Landing Evaluation in Soccer Players with or without Anterior Cruciate Ligament Reconstruction

Effects of adding dual-task or sport-specific task constrains to jump-landing tests on biomechanical parameters related to injury risk factors in team sports: a systematic review

Background

Jumping and landing tests are frequently used as a tool to assess muscle function. However, they are performed in a controlled and predictable environment. The physical tests commonly used as part of the criteria for return to sport after injury are often performed with little or no cognitive load and low coordinative demand compared to game-specific actions. The aim of this systematic review was to examine the influence of performing a dual task (DT) or sport-specific task constrains during jump-landing tests on biomechanical variables related to lower limb injury risk in team sports.

Methods

This systematic review followed the specific methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted in the databases Medline (PubMed), Web of Science, Cochrane Plus, and SportDiscus for studies published from 2013 until June 30, 2023. To be eligible, studies had to include: (1) kinematic and/or kinetic assessment of injury risk factors in the lower extremity; (2) a comparison between a simple jump or landing test and a DT jump or landing test which included cognitive information. The risk of bias in the selected articles was analyzed using the recommendations of the Cochrane Collaboration.

Results

Of the 656 records identified, 13 met the established criteria. Additionally, two more articles were manually included after screening references from the included articles and previous related systematic reviews. Regarding the Risk of bias assessment, 12 studies did not surpass a score of 3 points (out of a total of 7). Only three studies exceeded a score of 3 points, with one article achieving a total score of 6. From the included studies, comparative conditions included actions influenced by the inclusion of a sports ball (n = 6), performing tasks in virtual environments or with virtual feedback (n = 2), participation in cognitive tasks (n = 6), and tasks involving dual processes (n = 7). The execution of decision-making (DM) during the jump-landing action resulted in biomechanical changes such as lower peak angles of hip flexion and knee flexion, along with increased vertical ground reaction force, knee abduction, and tibial internal rotation. Regarding limitations, discrepancies arise in defining what constitutes DT. As a result, it is possible that not all studies included in this review fit all conceptual definitions of DT. The inclusion of DT or constraints in jump-landing tests significantly alters biomechanical variables related to lower extremity injury risk in team sports. In future research, it would be beneficial to incorporate tasks into jumping tests that simulate the specific cognitive demands of team sports. This systematic review was registered in PROSPERO (registration number: CRD42023462102) and this research received no external funding.

Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies

PURPOSE

Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear.

METHODS

A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed.

RESULTS

Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients.

CONCLUSION

This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury.

LEVEL OF EVIDENCE

III.

The effects of a high-intensity exercise bout on landing biomechanics post anterior cruciate ligament reconstruction: a quasi-experimental study

Background

We aimed to examine the effect of a high-intensity exercise bout on landing biomechanics in soccer players who underwent anterior cruciate ligament reconstruction (ACLR) and non-injured soccer players during a soccer-specific landing maneuver.

Methods

Eighteen soccer players who underwent ACLR and 18 normal soccer players were enrolled in this investigation (ACLR group; age, 26.11 ± 3.95 years; body mass index, 23.52 ± 2.69 kg/m²; surgery time, 5 ± 3.30 years: control group; age, 25.83 ± 3.51 years; body mass index, 24.09 ± 3.73 kg/m², respectively). Participants were evaluated during the landing maneuver before and after carrying out the high-intensity exercise bout using the Wingate test. The intensity of the exercise was defined as a blood lactate accumulation of at least 4 mmol/L. The dependent variables included sagittal-plane kinematics and kinetics of the ankle, knee and hip joints, and electromyography activity of the gastrocnemius, hamstrings, quadriceps, and gluteus maximus.

Results

On 2 × 2 analysis of variance, none of the dependent variable showed significant exercise×group interactions. Regardless of group, significant main effects of exercise were found. Post-exercise landing was characterized by increased flexion of hip (p = 0.01), knee (p = 0.001), and ankle joints (p = 0.002); increased extension moments of hip (p = 0.009), knee (p = 0.012), and ankle joints (p = 0.003), as well as decreased quadriceps activity (p = 0.007).

Conclusion

At 1 year or more post-ACLR, the effect of the high-intensity exercise bout on landing biomechanics is not expected to differ from that experienced by healthy soccer players.