1
|
Giacomazzo Q, Picot B, Chamu T, Samozino P, Pairot de Fontenay B. Impaired Symmetry in Single-Leg Vertical Jump and Drop Jump Performance 7 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241263794. [PMID: 39157022 PMCID: PMC11328232 DOI: 10.1177/23259671241263794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 08/20/2024] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) continues to be associated with a variable rate of return to sports and a concerning rate of further anterior cruciate ligament injury. Persistent functional deficits may explain these results and support the need to keep exploring lower limb functional indexes, especially during vertical jumping. This would help improve rehabilitation through the return-to-sports continuum and improve postoperative outcomes. Hypothesis Vertical jumping performance indexes are impaired among patients 7 months after ACLR. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 202 patients who underwent ACLR and 50 healthy participants performed single-leg vertical jump (SLVJ) and single-leg drop jump (SLDJ) testing. Jump height (H) as well as reactive strength index (RSI) were assessed and the limb symmetry index (LSI) of each parameter was compared between both groups. Vertical jumping indexes were also compared between healthy participants and the injured and contralateral legs of ACLR patients. Frequency analysis (chi-square test) of participants exhibiting an LSI >90% for each parameter was calculated in both groups. The level of association between SLVJ-H, SLDJ-H, and SLDJ-RSI was evaluated using the Pearson coefficient (r). Results At 6.6 ± 0.7 months (mean ± SD) postoperatively, participants after ACLR exhibited poorer LSI than the control group for all parameters (79.1 ± 14.8 vs 93.9 ± 4.5, 77.3 ± 14.6 vs 93.4 ± 5.2, and 71.9 ± 17.4 vs 93.4 ± 3.8; all P < .001; for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively). Vertical jumping performance was lower on both injured and contralateral legs compared with healthy participants (all P < .001). Only 27%, 25%, and 16% of the ACLR patients exhibited an LSI >90% for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively, in comparison with 80%, 72%, and 86% in the control group. Moderate correlations were observed between SLDJ-H and SLVJ-H (r = 0.494; P < .001) as well as between SLDJ-RSI and SLVJ-H (r = 0.488; P < .001) in the ACLR group. Conclusion Vertical jumping indexes (both symmetry and absolute values) were highly impaired 7 months after ACLR. Deficits were more marked for reactive strength ability. Clinicians should focus on restoring vertical jumping abilities to improve functional performance after ACLR.
Collapse
Affiliation(s)
| | - Brice Picot
- Univ Savoie Mont Blanc, Laboratory Interuniversity of Human Movement Sciences, Chambéry, France
- French Society of Sports Physical Therapy (SFMKS Lab), Asnières-sur-Oise, France
| | - Thomas Chamu
- Centre de kinésithérapie du sport, Lyon Ortho Clinic, Lyon, France
| | - Pierre Samozino
- Univ Savoie Mont Blanc, Laboratory Interuniversity of Human Movement Sciences, Chambéry, France
| | - Benoit Pairot de Fontenay
- French Society of Sports Physical Therapy (SFMKS Lab), Asnières-sur-Oise, France
- Interuniversity Laboratory of Human Movement Biology, Claude Bernard University Lyon 1, Villeurbanne, France
- Ramsay Santé, Clinique de la Sauvegarde, Lyon, France. P.S. and B.P.F. contributed equally to this article and also share last authorship
| |
Collapse
|
2
|
Maestroni L, Turner A, Papadopoulos K, Pedley J, Sideris V, Read P. Single leg drop jump is affected by physical capacities in male soccer players following ACL reconstruction. SCI MED FOOTBALL 2024; 8:201-211. [PMID: 37314868 DOI: 10.1080/24733938.2023.2225481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remain unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences was measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92-1.05), kinetic (d = 0.62-0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52-3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a 'stiff' knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk.
Collapse
Affiliation(s)
- Luca Maestroni
- ReAct, Bergamo (BG), Italy
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Jason Pedley
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Vasileios Sideris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Paul Read
- Institute of Sport, Exercise and Health, London, UK
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Sciences, St Marys University, Twickenham, UK
| |
Collapse
|
3
|
McCarthy-Ryan MF, Mellalieu SD, Jones H, Bruton A, Moore IS. Characterizing Longitudinal Alterations in Postural Control Following Lower Limb Injury in Professional Rugby Union Players. J Appl Biomech 2024; 40:287-295. [PMID: 38866380 DOI: 10.1123/jab.2023-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 06/14/2024]
Abstract
Assessment of player's postural control following a lower limb injury is of interest to sports medicine practitioners due to its fundamental role in daily tasks and sporting activities. The aim was to longitudinally monitor professional rugby union players' postural control during each phase of the rehabilitation program (acute, middle, and late) following a lower limb injury. Seven male rugby union players (height 1.80 [0.02] m; mass 100.3 [11.4] kg; age 24 [4] y) sustained a time loss, noncontact lower limb injury. Static postural control was assessed via sway path (in meters), and dynamic postural control was assessed via vertical postural stability index. Group differences (P < .05) were reported across the acute, middle, and late phase. Smaller magnitudes of sway path were observed for eyes-open sway path, and for the middle and late phase smaller magnitudes of vertical postural stability index (P < .05) at the end session compared with first session. Whereas larger magnitudes of vertical postural stability index were found between baseline and the last session (P < .05). Large interindividual and intraindividual variation was apparent across the 3 phases of rehabilitation. Postural control improvements were identified during rehabilitation. However, postural control did not return to baseline, with altered kinetics throughout each rehabilitation phase.
Collapse
Affiliation(s)
- Molly F McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Stephen D Mellalieu
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Holly Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Adam Bruton
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| |
Collapse
|
4
|
Kugach K, Stark NEP, Farah HG, Hansen RM, Arena SL, Queen RM. Total ankle arthroplasty improves discrete and continuous stance phase gait symmetry. Gait Posture 2024; 113:272-279. [PMID: 38970929 DOI: 10.1016/j.gaitpost.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is used to treat symptomatic end-stage ankle arthritis (AA). However, little is known about TAA's effects on gait symmetry. RESEARCH QUESTION Determine if symmetry changes from before surgery through two years following TAA utilizing the normalized symmetry index (NSI) and statistical parametric mapping (SPM). METHODS 141 patients with end-stage unilateral AA were evaluated from a previously collected prospective database, where each participant was tested within two weeks of surgery (Pre-Op), one year and two years following TAA. Walking speed, hip extension angle and moment, hip flexion angle, ankle plantarflexion angle and moment, ankle dorsiflexion angle, weight acceptance (GRF1), and propulsive (GRF2) vertical ground reaction forces were calculated for each limb. Gait symmetry was assessed using the NSI. A linear mixed effects model with a single response for each gait symmetry variable was used to examine the fixed effect of follow-up time (Pre-Op, Post-1 yr, Post-2 yr) and the random effect of participant with gait speed as a covariate in the model. A one-dimensional repeated measures analysis of variance (ANOVA) statistical parameter mapping (SPM) was completed to examine differences in the time-series NSI to determine regions of significant differences between follow-up times. RESULTS Relative to Pre-Op values, GRF1, and GRF2 showed increased symmetry for discrete metrics and the time-series NSI across sessions. Hip extension moment had the largest symmetry improvement. Ankle plantarflexion angle was different between Pre-Op and Post-2 yr (p=0.010); and plantarflexion moment was different between Pre- Op and each post-operative session (p<0.001). The time-series Ankle Angle NSI was greater during the early stance phase in the Pre-Op session compared to Post-2 yr. SIGNIFICANCE Symmetry across most of the stance phase improved following TAA indicating that TAA successfully improves gait symmetry and future work should determine if these improvements restore symmetry to levels equivalent with health age-match controls.
Collapse
Affiliation(s)
- Kelly Kugach
- Department of Orthopaedic Surgery, Virginia Tech - Carilion School of Medicine, Roanoke, VA 24014, USA
| | - Nicole E-P Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Hassan-Galaydh Farah
- Translational Biology, Medicine & Health, Virginia Tech, Roanoke, VA, 24014, USA
| | - Robyn M Hansen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Sara L Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Robin M Queen
- Department of Orthopaedic Surgery, Virginia Tech - Carilion School of Medicine, Roanoke, VA 24014, USA; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA.
| |
Collapse
|
5
|
Dennis JD, Holmes SC, Heredia C, Shumski EJ, Pamukoff DN. Lower extremity joint angle, moment, and coordination throughout a double limb drop vertical jump in individuals with anterior cruciate ligament reconstruction. Sports Biomech 2024:1-16. [PMID: 38767326 DOI: 10.1080/14763141.2024.2356845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Individuals with anterior cruciate ligament reconstruction (ACLR) utilise different landing biomechanics between limbs, but previous analyses have not considered the continuous or simultaneous joint motion that occurs during landing and propulsion. The purpose of this study was to compare sagittal plane ankle/knee and knee/hip coordination patterns as well as ankle, knee, and hip angles and moments and vertical ground reaction force (vGRF) between the ACLR and uninjured limbs during landing and propulsion. Fifteen females and thirteen males performed a drop vertical jump from a 30 cm box placed half their height from force platforms. Coordination was compared using a modified vector coding technique and binning analysis. Kinematics and kinetics were time normalised for waveform analyses. Coordination was not different between limbs. The ACLR limb had smaller dorsiflexion angles from 11 to 16% of landing and 24 to 75% of landing and propulsion, knee flexion moments from 5 to 15% of landing, 20 to 31% of landing, and 35 to 91% of landing and propulsion, and vGRF from 92 to 94% of propulsion compared with the uninjured limb. The ACLR limb exhibited smaller dorsiflexion angles to potentially reduce the knee joint moment arm and mitigate the eccentric and concentric demands on the ACLR knee during landing and propulsion, respectively.
Collapse
Affiliation(s)
- Justin D Dennis
- Department of Exercise and Sports Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| | - Caitlyn Heredia
- Department of Sports Medicine, New England Revolution, Foxborough, MA, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | | |
Collapse
|
6
|
Tummala SV, Vij N, Glattke KE, Vaughn J, Brinkman JC, Winters J, Brennan A, Salehi H, Zhao S, Chhabra A, Tokish JM, Menzer H. Hamstring Tendon Autograft Is Associated With Increased Knee Valgus Moment After Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis. Am J Sports Med 2024; 52:1220-1228. [PMID: 38476007 DOI: 10.1177/03635465241233705] [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] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is limited evidence related to the effects of autograft type on functional performance after anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS This study aimed to compare biomechanical outcomes during a drop vertical jump (DVJ) between patients with a hamstring tendon (HT) autograft, quadriceps tendon (QT) autograft with bone block, QT autograft without bone block, and bone-patellar tendon-bone autograft at 6 months postoperatively in an adolescent population. The authors' hypothesized there would be differences in DVJ biomechanics between athletes depending on the type of autograft used. STUDY DESIGN Controlled laboratory study. METHODS Patients aged 8 to 18 years who underwent primary ACLR were included for analysis. Kinematic and kinetic data collected during a DVJ using a 3-dimensional computerized marker system were assessed at 6 months after ACLR and compared with the uninjured contralateral limb. RESULTS A total of 155 participants were included. There were no significant differences in terms of age, sex, or affected leg (P≥ .1973) between groups. The HT group was significantly associated with a larger knee valgus moment at initial contact compared with the QT group (28 × 10-2 vs -35 × 10-2 N·m/kg, respectively; P = .0254) and a significantly larger maximum hip adduction moment compared with the QT with bone block group (30 × 10-2 vs -4 × 10-2 N·m/kg, respectively; P = .0426). Both the QT with bone block (-12 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0265) and QT (-13 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0459) groups demonstrated significantly decreased mean knee extension moments compared with the HT group. CONCLUSION The findings of this study suggest that utilizing an HT autograft resulted in a significantly increased knee valgus moment at initial contact compared with a QT autograft without bone block at 6 months after ACLR in adolescent patients performing a DVJ. A QT autograft was found to be associated with significantly decreased extensor mechanism function compared with an HT autograft. CLINICAL RELEVANCE This study adds unique kinematic and kinetic information regarding various ACLR autograft options and highlights the biomechanical deficits that should be taken into consideration in rehabilitation.
Collapse
Affiliation(s)
- Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Neeraj Vij
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Kaycee E Glattke
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - Hadi Salehi
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Sixue Zhao
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | |
Collapse
|
7
|
McFadden C, Strike S, Daniels KAJ. Are inter-limb differences in change of direction velocity and angle associated with inter-limb differences in kinematics and kinetics following anterior cruciate ligament reconstruction? Gait Posture 2024; 109:1-8. [PMID: 38232543 DOI: 10.1016/j.gaitpost.2023.12.014] [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: 11/28/2021] [Revised: 06/17/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Quantifying inter-limb differences in kinematics and kinetics during change of direction is proposed as a means of monitoring rehabilitation following anterior cruciate ligament reconstruction (ACLR). Velocity and centre of mass (CoM) deflection angle are fundamental task descriptors that influence kinematics and kinetics during change of direction. Inter-limb differences in approach velocity and CoM deflection angle have been identified following ACLR and may contribute to the presence of inter-limb differences in kinematics and kinetics during change of direction. RESEARCH QUESTION The aim of this study was to quantify the proportion of variance in kinematic and kinetic inter-limb differences attributable to inter-limb differences in approach velocity and centre of mass deflection angle during a change of direction task. METHODS A cohort of 192 patients (male, 23.8 ± 3.6 years, 6.3 ± 0.4 months post primary ACLR) completed a pre-planned 90° change of direction task on both their operated and non-operated limb. Inter-limb differences in approach velocity and CoM deflection angle were calculated alongside lower-extremity kinematic and kinetic variables. The relationship between inter-limb differences in task-level variables and inter-limb differences in kinematic and kinetic variables was examined using linear regression models. Kinematic and kinetic inter-limb differences were adjusted for inter-limb differences in approach velocity and CoM deflection angle. Adjusted and unadjusted inter-limb differences were submitted to one sample t-tests. RESULTS Inter-limb differences in approach velocity and centre of mass deflection angle explained 3 - 60% of the variance in kinematic and kinetic inter-limb differences. Statistical inferences remained consistent between adjusted and unadjusted conditions with the exception of hip flexion angle. SIGNIFICANCE Inter-limb differences in task-level features explain a large proportion of the variance in inter-limb differences in several kinematic and kinetic variables. Accounting for this variation reduced the magnitude of kinematic and kinetic inter-limb differences comparable to those previously observed in normative cohorts.
Collapse
Affiliation(s)
- Ciarán McFadden
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK.
| | - Siobhán Strike
- Department of Life Sciences, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
8
|
Yona T, Kamel N, Cohen-Eick G, Ovadia I, Fischer A. One-dimension statistical parametric mapping in lower limb biomechanical analysis: A systematic scoping review. Gait Posture 2024; 109:133-146. [PMID: 38306782 DOI: 10.1016/j.gaitpost.2024.01.018] [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: 10/08/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Biomechanics significantly impacts sports performance and injury prevention. Traditional methods like discrete point analysis simplify continuous kinetic and kinematic data, while one-dimensional Statistical Parametric Mapping (spm1d) evaluates entire movement curves. Nevertheless, spm1d's application in sports and injury research is limited. As no systematic review exists, we conducted a scoping systematic review, synthesizing the current applications of spm1d across various populations, activities, and injuries. This review concludes by identifying gaps in the literature and suggesting areas for future research. RESEARCH QUESTION What research exists using spm1d in sports biomechanics, focusing on the lower limbs, in what populations, and what are the current research gaps? METHODS We searched PubMed, Embase, Web of Science, and ProQuest databases for the following search string: "(((knee) OR (hip)) OR (ankle)) OR (foot) OR (feet) AND (statistical parametric mapping)". English peer-reviewed studies assessing lower limb kinetics or kinematics in different sports or sports-related injuries were included. Reviews, meta-analyses, conference abstracts, and grey literature were excluded. RESULTS Our search yielded 165 papers published since 2012. Among these, 112 examined healthy individuals (67 %), and 53 focused on injured populations (33 %). Running (n = 45), cutting (n = 25), and jumping/landing (n = 18) were the most common activities. The predominant injuries were anterior cruciate ligament rupture (n = 21), chronic ankle instability (n = 18), and hip-related pain (n = 9). The main research gaps included the unbalanced populations, underrepresentation of common sports and sport-related injuries, gender inequality, a lack of studies in non-laboratory settings, a lack of studies on varied sports gear, and a lack of reporting standardization. SIGNIFICANCE This review spotlights crucial gaps in spm1d research within sports biomechanics. Key issues include a lack of studies beyond laboratory settings, underrepresentation of various sports and injuries, and gender disparities in research populations. Addressing these gaps can significantly enhance the application of spm1d in sports performance, injury analysis, and rehabilitation.
Collapse
Affiliation(s)
- Tomer Yona
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel Kamel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Galya Cohen-Eick
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Inbar Ovadia
- Department of Mechanical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Arielle Fischer
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
9
|
Maestroni L, Turner A, Papadopoulos K, Cohen D, Sideris V, Graham-Smith P, Read P. Comparison of Strength and Power Characteristics Before ACL Rupture and at the End of Rehabilitation Before Return to Sport in Professional Soccer Players. Sports Health 2023; 15:814-823. [PMID: 37203795 PMCID: PMC10606975 DOI: 10.1177/19417381231171566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Strength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS). HYPOTHESIS Divergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS Isokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS. RESULTS Compared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction. CONCLUSION Strength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls. CLINICAL RELEVANCE Deficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.
Collapse
Affiliation(s)
- Luca Maestroni
- ReAct, Bergamo (BG), Italy
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Daniel Cohen
- Masira Research Institute, Faculty of Health Sciences, University of Santander (UDES), Bucaramanga, Colombia
- Mindeporte (Colombian Ministry of Sport) High Performance Centre, Bogota, Colombia
| | | | | | - Paul Read
- Institute of Sport, Exercise and Health, London, UK
- Division of Surgery and Interventional Science, University College London, UK
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| |
Collapse
|
10
|
Kotsifaki R, Sideris V, King E, Bahr R, Whiteley R. Performance and symmetry measures during vertical jump testing at return to sport after ACL reconstruction. Br J Sports Med 2023; 57:1304-1310. [PMID: 37263763 DOI: 10.1136/bjsports-2022-106588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Vertical jump tests are more sensitive in revealing asymmetries in performance metrics at the time of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) than horizontal hop tests. However, it remains unclear which vertical tests (bilateral or unilateral) and which metrics (kinetics or performance) are most effective in informing the rehabilitation status and readiness for return to sport. We aimed to investigate the status of athletes during vertical jump testing at return to sport after ACLR. METHODS A dual force platform system was used to evaluate jumping performance of 126 recreational and professional athletes at the time of return to sport after ACLR, as well as 532 healthy control participants. Performance and kinetic metrics were collected during four jump tests: double-leg countermovement jump, single-leg countermovement jump, double-leg 30 cm drop jump and single-leg 15 cm drop jump. Between-limb and between-group differences were explored using mixed models analyses. RESULTS At the time of return to sport after ACLR, athletes still presented significant differences favouring the uninvolved side, particularly in the symmetry of the concentric impulse (p<0.001) in all jumps compared with the control group. Peak landing force asymmetry was greater in the ACLR group than the controls during the countermovement (p<0.001, MD=-11.6; 95% CI -15.4 to -7.9) and the double-leg drop jump (p=0.023, MD=-8.9; 95% CI -14.9 to -2.8). The eccentric impulse asymmetry was significantly greater (p=0.018, MD=-3.8; 95% CI -5.8 to -1.7) in the ACLR group during the single-leg drop jump only. Jump height was significantly lower (p<0001) in the ACLR group compared with controls in all tests except the double-leg drop jump. CONCLUSION At the time of return to sport after ACLR, despite passing the traditional discharge criteria, athletes remained asymmetrical during all vertical jump tests, in the concentric (push-off) phase, during landing from bilateral jumps and for most performance metrics. Clinicians should aim to restore not only symmetry in ground reaction forces but also absolute performance metrics such as jump height, reactive strength index and contact times, to potentially reduce injury risk and improve overall athletic performance.
Collapse
Affiliation(s)
- Roula Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Vasileios Sideris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Life Sciences, Roehampton University, London, UK
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Sports Injury and Illness Prevention Programme (ASPREV), Aspetar, Orthopeadic and Sports Medicine Hospital, Doha, Qatar
| | - Rod Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- School of Human Movement & Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| |
Collapse
|
11
|
Read PJ, Davies WT, Bishop C, McAuliffe S, Wilson MG, Turner AN. Residual Deficits in Reactive Strength After Anterior Cruciate Ligament Reconstruction in Soccer Players. J Athl Train 2023; 58:423-429. [PMID: 37523420 PMCID: PMC11220905 DOI: 10.4085/0169-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
CONTEXT Deficits in plyometric abilities are common after anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. OBJECTIVE To examine the utility of a vertical hop test for assessing function after ACLR and establishing factors associated with performance. DESIGN Cross-sectional study. SETTING Rehabilitation program. PATIENTS OR OTHER PARTICIPANTS Soccer players with a history of ACLR (n = 73) and matched control individuals (n = 195). MAIN OUTCOME MEASURE(S) The 10-second vertical hop test provided measures of jump height, the Reactive Strength Index (RSI), and asymmetry. We also examined possible predictors of hop performance, including single-legged vertical drop jump, isokinetic knee-extension strength, and the International Knee Documentation Committee questionnaire score. RESULTS Between-limbs differences were identified only for the ACLR group, and asymmetry scores increased in those with a history of ACLR (P < .001) compared with the control group. The single-legged vertical drop jump, RSI, and knee-extension torque were significant predictors of 10-second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). CONCLUSIONS Vertical hop deficits were present after ACLR, even after participants completed a comprehensive rehabilitation program. This may have been due to reduced knee-extension and reactive strength. Vertical hop tests warrant inclusion as part of the return-to-sport test battery.
Collapse
Affiliation(s)
- Paul J. Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | | | | |
Collapse
|
12
|
Song Y, Li L, Jensen MA, Dai B. Using trunk kinematics to predict kinetic asymmetries during double-leg jump-landings in collegiate athletes following anterior cruciate ligament reconstruction. Gait Posture 2023; 102:80-85. [PMID: 36934474 PMCID: PMC10148905 DOI: 10.1016/j.gaitpost.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/10/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Bilateral vertical ground reaction force (VGRF) and knee extension moment asymmetries are commonly observed during jumping and landing tasks following anterior cruciate ligament (ACL) reconstructions (ACLR) in collegiate athletes. Kinetic asymmetries during landings are associated with increased ACL re-injury risk. Efforts have been made to predict bilateral kinetic asymmetries using trunk kinematics during squats but not during jump-landings. RESEARCH QUESTION To determine the correlations between trunk kinematics (medial-lateral shoulder positions, medial-lateral hip positions, and lateral trunk bending angles) and bilateral kinetic asymmetries (VGRF and knee extension moments) during double-leg jump-landings in collegiate athletes following ACLR. METHODS Fifteen National Collegiate Athletic Association Division I athletes who had ACLR in the past 24 months participated. Eleven of them performed two assessments over the study period for a total of 26 assessments for data analyses. Athletes performed three double-leg countermovement jumps. Kinematics and kinetics data were collected. Medial-lateral shoulder and hip positions relative to ankle positions, lateral trunk bending angles, and kinetic asymmetries were calculated during the jumping (the lowest hip position until takeoff) and landing (the first 100 ms after initial contact) phases. RESULTS Medial-lateral shoulder positions correlated with VGRF (r = 0.63, p < 0.001) and knee moment asymmetries (r = 0.53, p = 0.006) in the jumping phase. Medial-lateral hip positions correlated with VGRF (r = 0.61, p < 0.001; r = 0.52, p = 0.006) and knee moment asymmetries (r = 0.55, p = 0.004; r = 0.61, p < 0.001) in both jumping and landing phases. SIGNIFICANCE Medial-lateral hip positions correlated with kinetic asymmetries during double-leg jump-landings in collegiate athletes following ACLR. A 2D assessment using a standard video camera might be used as a low-cost and clinically applicable tool to assess bilateral kinetic asymmetries by quantifying medial-lateral hip positions during jump-landings following ACLR.
Collapse
Affiliation(s)
- Yu Song
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Megan A Jensen
- Department of Sports Medicine, University of Wyoming, Laramie, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA.
| |
Collapse
|
13
|
Tan T, Gatti AA, Fan B, Shea KG, Sherman SL, Uhlrich SD, Hicks JL, Delp SL, Shull PB, Chaudhari AS. A scoping review of portable sensing for out-of-lab anterior cruciate ligament injury prevention and rehabilitation. NPJ Digit Med 2023; 6:46. [PMID: 36934194 PMCID: PMC10024704 DOI: 10.1038/s41746-023-00782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/17/2023] [Indexed: 03/20/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) surgery are common. Laboratory-based biomechanical assessment can evaluate ACL injury risk and rehabilitation progress after ACLR; however, lab-based measurements are expensive and inaccessible to most people. Portable sensors such as wearables and cameras can be deployed during sporting activities, in clinics, and in patient homes. Although many portable sensing approaches have demonstrated promising results during various assessments related to ACL injury, they have not yet been widely adopted as tools for out-of-lab assessment. The purpose of this review is to summarize research on out-of-lab portable sensing applied to ACL and ACLR and offer our perspectives on new opportunities for future research and development. We identified 49 original research articles on out-of-lab ACL-related assessment; the most common sensing modalities were inertial measurement units, depth cameras, and RGB cameras. The studies combined portable sensors with direct feature extraction, physics-based modeling, or machine learning to estimate a range of biomechanical parameters (e.g., knee kinematics and kinetics) during jump-landing tasks, cutting, squats, and gait. Many of the reviewed studies depict proof-of-concept methods for potential future clinical applications including ACL injury risk screening, injury prevention training, and rehabilitation assessment. By synthesizing these results, we describe important opportunities that exist for clinical validation of existing approaches, using sophisticated modeling techniques, standardization of data collection, and creation of large benchmark datasets. If successful, these advances will enable widespread use of portable-sensing approaches to identify ACL injury risk factors, mitigate high-risk movements prior to injury, and optimize rehabilitation paradigms.
Collapse
Affiliation(s)
- Tian Tan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Anthony A Gatti
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Bingfei Fan
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Scott D Uhlrich
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jennifer L Hicks
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Scott L Delp
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Peter B Shull
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, Shanghai, China.
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| |
Collapse
|
14
|
Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
Collapse
Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| |
Collapse
|
15
|
Legnani C, Del Re M, Viganò M, Peretti GM, Borgo E, Ventura A. Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12020626. [PMID: 36675557 PMCID: PMC9866224 DOI: 10.3390/jcm12020626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Methods: Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL−Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI > 60), and group B (ACL-RSI < 60). Results: Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p < 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p < 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI > 60), while 11 were allocated in group B (ACL-RSI < 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p < 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Conclusions: Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction
Collapse
Affiliation(s)
- Claudio Legnani
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Correspondence:
| | - Matteo Del Re
- Department of Orthopedics and Traumatology, University of Milan, 20133 Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Enrico Borgo
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Alberto Ventura
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| |
Collapse
|
16
|
Jones HSR, Stiles VH, Verheul J, Moore IS. Angular Velocities and Linear Accelerations Derived from Inertial Measurement Units Can Be Used as Proxy Measures of Knee Variables Associated with ACL Injury. SENSORS (BASEL, SWITZERLAND) 2022; 22:9286. [PMID: 36502001 PMCID: PMC9740759 DOI: 10.3390/s22239286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
Given the high rates of both primary and secondary anterior cruciate ligament (ACL) injuries in multidirectional field sports, there is a need to develop easily accessible methods for practitioners to monitor ACL injury risk. Field-based methods to assess knee variables associated with ACL injury are of particular interest to practitioners for monitoring injury risk in applied sports settings. Knee variables or proxy measures derived from wearable inertial measurement units (IMUs) may thus provide a powerful tool for efficient injury risk management. Therefore, the aim of this study was to identify whether there were correlations between laboratory-derived knee variables (knee range of motion (RoM), change in knee moment, and knee stiffness) and metrics derived from IMUs (angular velocities and accelerations) placed on the tibia and thigh, across a range of movements performed in practitioner assessments used to monitor ACL injury risk. Ground reaction forces, three-dimensional kinematics, and triaxial IMU data were recorded from nineteen healthy male participants performing bilateral and unilateral drop jumps, and a 90° cutting task. Spearman's correlations were used to examine the correlations between knee variables and IMU-derived metrics. A significant strong positive correlation was observed between knee RoM and the area under the tibia angular velocity curve in all movements. Significant strong correlations were also observed in the unilateral drop jump between knee RoM, change in knee moment, and knee stiffness, and the area under the tibia acceleration curve (rs = 0.776, rs = -0.712, and rs = -0.765, respectively). A significant moderate correlation was observed between both knee RoM and knee stiffness, and the area under the thigh angular velocity curve (rs = 0.682 and rs = -0.641, respectively). The findings from this study suggest that it may be feasible to use IMU-derived angular velocities and acceleration measurements as proxy measures of knee variables in movements included in practitioner assessments used to monitor ACL injury risk.
Collapse
Affiliation(s)
- Holly S. R. Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| | - Victoria H. Stiles
- Sport and Health Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Jasper Verheul
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| | - Isabel S. Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| |
Collapse
|
17
|
Pang JCY, Tsang RSW. Reliability of three-dimensional motion analysis during single-leg side drop landing test after anterior cruciate ligament reconstruction: An in vivo motion analysis study. Hong Kong Physiother J 2022; 42:65-73. [PMID: 35782700 PMCID: PMC9244601 DOI: 10.1142/s1013702522500081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury is a common sport injury and investigation of landing biomechanics is helpful in injury prevention and rehabilitation. Recent study found a lateral single-leg drop landing test resulted in the highest peak knee valgus angle (PKVA), but its reliability on patients who received ACL reconstruction (ACLR) is unknown. Objective: This study aimed to investigate the reliability in both within and between days on the normalized vertical ground reaction force (NVGRF) and kinematics of lower limbs after receiving ACLR. The findings can form the cornerstone for further study related to lateral jumping-and-landing biomechanics in patients with ACLR. Methods: This was a test-retest reliability study. Twelve patients (four females and eight males) who received ACLR with mean age of 29.4 (SD ± 1.66) were recruited. The subjects were instructed to jump laterally from 30 cm height and landed with single-leg for five times. The procedure was conducted on both legs for comparison. The NVGRF and local maxima of the hip, knee and ankle angles during the first 100 ms in all three planes were analyzed. The measurement was conducted by the same assessor to evaluate the within-session reliability, and the whole procedure was repeated one week later for the evaluation of the between-session reliability. Intra-class correlation coefficient (ICC) test was used to assess the within- and between-session reliability by ICC (3, 1) and ICC (3, K) respectively. Results: The within-session reliability of NVGRF [ICC (3, 1)] was 0.899–0.936, and its between-session reliability [ICC (3, K)] was 0.947–0.923. Overall reliability for kinematics within-session [ICC (3, 1)] was 0.948–0.988, and the between-session reliability [ICC (3, K)] was 0.618–0.982, respectively. Good to excellent reliability for the lateral single-leg drop landing test was observed in most of the outcome measures for within- and between-session. The ICC value of NVGRF of ACLR leg was lower than that of the good leg in the within-session which may associate with lower neuromuscular control in ACLR leg than that of the good leg. Conclusion: The results of this study support the use of a lateral single-leg drop landing test to evaluate lower limb biomechanics for ACLR.
Collapse
Affiliation(s)
- Johnson Chun Yiu Pang
- School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, Tseung Kwan O, N.T., HKSAR, China
| | - Rachel Suet Wai Tsang
- Shatin Hospital, Hospital Authority, 33 A Kung Kok Street, Ma On Shan, Shatin, NT, HKSAR, China
| |
Collapse
|
18
|
Read PJ, Pedley JS, Eirug I, Sideris V, Oliver JL. Impaired Stretch-Shortening Cycle Function Persists Despite Improvements in Reactive Strength After Anterior Cruciate Ligament Reconstruction. J Strength Cond Res 2022; 36:1238-1244. [PMID: 35482544 DOI: 10.1519/jsc.0000000000004208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Read, PJ, Pedley, JS, Eirug, I, Sideris, V, and Oliver, JL. Impaired stretch-shortening cycle function persists despite improvements in reactive strength followingafter anterior cruciate ligament reconstruction. J Strength Cond Res 36(5): 1238-1244, 2022-Reactive strength index (RSI) during a single-leg drop jump (SLDJ) has been indicated to determine return-to-sport readiness after anterior cruciate ligament (ACL) reconstruction, but only cross-sectional studies are available. Ground reaction force data and characterization of stretch-shortening cycle (SSC) function also remain sparse. Single-leg drop jump performance, ground reaction force, and SSC function were examined in soccer players with ACL reconstruction (n = 26) and matched controls (n = 25). Injured players were tested at 2 time points (32 and 42 weeks postsurgery). Stretch-shortening cycle function was classified as good (no impact peak and spring like), moderate (impact peak but still spring like or no impact peak and not spring like), or poor (impact peak and not spring like). The involved limb displayed lower-jump height, poorer RSI, less spring-like behavior, earlier peak landing force, and a greater ratio of landing peak to take-off peak force compared with the uninvolved limb and controls at the initial assessment (p < 0.001). Proportionally, more involved limbs were categorized as poor or moderate at the initial assessment (69.2%) and follow-up (50%) in comparison with the control limbs (14%). The reactive strength index was the only variable to change significantly between the initial assessment and follow-up on the involved limb (p < 0.05). No changes in the proportion of ACL reconstructed individuals categorized as poor or moderate SSC function at the follow-up assessment were observed. Residual deficits are present in SLDJ performance, SSC function, and ground reaction force characteristics after ACL reconstruction. The reactive strength index should not be the sole metric, as observed increases did not correspond with changes in SSC function.
Collapse
Affiliation(s)
- Paul J Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Institute of Sport Exercise and Health, London, United Kingdom
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Jason S Pedley
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
| | - Ifan Eirug
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
| | | | - Jon L Oliver
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| |
Collapse
|
19
|
Lawson D, Jordan MJ, Herzog W. Effects of lead leg selection on bilateral landing force-time characteristics: Return to sport testing implications. Scand J Med Sci Sports 2022; 32:1192-1200. [PMID: 35441730 DOI: 10.1111/sms.14168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
We quantified the effect of lead leg selection on landing force-time characteristics during a vertical drop landing (VDL) initiated with a step-off. Plyometric-trained subjects (male: n = 8; female: n = 5; age =23 ± 3.3 years; body mass =74.4 ± 11.2 kg) performed 6 step-off-initiated VDLs from a 45-cm box (n = 3/lead leg). Pooled and lead leg stratified between-limb comparisons of limb-specific initial ground contact timing, peak vertical ground reaction force (Fzpeak ), and early landing-phase impulse (Impulse100ms ) were assessed by a two-factor, within-subject ANOVA, and limb symmetry indexes were calculated (α = 0.05). Pooled data showed that the lead leg made contact prior to the trail leg and contributed a greater fraction to Fzpeak compared with the trail leg. Stratifying trials by lead leg selection led to significant between-limb differences in Fzpeak (p < 0.05) and Impulse100ms (p < 0.01) with the right leg leading but not with the left leg leading. Lead leg selection in step-off-initiated VDLs influenced landing performance and limb symmetry indexes of variables associated with lower limb injury risk, suggesting the need to control for lead leg selection in these tasks. A step-off may not be a suitable technique to initiate landing tasks when assessing limb symmetry.
Collapse
Affiliation(s)
- Drew Lawson
- Canadian Sport Institute Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Jordan
- Canadian Sport Institute Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
20
|
Kurz E, Schwesig R, Pröger S, Delank KS, Bartels T. Foot tapping and unilateral vertical jump performance in athletes after knee surgery: an explorative cross-sectional study. BMC Sports Sci Med Rehabil 2022; 14:34. [PMID: 35241147 PMCID: PMC8896086 DOI: 10.1186/s13102-022-00422-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022]
Abstract
Background Guiding athletes through the rehabilitation process and judging the time at which return to sports can be enabled after anterior cruciate ligament (ACL) injuries are still challenging processes. The purpose of this explorative cross-sectional study was to retrospectively compare unilateral vertical jump as well as vertical foot tapping outcomes in athletes returned to sports after ACL reconstruction (ACLR) with uninjured athletes. Methods Seven-teen ACLR athletes (male/female: 12/5) were examined 11 (6–23) months after their ACL injury and after return to sport clearance together with 67 uninjured athletes (male/female: 51/16). Seventeen age and stature matched controls were selected from the sample of uninjured athletes. Participants unilaterally performed acyclic (squat jump, SJ; drop jump, DJ) and cyclic (foot tapping, FT) tests. SJ peak power, DJ take-off efficiency (TOE) and FT coefficients (FTC) were compared between ACLR and matched as well as unmatched control groups. Limb symmetry index (LSI) as well as performance score were calculated. Results Analyses of the SJ peak power revealed moderate effects of group (right: P < 0.09, ηp2 = 0.06; left: P < 0.05, ηp2 = 0.08). The TOE was largely affected by group (right: P < 0.01, ηp2 = 0.12; left: P < 0.01, ηp2 = 0.13). No effect of group was found on the FTC (P > 0.8, ηp2 < 0.01). The SJ peak power LSI (r = 0.46, P < 0.07) and TOE LSI (r = 0.38, P = 0.13) were positively associated with the performance score of the ACLR group. Conclusion Although already returned to sports, the ACLR group underperformed the matched and unmatched control groups significantly. Unilaterally performed vertical jumps may provide additional information on athletes’ rehabilitation progress and help to manage the rehabilitation process and decisions on potential readiness after ACLR. More attention should be paid to the direction of the LSI results.
Collapse
Affiliation(s)
- Eduard Kurz
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan Pröger
- Joint Surgery Center, Sports Clinic Halle, Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Bartels
- Joint Surgery Center, Sports Clinic Halle, Halle (Saale), Germany
| |
Collapse
|
21
|
Kotsifaki A, Van Rossom S, Whiteley R, Korakakis V, Bahr R, Sideris V, Jonkers I. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Br J Sports Med 2022; 56:490-498. [PMID: 35135826 PMCID: PMC9016240 DOI: 10.1136/bjsports-2021-104692] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 01/14/2023]
Abstract
Objectives Vertical jump performance (height) is a more representative metric for knee function than horizontal hop performance (distance) in healthy individuals. It is not known what the biomechanical status of athletes after anterior cruciate ligament (ACL) reconstruction (ACLR) is at the time they are cleared to return to sport (RTS) or whether vertical performance metrics better evaluate knee function. Methods Standard marker-based motion capture and electromyography (EMG) were collected from 26 male athletes cleared to RTS after ACLR and 22 control healthy subjects during single leg vertical jumps (SLJ) and single leg drop jumps (SLDJ). Performance outcomes, jump height and the Reactive Strength Index, were calculated. Sagittal plane kinematics, joint moments and joint work were obtained using inverse dynamics and lower limb muscle forces were computed using an EMG-constrained musculoskeletal model. Muscle contribution was calculated as a percentage of the impulse of all muscle forces in the model. Between-limb and between-group differences were explored using mixed models analyses. Results Jump performance, assessed by jump height and Reactive Strength Index, was significantly lower in the involved than the uninvolved limb and controls, with large effect sizes. For the ACLR group, jump height limb symmetry index was 83% and 77% during the SLJ and SLDJ, respectively. Work generation was significantly less in the involved knee compared to uninvolved limb and controls during the SLJ (p<0.001; d=1.19; p=0.003, d=0.91, respectively) and during the SLDJ (p<0.001; d=1.54; p=0.002, d=1.05, respectively). Hamstrings muscle contribution was greater in the involved compared to the uninvolved limb and controls, whereas soleus contribution was lower in the involved limb compared to controls. Conclusions During vertical jumps, male athletes after ACLR at RTS still exhibit knee biomechanical deficits, despite symmetry in horizontal functional performance and strength tests. Vertical performance metrics like jump height and RSI can better identify interlimb asymmetries than the more commonly used hop distance and should be included in the testing battery for the RTS.
Collapse
Affiliation(s)
- Argyro Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar .,Department of Movement Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Sam Van Rossom
- Department of Movement Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Rod Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,School of Human Movement & Nutrition Science, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Vasileios Korakakis
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Roald Bahr
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Aspetar Sports Injury and Illness Prevention Programme (ASPREV), Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Vasileios Sideris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| |
Collapse
|
22
|
Crotty NMN, Daniels KAJ, McFadden C, Cafferkey N, King E. Relationship Between Isokinetic Knee Strength and Single-Leg Drop Jump Performance 9 Months After ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671211063800. [PMID: 35005049 PMCID: PMC8738888 DOI: 10.1177/23259671211063800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Deficits in knee strength after anterior cruciate ligament reconstruction (ACLR) surgery are common. Deficits in the single-leg drop jump (SLDJ), a test of plyometric ability, are also found. Purpose: To examine the relationship between isokinetic knee strength, SLDJ performance, and self-reported knee function 9 months after ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Knee isokinetic peak torque, SLDJ jump height, contact time, and reactive strength index (RSI), as well as International Knee Documentation Committee (IKDC) scores were assessed in 116 male, field-sport athletes at 9.2 months after ACLR. SLDJ testing took place in a 3-dimensional biomechanics laboratory. Linear regression models were used to analyze the relationship between the variables. Results: A significant relationship was found between ACLR-limb isokinetic knee extensor strength and SLDJ jump height (P < .001, r2 = 0.29) and RSI (P < .001, r2 = 0.33), and between ACLR-limb isokinetic knee flexor strength and SLDJ jump height (P < .001, r2 = 0.12) and RSI (P < .001, r2 = 0.15). A significant positive relationship was also found between knee extensor asymmetry and SLDJ jump height asymmetry (P < .001, r2 = 0.27) and SLDJ reactive strength asymmetry (P < .001, r2 = 0.18). Combined ACLR-limb jump height and contact time best predicted IKDC scores (P < .001, r2 = 0.12). Conclusion: Isokinetic knee extension strength explained approximately 30% of SLDJ performance, with a much weaker relationship between knee flexion strength and SLDJ performance. Isokinetic strength and SLDJ performance were weak predictors of variation in IKDC scores.
Collapse
Affiliation(s)
| | - Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, Bristol, UK
| | - Ciaran McFadden
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Niall Cafferkey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| |
Collapse
|
23
|
Hurley ET, Mojica ES, Haskel JD, Mannino BJ, Alaia M, Strauss EJ, Jazrawi LM, Gonzlaez-Lomas G. Return to play testing following anterior cruciate reconstruction - A systematic review & meta-analysis. Knee 2022; 34:134-140. [PMID: 34896962 DOI: 10.1016/j.knee.2021.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 10/04/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to systematically review the evidence regarding return to sport evaluation following ACL reconstruction and evaluate the relationship between testing and secondary ACL injury. METHODS A systematic review of the literature with PubMed, Ovid MEDLINE, Cochrane Reviews, was performed on June, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they compared outcomes following passing and failing RTP testing subsequent to ACLR. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. Correlation was calculated with Spearman testing. RESULTS Overall, 8 studies with 1224 patients were included in the analysis. Overall, 34.3% (420/1224) patients passed the RTP testing. Those who passed the RTP testing had a statistically significant 47% lower rate of ACL graft re-rupture compared to those who did not pass the RTP testing (p = 0.03). However, there was a slightly higher, albeit not statistically significant, rate of contralateral ACL rupture in those who passed the RTP testing compared to those who did not (p = 0.42). There was a strong positive correlation between a high rate of patients passing the ACL RTP testing in studies and ACL graft rupture rate in those who failed (0.80). CONCLUSION Passing RTP testing following ACLR results in a lower rate of ACL graft rupture, but not contralateral ACL injury. Further evaluation and standardization of RTP testing is necessary in order to increase reliability in identifying patients at risk for re-injury after ACLR. LEVEL OF EVIDENCE Level of Evidence III.
Collapse
|
24
|
Hill CN, Ross S, Peebles A, Queen RM. Continuous similarity analysis in patient populations. J Biomech 2021; 131:110916. [PMID: 34952349 DOI: 10.1016/j.jbiomech.2021.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Decreased movement symmetry is associated with injury risk and accelerated disease progression. Methods to analyze continuous data either cannot be used in pathologic populations with abnormal movement patterns or are not defined in terms easily incorporated into clinical care. The purpose of this study was to develop a method of describing symmetry and movement quality in continuous time-series data that results in scores that can be readily incorporated into clinical care. Two scores were developed: (1) the symmetry score (SS) which evaluates similarities in time-series data between limbs and (2) the closeness-to-healthy score (CTHS) which evaluates the similarity of time-series data to a control population. Kinetic and kinematic data from 56 end-stage unilateral ankle arthritis (A-OA) patients and 56 healthy older adults, along with 16 anterior cruciate ligament reconstruction (ACLR) patients and 16 healthy young adults were used to test the ability for SS and CTHS to differentiate between healthy and patient groups. Unpaired t-tests, Cohen's D effect sizes, and receiver-operating-curve analyses assessed group differences [SPSS, V27, α = 0.05]. Patients had worse SS than controls and A-OA patients had worse CTHS compared to controls. SS had strong predictive capability, while the predictive capability of CTHS varied. Combined with clinically accessible data collection methods, the SS and CTHS could be used to evaluate patients' baseline movement quality, assess changes due to disease progression, and during recovery. Results could be utilized in clinical decision making to assess surgical intervention urgency and efficacy of surgical interventions or rehabilitation protocols to improve side-to-side limb symmetry.
Collapse
Affiliation(s)
- Cherice N Hill
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Shane Ross
- Department of Aerospace and Ocean Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alexander Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| |
Collapse
|
25
|
Zarro MJ, Stitzlein MG, Lee JS, Rowland RW, Gray VL, Taylor JB, Meredith SJ, Packer JD, Nelson CM. Single-Leg Vertical Hop Test Detects Greater Limb Asymmetries Than Horizontal Hop Tests After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. Int J Sports Phys Ther 2021; 16:1405-1414. [PMID: 34909247 PMCID: PMC8637251 DOI: 10.26603/001c.29595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knee function deficits may persist after anterior cruciate ligament reconstruction (ACLR). Return to sport (RTS) testing batteries assess recovery after ACLR and can guide RTS progression, but the ideal test components are debatable. The single leg vertical hop for height (SLVH) test using a commercially available jump mat may provide a valuable assessment of knee function. HYPOTHESIS/PURPOSE The purpose of this study was to compare the limb symmetry index (LSI) of SLVH to horizontal hop testing in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was the SLVH would elicit significantly lower LSI than horizontal hop tests. STUDY DESIGN Cross-Sectional Study. METHODS Eighteen National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 11 females) at 7.33 ± 2.05 months after ACLR were included in this retrospective study. LSI was calculated for single hop for distance (SHD), triple hop for distance (THD), cross-over hop for distance (CHD), timed 6-meter hop (T6H), and SLVH. A repeated measures ANOVA was performed to identify differences in LSI for each test. Spearman's Rho correlation coefficient was calculated to examine the relationship between LSIs for each test. RESULTS The LSI for SLVH (84.48% ± 11.41%) was significantly lower than LSI for SHD (95.48 ± 8.02%, p = 0.003), THD (94.40 ± 3.70%, p = 0.002), CHD (95.85 ± 7.00, p = 0.007), and T6H (97.69 ± 6.60%, p = 0.001). The correlation of LSI between SLVH and the horizontal hop tests was weak and non-significant for SHD (rs = 0.166, p = 0.509), CHD (rs = 0.199, p = 0.428), and T6H (rs = 0.211, p = 0.401) and moderate and non-significant for THD (rs = 0.405, p = 0.096). CONCLUSIONS Individuals after ACLR had lower LSI on the SLVH than on horizontal hop tests and weak to moderate correlations between the tests suggest SLVH detects performance deficits not identified by the horizontal hop tests. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Michael J Zarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine; Department of Orthopaedics, University of Maryland School of Medicine
| | - Matthew G Stitzlein
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | - Jason S Lee
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | - Robert W Rowland
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine; Department of Orthopaedics, University of Maryland School of Medicine
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | | | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine
| | - Christa M Nelson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine
| |
Collapse
|
26
|
Jones HSR, Moore IS, King E, Stiles VH, Laudani L, McCarthy-Ryan M, McFadden C, Daniels KAJ. Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 2021; 32:612-621. [PMID: 34797936 DOI: 10.1111/sms.14104] [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: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
Abstract
There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs = 0.728, p < 0.001), knee (rs = 0.638, p < 0.001) and hip (rs = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs = 0.10, p = 0.104), knee (rs = 0.106, p = 0.166) and hip (rs = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.
Collapse
Affiliation(s)
- Holly S R Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Enda King
- Sports Surgery Clinic, Dublin, Ireland
| | | | - Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Molly McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Ciarán McFadden
- Sports Surgery Clinic, Dublin, Ireland.,Sport and Exercise Science Research Centre, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
27
|
An Assessment of the Hopping Strategy and Inter-Limb Asymmetry during the Triple Hop Test: A Test–Retest Pilot Study. Symmetry (Basel) 2021. [DOI: 10.3390/sym13101890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aims of the present study are to: (1) determine within- and between-session reliability of multiple metrics obtained during the triple hop test; and (2) determine any systematic bias in both the test and inter-limb asymmetry scores for these metrics. Thirteen male young American football athletes performed three trials of a triple hop test on each leg on two separate occasions. In addition to the total distance hopped, manual detection of touch down and toe-off were calculated via video analysis, enabling flight time (for each hop), ground contact time (GCT), reactive strength index (RSI), and leg stiffness (between hops) to be calculated. Results showed all coefficient of variation (CV) values were ≤ 10.67% and intraclass correlation coefficients (ICC) ranged from moderate to excellent (0.53–0.95) in both test sessions. Intrarater reliability showed excellent reliability for all metrics (CV ≤ 3.60%, ICC ≥ 0.97). No systematic bias was evident between test sessions for raw test scores (g = −0.34 to 0.32) or the magnitude of asymmetry (g = −0.19 to 0.43). However, ‘real’ changes in asymmetry (i.e., greater than the CV in session 1) were evident on an individual level for all metrics. For the direction of asymmetry, kappa coefficients revealed poor-to-fair levels of agreement between test sessions for all metrics (K = −0.10 to 0.39), with the exception of the first hop (K = 0.69). These data show that, given the inherent limitations of distance jumped in the triple hop test, practitioners can confidently gather a range of reliable data when computed manually, provided sufficient test familiarization is conducted. In addition, although the magnitude of asymmetry appears to show only small changes between test sessions, limb dominance does appear to fluctuate between test sessions, highlighting the value of also monitoring the direction of the imbalance.
Collapse
|
28
|
Byrne L, King E, Mc Fadden C, Jackson M, Moran R, Daniels K. The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery. Knee 2021; 32:72-79. [PMID: 34425491 DOI: 10.1016/j.knee.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 07/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to examine the differences in patient-reported outcome measures, isokinetic strength, plyometric ability and ability to meet return to play criteria ten months after anterior cruciate ligament (ACL) reconstruction surgery between those who underwent meniscectomy, those who underwent meniscal repair and those with no meniscal intervention alongside ACL reconstruction surgery. METHODS Three hundred and thirteen athletes with clinically and radiologically confirmed ACL ruptures were included in this study. Participants were grouped according to their intra-operative procedures (isolated ACL reconstruction surgery n = 155, ACL reconstruction surgery with meniscectomy n = 128, ACL reconstruction surgery with meniscal repair n = 30). Participants completed patient-reported outcome measures questionnaires (Marx Activity Rating Scale, the ACL Return to Sport after Injury and the International Knee Documentation Committee Score) and completed a battery of objective functional testing including isokinetic dynamometry and jump performance testing (countermovement jump and drop jump) between 9 and 11 months after surgery. RESULTS No significant between-group differences were identified in any metric relating to patient-reported outcome measures (p = .611), strength and jump measures (p = .411) or the ability to achieve symmetry-based return to play criteria (p = .575). CONCLUSIONS Clinically, these results suggest that concomitant meniscal surgery has no significant effects on patient-reported outcome measures, strength and jump metrics at the return to play stage post-operatively and can inform the pre-operative counselling of those awaiting ACL reconstruction surgery with likely meniscal intervention.
Collapse
Affiliation(s)
- Laura Byrne
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.
| | - Enda King
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK
| | - Ciaran Mc Fadden
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK
| | - Mark Jackson
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Ray Moran
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Katherine Daniels
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Queen's School of Engineering, University of Bristol, Bristol, UK; Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
29
|
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.
Collapse
|
30
|
Markström JL, Grinberg A, Häger CK. Fear of Reinjury Following Anterior Cruciate Ligament Reconstruction Is Manifested in Muscle Activation Patterns of Single-Leg Side-Hop Landings. Phys Ther 2021; 102:6373317. [PMID: 34554253 PMCID: PMC8860189 DOI: 10.1093/ptj/pzab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether fear of re-injury is manifested in joint kinematics and muscle activation patterns during landings of a standardized rebound side-hop (SRSH), or in patient-reported outcome measures (PROMs), among individuals with anterior cruciate ligament reconstruction (ACLR). METHODS In this cross-sectional observational study, 38 individuals within 2 years post-ACLR were grouped into HIGH-FEAR (n = 21, median 11.2 months post-surgery) or LOW-FEAR (n = 17, median 10.1 months post-surgery) based on a discriminating question (Q9; Tampa Scale of Kinesiophobia-17). These individuals and 39 asymptomatic controls performed the SRSH. Three-dimensional motion recordings were used to calculate trunk, hip, and knee joint angles at initial contact and range of respective joint motion during landing. Surface electromyography registered mean amplitudes and co-contraction indexes for thigh muscles during pre-activation (50 ms) and landing phases. PROMs of knee function, knee health, and physical activity were also analyzed. RESULTS The HIGH-FEAR and LOW-FEAR classification was corroborated by distinct Tampa Scale of Kinesiophobia-17 total and subscale scores and revealed distinguishable muscle activation patterns. HIGH-FEAR demonstrated higher biceps femoris electromyography amplitude and higher anterior-posterior co-contraction index during landing than both LOW-FEAR and controls. However, there were no fear-related differences for kinematics or PROMs. Instead, both ACLR subgroups showed different kinematics at initial contact to controls; HIGH-FEAR with more trunk, hip, and knee flexion, and LOW-FEAR with more hip and knee flexion. CONCLUSION Individuals with ACLR who had high fear of re-injury seem to have adopted a protective strategy with higher muscular activation patterns, presumably to stabilize the knee joint, compared with individuals with low fear of re-injury and controls. SRSH landing kinematics or knee-related PROMs may not be as sensitive to fear of re-injury. IMPACT Fear of reinjury following anterior cruciate ligament injury should be evaluated as an independent psychological outcome throughout rehabilitation after ACLR for improved return to sport transition. LAY SUMMARY If you have an anterior cruciate ligament injury treated with reconstructive surgery, you might have a high fear of reinjury, and that can change how you activate the muscles around your knee. Your physical therapist can do a simple screening test in addition to functional tests to help reduce your fear and improve your treatment outcomes.
Collapse
Affiliation(s)
| | - Adam Grinberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
31
|
McFadden C, Daniels KAJ, Strike S. Six methods for classifying lower-limb dominance are not associated with asymmetries during a change of direction task. Scand J Med Sci Sports 2021; 32:106-115. [PMID: 34536246 DOI: 10.1111/sms.14054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 01/14/2023]
Abstract
Quantifying asymmetries between dominant and non-dominant limbs is a common research objective aimed at identifying systematic differences between limbs and establishing normative ranges of asymmetry. Multiple methods for classifying limb dominance exist, and it is unclear how different methods relate to directional asymmetries during change of direction (CoD). This study aimed to determine whether different methods of classifying limb dominance, including a novel CoD task-specific method, identified significant inter-limb asymmetries during a 90° CoD task. Fifty participants completed a testing battery consisting of jumping, hopping, CoD, and isokinetic dynamometry. Limb dominance was classified for each participant according to preferred kicking limb, vertical jump height, horizontal hop distance, initial force plate contact during landing, max isokinetic knee extensor strength, and turning velocity. Asymmetries in whole-body and joint-level mechanics were defined using each method. No method for classifying limb dominance was associated with consistent inter-limb biomechanical asymmetries during CoD, and no method was related to any other method. The magnitude of asymmetry relative to the magnitude of absolute asymmetry present within the cohort suggests that using these tasks to classify the dominant limb in this CoD is akin to assigning dominance to a randomly selected limb. Previous observations of group symmetry during CoD may be statistical artifacts as opposed to a true indication of normative movement. Until an appropriate means of classifying limbs during CoD is established, quantifying normative asymmetry based on limb dominance should be done with caution.
Collapse
Affiliation(s)
- Ciarán McFadden
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, Bristol, UK.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Siobhán Strike
- Department of Life Sciences, University of Roehampton, London, UK
| |
Collapse
|
32
|
Current perspectives and clinical practice of physiotherapists on assessment, rehabilitation, and return to sport criteria after anterior cruciate ligament injury and reconstruction. An online survey of 538 physiotherapists. Phys Ther Sport 2021; 52:103-114. [PMID: 34479178 DOI: 10.1016/j.ptsp.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate the perspectives and clinical practice of physiotherapists regarding rehabilitation after anterior cruciate ligament reconstruction (ACLR). DESIGN Online survey. SETTING Survey platform. PARTICIPANTS Greek physiotherapists. OUTCOME MEASURES The survey consisted of 7 sections: participant demographics, importance of ACLR rehabilitation, clinical measurements, practice, criteria to progress rehabilitation, return to running and return to sport. RESULTS Significant variability in measures and criteria used for clinical decision-making were found including: limb symmetry in strength and function, knee range of motion and effusion, progression, and return to sport criteria. The majority of the practitioners (28.3%) extrapolate knee strength from hop capacity. Return to running ranged from 3 to 5 months post-operatively reflecting that this was tied to physical capacities, not time from surgery. 70.0% of the Greek physiotherapists would allow return to sport ≤9 months after ACLR. Agreement was found in using: physical measures, function, and dynamic stability in ACLR rehabilitation, but the mode and interpretation varied substantially. Less than 29.0% of the physiotherapists reported using patient-reported outcome measures in their decision-making. CONCLUSION Current ACLR rehabilitation practices in Greece are largely not aligned with the contemporary scientific evidence and guidelines.
Collapse
|
33
|
McPhail J, Gonçalves BAM, Spörri J, Linnamo V. Unilateral Maximal Isometric Hex Bar Pull Test: Within-Session Reliability and Lower Body Force Production in Male and Female Freeski Athletes. Front Sports Act Living 2021; 3:715833. [PMID: 34435187 PMCID: PMC8380774 DOI: 10.3389/fspor.2021.715833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to (1) assess the within-session reliability of a unilateral isometric hex bar pull (UIHBP) maximal voluntary contraction (MVC) test and, (2) determine unilateral isometric absolute peak force (PFabs) and relative peak force (PF) values in freeski athletes. Twenty-one male and eight female academy to national team freeskiers performed the novel UIHBP MVC task on a force plate and PFabs and relative PF were assessed (1000 Hz). Within-session measures of PFabs offered high reliability on left and right limbs for males (ICC = 0.91-0.94, CV = 2.6-2.2%) and females (ICC = 0.94-0.94, CV = 1.4-1.6%), while relative PF measures showed good to high reliability in both left and right limbs for males (ICC = 0.8-0.84, CV = 2.6-2.2%) and females (ICC = 0.92-0.90, CV = 1.4-1.7%). We observed significantly lower PFabs (p < 0.001) and relative PF (p < 0.001) in females compared to males. No statistical difference was found between left and right limbs in males and females in PFabs (p = 0.98) and relative PF measures (p = 0.93). The UIHBP MVC test appears to be a reliable method for assessing PFabs and relative PF in male and female freeski athletes.
Collapse
Affiliation(s)
- Jonathan McPhail
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vesa Linnamo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
34
|
Schelin L, Pini A, Markström JL, Häger CK. Test-retest reliability of entire time-series data from hip, knee and ankle kinematics and kinetics during one-leg hops for distance: Analyses using integrated pointwise indices. J Biomech 2021; 124:110546. [PMID: 34171677 DOI: 10.1016/j.jbiomech.2021.110546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
Motion capture systems enable in-depth interpretations of human movements based on data from three-dimensional joint angles and moments. Such analyses carry important bearings for evaluation of movement control during for instance hop landings among sports-active individuals from a performance perspective but also in rehabilitation. Recent statistical development allows analysis of entire time-series of angle and moment during hops using functional data analysis, but the reliability of such multifaceted data is not established. We used integrated pointwise indices (intra-class correlation, ICC; standard error of measurement, SEM) to establish the test-retest reliability of three-dimensional hip, knee and ankle angle and moment curves during landings of one-leg hop for distance (OLHD) in 23 asymptomatic individuals aged 18-28. We contrasted these findings to reliability of discrete variables extracted at specific events (initial contact, peak value). We extended the calculations of ICC and SEM to handle unbalanced situations (varying number of repetitions) to include all available data. Hip and knee angle curves proved reliable with stable ICC curves throughout the landing, with integrated ICCs ≥ 0.71 for all planes except for knee internal/external rotation (ICC = 0.57). Hip and knee moment curves and ankle angle and moments were less reliable and less stable, particularly in the first ~ 10-25% of the landing (integrated ICCs 0.44-0.57). Curve data were generally not in agreement with the results for discrete event data, thus advocating analysis of curve data which contains more information. To conclude, hip and knee angle curve data during OLHD landings can reliably be evaluated, while moment curves necessitate careful consideration.
Collapse
Affiliation(s)
- Lina Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Samhällsvetarhuset, 901 87 Umeå, Sweden.
| | - Alessia Pini
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Jonas L Markström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
35
|
Davies WT, Myer GD, Read PJ. Is It Time We Better Understood the Tests We are Using for Return to Sport Decision Making Following ACL Reconstruction? A Critical Review of the Hop Tests. Sports Med 2021; 50:485-495. [PMID: 31745732 PMCID: PMC7018781 DOI: 10.1007/s40279-019-01221-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There has been a move towards a criterion-based return to play in recent years, with 4 single-leg hop tests commonly used to assess functional performance. Despite their widespread integration, research indicates that relationships between ‘passing’ ‘hop test criteria and successful outcomes following rehabilitation are equivocal, and, therefore, require further investigation. This critical review includes key information to examine the evolution of these tests, their reliability, relationships with other constructs, and sensitivity to change over time. Recommendations for how measurement and administration of the tests can be improved are also discussed. The evidence presented in this review shows that hop tests display good reliability and are sensitive to change over time. However, the use of more than 2 hop tests does not appear to be necessary due to high collinearity and no greater sensitivity to detect abnormality. The inclusion of other hop tests in different planes may give greater information about the current function of the knee, particularly when measured over time using both relative and absolute measures of performance. It is recommended that the contralateral limb be tested prior to surgery for a more relevant benchmark for performance, and clinicians are strongly advised to measure movement quality, as hop distance alone appears to overestimate the recovery of the knee.
Collapse
Affiliation(s)
- William T Davies
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar.
| | - Gregory D Myer
- Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Paul J Read
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
| |
Collapse
|
36
|
Kotsifaki A, Whiteley R, Van Rossom S, Korakakis V, Bahr R, Sideris V, Graham-Smith P, Jonkers I. Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction? Br J Sports Med 2021; 56:249-256. [DOI: 10.1136/bjsports-2020-103677] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 12/20/2022]
Abstract
BackgroundWe evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls).MethodsWe captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively.ResultsSignificant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion.ConclusionSymmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.
Collapse
|
37
|
Hammond KE, Kneer L, Cicinelli P. Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis. Clin Sports Med 2021; 40:409-428. [PMID: 33673896 DOI: 10.1016/j.csm.2021.01.002] [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] [Indexed: 11/25/2022]
Abstract
The athlete's hip is complex when it comes to the surrounding musculature-approximately 21 different muscles can cross the hip and pelvis region, all synchronously working to maintain pelvic stability and functional hip activities. Commonly injured muscle groups for high-level athletes include flexors, adductors, abductors, and/or proximal hamstring musculotendinous complex. These muscle groups work in harmony; however, each has an independent function and propensity for injury. Rehabilitation phases for each injury group can be broken down into 3 phases: acute management, strengthening, and return-to-sport or return-to-competition phase. Specific rehabilitation principles and modalities are described for each injury group.
Collapse
Affiliation(s)
- Kyle E Hammond
- Emory University Sports Medicine Center, 1968 Hawks Lane, Atlanta, GA 30329, USA.
| | - Lee Kneer
- Emory University Sports Medicine Center, 1968 Hawks Lane, Atlanta, GA 30329, USA. https://twitter.com/kneermd
| | - Pete Cicinelli
- Atlanta Braves, Truist Park, 755 Battery Avenue, Southeast, Atlanta, GA 30339, USA
| |
Collapse
|
38
|
King E, Richter C, Daniels KA, Franklyn-Miller A, Falvey E, Myer GD, Jackson M, Moran R, Strike S. Biomechanical but Not Strength or Performance Measures Differentiate Male Athletes Who Experience ACL Reinjury on Return to Level 1 Sports. Am J Sports Med 2021; 49:918-927. [PMID: 33617291 PMCID: PMC9677345 DOI: 10.1177/0363546520988018] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Performance measures such as strength, jump height/length, and change of direction (CoD) time during anterior cruciate ligament (ACL) rehabilitation have been used to determine readiness to return to play and identify those who may be at risk of rerupture. However, athletes may reach these criteria despite ongoing biomechanical deficits when performing these tests. Combining return-to-play criteria with an assessment of movement through 3-dimensional (3D) biomechanics in male field sports athletes to identify risk factors for ACL rerupture has not been explored previously. PURPOSE To prospectively examine differences in strength, jump, and CoD performance and movement using 3D biomechanics in a cohort of male athletes playing level 1 sports (ie, multidirectional field sports that involve landing, pivoting, or CoD) between those who reinjured the reconstructed ACL (RI group) and those with no reinjury (NRI group) after 2 years of follow-up and to examine the ability of these differences to predict reinjury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS After primary ACL reconstruction (ACLR), 1045 male athletes were recruited and underwent testing 9 months after surgery including isokinetic strength, jump, and CoD performance measures as well as patient-reported outcomes and 3D biomechanical analyses. Participants were followed up after 2 years regarding ACL reinjury status. Differences were determined between the RI and NRI groups in patient-reported outcomes, performance measures, and 3D biomechanics on the ACLR side and symmetry between limbs. The ability of these measures to predict ACL reinjury was determined through logistic regression. RESULTS No differences were identified in strength and performance measures on the ACLR side or in symmetry. Biomechanical analysis indicated differences on the ACLR side primarily in the sagittal plane for the double-leg drop jump (effect size, 0.59-0.64) and greater asymmetry primarily in the frontal plane during unplanned CoD (effect size, 0.61-0.69) in the RI group. While these biomechanical test results were different between groups, multivariate regression modeling demonstrated limited ability (area under the curve, 0.67 and 0.75, respectively) to prospectively predict ACL reinjury. CONCLUSION Commonly reported return-to-play strength, jump, and timed CoD performance measures did not differ between the RI and NRI groups. Differences in movement based on biomechanical measures during double-leg drop jump and unplanned CoD were identified, although they had limited ability to predict reinjury. Targeting these variables during rehabilitation may reduce reinjury risk in male athletes returning to level 1 sports after ACLR. REGISTRATION NCT02771548 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Department of Life Sciences, University of Roehampton, London, UK.,Address correspondence to Enda King, PT, PhD, Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland ()
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Katherine A.J. Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Queen’s School of Engineering, University of Bristol, Bristol, UK
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Eanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Mark Jackson
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland
| | - Ray Moran
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland
| | - Siobhan Strike
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland
| | | |
Collapse
|
39
|
King E, Richter C, Daniels KA, Franklyn-Miller A, Falvey E, Myer GD, Jackson M, Moran R, Strike S. Can Biomechanical Testing After Anterior Cruciate Ligament Reconstruction Identify Athletes at Risk for Subsequent ACL Injury to the Contralateral Uninjured Limb? Am J Sports Med 2021; 49:609-619. [PMID: 33560866 PMCID: PMC9938948 DOI: 10.1177/0363546520985283] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Athletes are twice as likely to rupture the anterior cruciate ligament (ACL) on their healthy contralateral knee than the reconstructed graft after ACL reconstruction (ACLR). Although physical testing is commonly used after ACLR to assess injury risk to the operated knee, strength, jump, and change-of-direction performance and biomechanical measures have not been examined in those who go on to experience a contralateral ACL injury, to identify factors that may be associated with injury risk. PURPOSE To prospectively examine differences in biomechanical and clinical performance measures in male athletes 9 months after ACLR between those who ruptured their previously uninjured contralateral ACL and those who did not at 2-year follow-up and to examine the ability of these differences to predict contralateral ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A cohort of male athletes returning to level 1 sports after ACLR (N = 1045) underwent isokinetic strength testing and 3-dimensional biomechanical analysis of jump and change-of-direction tests 9 months after surgery. Participants were followed up at 2 years regarding return to play or at second ACL injury. Between-group differences were analyzed in patient-reported outcomes, performance measures, and 3-dimensional biomechanics for the contralateral limb and asymmetry. Logistic regression was applied to determine the ability of identified differences to predict contralateral ACL injury. RESULTS Of the cohort, 993 had follow-up at 2 years (95%), with 67 experiencing a contralateral ACL injury and 38 an ipsilateral injury. Male athletes who had a contralateral ACL injury had lower quadriceps strength and biomechanical differences on the contralateral limb during double- and single-leg drop jump tests as compared with those who did not experience an injury. Differences were related primarily to deficits in sagittal plane mechanics and plyometric ability on the contralateral side. These variables could explain group membership with fair to good ability (area under the curve, 0.74-0.80). Patient-reported outcomes, limb symmetry of clinical performance measures, and biomechanical measures in change-of-direction tasks did not differentiate those at risk for contralateral injury. CONCLUSION This study highlights the importance of sagittal plane control during drop jump tasks and the limited utility of limb symmetry in performance and biomechanical measures when assessing future contralateral ACL injury risk in male athletes. Targeting the identified differences in quadriceps strength and plyometric ability during late-stage rehabilitation and testing may reduce ACL injury risk in healthy limbs in male athletes playing level 1 sports. CLINICAL RELEVANCE This study highlights the importance of assessing the contralateral limb after ACLR and identifies biomechanical differences, particularly in the sagittal plane in drop jump tasks, that may be associated with injury to this limb. These factors could be targeted during assessment and rehabilitation with additional quadriceps strengthening and plyometric exercises after ACLR to potentially reduce the high risk of injury to the previously healthy knee. REGISTRATION NCT02771548 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Life Sciences, Roehampton University, London, UK
- Address correspondence to Enda King, PT, PhD, Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland ()
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Life Sciences, Roehampton University, London, UK
| | - Katherine A.J. Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Queen’s School of Engineering, University of Bristol, Bristol, UK
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Eanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- ** Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Mark Jackson
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| | - Ray Moran
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| | - Siobhan Strike
- Department of Life Sciences, Roehampton University, London, UK
| | | |
Collapse
|
40
|
Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 48:209-218. [PMID: 33529930 DOI: 10.1016/j.ptsp.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury. OBJECTIVE The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks. DESIGN Narrative review. RESULTS The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.
Collapse
|
41
|
Whole-Body Change-of-Direction Task Execution Asymmetries After Anterior Cruciate Ligament Reconstruction. J Appl Biomech 2021; 37:176-181. [PMID: 33482630 DOI: 10.1123/jab.2020-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Cutting maneuvers can be executed at a range of angles and speeds, and these whole-body task descriptors are closely associated with lower-limb mechanical loading. Asymmetries in angle and speed when changing direction off the operated and nonoperated limbs after anterior cruciate ligament reconstruction may therefore influence the interpretation of interlimb differences in joint-level biomechanical parameters. The authors hypothesized that athletes would reduce center-of-mass heading angle deflection and body rotation during the change-of-direction stance phase when cutting from the operated limb, and would compensate for this by orienting their center-of-mass trajectory more toward the new intended direction of travel prior to touchdown. A total of 144 male athletes 8 to 10 months after anterior cruciate ligament reconstruction performed a maximum-effort sidestep cutting maneuver while kinematic, kinetic, and ground reaction force data were recorded. Peak ground reaction force and knee joint moments were lower when cutting from the operated limb. Center-of-mass heading angle deflection during stance phase was reduced for cuts performed from the operated limb and was negatively correlated with heading angle at touchdown. Between-limb differences in body orientation and horizontal velocity at touchdown were also observed. These systematic asymmetries in cut execution may require consideration when interpreting joint-level interlimb asymmetries after anterior cruciate ligament reconstruction and are suggestive of the use of anticipatory control to co-optimize task achievement and mechanical loading.
Collapse
|
42
|
Murphy D, Louw QA, Moloney C, Leibbrandt D, Clifford AM. Hop Performance After Return to Sport in Anterior Cruciate Ligament-Reconstructed Gaelic Football and Hurling Athletes. J Sport Rehabil 2021; 30:707-716. [PMID: 33418539 DOI: 10.1123/jsr.2019-0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/03/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. METHODS A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. RESULTS In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. CONCLUSIONS The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.
Collapse
|
43
|
Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
|
44
|
McFadden C, Daniels K, Strike S. The effect of simulated marker misplacement on the interpretation of inter-limb differences during a change of direction task. J Biomech 2020; 116:110184. [PMID: 33418480 DOI: 10.1016/j.jbiomech.2020.110184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/28/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
The objective assessment of biomechanical asymmetries during movement tasks is used to monitor rehabilitation following anterior cruciate ligament reconstruction (ACLR). Marker placement is an important source of methodological variability within human motion analysis. It is currently unclear how marker placement error effects the interpretation of biomechanical asymmetries throughout post ACLR rehabilitation. The aim of this investigation was to determine the effect of random marker placement variation on the interpretation of inter-limb differences during a change of direction (CoD) task. Forty-seven participants 9 months post-ACLR and fifty uninjured controls completed a 90° CoD task on both limbs. Inter-limb differences in kinematic and kinetic metrics during the CoD stance phase were calculated for both groups using the Vicon Plug-in Gait model, and ACLR subjects were classified as having 'normal' or 'abnormal' inter-limb differences relative to the control group. Simulated random marker displacements based on published marker placement error ranges were then repeatedly applied to the lateral thigh, femoral epicondyle and tibia markers. ACLR inter-limb differences were recalculated each time, allowing the estimation of 95% confidence intervals and minimal identifiable between-session changes. ACLR subjects were also reclassified relative to the control group after each simulation and the percentage of participants to change classification was calculated. Marker displacements caused large deviations in inter-limb difference measures in several variables including hip rotation angle, knee abduction angle and knee abduction moment, thus limiting the ability to identify participants with large inter-limb differences relative to a control group. These findings highlight the challenges in using marker-based biomechanical models to conduct objective assessments of inter-limb differences during CoD tasks.
Collapse
Affiliation(s)
- Ciarán McFadden
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK.
| | - Katherine Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; Queen's School of Engineering, University of Bristol, Bristol, UK; Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Siobhán Strike
- Department of Life Sciences, University of Roehampton, London, UK
| |
Collapse
|
45
|
Sharafoddin-Shirazi F, Letafatkar A, Hogg J, Saatchian V. Biomechanical asymmetries persist after ACL reconstruction: results of a 2-year study. J Exp Orthop 2020; 7:86. [PMID: 33159260 PMCID: PMC7647975 DOI: 10.1186/s40634-020-00301-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study was aimed to examine longitudinal (6, 12, 18, 24 months) asymmetries in double-leg landing kinetics and kinematics of subjects with and without unilateral ACLR. METHODS Three-dimensional kinematic and kinetic parameters of 40 participants (n = 20 post-ACLR, n = 20 healthy) were collected with a motion analysis system and force plate during a drop-landing task, and asymmetry indices were compared between groups. RESULTS The asymmetry index (AI) in the ACLR group compared to the healthy group decreased from six to 24 months for vertical ground reaction force (vGRF) from 100% to 6.5% and for anterior posterior ground reaction force (a-pGRF) from 155.5% to 7%. Also, the AI decreased for peak hip flexion moment from 74.5% to 17.1%, peak knee flexion moment from 79.0% to 5.8% and peak ankle dorsiflexion moment from 59.3% to 5.9%. As a further matter, the AI decreased for peak hip abduction moment from 67.8% to 5.1%, peak knee adduction moment from 55.7% to 14.8% and peak knee valgus angle from 48.7% to 23.5%. CONCLUSIONS Results obtained from this longitudinal study showed that ACLR patients still suffer from limb asymmetries during landing tasks, which appear to normalize by 24-monthspost-surgery. This finding can help us to better understand biomechanics of the limbs after ACLR, and design more efficient post-surgery rehabilitation programs. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | - Amir Letafatkar
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran. .,Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran.
| | - Jennifer Hogg
- Graduate Athletic Training Program, Health & Human Performance Department, University of Tennessee Chattanooga, Chattanooga, USA
| | - Vahid Saatchian
- Faculty of Physical Education and Sports Sciences, Imamreza University, Mashhad, Iran
| |
Collapse
|
46
|
Lloyd RS, Oliver JL, Kember LS, Myer GD, Read PJ. Individual hop analysis and reactive strength ratios provide better discrimination of ACL reconstructed limb deficits than triple hop for distance scores in athletes returning to sport. Knee 2020; 27:1357-1364. [PMID: 33010748 PMCID: PMC9892801 DOI: 10.1016/j.knee.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The triple hop for distance test commonly uses a limb symmetry index (LSI) 'pass' threshold of >90% for total hop distance following anterior cruciate ligament reconstruction (ACLR). However, understanding the manner in which athletes generate and dissipate forces during consecutive hops within the test may provide greater insight into residual limb deficits. The aim of the study was to examine reactive strength ratios (RSR) of individual hops during a triple hop test in a cohort of ACLR patients at discharge prior to return-to-sport. METHODS Twenty male athletes (24.6 ± 4.2 years; height 175.3 ± 10.2 cm; mass 73.6 ± 14.5 kg) completed the test on both non-operated and operated limbs. Total distance hopped, contact times, flight times and RSR were collected for each hop using a floor-level optical measurement system. RESULTS Significant, small to moderate between-limb differences (p < 0.05; d = 0.45-0.72) were shown for triple hop distance, flight time and RSR for each hop, with lower performance consistently displayed in the operated limb. Large, significant differences in RSR were evident between hops one and two on the operated limb (p < 0.05; d = 0.97). Despite 80% of participants achieving >90% LSI for total hop distance, less than 50% of participants reached the >90% LSI threshold for RSR. CONCLUSIONS Standardised LSI 'pass' thresholds (>90% LSI) for triple hop distance may mask residual deficits in reactive strength performance of operated limbs; therefore, more detailed analyses of individual hop performance may be warranted to enhance return to sport criteria following ACLR.
Collapse
Affiliation(s)
- Rhodri S. Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand,Corresponding author at: School of Sport, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff CF23 6XD, UK. . (R.S. Lloyd)
| | - Jon L. Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Lucy S. Kember
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Paul J. Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| |
Collapse
|
47
|
Carolan D, King E, Richter C, Franklyn-Miller A, Moran R, Jackson M. Differences in Strength, Patient-Reported Outcomes, and Return-to-Play Rates Between Athletes With Primary Versus Revision ACL Reconstruction at 9 Months After Surgery. Orthop J Sports Med 2020; 8:2325967120950037. [PMID: 32984423 PMCID: PMC7498981 DOI: 10.1177/2325967120950037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Patient-reported outcomes and return-to-play (RTP) rates are inferior after
revision anterior cruciate ligament reconstruction (ACLR) compared with
primary ACLR. Physical properties such as maximal, explosive, and reactive
strength influence reinjury and RTP rates after ACLR. No study has compared
these outcomes between revision and primary ACLR. Purpose: To compare maximal, explosive, and reactive strength of the ACLR limb, as
well as patient-reported outcomes and RTP rates between primary and revision
ACLR at 9 months after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A comparative study was performed at 9 months after surgery for 344 male
athletes who had undergone ACLR (298 primary, 46 revision). Maximal strength
of the ACLR limb was measured by means of isokinetic dynamometry. Explosive
strength was measured by use of single-leg countermovement jump height, and
reactive strength was measured by single-leg drop jump. Patient-reported
outcomes and responses to RTP questionnaires were recorded for both
groups. Results: The primary ACLR group had higher scores than the revision ACLR group for
single-leg countermovement jump height (P = .02) and
single-leg drop jump reactive strength index (P = .01) on
the ACLR limb. No significant difference was observed between groups on
maximal strength of the quadriceps or hamstring, and no significant
difference in limb symmetry index was observed between groups on any
strength or jump test. The primary ACLR group demonstrated higher scores on
the Marx Activity Rating Scale (P = .03) and the Anterior
Cruciate Ligament–Return to Sport after Injury scale (P
< .001). Athletes in the primary ACLR group were more likely to have
returned to sport (P < .001). Conclusion: At 9 months after surgery, athletes who had undergone revision ACLR achieved
maximal strength similar to that of athletes who had undergone primary ACLR.
However, athletes who had revision ACLR demonstrated lower scores on
explosive and reactive strength tests. Athletes who underwent revision ACLR
had lower RTP rates at 9 months after surgery, potentially due to explosive
and reactive strength deficits and lower perceived readiness for RTP.
Collapse
Affiliation(s)
- David Carolan
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland
| | - Enda King
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,Department of Life Sciences, Roehampton University, Roehampton, UK
| | - Chris Richter
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,Department of Life Sciences, Roehampton University, Roehampton, UK
| | - Andy Franklyn-Miller
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Ray Moran
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland
| | - Mark Jackson
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland
| |
Collapse
|
48
|
Heil J, Loffing F, Büsch D. The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review. SPORTS MEDICINE - OPEN 2020; 6:39. [PMID: 32844254 PMCID: PMC7447715 DOI: 10.1186/s40798-020-00270-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/12/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries. OBJECTIVE The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review. METHODS A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol. RESULTS Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters. CONCLUSIONS Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.
Collapse
Affiliation(s)
- Jessica Heil
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.
| | - Florian Loffing
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Dirk Büsch
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| |
Collapse
|
49
|
Maestroni L, Read P, Bishop C, Turner A. Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Sports Med 2020; 50:239-252. [PMID: 31559567 DOI: 10.1007/s40279-019-01195-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.
Collapse
Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy.
- StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| |
Collapse
|
50
|
Krafft FC, Stetter BJ, Stein T, Ellermann A, Flechtenmacher J, Eberle C, Sell S, Potthast W. Deficient knee joint biomechanics in bilateral jumping after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 77:105048. [PMID: 32454346 DOI: 10.1016/j.clinbiomech.2020.105048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to analyze sagittal-plane knee biomechanics in individuals with ACL reconstructions in bilateral countermovement jumps. This aimed to determine potential knee compensation strategies during a high-demanding symmetrical movement task from pre to six months post-ACL reconstruction. METHODS 20 ACL-reconstructed individuals were tested pre-operatively, and then seven weeks, three months, and six months after reconstruction. Additionally, a matched control group was analyzed. Data were sampled with 3D motion capture and two force plates. The following kinematic data were analyzed: peak knee flexion during countermovement, knee angle at toe-off, and knee flexion excursion during landing. The following kinetic data were analyzed: peak knee extension moments during countermovement and landing. FINDINGS ACL-reconstructed individuals showed significant increases in knee flexion during countermovement and knee flexion excursion during landing from six weeks to six months after reconstruction but they remained significantly below the level of the controls. The reconstructed knee joint showed increased flexion at toe-off compared to the non-injured leg at all test sessions. Knee extension moments during countermovement increased up to six months after reconstruction, but remained deficient in ACL-reconstructed individuals during countermovement and landing compared to the controls. INTERPRETATION Although ACL-reconstructed individuals showed increases in most kinematic and kinetic variables, they remained below the controls at six months post-ACL reconstruction. The deficits between contralateral legs and compared to the controls show that six months post-ACL reconstruction, knee joint functionality was still not equal between reconstructed and non-injured legs or in comparison to controls.
Collapse
Affiliation(s)
- Frieder Cornelius Krafft
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany.
| | - Bernd Josef Stetter
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Thorsten Stein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Andree Ellermann
- ARCUS Clinics, Rastatter Strasse 17-19, 75179 Pforzheim, Germany
| | | | - Christian Eberle
- ARCUS Clinics, Rastatter Strasse 17-19, 75179 Pforzheim, Germany
| | - Stefan Sell
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany; Joint Center Black Forest, Hospital Neuenbuerg, Marxzeller Strasse 46, 75305 Neuenbuerg, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| |
Collapse
|