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Butler L, Martinez A, Entessari M, Cardenas G, Wright M, Sugimoto D. Qualitative and quantitative return-to-sport test battery and second anterior cruciate ligament injury risk factors. BMJ Open Sport Exerc Med 2024; 10:e002000. [PMID: 39104374 PMCID: PMC11298729 DOI: 10.1136/bmjsem-2024-002000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
ABSTRACT Objective To determine risk factors for second anterior cruciate ligament (ACL) injury following primary ACL reconstruction (ACLR) using return-to-sport (RTS) tests consisting of qualitative and quantitative measures in young athletes. Methods A case-control study design was used, and a retrospective review of adolescent athletes after primary ACLR was performed. All athletes completed an RTS test consisting of qualitative and quantitative assessments and psychological assessments with the Tampa Scale of Kinesiophobia. Athlete demographics, surgical characteristics and sports participation were also examined. A binary logistic regression was performed to verify an independent association between risk factors and second ACL injury using adjusted OR (aORs), 95% CI and p<0.05. Results In 72 eligible athletes, 12 (16.7%) suffered a second ACL injury. The mean Tegner activity level was 8.4+1.1, and the mean time from ACLR to RTS test completion was 10.4+2.9 months. One variable that showed the lowest p-value in the preliminary analysis was entered into the binary logistic regression model, which resulted in that qualitative assessment of knee valgus during the sidestep cut was associated with second ACL injury (aOR=4.64, 95% CI: 1.18 to 18.23, p=0.03). Conclusion Athletes who demonstrated excessive dynamic knee valgus on the involved limb during the sidestep cut were approximately 4.6 times more likely to suffer a second ACL injury.
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Affiliation(s)
- Lauren Butler
- Florida International University, Miami, Florida, USA
- Nicklaus Children's Hospital, Miami, Florida, USA
| | | | | | | | | | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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Stensdotter AK, Schelin L, Häger CK. Whole-body kinematics of squats two decades following anterior cruciate ligament injury. J Electromyogr Kinesiol 2024; 76:102870. [PMID: 38507930 DOI: 10.1016/j.jelekin.2024.102870] [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: 04/13/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Kinematic studies suggest that injury of the anterior cruciate ligament (ACL) leads to long-lasting movement deficits or compensations to unload the injured knee. This study evaluated lower body kinematics during squats in individuals who suffered unilateral ACL-injury more than 20 years ago. METHOD Using motion capture, we compared maximum squat depth, time to complete the squat task, detailed kinematics, estimated kinetic-chain joint moments 0- 80° knee flexion, and weight distribution between legs across three groups with (ACLR, n = 27) and without ACL-reconstructive surgery (ACLPT, physiotherapy only, n = 28), and age-matched non-injured asymptomatic Controls (n = 31, average age across groups 47 years). RESULTS ACLPT demonstrated significantly reduced squat depth compared to Controls (p = 0.004), whereas ACLR performed similarly to Controls (p = 1.000). Other outcome variables were comparable between groups. All participants nevertheless demonstrated asymmetric weight distribution between legs but without systematic unloading of the injured side in the ACLgroups. CONCLUSION Expected compensatory strategies were not found in the ACL-groups, while poorer squat performance in the ACL-deficient group may depend on pure knee-joint mechanics, or lifestyle factors attributed to a less stable knee decades after ACL-injury.
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Affiliation(s)
- Ann-Katrin Stensdotter
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Community Medicine and Rehabilitation; Physiotherapy, Umeå University, Umeå, Sweden
| | - Lina Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation; Physiotherapy, Umeå University, Umeå, Sweden.
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Zhu S, Li R. All-Inside Anterior Cruciate Ligament Reconstruction Had Clinical Outcome Similar to the Transtibial Technique Except for Improved Side-to-Side Difference and Tegner Activity Scale: A Systematic Review and Meta-Analysis. Arthroscopy 2024:S0749-8063(24)00100-2. [PMID: 38354760 DOI: 10.1016/j.arthro.2024.01.044] [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: 10/19/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare clinical outcomes of the all-inside technique with the transtibial technique in anterior cruciate ligament reconstruction based on available literature on this topic. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, we conducted a systematic search for randomized controlled trials and cohort studies. Our comprehensive search encompassed PubMed, Embase, Cochrane Library, and Web of Science. We included randomized controlled trials (RCTs) and cohort studies that compared the 2 techniques with a minimal 1-year follow-up. Two independent authors assessed RCTs using the risk of bias tool developed by the Cochrane Collaboration and evaluated the quality of cohort studies using the Newcastle-Ottawa Scale for Assessing the Quality of Nonrandomized Comparative Trials. The subjective and objective outcomes, complications, and graft failure were obtained. R software was used to perform the analysis. RESULTS The present analysis enrolled 9 RCTs (n = 687) and 11 cohort studies (n = 910). After a minimal 1-year follow-up in RCTs, functional outcomes such as International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, Knee Society Score, and hop test were found to be similar between 2 techniques. The laxity outcomes, including the IKDC objective grade and pivot-shift test, were suggested to be comparable. There was a significant difference favoring the transtibial technique in terms of side-to-side difference (P = .04; 95% confidence interval [CI], 0.08-0.90). The pooled data from cohort studies indicated equivalent results in terms of IKDC subjective score, Lysholm score, side-to-side difference, IKDC objective grade, complications, and graft failure, with the exception of statistical difference in the Tegner activity scale (P = .03; 95% CI, -0.50 to -0.04). CONCLUSIONS Our findings suggest that there is no difference in most outcome scores between the all-inside and transtibial techniques for anterior cruciate ligament reconstruction. There are statistically significant differences in side-to-side difference and Tegner activity scale favoring the all-inside technique. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I to IV studies.
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Affiliation(s)
- Shuang Zhu
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China
| | - Renbin Li
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China.
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Soni MK, Shamim S, Verma A, Singh GK. A Comparative Study of Anterior Cruciate Ligament Reconstruction Versus Conservative Treatment. Cureus 2023; 15:e49148. [PMID: 38130557 PMCID: PMC10733647 DOI: 10.7759/cureus.49148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background The anterior cruciate ligament (ACL) rupture is a common injury with an incidence of 68.6 in 100,000 patients per year. Despite extensive research on ACL rupture, there are insufficient high-quality studies to determine clear treatment strategies for adults lacking the ACL. This study aims to examine the functional differences between surgical and conservative treatment based on the quality of the surgical process. Methodology In this prospective, comparative study, a total of 136 patients aged between 18 and 35 years were enrolled per inclusion and exclusion criteria. Using the lottery system, patients were divided into the following two groups: group A (n = 71) and group B (n = 65). Group A was treated with arthroscopic ACL reconstruction and rehabilitation, whereas group B was treated conservatively (rehabilitation). Patient data, including age, sex, body mass index, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Level (TAL) score, and complications were recorded and compared. Results The demographic data were comparable, where males had dominancy in both groups. The mean IKDC and KOOS scores were higher in group A at all follow-ups compared to group B. The scores gradually increased at every follow-up till six months. At the final follow-up, the IKDC and KOOS scores were higher in group A than in group B, and a significant difference was observed among both groups. The TAL score also gradually increased at every follow-up till 6 months. At the final follow-up, the TAL score was higher in group A than in group B, with a significant difference between the two groups (p = 0.0032). Complications in both groups were comparable. Conclusions This study showed that both the conservatively treated group and the rebuilt group had identical outcomes, with the exception of the conservative group having greater objectively quantifiable instability. However, at the final follow-up, patients reported feeling just as satisfied with their knee without surgery, demonstrating no subjective difference in activity levels or functional outcomes. Therefore, non-athletes with an ACL-insufficient knee should still choose conservative treatment.
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Affiliation(s)
- Mahesh K Soni
- Department of Orthopaedics, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Sharib Shamim
- Department of Orthopaedics, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Anil Verma
- Department of Orthopaedics, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - G K Singh
- Department of Orthopaedics, Era's Lucknow Medical College and Hospital, Lucknow, IND
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Liu Y, Wu L. Effect of instrument-assisted soft tissue mobilization combined with blood flow restriction training on function, pain and strength of patients with patellofemoral joint pain. BMC Musculoskelet Disord 2023; 24:698. [PMID: 37653489 PMCID: PMC10469828 DOI: 10.1186/s12891-023-06701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Patellofemoral pain syndrome is a prevalent sports injury that affects athletes both in their daily lives and during training. This condition causes pain in the area where the kneecap and thigh bone meet, and it can be quite debilitating. Whether an athlete is simply going about their day or pushing themselves to the limit during a workout, patellofemoral pain can be a significant hindrance. PURPOSE The purpose of this study is to investigate the impact of combining Instrument-Assisted Soft Tissue Mobilization (IASTM) treatment with blood flow restriction training on individuals with patellofemoral pain. Specifically, the study will assess improvements in pain levels, functional ability, strength, and joint mobility resulting from this treatment approach. METHODS Twenty-six patients diagnosed with patellofemoral pain were selected as observation subjects and randomly divided into two groups: the IASTM combined with blood flow restriction training treatment group (n = 13) and the IASTM treatment group alone (n = 13). The treatment period was 4 weeks. In this study, we conducted a comparison and analysis of the knee's visual analogue pain scale (VAS), Lysholm score, and a modified version of the Thomas test (MTT) at three different time points.In this subject paper, we compared and analyzed the VAS score of the knee, Lysholm score of the knee, and MTT at three different time points-before treatment, immediately after the first treatment, and after four weeks of treatment. Additionally, we recorded data using a maximum isometric muscle strength testing system for the lower extremity extensors four weeks before and after treatment. RESULTS In comparing the Lysholm scores within the groups, a significant difference was observed between the two groups following the initial treatment and after 4 weeks of treatment (p < 0.05). The scores increased, indicating a significant improvement in function. The VAS scores significantly differed after the first treatment and 4 weeks of treatment compared to before treatment (p < 0.05), indicating a significant improvement in pain. Additionally, after 4 weeks of treatment, the strength of the extensor muscle in the lower extremity significantly improved (p < 0.001). However, there was no significant difference in the strength test between the groups (p > 0.05). The MTT test revealed significant changes in the three joint angles before and after treatment (p > 0.05), suggesting an improvement in joint mobility. Overall, these results demonstrate the effectiveness of the treatment in improving pain and muscle strength in the lower extremity. CONCLUSION The combination of IASTM treatment and blood flow restriction has been shown to significantly reduce pain and improve periprosthetic soft tissue flexibility. Additionally, IASTM treatment alone was found to be more effective in improving knee pain and muscle flexibility, ultimately leading to increased knee strength in a pain-free state. In terms of the overall treatment outcome, it was found that the combined treatment was significantly more effective than the adjuvant soft tissue release treatment alone.
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Affiliation(s)
- Yang Liu
- Wuhan Institute of Sports, No. 461 Luoyu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Lianqing Wu
- Wuhan Institute of Sports, No. 461 Luoyu Road, Hongshan District, Wuhan, Hubei Province, China.
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Waiteman MC, Chia L, Ducatti MHM, Bazett-Jones DM, Pappas E, de Azevedo FM, Briani RV. Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:145. [PMID: 36503991 PMCID: PMC9742076 DOI: 10.1186/s40798-022-00536-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls. METHODS Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. RESULTS A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58-1.18) and stepping tasks (SMD 0.56, 95% CI 0.13-.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60-2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90-2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01-1.12) or ACLR (SMD 0.48; 95% CI 0.21-.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33-1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders. CONCLUSION Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019129257.
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Affiliation(s)
- Marina C. Waiteman
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Lionel Chia
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,Cleveland Guardians Baseball Company, Cleveland, OH USA
| | - Matheus H. M. Ducatti
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - David M. Bazett-Jones
- grid.267337.40000 0001 2184 944XSchool of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH USA
| | - Evangelos Pappas
- grid.1007.60000 0004 0486 528XSchool of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW Australia
| | - Fábio M. de Azevedo
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Ronaldo V. Briani
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
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Huby CL, Miari I, Hagen M, Verschueren S, Vanrenterghem J, Smeets A. Push-Off Dynamics Reveal Task-Independent Alterations in Athletes Returning to Sport after ACL Reconstruction. Med Sci Sports Exerc 2022; 54:2045-2053. [PMID: 35797624 DOI: 10.1249/mss.0000000000002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Athletes with an anterior cruciate ligament (ACL) reconstruction (ACLR) show persisting biomechanical and neuromuscular landing alterations. So far, most research focused on the landing phase of dynamic tasks where most ACL injuries occur. This study will assess whether these landing alterations are also present in the propulsion phase, in an attempt to identify generalized movement alterations. METHODS Twenty-one athletes with ACLR (cleared by their surgeon and/or physiotherapist for return-to-sport) and twenty-one controls performed five single-leg hop tasks. Propulsion kinematics, kinetics, and muscle activations were compared between legs and between groups. RESULTS Increased hamstrings activation was found during propulsion when comparing the ACLR limb with both the uninjured limb and the controls. In addition, decreased internal knee extension moments were found in the ACLR limb compared with the uninjured limb. CONCLUSIONS Athletes with ACLR show task-independent alterations that unload the knee during the propulsion phase of single-leg hopping tasks. If longitudinal data deem these alterations to be maladaptive, more emphasis must be placed on their normalization during the propulsion phase, assuming beneficial carryover effects into the landing phase. Normalizing these patterns during rehabilitation may potentially reduce the risk of long-term complications such as reinjuries and posttraumatic osteoarthritis.
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Affiliation(s)
- Claire Louise Huby
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Ioanna Miari
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Michiel Hagen
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
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Ronden AE, Koc BB, van Rooij L, Schotanus MG, Jansen EJ. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34:102025. [PMID: 36147380 PMCID: PMC9486609 DOI: 10.1016/j.jcot.2022.102025] [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: 05/05/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55-80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). Methods Patients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. Results Eighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. Conclusion Low percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidence II.
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Affiliation(s)
- Annick E. Ronden
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Baris B. Koc
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Lize van Rooij
- Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edwin J.P. Jansen
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
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Manchado I, Motta LM, Blanco G, González J, Garcés GL. Isometric Knee Muscle Strength and Patient-Reported Measures Five Years after Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Autograft Hamstring Tendon Harvesting. J Clin Med 2022; 11:jcm11195682. [PMID: 36233550 PMCID: PMC9572358 DOI: 10.3390/jcm11195682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
There is some controversy regarding the use of one or two hamstring tendons for anterior cruciate ligament reconstruction (ACLR). In this study, two cohorts of 22 male patients underwent an ACLR with hamstring tendon autografts. One cohort was reconstructed through an all-inside technique with the semitendinosus tendon (ST group) and the other with the semitendinosus and gracilis tendons (ST-G group). Anterior tibial translation (ATT), Lysholm, and IKDC scores were assessed preoperatively and five years postoperation. Additionally, isometric knee muscle strength was manually measured in both groups and in another cohort of 22 uninjured control male subjects five years after the operation. There were no significant differences in ATT and Lysholm scores between the operated groups. The IKDC score was lower in the ST-G group than in the ST group—9.57 (CI 14.89−4.25) (p < 0.001). No significant differences between injured and uninjured knees were detected in hamstring to quadriceps ratio strength and quadriceps limb symmetry index of the two operated groups, but the hamstring limb symmetry index was significantly lower in the ST-G group than in the ST and control groups. This study shows that using an ST-G autograft for ACLR yielded less flexor strength and worse results in some patient-reported outcome measures (PROM) than using an ST autograft five years after the operation. The observed results let us suggest that the use of one autograft hamstring tendon for ACLR is clinically preferable to the use of two hamstring tendons.
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Affiliation(s)
- Ignacio Manchado
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
| | - Luci M. Motta
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
| | | | - Jesús González
- Unidad de Investigación, Hospital Dr Negrin, 35007 Las Palmas, Spain
| | - Gerardo L. Garcés
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
- Correspondence: ; Tel.: +34-696-471-915
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10
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Dudley RI, Lohman EB, Patterson CS, Knox KG, Gharibvand L. The relationship between kinesiophobia and biomechanics in anterior cruciate ligament reconstructed females. Phys Ther Sport 2022; 56:32-37. [PMID: 35717878 DOI: 10.1016/j.ptsp.2022.06.002] [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: 03/08/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Kinesiophobia has been associated with deleterious biomechanical alterations during dual-limb landing tasks in anterior cruciate ligament (ACL) reconstructed females, however, no research has yet investigated single-limb tasks related to ACL injury. The aim of this investigation was to examine the relationship between kinesiophobia and biomechanics during a series of dual and single-limb functional tasks associated with ACL injury risk. DESIGN Cross-sectional study. PARTICIPANTS Fifteen females (age = 22.67 ± 2.58yrs, height = 1.65 ±0 .05m, mass = 65.28 ± 10.36 kg) with a history of ACL reconstruction (time post surgery = 3.40 ±0 .74yrs) were recruited for this investigation. MAIN OUTCOME MEASURES Kinesiophobia, measured via the Tampa Scale of Kinesiophobia (TSK-11). Kinematics and muscle activation were measured during three functional tasks: the drop jump (DJ), single-limb hop (SLH), and single-limb landing (SLL). RESULTS For the DJ task, there was a strong negative correlation between kinesiophobia and knee flexion (r = -.592, p = .20) and between kinesiophobia and trunk flexion (r = -0.724, p = .002). For the SLH task, there was a strong positive correlation between kinesiophobia and hip flexion (r = 0.560, p = .03). CONCLUSIONS These findings indicate that kinesiophobia is associated with movement alterations years after completion of ACL reconstruction and rehabilitation.
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Affiliation(s)
- Robert I Dudley
- Loma Linda University School of Allied Health Professions, USA; Pepperdine University Faculty of Sports Medicine, USA.
| | | | | | - Kyra G Knox
- Azusa Pacific University Department of Kinesiology, USA
| | - Lida Gharibvand
- Loma Linda University School of Allied Health Professions, USA
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11
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Grinberg A, Strong A, Häger CK. Does a knee joint position sense test make functional sense? Comparison to an obstacle clearance test following anterior cruciate ligament injury. Phys Ther Sport 2022; 55:256-263. [DOI: 10.1016/j.ptsp.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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12
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Nae JÄ, Cronström A. Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury. Phys Ther Sport 2022; 55:160-167. [DOI: 10.1016/j.ptsp.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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13
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DiBartola AC. Editorial Commentary: Age-Appropriate Expectations Are Critical When Analyzing Knee Anterior Cruciate Ligament Reconstruction Outcomes: Age Is More Than Just a Number. Arthroscopy 2022; 38:1544-1546. [PMID: 35501019 DOI: 10.1016/j.arthro.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
In patients undergoing anterior cruciate ligament (ACL) reconstruction, age affects treatment and postoperative recovery decisions, as well as failure rates and outcomes. However, how age affects postoperative patient-reported outcomes and the appropriateness of using the International Knee Documentation Committee patient acceptable symptoms state score in the >40-year-old patient population has received little attention. This study assesses commonly used patient-reported outcomes in older patients undergoing ACL reconstruction and aims to redefine a more suitable patient acceptable symptoms state score for this patient population. As our understanding of both the importance of ACL reconstruction on knee biomechanics and joint stability, as well as the increased rate of ACL reconstruction in older patients grows, having age-appropriate outcomes expectations is critical to both counseling patients and developing future research aims. Future application of outcomes scores in clinical practice and in the research, arena must take into account patient age and function after ACL reconstruction.
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Sritharan P, Muñoz MA, Pivonka P, Bryant AL, Mokhtarzadeh H, Perraton LG. Biomechanical Markers of Forward Hop-Landing After ACL-Reconstruction: A Pattern Recognition Approach. Ann Biomed Eng 2022; 50:330-342. [PMID: 35099657 PMCID: PMC8847210 DOI: 10.1007/s10439-022-02921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
Biomechanical changes after anterior cruciate ligament reconstruction (ACLR) may be detrimental to long-term knee-joint health. We used pattern recognition to characterise biomechanical differences during the landing phase of a single-leg forward hop after ACLR. Experimental data from 66 individuals 12-24 months post-ACLR (28.2 ± 6.3 years) and 32 controls (25.2 ± 4.8 years old) were input into a musculoskeletal modelling pipeline to calculate joint angles, joint moments and muscle forces. These waveforms were transformed into principal components (features), and input into a pattern recognition pipeline, which found 10 main distinguishing features (and 8 associated features) between ACLR and control landing biomechanics at significance \documentclass[12pt]{minimal}
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\begin{document}$$\alpha =0.05$$\end{document}α=0.05. Our process identified known biomechanical characteristics post-ACLR: smaller knee flexion angle; less knee extensor moment; lower vasti, rectus femoris and hamstrings forces. Importantly, we found more novel and less well-understood adaptations: smaller ankle plantar flexor moment; lower soleus forces; and altered patterns of knee rotation angle, hip rotator moment and knee abduction moment. Crucially, we identified, with high certainty, subtle aberrations indicating landing instability in the ACLR group for: knee flexion and internal rotation angles and moments; hip rotation angles and moments; and lumbar rotator and bending moments. Our findings may benefit rehabilitation and assessment for return-to-sport 12–24 months post-ACLR.
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Affiliation(s)
- Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.
| | - Mario A Muñoz
- School of Mathematics & Statistics, University of Melbourne, Melbourne, Australia
| | - Peter Pivonka
- School of Mechanical, Medical & Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Hossein Mokhtarzadeh
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - Luke G Perraton
- Department of Physiotherapy, Monash University, Melbourne, Australia
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15
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Grinberg A, Strong A, Buck S, Selling J, Häger CK. An obstacle clearance test for evaluating sensorimotor control after anterior cruciate ligament injury: A kinematic analysis. J Orthop Res 2022; 40:105-116. [PMID: 33650722 DOI: 10.1002/jor.25016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
Sensorimotor deficits, particularly proprioceptive, are often reported following rupture of the anterior cruciate ligament (ACL). High secondary injury rates and long-term negative consequences suggest that these deficits are not properly identified using current assessment methods. We explored a novel obstacle clearance test to evaluate sensorimotor control in individuals following ACL reconstruction (ACLR) and rehabilitation. Thirty-seven post-ACLR individuals, 23 nonathletic asymptomatic controls (CTRL), and 18 elite athletes stepped over a hurdle-shaped obstacle, downward vision occluded, aiming for minimal clearance. Kinematic outcomes (3D motion capture) for the leading and trailing legs, for two unpredictably presented obstacle heights, were categorized into Accuracy: vertical foot clearance and minimal distance from the obstacle; Variability: end-point and hip/knee trajectory; and Symmetry: trunk/hip/knee crossing angles, hip-knee-ankle movement, and velocity curves. Accuracy was worse for CTRL compared with both other groups. ACLR had less leading and trailing vertical foot clearance with their injured compared with their noninjured leg. ACLR and athletes had less crossing knee flexion in their injured/nondominant legs compared with their contralateral leg, both leading and trailing. ACLR showed greater trunk flexion when crossing with their injured leg, both leading and trailing. For the leading leg, ACLR showed greater asymmetry for the hip-knee-ankle velocity curve compared with elite athletes. Trailing leg trajectory variability was lower for ACLR compared with CTRL and athletes for higher obstacles. Clinical significance: Sensorimotor deficits in individuals post-ACLR were reflected by greater asymmetry and less variable (more stereotypical) trajectories rather than limb positioning ability. This consideration should be addressed in clinical evaluations.
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Affiliation(s)
- Adam Grinberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Andrew Strong
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Sebastian Buck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Jonas Selling
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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16
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van Melick N, Pronk Y, Nijhuis-van der Sanden M, Rutten S, van Tienen T, Hoogeboom T. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res 2022; 40:117-128. [PMID: 33650704 DOI: 10.1002/jor.25017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.
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Affiliation(s)
- Nicky van Melick
- Research Department, Kliniek ViaSana, Mill, The Netherlands.,KneeSearch, Heesch, The Netherlands
| | - Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands
| | - Maria Nijhuis-van der Sanden
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastiaan Rutten
- Department of Orthopedic Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Tony van Tienen
- Department of Orthopedic Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Thomas Hoogeboom
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Sikorski Ł, Czamara A. Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery. J Clin Med 2021; 10:jcm10225299. [PMID: 34830581 PMCID: PMC8620226 DOI: 10.3390/jcm10225299] [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: 09/18/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.
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Affiliation(s)
- Łukasz Sikorski
- Department of Physiotherapy, College of Physiotherapy in Wrocław, 50-038 Wrocław, Poland;
- Correspondence: ; Tel.: +48-601-911-013
| | - Andrzej Czamara
- Department of Physiotherapy, College of Physiotherapy in Wrocław, 50-038 Wrocław, Poland;
- Center of Rehabilitation and Medical Education, 50-038 Wrocław, Poland
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18
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Markström JL, Grinberg A, Häger CK. Fear of Reinjury Following Anterior Cruciate Ligament Reconstruction Is Manifested in Muscle Activation Patterns of Single-Leg Side-Hop Landings. Phys Ther 2021; 102:6373317. [PMID: 34554253 PMCID: PMC8860189 DOI: 10.1093/ptj/pzab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether fear of re-injury is manifested in joint kinematics and muscle activation patterns during landings of a standardized rebound side-hop (SRSH), or in patient-reported outcome measures (PROMs), among individuals with anterior cruciate ligament reconstruction (ACLR). METHODS In this cross-sectional observational study, 38 individuals within 2 years post-ACLR were grouped into HIGH-FEAR (n = 21, median 11.2 months post-surgery) or LOW-FEAR (n = 17, median 10.1 months post-surgery) based on a discriminating question (Q9; Tampa Scale of Kinesiophobia-17). These individuals and 39 asymptomatic controls performed the SRSH. Three-dimensional motion recordings were used to calculate trunk, hip, and knee joint angles at initial contact and range of respective joint motion during landing. Surface electromyography registered mean amplitudes and co-contraction indexes for thigh muscles during pre-activation (50 ms) and landing phases. PROMs of knee function, knee health, and physical activity were also analyzed. RESULTS The HIGH-FEAR and LOW-FEAR classification was corroborated by distinct Tampa Scale of Kinesiophobia-17 total and subscale scores and revealed distinguishable muscle activation patterns. HIGH-FEAR demonstrated higher biceps femoris electromyography amplitude and higher anterior-posterior co-contraction index during landing than both LOW-FEAR and controls. However, there were no fear-related differences for kinematics or PROMs. Instead, both ACLR subgroups showed different kinematics at initial contact to controls; HIGH-FEAR with more trunk, hip, and knee flexion, and LOW-FEAR with more hip and knee flexion. CONCLUSION Individuals with ACLR who had high fear of re-injury seem to have adopted a protective strategy with higher muscular activation patterns, presumably to stabilize the knee joint, compared with individuals with low fear of re-injury and controls. SRSH landing kinematics or knee-related PROMs may not be as sensitive to fear of re-injury. IMPACT Fear of reinjury following anterior cruciate ligament injury should be evaluated as an independent psychological outcome throughout rehabilitation after ACLR for improved return to sport transition. LAY SUMMARY If you have an anterior cruciate ligament injury treated with reconstructive surgery, you might have a high fear of reinjury, and that can change how you activate the muscles around your knee. Your physical therapist can do a simple screening test in addition to functional tests to help reduce your fear and improve your treatment outcomes.
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Affiliation(s)
| | - Adam Grinberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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19
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Fjellman-Wiklund A, Söderman K, Lundqvist M, Häger CK. Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance. Disabil Rehabil 2021; 44:6267-6276. [PMID: 34388952 DOI: 10.1080/09638288.2021.1962415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury. METHODS Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20-29 years ago. RESULTS A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying. CONCLUSION ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight.Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight.Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour.ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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Affiliation(s)
| | - Kerstin Söderman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Mari Lundqvist
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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20
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Molinaro L, Taborri J, Santospagnuolo A, Vetrano M, Vulpiani MC, Rossi S. Sensor-Based Indices for the Prediction and Monitoring of Anterior Cruciate Ligament Injury: Reliability Analysis and a Case Study in Basketball. SENSORS 2021; 21:s21165341. [PMID: 34450783 PMCID: PMC8398404 DOI: 10.3390/s21165341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
The possibility of measuring predictive factors to discriminate athletes at higher risk of anterior cruciate ligament (ACL) injury still represents an open research question. We performed an observational study with thirteen female basketball players who performed monopodalic jumps and single-leg squat tests. One of them suffered from an ACL injury after the first test session. Data gathered from twelve participants, who did not suffer from ACL injury, were used for a reliability analysis. Parameters related to leg stability, load absorption capability and leg mobility showed good-to-excellent reliability. Path length, root mean square of the acceleration and leg angle with respect to the vertical axis revealed themselves as possible predictive factors to identify athletes at higher risk. Results confirm that six months after reconstruction represents the correct time for these athletes to return to playing. Furthermore, the training of leg mobility and load absorption capability could allow athletes to reduce the probability of new injuries.
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Affiliation(s)
- Luca Molinaro
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Adriano Santospagnuolo
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
- Sports Medicine Institute CONI Rome, 00197 Rome, Italy;
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
- Correspondence: ; Tel.: +39-07-6135-7049
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21
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Strandberg J, Pini A, Häger CK, Schelin L. Analysis Choices Impact Movement Evaluation: A Multi-Aspect Inferential Method Applied to Kinematic Curves of Vertical Hops in Knee-Injured and Asymptomatic Persons. Front Bioeng Biotechnol 2021; 9:645014. [PMID: 34055756 PMCID: PMC8160465 DOI: 10.3389/fbioe.2021.645014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
Three-dimensional human motion analysis provides in-depth understanding in order to optimize sports performance or rehabilitation following disease or injury. Recent developments of statistical methods for functional data allow for novel ways to analyze often complex biomechanical data. Even so, for such methods as well as for traditional well-established statistical methods, the interpretations of the results may be influenced by analysis choices made prior to the analysis. We evaluated the consequences of three such choices when comparing one-leg vertical hop (OLVH) performance in individuals who had ruptured their anterior cruciate ligament (ACL), to that of asymptomatic controls, and also athletes. Kinematic data were analyzed using a statistical approach for functional data, targeting entire curve data. This was done not only for one joint at a time but also for multiple lower limb joints and movement planes simultaneously using a multi-aspect methodology, testing for group differences while also accounting for covariates. We present the results of when an individual representative curve out of three available was either: (1) a mean curve (Mean), (2) a curve from the highest hop (Max), or (3) a curve describing the variability (Var), as a representation of performance stability. We also evaluated choice of sample leg comparison; e.g., ACL-injured leg compared to either the dominant or non-dominant leg of asymptomatic groups. Finally, we explored potential outcome effects of different combinations of included joints. There were slightly more pronounced group differences when using Mean compared to Max, while the specifics of the observed differences depended on the outcome variable. For Var there were less significant group differences. Generally, there were more disparities throughout the hop movement when comparing the injured leg to the dominant leg of controls, resulting in e.g., group differences for trunk and ankle kinematics, for both Mean and Max. When the injured leg was instead compared to the non-dominant leg of controls, there were trunk, hip and knee joint differences. For a more stringent comparison, we suggest considering to compare the injured leg to the non-dominant leg. Finally, the multiple-joint analyses were coherent with the single-joint analyses. The direct effects of analysis choices can be explored interactively by the reader in the Supplementary Material. To summarize, the choices definitively have an impact on the interpretation of a hop test results commonly used in rehabilitation following knee injuries. We therefore strongly recommend well-documented methodological analysis choices with regards to comparisons and representative values of the measures of interests.
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Affiliation(s)
- Johan Strandberg
- Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden
| | - Alessia Pini
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Charlotte K Häger
- Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Lina Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
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22
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Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors. SENSORS 2021; 21:s21072331. [PMID: 33810610 PMCID: PMC8037754 DOI: 10.3390/s21072331] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.
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23
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Markström JL, Tengman E, Häger CK. Side-hops challenge knee control in the frontal and transversal plane more than hops for distance or height among ACL-reconstructed individuals. Sports Biomech 2021; 22:142-159. [PMID: 33586624 DOI: 10.1080/14763141.2020.1869296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We compared knee landing mechanics with presumed relation to risk of anterior cruciate ligament (ACL) injury among three single-leg hop tests and between legs in individuals with unilateral ACL reconstruction. Thirty-four participants (>10 months' post-surgery, 23 females) performed the standardised rebound side hop (SRSH), maximal hop for distance (OLHD) and maximal vertical hop (OLVH). We calculated the following knee outcomes from motion capture and force plate data: finite helical axis inclination angles (approximates knee robustness), frontal and transversal plane angles at initial contact, peak angles of abduction and internal rotation during landing, and peak external moments of flexion, abduction and internal rotation during landing. Repeated-measures MANOVA analysis ('sex' as covariate) confirmed that SRSH induced greater angles and moments, particularly in the frontal plane, compared to OLHD and OLVH. There was between-leg asymmetry for peak knee flexion moment for males during OLHD and OLVH, and for females during SRSH. Our results advocate the SRSH over OLHD and OLVH for assessment of knee landing control to screen for movement patterns potentially related to ACL injury risk. However, clear differences in both knee kinematics and kinetics between OLHD and SRSH motivate the use of both tests to evaluate different aspects of landing control.
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Affiliation(s)
- Jonas L Markström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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24
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Pontillo M, Hines SM, Sennett BJ. Prediction of ACL Injuries from Vertical Jump Kinetics in Division 1 Collegiate Athletes. Int J Sports Phys Ther 2021; 16:156-161. [PMID: 33604145 PMCID: PMC7872458 DOI: 10.26603/001c.18819] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 07/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The incidence of ACL injuries continues to rise secondary to an increase in sport participation. Evidence supports the use of force plate testing to quantify kinetics during rehabilitation after injury and recovery; however, there is limited current research regarding if jump kinetics can identify athletes who are at higher risk for injury. Altered kinetics could potentially lead to abnormal force dissipation and resultant injury. PURPOSE The purpose of this investigation was to identify whether the force-time variables from vertical jumps could predict ACL injuries in collegiate athletes. STUDY DESIGN Retrospective cohort. METHODS Vertical jump testing is performed by all healthy varsity collegiate athletes at several intervals throughout the athletic year at a Division I institution using a commercially available force plate system with dedicated software. Athletes who sustained an ACL injury between 1/1/15 and 6/1/19 were identified (n=16) and compared to healthy athletes who participated in the same sports (n = 262). ACL injuries were considered for this study if they occurred no more than 10 weeks after a jump test. The outcome variables were load, explode, and drive, operationally defined as the average eccentric rate of force development, average relative concentric force, and concentric relative impulse, respectively, which the system normalized to T scores. Mann-Whitney U tests were used to assess group differences for load, explode, drive, and the ratio between the variables. Logistic regression was used to determine if the battery of variables could predict whether or not an athlete would sustain an ACL injury. The p-value was set to 0.10 for the Mann-Whitney U tests, and 0.05 for the logistic regression. RESULTS Significant differences between the ACL and healthy groups were seen for explode (p=0.08), drive (p=0.06), load:explode ratio (p=0.06), and explode:drive ratio (p=0.03). Explode and drive, when entered into the regression equation, showed the ability to predict injury, χ 2 = 6.8, df = 2, p=0.03. CONCLUSIONS The vertical jump force plate variables were able to identify athletes who sustained an ACL injury within 66 days of testing. Athletes who sustained an ACL injury demonstrated altered kinetics and less ability to transmit forces during the vertical jump. LEVEL OF EVIDENCE 3.
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Wellsandt E, Khandha A, Capin J, Buchanan TS, Snyder-Mackler L. Operative and nonoperative management of anterior cruciate ligament injury: Differences in gait biomechanics at 5 years. J Orthop Res 2020; 38:2675-2684. [PMID: 32159239 PMCID: PMC7808330 DOI: 10.1002/jor.24652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/05/2019] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
Gait biomechanics after anterior cruciate ligament (ACL) injury are associated with functional outcomes and the development of posttraumatic knee osteoarthritis. However, biomechanical outcomes between patients treated nonoperatively compared with operatively are not well understood. The primary purpose of this study was to compare knee joint contact forces, angles, and moments during loading response of gait between individuals treated with operative compared with nonoperative management at 5 years after ACL injury. Forty athletes treated operatively and 17 athletes treated nonoperatively completed gait analysis at 5 years after ACL reconstruction or completion of nonoperative rehabilitation. Medial compartment joint contact forces were estimated using a previously validated, patient-specific electromyography-driven musculoskeletal model. Knee joint contact forces, angles, and moments were compared between the operative and nonoperative group using mixed model 2 × 2 analyses of variance. Peak medial compartment contact forces were larger in the involved limb of the nonoperative group (Op: 2.37 ± 0.47 BW, Non-Op: 3.03 ± 0.53 BW; effect size: 1.36). Peak external knee adduction moment was also larger in the involved limb of the nonoperative group (Op: 0.25 ± 0.08 Nm/kg·m, Non-Op: 0.32 ± 0.09 Nm/kg·m; effect size: 0.89). No differences in radiographic tibiofemoral osteoarthritis were present between the operative and nonoperative groups. Overall, participants treated nonoperatively walked with greater measures of medial compartment joint loading than those treated operatively, while sagittal plane group differences were not present. Statement of clinical relevance: The differences in medial knee joint loading at 5 years after operative and nonoperative management of ACL injury may have implications on the development of posttraumatic knee osteoarthritis.
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Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, NE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Jacob Capin
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, NE, USA,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Thomas S. Buchanan
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Koh YG, Nam JH, Chung HS, Kim HJ, Lee HY, Kang KT. Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI. Knee Surg Sports Traumatol Arthrosc 2020; 28:2990-2997. [PMID: 31549209 DOI: 10.1007/s00167-019-05730-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Optimal rotational alignment of the femoral component is essential for total knee arthroplasty (TKA). The femoral transepicondylar axis (TEA), Whiteside's line (WSL), and posterior condylar axis (PCA) are various intra-operative references that can be used to determine femoral rotation, and each has advantages and disadvantages. This study aimed to define the rotational anatomy of the distal femur and investigate its relationship with gender in osteoarthritic knees. METHODS Magnetic resonance imaging (MRI) was obtained from 1522 patients (1298 females and 224 males) with end-stage knee osteoarthritis prior to TKA. MRI was constructed into three-dimensional models. The angles between the TEA and WSL, WSL and PCA, and TEA and PCA were calculated for each patient. In addition, gender differences in femoral rotation were evaluated. RESULTS The PCA was 2.2° ± 1.0° internally rotated relative to the TEA. WSL was 1.2° ± 2.8° externally rotated relative to the TEA. The WSL to TEA relationship exhibited greater variability than the PCA to TEA relationship. PCA was more internally rotated and WSL was more externally rotated relative to TEA in female group than male group. Based on the standard reference rules of 3° external rotation from the PCA that has been conventionally used, 15.7% of patients showed external rotation lower 1° or greater than 5° external rotation from the PCA. In the mean external rotation of the TEA from the PCA (2.2°) from this population; however, the percentage of patients showing ± 2° from their TEA dropped to 5.1% of patients. CONCLUSION Gender difference and variability exist in distal femoral rotational anatomy. These data can be useful in consideration of femoral anatomy variability and gender difference. The same cutting angle may lead to malrotation of the femoral component. LEVEL OF EVIDENCE Consecutive patients, level III.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Seok Chung
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjaedaero, Songpa-gu, Seoul, 05541, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Sritharan P, Perraton LG, Munoz MA, Pivonka P, Bryant AL. Muscular Coordination of Single-Leg Hop Landing in Uninjured and Anterior Cruciate Ligament-Reconstructed Individuals. J Appl Biomech 2020; 36:235-243. [PMID: 32659745 DOI: 10.1123/jab.2019-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/22/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022]
Abstract
This study compared lower-limb muscle function, defined as the contributions of muscles to center-of-mass support and braking, during a single-leg hopping task in anterior cruciate ligament-reconstructed (ACLR) individuals and uninjured controls. In total, 65 ACLR individuals and 32 controls underwent a standardized anticipated single-leg forward hop. Kinematics and ground reaction force data were input into musculoskeletal models to calculate muscle forces and to quantify muscle function by decomposing the vertical (support) and fore-aft (braking) ground reaction force components into contributions by individual lower-limb muscles. Four major muscles, the vasti, soleus, gluteus medius, and gluteus maximus, were primarily involved in support and braking in both ACLR and uninjured groups. However, although the ACLR group demonstrated lower peak forces for these muscles (all Ps < .001, except gluteus maximus, P = .767), magnitude differences in these muscles' contributions to support and braking were not significant. ACLR individuals demonstrated higher erector spinae (P = .012) and hamstrings forces (P = .085) to maintain a straighter, stiffer landing posture with more forward lumbar flexion. This altered landing posture may have enabled the ACLR group to achieve similar muscle function to controls, despite muscle force deficits. Our findings may benefit rehabilitation and the development of interventions to enable faster and safer return to sport.
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Hetsroni I, Wiener Y, Ben-Sira D, Iacono AD, Marom N, van Stee M, Ayalon M. Symmetries in Muscle Torque and Landing Kinematics Are Associated With Maintenance of Sports Participation at 5 to 10 Years After ACL Reconstruction in Young Men. Orthop J Sports Med 2020; 8:2325967120923267. [PMID: 32566693 PMCID: PMC7285949 DOI: 10.1177/2325967120923267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Long-term maintenance of sports participation is important for young men undergoing anterior cruciate ligament (ACL) reconstruction. Identifying biomechanical characteristics in patients who achieve this goal can assist in elaborating rehabilitation programs and in identifying successful recovery, but this has rarely been investigated. Purpose: To test the association between maintenance of sports participation at 5 to 10 years after ACL reconstruction and measures of force production and landing biomechanics in men. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 30 men who underwent isolated ACL reconstruction were examined. At 5- to 10-year follow-up, associations were tested between reported outcomes of sports maintenance and objective biomechanical measures. The biomechanical tests included isokinetic knee torque and lower limb kinetics and kinematics during landing tasks. Measurements for each limb were conducted separately, and side-to-side symmetry indices (SI) were calculated. Subgroups included SI greater than +10% (ie, extreme positive), SI lower than –10% (ie, extreme negative), and SI between –10% and +10% (ie, symmetric). Results: At follow-up, concentric knee torque in the operated limb correlated with Tegner and Marx scores (r = 0.42-0.47; P ≤ .05). Regarding the SI of knee torque, the highest Tegner, Marx, and KOOS (Knee injury and Osteoarthritis Outcome Score) results were associated with symmetry, as opposed to patients with extreme positive or extreme negative SIs (P < .05). As for landing kinematics, Tegner score negatively correlated with knee range of motion (ROM) in the operated limb (r = –0.38; P ≤ .05). With regard to SI, hip and knee ROM correlated with Tegner, IKDC, and KOOS scores (r = 0.41-0.51; P ≤ .05). Specifically, the highest sports participation levels were associated with achieving symmetric hip and knee ROM but also with extreme positive SIs, as opposed to patients with extreme negative SIs (P < .03), indicating substantially higher ROM in the uninjured limb as compared with the operated limb. Conclusion: At 5 to 10 years after ACL reconstruction, maintenance of sports participation was associated with symmetric side-to-side concentric knee torque and with producing greater attenuation of hip and knee ROM during the drop jump landing in the operated limb. Therefore, eccentric load programs that can improve attenuation-phase kinematics during landing tasks may be valuable in addition to concentric training and may facilitate enhanced long-term outcomes.
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Affiliation(s)
- Iftach Hetsroni
- Sports Medicine Injuries Service, Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yohay Wiener
- The Academic College at Wingate, Netanya, Israel
| | | | | | - Niv Marom
- Sports Medicine Injuries Service, Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mischa van Stee
- Sports Medicine Injuries Service, Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Ayalon
- The Academic College at Wingate, Netanya, Israel
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Grip H, Tengman E, Liebermann DG, Häger CK. Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury. PLoS One 2019; 14:e0224261. [PMID: 31671111 PMCID: PMC6822751 DOI: 10.1371/journal.pone.0224261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
The purpose was to evaluate the dynamic knee control during a drop jump test following injury of the anterior cruciate ligament injury (ACL) using finite helical axes. Persons injured 17–28 years ago, treated with either physiotherapy (ACLPT, n = 23) or reconstruction and physiotherapy (ACLR, n = 28) and asymptomatic controls (CTRL, n = 22) performed a drop jump test, while kinematics were registered by motion capture. We analysed the Preparation phase (from maximal knee extension during flight until 50 ms post-touchdown) followed by an Action phase (until maximal knee flexion post-touchdown). Range of knee motion (RoM), and the length of each phase (Duration) were computed. The finite knee helical axis was analysed for momentary intervals of ~15° of knee motion by its intersection (ΔAP position) and inclination (ΔAP Inclination) with the knee’s Anterior-Posterior (AP) axis. Static knee laxity (KT100) and self-reported knee function (Lysholm score) were also assessed. The results showed that both phases were shorter for the ACL groups compared to controls (CTRL-ACLR: Duration 35±8 ms, p = 0.000, CTRL-ACLPT: 33±9 ms, p = 0.000) and involved less knee flexion (CTRL-ACLR: RoM 6.6±1.9°, p = 0.002, CTRL-ACLR: 7.5 ±2.0°, p = 0.001). Low RoM and Duration correlated significantly with worse knee function according to Lysholm and higher knee laxity according to KT-1000. Three finite helical axes were analysed. The ΔAP position for the first axis was most anterior in ACLPT compared to ACLR (ΔAP position -1, ACLPT-ACLR: 13±3 mm, p = 0.004), with correlations to KT-1000 (rho 0.316, p = 0.008), while the ΔAP inclination for the third axis was smaller in the ACLPT group compared to controls (ΔAP inclination -3 ACLPT-CTRL: -13±5°, p = 0.004) and showed a significant side difference in ACL injured groups during Action (Injured-Non-injured: 8±2.7°, p = 0.006). Small ΔAP inclination -3 correlated with low Lysholm (rho 0.391, p = 0.002) and high KT-1000 (rho -0.450, p = 0.001). Conclusions Compensatory movement strategies seem to be used to protect the injured knee during landing. A decreased ΔAP inclination in injured knees during Action suggests that the dynamic knee control may remain compromised even long after injury.
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Affiliation(s)
- Helena Grip
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- * E-mail:
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Dario G. Liebermann
- Department of Physiotherapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Charlotte K. Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Strong A, Tengman E, Srinivasan D, Häger CK. One-leg rise performance and associated knee kinematics in ACL-deficient and ACL-reconstructed persons 23 years post-injury. BMC Musculoskelet Disord 2019; 20:476. [PMID: 31653212 PMCID: PMC6814967 DOI: 10.1186/s12891-019-2887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research indicates reduced knee function and stability decades after anterior cruciate ligament (ACL) injury. Assessment requires reliable functional tests that discriminate such outcomes from asymptomatic knees, while providing suitable loading for different populations. The One-leg rise (OLR) test is common in clinics and research but lacks scientific evidence for its implementation. Our cross-sectional study compared performance including knee kinematics of the OLR between ACL-injured persons in the very long term to controls and between legs within these groups, and assessed the within-session reliability of the kinematics. METHODS Seventy ACL-injured individuals (mean age 46.9 ± 5.4 years) treated with either reconstructive surgery and physiotherapy (ACLR; n = 33) or physiotherapy alone (ACLPT; n = 37), on average 23 years post-injury, and 33 age- and sex-matched controls (CTRL) attempted the OLR. Participants completed as many repetitions as possible to a maximum of 50 while recorded by motion capture. We compared between all groups and between legs within groups for total repetitions and decomposed the OLR into movement phases to compare phase completion times, maximum and range of knee abduction and adduction angles, and mediolateral knee control in up to 10 repetitions per participant. RESULTS ACLPT performed significantly fewer OLR repetitions with their injured leg compared to the CTRL non-dominant leg (medians 15 and 32, respectively) and showed significantly greater knee abduction than ACLR and CTRL (average 2.56°-3.69° depending on phase and leg). Distribution of repetitions differed between groups, revealing 59% of ACLPT unable to complete more than 20 repetitions on their injured leg compared to 33% ACLR and 36% CTRL for their injured and non-dominant leg, respectively. Within-session reliability of all kinematic variables for all groups and legs was high (ICC 3,10 0.97-1.00, 95% CI 0.95-1.00, SEM 0.93-1.95°). CONCLUSIONS Negative outcomes of OLR performance, particularly among ACLPT, confirm the need to address aberrant knee function and stability even decades post-ACL injury. Knee kinematics derived from the OLR were reliable for asymptomatic and ACL-injured knees. Development of the OLR protocol and analysis methods may improve its discriminative ability in identifying reduced knee function and stability among a range of clinical populations.
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Affiliation(s)
- Andrew Strong
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden
| | - Divya Srinivasan
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden
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Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:855-862. [PMID: 30765021 DOI: 10.3238/arztebl.2018.0855] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 04/25/2018] [Accepted: 10/01/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a serious injury in patients who are typically young and athletically active, with potential long-term complica- tions including functional limitation, posttraumatic osteoarthritis of the knee, and impaired quality of life. ACL reconstruction is now considered the gold standard of treatment for regaining stability and improving knee function. Conservative treatment is an alternative. METHODS To compare operative and conservative treatment, we reviewed pertinent publications retrieved by a systematic search in Ovid MEDLINE, the Cochrane Database of Systematic Reviews, and other databases. PROSPERO registration of the study protocol: CRD42017060462 on 31 March 2017. RESULTS 13 publications concerning a total of 1246 patients were included in the analysis; only two were reports of randomized controlled trials (RCTs). In one of the RCTs, ACL reconstruction was found to yield better functional outcomes than con- servative management. The other RCT did not reveal any harm from initial conser- vative management, although the conservative-to-operative crossover rate in this trial was 51%. The functional outcomes were heterogeneous. In six observational studies, knee function was significantly better after surgery; in seven others, it was not. Five out of nine analyses in which knee-joint stability was restored after surgery showed superior functional outcomes after ACL reconstruction compared to conser- vative management. Three studies in which no satisfactory postoperative knee-joint stability was found did not show any functional difference between surgery and conservative management. CONCLUSION On the basis of RCTs published to date, it cannot be definitively con- cluded whether surgery or conservative (expectant) management of ACL rupture yields a better functional outcome. There is a trend in observational studies toward better functional outcomes after ACL reconstruction. As an average across studies, conservative treatment fails in 17.5% (± 15.5%) of patients.
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Affiliation(s)
- Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf; Department of General Orthopedics and Center for Endoprosthetics, Schön Klinik Hamburg Eilbek; Department of Sports Orthopedics, University Hospital rechts der Isar, Technical University of Munich (TUM); Department of Orthopedics and Trauma Surgery, Martin-Luther-Hospital, Berlin; Department of Trauma and Reconstructive Surgery With Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Klinik St. Georg, Hamburg
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Brumitt J, Mattocks A, Engilis A, Isaak D, Loew J. Prior history of anterior cruciate ligament (ACL) reconstruction is associated with a greater risk of subsequent ACL injury in female collegiate athletes. J Sci Med Sport 2019; 22:1309-1313. [PMID: 31515168 DOI: 10.1016/j.jsams.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/28/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The risk of a subsequent anterior cruciate ligament (ACL) sprain is greater in high school aged female athletes with prior history of ACL reconstruction (ACLR) than in age-matched controls. The risk of a subsequent ACL injury in female collegiate athletes with prior ACLR is unknown. The primary purpose of this study was to determine the relative risk of a subsequent ACL injury in female collegiate athletes with prior ACLR when compared to age-matched controls. The secondary purpose of this study was to evaluate the ability of jump and hop tests to discriminate ACL injury risk. DESIGN Prospective cohort. METHODS Three hundred and sixty female collegiate athletes (mean age 19.3 ± 1.4 years) representing the following sports: volleyball, soccer, and basketball were recruited. Subjects reported prior history of ACLR and standing long jump (SLJ) and single-leg hop (SLH) scores were collected during the preseason. Noncontact time-loss ACL and lower quadrant (i.e., low back and lower extremities) injuries were tracked by university athletic trainers. RESULTS Female collegiate athletes with a prior history of ACLR were 6 times (RR = 6.8 [95% CI: 1.4, 32.9] p-value = 0.007) more likely to experience an ACL injury than controls. Suboptimal performance on a battery of tests (SLJ ≤ 79% height, (B) SLH ≤ 69% height) was associated with a greater risk of lower quadrant injury (RR = 1.6 [95% CI: 1.1, 2.4] p-value = 0.028); however performance on these tests was not associated with ACL injury. CONCLUSIONS Female collegiate athletes should be screened for history of ACLR.
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Affiliation(s)
- Jason Brumitt
- School of Physical Therapy, George Fox University, United States.
| | | | | | - Dale Isaak
- Athletic Training Education Program, George Fox University, United States.
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Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8122586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study investigates whether double-leg and single-leg vertical hops (VH) landing between-limb symmetry in males, an average of two years after anterior cruciate ligament (ACL) reconstruction (ACLR), is associated with postoperative physiotherapy supervision duration. Thirty-eight healthy controls and thirty-eight males after primary unilateral ACLR, with the use of ipsilateral semitendinosus and gracilis tendon autograft, on average two years before, underwent bilateral peak vertical ground reaction force (vGRF) measurements during double-leg and single-leg VH landing, using two force plates. The vGRF was normalized to the body mass (vGRF BM). The vGRF BM limb symmetry index (LSI) was calculated. Tests for dependent and independent samples and linear Pearson’s correlation coefficient (r) calculations were performed. There were significant between-leg differences in the double-leg (p < 0.001) vGRF BM values. The longer the postoperative physiotherapy supervision duration was, the higher the double-leg VH LSI values (r = 0.727; p < 0.001). There was also a significant but weak positive association between the single-leg VH landing LSI value and the physiotherapy supervision duration (r = 0.333; p = 0.041). Between-limb symmetry during double-leg VH landing in males, an average of two years after ACLR, was correlated with postoperative physiotherapy supervision duration. Fully supervised postoperative physiotherapy for a minimum of six months is more effective for improving VH landing limb symmetry in patients after ACLR.
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Markström JL, Schelin L, Häger CK. A novel standardised side hop test reliably evaluates landing mechanics for anterior cruciate ligament reconstructed persons and controls. Sports Biomech 2018; 20:213-229. [PMID: 30526381 DOI: 10.1080/14763141.2018.1538385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We propose a novel one-leg standardised rebound side-hop test (SRSH) specifically designed for detailed analysis of landing mechanics. Anterior cruciate ligament reconstructed persons (ACLR, n = 30) and healthy-knee controls (CTRL, n = 30) were tested for within-session and test-retest (CTRL only, n = 25) reliability and agreement. Trunk, hip and knee angles and moments in sagittal, frontal, and transversal planes during landing, including time to stabilisation (TTS), were evaluated using intra-class correlations (ICCs), average within-person standard deviations (SW) and minimal differences. Excellent within-session reliability were found for angles in both groups (most ICCs > 0.90, SW ≤ 5°), and excellent to good for moments (most ICCs > 0.80, SW ≤ 0.34 Nm/kg). Only knee internal rotation moment showed poor reliability (ICC < 0.4). Test-retest results were excellent to fair for all angles and moments (ICCs 0.47-0.91, SW < 5° and ≤ 0.25 Nm/kg), except for peak trunk lateral bending angle and knee internal rotation moment. TTS showed excellent to fair within-session reliability but poor test-retest results. These results, with a few exceptions, suggest promising potential of evaluating landing mechanics during the SRSH for ACLR and CTRL, and emphasise the importance of joint-specific movement control variables in standardised tasks.
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Affiliation(s)
- Jonas L Markström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University , Umeå, Sweden
| | - Lina Schelin
- Umeå School of Business, Economics and Statistics, Department of Statistics, Umeå University , Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University , Umeå, Sweden
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The role of muscle function after anterior cruciate ligament rupture and treatment. Knee Surg Sports Traumatol Arthrosc 2018; 26:355-357. [PMID: 29340747 DOI: 10.1007/s00167-018-4829-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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