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Labban W, Manaseer T, Golberg E, Sommerfeldt M, Nathanail S, Dennett L, Westover L, Beaupre L. Jumping into recovery: A systematic review and meta-analysis of discriminatory and responsive force plate parameters in individuals following anterior cruciate ligament reconstruction during countermovement and drop jumps. J Exp Orthop 2024; 11:e12018. [PMID: 38572392 PMCID: PMC10986632 DOI: 10.1002/jeo2.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose Comprehensive understanding of force plate parameters distinguishing individuals postprimary anterior cruciate ligament reconstruction (ACLR) from healthy controls during countermovement jumps (CMJ) and/or drop jumps (DJ) is lacking. This review addresses this gap by identifying discriminative force plate parameters and examining changes over time in individuals post-ACLR during CMJ and/or DJ. Methods We conducted a systematic review and meta analyses following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine databases were searched from inception to March 2022. We included cross-sectional papers comparing post-ACLR with healthy controls or longitudinal studies of individuals at least 6 months postprimary ACLR while performing CMJ and/or DJ on force plates. The methodological quality was appraised using the Modified Downs and Black Checklist. Results Thirty-three studies including 1185 (50.38%) participants post-ACLR, and 1167 (49.62%) healthy controls, were included. Data were categorised into single-leg CMJ, double-leg CMJ, single-leg DJ, and double-leg DJ. Jump height was reduced in both single (mean difference [MD] = -3.13; p < 0.01; 95% confidence interval [CI]: [-4.12, -2.15]) and double-leg (MD = -4.24; p < 0.01; 95% CI: [-5.14, -3.34]) CMJs amongst individuals with ACLR. Similarly, concentric impulse and eccentric/concentric impulse asymmetry could distinguish between ACLR (MD = 3.42; p < 0.01; 95% CI: [2.19, 4.64]) and non-ACLR (MD = 5.82; p < 0.01; 95% CI: [4.80, 6.80]) individuals. In double-leg DJs, peak vertical ground reaction forces were lower in the involved side (MD = -0.10; p = 0.03; 95% CI: [-0.18, -0.01]) but higher in the uninvolved side (MD = 0.15; p < 0.01; 95% CI: [0.10, 0.20]) when compared to controls and demonstrated significant changes between 6 months and 3 years post-ACLR. Conclusion This study identified discriminative kinetic parameters when comparing individuals with and without ACLR and also monitored neuromuscular function post-ACLR. Due to heterogeneity, a combination of parameters may be required to better identify functional deficits post-ACLR. Level of Evidence Level III.
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Affiliation(s)
- Wasim Labban
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Mirdif Center for Physiotherapy and RehabilitationDubaiUnited Arab Emirate
| | - Thaer Manaseer
- Department of Sport Rehabilitation, Faculty of Physical Education & Sports SciencesThe Hashemite UniversityZarqaJordan
| | - Eric Golberg
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
| | - Mark Sommerfeldt
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
- Glen Sather Sports Medicine ClinicUniversity of AlbertaEdmontonCanada
| | | | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences LibraryUniversity of AlbertaEdmontonCanada
| | | | - Lauren Beaupre
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
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Wang X, Wang D, Zhang C, Zhang K, Du C, Shi H. Study on the use of 3D printed guides in the individualized reconstruction of the anterior cruciate ligament. BMC Musculoskelet Disord 2024; 25:126. [PMID: 38336676 PMCID: PMC10854030 DOI: 10.1186/s12891-024-07234-2] [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: 03/27/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE Evaluation of the accuracy and effectiveness of 3D printed guides to assist femoral tunnel preparation in individualised reconstruction of the anterior cruciate ligament. METHODS Sixty patients who attended the Affiliated Hospital of Binzhou Medical College for autologous hamstring single bundle reconstruction of the anterior cruciate ligament from October 2018 to October 2020 were selected and randomly divided into two groups, including 31 cases in the 3D printing group (14 males and 17 females, mean age 41.94 ± 10.15 years) and 29 cases in the control group (13 males and 16 females, mean age 37.76 ± 10.34 years). Patients in both groups were assessed for intraoperative femoral tunnel accuracy, the number of intraoperative positioning and the time taken to prepare the femoral tunnel, the length of the anteromedial approach incision, the pre-planned bone tunnel length and intraoperative bone tunnel length in the 3D printed group, IKDC score and Lysholm score preoperatively and at 3, 6 and 12 months postoperatively, the Lachman、pivot-shift test preoperatively and at 6 months postoperatively, gait analysis to assess internal and external rotation in flexion of the knee at 12 months postoperatively and postoperative complications in both groups. RESULTS There was no statistical difference in functional knee scores and anteromedial approach incision length between the 3D printed and control groups (p > 0.05), while there was a statistical difference in the accuracy of tunnel positioning, the time taken to prepare the femoral bone tunnel and the degree of external rotation of the knee in flexion between the two groups (p < 0.05). There was no statistical difference between the preoperative planning of the bone tunnel length and the intraoperative bone tunnel length (p > 0.05). COMPLICATIONS One case in the 3D printing group developed intermuscular vein thrombosis in the affected lower limb after surgery, which disappeared after treatment, while three cases in the control group developed intermuscular vein thrombosis in the affected lower limb. No complications such as bone tunnel rupture, deep vein thrombosis in the lower limb and infection occurred in either group. CONCLUSION 3D printed guides assisted with individualized ACL reconstruction may improve the accuracy of femoral tunnel positioning, which is safe and effective, while reducing the operative time and the number of intraoperative positioning, without increasing the length of incision, and may obtain higher functional scores and rotational stability of the knee joint, which is in line with the concept of individualized ACL reconstruction.
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Affiliation(s)
- Xin Wang
- Department of Bone, Nanyang Central Hospital, Henan, China
| | - Dening Wang
- Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China
| | - Chenchen Zhang
- Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China
| | - Kefan Zhang
- Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China
| | - Changling Du
- Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China
| | - Hui Shi
- Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China.
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Martínez-Pascual D, Catalán JM, Blanco-Ivorra A, Sanchís M, Arán-Ais F, García-Aracil N. Estimating vertical ground reaction forces during gait from lower limb kinematics and vertical acceleration using wearable inertial sensors. Front Bioeng Biotechnol 2023; 11:1199459. [PMID: 37840666 PMCID: PMC10570513 DOI: 10.3389/fbioe.2023.1199459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
One of the most important forces generated during gait is the vertical ground reaction force (vGRF). This force can be measured using force plates, but these can limit the scope of gait analysis. This paper presents a method to estimate the vGRF using inertial measurement units (IMU) and machine learning techniques. Four wearable IMUs were used to obtain flexion/extension angles of the hip, knee, and ankle joints, and an IMU placed over the C7 vertebra to measure vertical acceleration. We trained and compared the performance of two machine learning algorithms: feedforward neural networks (FNN) and random forest (RF). We investigated the importance of the inputs introduced into the models and analyzed in detail the contribution of lower limb kinematics and vertical acceleration to model performance. The results suggest that the inclusion of vertical acceleration increases the root mean square error in the FNN, while the RF appears to decrease it. We also analyzed the ability of the models to construct the force signal, with particular emphasis on the magnitude and timing of the vGRF peaks. Using the proposed method, we concluded that FNN and RF models can estimate the vGRF with high accuracy.
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Affiliation(s)
- David Martínez-Pascual
- Biomedical Neuroengineering Research Group, Robotics and Artificial Intelligence Unit, Bioengineering Institute, Miguel Hernandez University, Elche, Spain
| | - José M. Catalán
- Biomedical Neuroengineering Research Group, Robotics and Artificial Intelligence Unit, Bioengineering Institute, Miguel Hernandez University, Elche, Spain
| | - Andrea Blanco-Ivorra
- Biomedical Neuroengineering Research Group, Robotics and Artificial Intelligence Unit, Bioengineering Institute, Miguel Hernandez University, Elche, Spain
| | - Mónica Sanchís
- INESCOP Footwear Technology Center, Elda, Alicante, Spain
| | | | - Nicolás García-Aracil
- Biomedical Neuroengineering Research Group, Robotics and Artificial Intelligence Unit, Bioengineering Institute, Miguel Hernandez University, Elche, Spain
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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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Moore JM, Cessford K, Willmott AP, Raj D, Exell TA, Burbage J, Mullineaux DR. Lower limb biomechanics before and after anterior cruciate ligament reconstruction: A systematic review. J Biomech 2020; 106:109828. [PMID: 32517975 DOI: 10.1016/j.jbiomech.2020.109828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/30/2020] [Accepted: 05/02/2020] [Indexed: 12/29/2022]
Abstract
This review aimed to synthesise the findings of literature that have assessed the changes in lower limb biomechanics following anterior cruciate ligament (ACL) reconstructive surgery. Systematic searches of CINHAL, MEDLINE, SCOPUS, and SPORTDiscus databases were run. All included studies had presented biomechanical variables pre- and post-surgery for the same participants. Articles were categorised by the analysed movement, and effect sizes were calculated. Fifty-four studies met the inclusion criteria, providing data on gait (n = 31), balance (n = 12), joint position sense (n = 5), stair ambulation (n = 4), pivoting (n = 6), and landing (n = 5). Measures of balance performance and joint position sense showed improvements from pre- to post-surgery. Changes in joint kinematics were inconsistent between studies, however increased knee flexion excursion, and reduced tibial anterior translation and internal rotation post reconstruction were identified. Joint kinetics reduced in magnitude in the early stages after surgery (≤5 weeks), then increased later in recovery (≥24 weeks). Risk of bias assessment identified most articles had a moderate or high risk (low = 5; moderate = 21; high = 11) resulting from participant retention and surgical intervention differences. The results of the review identified that although lower limb biomechanics did alter following reconstruction, few variables provided consistent results across studies and tasks. The low methodological quality of some articles may have contributed to these inconsistent findings. Alternatively, differences across studies may have resulted from individual coping strategies of participants that have previously been suggested to be present before reconstructive surgery, and future research should look to explore individual coping strategies to ACL reconstruction.
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Affiliation(s)
- Joseph M Moore
- School of Sport, Health and Exercise Science, University of Portsmouth, UK.
| | - Kimberly Cessford
- School of Sport, Health and Exercise Science, University of Portsmouth, UK; Department of Sport and Exercise Sciences, University of Chichester, UK
| | | | - Dipak Raj
- Department of Orthopaedics, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, UK
| | - Timothy A Exell
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
| | - Jenny Burbage
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
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Dai B, Layer JS, Bordelon NM, Critchley ML, LaCroix SE, George AC, Li L, Ross JD, Jensen MA. Longitudinal assessments of balance and jump-landing performance before and after anterior cruciate ligament injuries in collegiate athletes. Res Sports Med 2020; 29:129-140. [PMID: 32009460 DOI: 10.1080/15438627.2020.1721290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose was to quantify the effect of an anterior cruciate ligament (ACL) injury on balance and jump-landing performance and bilateral asymmetries. Among 500 collegiate athletes who performed a reaching test and a double-leg counter-movement jump-landing test at baseline, 8 male and 6 female athletes suffered ACL injuries. In the follow-up, they performed the reaching test 3 and 6 months after ACL reconstruction (ACLR) and the jump-landing test 6 months after ACLR. Less reaching distances for the injured leg and increased reaching distance asymmetries were observed 3 and 6 months after ACLR compared to baseline. Less peak jumping and landing forces for the injured leg and increased jumping and landing force asymmetries were found 6 months after ACLR compared to baseline. The decreased performance of the injured leg and increased asymmetries may contribute to the high ACL re-injury rates. Baseline assessments would be useful for establishing an individual's pre-injury performance.
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Affiliation(s)
- Boyi Dai
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jacob S Layer
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Nicole M Bordelon
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Meghan L Critchley
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Sydne E LaCroix
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Ana C George
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jeremy D Ross
- Department of Sports Medicine, University of Wyoming , Laramie, WY, USA
| | - Megan A Jensen
- Department of Sports Medicine, University of Wyoming , Laramie, WY, USA
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Cardona M, García Cena CE, Serrano F, Saltaren R. ALICE: Conceptual Development of a Lower Limb Exoskeleton Robot Driven by an On-Board Musculoskeletal Simulator. SENSORS (BASEL, SWITZERLAND) 2020; 20:E789. [PMID: 32023988 PMCID: PMC7038445 DOI: 10.3390/s20030789] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/20/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this article, we present the conceptual development of a robotics platform, called ALICE (Assistive Lower Limb Controlled Exoskeleton), for kinetic and kinematic gait characterization. The ALICE platform includes a robotics wearable exoskeleton and an on-board muscle driven simulator to estimate the user's kinetic parameters. BACKGROUND Even when the kinematics patterns of the human gait are well studied and reported in the literature, there exists a considerable intra-subject variability in the kinetics of the movements. ALICE aims to be an advanced mechanical sensor that allows us to compute real-time information of both kinetic and kinematic data, opening up a new personalized rehabilitation concept. METHODOLOGY We developed a full muscle driven simulator in an open source environment and validated it with real gait data obtained from patients diagnosed with multiple sclerosis. After that, we designed, modeled, and controlled a 6 DoF lower limb exoskeleton with inertial measurement units and a position/velocity sensor in each actuator. SIGNIFICANCE This novel concept aims to become a tool for improving the diagnosis of pathological gait and to design personalized robotics rehabilitation therapies. CONCLUSION ALICE is the first robotics platform automatically adapted to the kinetic and kinematic gait parameters of each patient.
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Affiliation(s)
- Manuel Cardona
- Centre for Automation and Robotics (CAR), Universidad Politécnica de Madrid (UPM), 28006 Madrid, Spain; (C.E.G.C.); (R.S.)
- Faculty of Engineering, Universidad Don Bosco (UDB), San Salvador, El Salvador
| | - Cecilia E. García Cena
- Centre for Automation and Robotics (CAR), Universidad Politécnica de Madrid (UPM), 28006 Madrid, Spain; (C.E.G.C.); (R.S.)
| | - Fernando Serrano
- Faculty of Engineering and Architecture, Universidad Tecnológica Centroamericana (UNITEC), Frente a Residencial, V-782 Boulevard Kennedy, Tegucigalpa, Honduras;
| | - Roque Saltaren
- Centre for Automation and Robotics (CAR), Universidad Politécnica de Madrid (UPM), 28006 Madrid, Spain; (C.E.G.C.); (R.S.)
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Dai B, Layer J, Vertz C, Hinshaw T, Cook R, Li Y, Sha Z. Baseline Assessments of Strength and Balance Performance and Bilateral Asymmetries in Collegiate Athletes. J Strength Cond Res 2020; 33:3015-3029. [PMID: 29985219 DOI: 10.1519/jsc.0000000000002687] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dai, B, Layer, J, Vertz, C, Hinshaw, T, Cook, R, Li, Y, and Sha, Z. Baseline assessments of strength and balance performance and bilateral asymmetries in collegiate athletes. J Strength Cond Res 33(11): 3015-3029, 2019-Injuries to upper and lower extremities comprise more than 70% of the total injuries in collegiate athletes. Establishing normative data of upper and lower extremity strength and balance may help guide postinjury rehabilitation and return-to-play decisions. The purposes of the current study were to develop the normative data of performance and bilateral asymmetries during 4 upper and lower extremity strength and balance tests in collegiate athletes and to quantify the correlations between strength and balance performance and bilateral asymmetries. A total of 304 male and 195 female Division I athletes from 14 sports performed a maximum push-up test to assess upper extremity strength, a countermovement jump test to assess lower extremity strength, an upper extremity reaching test to assess upper extremity balance, and a lower extremity reaching test to assess lower extremity balance. Bilateral ground reaction forces were collected for the push-up and jump tests. Reaching distances were measured for the 2 balance tests. Bilateral asymmetries were generally less than 10%. Significant sports effects were observed for all 5 performance variables (p < 0.001) but not for asymmetry variables (p ≥ 0.36). Weak correlations were found between strength and balance performance and asymmetries (r < 0.3). Normative data are sex and sports specific in collegiate athletes. Increased asymmetries could be more individualized rather than sex and sports specific. When return-to-play decisions are made, athletes following injuries need to demonstrate less than 10% of asymmetries to be consistent with the normative data. Strength and balance should be evaluated and improved with specific focuses.
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Affiliation(s)
- Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, Wyoming
| | - Jacob Layer
- Division of Kinesiology and Health, University of Wyoming, Laramie, Wyoming
| | - Cole Vertz
- Department of Sports Medicine, University of Wyoming, Laramie, Wyoming
| | - Taylour Hinshaw
- Division of Kinesiology and Health, University of Wyoming, Laramie, Wyoming
| | - Ross Cook
- Division of Kinesiology and Health, University of Wyoming, Laramie, Wyoming
| | - Yongming Li
- College of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Zhanxin Sha
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi
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Shimizu T, Markes AR, Samaan MA, Tanaka MS, Souza RB, Li X, Ma CB. Patients With Abnormal Limb Kinetics at 6 Months After Anterior Cruciate Ligament Reconstruction Have an Increased Risk of Persistent Medial Meniscal Abnormality at 3 Years. Orthop J Sports Med 2020; 8:2325967119895248. [PMID: 32030346 PMCID: PMC6978828 DOI: 10.1177/2325967119895248] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Several reports have shown that altered biomechanics after anterior cruciate
ligament reconstruction (ACLR) are associated with the development of
posttraumatic osteoarthritis. However, it is not fully understood whether
altered biomechanics are associated with meniscal changes after ACLR. Purpose: To investigate changes in gait and landing biomechanics over a 3-year period
and their correlation with meniscal matrix alterations present before and
after ACLR through use of magnetic resonance T1ρ/T2 mapping, which can allow
detection of early meniscal degeneration. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 36 patients with ACLR and 14 healthy controls were included in
this study. All patients underwent magnetic resonance imaging and
biomechanical analysis during gait of the injured knee and contralateral
knee preoperatively and at 6 months, 1 year, 2 years, and 3 years after
ACLR, as well as biomechanical analysis during drop-landing from 6 months to
3 years postoperatively. To evaluate biochemical changes of the mensical
matrix, T1ρ/T2 relaxation times of the meniscus were calculated. Results: Mean T1ρ/T2 values of ACLR knees were significantly higher than values in the
contralateral and control knees in the posterior lateral and medial horns up
to 1 year after surgery; however, the differences were not seen at 3 years
after surgery. The ACLR knee exhibited significantly lower peak knee flexion
moment and angle during gait at 6 months compared with baseline and
continued to decrease until 3 years. The ACLR knee exhibited significantly
lower peak vertical ground-reaction force and peak knee flexion moment and
angle during landing at 6 months. However, the differences were no longer
present at 3 years. Biomechanics at 6 months had significant correlations
with changes of mean T1ρ/T2 values in the medial posterior horn from 6
months to 3 years after ACLR. Conclusion: Although mean T1ρ/T2 values of meniscus seen before ACLR improved after 3
years, approximately 30% of patients with ACLR did not show decreases from 6
months to 3 years. Patients with abnormal lower limb kinetics of the ACLR
knee at 6 months showed less recovery in the medial posterior horn from 6
months to 3 years, suggesting that biomechanical parameters during the early
stage of recovery might be potential biomarkers for predicting persistent
medial meniscal abnormality after ACLR.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.,Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Alexander R Markes
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew S Tanaka
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
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A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement. Appl Bionics Biomech 2019; 2019:7863674. [PMID: 31885689 PMCID: PMC6915000 DOI: 10.1155/2019/7863674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/09/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose We propose a new concept of symmetry, the symmetry function, as a continuous function of the percentage of differences between sides of body movement and normalised throughout the whole range of motion. The method is used to assess the dynamical symmetry of gait of patients after unilateral total hip replacement (asymmetric group) and healthy people (symmetric group) and also to reveal discrepancies between normal and abnormal movement patterns. Methods The gait of twelve male patients (49.7 ± 2.8 y), six weeks after unilateral total hip replacement (uTHR), was analysed against the gait of thirteen healthy men (36.1 ± 3.1 y). The speed of healthy men was matched to the speed of the patients. Comparison of the affected limb in uTHR patients with the healthy limb of able-bodied men was carried out on the basis of the highest symmetry values in the sagittal plane. Results In uTHR patients, the symmetry function provides information on the symmetry of movements in the whole range of motion in contrast to symmetry indices which are calculated for selected parameters or peak values. Research revealed average asymmetric discrepancies for pelvic tilt up to 250% for the entire gait cycle with a peak of approx. 400% at the end of the loading response and terminal swing phases. Asymmetry of gait observed in other joints was below 200% of the mean range of motion. Conclusions Regions of the greatest asymmetry in pathological movements are usually different from the region of the greatest range of motion. Therefore, it is insufficient to measure symmetry only for selected regions during motion. The symmetry function is a simple method which can complement other robust methods in time series data evaluation and interpretation.
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Dan MJ, Lun KK, Dan L, Efird J, Pelletier M, Broe D, Walsh WR. Wearable inertial sensors and pressure MAT detect risk factors associated with ACL graft failure that are not possible with traditional return to sport assessments. BMJ Open Sport Exerc Med 2019; 5:e000557. [PMID: 31354961 PMCID: PMC6615852 DOI: 10.1136/bmjsem-2019-000557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is associated with poor return to sport and high graft re-rupture rates. This study explored the use of a wearable inertial sensor (ViMove) that incorporates an accelerometer and gyroscope, and MatScan pressure sensing mat (TekScan, South Boston, Massachusetts, USA) to provide objective return-to-sport measures. Methods Three cohorts’ ACLR patients, non-athletic controls and elite athletes (Australian seven’s rugby Olympic Gold medallist). Patients performed biometric and functional tests (thigh circumference and triple hop) and the ViMove knee module (consisting of single and double leg squats, hops and box drops) for lower limb alignment assessment, concurrently with force plate. Results Elite athletes had less varus/valgus (VV) movement during ViMove exercises compared with the ACLR cohort, who in turn had less VV malalignment than controls. When analysing side-to-side differences, single leg squats and box drop were asymmetrical in the ACL group, with greater malalignment in the reconstructed leg (p<0.05). Subgroup analysis failed to differentiate who passed or failed current return to sport assessment. TekScan pressure plate detected differences in double leg landing and flight time while hopping not detected with ViMove, suggesting ACL patients compensate by offloading the reconstructed leg to improve coronal alignment during double leg activity. Conclusion The inertial sensor detected differences in motion for patients following ACLR, which are known to be associated with graft rupture and were not detected with functional return to sport testing. Coupling the device with data from a pressure plate provides a powerful assessment tool detecting alignment differences known to be associate with graft failure only previously detected in formal gait analysis.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Kimberly Kai Lun
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Luke Dan
- Sports Medicine Department, Narrabeen Sports Medicine Faculty, Narrabeen, New South Wales, Australia
| | - Jimmy Efird
- HRMI, University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Pelletier
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - David Broe
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
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12
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Effect of Graft Type on Balance and Hop Tests in Adolescent Males Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2019; 28:468-475. [PMID: 29466066 DOI: 10.1123/jsr.2017-0244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Recent epidemiology studies indicated a steady increase of anterior cruciate ligament (ACL) injury in young athletes. ACL reconstruction (ACLR) is currently a standard of care, but the effect of ACLR graft including bone patellar tendon bone (BTB), hamstring tendon (HT), or iliotibial band (ITB) on balance and hop performance is understudied. Objective: To compare balance and hop deficits between uninvolved and reconstructed limbs in each autograft type (aim 1) and among the 3 autograft groups (aim 2). Setting: Biomechanical laboratory. Participants: Male ACLR patients who are younger than 22 years (total N = 160; BTB: N = 19, HT: N = 108, ITB: N = 33). Intervention: Approximately 6 to 9 months following ACLR, Y-balance and 4 types of hop tests were measured bilaterally. Main Outcome Measures: Limb symmetry index of balance and hop tests within each graft type and between the 3 graft types. Results: In the BTB group, significant anterior reach, single hop, triple hops, and cross-over hops deficits were observed on the ACLR limb compared with the uninvolved limb. The HT group showed significant deficits in single hop, triple hops, and cross-over hops on the ACLR limb relative to the uninvolved limb. Compared with the uninvolved limb, significantly decreased triple hops and 6-m timed hop deficits in the ACLR limb were recorded in the ITB group. When controlling for confounders and comparing among the 3 autograft types, the only significant difference was anterior reach, in which the BTB group showed significant deficits. Conclusion: Compared with the uninvolved limb, significant hop deficits in ACLR limb were prevalent among adolescent ACLR at ∼6 to 9 months postoperatively. After controlling covariates, significantly reduced anterior reach balance was found in the BTB group compared with the HT and ITB groups.
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13
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Setuain I, Bikandi E, Amú-Ruiz FA, Izquierdo M. Horizontal jumping biomechanics among elite male handball players with and without anterior cruciate ligament reconstruction. An inertial sensor unit-based study. Phys Ther Sport 2019; 39:52-63. [PMID: 31254917 DOI: 10.1016/j.ptsp.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Anterior cruciate ligament (ACL) tears are one of the most devastating injuries that any handball player can suffer during landing and pivoting actions. The aim of this study was to analyze the horizontal jumping biomechanics among male elite handball players with or without previous ACLR. DESIGN Descriptive study. SETTING Spanish elite male handball players. PARTICIPANTS Twenty-six male participants (6 ACL-R and 20 uninjured controls) were recruited. MAIN OUTCOME MEASURES Two horizontal hopping tasks were evaluated using an inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. RESULTS Non-significant differences were found in relation to any of the biomechanical or performance related analyzed variables. CONCLUSIONS Previously ACL-R elite male handball players who have returned to the top level of sports participation do not seem to possess lasting biomechanical and/or performance deficits 6 years after the original surgical ligament repair.
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Affiliation(s)
- Igor Setuain
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; TDN. Advanced Rehabilitation Center, Clinical Research Department. Calle V, 3. 31192 Mutilva Baja, Navarra, Spain.
| | - Eder Bikandi
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; Athletic Club, Mazarredo Zumarkalea, 23. 48009, Bilbao, Bizkaia, Spain.
| | - Francisco Antonio Amú-Ruiz
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; Department of Sports Science, Universidad del Valle, Cali, Colombia.
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain.
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14
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Kotsifaki A, Korakakis V, Whiteley R, Van Rossom S, Jonkers I. Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis. Br J Sports Med 2019; 54:139-153. [DOI: 10.1136/bjsports-2018-099918] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Abstract
ObjectiveTo systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls.DesignSystematic review with meta-analysis.Data sourcesA systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018.Eligibility criteria for selecting studiesStudies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits.ResultsThe literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen.ConclusionDuring SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR.PROSPERO trial registration number CRD42018087779.
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15
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Aljehani M, Madara K, Snyder-Mackler L, Christiansen C, Zeni JA. The contralateral knee may not be a valid control for biomechanical outcomes after unilateral total knee arthroplasty. Gait Posture 2019; 70:179-184. [PMID: 30878729 PMCID: PMC8963525 DOI: 10.1016/j.gaitpost.2019.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/03/2018] [Accepted: 01/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb. RESEARCH QUESTION The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA. METHODS Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed. RESULTS The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models. SIGNIFICANCE AND INTERPRETATION Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
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Affiliation(s)
- Moiyad Aljehani
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA,Umm Al-Qura University, Department of Physical Therapy, P.O. Box 715, Makkah 21421, Saudi Arabia
| | - Kathleen Madara
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA
| | - Lynn Snyder-Mackler
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA
| | - Cory Christiansen
- Physical Medicine and Rehabilitation Department, University of Colorado Denver, Mailstop C244, 13121 East 17th Avenue, Aurora, CO 80045, USA
| | - Joseph A. Zeni
- Rutgers, The State University of New Jersey, School of Health Professions, Department of Rehabilitation and Movement Sciences, Physical Therapy Program North, 65 Bergen Street - Office 714A, Newark, NJ 07107, USA
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16
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Abnormal Biomechanics at 6 Months Are Associated With Cartilage Degeneration at 3 Years After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:511-520. [PMID: 30473456 PMCID: PMC6361700 DOI: 10.1016/j.arthro.2018.07.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the changes in landing biomechanics over a 3-year period and their correlation with cartilage degenerative changes in the medial tibiofemoral joint of the knee after anterior cruciate ligament reconstruction (ACLR) using magnetic resonance T1ρ mapping. METHODS Thirty-one anterior cruciate ligament-injured patients underwent magnetic resonance imaging of the injured knee before ACLR and 3 years after ACLR, as well as biomechanical analysis of a drop-landing task at 6 months and 3 years after ACLR. Sixteen healthy individuals were recruited and underwent knee magnetic resonance imaging and biomechanical assessment during a drop-landing task. T1ρ cartilage relaxation times were calculated for the medial femur and tibia. RESULTS ACLR patients exhibited increased peak vertical ground reaction force (VGRF), VGRF impulse, peak knee flexion moment (KFM), and KFM impulse from 6 months to 3 years (P < .001 for each). Although the ACLR knees showed significantly lower peak VGRF and KFM at 6 months (P < .001 for both) when compared with the controls, there were no significant differences at 3 years. At 3 years, ACLR patients showed higher T1ρ values over the medial femur (P < .001) and tibia (P = .012) when compared with their preoperative values and with healthy control values. Within the ACLR group, side-to-side differences in peak VGRF and sagittal knee biomechanics at 6 months were associated with increased T1ρ values from baseline to 3 years. CONCLUSIONS The results of this longitudinal study show that landing biomechanics are altered after ACLR but biomechanical abnormalities tend to recover at 3 years after ACLR. Differences in lower-extremity mechanics during a landing task at 6 months may be associated with cartilage degeneration at 3 years after anterior cruciate ligament injury and reconstruction. LEVEL OF EVIDENCE Level II, prospective trial.
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