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Tortoli E, Pellicciari L, Giovannico G, Tak I. Return to running criteria after anterior cruciate ligament reconstruction: an online survey of 1404 Italian physiotherapists. J Sports Med Phys Fitness 2024; 64:931-941. [PMID: 38863416 DOI: 10.23736/s0022-4707.24.15811-2] [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: 06/13/2024]
Abstract
BACKGROUND The aim of this study is to study the clinical decision-making practice of Italian physiotherapists in return to running (RTR) after anterior cruciate ligament (ACL) reconstruction, and the differences in decision-making in relation to physiotherapist's characteristics. METHODS An online survey was developed, 1404 physiotherapists were contacted by email, via chartered association, or via social media. RESULTS Most respondents (83%) indicated that the RTR decision should be made by a multidisciplinary team with RTR clearance around 3-4 months after surgery (47%). The most important criteria guiding the RTR decision were knee flexion range of motion (ROM) >130° (50%), complete extension ROM (95%), no pain (45%) and no effusion (68%). A Limb Symmetry Index (LSI) >70% for quadriceps (49%), hamstring (48%) and LSI >90% for posterolateral hip (45%) and triceps surae strength (42%) should be achieved for RTR. Approximately half of the participants (49%) do not consider ACL laxity tests to be used for RTR decisions. Response differences were found between sample subgroups. More experienced physiotherapists and those with post graduate training had lower thresholds to clear RTR. CONCLUSIONS Experienced physiotherapists who treated a higher number of patients after ACL reconstruction, who had certified specialist training and a specific interest towards ACL rehabilitation, generally reported clinical practice modalities more in line with current evidence.
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Affiliation(s)
- Emanuele Tortoli
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy -
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Igor Tak
- Sports Rehabilitation and Manual Therapy, Fysiotherapie Utrecht Oost, Utrecht, the Netherlands
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam UMC, Amsterdam, the Netherlands
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Adhitya IPGS, Kurniawati I, Sawa R, Wijaya TF, Dewi NPAC. The Risk Factors and Preventive Strategies of Poor Knee Functions and Osteoarthritis after Anterior Cruciate Ligament Reconstruction: A Narrative Review. Phys Ther Res 2023; 26:78-88. [PMID: 38125289 PMCID: PMC10730125 DOI: 10.1298/ptr.r0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.
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Affiliation(s)
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| | - Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Tabita Febyola Wijaya
- Bachelor and Professional Program of Physical Therapy, College of Medicine, Universitas Udayana, Indonesia
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Johnson AK, Heebner NR, Hunt ER, Conley CE, Jacobs CA, Ireland ML, Abt JP, Lattermann C. Pain Early After Anterior Cruciate Ligament Reconstruction is Associated With 6-Month Loading Mechanics During Running. Sports Health 2023; 15:908-916. [PMID: 36519181 PMCID: PMC10606962 DOI: 10.1177/19417381221139478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) results in persistent altered knee biomechanics, but contributing factors such as pain or patient function, leading to the altered loading, are unknown. HYPOTHESIS Individuals with worse self-reported pain after ACLR would have poorer biomechanics during running, and poor loading mechanics would be present in the ACLR limb compared with contralateral and control limbs. STUDY DESIGN Cohort pilot study. LEVEL OF EVIDENCE Level 3. METHODS A total of 20 patients after ACLR (age, 18.4 ± 2.7 years; height, 1.7 ± 0.1 m; mass, 84.2 ± 19.4 kg) completed visual analog scale and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1 and 6 months postsurgery. At 6 months postsurgery, patients underwent biomechanical testing during running. A total of 20 control individuals also completed running biomechanical analyses. Associations between patient outcomes and biomechanics were conducted, and differences in running biomechanics between groups were analyzed. RESULTS KOOS pain score 1 month after surgery was associated with peak ACLR knee abduction moment (R2 = 0.35;P = 0.01). At 6-months, KOOS sport score was related to peak abduction moment in the ACLR limb (R2 = 0.23; P = 0.05). For change scores, the improvement in pain scores related to ACLR limb peak knee abduction moment (R2 = 0.55; P = 0.001). The ACLR limb had lower knee excursion, extension moments, and ground-reaction forces compared with the uninvolved and control limb. The uninvolved limb also had higher ground-reaction forces compared with the ACLR limb and control limb. CONCLUSION These results suggest that patient-reported outcomes 1 and 6 months after surgery are associated with running mechanics 6 months after ACLR. Further, the underloading present in the ACLR limb and overloading in the uninvolved limb indicates greater need for running rehabilitation after ACLR. CLINICAL RELEVANCE Understanding pain and how it may be linked to movement dysfunction is important for improving long-term outcomes.
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Affiliation(s)
- Alexa K. Johnson
- Orthopaedic Rehabilitation and Biomechanics Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Nicholas R. Heebner
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Emily R. Hunt
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Caitlin E.W. Conley
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Mary L. Ireland
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - John P. Abt
- Children’s Health, Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas
| | - Christian Lattermann
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Schache AG, Sritharan P, Crossley KM, Perraton LG, Bryant AL, Morris HG, Whitehead TS, Culvenor AG. Is quadriceps strength associated with patellofemoral joint loading after anterior cruciate ligament reconstruction? Phys Ther Sport 2023; 63:31-37. [PMID: 37478626 DOI: 10.1016/j.ptsp.2023.06.006] [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: 05/09/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To test whether quadriceps strength is associated with measures of patellofemoral (PF) joint loading during running and hopping in people after an anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PARTICIPANTS Sixty-five participants (24 women; 41 men) 1-2 years post-ACLR. MAIN OUTCOME MEASURES Peak isometric quadriceps strength for the surgical limb was measured using a dynamometer. Motion analysis and ground reaction force data were combined with musculoskeletal modelling to measure PF joint loading variables for the reconstructed knee (peak knee flexion angle; peak/impulse of the PF joint contact force; time to peak PF joint contact force) during the stance phase of running and during the landing phase of a standardised forward hop. Linear regression analysis (adjusting for age and sex) assessed the association between quadriceps strength and PF joint loading variables. RESULTS Two significant, albeit modest, associations were revealed. Quadriceps strength was associated with the time to peak PF joint contact force during running (β = -0.001; 95%CI -0.002 to -0.000; R2 = 0.179) and the impulse of the PF joint contact force during hopping (β = 0.014; 95%CI 0.003 to 0.024; R2 = 0.159). CONCLUSIONS A strong link between quadriceps strength and PF joint loading was not evident in people 1-2 years post-ACLR.
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Affiliation(s)
- Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke G Perraton
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | | | | | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Van Hooren B, Hirsch SM, Meijer K. A comparison of five methods to normalize joint moments during running. Gait Posture 2023; 105:81-86. [PMID: 37494781 DOI: 10.1016/j.gaitpost.2023.07.278] [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: 07/23/2022] [Revised: 05/08/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Net joint moments (NJM) are typically normalized for a (combination of) physical body characteristics such as mass, height, and limb length using ratio scaling to account for differences in body characteristics between individuals. Four assumptions must be met when normalizing NJM data this way to ensure valid conclusions. First, the relationship between the non-normalized NJM and participant characteristic should be linear. Second, the regression line between NJM and the characteristic(s) used should pass through the origin. Third, scaling should not significantly perturb the statistical distribution of the data. Fourth, normalizing a NJM should eliminate its correlation with the characteristic(s) normalized for. RESEARCH QUESTION This study assessed these assumptions using data collected among 59 individuals running at 10 km h-1. METHODS Standard inverse dynamics analyses were conducted, and ratios were computed between the sagittal-plane hip, knee and ankle NJM's and the participant's mass, height, leg length, mass × height, and mass × leg length. RESULTS The most important finding of this study was that none of the scaling variables fulfilled all assumptions across all joints. However, scaling by mass, mass*height and mass*leg length satisfied the assumptions for the knee joint moment and log-transformed hip joint moment, suggesting these methods generally performed best. SIGNIFICANCE Our findings suggests that scaling by mass, mass*height and mass*leg length may be considered to normalize joint moments during running. Nevertheless, we urge researchers to check the statistical assumptions to ensure valid conclusions. We provide supplementary code to check the statistical assumptions, and discuss consequences of inappropriate scaling.
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Affiliation(s)
- Bas Van Hooren
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Nutrition and Movement Sciences, Maastricht, the Netherlands.
| | - Steven M Hirsch
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Nutrition and Movement Sciences, Maastricht, the Netherlands
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Pairot de Fontenay B, Roy JS, Plemmons M, Willy R. Knee joint underloading does not evolve after a two-week reintroduction to running program after anterior cruciate ligament reconstruction. Phys Ther Sport 2023; 61:122-128. [PMID: 37023590 DOI: 10.1016/j.ptsp.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Knee underloading patterns have been reported mid- and long-term after return to running post-ACLR, but changes in these patterns during the reintroduction to running are unknown. We evaluated knee biomechanics in individuals within 6 months of ACL-R at the start and completion of a reintroduction to running program. DESIGN Longitudinal laboratory study. SETTING Three-dimensional running biomechanics during instrumented treadmill running. PARTICIPANTS 24 participants post-ACL-R with hamstring autograft and 24 healthy, matched controls. MAIN OUTCOME MEASURES Tibiofemoral joint (TFJ) and patellofemoral joint (PFJ) contact forces, peak knee extension moment and peak knee flexion angle. RESULTS Significant LIMB∗GROUP interactions (all p < 0.05) but no TIME effects were found. PFJ and TFJ contact forces, peak knee flexion angle and peak knee extensor moment were lower (all p < 0.001) on the injured-limb compared to both contralateral-limb and CONTROL. PFJ and TFJ contact forces and peak knee flexion, knee extension moment were greater (all p < 0.01) on the contralateral-limb of ACL-R compared to CONTROL. There was no change in knee biomechanics after two weeks of the reintroduction to running. CONCLUSIONS Clinicians should be aware that substantial and persistent knee underloading does not resolve upon reintroduction to running after ACL-R. LEVEL OF EVIDENCE Longitudinal observational study, level III.
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Neal K, Williams JR, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2025-2038. [PMID: 34989019 PMCID: PMC9256843 DOI: 10.1002/jor.25250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.
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Affiliation(s)
- Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | - Jack R. Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | | | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
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Kinetic measurement system use in individuals following anterior cruciate ligament reconstruction: a scoping review of methodological approaches. J Exp Orthop 2021; 8:81. [PMID: 34568996 PMCID: PMC8473525 DOI: 10.1186/s40634-021-00397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs). Methods We followed the PRISMA extension for scoping reviews and Arksey and O’Malley’s 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included. Results In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs. Conclusion Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00397-0.
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Knurr KA, Kliethermes SA, Stiffler-Joachim MR, Cobian DG, Baer GS, Heiderscheit BC. Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes. Am J Sports Med 2021; 49:2607-2614. [PMID: 34260290 PMCID: PMC8338897 DOI: 10.1177/03635465211026665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preinjury running biomechanics are an ideal comparator for quantifying recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), allowing for assessments within the surgical and nonsurgical limbs. However, availability of preinjury running biomechanics is rare and has been reported in case studies only. PURPOSE/HYPOTHESIS The purpose of this study was to determine if running biomechanics return to preinjury levels within the first year after ACLR among collegiate athletes. We hypothesized that (1) surgical knee biomechanics would be significantly reduced shortly after ACLR and would not return to preinjury levels by 12 months and (2) nonsurgical limb mechanics would change significantly from preinjury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Thirteen Division I collegiate athletes were identified between 2015 and 2020 (6 female; mean ± SD age, 20.7 ± 1.3 years old) who had whole body kinematics and ground-reaction forces recorded during treadmill running (3.7 ± 0.6 m/s) before sustaining an ACL injury. Running analyses were repeated at 4, 6, 8, and 12 months (4M, 6M, 8M, 12M) after ACLR. Linear mixed effects models were used to assess differences in running biomechanics between post-ACLR time points and preinjury within each limb, reported as Tukey-adjusted P values. RESULTS When compared with preinjury, the surgical limb displayed significant deficits at all postoperative assessments (P values <.01; values reported as least squares mean difference [SE]): peak knee flexion angle (4M, 13.2° [1.4°]; 6M, 9.9° [1.4°]; 8M, 9.8° [1.4°]; 12M, 9.0° [1.5°]), peak knee extensor moment (N·m/kg; 4M, 1.32 [0.13]; 6M, 1.04 [0.13]; 8M, 1.04 [0.13]; 12M, 0.87 [0.15]; 38%-57% deficit), and rate of knee extensor moment (N·m/kg/s; 4M, 22.7 [2.4]; 6M, 17.9 [2.3]; 8M, 17.5 [2.4]; 12M, 16.1 [2.6]; 33%-46% deficit). No changes for these variables from preinjury (P values >.88) were identified in the nonsurgical limb. CONCLUSION After ACLR, surgical limb knee running biomechanics were not restored to the preinjury state by 12M, while nonsurgical limb mechanics remained unchanged as compared with preinjury. Collegiate athletes after ACLR demonstrate substantial deficits in running mechanics as compared with preinjury that persist beyond the typical return-to-sport time frame. The nonsurgical knee appears to be a valid reference for recovery of the surgical knee mechanics during running, owing to the lack of change within the nonsurgical limb.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Geoffrey S. Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA,Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA,Corresponding Author: Bryan C. Heiderscheit, PT, PhD, Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Avenue, Madison, WI 53705-2281, USA ()
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Huang YL, Chang E, Johnson ST, Pollard CD, Hoffman MA, Norcross MF. Explosive Quadriceps Strength and Landing Mechanics in Females with and without Anterior Cruciate Ligament Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7431. [PMID: 33065986 PMCID: PMC7599476 DOI: 10.3390/ijerph17207431] [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: 08/16/2020] [Revised: 10/02/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
Lower explosive quadriceps strength, quantified as rate of torque development (RTD), may contribute to landing mechanics associated with anterior cruciate ligament (ACL) injury risk. However, the association between quadriceps RTD and landing mechanics during high demand tasks remains unclear. Therefore, this study investigated the influence of quadriceps RTD on sagittal plane landing mechanics during double-leg jump landings (DLJL) and single-leg jump cuts (SLJC) in females with and without ACL reconstruction (ACLR). Quadriceps RTD was measured during isometric muscle contractions. Landing mechanics were collected during DLJL and SLJC tasks. Separate stepwise multiple linear regression models determined the amount of variance in sagittal plane landing mechanics that could be explained by quadriceps RTD, group (ACLR or Control), and their interaction. The results indicate that greater quadriceps RTD is associated with lower loading rate (p = 0.02) and longer time to peak vertical ground reaction force (p = 0.001) during SLJC, regardless of ACLR status. As greater loading rate may lead to higher risk of ACL injuries and post-traumatic knee osteoarthritis post-ACLR, explosive muscle strength interventions might be useful for individuals with and without ACLR to facilitate the use of safer landing mechanics.
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Affiliation(s)
- Yu-Lun Huang
- Department of Kinesiology, College of Education and Human Sciences, University of Wisconsin–Eau Claire, Eau Claire, WI 54702, USA
| | - Eunwook Chang
- Department of Kinesiology, Inha University, Incheon 22212, Korea
| | - Samuel T. Johnson
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
| | - Christine D. Pollard
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University-Cascades, Bend, OR 97701, USA;
| | - Mark A. Hoffman
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
| | - Marc F. Norcross
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
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Lloyd RS, Oliver JL, Kember LS, Myer GD, Read PJ. Individual hop analysis and reactive strength ratios provide better discrimination of ACL reconstructed limb deficits than triple hop for distance scores in athletes returning to sport. Knee 2020; 27:1357-1364. [PMID: 33010748 PMCID: PMC9892801 DOI: 10.1016/j.knee.2020.07.003] [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: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The triple hop for distance test commonly uses a limb symmetry index (LSI) 'pass' threshold of >90% for total hop distance following anterior cruciate ligament reconstruction (ACLR). However, understanding the manner in which athletes generate and dissipate forces during consecutive hops within the test may provide greater insight into residual limb deficits. The aim of the study was to examine reactive strength ratios (RSR) of individual hops during a triple hop test in a cohort of ACLR patients at discharge prior to return-to-sport. METHODS Twenty male athletes (24.6 ± 4.2 years; height 175.3 ± 10.2 cm; mass 73.6 ± 14.5 kg) completed the test on both non-operated and operated limbs. Total distance hopped, contact times, flight times and RSR were collected for each hop using a floor-level optical measurement system. RESULTS Significant, small to moderate between-limb differences (p < 0.05; d = 0.45-0.72) were shown for triple hop distance, flight time and RSR for each hop, with lower performance consistently displayed in the operated limb. Large, significant differences in RSR were evident between hops one and two on the operated limb (p < 0.05; d = 0.97). Despite 80% of participants achieving >90% LSI for total hop distance, less than 50% of participants reached the >90% LSI threshold for RSR. CONCLUSIONS Standardised LSI 'pass' thresholds (>90% LSI) for triple hop distance may mask residual deficits in reactive strength performance of operated limbs; therefore, more detailed analyses of individual hop performance may be warranted to enhance return to sport criteria following ACLR.
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Affiliation(s)
- Rhodri S. Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand,Corresponding author at: School of Sport, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff CF23 6XD, UK. . (R.S. Lloyd)
| | - Jon L. Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Lucy S. Kember
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Paul J. Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
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12
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Sritharan P, Schache AG, Culvenor AG, Perraton LG, Bryant AL, Crossley KM. Between-Limb Differences in Patellofemoral Joint Forces During Running at 12 to 24 Months After Unilateral Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:1711-1719. [PMID: 32374673 DOI: 10.1177/0363546520914628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, >12 months) after ACLR. PURPOSE/HYPOTHESIS The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in individuals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. STUDY DESIGN Controlled laboratory study. METHODS A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. RESULTS In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW]; uninjured, 6.7 ± 1.4 BW; P < .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs]; uninjured, 0.81 ± 0.17 BWs; P < .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT]; uninjured, 15.5 ± 2.5 %BW*HT; P < .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT; uninjured, 11.5 ± 2.7 %BW*HT; P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT; uninjured, 1.6 ± 2.3 %BW*HT; P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT]; uninjured, 5.4 ± 1.0 %HT; P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. CONCLUSION The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. CLINICAL RELEVANCE Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.
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Affiliation(s)
| | | | - Adam G Culvenor
- School of Allied Health, La Trobe University, Victoria, Australia
| | - Luke G Perraton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Victoria, Australia
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13
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Patterson BE, Crossley KM, Perraton LG, Kumar AS, King MG, Heerey JJ, Barton CJ, Culvenor AG. Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function. Phys Ther Sport 2020; 44:67-74. [PMID: 32447259 DOI: 10.1016/j.ptsp.2020.04.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/14/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Evaluate change in functional performance from 1- to 5-years after anterior cruciate ligament reconstruction (ACLR). METHODS 59 participants (38 men) aged 29 ± 16 years completed three hops and one-leg rise 1- and 5-years following ACLR. Linear mixed-effects models evaluated differences in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the three hops (n = 41) and one-leg rise (n = 31) as reference data. RESULTS The contralateral limb had a significantly greater decrease in functional performance between 1- and 5-years for the three hops, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single hop (mean 87% at 1-year to 95% at 5-years), side hop (77%to 86%) and one-leg rise (76% to85%). Performance of both ACLR and contralateral limbs and the LSI remained below the healthy controls. CONCLUSION Functional performance changes differ between limbs between 1- and 5-years post-ACLR. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement, due to worsening contralateral limb function.
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Affiliation(s)
- Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Luke G Perraton
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Australia
| | - Avnish S Kumar
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia.
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14
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Wei Z, Li JX, Fu W, Wang L. Plantar load characteristics among runners with different strike patterns during preferred speed. J Exerc Sci Fit 2020; 18:89-93. [PMID: 32636890 PMCID: PMC7327771 DOI: 10.1016/j.jesf.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to compare the plantar loads between habitual rearfoot strike (RFS) and non-RFS (NRFS) during running under the participant’s preferred speed. Methods A total of 66 (36 RFS, 30 NRFS) healthy amateur male runners were included in our study. In-shoe pressure sensors were utilised to the test plantar loads when participants were running using their preferred foot strike pattern and running speed (RFS: 3.2 ± 0.3 m/s; NRFS: 3.4 ± 0.4 m/s). Results Results indicated that running speed has a significant effect on the total contact area [F (1, 64) = 7.061, P = 0.01, η2 = 0.101], which also affects midfoot and forefoot regions. No significant difference was found on the total maximum force, force-time-integral, peak pressure (PP) and pressure-time-integral (PTI), but the total contact area of RFS was higher than that of NRFS runners [F (1, 64) = 77.406, P < 0.001, η2 = 0.551]. Plantar loads were mainly focused on the heel and midfoot for RFS runners in all variables, and NRFS runners experienced increased PP and PTI in medial forefoot regions. Conclusion Habitual runners tend to adjust their contact area according to the running speed through midfoot and forefoot regions. RFS runners remain susceptible to high impact force on the heel and midfoot, and NRFS runners experience high impact force in the first metatarsal regions. Therefore, runners should note this situation to avoid running-related injuries.
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Affiliation(s)
- Zhen Wei
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jing Xian Li
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Lin Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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15
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Pairot-de-Fontenay B, Willy RW, Elias ARC, Mizner RL, Dubé MO, Roy JS. Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Med 2019; 49:1411-1424. [DOI: 10.1007/s40279-019-01120-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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16
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PEEBLES ALEXANDERT, RENNER KRISTENE, MILLER THOMASK, MOSKAL JOSEPHT, QUEEN ROBINM. Associations between Distance and Loading Symmetry during Return to Sport Hop Testing. Med Sci Sports Exerc 2019; 51:624-629. [DOI: 10.1249/mss.0000000000001830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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DeFrate LE, Kim-Wang SY, Englander ZA, McNulty AL. Osteoarthritis year in review 2018: mechanics. Osteoarthritis Cartilage 2019; 27:392-400. [PMID: 30597275 PMCID: PMC6489451 DOI: 10.1016/j.joca.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review recent biomechanics literature focused on the interactions between biomechanics and articular cartilage health, particularly focused on macro-scale and human studies. DESIGN A literature search was conducted in PubMed using the search terms (biomechanics AND osteoarthritis) OR (biomechanics AND cartilage) OR (mechanics AND osteoarthritis) OR (mechanics AND cartilage) for publications from April 2017 to April 2018. RESULTS Abstracts from the 559 articles generated from the literature search were reviewed. Due to the wide range of topics, 62 full texts with a focus on in vivo biomechanical studies were included for further discussion. Several overarching themes in the recent literature were identified and are summarized, including 1) new methods to detect early osteoarthritis (OA) development, 2) studies describing healthy and OA cartilage and biomechanics, 3) ACL injury and OA development, 4) meniscus injury and OA development, and 5) OA prevention, treatment, and management. CONCLUSIONS Mechanical loading is a critical factor in the maintenance of joint health. Abnormal mechanical loading can lead to the onset and progression of OA. Thus, recent studies have utilized various biomechanical models to better describe the etiology of OA development and the subsequent effects of OA on the mechanics of joint tissues and whole body biomechanics.
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Affiliation(s)
- Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Sophia Y. Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Pathology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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18
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Perraton LG, Clark RA, Crossley KM, Pua YH, Whitehead TS, Morris HG, Culvenor AG, Bryant AL. Greater knee flexion excursion/moment in hopping is associated with better knee function following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:596-603. [PMID: 30293181 DOI: 10.1007/s00167-018-5197-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/02/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Individuals with impaired knee function after anterior cruciate ligament reconstruction (ACLR) may be at greater risk of developing knee osteoarthritis related to abnormal knee joint movement and loading. The aim of this study was to assess the association between knee biomechanics and knee laxity during hopping and clinically assessed knee function (i.e., patient-reported knee function and hop tests) following ACLR. METHODS Sixty-six participants (23 women, mean age 28 ± 6 years, mean 18 ± 3 months following ACLR) completed a standardized single-leg hopping task. Three-dimensional movement analysis was used to assess knee flexion excursion and body weight/height normalized knee flexion moments during landing for the involved limb. Anterior-posterior knee laxity was assessed with a KT-1000 knee arthrometer. Participants then completed a patient-reported knee function questionnaire and three separate hop tests (% of uninvolved limb) and were divided into poor and satisfactory knee function groups (satisfactory: ≥85% patient-reported knee function and ≥ 85% hop test symmetry). Associations between knee function and hop biomechanics/knee laxity were assessed using logistic regression and interquartile range scaled odds ratios (ORIQR). RESULTS Greater knee flexion excursion (ORIQR 2.9, 95%CI 1.1-7.8), greater knee flexion moment (ORIQR 4.9, 95%CI 1.6-14.3) and lesser knee laxity (ORIQR 4.7, 95%CI 1.5-14.9) were significantly associated with greater odds of having satisfactory knee function (≥ 85% patient-reported knee function and ≥ 85% hop test symmetry). CONCLUSION Greater knee flexion excursion/moment during hop-landing and lesser knee laxity is associated with better patient-reported knee function and single-leg hop test performance following ACLR. Patients with lower levels of knee function following ACLR demonstrated hop-landing biomechanics previously associated with early patellofemoral osteoarthritis. Therefore, interventions aimed at improving hop landing biomechanics in people with poor knee function are likely required. LEVEL OF EVIDENCE III, Cross-sectional study.
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Affiliation(s)
- Luke G Perraton
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Building B, McMahons Road, Peninsula campus, Frankston, VIC, 3199, Australia.
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Bundoora, Australia
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | | | | | - Adam G Culvenor
- School of Allied Health, La Trobe University, Bundoora, Australia.,Paracelsus Medical University, Institute of Anatomy Salzburg and Nuremburg, Salzburg, Austria
| | - Adam L Bryant
- Melbourne School of Physiotherapy, The University of Melbourne, Melbourne, Australia
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