Trunk and hip control neuromuscular training to target inter limb asymmetry deficits associated with anterior cruciate ligament injury

Double-Leg and Single-Leg Jump Test Reference Values for Athletes With and Without Anterior Cruciate Ligament Reconstruction Who Play Popular Pivoting Sports, Including Soccer and Basketball: A Scoping Review

OBJECTIVE: To synthesize and present reference values for double-leg and single-leg jump tests in healthy athletes who play pivoting sports, and athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. DESIGN: Scoping review. LITERATURE SEARCH: We searched PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science until April 7, 2023. STUDY SELECTION CRITERIA: We included reference values in 2 different categories: (1) double-leg and/or single-leg jump test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation, and (2) double-leg and/or single-leg jump test outcomes in healthy pivoting-sport athletes. DATA SYNTHESIS: We performed data synthesis for reference values from double-leg jump tests (squat jump and countermovement jump) and single-leg jump tests (vertical hop, single hop for distance, triple hop for distance, crossover hop for distance, medial triple hop for distance, lateral triple hop for distance, 6-m timed hop, side hop, drop jump, and 10-second repeated hop) that were performed according to a standardized test description. We summarized the data for type of sport, sex, sport participation level, and age group. RESULTS: Of the 27 included studies, nine reported reference values from healthy soccer players, six from healthy basketball players, and eleven from other healthy pivoting-sport athletes. LSI dominant/nondominant (LSI-D/ND) ranged between 97% and 106% for healthy soccer players, and between 99% and 120% for healthy basketball players. Four studies reported reference values from pivoting-sport athletes with ACLR from 7 to 10 months postsurgery. CONCLUSION: This scoping review summarizes double-leg and single-leg jump test reference values for athletes who play common pivoting sports, including soccer and basketball. J Orthop Sports Phys Ther 2024;54(6):1-14. Epub 20 March 2024. doi:10.2519/jospt.2024.12374.

Foot rotation and pelvic angle correlate with knee abduction moment during 180° lateral cut in football players

BACKGROUND

Lateral movements are challenging for 2D video-analysis and are therefore often omitted in functional tests for Anterior Cruciate Ligament (ACL) injury risk assessment. The purpose of the present study was to investigate the association between frontal and transverse plane angles obtained from 2D video-analysis and knee abduction moment (KAM) from gold standard 3D motion capture in a 180° lateral cut task. The hypothesis was that 2D angles other than the knee joint effectively explain variations in KAM.

METHODS

Thirty-four healthy football players (age 22.8 ± 4.1 years) performed a series of 180° lateral cut (lateral shuffles) tasks. The peak KAM was collected through a 3D motion capture system. A 2D video-analysis movement assessment identified frontal and transverse plane joint kinematics: foot projection angle (FPA), Frontal Plane Knee Projection Angle (FPKPA), Pelvis tilt angle (PA), and Trunk tilt angle (TA). A forward stepwise regression model was used to assess significant 2D predictors of KAM (p < 0.05).

RESULTS

FPA and PA were the only significant predictors (R2-ajdusted = 9.2%, p < 0.001), with external foot rotation and contralateral pelvic drop associated with higher KAM. Based on the regression model, the "High FPA & PA group" was defined and showed higher KAM than the rest of the cohort (p = 0.012, ES = 0.71).

CONCLUSIONS

The external foot rotation and the contralateral pelvic drop from 2D video-analysis were associated with higher peak KAM during the 180° lateral cut. A qualitative assessment of the 180° lateral cut could offer precious insights on ACL injury risk mitigation.

LEVEL OF EVIDENCE

Descriptive Laboratory Study.

Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament-Deficient Patients With and Without Medial Meniscal Posterior Horn Tears

Background:

Patients with anterior cruciate ligament–deficient (ACLD) knees with medial meniscal posterior horn tears (MMPHTs) have been reported to demonstrate a combined stiffening and pivot-shift gait pattern compared with healthy controls. Movement asymmetries are implicated in the development and progression of osteoarthritis.

Purpose:

To investigate the knee kinematics and kinetic asymmetries in ACLD patients with (ACLD + MMPHT group) and without (ACLD group) MMPHTs while walking on level ground.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 15 patients with isolated unilateral ACL ruptures, 10 with unilateral ACL ruptures and MMPHTs, and 22 healthy controls underwent gait testing between January 2014 and December 2016. Between-leg differences (BLDs) in knee kinematics and kinetics were compared among participants in all groups.

Results:

The ACLD + MMPHT group demonstrated significantly greater BLDs in knee moments in the sagittal plane during the loading response phase than the ACLD and control groups. Compared with the control group, the ACLD and ACLD + MMPHT groups demonstrated significantly greater BLDs in knee angles in the sagittal plane during the midstance and terminal stance phases. Compared with the control group, significantly greater BLDs in knee rotation moments were found throughout the stance phase in both the ACLD and the ACLD + MMPHT groups. BLDs in lateral ground-reaction forces (GRFs) in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. BLDs in anterior GRFs in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. Only the ACLD + MMPHT group demonstrated greater BLDs in vertical GRFs than the control group during the loading response phase, while no significant differences were observed between the ACLD and control groups.

Conclusion:

The ACLD + MMPHT group demonstrated significantly more knee flexion moment asymmetries than the ACLD and control groups during the loading response phase. Both the ACLD + MMPHT and the ACLD groups demonstrated significant knee angle and moment asymmetries in the sagittal plane during the terminal stance phase than the control group. Both the ACLD + MMPHT and the ACLD groups demonstrated knee rotation moment asymmetries during the midstance and terminal stance phases compared with the control group. A rehabilitation program for ACLD patients both with and without MMPHTs should take into consideration these asymmetric gait patterns.