/2024]
Abstract
Bundles of engineered collagen microfibers are promising synthetic tendons as substitutes for autogenous grafts. The purpose of this study was to develop high-speed and continuous spinning of collagen microfibers that involves stretching of collagen stream. Our study revealed the 'critical fibrillogenesis concentration (CFC)' of neutralized collagen solutions, which is defined as the upper limit of the collagen concentration at which neutralized collagen molecules remain stable as long as they are cooled (⩽10 °C). Neutralized collagen solutions at collagen concentrations slightly below the CFC formed cord-like collagen gels comprising longitudinally aligned fibrils when extruded from nozzles into an ethanol bath. Dry collagen microfibers with a controlled diameter ranging from 122 ± 2-31.2 ± 1.7 μm can be spun from the cord-like gels using nozzles of various sizes. The spinning process was improved by including stretching of collagen stream to further reduce diameter and increase linear velocity. We extruded a collagen solution through a 182 μm diameter nozzle while simultaneously stretching it in an ethanol bath during gelation and fiber formation. This process resembles the stretching of a melted thermoplastic resin because it solidifies during melt spinning. The mechanical properties of the stretched collagen microfibers were comparable to the highest literature values obtained using microfluidic wet spinning, as they exhibited longitudinally aligned fibrils both on their surface and in their core. Previous wet spinning methods were unable to generate collagen microfibers with a consistent tendon-like fibrillar arrangement throughout the samples. Although the tangent modulus (137 ± 7 MPa) and stress at break of the swollen bundles of stretched microfibers (13.8 ± 1.9 MPa) were lower than those of human anterior cruciate ligament, they were within the same order of magnitude. We developed a spinning technique that produces narrow collagen microfibers with a tendon-like arrangement that can serve as artificial fiber units for collagen-based synthetic tendons.
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Affiliation(s)
- Shunji Yunoki
- Institute for the Promotion of Business-Regional Collaboration, Hokkaido University, kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Masanori Kishimoto
- Biomedical Department, R&D Center, Nitta Gelatin Inc., 2-22, Futamata, Yao City, Osaka 581-0024, Japan
| | - Yoshinobu Mandai
- Biomedical Department, R&D Center, Nitta Gelatin Inc., 2-22, Futamata, Yao City, Osaka 581-0024, Japan
| | - Yosuke Hiraoka
- Biomedical Department, R&D Center, Nitta Gelatin Inc., 2-22, Futamata, Yao City, Osaka 581-0024, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
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Mathieu-Kälin M, Müller M, Weber M, Caminada S, Häberli M, Baur H. Content validity, interpretability, and internal consistency of the "Quality First" assessment to evaluate movement quality in hop tests following ACL rehabilitation. A cross-sectional study. Front Sports Act Living 2023; 5:1180957. [PMID: 37398553 PMCID: PMC10313111 DOI: 10.3389/fspor.2023.1180957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Current approaches fail to adequately identify sport readiness after anterior cruciate ligament (ACL) rehabilitation. Altered landing biomechanics after ACL reconstruction are associated with increased risk of a noncontact ACL reinjury. There is a lack of objective factors to screen for deficient movement patterns. Therefore, the aim of this study was to investigate content validity, interpretability, and internal consistency for the newly developed "Quality First" assessment to evaluate movement quality during hop tests in patients after ACL rehabilitation. Method Participants in this cross-sectional study were recruited in collaboration with the Altius Swiss Sportmed Center in Rheinfelden, Switzerland. After a successful ACL reconstruction, the movement quality of 50 hop test batteries was evaluated between 6 and 24 months postoperatively with the "Quality First" assessment. Content validity was assessed from the perspective of professionals. To check the interpretability, classical test theory was employed. Cronbach's α was calculated to evaluate internal consistency. Results Content validity resulted in the inclusion of three different hop tests (single-leg hop for distance, vertical hop, and side hop). The "Quality First" assessment is enabled to evaluate movement quality in the sagittal, vertical, and the transversal plane. After the exclusion process, the "Quality First" assessment was free from floor and ceiling effects and obtained a sufficient Cronbach's α. The final version consists of 15 items, rated on a 4-point scale. Discussion By means of further validations, the "Quality First" assessment could offer a possibility to evaluate movement quality after ACL rehabilitation during hop tests.
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Affiliation(s)
- Moritz Mathieu-Kälin
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Mirjam Müller
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Melanie Weber
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | | | - Heiner Baur
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Zeng X, Zhong G, Yang T, Xie Z, Ma L, Huang W, Zhang Y. Generalized joint hypermobility subjects without knee hyperextension have greater walking anterior tibial translation and flexion angle than those with knee hyperextension. Gait Posture 2023; 101:166-172. [PMID: 36863091 DOI: 10.1016/j.gaitpost.2023.02.015] [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: 11/02/2021] [Revised: 02/09/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The walking knee kinematic results of generalized joint hypermobility (GJH) subjects were controversial in previous studies. We proposed that this could be related to the knee statuses of GJH subjects with/without knee hyperextension (KH) and assumed that there are significant sagittal knee kinematic differences between GJH subjects with/without KH during gait. RESEARCH QUESTION Do GJH subjects with KH exhibit significantly different kinematic characteristics than those without KH during walking? METHODS 35 GJH subjects without KH, 34 GJH subjects with KH, and 30 healthy controls were recruited in this study. A three-dimensional gait analysis system was used to record and compare the knee kinematics of the participants. RESULTS Significant walking knee kinematics differences were found between GJH subjects with/without KH during walking. GJH subjects without KH had greater flexion angles (4.7-6.0°, 24-53 % gait cycle (GC), p < 0.001; 5.1-6.1°, 65-77 % GC, p = 0.008) and anterior tibial translation (ATT) (3.3-4.1 mm, 0-4 % GC, p = 0.015; 3.8-4.3 mm, 91-100 % GC, p = 0.01) than those with KH. Compared to controls, GJH without KH exhibited increased ATT (4.0-5.7 mm, 0-26 % GC, p < 0.001; 5.1-6.7 mm, 78-100 % GC, p < 0.001), and range of motion of ATT (3.3 mm, p = 0.028) whereas GJH with KH only exhibited increased extension angle (6.9-7.3°, 62-66 % GC, p = 0.015) during walking. SIGNIFICANCE The findings confirmed the hypothesis and suggested that GJH subjects without KH had more walking ATT and flexion angle asymmetries than those with KH. This may raise concerns about the differences in knee health and risk of knee diseases between GJH subjects with/without KH. However, further investigations should be done to explore the exact influence of walking ATT and flexion angle asymmetries in GJH subjects without KH.
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Affiliation(s)
- Xiaolong Zeng
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Medical college, Shantou University, Shantou 515000, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Medical college, Shantou University, Shantou 515000, Guangdong, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Yu Zhang
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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High revision arthroscopy rate after ACL reconstruction in men's professional team sports. Knee Surg Sports Traumatol Arthrosc 2023; 31:142-151. [PMID: 35976389 DOI: 10.1007/s00167-022-07105-0] [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: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined. METHODS This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included. RESULTS In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation. CONCLUSION The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey. LEVEL OF EVIDENCE Level III.
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Paudel YR, Sommerfeldt M, Voaklander D. Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study. Knee Surg Sports Traumatol Arthrosc 2023; 31:248-255. [PMID: 35948850 DOI: 10.1007/s00167-022-07093-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery. METHODS In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10 years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period. RESULTS A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10 years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20-29 year age group, whereas peak incidence in females was observed in 10-19 years of age. The number of ACLR in females outnumbers those among males for 10-19 year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19. CONCLUSION The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20 years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Mark Sommerfeldt
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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AKGÜN AS, TEKCAN A. Assessment Of Femoral Notch Morphology In Male Patients With Anterior Cruciate Ligament Injury: An MRI Study. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1069144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The objective of the present study was to evaluate the femoral notch type, notch width index (NWI), notch angle (NA) and α angle in patients with ACL injury and compare with nonathletic male population using magnetic resonance imaging (MRI).
Methods: 79 patients with complete ACL tear and 80 patients as control group (aged 19-43 years) who had knee MRI were evaluated. NWI, NA measurements and notch shape were evaluated on axial fat-saturated proton-weighted sequences. Femoral notch shape was classified as A, U and W types.
Results: A statistically significant association was found between notch type, NWI, NA and ACL injury (p
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Rolley TL, Saunders N, Bonacci J, Keast M, Fox AS. Video Analysis of Anterior Cruciate Ligament Injury Situations in the Women's Australian Football League. SCI MED FOOTBALL 2022; 7:106-123. [PMID: 35544763 DOI: 10.1080/24733938.2022.2076897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anterior cruciate ligament (ACL) injury rates in the Women's Australian Football League (AFLW) are alarmingly high. Understanding injuries within their sporting context is important to develop effective injury prevention strategies, yet there is currently little knowledge of how ACL injuries occur to AFLW players. This study addressed the common scenarios and characteristics of ACL injuries in the AFLW. Online match and AFLW club injury reports identified 38 ACL injury cases. After excluding injuries where footage was unavailable (i.e. training, pre-season games), a video analysis of 21 match ACL injuries from the 2017-2020 AFLW seasons was performed. We examined match characteristics, and the player's movements and body postures preceding and at the estimated time of injury. Descriptive frequencies and relative proportions were determined across the assessed categories. Non-contact ACL injuries were frequently observed (n=13, 61.9%), while contact preceding the injury event (i.e. indirect contact) was also common (n=10, 47.6%). The most common game situation was direct defence (i.e. defending an opponent in possession) (n=14, 66.7%). Sidestep cutting was the most prevalent movement (n=11, 52.4%), with this commonly performed while applying defensive pressure (n=6 of 11, 54.6%). Sidestep cutting when applying defensive pressure is the most common non-contact ACL injury scenario in the AFLW. Preceding contact potentially contributing to a player's loss of balance was another prominent AFLW scenario. AFLW players may benefit from injury prevention programs emphasising appropriate sidestep cutting technique during reactive defensive scenarios, and maintenance of lower limb postures known to withstand knee loading relative to the sporting task.
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Affiliation(s)
- Tess L Rolley
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Natalie Saunders
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jason Bonacci
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Meghan Keast
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Aaron S Fox
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Hogg JA, Avedesian JM, Diekfuss JA, Acocello SN, Shimmin RD, Kelley EA, Kostrub DA, Myer GD, Wilkerson GB. Sex Moderates the Relationship between Perceptual-Motor Function and Single-Leg Squatting Mechanics. J Sports Sci Med 2022; 21:104-111. [PMID: 35250339 PMCID: PMC8851119 DOI: 10.52082/jssm.2022.104] [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: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
To examine the isolated and combined effects of sex and perceptual-motor function on single-leg squatting mechanics in males and females. We employed a cross-sectional design in a research laboratory. Fifty-eight females (22.2 ± 3.5 yrs, 1.60 ± .07 m, 64.1 ± 13.0 kg) and 35 males (23.5 ± 5.0 yrs, 1.80 ± .06m, 84.7 ± 15.3 kg) free from time-loss injury in the six months prior, vertigo, and vestibular conditions participated in this study. Independent variables were sex, perceptual-motor metrics (reaction time, efficiency index, conflict discrepancy), and interaction effects. Dependent variables were peak frontal plane angles of knee projection, ipsilateral trunk flexion, and contralateral pelvic drop during single-leg squatting. After accounting for the sex-specific variance and perceptual-motor function effects on frontal plane squatting kinematics, female sex amplified the associations of: higher reaction time, lower efficiency index, and higher conflict discrepancy with greater right ipsilateral peak trunk lean (R2 = .13; p = .05); higher reaction time, lower efficiency index, and higher conflict discrepancy with decreased right contralateral pelvic drop (R2 = .22; p < .001); higher reaction time and lower conflict discrepancy with greater right frontal plane knee projection angle (R2 = .12; p = .03); and higher reaction time with greater left frontal plane knee projection angle (R2 = .22; p < .001). Female sex amplified the relationship between perceptual-motor function and two-dimensional frontal plane squatting kinematics. Future work should determine the extent to which perceptual-motor improvements translate to safer movement strategies.
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Affiliation(s)
- Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | | | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shellie N Acocello
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | | | | | | | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), 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, USA
| | - Gary B Wilkerson
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
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Valério MM, Drews R, Macksoud MP, Silva FMD. Injuries in competitive sports: an analysis of Brazilian padel athletes. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21017229012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aimed to analyze the prevalence of injuries in Brazilian padel athletes. In total, 62 padel players (40 men) participated, with an average age of 31.03±7.32 years who periodically trained for at least eight months. All individuals responded to the Referred Morbidity Survey in a stage of the national circuit of the sport, which contained questions on the athletes’ identification, anatomical site, mechanism, nature, time, and severity of the injury and return to normal activities and injury recurrence. Results showed an injury rate of 1.39 per athlete and 2.05 per injured athlete, with the most prevalent injury mechanism being non-contact and the most frequent injury occurring at the end of the matches. The most affected anatomical site was the upper limb with mild severity and a symptomatic return to activities. We concluded that padel players show a high injury rate per athlete, as well as a high injury rate per injured athlete.
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Lim BO, Kim J, Kim SH, Cho JH, Lim S, Lim ST. The effects of taekwondo shoes on anterior cruciate ligament injury risk factors during jump whip kicks. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Valério MM, Drews R, Macksoud MP, Silva FMD. Lesões no esporte de rendimento: uma análise em atletas brasileiros de pádel. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21017229012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi analisar a prevalência de lesões em atletas brasileiros de pádel. Participaram 62 padelistas (40 homens), com idade média de 31,03±7,32 anos e com o treinamento periódico do esporte de pelo menos oito meses. Todos responderam ao Inquérito de Morbidade Referida (IMR), em uma etapa do circuito nacional da modalidade. O IMR continha questões que abrangiam desde a identificação dos atletas até o local anatômico, além de investigar o mecanismo, a natureza, o momento e a gravidade da lesão, assim como o retorno às atividades normais e recidivas. Os resultados revelaram uma taxa de lesão de 1,39 por atleta e 2,05 por atleta lesionado, sendo o mecanismo de lesão mais prevalente o sem contato e o momento de lesão mais frequente, o final das partidas. O local anatômico mais acometido foi o membro superior, com gravidade leve e retorno sintomático. Conclui-se que padelistas têm uma alta taxa de lesão por atleta, bem como uma alta taxa de lesão por atleta lesionado.
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Arundale AJH, Silvers-Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going? J Orthop Res 2022; 40:43-54. [PMID: 33913532 DOI: 10.1002/jor.25058] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.
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Affiliation(s)
- Amelia J H Arundale
- Department of Rehabilitation, Icahn School of Medicine, Mount Sinai Health System, New York, New York, USA.,Red Bull Athlete Performance Center, Red Bull GmBH, Thalgua, Austria
| | - Holly J Silvers-Granelli
- Velocity Physical Therapy, Santa Monica, California, USA.,Major League Soccer, Medical Research Committee, New York, New York, USA
| | - Grethe Myklebust
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Olivares-Jabalera J, Fílter-Ruger A, Dos’Santos T, Afonso J, Della Villa F, Morente-Sánchez J, Soto-Hermoso VM, Requena B. Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13351. [PMID: 34948963 PMCID: PMC8704173 DOI: 10.3390/ijerph182413351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
| | | | - Thomas Dos’Santos
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester M15 6BH, UK
- Manchester Institute of Sport 2.01, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Jose Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sports of the University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
| | | | - Víctor Manuel Soto-Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
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15
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Ikawa MH, Yamada AF, da Rocha Corrêa Fernandes A, Skaf AY, Cohen M, Arliani GG. Relationship between anterior cruciate ligament rupture and the posterior tibial and meniscal slopes in professional soccer athletes. Skeletal Radiol 2021; 50:2041-2047. [PMID: 33825908 DOI: 10.1007/s00256-021-03776-x] [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: 12/11/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Several anatomical parameters have been associated with increased risk of anterior cruciate ligament rupture; however, published studies provide conflicting results. The objectives of this study are to assess whether there is a relationship between anterior cruciate ligament rupture and the lateral and medial posterior tibial slopes, as well as the lateral and medial posterior meniscal slopes and posterior tibial and meniscal delta-slopes. MATERIALS AND METHODS A retrospective case-control study was conducted in professional soccer athletes, using images from knee magnetic resonance imaging scans in athletes with clinical and radiological diagnosis of anterior cruciate ligament rupture, and control group, with no signs of ligament rupture. RESULTS The lateral and medial posterior tibial slopes, the lateral and medial posterior meniscal slopes, and the posterior tibial and meniscal delta-slopes showed significant differences between the groups (p < 0.05). Multivariate analysis logistic regression revealed that the lateral and medial posterior meniscal slopes proved to be predictors for increased risk of anterior cruciate ligament rupture in professional soccer players. CONCLUSION Posterior tibial and meniscal slopes and tibial and meniscal delta-slopes are related to a greater risk of rupture of the anterior cruciate ligament in professional male soccer athletes. The lateral and medial posterior meniscal slopes are predictors for ligament rupture.
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Affiliation(s)
- Marcos Hiroyuki Ikawa
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.,Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, SP, Brazil.,ALTA Diagnostic Center (DASA Group), São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil. .,Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, SP, Brazil. .,ALTA Diagnostic Center (DASA Group), São Paulo, SP, Brazil. .,, São Paulo, Brazil.
| | | | - Abdalla Youssef Skaf
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.,ALTA Diagnostic Center (DASA Group), São Paulo, SP, Brazil
| | - Moisés Cohen
- Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, SP, Brazil
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16
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Jha V, Pandit A. Notch Volume Measured on Magnetic Resonance Imaging Is Better Than 2-Dimensional Notch Parameters for Predicting Noncontact Anterior Cruciate Ligament Injury in Males. Arthroscopy 2021; 37:1534-1543.e1. [PMID: 33278532 DOI: 10.1016/j.arthro.2020.11.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare intercondylar notch volume with other 2-dimensional notch parameters (measured on magnetic resonance imaging [MRI]) for prediction of noncontact anterior cruciate ligament (ACL) injury in males. METHODS Retrospective case-control study in males based on MRI images. The case group consisted of 80 noncontact ACL-injured males and a control group of 80 age- and height-matched ACL-intact males. Inclusion criteria were 18 to 50 years old, full-thickness tear, MRI obtained within 1 year of injury, and ACL tear visually documented during arthroscopy. Multiligamentous, bilateral, or concomitant bony injuries were excluded. Notch volume and 2D parameters in both planes, including notch depth, notch width, intercondylar notch angle, notch-width index, and notch-shape index, were measured on MRI and compared. Slice interval was included in the formula for notch-volume assessment. Bivariate Pearson correlation between notch volume and 2D parameters was estimated. Multivariate conditional logistic regression analysis was used for predictor model. Receiver operating characteristic (ROC) curves were plotted. RESULTS All MRIs had a standard slice thickness of 3 mm and slice interval of 0.3 mm. Notch volume (P < .001), notch angle in the axial plane (P = .001), and notch width in the coronal plane (P = .009) were significantly smaller in the ACL-injured group. Notch volume had inconsistent and negligible to low correlation with 2D parameters. Notch volume was the only significant contributor in the predictor model (P < .001). ROC curve showed that notch volume had highest area under the curve of 84.1% and optimal cutoff at 7.1550 cm3 (specificity, 88.7%; sensitivity, 65%). CONCLUSION Significantly smaller intercondylar notch volume is associated with noncontact ACL injury in men and is the most important predictor for such an injury (optimal cutoff of 7.1550 cm3). Two-dimensional notch parameters are inconsistently associated with noncontact ACL injury in men, and none of the 2D parameters can be used as a surrogate for notch volume. Two-dimensional notch parameters fare poorly in predicting noncontact ACL injury in males. Notch volume measurement should include slice interval as a factor. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Vivek Jha
- Department of Orthopedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India.
| | - Abhishek Pandit
- Department of Orthopedics, IQCity Medical College, Durgapur, West Bengal, India
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17
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de Sousa Filho PGT, Marques AC, Pereira LS, Pigozzo BA, Albuquerque RSPE. Analysis of Posterior Tibial Slope as Risk Factor to Anterior Cruciate Ligament Tear. Rev Bras Ortop 2021; 56:47-52. [PMID: 33627899 PMCID: PMC7895634 DOI: 10.1055/s-0040-1712495] [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] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Objective
The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination.
Methods
Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age.
Results
Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8°, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8° (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8.
Conclusion
It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8°.
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Affiliation(s)
- Pedro Guilme Teixeira de Sousa Filho
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.,Grupo GENU, Fortaleza, CE, Brasil
| | - Andre Cavalcante Marques
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Leonardo Soares Pereira
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Breno Almeida Pigozzo
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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18
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Bates NA, Myer GD, Hale RF, Schilaty ND, Hewett TE. Prospective Frontal Plane Angles Used to Predict ACL Strain and Identify Those at High Risk for Sports-Related ACL Injury. Orthop J Sports Med 2020; 8:2325967120957646. [PMID: 33110927 PMCID: PMC7557696 DOI: 10.1177/2325967120957646] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Knee abduction moment during landing has been associated with anterior cruciate ligament (ACL) injury. However, accurately capturing this measurement is expensive and technically rigorous. Less complex variables that lend themselves to easier clinical integration are desirable. Purpose: To corroborate in vitro cadaveric simulation and in vivo knee abduction angles from landing tasks to allow for estimation of ACL strain in live participants during a landing task. Study Design: Descriptive laboratory study. Methods: A total of 205 female high school athletes previously underwent prospective 3-dimensional motion analysis and subsequent injury tracking. Differences in knee abduction angle between those who went on to develop ACL injury and healthy controls were assessed using Student t tests and receiver operating characteristic analysis. A total of 11 cadaveric specimens underwent mechanical impact simulation while instrumented to record ACL strain and knee abduction angle. Pearson correlation coefficients were calculated between these variables. The resultant linear regression model was used to estimate ACL strain in the 205 high school athletes based on their knee abduction angles. Results: Knee abduction angle was greater for athletes who went on to develop injury than for healthy controls (P < .01). Knee abduction angle at initial contact predicted ACL injury status with 78% sensitivity and 83% specificity, with a threshold of 4.6° of knee abduction. ACL strain was significantly correlated with knee abduction angle during cadaveric simulation (P < .01). Subsequent estimates of peak ACL strain in the high school athletes were greater for those who went on to injury (7.7-8.1% ± 1.5%) than for healthy controls (4.1-4.5% ± 3.6%) (P < .01). Conclusion: Knee abduction angle exhibited comparable reliability with knee abduction moment for ACL injury risk identification. Cadaveric simulation data can be extrapolated to estimate in vivo ACL strain. Athletes who went on to ACL injury exhibited greater knee abduction and greater ACL strain than did healthy controls during landing. Clinical Relevance: These important associations between the in vivo and cadaveric environments allow clinicians to estimate peak ACL strain from observed knee abduction angles. Neuromuscular control of knee abduction angle during dynamic tasks is imperative for knee joint health. The present associations are an important step toward the establishment of a minimal clinically important difference value for ACL strain during landing.
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Affiliation(s)
- Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory D Myer
- The Sport Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Rena F Hale
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Sparta Science, Menlo Park, California, USA.,The Rocky Mountain Consortium for Sports Research, Edwards, Colorado, USA
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19
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Nevot-Casas O, Pujol-Marzo M, Moreno-Planes B, Fort-Vanmeerhaeghe A. Neuromuscular fatigue effects on Hamstring to Quadriceps Ratio in young female players. APUNTS SPORTS MEDICINE 2020. [DOI: 10.1016/j.apunsm.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Sugimoto D, Borg DR, Brilliant AN, Meehan WP, Micheli LJ, Geminiani ET. Effect of Sports and Growth on Hamstrings and Quadriceps Development in Young Female Athletes: Cross-Sectional Study. Sports (Basel) 2019; 7:sports7070158. [PMID: 31261679 PMCID: PMC6680738 DOI: 10.3390/sports7070158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022] Open
Abstract
Context: Lower extremity muscular strength may vary by different sport participation during growth process. Objective: To investigate effect of sport participation and growth by comparing strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio) between young female figure skaters and soccer players. Design: Cross-sectional. Settings: Laboratory affiliated with regional sports medicine center. Participants: pediatric and adolescent female athletes. Procedures: Isometric hamstrings and quadriceps strength were measured. Main Outcome Measures: Strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio). Statistical Analysis: Effect of sport participation and growth was analyzed through a two-way (two sports: figure skaters and soccer players; three age groups: <12 years, 13–16 years, and >17 years) analysis of covariance. Results: Hamstrings strength was significantly greater in figure skaters than soccer players. Also, hamstring strength of 13–16 years and >17 years was higher compared to <12 years. Additionally, significantly higher H:Q ratio in figure skaters compared to soccer players. Conclusions: There is effect of growth on hamstrings strength among 13–16 years and >17 years compared to <12 years. Figure skaters showed greater hamstrings strength and H:Q ratio than female soccer players.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA.
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02453, USA.
| | - Dennis R Borg
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA
| | - Anna N Brilliant
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA
| | - William P Meehan
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02453, USA
| | - Lyle J Micheli
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02453, USA
| | - Ellen T Geminiani
- The Micheli Center-for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02453, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02453, USA
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21
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Bisciotti GN, Chamari K, Cena E, Bisciotti A, Bisciotti A, Corsini A, Volpi P. Anterior cruciate ligament injury risk factors in football. J Sports Med Phys Fitness 2019; 59:1724-1738. [PMID: 31062538 DOI: 10.23736/s0022-4707.19.09563-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury. EVIDENCE ACQUISITION Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. EVIDENCE SYNTHESIS To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made. CONCLUSIONS This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).
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Affiliation(s)
- Gian Nicola Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar -
| | - Karim Chamari
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Emanuele Cena
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | | | | | | | - Piero Volpi
- FC Internazionale Milano, Milan, Italy.,Unit of Traumatology, Department of Knee Orthopedic and Sports, Humanitas Research Hospital, Rozzano, Milan, Italy
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22
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Loose O, Fellner B, Lehmann J, Achenbach L, Krutsch V, Gerling S, Jansen P, Angele P, Nerlich M, Krutsch W. Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football. Knee Surg Sports Traumatol Arthrosc 2019; 27:978-984. [PMID: 30167753 DOI: 10.1007/s00167-018-5119-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Injuries are a common occurrence in football. Sufficient epidemiological data are available in professional football but not in salaried semi-professional football. This study investigates the injury incidence at different levels of semi-professional football with focus on junior football. METHODS The data were based on injury reports provided by players and medical staff over the 2015-2016 season, which corresponded to the consensus statement for data samples in football. This study investigated the injury incidence and prevalence of five skill levels of semi-professional football (the fourth to the seventh league and elite junior football). RESULTS 1130 players had sustained 2630 injuries over the 2015-2016 season. The overall injury incidence was 9.7 per 1000 h football exposure; prevalence with at least one injury was 79%. The highest overall injury incidence in elite junior football was 10.4 in 1000 h football exposure. The fifth league had the lowest incidence with 9.0 in 1000 h football (p < 0.05). Traumatic injuries most often occurred in the fourth league (3.9 in 1000 h football). The body areas most affected by traumatic injury were knees, ankles and thighs. Elite junior players had a significantly higher incidence of overuse complaints (7.4 in 1000 h football) than the fourth league (5.4, p = 0.005). The body areas most affected by overuse complaints were the lower back, thigh and groin. No differences were found between the different positions on field. CONCLUSIONS Salaried semi-professional football involves a high overall injury incidence. The highest incidence, particularly of overuse injuries, was seen in elite junior football. These findings should be incorporated in specific injury prevention training or screenings beginning in junior football. Level of evidence II.
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Affiliation(s)
- Oliver Loose
- Clinic of Paediatric Surgery, Clinic St. Hedwig Regensburg, Regensburg, Germany
| | - Birgit Fellner
- Institute of Sport Science, University of Regensburg, Regensburg, Germany
| | - Jennifer Lehmann
- Institute of Sport Science, University of Regensburg, Regensburg, Germany
| | - Leonard Achenbach
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Krutsch
- Department of Otorhinolaryngology, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Gerling
- Clinic of Pediatric and Adolescent Medicine, St. Hedwig Clinic, Regensburg, Germany
| | - Petra Jansen
- Institute of Sport Science, University of Regensburg, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
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23
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Taylor JB, Wright AA, Dischiavi SL, Townsend MA, Marmon AR. Activity Demands During Multi-Directional Team Sports: A Systematic Review. Sports Med 2018; 47:2533-2551. [PMID: 28801751 DOI: 10.1007/s40279-017-0772-5] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Late-stage rehabilitation programs often incorporate 'sport-specific' demands, but may not optimally simulate the in-game volume or intensity of such activities as sprinting, cutting, jumping, and lateral movement. OBJECTIVE The aim of this review was to characterize, quantify, and compare straight-line running and multi-directional demands during sport competition. DATA SOURCES A systematic review of PubMed, CINAHL, SPORTDiscus, and Cochrane Central Register of Controlled Trials databases was conducted. STUDY ELIGIBILITY CRITERIA Studies that reported time-motion analysis data on straight-line running, accelerations/decelerations, activity changes, jumping, cutting, or lateral movement over the course of an entire competition in a multi-directional sport (soccer, basketball, lacrosse, handball, field hockey, futsal, volleyball) were included. STUDY APPRAISAL AND SYNTHESIS METHODS Data was organized based on sport, age level, and sex and descriptive statistics of the frequency, intensity, time, and volume of the characteristics of running and multi-directional demands were extracted from each study. RESULTS Eighty-one studies were included in the review (n = 47 soccer, n = 11 basketball, n = 9 handball, n = 7 field hockey, n = 3 futsal, n = 4 volleyball). Variability of sport demand data was found across sports, sexes, and age levels. Specifically, soccer and field hockey demanded the most volume of running, while basketball required the highest ratio of high-intensity running to sprinting. Athletes change activity between 500 and 3000 times over the course of a competition, or once every 2-4 s. Studies of soccer reported the most frequent cutting (up to 800 per game), while studies of basketball reported the highest frequency of lateral movement (up to 450 per game). Basketball (42-56 per game), handball (up to 90 per game), and volleyball (up to 35 per game) were found to require the most jumping. LIMITATIONS These data may provide an incomplete view of an athlete's straight-line running load, considering that only competition and not practice data was provided. CONCLUSIONS Considerable variability exists in the demands of straight-line running and multi-directional demands across sports, competition levels, and sexes, indicating the need for sports medicine clinicians to design future rehabilitation programs with improved specificity (including the type of activity and dosage) to these demands.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA.
| | - Alexis A Wright
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - M Allison Townsend
- Department of Exercise Science, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Adam R Marmon
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, Newark, DE, 19711, USA
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24
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Bagherifard A, Jabalameli M, Yahyazadeh H, Shafieesabet A, Gharanizadeh K, Jahansouz A, Khanlari P. Diminished femoral head-neck offset and the restricted hip range of motion suggesting a possible role in ACL injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:368-373. [PMID: 28585048 DOI: 10.1007/s00167-017-4589-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 05/26/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE Femoroacetabular impingement may be associated with anterior cruciate ligament (ACL) injuries. The purpose of this study was to determine the head-neck offset, as measured by 45° Dunn's view alpha angles, in patients with ACL injuries compared to control subjects. METHODS In this retrospective study, 140 consecutive non-professional athletes with primary ACL ruptures confirmed with knee arthroscopy and 100 consecutive patients with non-ACL injury were enrolled. Hip range of motion was assessed in lower extremities in all participants, and alpha angle was calculated according to 45° Dunn's view radiographs. RESULTS There is not any difference in age, gender distribution, height, weight, and BMI between groups. Internal rotation, abduction, and adduction of the hip were significantly decreased in ACL-injured patients comparing with control subjects (p < 0.001). ACL-injured patients had also a significantly higher alpha angle comparing to the control individuals (p < 0.001). The mean of alpha angle in the ACL-injured patients was 56.1 (SD 10.1) and in the non-ACL-injured group was 49.3 (SD 9.4). CONCLUSIONS The patients in ACL-injured group showed a significant restriction in hip range of motion and also a diminished femoral head-neck offset suggesting a possible role of these findings in the outcome assessed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran
| | - Mahmoud Jabalameli
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran
| | - Hooman Yahyazadeh
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran.
| | - Azadeh Shafieesabet
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran
| | - Kaveh Gharanizadeh
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran
| | - Ali Jahansouz
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedic Hospital, Iran University of Medical Sciences, Mojahedin Islam Avenue, Shohada Square, Tehran, 1157637131, Islamic Republic of Iran
| | - Parhan Khanlari
- Medical Department of Iran Football Federation, FFIRI, Tehran, Iran
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The Effects of Maturation on Measures of Asymmetry During Neuromuscular Control Tests in Elite Male Youth Soccer Players. Pediatr Exerc Sci 2018; 30:168-175. [PMID: 28787266 PMCID: PMC6538932 DOI: 10.1123/pes.2017-0081] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Asymmetry is a risk factor for male youth soccer players. There is a paucity of data confirming the presence of asymmetry using practically viable screening tasks in players at different stages of maturation. METHODS A cross-sectional sample (N = 347) of elite male youth soccer players who were either pre-, circa-, or post-peak height velocity (PHV) completed the following assessments: single-leg Y-Balance anterior reach, single-leg hop for distance, single-leg 75% hop and stick, and single-leg countermovement jumps. RESULTS Single-leg countermovement jumps landing force asymmetry was higher in both circa- and post-PHV groups (P < .001; d = 0.41-0.43). Single-leg 75% hop and stick landing force asymmetries were also highest in circa-PHV players, but between-group comparisons were not statistically significant and effect sizes were small. Single-leg hop for distance and single-leg Y-Balance anterior reach asymmetries reduced with maturation; however, no group differences were significant, with small to trivial effect sizes (d ≤ 0.25). CONCLUSION Stage of maturation did not have a profound effect on asymmetry. Between-limb differences in functional performance seem to be established in early childhood; thus, targeted interventions to reduce this injury risk factor should commence in pre-PHV athletes and be maintained throughout childhood and adolescence to ensure asymmetry does not increase.
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Fischer F, Fink C, Herbst E, Hoser C, Hepperger C, Blank C, Gföller P. Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:418-425. [PMID: 28324151 DOI: 10.1007/s00167-017-4522-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/10/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to compare isokinetic quadriceps and hamstring muscle strength in patients following anterior cruciate ligament (ACL) reconstruction who received either hamstring (HT) or quadriceps (QT) tendon autografts at two time intervals within the first year after surgery. METHODS One hundred twenty-four patients, 81 males (age 22.0 ± 6.2 years) and 43 females (age 20.9 ± 8.7 years), participated in this study. ACL reconstruction was performed with either quadriceps tendon autografts (QT; n = 61) or hamstring tendon autografts (HT; n = 63). Two isokinetic muscle strength tests (t1: 5.5 ± 1.2 months; t2: 7.6 ± 1.6 months) were performed at an angular velocity of 60°/s in both the injured and contralateral knees. An independent t test as well as a two-factor analysis of variance with repeated measurements was used. The significance level was set at p < 0.05. RESULTS A statistically significant lower knee extensor strength was observed in the QT group within one year after surgery (p < 0.001). Additionally, data showed a significant higher H/Q ratio in QT patients compared to the HT group at t1 (p < 0.001) and t2 (p = 0.001) as well as a significant effect over time (p < 0.001) and interaction effect of time and graft (p = 0.007). Side-to-side values for extensor muscle strength were significantly (p < 0.001) greater in HT graft patients, while QT patients showed significantly (p < 0.001) greater values for flexor muscle strength at both time points of isokinetic testing, respectively. CONCLUSION The results of this study indicate that graft choice has an impact on extensor strength in the first months after ACL reconstruction; however, there is no impact on flexor strength. The finding of a higher H/Q ratio in patients with QT grafts within the first months following surgery is possibly of clinical relevance. This may potentially be associated with lower stress on the maturing ACL graft. Furthermore, normal thigh strength can be restored over time. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Felix Fischer
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Christian Fink
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria.
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Caroline Hepperger
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Cornelia Blank
- Institute of Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Peter Gföller
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
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Welling W, Benjaminse A, Seil R, Lemmink K, Gokeler A. Altered movement during single leg hop test after ACL reconstruction: implications to incorporate 2-D video movement analysis for hop tests. Knee Surg Sports Traumatol Arthrosc 2018; 26:3012-3019. [PMID: 29549389 PMCID: PMC6154044 DOI: 10.1007/s00167-018-4893-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/08/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE There is a lack of objective factors which can be used in guiding the return to sport (RTS) decision after an anterior cruciate ligament reconstruction (ACLR). The purpose of the current study was to conduct qualitative analysis of the single leg hop (SLH) in patients after ACLR with a simple and clinical friendly method and to compare the possible difference in movement pattern between male and female patients. METHODS Sixty-five patients performed the single leg hop (SLH) test at 6.8 ± 1.0 months following isolated ACLR. Digital video camcorders recorded frontal and sagittal plane views of the patient performing the SLH. Knee flexion at initial contact (IC), peak knee flexion, knee flexion range of motion (RoM), and knee valgus RoM were calculated. In addition, limb symmetry index (LSI) scores were calculated. RESULTS No differences were found in movement pattern between males and females. Movement analysis revealed that males had a decrease in knee flexion at IC (p = 0.018), peak knee flexion (p = 0.002), and knee flexion RoM (p = 0.017) in the injured leg compared to the non-injured leg. Females demonstrated a decrease in peak knee flexion (p = 0.011) and knee flexion RoM (p = 0.023) in the injured leg compared to the non-injured leg. Average LSI scores were 92.4% for males and 94.5% for females. CONCLUSIONS Although LSI scores were > 90%, clinical relevant altered movement patterns were detected in the injured leg compared to the non-injured leg. Caution is warranted to solely rely on LSI scores to determine RTS readiness. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION The University of Groningen, ID 2012.362. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wouter Welling
- Medisch Centrum Zuid, Sportlaan 2-1, 9728 PH, Groningen, The Netherlands. .,Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Anne Benjaminse
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands ,School of Sport Studies, Hanze University Groningen, Zernikeplein 17, 9747 AS Groningen, The Netherlands
| | - Romain Seil
- Département de l’Appareil Locomoteur, Centre Hospitalier de Luxemburg, 4 Rue Nicolas Ernest Barblé, 1210 Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, 4 Rue Nicolas Ernest Barblé, 1210 Luxembourg, Luxembourg
| | - Koen Lemmink
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Alli Gokeler
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.
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Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 2017; 46:1059-66. [PMID: 26856339 DOI: 10.1007/s40279-016-0479-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.
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Fleaca R, Roman M, Bățagă T, Feier AM, Prejbeanu R, Predescu V, Zuh SG, Gergely I, Russu O. Prevention of Primary ACL Injuries: A Novel, Innovative Approach. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Anterior cruciate ligament (ACL) injuries are increasing amongst professional and recreational athletes, and creating prevention programs to reduce the occurrence of ACL damages is becoming a necessity. To prevent an ACL tear, it is necessary to comprehend the mechanisms and the risk factors of injury. Biomechanical and clinical studies try to understand these complex mechanisms in order to identify factors that can be improved and to develop training programs to prevent at least non-contact ACL injuries. There are several promising programs, but there are still many questions to answer. This paper analyzes the risk factors for ACL injuries and some aspects of the modern programs developed to decrease the rate of ACL tears.
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Affiliation(s)
- Radu Fleaca
- “Victor Papillan” Faculty of Medicine , “Lucian Blaga” University , Sibiu , Romania
| | - Mihai Roman
- “Victor Papillan” Faculty of Medicine , “Lucian Blaga” University , Sibiu , Romania
| | - Tiberiu Bățagă
- University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | | | - Radu Prejbeanu
- “Victor Babeş” University of Medicine and Pharmacy , Timişoara , Romania
| | - Vlad Predescu
- “Carol Davila” University of Medicine and Pharmacy , Bucharest , Romania
| | | | - István Gergely
- University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | - Octav Russu
- University of Medicine and Pharmacy , Tîrgu Mureş , Romania
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Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk. Orthop J Sports Med 2017; 5:2325967116688664. [PMID: 28255568 PMCID: PMC5315236 DOI: 10.1177/2325967116688664] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.
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Affiliation(s)
| | - Mélanie L Beaulieu
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M Wojtys
- MedSport, Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Benjaminse A, Otten B, Gokeler A, Diercks RL, Lemmink KAPM. Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2365-2376. [PMID: 26259551 PMCID: PMC5522510 DOI: 10.1007/s00167-015-3727-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during unexpected sidestep cutting in female and male athletes and how these effects remained over time. METHODS Ninety experienced basketball athletes performed sidestep cutting manoeuvres in three sessions (S1, S2 and S3). In this randomized controlled trial, athletes were allocated to three groups: visual (VIS), verbal (VER) and control (CTRL). Kinematics and kinetics were collected at the time of peak knee frontal plane moment. RESULTS Males in the VIS group showed a larger vertical ground reaction force (S1: 25.4 ± 3.1 N/kg, S2: 25.8 ± 2.9 N/kg, S3: 25.2 ± 3.2 N/kg) and knee flexion moments (S1: -3.8 ± 0.9 Nm/kg, S2: -4.0 ± 1.2 Nm/kg, S3: -3.9 ± 1.3 Nm/kg) compared to the males in the VER and CTRL groups and to the females in the VIS group (p < 0.05). Additionally, the males in the VIS group reduced knee valgus moment and the females in the VER group reduced knee varus moment over time (n.s.). CONCLUSION Male subjects clearly benefit from visual feedback. Females may need different feedback modes to learn a correct movement pattern. Sex-specific learning preferences may have to be acknowledged in day by day practice. Adding video instruction or feedback to regular training regimens when teaching athletes safe movement patterns and providing individual feedback might target suboptimal long-term results and optimize ACL injury prevention programmes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Anne Benjaminse
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
- School of Sport Studies, Hanze University Groningen, Zernikeplein 17, 9747 AS, Groningen, The Netherlands.
| | - Bert Otten
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Alli Gokeler
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Ron L Diercks
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands
| | - Koen A P M Lemmink
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Abstract
Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.
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Affiliation(s)
| | - Emily Naclerio
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA,Address for correspondence: Dr. Seth L Sherman, Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212, USA. E-mail:
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Sayampanathan AA, Howe BKT, Bin Abd Razak HR, Chi CH, Tan AHC. Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice. J Orthop Surg (Hong Kong) 2017; 25:2309499016684289. [PMID: 28142351 DOI: 10.1177/2309499016684289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are common knee injuries, especially among sportsmen and sportswomen. The aim of this study is to better understand the epidemiology of surgically managed ACL tears sustained in our institution. METHODS All patients who underwent arthroscopic ACL reconstruction by the senior author of this article in Singapore from 2008 to 2013 were studied. Patients who were diagnosed clinically and/or radiologically to have a complete tear of the ACL and subsequently underwent arthroscopic ACL reconstruction were included. Patients who suffered from traumatic knee dislocation were excluded. Two hundred and ninety-two patients were available for analysis. All patients were operated on by the senior author. RESULTS 83.9% of patients were male. 60.5, 23.0, 8.46, and 8.11% were of Chinese, Malay, Indian and other origins, respectively. 69.6 and 28.7% were in white-collared and blue-collared jobs, respectively, while 1.69% were unemployed. Mean age at operation was 29.4 years. Mean body mass index was 25.3 kg/m2. 82.4 and 17.6% of ACL tears were sports (contact-27.5%; non-contact-72.5%) and non-sports injuries (activities of daily living-94.2%, road traffic accidents-5.77%), respectively. The top four sporting activities causing ACL tears were soccer, basketball, racquet games and volleyball. 56.2% of ACL tears presented with concomitant knee injuries (medial meniscus-63.4%; lateral meniscus-31.1%; posterior cruciate ligament-5.49%). 84.5% were primary tears. CONCLUSIONS In this epidemiological review of ACL injuries, we found that ACL injuries tend to cluster within certain population subgroups. Patterns of mechanisms of injuries have been observed. These findings may lead to better preventive and treatment strategies in the management of ACL tears.
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Affiliation(s)
| | | | | | - Chong Hwei Chi
- 2 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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35
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Petrofsky JS, Laymon MS, Alshammari FS, Lee H. Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial. J Strength Cond Res 2016; 30:3107-3115. [PMID: 27776079 DOI: 10.1519/jsc.0000000000001409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.
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Affiliation(s)
- Jerrold S Petrofsky
- 1School of Physical, Touro University, Henderson, Nevada; 2Department of Physical Therapy, Hashemite University, Zarqa, Jordan; and 3Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea
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Anterior cruciate ligament rupture is associated with abnormal and asymmetrical lower limb loading during walking. J Sci Med Sport 2016; 20:432-437. [PMID: 27756526 DOI: 10.1016/j.jsams.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 08/25/2016] [Accepted: 09/24/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Anterior Cruciate Ligament (ACL) deficiency may result in abnormal lower limb loading with increased foot pronation. This study evaluated spatiotemporal parameters and plantar pressure distribution during walking in participants with and without an ACL rupture. DESIGN Cross-sectional. METHODS Plantar pressure was measured in 42 unilateral ACL deficient (ACLD) participants and 32 healthy controls while walking barefoot. Spatiotemporal parameters, pressure distribution and center of pressure (CoP) during foot roll off were determined. Differences in spatiotemporal parameters and pressure distribution were analyzed using a Linear Mixed Model. CoP position was analyzed with one-way ANOVA. RESULTS ACLD participants had a longer contact time and earlier forefoot contact compared to controls. The ACLD side showed a shorter contact time and a faster roll off toward the forefoot compared to the ACL intact side. Compared to controls, ACLD participants had increased pressure under the medioproximal side of the midfoot. Within ACLD participants, the ACLD side had decreased pressure under the heel and increased pressure under the forefoot. Foot pronation was not different between groups or within ACLD participants. CoP of the ACLD participants was significantly more toward the toes during initial contact and toward the heel during foot flat. CONCLUSIONS Changes in lower limb loading during barefoot walking in ACLD participants are due to changes in roll off pattern, most likely in order to reduce anterior shear forces on the knee. Dynamic plantar pressure measurements may assist in evaluating and guiding interventions aimed at normalizing lower limb and knee biomechanics in ACL deficiency.
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Sugimoto D, Bowen SL, Meehan WP, Stracciolini A. Effects of Neuromuscular Training on Children and Young Adults with Down Syndrome: Systematic Review and Meta-Analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:197-206. [PMID: 27123540 DOI: 10.1016/j.ridd.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To synthesize existing research evidence and examine effects of neuromuscular training on general strength, maximal strength, and functional mobility tasks in children and young adults with Down syndrome. METHODS PubMed and EBSCO were used as a data source. To attain the aim of this study, literature search was performed under following inclusion criteria: (1) included participants with Down syndrome, (2) implemented a neuromuscular training intervention and measured outcome variables of general strength, maximal strength, and functional mobility tasks, (3) had a group of participants whose mean ages were under 30 years old, (4) employed a prospective controlled design, and (5) used mean and standard deviations to express the outcome variables. Effect size was calculated from each study based on pre- and post-testing value differences in general strength, maximal strength, and functional mobility tasks between control and intervention groups. The effect size was further classified in to one of the following categories: small, moderate, and large effects. RESULTS Seven studies met inclusion criteria. Analysis indicated large to moderate effects on general strength, moderate to small effects on maximal strength, and small effect on functional mobility tasks by neuromuscular training. CONCLUSIONS Although there were limited studies, the results showed that neuromuscular training could be used as an effective intervention in children and young adults with Down syndrome. WHAT THIS PAPER ADDS Synthesis of seven reviewed studies indicated that neuromuscular training could be beneficial to optimize general and maximal muscular strength development in children and young adults with Down syndrome.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | | | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, United States; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Kosaka M, Nakase J, Numata H, Oshima T, Takata Y, Moriyama S, Oda T, Shima Y, Kitaoka K, Tsuchiya H. Psychological traits regarding competitiveness are related to the incidence of anterior cruciate ligament injury in high school female athletes. Knee 2016; 23:681-5. [PMID: 27242282 DOI: 10.1016/j.knee.2016.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between psychological competitive ability and the incidence of noncontact ACL injuries among high school female athletes. METHODS A three-year prospective cohort study was conducted using 300 15-year-old high school female athletes with no previous injuries or symptoms in their lower limbs (106 handball players and 194 basketball players). At baseline, their psychological competitive abilities were assessed using a self-administered questionnaire-the Diagnostic Inventory of Psychological Competitive Ability (DIPCA.3). After the baseline examination was performed at high school entry, all players were prospectively followed for 36months to document any subsequent incidence of ACL injury, according to their coaches. An unpaired t-test with Welch's correction was performed to compare the differences in the psychological competitive abilities between the injured and uninjured players. RESULTS Of the 300 players, 25 (8.3%) experienced a noncontact ACL injury during the three-year observation period. The injured players had significantly higher total DIPCA.3 scores for psychological competitive ability than the uninjured players (169.9±18.8 vs. 159.2±21.6, P=.036). Additionally, the injured players had significantly higher scores than the uninjured players in the following categories: aggressiveness, volition for self-realization, volition for winning, judgment, and cooperation. However, no significant differences were observed in patience, self-control, ability to relax, concentration, confidence, decision, and predictive ability. CONCLUSIONS High psychological competitive ability was associated with the incidence of noncontact ACL injuries in high school female athletes. LEVEL OF EVIDENCE Level II (prospective cohort study).
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Affiliation(s)
- Masahiro Kosaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
| | - Hitoaki Numata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shigenori Moriyama
- Division of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Takumi Oda
- Division of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Yosuke Shima
- Department of Orthopaedic Surgery, KKR Hokuriku Hospital, Kanazawa, Japan
| | | | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Rahnemai-Azar AA, Yaseen Z, van Eck CF, Irrgang JJ, Fu FH, Musahl V. Increased Lateral Tibial Plateau Slope Predisposes Male College Football Players to Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2016; 98:1001-6. [PMID: 27307360 DOI: 10.2106/jbjs.15.01163] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are conflicting reports regarding the role of osseous morphologic characteristics such as an increased tibial slope as associated with an anterior cruciate ligament (ACL) injury. Few studies have analyzed the role of a combination of osseous morphologic characteristics in matched case control studies. The aim of this study was to determine if there is an association between osseous morphologic characteristics and ACL injury in male college American-football players. METHODS Ninety male U.S. National Collegiate Athletic Association (NCAA) Division-I college football players who underwent magnetic resonance imaging (MRI) for a knee injury between 2005 and 2014 were included. Subjects with an ACL injury (ACL-injured group) were matched for age, height, weight, and body mass index to subjects without an ACL injury (control group). Several osseous morphologic characteristics including medial and lateral condylar width, medial and lateral plateau width, notch width, bicondylar width, notch width index, and medial and lateral tibial slopes were measured and were compared between groups. Conditional logistic regression was used to analyze the data. Significance was set at p < 0.05. RESULTS According to univariable analysis, a narrower lateral femoral condyle (odds ratio, 0.82 [95% confidence interval (95% CI), 0.68 to 0.97]), increased medial tibial plateau slope (odds ratio, 1.42 [95% CI, 1.09 to 1.85]), and increased lateral tibial plateau slope (odds ratio, 1.43 [95% CI, 1.15 to 1.78]) were significantly associated with ACL injury. Multivariable analysis revealed that increased lateral tibial slope (odds ratio, 1.32 [95% CI, 1.03 to 1.70]) was the sole independent predictor of ACL injury. CONCLUSIONS Based on this study, osseous morphology, specifically increased lateral tibial slope, is associated with ACL injury in male college football players. These data might help to improve prevention strategies to lower ACL injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Zaneb Yaseen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.
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Affiliation(s)
- Jason P Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Gerald A Ferrer
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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Krosshaug T, Steffen K, Kristianslund E, Nilstad A, Mok KM, Myklebust G, Andersen TE, Holme I, Engebretsen L, Bahr R. The Vertical Drop Jump Is a Poor Screening Test for ACL Injuries in Female Elite Soccer and Handball Players: A Prospective Cohort Study of 710 Athletes. Am J Sports Med 2016; 44:874-83. [PMID: 26867936 DOI: 10.1177/0363546515625048] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence linking knee kinematics and kinetics during a vertical drop jump (VDJ) to anterior cruciate ligament (ACL) injury risk is restricted to a single small sample. Still, the VDJ test continues to be advocated for clinical screening purposes. PURPOSE To test whether 5 selected kinematic and kinetic variables were associated with future ACL injuries in a large cohort of Norwegian female elite soccer and handball players. Furthermore, we wanted to assess whether the VDJ test can be recommended as a screening test to identify players with increased risk. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Elite female soccer and handball players participated in preseason screening tests from 2007 through 2014. The tests included marker-based 3-dimensional motion analysis of a drop-jump landing. We followed a predefined statistical protocol in which we included the following candidate risk factors in 5 separate logistic regression analyses, with new ACL injury as the outcome: (1) knee valgus angle at initial contact, (2) peak knee abduction moment, (3) peak knee flexion angle, (4) peak vertical ground-reaction force, and (5) medial knee displacement. RESULTS A total of 782 players were tested (age, 21 ± 4 years; height, 170 ± 7 cm; body mass, 67 ± 8 kg), of which 710 were included in the analyses. We registered 42 new noncontact ACL injuries, including 12 in previously ACL-injured players. Previous ACL injury (relative risk, 3.8; 95% CI, 2.1-7.1) and medial knee displacement (odds ratio, 1.40; 95% CI, 1.12-1.74 per 1-SD change) were associated with increased risk for injury. However, among the 643 players without previous injury, we found no association with medial knee displacement. A receiver operating characteristic curve analysis of medial knee displacement showed an area under the curve of 0.6, indicating a poor-to-failed combined sensitivity and specificity of the test, even when including previously injured players. CONCLUSION Of the 5 risk factors considered, medial knee displacement was the only factor associated with increased risk for ACL. However, receiver operating characteristic curve analysis indicated a poor combined sensitivity and specificity when medial knee displacement was used as a screening test for predicting ACL injury. For players with no previous injury, none of the VDJ variables were associated with increased injury risk. CLINICAL RELEVANCE VDJ tests cannot predict ACL injuries in female elite soccer and handball players.
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Affiliation(s)
- Tron Krosshaug
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kathrin Steffen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Eirik Kristianslund
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Agnethe Nilstad
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kam-Ming Mok
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ingar Holme
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Anderson MJ, Browning WM, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med 2016; 4:2325967116634074. [PMID: 27047983 PMCID: PMC4794976 DOI: 10.1177/2325967116634074] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). PURPOSE To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded. RESULTS A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature.
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Affiliation(s)
| | | | | | | | - Leslie J. Bisson
- The State University of New York at Buffalo, Buffalo, New York, USA
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43
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Is posterior tibial slope associated with noncontact anterior cruciate ligament injury? Knee Surg Sports Traumatol Arthrosc 2016; 24:830-7. [PMID: 25326762 DOI: 10.1007/s00167-014-3382-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to: (1) examine whether the association between posterior tibial slope and noncontact ACL injury exists in Chinese population; (2) compare the reliability and consistency of the three methods (longitudinal axis, posterior and anterior tibial cortex axis) in lateral radiograph. METHODS Case-control study contained 146 patients in total (73 noncontact ACL injuries and 73 meniscus injuries, matched for age and gender), which were verified by arthroscopy, MRI and physical examination. RESULTS For the total population and the male subgroup, the mean posterior tibial slope of the ACL-injured group was significantly higher than that of the control group (P < 0.001). In addition, the longitudinal axis method exhibited the highest inter-rater (0.898) and intrarater reliability (0.928), whereas the anterior tibial cortex was the most variable (inter-rater reliability, 0.805; intrarater reliability, 0.824). The anterior tibial cortex method produced largest posterior tibial slope measurements (13.8 ± 3.3 for injury group; 11.6 ± 2.7 for control group), while the posterior tibial cortex method was the smallest (9.1 ± 3.1 for injury group; 7.2 ± 2.6 for control group). All three methods were not affected by age, sex, height, weight and BMI (n.s.). CONCLUSIONS The results of this study suggested that an increased posterior tibial slope was associated with the risk of noncontact ACL injury in Chinese population. Meanwhile, the longitudinal axis method is recommended for measuring posterior tibial slope in lateral radiograph in future studies. Posterior tibial slope measured by longitudinal axis method may be used as predictor of ACL injury. LEVEL OF EVIDENCE Case-control study, Level III.
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Wetters N, Weber AE, Wuerz TH, Schub DL, Mandelbaum BR. Mechanism of Injury and Risk Factors for Anterior Cruciate Ligament Injury. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Bisciotti GN, Chamari K, Cena E, Carimati G, Volpi P. ACL injury in football: a literature overview of the prevention programs. Muscles Ligaments Tendons J 2016; 6:473-479. [PMID: 28217569 DOI: 10.11138/mltj/2016.6.4.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The ACL prevention programs are addressed to the control and/or modification of the so-called "modifiable risk factors". All these programs focus on different intervention strategies aimed to decrease the ACL injury risk, particularly in female athletes population. PURPOSE To furnish an overview of the most used ACL injury prevention program through a narrative review. CONCLUSION In literature there are many reports on prevention programs whose common denominator is the proper alignment of the lower limb joints and proper motor control during movements that are considered at risk for ACL integrity, as the landing phase after a jump. Nevertheless, some programs would appear more effective than others. In any cases a major problem remains the lack of sufficient compliance in respect of prevention programs. Finally, it is important to remember that the ethiology of ACL injuries is multifactorial. For this reason a prevention program able to prevent all the risk situations is utopian. STUDY DESIGN Narrative review.
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Affiliation(s)
- Gian Nicola Bisciotti
- Qatar Orthopaedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Karim Chamari
- Qatar Orthopaedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Emanuele Cena
- Qatar Orthopaedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Giulia Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital. Rozzano (MI), Italy
| | - Piero Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital. Rozzano (MI), Italy; FC Internazionale Medical Staff. Milano, Italy
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Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs. Sports Med 2016; 45:809-22. [PMID: 25663251 DOI: 10.1007/s40279-015-0311-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination.
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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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Welling W, Benjaminse A, Gokeler A, Otten B. Enhanced retention of drop vertical jump landing technique: A randomized controlled trial. Hum Mov Sci 2015; 45:84-95. [PMID: 26615475 DOI: 10.1016/j.humov.2015.11.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/06/2015] [Accepted: 11/16/2015] [Indexed: 11/19/2022]
Abstract
External focus instructions have been shown to result in superior motor performance compared to internal focus instructions. Using an EF may help to optimize current anterior cruciate ligament (ACL) injury prevention programs. The purpose of the current study was to investigate the effects of instructions on landing technique and performance by comparing an external focus (EF), internal focus (IF), video (VI) and control (CTRL) group. Subjects (age 22.50±1.62years, height 179.70±10.43cm, mass 73.98±12.68kg) were randomly assigned to IF (n=10), EF (n=10), VI (n=10) or CTRL group (n=10). Landing was assessed from a drop vertical jump (DVJ) in five sessions: pretest, two training blocks (TR1 and TR2) and directly after the training sessions (post test) and retention test 1week later. Group specific instructions were offered in TR1 and TR2. Landing technique was assessed with the Landing Error Scoring System (LESS) and jump height was taken as performance measure. The results show that males in the VI group and females both in the VI and EF groups significantly improved jump-landing technique. Retention was achieved and jump height was maintained for males in the VI group and females both in the VI and EF groups. It is therefore concluded that EF and VI instructions have great potential in ACL injury prevention.
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Affiliation(s)
- Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Anne Benjaminse
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands; School of Sport Studies, Hanze University, Groningen, The Netherlands.
| | - Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Bert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Silvers-Granelli H, Mandelbaum B, Adeniji O, Insler S, Bizzini M, Pohlig R, Junge A, Snyder-Mackler L, Dvorak J. Efficacy of the FIFA 11+ Injury Prevention Program in the Collegiate Male Soccer Player. Am J Sports Med 2015; 43:2628-37. [PMID: 26378030 PMCID: PMC4839291 DOI: 10.1177/0363546515602009] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Fédération Internationale de Football Association (FIFA) 11+ program has been shown to be an effective injury prevention program in the female soccer cohort, but there is a paucity of research to demonstrate its efficacy in the male population. HYPOTHESIS To examine the efficacy of the FIFA 11+ program in men's collegiate United States National Collegiate Athletic Association (NCAA) Division I and Division II soccer. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Before the commencement of the fall 2012 season, every NCAA Division I and Division II men's collegiate soccer team (N = 396) was solicited to participate in this research study. Human ethics review board approval was obtained through Quorum Review IRB. Sixty-five teams were randomized: 34 to the control group (CG; 850 players) and 31 to the intervention group (IG; 675 players). Four teams in the IG did not complete the study, reducing the number for analysis to 61. The FIFA 11+ injury prevention program served as the intervention and was utilized weekly. Athlete-exposures (AEs), compliance, and injury data were recorded using a secure Internet-based system. RESULTS In the CG, 665 injuries (mean ± SD, 19.56 ± 11.01) were reported for 34 teams, which corresponded to an incidence rate (IR) of 15.04 injuries per 1000 AEs. In the IG, 285 injuries (mean ± SD, 10.56 ± 3.64) were reported for 27 teams, which corresponded to an IR of 8.09 injuries per 1000 AEs. Total days missed because of injury were significantly higher for the CG (mean ± SD, 13.20 ± 26.6 days) than for the IG (mean ± SD, 10.08 ± 14.68 days) (P = .007). There was no difference for time loss due to injury based on field type (P = .341). CONCLUSION The FIFA 11+ significantly reduced injury rates by 46.1% and decreased time loss to injury by 28.6% in the competitive male collegiate soccer player (rate ratio, 0.54 [95% CI, 0.49-0.59]; P < .0001) (number needed to treat = 2.64).
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Affiliation(s)
- Holly Silvers-Granelli
- Santa Monica Sports Medicine Foundation, Santa Monica, California, USA,Department of Biomechanical and Movement Sciences, University of Delaware, Newark, Delaware, USA,Institute for Sports Sciences, Los Angeles, California, USA,Address correspondence to Holly Silvers-Granelli, MPT, Santa Monica Sports Medicine Foundation, 11611 San Vicente Boulevard, GF-1, Los Angeles, CA 90049, USA ()
| | - Bert Mandelbaum
- Santa Monica Sports Medicine Foundation, Santa Monica, California, USA,Institute for Sports Sciences, Los Angeles, California, USA
| | - Ola Adeniji
- Santa Monica Sports Medicine Foundation, Santa Monica, California, USA
| | - Stephanie Insler
- Santa Monica Sports Medicine Foundation, Santa Monica, California, USA
| | - Mario Bizzini
- Fédération Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland
| | - Ryan Pohlig
- Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Astrid Junge
- Fédération Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland
| | - Lynn Snyder-Mackler
- Department of Biomechanical and Movement Sciences, University of Delaware, Newark, Delaware, USA,Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Jiri Dvorak
- Fédération Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland
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50
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Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research Retreat VII: An Update on Anterior Cruciate Ligament Injury Risk Factor Identification, Screening, and Prevention. J Athl Train 2015; 50:1076-93. [PMID: 26340613 PMCID: PMC4641546 DOI: 10.4085/1062-6050-50.10.06] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Anne Benjaminse
- The Department of Human Movement Sciences, University of Groningen, and The School of Sports Studies, Hanze University, Groningen, The Netherlands
| | - Malcolm Collins
- Department of Human Biology, University of Cape Town, South Africa
| | - Kevin Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Anthony S. Kulas
- Department of Health Education and Promotion, Eastern Carolina University, Greenville, NC
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