Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes

Relationship of strength, joint kinesthesia, and plantar tactile sensation to dynamic and static postural stability among patients with anterior cruciate ligament reconstruction

Objective: Postural stability is essential for high-level physical activities after anterior cruciate ligament reconstruction (ACLR). This study was conducted to investigate the relationship of muscle strength, joint kinesthesia, and plantar tactile sensation to dynamic and static postural stability among patients with anterior cruciate ligament reconstruction. Methods: Forty-four patients over 6 months post anterior cruciate ligament reconstruction (age: 27.9 ± 6.8 years, height: 181.7 ± 8.7 cm, weight: 80.6 ± 9.4 kg, postoperative duration: 10.3 ± 3.6 months) participated in this study. Their static and dynamic postural stability, muscle strength, hamstring/quadriceps ratio, joint kinesthesia, and plantar tactile sensation were measured. Partial correlations were used to determine the correlation of the above-mentioned variables with time to stabilization (TTS) and root mean square of the center of pressure (COP-RMS) in anterior-posterior (AP) and mediolateral (ML) directions. Results: Both TTS_AP and TTS_ML were related to muscle strength and joint kinesthesia of knee flexion and extension; COP-RMS_AP was correlated with plantar tactile sensations at great toe and arch, while COP-RMS_ML was correlated with joint kinesthesia of knee flexion, and plantar tactile sensation at great toe and heel. Dynamic stability was sequentially correlated with strength and joint kinesthesia, while static stability was sequentially correlated with plantar tactile sensation and joint kinesthesia. Conclusion: Among patients with anterior cruciate ligament reconstruction, strength is related to dynamic postural stability, joint kinesthesia is related to dynamic and static postural stability, and plantar tactile sensation is related to static postural stability. Strength has a higher level of relationship to dynamic stability than joint kinesthesia, and plantar tactile sensation has a higher level of relationship to static stability than joint kinesthesia.

Deficits in Dynamic Balance and Hop Performance Following ACL Reconstruction Are Not Dependent on Meniscal Injury History

Background

Athletes often exhibit persistent deficits in dynamic balance and hop performance in their involved limb following ACL reconstruction. However, it is unclear how meniscal injury history affects inter-limb asymmetry.

Purpose

The purpose of this study was to compare inter-limb asymmetry in dynamic balance and hop performance in athletes with and without a history of concomitant meniscal injury.

Study Design

Cross-sectional study.

Methods

Dynamic balance and hop test data were analyzed for 34 adolescent athletes who had undergone ACL reconstruction; 19 athletes had sustained an isolated ACL tear, while 15 had sustained an ACL tear along with a meniscus injury. Athletes who had sustained a meniscus injury were sub-divided into those who underwent a meniscal repair (n = 9) versus a partial meniscectomy (n = 6). Dynamic balance was assessed using the Y-Balance Test, while hop performance was assessed using the single and triple hop tests. Data were recorded at the time of return-to-sport testing (5-11 months post-surgery). For each variable, mixed-model analysis of variance, with a between-subjects factor of group (isolated ACL tear, meniscal repair, partial meniscectomy) and a within-subjects factor of limb (involved, uninvolved), was conducted.

Results

The groups exhibited similar degrees of inter-limb asymmetry in dynamic balance and hop test performance, as there was not a group-by-limb interaction effect for the Y-Balance Test distances (p ≥ 0.43) or hop test distances (p ≥ 0.96). However, there was a main effect of limb for the anterior and posteromedial Y-Balance Test distances and the single and triple hop test distances (p ≤ 0.004). For each variable, performance was worse for the involved limb, compared to the uninvolved limb.

Conclusion

It appears that deficits in dynamic balance and hop performance among adolescent athletes who have undergone ACL reconstruction are not dependent on meniscal injury/surgery history.

Level of Evidence

3.

Effect of Graft Rupture Prevention Training on Young Athletes After Anterior Cruciate Ligament Reconstruction: An 8-Year Prospective Intervention Study

Background:

There is a lack of research on the effects of a postoperative rehabilitation program on anterior cruciate ligament (ACL) graft rupture.

Hypothesis:

We hypothesized that a hip-focused rehabilitation protocol with graft rupture education and avoidance training (HIP-GREAT program) would demonstrate lower ACL graft rupture rates compared with a traditional physical therapy (PT) program.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study consisted of young athletes who had undergone ACL reconstruction at a single institution. Postoperatively, 136 participants (mean age, 16.9 ± 2.4 years) were enrolled in a traditional PT protocol between 2006 and 2010, and 153 participants (mean age, 17.0 ± 2.3 years) were enrolled in the HIP-GREAT protocol between 2011 and 2015. Follow-up rates were 31% (42/136) and 27% (41/153) in the traditional PT and HIP-GREAT groups, respectively, at 3 years postoperatively. The hazard ratio was calculated, and absolute risk reduction (ARR) and number-needed-to-treat (NNT) analyses were performed to compare the 2 protocols.

Results:

ACL graft rupture occurred in 10 patients (7.4%) in the traditional PT group and 5 patients (3.3%) in the HIP-GREAT group. This difference was not statistically significant (hazard ratio, 0.39; 95% CI, 0.14 to 1.16; P = .09). The ARR was 0.041 (95% CI, –0.011 to 0.093), and the NNT was 24.5.

Conclusion:

This study did not demonstrate a statistically significant reduction of ACL graft rupture in patients in the HIP-GREAT group. However, high ARR values and low NNT values were found, which suggests the possible effectiveness of the HIP-GREAT protocol to reduce ACL graft ruptures in young athletes.

Impact of Visual Biofeedback of Trunk Sway Smoothness on Motor Learning during Unipedal Stance

The assessment of trunk sway smoothness using an accelerometer sensor embedded in a smartphone could be a biomarker for tracking motor learning. This study aimed to determine the reliability of trunk sway smoothness and the effect of visual biofeedback of sway smoothness on motor learning in healthy people during unipedal stance training using an iPhone 5 measurement system. In the first experiment, trunk sway smoothness in the reliability group (n = 11) was assessed on two days, separated by one week. In the second, the biofeedback group (n = 12) and no-biofeedback group (n = 12) were compared during 7 days of unipedal stance test training and one more day of retention (without biofeedback). The intraclass correlation coefficient score 0.98 (0.93–0.99) showed that this method has excellent test–retest reliability. Based on the power law of practice, the biofeedback group showed greater improvement during training days (p = 0.003). Two-way mixed analysis of variance indicates a significant difference between groups (p < 0.001) and between days (p < 0.001), as well as significant interaction (p < 0.001). Post hoc analysis shows better performance in the biofeedback group from training days 2 and 7, as well as on the retention day (p < 0.001). Motor learning objectification through visual biofeedback of trunk sway smoothness enhances postural control learning and is useful and reliable for assessing motor learning.

Six-month post-surgical elevations in cartilage T1rho relaxation times are associated with functional performance 2 years after ACL reconstruction

The current study looks to: (i) investigate postural stability following anterior cruciate ligament (ACL) reconstruction, as assessed by Y-Balance Test, by comparing single-leg balance of the injured limb against those of controls and the uninjured limb; (ii) analyze the relationship between postural stability symmetry with localized cartilage matrix changes and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee MRI of 36 patients who underwent ACL reconstruction were performed before surgery, 6 months, 1 year, and 2 years, postoperatively. Postural stability was evaluated based on Y-Balance Test at 1 and 2 years. ACL patients were also split into three groups based on postural stability symmetry at 2 years and symmetry thresholds associated with elevated risks of lower extremity injury. Voxel-based relaxometry employing analysis of covariance was used to analyze localized differences in cartilage composition at all time-points (using quantitative magnetic resonance [MR] T1ρ and T2 mapping) between the three groups. The ACL patients displayed no significant deficits in postural stability. Compared with symmetric patients, those with asymmetric postural stability at 2 years had significantly prolonged cartilage T1ρ-indicating deterioration of the cartilage matrix-specifically in the injured knee's medial tibia as early as 6-month post-reconstruction. Prolonged T1ρ in asymmetric patients persisted up to 2 years, where the group also reported worse KOOS. Our results demonstrate an association between early stages of cartilage matrix deterioration and postural stability symmetry that may manifest in elevated lower extremity injury risk and worse patient-reported outcomes. Quantitative MR, in combination with local analysis performed with voxel-based relaxometry, is a tool to further study this relationship. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1132-1140, 2020.

Risk factors associated with self-reported injury history in female youth soccer players

BACKGROUND

studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status.

OBJECTIVE

to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players.

METHODS

we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant.

RESULTS

a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014).

CONCLUSIONS

musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players.

Physical activity outside of organised sports is associated with functional performance

AIM

The purpose of this study was to determine whether high levels of strenuous physical activity outside of organised sports are associated with better functional test performance.

METHODS

Youth athletes (n = 445, mean = 14.2 ± 2.5 years) reported their frequency of strenuous physical activity outside of organised sports. The functional performance tests: vertical jump height, pro agility test time, estimated maximal oxygen uptake (VO₂ max), front plank time and postural stability were measured and compared between groups.

RESULTS

Athletes in the five or more times a week group demonstrated faster pro agility times (5.37 ± 0.43 seconds) than the never group (5.59 ± 0.56 seconds; p = 0.002) and the 1-4 times a week group (5.52 ± 0.47 seconds; p = 0.005). The five or more times a week group demonstrated higher mean vertical jump height (42.9 ± 13.3 vs. 40.3 ± 10.8 cm; p = 0.009) and higher estimated VO₂ max (48.1 vs. 45.6 mL/kg/minute; p = 0.001) than the 1-4 times a week group.

CONCLUSION

Youth athletes who engaged in strenuous physical activity outside of organised sports five or more times a week performed best on functional performance tests.

Evaluation of postural stability in youth athletes: the relationship between two rating systems

OBJECTIVES

The Balance Error Scoring System (BESS) has been documented as a useful way to evaluate postural control following sport-related concussions sustained by youth athletes. However, limitations have been reported with its use due to the reliance on visual observation as the primary measurement outcome. The primary purpose of this study was to examine the correlation between the modified BESS (mBESS) as rated by a clinician and a simultaneous analysis performed by an integrated video-force plate system. The secondary purpose was to assess if a history of prior concussion affected postural control.

METHODS

A group of healthy youth athletes (n = 398; mean age 13.7 ± 2.4 years) completed the mBESS while simultaneously undergoing an integrated video-force plate evaluation to measure postural stability. Spearman rank-order correlations were used to determine the strength of correlation between the 2 rating systems. In addition, performance on the mBESS between those with and without a history of concussion was compared using univariate ANCOVAs.

RESULTS

A moderately high correlation was found during single-leg stance (ρ = -0.64, p < .001), while a weak correlation was found during tandem stance (ρ = -0.30, p < .001). No postural control differences were found between groups with and without a concussion history.

CONCLUSION

The video-force plate rating system correlates well with the clinician rating during the single-leg stance of the mBESS, but not during double-leg or tandem stances. A history of concussion did not affect mBESS scores.