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Asaeda M, Nakamae A, Mikami Y, Hirata K, Kono Y, Abe T, Deie M, Adachi N. Detecting side-to-side differences of lower limb biomechanics during single-legged forward landing after anterior cruciate ligament reconstruction. J Orthop Sci 2023; 28:1303-1310. [PMID: 36167705 DOI: 10.1016/j.jos.2022.09.002] [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: 04/09/2022] [Revised: 07/29/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Motion analysis can be used to evaluate functional recovery after anterior cruciate ligament (ACL) reconstruction; however, the biomechanics parameters of the lower limb that are specifically altered in ACL-reconstructed knees compared to the contralateral side are not well understood. This retrospective study aimed to compare side-to-side differences in lower limb biomechanics during the first 100 milliseconds (ms) after initial contact in a single-leg forward landing task. METHODS Using three-dimensional motion analysis, lower joint kinematic and kinetic variables were measured 8-10 months postoperatively in 22 patients who had undergone ACL reconstruction. We determined side-to-side differences in lower limb biomechanics over the 100-ms timeframe after landing, and receiver operating characteristic (ROC) curve analyses were performed to calculate the area under the curve (AUC) for parameters showing significant side-to-side differences. RESULTS During the 100-ms timeframe after landing, 58 kinematic and kinetic items showed significant side-to-side differences. Side-to-side differences in lower limb biomechanics over the 40-ms timeframe after landing existed. The ROC curve analysis identified 11 items with AUC values ≥ 0.70, including hip flexion, abduction moment, and knee joint power, and their AUC values were not significantly different. CONCLUSION Hip flexion/abduction moment and knee power after GRF max could be used as outcomes for assessing functional recovery in patients who have undergone ACL reconstruction.
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Affiliation(s)
- Makoto Asaeda
- Sports Medical Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, 2252, Nakanoshima, Wakayama, 640-8392, Japan.
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiko Hirata
- Sports Medical Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yoshifumi Kono
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takumi Abe
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Masataka Deie
- Department of Orthopaedic Surgery, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Nobuo Adachi
- Sports Medical Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Long T, Fernandez J, Liu H, Li H. Evaluating the risk of knee osteoarthritis following unilateral ACL reconstruction based on an EMG-assisted method. Front Physiol 2023; 14:1160261. [PMID: 37153223 PMCID: PMC10160379 DOI: 10.3389/fphys.2023.1160261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Objective: Anterior cruciate ligament reconstruction (ACLR) cannot decrease the risk of knee osteoarthritis after anterior cruciate ligament rupture, and tibial contact force is associated with the development of knee osteoarthritis. The purpose of this study was to compare the difference in bilateral tibial contact force for patients with unilateral ACLR during walking and jogging based on an EMG-assisted method in order to evaluate the risk of knee osteoarthritis following unilateral ACLR. Methods: Seven unilateral ACLR patients participated in experiments. The 14-camera motion capture system, 3-Dimension force plate, and wireless EMG test system were used to collect the participants' kinematics, kinetics, and EMG data during walking and jogging. A personalized neuromusculoskeletal model was established by combining scaling and calibration optimization. The inverse kinematics and inverse dynamics algorithms were used to calculate the joint angle and joint net moment. The EMG-assisted model was used to calculate the muscle force. On this basis, the contact force of the knee joint was analyzed, and the tibial contact force was obtained. The paired sample t-test was used to analyze the difference between the participants' healthy and surgical sides of the participants. Results: During jogging, the peak tibial compression force on the healthy side was higher than on the surgical side (p = 0.039). At the peak moment of tibial compression force, the muscle force of the rectus femoris (p = 0.035) and vastus medialis (p = 0.036) on the healthy side was significantly higher than that on the surgical side; the knee flexion (p = 0.042) and ankle dorsiflexion (p = 0.046) angle on the healthy side was higher than that on the surgical side. There was no significant difference in the first (p = 0.122) and second (p = 0.445) peak tibial compression forces during walking between the healthy and surgical sides. Conclusion: Patients with unilateral ACLR showed smaller tibial compression force on the surgical side than on the healthy side during jogging. The main reason for this may be the insufficient exertion of the rectus femoris and vastus medialis.
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Affiliation(s)
- Ting Long
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Biomechanics Laboratory, Beijing Sport University, Beijing, China
- *Correspondence: Ting Long, ; Hanjun Li,
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Hanjun Li
- Biomechanics Laboratory, Beijing Sport University, Beijing, China
- *Correspondence: Ting Long, ; Hanjun Li,
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Miles JJ, McGuigan PM, King E, Daniels KAJ. Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction. Scand J Med Sci Sports 2022; 32:1236-1248. [PMID: 35419809 DOI: 10.1111/sms.14166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Nine months after anterior cruciate ligament (ACL) reconstruction, athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft demonstrate higher loading asymmetries during vertical jumping than those with a hamstring tendon (HT) autograft. These asymmetries may transfer into sporting movements with a greater ACL injury risk. The aim of this study was to compare between-limb asymmetries in knee mechanics and task performance during an unplanned 90° change-of-direction (CoD) task in male field sport athletes reconstructed with BPTB or HT autografts. Seventy-eight male multidirectional field sport athletes with either a BPTB (n = 39) or HT (n = 39) autograft completed maximal unplanned CoD trials in a three-dimensional motion capture laboratory at approximately 9 months post-surgery. A mixed-model 2x2 ANOVA (autograft type x limb) was used to compare variables related to ACL injury risk (e.g., internal knee moments) and performance (e.g., completion time) between autografts and limbs. Statistical parametric mapping was used for a waveform comparison throughout stance, supplemented with a discrete point analyses of peak knee moments and performance variables. Interaction effects were found at the knee joint, with BPTB demonstrating greater asymmetries than HT in knee extension moment (p < 0.001); resultant ground reaction force (p < 0.001); peak knee external rotation moment (p = 0.04); and knee adduction (p = 0.05), medial rotation (p < 0.001), and flexion (p < 0.001) angles. No differences were found between autografts for any performance variable. BPTB demonstrated greater lower-limb biomechanical asymmetries than HT during CoD, which may influence knee loading and longer-term outcomes and should thus be targeted during rehabilitation prior to return to play.
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Affiliation(s)
- Joshua J Miles
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department for Health, University of Bath, Bath, UK
| | | | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
| | - Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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Nagelli CV, Di Stasi S, Wordeman SC, Chen A, Tatarski R, Hoffman J, Hewett TE. Knee Biomechanical Deficits During a Single-Leg Landing Task Are Addressed With Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Athletes. Clin J Sport Med 2021; 31:e347-e353. [PMID: 31842056 PMCID: PMC7247920 DOI: 10.1097/jsm.0000000000000792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Faulty neuromuscular and biomechanical deficits of the knee are nearly ubiquitous in athletes after anterior cruciate ligament (ACL) reconstruction (ACLR). Knee biomechanical deficits are directly associated with an increased risk of second ACL injury, which typically occurs during a sports-related movement on a single limb. To date, the biomechanical effects of a neuromuscular training (NMT) program on knee biomechanics during a single-leg landing task have not been investigated. DESIGN Prospective Cohort Study. SETTING Controlled laboratory setting. PARTICIPANTS Eighteen ACLR and 10 control athletes. INTERVENTIONS Neuromuscular training. MAIN OUTCOME MEASURES Knee kinematics and kinetics. RESULTS There were no significant interactions of session and limb (P > 0.05) for the athletes with ACLR after training. However, there were several significant main effects of session (P < 0.05) for knee kinematics and kinetics during the single-leg landing task. After training, the athletes with ACLR landed with greater knee flexion angles, decreased knee abduction angles, increased knee flexion range of motion, and decreased knee excursion. Also, the ACLR athletes landed with lower knee flexion moments, greater knee adduction moments, and lower peak vertical ground reaction force. Post-training comparison of the ACLR and control cohorts found no significant interactions of group and limb (P > 0.05) and only a significant main effect of group (P < 0.05) for frontal plane knee angle at initial contact. The athletes with ACLR landed with greater knee adduction angles than the control group. CONCLUSIONS Deficits in knee biomechanics that are associated with an increased risk of ACL injury are attenuated after completion of this NMT program.
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Affiliation(s)
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State, Columbus, OH
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Samuel C. Wordeman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Albert Chen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rachel Tatarski
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joshua Hoffman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy E. Hewett
- Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Sports Medicine Center, Mayo Clinic, Rochester, MN
- Department of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, MN
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Webster KE, Ristanis S, Feller JA. A longitudinal investigation of landing biomechanics following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 50:36-41. [PMID: 33865216 DOI: 10.1016/j.ptsp.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Abnormal movement patterns have been shown during landing in patients who have undergone anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to investigate landing biomechanics over time in this patient group to determine whether asymmetry between limbs reduced with time and after a return to physical activity. DESIGN Prospective longitudinal study. SETTING Biomechanics laboratory. PARTICIPANTS Fourteen patients who had undergone ACL reconstruction surgery. MAIN OUTCOME MEASURE Single limb landing assessments were made at two time points; within the first year (mean of 10 months) and at 3 years (after patients had returned to sport) following ACL reconstruction. Three-dimensional motion analysis was used to record kinematic and kinetic variables, which were compared across time and limb using ANOVA models. RESULTS Most biomechanical variables showed little change over time except for the external knee adduction moment at the operated knee, which increased (effect size d = 0.5), but remained less than the contralateral side. In the sagittal plane, asymmetrical landing patterns were seen at both assessments. Patients landed with reduced knee flexion angles (effect size range 0.76-0.9) and moments (effect size range 0.56-0.9) compared to the uninjured limb and made compensations for this by increasing the hip flexion moment (effect size range d = 0.6-0.75). CONCLUSIONS Asymmetrical landing biomechanics persisted at three years after ACL reconstruction in athletes who returned to sporting activity. Long term implications of controlling the landing by increasing the hip moment are unknown and require further investigation.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | | | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; OrthoSport Victoria Research Unit, Melbourne, Australia
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Milandri G, Sivarasu S. A Randomized Controlled Trial of Eccentric Versus Concentric Cycling for Anterior Cruciate Ligament Reconstruction Rehabilitation. Am J Sports Med 2021; 49:626-636. [PMID: 33555943 DOI: 10.1177/0363546520987566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent strength and biomechanical deviations remain after anterior cruciate ligament reconstruction (ACLR). Eccentric training may reduce these and associated reinjury or osteoarthritis risks. HYPOTHESIS For male patients who have undergone ACLR, eccentric training is more effective than concentric training at improving knee flexion angle and other biomechanical deviations, as well as strength and patient-reported outcomes, using a matched perceived exertion dose. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 26 men, 10-16 weeks after hamstring tendon graft ACLR, were randomized to an eccentric training group or a concentric control group. Both groups trained 3 times a week for 8 weeks using the same isokinetic cycle ergometer in a matched studio environment. Exercise dose was matched in training frequency, time, progression, and intensity using a target rating of perceived exertion. Baseline and follow-up testing included questionnaires, dynamometer strength testing, and walk/run gait analysis. RESULTS Eccentric training increased knee (+2.1°; P = .022) and hip (+2.1°; P = .010) flexion angles more than concentric training but not more than the minimal clinically important difference of 3°. Very large asymmetries in baseline knee abduction moment (walk, -0.10 N·m/kg/m; run, -0.54 N·m/kg/m) had not changed in either group by follow-up. Knee valgus angle effects were mixed. Tibial rotation angle increased in both groups, but concentric training was more effective at promoting symmetry (P < .001). Both groups had similar increases in affected limb quadriceps strength and knee flexion moments during walk/run gait (by 20% to 33%). Hamstring strength increased in the eccentric group (+15.4%) but not the concentric group. Eccentric group limb forces were 33% to 70% higher than those of the concentric group, with a lower heart rate. Both groups had low pain scores throughout. CONCLUSION For rehabilitation after ACLR, progressive eccentric cycle training was not more clinically effective than concentric training at a matched perceived intensity dose in male patients. This can guide exercise prescription for reducing gait and strength deviations of these patients. REGISTRATION PACTR201602001449365 (Pan African Clinical Trials Registry), NHREC 4344 (South African).
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Affiliation(s)
- Giovanni Milandri
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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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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Hewett TE, Webster KE. Early Abnormal Biomechanics May Lead to Increased Risk of Osteoarthritis and Poorer Outcomes After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:1012-1013. [PMID: 30954092 DOI: 10.1016/j.arthro.2019.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
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Macri EM, d'Entremont AG, Crossley KM, Hart HF, Forster BB, Wilson DR, Ratzlaff CR, Goldsmith CH, Khan KM. Alignment differs between patellofemoral osteoarthritis cases and matched controls: An upright 3D MRI study. J Orthop Res 2019; 37:640-648. [PMID: 30690776 PMCID: PMC6593798 DOI: 10.1002/jor.24237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/11/2019] [Indexed: 02/04/2023]
Abstract
Patellofemoral (PF) osteoarthritis (OA) is a prevalent and clinically important knee OA subgroup. Malalignment may be an important risk factor for PF OA. However, little is known about alignment in PF OA, particularly in an upright, weightbearing environment. Using a vertically-oriented open-bore MR scanner, we evaluated 3D knee alignment in 15 PF OA cases and 15 individually matched asymptomatic controls. We imaged one knee per participant while they stood two-legged at four flexion angles (0°, 15°, 30°, 45°), and also while they stood one-legged at 30° knee flexion. We calculated 3D patellofemoral and tibiofemoral alignment. Using mixed effects models, four of the five patellofemoral measures differed by group. For key measures, PF OA patellae were 6.6° [95%CI 5.0, 8.2] more laterally tilted, 2.4 mm [1.3, 3.5] more laterally translated, and at least 3.7 mm [0.2, 7.2] more proximally translated compared to controls (more with knees flexed). Alignment did not differ between two-legged stance and one-legged stance in either group. Statement of Clinical Significance: Our study demonstrated significant and clinically relevant differences in alignment between PF OA cases and controls in upright standing and squatting positions. Our findings were similar to those in previous studies of PF OA using traditional MR scanners in supine positions, supporting the clinical usefulness of existing methods aimed at identifying individuals who may benefit from interventions designed to correct malalignment. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. 9999:1-9, 2019.
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Affiliation(s)
- Erin M. Macri
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Agnes G. d'Entremont
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia
| | - Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia,Department of Physical TherapyWestern UniversityLondonOntarioCanada
| | - Bruce B. Forster
- Centre for Hip Health and Mobility, Department of RadiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Department of OrthopaedicsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Charlie H. Goldsmith
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada,Department of Occupational Science and Occupational TherapyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karim M. Khan
- Centre for Hip Health and Mobility, Department of Family PracticeThe University of British ColumbiaVancouverBritish ColumbiaCanada
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Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction? Eur J Radiol 2019; 113:32-38. [PMID: 30927957 DOI: 10.1016/j.ejrad.2019.01.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE We described patellofemoral alignment and trochlear morphology at one and five years after anterior cruciate ligament reconstruction (ACLR), and evaluated the associations between alignment and trochlear morphology (at one year) and worsening patellofemoral osteoarthritis (OA) features by five years. We also evaluated the associations between alignment and morphology to self-reported pain and function (Knee injury and Osteoarthritis Outcome Score, KOOS) at five years. MATERIALS AND METHODS In this longitudinal observational study, we followed 73 participants (mean age 29[9] years, 40% women) from one- to five-years after ACLR. Using MRI, we measured alignment and morphology, and scored cartilage and bone marrow lesions at both time points. We used mixed effects and linear regression models to achieve our stated aims. RESULTS Greater lateral patella displacement increased risk of cartilage worsening (Odds Ratio [95% CI]: 1.09 [1.01, 1.16]); while less lateral tilt (0.91 [0.83, 0.99]) and greater trochlear angle (0.88 [0.77, 1.00]) were protective. Greater medial trochlear inclination increased risk of bone marrow lesion worsening (1.12 [1.04, 1.19]); while greater trochlear angle was protective (0.80 [0.67, 0.96]). Greater lateral displacement was associated with worse self-reported KOOS sport and recreation scores (β [95% CI]: -11.0 [-20.9, -1.2]) and quality of life scores (-10.5 [-20.4, -0.7]). CONCLUSIONS Lateral displacement, lateral tilt, and morphology at 1 year post-ACLR altered the risk of worsening patellofemoral OA features four years later. Lateral displacement was the only measure associated with worse self-reported symptoms at five years. These findings may lead to novel treatment strategies for secondary prevention after ACLR.
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Lower Limb Biomechanics During Single-Leg Landings Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2018; 48:2103-2126. [PMID: 29949109 DOI: 10.1007/s40279-018-0942-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) may not restore lower limb biomechanics during single-limb landings. OBJECTIVES Our objective was to identify and evaluate differences in lower limb biomechanics during high-demand single-limb landings between the ACLR limb and the contralateral limb and healthy control participants. METHODS A systematic review of the literature was conducted using six electronic databases searched until April 2017 for published peer-reviewed studies that investigated lower limb biomechanics on the ACLR limb compared with either the contralateral limb or those of control participants. Meta-analysis with standardized mean differences (SMD) were performed for peak angles and moments (hip, knee and ankle joints) in the sagittal plane during single-limb landing tasks. RESULTS A total of 35 studies met inclusion criteria. Four different single-leg landing tasks were identified: forward hop (n = 24 studies), landing from a height (n = 9 studies), vertical hop (n = 4 studies), and diagonal leap (n = 1 study). A reduced peak knee flexion angle was found in the ACLR limb compared with the contralateral limb during a forward hop landing task (SMD - 0.39; 95% confidence interval [CI] - 0.59 to - 0.18) and compared with a control group (SMD between - 1.01 and - 0.45) for all three reported single-leg landing tasks: forward hop, landing from a height, and diagonal leap. Similarly, a reduced peak knee internal extensor moment was found in the ACLR limb compared with the contralateral limb for all three reported landing tasks: forward hop, landing from a height, vertical hop (SMD between - 1.43 and - 0.53), and in two of three landing tasks when compared with a control group (SMD between - 1.2 and - 0.52). No significant differences in peak flexion (hip and ankle) angle or peak (hip and ankle) internal extensor moment were found in the ACLR limb compared with both the contralateral limb and a control group. CONCLUSIONS Participants performed single-limb landings on the ACLR limb with reductions in peak sagittal knee kinematics as well as peak joint moments compared with both the contralateral limb and a control group. Stiffer single-leg landings potentially expose the knee joint to higher forces, which may increase risk of injury. Clinical testing after ACLR surgery should explore movement quality as well as performance of functional tasks. LEVEL OF EVIDENCE Case-control, IV.
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Zhang Q, Kou Y, Yuan Z. A meta-analysis on anterior cruciate ligament reconstruction: Is modified transtibial technique inferior to independent drilling techniques? Exp Ther Med 2018; 16:1790-1799. [PMID: 30186403 PMCID: PMC6122342 DOI: 10.3892/etm.2018.6395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
This report respectively compared the standard transtibial (sTT) technique to the independent drilling (ID) techniques applied to anterior cruciate ligament (ACL) reconstruction. It also made a comparison between the clinical results of the modified transtibial (mTT) technique and of the ID techniques. Prospective studies on transtibial (TT) and ID techniques for ACL reconstruction were retrieved from several databases and a subgroup analysis was performed to compare the sTT technique with the ID techniques and the mTT with the ID techniques. Furthermore, comparison of the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score and Tegner activity scale were conducted. This report included 12 clinical studies that involved 681 patients having received ACL reconstruction. The study results indicated that in comparison between the sTT and ID techniques, the ID techniques outperformed the sTT technique in the IKDC subjective score (P=0.01) and laxity (P=0.0004). However, there was no significant difference in the IKDC objective score (P=0.34), pivot-shift test (P=0.24), Lachman test (P=0.21), Lysholm score (P=0.14) and Tegner activity scale (P=0.66). The comparison between the new mTT technique and the ID techniques suggested no significant difference in the IKDC objective and subjective scores (P=0.86), laxity (P=0.38), pivot-shift test (P=0.66), Lachman test (P=0.10), Lysholm score (P=0.10) and Tegner activity scale (P=0.55). Compared to the sTT technique, the mTT and ID techniques are more suitable for ACL reconstruction because they can present better subjective feelings. Moreover, considering that the TT technique is familiar to surgeons and the mTT technique can bring favorable subjective feelings and objective clinical outcomes, the mTT technique shows greater utilization potential.
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Affiliation(s)
- Qunhu Zhang
- Department of Orthopedics, Shuyang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suqian Jiangsu 223600, P.R. China
| | - Yu Kou
- Medical College of Soochow University, Suzhou Jiangsu 215123, P.R. China
| | - Zhen Yuan
- Center of Sports Medicine and Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
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Hamrin Senorski E, Seil R, Svantesson E, Feller JA, Webster KE, Engebretsen L, Spindler K, Siebold R, Karlsson J, Samuelsson K. "I never made it to the pros…" Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury-Current evidence and future directions. Knee Surg Sports Traumatol Arthrosc 2018; 26:1011-1018. [PMID: 29188332 PMCID: PMC5876277 DOI: 10.1007/s00167-017-4811-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/20/2017] [Indexed: 12/04/2022]
Abstract
The management of anterior cruciate ligament (ACL) injuries in the skeletally immature and adolescent patient remains an area of controversy in sports medicine. This study, therefore, summarizes and discusses the current evidence related to treating pediatric and adolescent patients who sustain an ACL injury. The current literature identifies a trend towards ACL reconstruction as the preferred treatment option for ACL injuries in the young, largely justified by the risk of further structural damage to the knee joint. Worryingly, a second ACL injury is all too common in the younger population, where almost one in every three to four young patients who sustain an ACL injury and return to high-risk pivoting sport will go on to sustain another ACL injury. The clinical experience of these patients emphasizes the rarity of an athlete who makes it to elite level after a pediatric or adolescent ACL injury, with or without reconstruction. If these patients are unable to make it to an elite level of sport, treatment should possibly be modified to take account of the risks associated with returning to pivoting and strenuous sport. The surveillance of young athletes may be beneficial when it comes to reducing injuries. Further research is crucial to better understand specific risk factors in the young and to establish independent structures to allow for unbiased decision-making for a safe return to sport after ACL injury. Level of evidence V.
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Affiliation(s)
- Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Romain Seil
- 0000 0004 0621 531Xgrid.451012.3Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Eleonor Svantesson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Julian A. Feller
- 0000 0001 0459 5396grid.414539.eOrthoSport Victoria, Epworth HealthCare, Melbourne, VIC Australia
| | - Kate E. Webster
- 0000 0001 2342 0938grid.1018.8School of Allied Health, La Trobe University, Melbourne, VIC Australia
| | - Lars Engebretsen
- 0000 0004 0389 8485grid.55325.34Oslo University Hospital and University of Oslo, Oslo, Norway ,0000 0000 8567 2092grid.412285.8OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
| | - Kurt Spindler
- 0000 0001 0675 4725grid.239578.2Cleveland Clinic Sports Health Center, Garfield Heights, OH USA
| | - Rainer Siebold
- 0000 0001 2190 4373grid.7700.0Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany ,HKF, International Center for Hip, Knee, Foot Surgery and Sportstraumatology, ATOS Klinik, Heidelberg, Germany
| | - Jón Karlsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
| | - Kristian Samuelsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
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ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury. Knee Surg Sports Traumatol Arthrosc 2018; 26:358-367. [PMID: 28337590 PMCID: PMC5794830 DOI: 10.1007/s00167-017-4528-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated. METHODS Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics. RESULTS Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL. CONCLUSION Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Webster KE, Feller JA. Exploring the High Reinjury Rate in Younger Patients Undergoing Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:2827-2832. [PMID: 27390346 DOI: 10.1177/0363546516651845] [Citation(s) in RCA: 306] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Younger age is being increasingly recognized as a risk factor for anterior cruciate ligament (ACL) graft rupture and contralateral ACL injury after ACL reconstruction. Recent reports estimate second ACL injury rates to be in the range of 20% to 40%, which is a significant concern and requires further exploration. PURPOSE The primary purpose was to determine the rates of graft rupture and injury to the contralateral native ACL in younger athletes. We also sought to explore the influence of sex and age groupings (<18 years vs 18-19 years at the time of surgery) on the risk of subsequent ACL injury. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study cohort consisted of 354 consecutive patients who were younger than 20 years when they underwent their first primary hamstring tendon autograft ACL reconstruction. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a mean follow-up of 5 years (range, 3-10 years). Subgroup analysis included sex and age (<18 years vs 18-19 years at the time of surgery) comparisons. Descriptive statistics were calculated for the timing of ACL graft rupture and contralateral ACL injury. RESULTS The overall follow-up rate was 89% (316/354). Graft ruptures occurred in 57 patients (18%) at an average time of 1.8 years after surgery. Almost half (47%) occurred within the first postoperative year, and 74% occurred within the first 2 years. The highest graft rupture rate of 28.3% was in the youngest males (<18 years), and this was significantly higher than in females of the same age (12.9%), as well as in male patients older than 18 years (13.8%). Contralateral ACL injuries occurred in 56 patients (17.7%) at an average time of 3.7 years after surgery. There were no significant age- or sex-based differences for contralateral ACL injuries. The total number of patients who had at least 1 further ACL injury subsequent to the primary surgery was 110 (35%). CONCLUSION The high rate of subsequent ACL injury in younger patients was confirmed. Early graft ruptures were more prevalent in patients who underwent surgery when they were younger than 18 years versus those in the 18- to 19-year age group. Males had higher rates of graft rupture than did females, with the youngest males (<18 years) at the highest risk in the investigated cohort.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
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Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2016; 46:1869-1895. [DOI: 10.1007/s40279-016-0510-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kinematic analysis of knee varus and rotation movements at the initial stance phase with severe osteoarthritis of the knee. Knee 2015; 22:213-6. [PMID: 25795547 DOI: 10.1016/j.knee.2015.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purposes of this study were to understand the kinematics changes in the frontal and horizontal planes with severe medial knee OA at the stance phase and to examine the relationship between varus and rotational movements. METHODS The OA group comprised 18 knees in 12 subjects (five men, seven women) with a Kellgren-Lawrence grade of three or four in at least one knee. From the results of gait analysis, we calculated Spearman rank-correlation coefficients for the following items: varus angle at initial contact (IC); varus angle at loading response (LR); amount of varus thrust from IC to LR; rotational angle at IC; rotational angle at LR and amount of rotational angle change from IC to LR. RESULTS The results indicated that, as the external rotation angle at IC and internal rotational movement from IC to LR increased, the maximum varus angle to LR showed a tendency to become large. In addition, varus thrust showed a tendency to become larger as the external rotation angles increased at IC and LR. The subjects with severe knee OA showed a strong correlation between the knee varus angle at IC and at LR. Furthermore, an increase in movement to internal rotation of the knee during the initial stance phase increased the knee varus angle at LR. CONCLUSIONS The control of the rotational movement according to the extent of varus thrust during the initial stance phase may have possible effects to decrease the load on the medial compartment of the knee.
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Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:641-7. [PMID: 24451111 DOI: 10.1177/0363546513517540] [Citation(s) in RCA: 318] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. PURPOSE To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. RESULTS Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. CONCLUSION Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.
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Affiliation(s)
- Kate E Webster
- Kate E. Webster, School of Allied Health, Faculty of Health Sciences, La Trobe University, Victoria 3086, Australia.
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Webster KE, Wotherspoon S, Feller JA, McClelland JA. The effect of anterior cruciate ligament graft orientation on rotational knee kinematics. Knee Surg Sports Traumatol Arthrosc 2013; 21:2113-20. [PMID: 23223908 DOI: 10.1007/s00167-012-2310-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether coronal graft orientation and tunnel placement for single-bundle anterior cruciate ligament (ACL) reconstruction is associated with tibial rotation excursion during functional activities. METHODS Eighty-four patients who had undergone ACL reconstruction over a ten-year time span had tibial rotation measured during level walking, using a three-dimensional motion analysis system. Fifty-two patients also had measures taken during the more dynamic task of single-limb landing. During the 10-year period, the position of the graft was deliberately changed from a vertical to more horizontal orientation in the coronal plane. Post-operative radiographs were analysed for the coronal graft orientation and femoral and tibial tunnel positions. Radiographic measurements of graft orientation and tunnel position were then correlated with the amount of tibial rotational excursion recorded during the walking and landing tasks. RESULTS For the single-limb landing task, a significant positive correlation was observed between the coronal graft angle and rotational excursion (R = 0.35, R (2) = 0.12, p = 0.01). This indicated greater rotational excursion was associated with vertical graft orientation, but only explained 12 % of the variance. No correlations were found between coronal graft angle and tibial rotation during level walking. CONCLUSIONS These findings support the notion that ACL graft orientation may play a role in rotational kinematics of the ACL-reconstructed knee, particularly during higher impact activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kate E Webster
- Musculoskeletal Research Centre, La Trobe University, Melbourne, Bundoora, VIC, 3086, Australia.
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