1
|
Mohammadi Orangi B, Dehghani M, Jones PA. Manipulation of task constraints is the most effective motor learning method for reducing risk factors for ACL injury during side-step cutting in both male and female athletes. Res Sports Med 2024; 32:631-647. [PMID: 37158705 DOI: 10.1080/15438627.2023.2209248] [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: 01/11/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
This study compared the efficacy of linear, non-linear and differential methods on variables related to ACL injury risk of a side-step cutting task in male and female basketball players. Thirty males and thirty females practiced basketball skills in sixty 90-minute sessions across 5 months. Ten players trained in each of the LP, NLP and DL female/male groups separately. Before and after the intervention, each player was tested on a side-step cutting task. A repeated 3 × 2 × 2 factorial ANOVA with repeated measures was performed for each biomechanical variable. Variables (trunk, hip, and knee flexion angle, knee valgus angle, ankle dorsiflexion angle, hip, knee, and ankle ROM, peak VGRF and knee extension/flexion, knee moment and ankle dorsiflexion moment) all revealed significant test by group interactions (P < 0.05) but no significant group by sex interactions (P > 0.05). In both sex, biomechanical changes were better in the NLP, followed by the DL and LP. It is argued that the advantage of the NLP method results from increased exploration of movement solutions induced by the manipulation of task constraints. Therefore, according to the NLP, it is possible to manipulate the constraints without feedback and the model/pattern can keep the athlete away from possible risks.
Collapse
Affiliation(s)
| | - Mahrokh Dehghani
- Faculty of Physical Education and Sport Sciences, University of Mohaghegh Ardabili, Iran
| | - Paul A Jones
- Centre for Health Sciences Research, School of Health & Society, University of Salford, UK
| |
Collapse
|
2
|
Ubl ST, Vieider RP, Seilern und Aspang J, Gaebler C, Platzgummer H. Bone bruise distribution predicts anterior cruciate ligament tear location in non-contact injuries. J Exp Orthop 2024; 11:e12034. [PMID: 38741902 PMCID: PMC11089843 DOI: 10.1002/jeo2.12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between bone bruise (BB) distribution or depth and ACL tear location. Methods A retrospective analysis of 446 consecutive patients with acute non-contact ACL injury was performed. Only patients with complete ACL tears verified during subsequent arthroscopy were included. Magnetic resonance imaging (MRI) was used to classify BB location, BB depth, ACL tear location and concomitant injuries (medial/lateral meniscus and medial/lateral collateral ligament). Demographic characteristics included age, gender, body mass index (BMI), type of sport and time between injury and MRI. Multiple linear regression analysis was used to identify independent predictors of ACL tear location. Results One hundred and fifty-eight skeletally mature patients met the inclusion criteria. The presence of BB in the lateral tibial plateau was associated with a more distal ACL tear location (β = -0.27, p < 0.001). Less BB depth in the lateral femoral condyle showed a tendency towards more proximal ACL tears (β = -0.14; p = 0.054). Older age predicted a more proximal ACL tear location (β = 0.31, p < 0.001). No significant relationship was found between ACL tear location and gender, BMI, type of sport, concomitant injuries and time between injury and MRI. Conclusion ACL tear location after an acute non-contact injury is associated with distinct patterns of BB distribution, particularly involving the lateral compartment, indicating that different injury mechanisms may lead to different ACL tear locations. Level of Evidence Level III.
Collapse
Affiliation(s)
- Steffen T. Ubl
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical CenterWitten/Herdecke UniversityCologneGermany
| | - Romed P. Vieider
- Department of Sports Orthopaedics, Klinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Jesse Seilern und Aspang
- Department of Orthopaedic Surgery, Grady Memorial HospitalEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christian Gaebler
- Sportambulatorium Wien – Zentrum für Orthopaedie und Sportchirurgie (ZOS)ViennaAustria
| | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| |
Collapse
|
3
|
Ye B, Liu G, He Z, Xu J, Pan H, Zhu H. Biomechanical mechanisms of anterior cruciate ligament injury in the jerk dip phase of clean and jerk: A case study of an injury event captured on-site. Heliyon 2024; 10:e31390. [PMID: 38832262 PMCID: PMC11145241 DOI: 10.1016/j.heliyon.2024.e31390] [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: 03/16/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Background Weightlifting exposes athletes to significant loads, potentially placing the knee joint in an abnormal mechanical environment and leading to anterior cruciate ligament (ACL) injuries. Once an ACL injury occurs, it can affect athletes' competitive ability to varying degrees and even prematurely end their career. Understanding the biomechanical mechanisms of ACL injuries in weightlifters helps in comprehensively understanding the stress patterns and degrees on ACL during human movement, and identifying potential injury-causing factors, thereby enabling the implementation of appropriate preventive measures to reduce the occurrence of injuries. This study aimed to explore the biomechanical mechanisms of ACL injuries during the jerk dip phase of clean and jerk in weightlifters, providing a theoretical basis for the prevention of ACL injuries in weightlifting sports. Methods This study utilized the German SIMI Motion 10.2 movement analysis system and the AnyBody simulation system to analyze the kinematic and dynamic parameters of a 109 kg + class weightlifter (height: 191 cm, age: 22 years, weight: 148 kg, athletic level: elite) performing a 205 kg clean and jerk (non-injured) and a 210 kg clean and jerk (ACL injury occurred). The differences in kinematic and dynamic indicators of lower limb joints under injured and non-injured jerk dip conditions were investigated. Results Knee joint torque during non-injured clean and jerk was consistently positive (i.e., external rotation) but turned from positive to negative (i.e., from external rotation to internal rotation) during injured clean and jerk and reached a maximum internal rotation torque of 21.34 Nm at the moment of injury. At every moment, the muscle activation and simulated muscle force of the quadriceps and gastrocnemius during the injured clean and jerk were higher than those during the non-injured clean and jerk. By contrast, the muscle activation and simulated muscle force of the semitendinosus, semimembranosus, biceps femoris, and soleus during non-injured clean and jerk were higher than those during injured clean and jerk. The knee joint internal rotation angle during injured clean and jerk first increased and then declined, reaching a peak at 46.93° at the moment of injury, whereas it gradually increased during non-injured clean and jerk. The proximal tibia on the left side during the injured clean and jerk moved forward faster by 0.76 m/s compared with that during the non-injured clean and jerk. Conclusions The small muscle activation and simulated muscle force of the hamstring and soleus could not resist timely and effectively the large muscle activation and simulated muscle force of the quadriceps (especially the medial quad) and gastrocnemius. As such, the force applied to the ACL could exceed its ultimate load-bearing capacity. Kinematic indicators in the athlete's injured lift demonstrated certain disparities from those in their non-injured lift. Knee internal rotation and tibial anterior translation during the jerk dip phase of weightlifting might be the kinematic characteristics of ACL injuries.
Collapse
Affiliation(s)
- Binyong Ye
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, 321000, China
| | - Gongju Liu
- Scientific Research Center & Laboratory of Aquatic Sports Science of General Administration of Sports China, Zhejiang College of Sports, Hangzhou, 311200, China
| | - Zhanyang He
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, 321000, China
| | - Jun Xu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, 321000, China
| | - Huiju Pan
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, 321000, China
| | - Houwei Zhu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, 321000, China
| |
Collapse
|
4
|
Butcher AJ, Ward S, Clissold T, Richards J, Hébert-Losier K. Maturation and biomechanical risk factors associated with anterior cruciate ligament injury: Is there a link? A systematic review. Phys Ther Sport 2024; 68:31-50. [PMID: 38908221 DOI: 10.1016/j.ptsp.2024.06.002] [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: 04/10/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To establish the potential link between sex-specific maturation and biomechanical factors associated with ACL injury during dynamic tasks. DESIGN Systematic review. LITERATURE SEARCH Five databases (CINHAL®, Cochrane Library, PubMed®, Scopus®, and SPORTDiscus) were searched and monitored until 27 May 2024. STUDY SELECTION CRITERIA Cross-sectional, cohort, case-control, or interventional studies reporting one or more biomechanical variable linked with ACL injury and which assessed participants across two or more maturation phases were considered eligible. DATA SYNTHESIS Studies were assessed for risk of bias using a modified version of the Newcastle Ottawa Scale and overall quality of evidence was rated using GRADE. Metrics and effect sizes were presented where available. RESULTS Eighteen included studies examined 400 males, 1377 females, and 315 participants of undefined sex across various maturation phases. The methodological quality of most studies (n = 16) was considered good, and satisfactory for two. Knee abduction angle, knee abduction moment, knee flexion angle, and ground reaction forces were most commonly reported. Knee abduction angles and moments and knee flexion angles were greater in late and post-pubertal females than males and pre-pubertal females during both landing and cutting tasks. When normalised for body mass, ground reaction forces were generally greater in males compared to females overall and for less mature participants for both sexes. Overall quality of evidence was low or medium across the four biomechanical measures. CONCLUSION Sex-specific maturation considerations are important in the targeted development and implementation of ACL injury risk identification and prevention strategies.
Collapse
Affiliation(s)
- Anna J Butcher
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand.
| | - Sarah Ward
- Department of Exercise Sciences, University of Auckland, Suiter Street, Newmarket, New Zealand. https://twitter.com/sarahward_nz
| | - Tracey Clissold
- Toi Ohomai Institute of Technology, 70 Windermere Drive, Poike, 3112, Tauranga, New Zealand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, England, United Kingdom. https://twitter.com/ProfJimRichards
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand. https://twitter.com/KimHebertLosier
| |
Collapse
|
5
|
Hardaker NJ, Hume PA, Sims ST. Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis. Sports Med 2024; 54:1595-1665. [PMID: 38536647 DOI: 10.1007/s40279-024-02010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries. OBJECTIVE The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist. RESULTS Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition. DISCUSSION Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes. CONCLUSIONS Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury. TRIAL REGISTRY PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).
Collapse
Affiliation(s)
- Natalie J Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
- Accident Compensation Corporation, Wellington, New Zealand.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Tech & Policy Lab, Law School, The University of Western Australia, Perth, Australia
| | - Stacy T Sims
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Stanford Lifestyle Medicine, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
6
|
Figueroa D, Figueroa ML, Figueroa F. Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis. J ISAKOS 2024; 9:378-385. [PMID: 38242500 DOI: 10.1016/j.jisako.2024.01.008] [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: 10/31/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
IMPORTANCE Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes. OBJECTIVE The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS. EVIDENCE REVIEW A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted. FINDINGS Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]. CONCLUSIONS This systematic review demonstrates that a majority of female athletes (69 %) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- David Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile
| | - María Loreto Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile.
| | - Francisco Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile; Departamento de Traumatología, Hospital Dr. Sótero del Río, Santiago, 8207257, Chile
| |
Collapse
|
7
|
Girts RM, Harmon KK, Rodriguez G, Beausejour JP, Pagan JI, Carr JC, Garcia J, Stout JR, Fukuda DH, Stock MS. Sex differences in muscle-quality recovery following one week of knee joint immobilization and subsequent retraining. Appl Physiol Nutr Metab 2024; 49:805-817. [PMID: 38382056 DOI: 10.1139/apnm-2023-0242] [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: 02/23/2024]
Abstract
This manuscript represents the second phase of a clinical trial designed to examine the effects of knee joint immobilization and retraining on muscle strength and mass. In Phase 2, we examined sex differences in the recovery of multiple indices of muscle quality after a resistance training-based rehabilitation program. Following 1 week of immobilization, 27 participants (16 males, 11 females) exhibiting weakness underwent twice weekly resistance training sessions designed to re-strengthen their left knee. Unilateral retraining sessions utilizing leg press, extension, and curl exercises were conducted until participants could reproduce their pre-immobilization knee extension isometric maximal voluntary contraction (MVC) peak torque. Post-immobilization, both sexes demonstrated impaired MVC peak torque (males = -10.8%, females = -15.2%), specific torque (-9.8% vs. -13.1%), echo intensity of the vastus lateralis (+6.9% vs. +5.9%) and rectus femoris (+5.9% vs. +2.1), and extracellular water/intracellular water ratio (+7.8% vs. +9.0%). The number of retraining sessions for peak torque to return to baseline for males (median = 1, mean = 2.13) versus females (median = 2, mean = 2.91) was not significantly different, though the disparity in recovery times may be clinically relevant. Following retraining, specific torque was the only muscle-quality indicator that improved along with MVC peak torque (males = 20.1%, females = 22.4%). Our findings indicate that measures of muscle quality demonstrate divergent recovery rates following immobilization, with muscle mass lagging behind improvements in strength. Greater immobilization-induced strength loss among females suggests that sex-specific rehabilitation efforts may be justified.
Collapse
Affiliation(s)
- Ryan M Girts
- Department of Natural and Health Sciences, Pfeiffer University, Misenheimer, NC, USA
| | - Kylie K Harmon
- Department of Exercise ScienceSyracuse University, Syracuse, NY, USA
| | - Gabriela Rodriguez
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Jonathan P Beausejour
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Jason I Pagan
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Joshua C Carr
- Department of Kinesiology, Texas Christian University, Fort Worth, TX, USA
- Department of Medical Education, Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, TX, USA
| | - Jeanette Garcia
- School of Sport Sciences West Virginia University, Morgantown, WV, USA
| | - Jeffrey R Stout
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - David H Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| | - Matt S Stock
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
8
|
Kashikar-Zuck S, Thomas S, Bonnette S, Gibler RC, DiCesare C, Schille A, Hulburt T, Briggs MS, Ounpuu S, Myer GD. Comparison of Pain Characteristics, Strength, and Movement Patterns in Adolescents With Juvenile Fibromyalgia and High Versus Low Fear of Movement. THE JOURNAL OF PAIN 2024:104586. [PMID: 38823603 DOI: 10.1016/j.jpain.2024.104586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/30/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
Physical activity avoidance and fear of movement (FOM) is often observed in individuals with chronic musculoskeletal pain, along with difficulties coping with pain. There is little research regarding how FOM may also relate to reduced physical strength and altered movement patterns that may perpetuate a cycle of pain, FOM, and disability. The objective of this observational study was to compare how adolescents with juvenile fibromyalgia (JFM) exhibiting high versus low FOM (Tampa Scale of Kinesiophobia-11) differed on patient-reported measures of pain, fatigue, catastrophizing and pain interference, and performance-based measures of strength, postural control, and biomechanical function. Participants were youth with JFM (N = 135, Meanage = 15.6 years, 88.9% female) enrolled in an ongoing clinical trial who completed self-report questionnaires and standardized tests, including knee and hip strength, the Star Excursion Balance Test, and the Drop Vertical Jump (with 3 dimensional motion capture). Participants were categorized into Low, Medium, and High FOM groups based on Tampa Scale of Kinesiophobia-11 tertile scores. Relative to the Low FOM group, the High FOM group reported significantly greater fatigue, pain interference and catastrophizing, as well as reduced dominant leg knee strength. Additionally, those with high FOM showed altered lower-extremity movement patterns. This preliminary study highlights the importance of combining self-reported measures of symptoms and functioning with physical assessments to gain a more comprehensive view of the impact of FOM in patients with chronic musculoskeletal pain. The results could inform the development of more precise interventions to reduce FOM using a combination of behavioral and exercise-based interventions. PERSPECTIVE The results of this study demonstrate the association between FOM, fatigue and pain interference in adolescents with JFM, as well as preliminary evidence for altered movement patterns in that may predispose them to further pain/injury and activity avoidance. CLINICAL TRIALS GOV REGISTRATION NCT03268421.
Collapse
Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio.
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Robert C Gibler
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Andrew Schille
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, Georgia
| | - Tessa Hulburt
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew S Briggs
- Sports Medicine Research Institute, Department of Orthopaedics, and Rehabilitation Services The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sylvia Ounpuu
- Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, Farmington, Connecticut
| | - Greg D Myer
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
9
|
Bennett H, Fuller J, Debenedictis T, Chalmers S. Ankle sprain, concussion, and anterior cruciate ligament injuries are common and burdensome in sub-elite female Australian football players. J Sci Med Sport 2024:S1440-2440(24)00157-9. [PMID: 38839540 DOI: 10.1016/j.jsams.2024.05.008] [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: 11/22/2023] [Revised: 02/28/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To describe the epidemiology of injuries in sub-elite female Australian Football (AF). DESIGN Prospective cohort. METHODS 424 athletes were tracked across a 12-match season. Injury characteristics (location, severity, mechanism) were reported. Injury incidence (injuries per 1000 h) and injury burden (days absent per 1000 h) were calculated. Severity was considered as the number of days missed between injury onset and return to full training. Incidence was compared using incidence rate ratios, and severity using a Mann-Whitney U test. RESULTS Total injury incidence was 10.8 (95 % confidence interval [CI] = 9.0, 12.8) injuries per 1000 h. Match incidence was 34.6 (95 % CI = 28.0, 42.4) injuries per 1000 h. Ankle sprain injuries (2.2 per 1000 h, 95 % CI = 1.4, 3.1) and concussion (1.6 per 1000 h, 95 % CI = 1.0, 2.5) injuries were the most frequent, followed by anterior cruciate ligament (ACL) injuries (0.9 per 1000 h, 95 % CI = 0.4, 1.6). ACL (40.4 days per 1000 h, 95 % CI = 36.9, 44.1), ankle sprain injuries (31.4 per 1000 h, 95 % CI =28.4, 34.7), and concussion (19.9 per 1000 h, 95 % CI = 17.5, 22.5) injuries were also the most burdensome. There were 78 mild, 34 moderate, and 21 severe injuries. ACL injuries were the most severe injury (56.0 [77.0] in-season days missed). CONCLUSIONS This research describes the first large-scale injury profile of sub-elite female AF, reporting time-loss measures of incidence and burden for many injury types. Ankle sprain injuries, concussions, and ACL injuries are common and burdensome, and should be prioritised for prevention.
Collapse
Affiliation(s)
- Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Australia; Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Australia.
| | - Joel Fuller
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Thomas Debenedictis
- South Australian National Football League, Australia. https://twitter.com/tommyd_90
| | - Samuel Chalmers
- Allied Health and Human Performance, University of South Australia, Australia; Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Australia. https://twitter.com/_samchalmers
| |
Collapse
|
10
|
Hernandez PA, Bradford JC, Brahmachary P, Ulman S, Robinson JL, June RK, Cucchiarini M. Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life? Osteoarthritis Cartilage 2024:S1063-4584(24)01172-5. [PMID: 38703811 DOI: 10.1016/j.joca.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. DESIGN We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives. RESULTS The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. CONCLUSIONS We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.
Collapse
Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | - Priyanka Brahmachary
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Sophia Ulman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Movement Science Laboratory, Scottish Rite for Children, Frisco, TX 75034, USA.
| | - Jennifer L Robinson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar D-66421, Germany.
| |
Collapse
|
11
|
Bill K, Mai P, Mausehund L, Solbakken S, Krosshaug T, Kersting UG. Individualized Technique Feedback for Instant Technique Improvements and Knee Abduction Moment Reductions - A New Approach for 'Sidestepping' ACL Injuries? Int J Sports Phys Ther 2024; 19:535-547. [PMID: 38707847 PMCID: PMC11065769 DOI: 10.26603/001c.116274] [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: 11/22/2023] [Accepted: 03/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background Sidestep cutting technique is highly individual and has been shown to influence knee joint loading. However, studies assessing whether individualized technique feedback improves technique and ACL injury-relevant knee joint loads instantly in a sport-specific task are lacking. Purpose To determine the instant effects of individualized augmented technique feedback and instructions on technique and the peak external knee abduction moment (pKAM) in a handball-specific sidestep cut. Additionally, to determine the effects of technique modifications on the resultant ground reaction force and its frontal plane moment arm to the knee joint center. Study Design Controlled laboratory cohort study. Methods Three-dimensional biomechanics of 48 adolescent female handball players were recorded during a handball-specific sidestep cut. Following baseline cuts to each side, leg-specific visual and verbal technique feedback on foot strike angle, knee valgus motion, or vertical impact velocity using a hierarchically organized structure accounting for the variables' association with performance was provided. Subsequently, sidestep cuts were performed again while verbal instructions were provided to guide technique modifications. Combined effects of feedback and instructions on technique and pKAM as well as on the resultant ground reaction force and its frontal plane moment arm to the knee joint center were assessed. Results On average, each targeted technique variable improved following feedback and instructions, leading to instant reductions in pKAM of 13.4% to 17.1%. High inter-individual differences in response to feedback-instruction combinations were observed. These differences were evident in both the adherence to instructions and the impact on pKAM and its components. Conclusion Most players were able to instantly adapt their technique and decrease ACL injury-relevant knee joint loads through individualized augmented technique feedback, thereby potentially reducing the risk of injury. More research is needed to assess the retention of these adaptations and move towards on-field technique assessments using low-cost equipment. Level of Evidence Level 3.
Collapse
Affiliation(s)
- Kevin Bill
- Institute of Biomechanics and OrthopaedicsGerman Sport University Cologne
| | - Patrick Mai
- Institute of Biomechanics and OrthopaedicsGerman Sport University Cologne
- Department of Physical PerformanceNorwegian School of Sport Sciences
- Institute of Advanced Biomechanics and Motion StudiesOffenburg University of Applied Sciences
| | - Lasse Mausehund
- Oslo Sports Trauma Research Center, Department of Sports MedicineNorwegian School of Sport Sciences
| | | | - Tron Krosshaug
- Oslo Sports Trauma Research Center, Department of Sports MedicineNorwegian School of Sport Sciences
| | - Uwe G. Kersting
- Institute of Biomechanics and OrthopaedicsGerman Sport University Cologne
| |
Collapse
|
12
|
Ramachandran AK, Pedley JS, Moeskops S, Oliver JL, Myer GD, Lloyd RS. Changes in Lower Limb Biomechanics Across Various Stages of Maturation and Implications for ACL Injury Risk in Female Athletes: a Systematic Review. Sports Med 2024:10.1007/s40279-024-02022-3. [PMID: 38671176 DOI: 10.1007/s40279-024-02022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Female athletes are four to six times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Jump-landing biomechanics are influenced by maturation, with post-pubertal female athletes at a heightened risk of ACL injuries. OBJECTIVE The aim of our systematic review was to identify and summarise the current evidence regarding the changes in kinematic and kinetic risk factors associated with ACL injuries during jump-landing tasks in female athletes at various stages of maturity. METHODS A systematic search was conducted in PubMed, CINAHL, Web of Science, SPORTDiscus, EMBASE and Scopus. Articles were included if they: (1) conducted the research on uninjured female athletes with no restriction on playing level/experience; (2) provided information regarding the stage of the maturity and the scale used for estimating the maturity status of the participants; and (3) reported a biomechanical risk factor associated with ACL injuries during jump-landing tasks across at least two different maturity groups (e.g. pre-pubertal vs post-pubertal). RESULTS Sixteen articles involving 2323 female athletes were included in our review. A total of 12 kinematic and 8 kinetic variables were identified across these studies. Of the 12 kinematic variables reported in our review, we found strong evidence for higher peak knee abduction angle in post-pubertal female individuals compared with pre-pubertal girls (p < 0.05). With regard to the 8 kinetic variables, we found strong evidence for lower relative peak vertical ground reaction force, higher external knee abduction moment and internal rotation moment in post-pubertal compared with pre-pubertal athletes. The strength of evidence for the remaining kinematic and kinetic variables ranged from conflicting to moderate and, in some instances, could not be determined. CONCLUSIONS Our study provides an overview of the changes in biomechanical risk factors in female athletes during jump-landing tasks at various stages of maturity. We found moderate-to-limited evidence for most kinematic and kinetic variables, highlighting the need for further research.
Collapse
Affiliation(s)
- Akhilesh Kumar Ramachandran
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK.
| | - Jason S Pedley
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Sylvia Moeskops
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Gregory D Myer
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, 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
| |
Collapse
|
13
|
Fortington LV, Badenhorst M, Derman W, Emery C, Pasanen K, Schwellnus M, Verhagen E, Finch CF. What impact have the IOC medical consensus statements made on athlete health? A survey of medical commissions from National Olympic/Paralympic Committees and International Sports Federations. BMJ Open Sport Exerc Med 2024; 10:e001794. [PMID: 38665384 PMCID: PMC11043694 DOI: 10.1136/bmjsem-2023-001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Background The International Olympic Committee (IOC) Medical and Scientific Commission has supported collating and sharing evidence globally by developing sports medicine consensus statements ('Statements''). Publishing the Statements requires substantial resources that must be balanced by use and impact on policy and practice. This study aimed to gain a better understanding of awareness and uptake of the Statements globally through a survey of the National Olympic Committees (NOC), National Paralympic Committees (NPC) and International Federations (IF). Method A cross-sectional survey of medical commission representatives from NOCs/NPCs/IFs. A structured questionnaire was distributed through the IOC head office, informed by prior research. Questions comprised a mix of closed and open-text responses with results presented descriptively by organisation type and total. Results 55 responses were included: 29 (52%) from NOC/NPC representatives (response rate 14%) and 26 (47%) from IF representatives (response rate 63%). All Statements had been used by at least one respondent, with the Statement addressing concussion ranked highest (used by 33/55). The main barriers to use were financial limitations (n=21), club/sport culture and behaviours (n=19) and lack of understanding from coaches/team sport personnel (n=19). Participants believed the Statements were a successful strategy for improving athlete health (n=39/51 agree or strongly agree). Conclusion There was clear support for the continued development of sports medicine guidance, including in the format of these Statements. To ensure Statements lead to demonstrable health benefits for athletes, input from athletes, coaches and supporting staff is needed, as well as clearer identification of the purpose and audience of each topic developed.
Collapse
Affiliation(s)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Wayne Derman
- IOC Research Centre South Africa, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Carolyn Emery
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kati Pasanen
- Sport Injury Prevention Research Centre, University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Martin Schwellnus
- IOC Research Centre South Africa, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands, Amsterdam, The Netherlands
| | | |
Collapse
|
14
|
Gopinatth V, Smith MV, Matava MJ, Brophy RH, Knapik DM. Most Anterior Cruciate Ligament Injuries in Professional Athletes Occur Without Contact to the Injured Knee: A Systematic Review of Video Analysis Studies. Arthroscopy 2024:S0749-8063(24)00275-5. [PMID: 38663569 DOI: 10.1016/j.arthro.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To systematically review studies using video analyses to evaluate anterior cruciate ligament (ACL) injury mechanisms in athletes during sport to better understand risk factors and the potential for injury prevention. METHODS A literature search was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines statement using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through June 2023. Inclusion criteria included studies reporting on ACL injury mechanisms occurring in athletes based on video analysis. Athlete demographics, injury mechanisms, position of the lower extremity, and activity at the time of injury were recorded. RESULTS A total of 13 studies, consisting of 542 athletes, met inclusion criteria. Most athletes competed at the professional level (91%, n = 495/542), with 79% (n = 422/536) of athletes being male. The most common sports were soccer (33%, n = 178/542) and American football (26%, n = 140/542). The most common injury mechanism was noncontact in 42.9% (n = 230/536) of athletes, followed by indirect contact (32.6%, n = 175/536) and direct contact (22.4%, n = 120/536). The most common position of injury was with a planted foot (91.7%, n = 110/120), full or near-full knee extension (84.4%, n = 49/58), and axial loading (81.3%, n = 87/107). Injuries commonly involved a deceleration/shift in momentum (50.4%, n = 123/244) or pivoting maneuver (36.1%, n = 77/213). At the time of injury, the knee commonly fell into valgus (76.8%, n = 225/293) with associated internal (53.5%, n = 46/86) or external tibiofemoral rotation (57.7%, n = 101/175). CONCLUSIONS Most ACL injuries, when evaluated by video analysis, involve professional athletes participating in soccer and American football. The most common injury mechanism occurred without contact with the knee in extension during a deceleration or momentum shift, with resultant valgus and rotational force across the knee. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
Collapse
Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A..
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| |
Collapse
|
15
|
Rao H, Bakker R, McLachlin S, Chandrashekar N. Computational study of extrinsic factors affecting ACL strain during single-leg jump landing. BMC Musculoskelet Disord 2024; 25:318. [PMID: 38654258 PMCID: PMC11036765 DOI: 10.1186/s12891-024-07372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain. METHODS 3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen's ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants. RESULTS The maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05). CONCLUSIONS Soft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.
Collapse
Affiliation(s)
- Harish Rao
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ryan Bakker
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Naveen Chandrashekar
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| |
Collapse
|
16
|
Hill M, Kiesewetter P, Milani TL, Mitschke C. An Investigation of Running Kinematics with Recovered Anterior Cruciate Ligament Reconstruction on a Treadmill and In-Field Using Inertial Measurement Units: A Preliminary Study. Bioengineering (Basel) 2024; 11:404. [PMID: 38671825 PMCID: PMC11048090 DOI: 10.3390/bioengineering11040404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) may affect movement even years after surgery. The purpose of this study was to determine possible interlimb asymmetries due to ACLR when running on a treadmill and in field conditions, with the aim of contributing to the establishment of objective movement assessment in real-world settings; moreover, we aimed to gain knowledge on recovered ACLR as a biomechanical risk factor. Eight subjects with a history of unilateral ACLR 5.4 ± 2.8 years after surgery and eight healthy subjects ran 1 km on a treadmill and 1 km on a concrete track. The ground contact time and triaxial peak tibial accelerations were recorded using inertial measurement units. Interlimb differences within subjects were tested and compared between conditions. There were no significant differences between limbs in the ACLR subjects or in healthy runners for any of the chosen parameters on both running surfaces. However, peak tibial accelerations were higher during field running (p-values < 0.01; Cohen's d effect sizes > 0.8), independent of health status. To minimize limb loading due to higher impacts during field running, this should be considered when choosing a running surface, especially in rehabilitation or when running with a minor injury or health issues.
Collapse
Affiliation(s)
| | | | | | - Christian Mitschke
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany; (M.H.); (P.K.); (T.L.M.)
| |
Collapse
|
17
|
Figueroa ML, Hiemstra LA. How do we treat our male and female patients? - A primer on gender-based health care inequities. J ISAKOS 2024:S2059-7754(24)00077-4. [PMID: 38604569 DOI: 10.1016/j.jisako.2024.04.006] [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: 11/14/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Health is a fundamental human right, yet disparities in healthcare, based on gender, persist for women. These inequities stem from a patriarchal society that has regarded men as the default standard, leading to women being treated merely as smaller men. Contributing to these disparities are the gender stereotypes that pervade our society. Women possess differences in anatomy, physiology, psychology and social experience than men. To achieve health equity, it is vital to understand and be open to consider and evaluate these aspects in each individual patient. This requires an understanding of our own biases and a commitment to valuing diversity in both patient and caregiver. Improving equity and diversity throughout all aspects of the medical system will be necessary to provide optimal patient care for all.
Collapse
|
18
|
Fritz B. [Imaging of the anterior cruciate ligament and anterolateral rotational instability of the knee joint]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:261-270. [PMID: 38441595 DOI: 10.1007/s00117-024-01278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
The anterior cruciate ligament (ACL) is essential for the stability of the knee joint and ACL tears are one of the most common sports injuries with a high incidence, especially in sports that require rotational movements and abrupt changes in direction. Injuries of the ACL are rarely isolated and are often accompanied by meniscal and other internal knee injuries, which increase the risk of osteoarthritis. The spectrum of ACL injuries includes strains, partial tears and complete tears. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnostics as it can accurately depict not only the ACL but also accompanying injuries. Proton density and T2-weighted sequences are particularly suitable for evaluating the ACL, which is usually well visible and assessable in all planes. In addition to depicting fiber disruption as a direct sign and central diagnostic indicator of an ACL tear, there are numerous other direct and indirect signs of an ACL injury in MRI. These include abnormal fiber orientations, signal increases and an anterior subluxation of the tibia relative to the femur. The bone marrow edema patterns often associated with ACL tears are indicative of the underlying injury mechanism. The treatment of ACL tears can be conservative or surgical depending on various factors, such as the patient's activity level and the presence of accompanying injuries. The precise and comprehensive description of ACL injuries by radiology is crucial for optimal treatment planning. Anterolateral rotational instability (ALRI) of the knee joint characterizes a condition of excessive lateral and rotational mobility of the tibia in relation to the femur in the anterolateral knee region. This instability is primarily caused by a rupture of the ACL, with the anterolateral ligament (ALL) that was rediscovered about 10 years ago, also being attributed a role in stabilizing the knee. Although ALRI is primarily diagnosed through clinical examinations, MRI is indispensable for detecting injuries to the ACL, ALL, and other internal knee structures, which is essential for developing an optimal treatment strategy.
Collapse
Affiliation(s)
- Benjamin Fritz
- Abteilung für Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
- Medizinische Fakultät, Universität Zürich, Zürich, Schweiz.
| |
Collapse
|
19
|
Nutarelli S, Rocchi JE, Salerno M, Sangiorgio A, Deabate L, Filardo G. Higher Eccentric Hamstring Muscle Fatigue After Participation in a Soccer Match in Young Female Athletes. Sports Health 2024:19417381241230613. [PMID: 38406840 DOI: 10.1177/19417381241230613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Hamstring (HS) strength deficits and imbalances have been identified as risk factors for sustaining anterior cruciate ligament (ACL) injuries and muscular strains, with HS injuries being the most prevalent muscle injuries in soccer athletes. The aim of this study was to investigate HS eccentric strength before and after a soccer match in both male and female soccer athletes. HYPOTHESIS Soccer athletes have changes in eccentric HS strength after a soccer game. STUDY DESIGN Cohort observational study. LEVEL OF EVIDENCE Level 3. METHODS HS eccentric strength (mean and absolute peak torque and total work) was measured in 64 healthy male and female competitive football athletes (14-25 years) with an automatic device during the execution of the Nordic hamstring exercise (NHE) test before and after a 90-minute soccer match. The anterior-knee laxity (AKL) was quantified with an arthrometer. RESULTS Mean and absolute eccentric HS peak torque decreased by 24.5 N.m (-12.34%; P < 0.01) and 21.9 N.m (-10.08%; P < 0.01) in female athletes, whereas their male peers improved by 19.9 N.m (+9.01%; P = 0.01) and by 20.9 N.m (+8.51%; P = 0.02), respectively. HS total work in female athletes decreased by 831.1 J (P < 0.01) compared with the male athlete reduction of 235.3 J. Both the pre- versus postmatch intersex mean and absolute eccentric HS peak torque changes were significant (P < 0.01), as were the changes in HS total work (P < 0.01). The pre- versus postmatch AKL difference and the dominant versus nondominant limb comparison of the strength parameters were not significantly different. Younger female athletes (14-19 years old) presented a greater decrease in mean and absolute peak HS eccentric strength compared with those in older female athletes and men. CONCLUSION HS eccentric strength and work differ based on athlete sex, as measured by the NHE test. Mean peak, absolute peak, and total work showed greater reductions in female athletes than those in their male peers. The subgroup of 14- to 19-year-old female athletes experienced the highest reduction in strength parameters.
Collapse
Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jacopo Emanuele Rocchi
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
- Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Rome, Italy
| | - Manuela Salerno
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Deabate
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
20
|
Rostami M, Sedaghati P, Daneshmandi H. The effectiveness of the STOP-X training program on the knee valgus angle and balance in female basketball players with dynamic knee valgus: a randomized controlled trial. BMC Sports Sci Med Rehabil 2024; 16:52. [PMID: 38383435 PMCID: PMC10882901 DOI: 10.1186/s13102-024-00844-2] [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: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Dynamic knee valgus (DKV) accompanied by poor balance is the cause of anterior cruciate ligament (ACL) injury in athletes, and the identification and correction of these factors are always of interest to researchers. Therefore, the purpose of this research was to investigate the effect of the STOP-X program on the knee valgus angle and static and dynamic balance in female basketball players with DKV defects. METHODS The present study was a quasi-experimental study. Thirty female basketball players with DKV defects were purposefully identified by the single-leg landing (SLL) test and were randomly assigned to two control (n = 15) and experimental (n = 15) groups. Static balance status was evaluated with the BASS STICK test, and dynamic balance status was evaluated with the Y-balance test (YBT). The experimental group performed the STOP-X program for 25-40 min for eight weeks (three times per week), and the control group performed their traditional warm-up program. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (P < 0.05) with SPSS version 26. RESULTS The results showed that with the use of the STOP-X program, there was a significant difference between the experimental and control groups in variables of the static balance (F = 56.45; P = 0.001; ES = 0.66, PC=↑59.64%), total dynamic balance score (F = 107.57; P = 0.001; ES=↑0.79, PC=↑19.84%), and knee valgus angle (F = 119.46; P = 0.001; ES = 0.81, PC=↓34.36%). CONCLUSION In addition to reducing the knee valgus angle, applying the STOP-X injury prevention program can improve static and dynamic balance in female basketball players with DKV defects. Therefore, it can be recommended that sports trainers benefit from these advantages by adding STOP-X training to routine basketball exercises.
Collapse
Affiliation(s)
- Mohadeseh Rostami
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| | - Parisa Sedaghati
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran.
| | - Hassan Daneshmandi
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| |
Collapse
|
21
|
Yaka H, Bilge O, Kekeç AF, Demiryürek M, Doral MN. Evaluation of posterior tibial slope relationship with common knee pathologies in pediatric and adolescent age groups in the Turkish population. J Pediatr Orthop B 2024:01202412-990000000-00186. [PMID: 38375867 DOI: 10.1097/bpb.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Anterior cruciate ligament rupture (ACLR), tibial eminence fracture (TEF), and Osgood-Schlatter disease (OSD) have been linked to a steep posterior tibial slope (PTS) in children and adolescents. This study aims to examine and compare these associations. 418 patients aged 8-18, 237 males and 181 females with knee pain between 2010 and 2019 were included and the patients belonged to the Turkish population. They consisted of ACLR (n = 47), TEF (n = 22), OSD (n = 51), and a control group (n = 298). The study and control groups were compared for PTS, sex, and age, with ACLR, TEF, OSD, retrospectively. The ACLR, OSD, and TEF groups had higher PTS values than the control group (P < 0.001). There was no significant difference in ACLR-OSD, ACLR-TEF, and OSD-TEF comparisons (P = 0.22, P = 0.99, and P = 0.99, respectively). PTS increase was linked to ACLR, TEF, and OSD in the multinomial regression analysis, (P < 0.001). Increase in PTS was associated with ACLR, TEF, and OSD for both males and females (independently of other factors; ACLR: P < 0.001, P < 0.001, OR: 1.59, OR: 2.63, TEF: P = 0.001, P < 0.001, OR: 1.98, OR: 1.44; OSD: P = 0.001, P < 0.001, OR: 1.49, OR: 1.28 for males and females respectively). ACLR, TEF, and OSD are associated with increased PTS in the pediatric and adolescent age groups, and there are differences between these pathologies in terms of the amount of PTS increase, age, and sex. Consideration of age and gender in pediatric and adolescent patients with increased PTS may be useful in predicting pathologies associated with increased PTS. Level of evidence: III retrospective comparative study.
Collapse
Affiliation(s)
- Haluk Yaka
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya
| | - Onur Bilge
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya
| | - Ahmet Fevzi Kekeç
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya
| | - Mehmet Demiryürek
- Department of Orthopaedics & Traumatology, Bingöl State Hospital, Bingöl
| | - Mahmut Nedim Doral
- Department of Orthopaedics & Traumatology, Ufuk University School of Medicine, Ankara, Turkey
| |
Collapse
|
22
|
Fong HB, Nelson AK, McGhee D, Ford KR, Powell DW. Increasing Breast Support is Associated With a Distal-to-Proximal Redistribution of Joint Negative Work During a Double-Limb Landing Task. J Appl Biomech 2024; 40:14-20. [PMID: 37917960 DOI: 10.1123/jab.2022-0244] [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: 10/05/2022] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 11/04/2023]
Abstract
Female athletes exhibit greater rates of anterior cruciate ligament injury compared with male athletes. Biomechanical factors are suggested to contribute to sex differences in injury rates. No previous investigation has evaluated the role of breast support on landing biomechanics. This study investigates the effect of breast support on joint negative work and joint contributions to total negative work during landing. Thirty-five female athletes performed 5 landing trials in 3 breast support conditions. Lower-extremity joint negative work and relative joint contributions to total negative work were calculated. Univariate analyses of variance were used to determine the effect of breast support on negative joint work values. Increasing levels of breast support were associated with lower ankle negative work (P < .001) and ankle relative contributions (P < .001) and increases in hip negative work (P = .008) and hip relative contributions (P < .001). No changes were observed in total negative work (P = .759), knee negative work (P = .059), or knee contributions to negative work (P = .094). These data demonstrate that the level of breast support affects lower-extremity biomechanics. The distal-to-proximal shift in negative joint work and relative joint contributions may be indicative of a more protective landing strategy for anterior cruciate ligament injuries.
Collapse
Affiliation(s)
- Hailey B Fong
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Alexis K Nelson
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Deirdre McGhee
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Kevin R Ford
- Biomechanics and Physiology Laboratory, High Point University, High Point, NC, USA
| | - Douglas W Powell
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
| |
Collapse
|
23
|
Loud D, Grimshaw P, Kelso R. 3D Kinematics of Male and Female Soccer Players for a Variety of Game-Specific Skills. Appl Bionics Biomech 2024; 2024:9588416. [PMID: 38230371 PMCID: PMC10789512 DOI: 10.1155/2024/9588416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
Soccer is played by a variety of individuals with varying abilities. The complicated lower limb movements involved within the game often lead to knee and ankle injuries, with anterior cruciate ligament injuries being the most severe with regard to rehabilitation time and ongoing health risks. This research explores the biomechanical kinematics of male and female soccer players on synthetic grass to determine whether trends in lower limb biomechanics over a variety of movements could explain injury risk. Both male and female players (n = 10) aged between 19 and 24 years performed running-based and stationary-start movements. Biomechanical measurements at the hip, knee, and ankle were recorded. Observations showed that specific differences in joint angles were largely dependent on the movements performed; however, for male players, on average, across all movements, 84.6% and 72.6% of the variation in joint angles could be explained by internal/external rotation at the hip and knee, respectively. For female players, internal/external knee rotation, as well as hip abduction and adduction, accounted for 83.6% and 80.2% of the variation in joint angles, respectively, across all the tested movements. This highlights the importance of hip mechanics and knee alignment for players when performing a variety of movements.
Collapse
Affiliation(s)
- Danyon Loud
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Paul Grimshaw
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Richard Kelso
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
24
|
Kemper WC, Carpenter CM, Wagner KJ, Chen CC, Saleem L, Wilson PL, Ellis HB. Differences in Short-Term Sport-Specific Functional Recovery After Primary ACL Reconstruction in the Adolescent Athlete. Sports Health 2024; 16:139-148. [PMID: 36872596 PMCID: PMC10732105 DOI: 10.1177/19417381231156395] [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: 03/07/2023] Open
Abstract
BACKGROUND Although anterior cruciate ligament (ACL) injury rates have been studied extensively, it is unclear whether levels of functional and psychological readiness for return-to-sport after primary ACL reconstruction (ACLR) differ based on an athlete's primary sport. HYPOTHESIS Youth athletes in different primary sports will demonstrate differences in short-term functional recovery, as well as patient-reported psychological and functional recovery after primary ACLR. STUDY DESIGN Retrospective cohort study of consecutive patients treated for ACL injury in pediatric sports medicine clinics. LEVEL OF EVIDENCE Level 3. METHODS Patients included underwent primary ACLR between December 1, 2015 and December 31, 2019 and reported sports participation at the time of injury. Demographic data, sports participation, surgical data, functional testing scores (Y-Balance Test [YBT]), functional and psychological patient-reported outcome measures (PROMs), and timing of return-to-play clearance were reviewed. YBT scores were the primary metric for clearance. Four groups were studied: soccer, football, basketball, and other. RESULTS A total of 220 male and 223 female athletes were included; 65.28% of soccer players were female and 100% of football players were male (P < 0.01). At initial postoperative YBT testing (6-9 months), soccer players had higher operative (P < 0.01) and nonoperative (P < 0.01) leg composite scores when compared with basketball players. No significant differences were found between sports in functional or psychological PROMs at presurgical baseline or 6 months postoperatively. When compared with football, soccer players completed functional clearance in a shorter time from surgery (P = 0.02). Multivariate analysis showed level of competition as a significant independent variable for clearance in female athletes. CONCLUSION After primary ACLR, athletes, especially female athletes, demonstrated short-term sport-specific differences in YBT scores. Soccer players attained clearance sooner than football players. Level of competition influenced YBT composite scores in all athletes and time to clearance in female athletes. CLINICAL RELEVANCE Sport-specific differences in reinjury should be investigated to determine whether changes in return-to-play evaluation should be implemented.
Collapse
Affiliation(s)
| | | | - K. John Wagner
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | | | - Laura Saleem
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | - Philip L. Wilson
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
25
|
Mehl J, Siebenlist S. [Influence of the bony alignment on the ligaments of the knee joint]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:27-34. [PMID: 37610469 DOI: 10.1007/s00113-023-01363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/24/2023]
Abstract
In recent years biomechanical and clinical studies have shown that the three-dimensional bony alignment of the lower extremities has a relevant influence on the ligamentous structures of the knee and consequently on the stability of the knee joint. Therefore, in the case of pathological ligamentous damage of the knee joint, a possible malalignment must always be thoroughly evaluated and if necessary, included in the treatment planning. Varus malalignment plays an important role especially with respect to the cruciate ligaments as well as the posterolateral ligamentous structures and has been identified as a significant risk factor for failure after surgical reconstruction of these ligamentous structures. Similar data have also been published for valgus malalignment particularly with respect to its negative influence on the anterior cruciate ligament and the medial capsuloligamentous complex. Alignment deviations in the sagittal plane, especially the inclination of the tibial articular surface (slope), have been extensively investigated in several recent studies. It has been demonstrated that the tibial slope has a relevant influence on the anteroposterior stability of the knee joint and hence on the cruciate ligaments. First clinical studies on the surgical correction of the axis in selected patients showed very promising results with the potential of protecting ligament reconstructions against repeated failure; however, further data especially regarding the importance and the exact indications for an additional alignment correction are necessary.
Collapse
Affiliation(s)
- Julian Mehl
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Sebastian Siebenlist
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| |
Collapse
|
26
|
Augustsson SR, Gannby E. The Significance of Maximal Squat Strength for Neuromuscular Knee Control in Elite Handball Players: A Cross-Sectional Study. Sports (Basel) 2023; 11:236. [PMID: 38133103 PMCID: PMC10748350 DOI: 10.3390/sports11120236] [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: 10/29/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Both weak muscle strength and impaired neuromuscular control has previous been suggested as risk factors for future traumatic knee injury. However, data on the relationship between these two factors are scarce. Thus, the aim of this study was to investigate the relationship and influence of the one repetition maximum (1RM) barbell squat strength on dynamic knee valgus in elite female and male handball players. In this cross-sectional study 22 elite handball players (7 females) were included. A unilateral drop jump (VDJ) test was used for the assessment of frontal plane dynamic knee valgus. Players also performed a one repetition maximum (1RM) barbell squat test, expressed relative to bodyweight (r1RM), to assess maximal strength, which were dichotomized to analyze 'weak' versus 'strong' players according to median. Correlations were noted between r1RM in squat and knee valgus angle for both the non-dominant (r = -0.54; p = 0.009) and dominant leg (r = -0.46, p = 0.03). The odds of knee valgus were eight times higher, for the dominant leg, in the weak group compared to the strong group (p = 0.03) and 27 times higher, for the non-dominant leg (p = 0.002). The outcome of the present study suggests that maximum squat strength plays an important role when it comes to neuromuscular control of the knee, and that weak handball players are at higher risk of knee valgus compared to strong players during jumping activity.
Collapse
Affiliation(s)
- Sofia Ryman Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 39231 Kalmar, Sweden;
| | - Erik Gannby
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 39231 Kalmar, Sweden;
- Kry Health Center, 29535 Bromölla, Sweden
| |
Collapse
|
27
|
Cejudo A, Armada-Zarco JM, Ayala F, Sainz de Baranda P. Prediction of ACL-tear by lower limbs muscle strength and flexibility: a prospective cohort study in 95 female soccer players. Res Sports Med 2023:1-23. [PMID: 37966277 DOI: 10.1080/15438627.2023.2280554] [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: 07/26/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
The aims of the study were to build models using logistic regression analysis of flexibility and strength tests to prospectively predict risk factors for anterior cruciate ligament tear (ACL-tear) in female soccer (FS) players, and to determine training cut-off for risk factors of the predictive model built. A prospective cohort study of 95 female players (aged 14-33 years) was conducted. Age, anthropometric data, soccer history, lower limb range of motion (ROM) and hip maximal isometric strength (MIS) were measured. At the prospective follow-up after 12 months, 7.4% of the players had developed an ACL-tear. The model showed a significant relationship (χ2(93) = 30.531, p < 0.001) between the ACL-tear and the predictor variables (leg length, HAD-NH [hip adduction] MIS, asymmetric ROM [ankle dorsiflexion with knee extended (AD-KE) and with knee flexed (AD-KF), and HE (hip extension)], hip ROM [HIR (internal rotation) and HAB (abduction)]). The Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) for model fit were 30.24 and 51.79, respectively. The value R2 showed good model fit, 76.5% for Nagelkerke´s R2, 71.4% for McFadden´s R2 and 67.5% for Tjur´s R2. For the screening test, cut-off for leg length of ≥0.40 m, for HIR ROM of ≤44º and for asymmetry of HE ROM of ≥5° were set, which have an acceptable (AUC ≥ 0.755) discriminatory ability for the development of ACL-tear.
Collapse
Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Universidad de Murcia, Murcia, Spain
| | | | - Francisco Ayala
- Department of Physical Activity and Sport, Universidad de Murcia, Murcia, Spain
| | | |
Collapse
|
28
|
Leung A, Kantak S, Hammoud S, Abraham R, Zarzycki R. Sex differences in corticospinal excitability and quadriceps performance after anterior cruciate ligament reconstruction. J Orthop Res 2023. [PMID: 37938095 DOI: 10.1002/jor.25725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/20/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Anterior cruciate ligament (ACL) ruptures result in lasting quadriceps dysfunction that contributes to secondary injury risk and development of osteoarthritis. There is evidence of persistent reduced nervous system drive (corticospinal excitability [CSE]) to the quadriceps and sex differences in both quadriceps performance and CSE post-ACL reconstruction (ACLR). The purposes of this study were to investigate the differences in CSE and quadriceps dysfunction after ACLR between sexes and relative to controls. Twenty subjects 4-9 months post-ACLR and 20 age, sex, and activity matched controls participated in this study. Quadriceps performance (peak torque, PT; rate of torque development from onset to 100 ms, RTD100; and RTD from 100 to 200ms, RTD200) and CSE (active motor threshold; slope of the stimulus response (SR) curve, SR curve slope) were measured using an isokinetic dynamometer (HUMAC NORM) and transcranial magnetic stimulation respectively. Significant group differences were found for SR curve slope, PT, RTD100, and RTD200 on the surgical limb. Males after ACLR had higher slopes (higher CSE) than females. Females after ACLR had worse surgical limb quadriceps PT than control males and slower RTD100 and RTD200 than control males and control females. Higher CSE in males after ACLR may point to a potentially adaptive neurological change in males post-ACLR and indicate greater need for novel interventions to address cortical drive in females after ACLR.
Collapse
Affiliation(s)
- Anne Leung
- Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Shailesh Kantak
- Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
- Department of Rehabilitation Medicine, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | - Sommer Hammoud
- Orthopaedic Surgery, Sidney Kimmel Medical College, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Rebekah Abraham
- Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Ryan Zarzycki
- Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| |
Collapse
|
29
|
Mayr HO, Rosenstiel N, Prakash KS, Comella LM, Woias P, Schmal H, Seidenstuecker M. Digital measurement of anterolateral knee laxity using strain sensors. Arch Orthop Trauma Surg 2023; 143:6719-6729. [PMID: 37592159 PMCID: PMC10542724 DOI: 10.1007/s00402-023-05024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The ambition of the research group was to develop a sensor-based system that allowed the transfer of results with strain sensors applied to the knee joint. This system was to be validated in comparison to the current static mechanical measurement system. For this purpose, the internal rotation laxity of the knee joint was measured, as it is relevant for anterolateral knee laxity and anterior cruciate ligament (ACL) injury. METHODS This is a noninvasive measurement method using strain sensors which are applied to the skin in the course of the anterolateral ligament. The subjects were placed in supine position. First the left and then the right leg were clinically examined sequentially and documented by means of an examination form. 11 subjects aged 21 to 45 years, 5 women and 6 men were examined. Internal rotation of the lower leg was performed with a torque of 2 Nm at a knee flexion angle of 30°. RESULTS Comparison of correlation between length change and internal knee rotation angle showed a strong positive correlation (r = 1, p < 0.01). Whereas females showed a significant higher laxity vs. males (p = 0.003). CONCLUSIONS The present study showed that the capacitive strain sensors can be used for reproducible measurement of anterolateral knee laxity. In contrast to the previous static systems, a dynamic measurement will be possible by this method in the future.
Collapse
Affiliation(s)
- Hermann O Mayr
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Nikolaus Rosenstiel
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Karthika S Prakash
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Laura M Comella
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Peter Woias
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Seidenstuecker
- G.E.R.N. Center of Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| |
Collapse
|
30
|
Kudo S, Miyashita T, Yamamoto A, Katayama S, Takasaki R. The effects of the functional garment on the biomechanics during the single leg drop landing. J Bodyw Mov Ther 2023; 36:142-147. [PMID: 37949551 DOI: 10.1016/j.jbmt.2023.06.010] [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: 04/10/2022] [Revised: 04/29/2023] [Accepted: 06/05/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION A functional biomechanics garment (FBG) may help to prevent injury by improved kinematics during motion such as single leg drop landing (SLDL). The purpose of this study was to investigate the effects of the FBG on the biomechanics of SLDL. METHOD Seventeen female university basketball players participated. Characteristics of the FBG were designed based on biomechanics during weight-loaded performance of human movement. The average values of lower limb kinematics and kinetics in the sagittal and frontal planes from 3 SLDL with and without FBG were measured and compared. RESULTS The maximum varus angle of the knee showed a significant difference between the use of FBG (15.3 ± 15.1°) and without the use of FBG (5.9 ± 15.4°), the flexion angular displacement of the hip (with FBG, 21.5 ± 8.1°; without FBG, 24.0 ± 6.7°) between with and without FBG. The moment of the hip with FGB (1.1 ± 0.6 Nm) was significantly smaller than without FGB (1.4 ± 0.8 Nm). DISCUSSION Regarding function of the FBG, the rigid part of the hip could counter the excessive adduction and flexion of the hip, and the elastic part of the thigh could support the varus moment when the elastic part stretched. Therefore, the subjects with FBG could control the frontal motion of the knee, which has a risk of knee injury, such as the dynamic valgus of the knee during the SLDL. CONCLUSION Use of the FBG decreases dynamic knee valgus, which reduces risk of knee injury.
Collapse
Affiliation(s)
- Shintarou Kudo
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Osaka, Japan; Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; AR-Ex Medical Research Center, Tokyo, Japan.
| | - Toshinori Miyashita
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Osaka, Japan
| | - Ayane Yamamoto
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedics Clinic, Setagaya, Tokyo, Japan
| | - Syo Katayama
- Department of Rehabilitation, Meidaimae Orthopedics Clinic, Setagaya, Tokyo, Japan
| | - Raita Takasaki
- Department of Acupuncture, Morinomiya University of Medical Sciences, Osaka, Japan
| |
Collapse
|
31
|
Forman DA, Alizadeh S, Button DC, Holmes MW. The Use of Elastic Resistance Bands to Reduce Dynamic Knee Valgus in Squat-Based Movements: A Narrative Review. Int J Sports Phys Ther 2023; 18:1206-1217. [PMID: 37795322 PMCID: PMC10547095 DOI: 10.26603/001c.87764] [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: 03/01/2023] [Accepted: 08/17/2023] [Indexed: 10/06/2023] Open
Abstract
An elastic band wrapped around the distal thighs has recently been proposed as a method for reducing dynamic knee valgus (medial movement of the knee joint in the frontal/coronal plane) while performing squats. The rationale behind this technique is that, by using an external force to pull the knees into further knee valgus, the band both exaggerates the pre-existing movement and provides additional local proprioceptive input, cueing individuals to adjust their knee alignment. If these mechanisms are true, then elastic bands might indeed reduce dynamic knee valgus, which could be promising for use in injury prevention as excessive knee valgus may be associated with a greater risk of sustaining an ACL rupture and/or other knee injuries. Due to this possibility, certain athletic populations have already adopted the use of elastic bands for training and/or rehab, despite a limited number of studies showing beneficial findings. The purpose of this narrative review is to examine current literature that has assessed lower limb muscle activity and/or lower limb kinematics performance on squat-based movements with or without an elastic band(s). Importantly, this paper will also discuss the key limitations that exist in this area, propose suggestions for future research directions, and provide recommendations for training implementations. Level of Evidence 5.
Collapse
Affiliation(s)
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation Memorial University of Newfoundland
| | - Duane C Button
- School of Human Kinetics and Recreation Memorial University of Newfoundland
| | | |
Collapse
|
32
|
Li W, Hadizadeh M, Yusof A, Naharudin MN. Distribution and Prevalence of Elbow Pain (EP) in Elite Swimmers in Tianjin, China-A Regional Epidemiological Study. Healthcare (Basel) 2023; 11:2612. [PMID: 37830649 PMCID: PMC10572555 DOI: 10.3390/healthcare11192612] [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: 08/28/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Elbow pain (EP) in overhead sports is a common phenomenon. Swimming is classified as an overhead sport, but a lack of attention regarding EP in swimming has created a gap in the knowledge around elite freestyle swimming in Tianjin, China. The purpose of this study was to identify the distribution and prevalence of EP among elite freestyle swimmers in Tianjin, China. The methodology involved a total of 311 qualified participants who volunteered to undertake all measurements. The main findings showed that 183 of the elite freestyle swimmers in this study had EP (accounting for 58.84% of the total 311 participants), with 147 in slight pain and 36 in critical pain. The characteristics of a heavier body weight, taller height, longer left/right forearm length, and longer weekly average training hours serve as contributing factors to the occurrence of EP issues. Gender, age, weekly average training hours, and left/right forearm length are the primary factors correlating with and influencing the assessment scores. In conclusion, swimmers with longer weekly training hours, older ages, heavier bodyweight, and longer forearm lengths should receive greater attention in relation to EP. Regular assessments at a high frequency serve as a means to identify the risk of EP.
Collapse
Affiliation(s)
| | - Maryam Hadizadeh
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (W.L.); (A.Y.); (M.N.N.)
| | | | | |
Collapse
|
33
|
Bingzheng Z, Xinzhuo Z, Zhuo J, Xing Y, Bin L, Lunhao B. The effects of sex hormones during the menstrual cycle on knee kinematics. Front Bioeng Biotechnol 2023; 11:1209652. [PMID: 37744250 PMCID: PMC10512414 DOI: 10.3389/fbioe.2023.1209652] [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: 04/27/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
The effects of the menstrual cycle and sex hormones on knee kinematics remain unclear. The purpose of the study was to investigate the effects of the menstrual cycle and serum sex hormone concentrations on knee kinematic parameters of the 90°cutting in female college soccer athletes. Three female college soccer teams (53 subjects) participated in the study. During the first menstrual cycle, a three-step method was used to exclude subjects with anovulatory and luteal phase-deficient (LPD) (12 subjects). The subjects' menstrual cycle was divided into the menstrual phase, late-follicular phase, ovulatory phase, and mid-luteal phase (group 1, 2, 3, 4). In each phase of the second menstrual cycle, we used a portable motion analysis system to enter the teams and tested the sex hormones concentrations and knee kinematics parameters in three universities in turn. We found that subjects had a lower maximum knee valgus in group 4 compared with other groups. This meant that subjects had a lower biomechanical risk of non-contact anterior cruciate ligament (ACL) injury in the mid-luteal phase. There was no significant correlation between serum estrogen, progesterone concentration, and knee kinematic parameters. This meant that sex hormones did not have a protective effect. Future studies need to incorporate more factors (such as neuromuscular control, etc.) to investigate.
Collapse
Affiliation(s)
- Zhou Bingzheng
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhao Xinzhuo
- Department of Biomedical Engineering, Shenyang University of Technology, Shenyang, Liaoning, China
| | - Jin Zhuo
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Xing
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Li Bin
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bai Lunhao
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
34
|
Laupattarakasem P, Cook JL, Stannard JP, Smith PA, Blecha KM, Guess TM, Sharp RL, Leary E. Using a Markerless Motion Capture System to Identify Preinjury Differences in Functional Assessments. J Knee Surg 2023. [PMID: 37586406 DOI: 10.1055/s-0043-1772238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Functional assessments identify biomechanical issues which may indicate risk for injury and can be used to monitor functional recovery after an injury or surgery. Although the gold standard to assess functional movements is marker-based motion capture systems, these are cost prohibitive and have high participant burden. As such, this study was conducted to determine if a markerless motion capture system could detect preinjury differences in functional movements between those who did and did not experience a noncontact lower extremity injury (NCLEI). A three-dimensional markerless motion capture system comprised an area of 3 m × 5 m × 2.75 m was used. Participants were Division I collegiate athletes wearing plain black long-sleeve shirts, pants, and running shoes of their choice. Functional assessments were the bilateral squat, right and left squat, double leg drop vertical jump, static vertical jump, right and left vertical jump, and right and left 5 hop. Measures were recorded once and the first NCLEI was recorded during the first year after measurement. Two-factor analysis of variance models were used for each measure with factors sex and injury status. Preinjury functional measures averaged 8.4 ± 3.4 minutes capture time. Out of the 333 participants recruited, 209 were male and 124 were female. Of those, 127 males (61%) and 92 females (74%) experienced later NCLEI. The most common initial NCLEI was nonanterior cruciate ligament knee injury in 38 females (41.3%) and 80 males (62.0%). Females had decreased flexion and lower valgus/varus displacement during the bilateral squat (p < 0.006). In addition, knee loading flexion for those who were not injured were more than that seen in the injured group, and was more pronounced for injured females (p < 0.03). The markerless motion capture system can efficiently provide data that can identify preinjury functional differences for lower extremity noncontact injuries. This method holds promise for effectively screening patients or other populations at risk of injury, as well as for monitoring pre-/postsurgery function, without the large costs or participant burden.
Collapse
Affiliation(s)
- Pat Laupattarakasem
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Missouri Orthopaedic Institute, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Missouri Orthopaedic Institute, Columbia, Missouri
| | | | - Kyle M Blecha
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Missouri Orthopaedic Institute, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
| | - Rex L Sharp
- Intercollegiate Athletics, University of Missouri, Columbia, Missouri
| | - Emily Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| |
Collapse
|
35
|
Ajdaroski M, Esquivel A. Can Wearable Sensors Provide Accurate and Reliable 3D Tibiofemoral Angle Estimates during Dynamic Actions? SENSORS (BASEL, SWITZERLAND) 2023; 23:6627. [PMID: 37514921 PMCID: PMC10383318 DOI: 10.3390/s23146627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
The ability to accurately measure tibiofemoral angles during various dynamic activities is of clinical interest. The purpose of this study was to determine if inertial measurement units (IMUs) can provide accurate and reliable angle estimates during dynamic actions. A tuned quaternion conversion (TQC) method tuned to dynamics actions was used to calculate Euler angles based on IMU data, and these calculated angles were compared to a motion capture system (our "gold" standard) and a commercially available sensor fusion algorithm. Nine healthy athletes were instrumented with APDM Opal IMUs and asked to perform nine dynamic actions; five participants were used in training the parameters of the TQC method, with the remaining four being used to test validity. Accuracy was based on the root mean square error (RMSE) and reliability was based on the Bland-Altman limits of agreement (LoA). Improvement across all three orthogonal angles was observed as the TQC method was able to more accurately (lower RMSE) and more reliably (smaller LoA) estimate an angle than the commercially available algorithm. No significant difference was observed between the TQC method and the motion capture system in any of the three angles (p < 0.05). It may be feasible to use this method to track tibiofemoral angles with higher accuracy and reliability than the commercially available sensor fusion algorithm.
Collapse
Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, College of Engineering and Computer Science, University of Michigan-Dearborn, Dearborn, MI 48128, USA
| | - Amanda Esquivel
- Department of Mechanical Engineering, College of Engineering and Computer Science, University of Michigan-Dearborn, Dearborn, MI 48128, USA
| |
Collapse
|
36
|
Ogasawara I, Revankar GS, Konda S, Matsuo T, Aoyama C, Nakata K. Individual Variation in Adaptive Ability of the Anticipated Postural Stability During a Dual-Task Single-Leg Landing in Female Athletes. Orthop J Sports Med 2023; 11:23259671231177312. [PMID: 37435428 PMCID: PMC10331203 DOI: 10.1177/23259671231177312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 07/13/2023] Open
Abstract
Background Precise postural control helps prevent anterior cruciate ligament injury. However, it is unknown whether the anticipated postural stability can be improved during a physically uncertain and cognitively demanding task. Hypothesis Anticipated postural stability will improve through unanticipated single-leg landing with a rapid foot placement target tracking. Study Design Controlled laboratory study. Methods A total of 22 healthy female university-level athletes performed a novel dual-task paradigm: an unanticipated single-leg landing with foot placement target tracking. In the normal condition (60 trials), the participants jumped from a 20 cm-high box onto the landing target with their dominant leg as softly as possible. In the subsequent perturbation condition (PC) (60 trials), the initially assigned landing target was abruptly switched randomly, requiring participants to modify their preplanned foot placement position to the newly assigned position. The center-of-pressure trajectory length within the first 100 ms after foot impact (CoP100) was calculated as a measure of anticipated postural stability for each trial. In addition, the peak vertical ground-reaction force (FzPeak) was quantified to assess landing load, and the degree of postural adaptation during PC was quantified by fitting an exponential function to trial-by-trial changes in CoP100. Participants were divided into 2 groups according to increase or decrease in CoP100, and results were compared between the groups. Results The direction and magnitude of postural sway alterations of the 22 participants showed a spectrum-like variation during the repeated trials. Twelve participants (sway-decreased group) exhibited a gradual reduction in postural sway (CoP100) during the PC, while the remaining 10 participants (sway-increased group) showed a gradual increase in CoP100. The FzPeak during the PC was significantly less in the sway-decreased group compared with the sway-increased group (P < .05). Conclusion Variation in the direction and magnitude of postural sway alteration among participants suggested that there was individual variation in an athlete's adaptive ability of the anticipated postural stability. Clinical Relevance The novel dual-task paradigm described in this study may be useful for rating individual injury risk based on an athlete's postural adaptation ability and may aid in targeted prevention strategies.
Collapse
Affiliation(s)
- Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Gajanan S. Revankar
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoyuki Matsuo
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Chisa Aoyama
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
37
|
Sasaki E, Kamitani T, Kinouchi S, Kamiya N, Ikumi A, Tateishi T, Miyazaki S, Ishibashi Y, Nagahiro S. Incidence of anterior cruciate ligament injury patterns in Japanese judo players from a nationwide insurance database. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 33:6-12. [PMID: 37663061 PMCID: PMC10470359 DOI: 10.1016/j.asmart.2023.08.011] [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: 03/17/2023] [Revised: 05/08/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Objective This study aimed to characterize the age- and sex-specific Anterior cruciate ligament (ACL) injury rates and related injury patterns in judo players in Japan using the nationwide insurance database. Methods This was a descriptive epidemiological study. We examined a total of 2142 adolescents with anterior cruciate ligament injuries registered in the insurance system of the Japan Sports Council between January 2009 and December 2018. The age- and sex-specific incidences were estimated for the levels of 7th, 8th, and 9th grades of junior high school and 10th, 11th, and 12th grades of high school. The anterior cruciate ligament injury circumstances were classified into three patterns based on the impact to the involved knee: high-impact valgus force, low-impact trunk displacement, or no-impact knee twisting. Results The incidence of anterior cruciate ligament injury from the 7th to 12th grades were 0.5, 0.9, 0.9, 6.9, 8.6, and 6.1 per 1000 athlete-years in male players and 1.3, 3.8, 3.4, 16.8, 19.5, and 13.6 per 1000 athlete-years in female players. The most prevalent injury pattern was a low-impact contact injury (42.6%) with Osoto-gari, followed by a high-impact contact injury (29.8%). The concomitant medial collateral ligament (MCL) injury rate was 18.1%, which was correlated with a high-impact contact injury (p = 0.005) by multiple regression analysis. Conclusions The highest incidence of age- and sex-specific anterior cruciate ligament injury was 19.5 per 1000 athlete-years in female high school students in the 11th grade. The most frequent injury pattern was low-impact contact injury with trunk displacement, indicating that trunk stabilization training could help prevent anterior cruciate ligament injury in judo.
Collapse
Affiliation(s)
- Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- All Japan Judo Federation Medical Committee, Tokyo, Japan
| | - Takeshi Kamitani
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Tokai Gakuen University, The School of Sports and Health Science, Miyoshi, Japan
| | - Shotaro Kinouchi
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Nobuhiro Kamiya
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Faculty of Budo and Sport Studies, Tenri University, Nara, Japan
| | - Akira Ikumi
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomohiko Tateishi
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Athroscopy and Sports Center, Doai Memorial Hospital, Tokyo, Japan
| | - Seiji Miyazaki
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- School of Physical Education, Tokai University, Kanagawa, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shinji Nagahiro
- All Japan Judo Federation Medical Committee, Tokyo, Japan
- Department of Neurosurgery, Yoshinogawa Hospital, Tokushima, Japan
| |
Collapse
|
38
|
Leung A, DeSandis B, O’Brien L, Hammoud S, Zarzycki R. Postoperative considerations based on graft type after anterior cruciate ligament reconstruction a narrative review. ANNALS OF JOINT 2023; 8:26. [PMID: 38529227 PMCID: PMC10929311 DOI: 10.21037/aoj-22-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/09/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Graft selection for anterior cruciate ligament reconstruction (ACLR) affects rehabilitation throughout the course of postoperative care. Methods A search of PubMed and EBSCO was performed and abstracts independently reviewed by two authors. This search was also supplemented with additional evidence relevant to each phase of ACLR rehabilitation. Key Content and Findings Direct implications of graft type on clinical decisions vary throughout treatment phases, transitioning from potential differences in acute postoperative pain management immediately after surgery to facilitating sufficient and appropriate lower extremity loading in subsequent weeks. Regardless of graft type, surgical limb weakness persists throughout the course of rehabilitation; however, harvest site selection for autografts contributes to disproportionate weakness of the harvested muscle group and the potential for surgical-induced tendinopathy. In later phases of rehabilitation, as athletes are transitioning into return to sport (RTS), treatment decisions and protocols are less affected by graft type but expectations for meeting clinical milestones and the time required to do so does differ between graft types. Conclusions Targeted strengthening interventions to address muscle weakness following graft harvest in autografts should be continued throughout the rehabilitation process. Lingering deficits in quadriceps strength symmetry may also influence time to meet progression and RTS criteria following graft harvest from the extensor mechanism.
Collapse
Affiliation(s)
- Anne Leung
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
| | | | | | - Sommer Hammoud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Rothman Institute, Philadelphia, PA, USA
| | - Ryan Zarzycki
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
| |
Collapse
|
39
|
Weaver KJ, Relph N. Lower Limb Anthropometric Profiling in Professional Female Soccer Players: A Proof of Concept for Asymmetry Assessment Using Video Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6124. [PMID: 37372711 DOI: 10.3390/ijerph20126124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 06/29/2023]
Abstract
The objective was to evaluate the clinical joint and limb measures in professional female soccer players. The study was a cross-sectional observational design. It was a preseason clinical setting. The inclusion criteria were outfield professional female soccer players, based in the UK, competing in the highest English league. The exclusion criteria included players who had had surgery in the last six months or had missed a single training session or match due to injury in the previous three months. In terms of the outcome measures, the dependent variables were the true limb length, ankle dorsiflexion, knee flexion and extension, hip flexion, extension, internal rotation and external rotation, and straight leg raise measured using video analysis software. Additionally, passive clinical knee and ankle stability tests were conducted. The independent variables were leg dominance and playing position (defender, midfielder, and attacker). For the results, all the ROM measurements demonstrated limb symmetry (p = 0.621). However, there were significant main effects of the playing position on the ankle dorsiflexion and hip internal rotation, with defenders demonstrating a significantly reduced range of motion in comparison to midfielders and attackers. A notable finding from the bilateral passive stability measures was that 38.3% of players exhibited ankle talar inversion instability when using a talar tilt. In conclusion, bilateral differences do not appear to be apparent in this population; however, positional differences may occur in the ankle and hip range of motion measures. A high proportion of this population may present with passive ankle inversion instability. Future research should consider whether this leads to a higher risk of injury in this population.
Collapse
Affiliation(s)
- Kristian J Weaver
- Sports Injuries Research Group, Edge Hill University, St. Helens Road, Ormskirk, Lancashire L39 4QP, UK
| | - Nicola Relph
- Faculty of Health, Social Care and Medicine, Edge Hill University, St. Helens Road, Ormskirk, Lancashire L39 4QP, UK
| |
Collapse
|
40
|
Hu Z, Zhang Y, Dong T, Dong M, Kim S, Kim Y. Gender Differences in Neuromuscular Control during the Preparation Phase of Single-Leg Landing Task in Badminton. J Clin Med 2023; 12:jcm12093296. [PMID: 37176736 PMCID: PMC10179252 DOI: 10.3390/jcm12093296] [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: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Studies on the biomechanical mechanisms of an anterior cruciate ligament (ACL) injury have been extensively studied, but studies on the neuromuscular control-related risk factors for an ACL injury in specific maneuvers have not been reported for badminton players. STUDY DESIGN Controlled laboratory study. METHODS Sixteen badminton players (8 male, 8 female) performed a single-leg badminton ball landing task, and lower limb muscle activity, kinematic data, and ground reaction force were measured during this procedure using marker-based movement analysis, force plates, and electromyography (EMG). Gender differences in the lower limb kinematic data, mean values of normalized lower limb muscle activation (MVC%), and co-contraction values during the landing preparation phase (100 ms before initial contact) were analyzed using MANOVA. RESULTS In the badminton landing task, the knee valgus angle was greater in females than in males (6.27 ± 2.75 vs. 1.72 ± 3.20) in the pre-landing preparation position. Compared to male badminton players, females exhibited greater gluteus maximus (44.92 ± 18.00 vs. 20.34 ± 11.64), rectus femoris (41.56 ± 9.84 vs. 26.14 ± 10.46), and medial gastrocnemius (37.39 ± 17.31 vs. 19.11 ± 11.17) lateral gastrocnemius (36.86 ± 17.82 vs. 13.59 ± 2.71) muscle activity (MVC%). CONCLUSION Female badminton players exhibit neuromuscular control strategies that may be inadequate for ACL protection and may be a potential risk factor for a high incidence of ACL injury In the future, when devising injury prevention plans for female badminton players, optimizing neuromuscular control during the pre-landing phase can be targeted.
Collapse
Affiliation(s)
- Zhe Hu
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Yanan Zhang
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Tengfei Dong
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Maolin Dong
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Sukwon Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Youngsuk Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| |
Collapse
|
41
|
Bjornsen E, Lisee C, Schwartz TA, Creighton R, Kamath G, Spang J, Blackburn T, Pietrosimone B. Improvement Trajectories in Patient-Reported Outcomes Between Males and Females After Anterior Cruciate Ligament Reconstruction. J Athl Train 2023; 58:430-436. [PMID: 35788341 PMCID: PMC11220900 DOI: 10.4085/1062-6050-0093.22] [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: 11/09/2022]
Abstract
CONTEXT Patient-reported outcomes (PROs) are used to track recovery and inform clinical decision-making after anterior cruciate ligament reconstruction (ACLR). Whether sex influences the trajectory of improvements in PROs over time post-ACLR remains unclear. OBJECTIVES To (1) examine the effect of sex on the association between months post-ACLR and Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QOL) scores in individuals with ACLR and (2) assess sex differences in the KOOS QOL score at selected timepoints post-ACLR. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 133 females (20± 3 years) and 85 males (22 ± 4 years) within 6 to 60 months of primary, unilateral ACLR. MAIN OUTCOME MEASURE(S) The KOOS QOL was completed at a single follow-up timepoint post-ACLR. A multivariate linear regression model was calculated to assess the interaction of sex on the association between months post-ACLR and KOOS QOL score. Sex-specific linear regression models were then used to predict KOOS QOL estimated marginal means at each clinical timepoint (6, 12, 24, 36, 48, and 60 months post-ACLR) and compare the sexes. RESULTS In the primary model (R2 = 0.16, P < .0001), a significant interaction existed between sex and time post-ACLR (β = -0.46, P < .01). Greater months post-ACLR were associated with better KOOS QOL scores for males (R2 = 0.29, β = 0.69, P < .001); months post-ACLR was a weaker predictor of KOOS QOL scores for females (R2 = 0.04, β = 0.23, P < .02). Estimated marginal means for KOOS QOL scores were greater for males than females at 36 months (t210 = 2.76, P < .01), 48 months (t210 = 3.02, P < .01), and 60 months (t210 = 3.09, P = .02) post-ACLR. CONCLUSIONS Males exhibited PRO improvement post-ACLR as the months post-ACLR increased, whereas females did not demonstrate the same magnitude of linear increase in KOOS QOL score. Females may require extended intervention to improve clinical outcomes post-ACLR and address a plateau in QOL score.
Collapse
Affiliation(s)
| | | | - Todd A. Schwartz
- Human Movement Science Curriculum
- Department of Exercise and Sport Science
- Department of Biostatistics, Gillings School of Global Public Health
| | - Robert Creighton
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Ganesh Kamath
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | | | | |
Collapse
|
42
|
Georgoulis JD, Melissaridou D, Patras K, Megaloikonomos PD, Trikoupis I, Savvidou OD, Papagelopoulos PJ. Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies. J Exp Orthop 2023; 10:43. [PMID: 37058177 PMCID: PMC10105000 DOI: 10.1186/s40634-023-00603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear. METHODS A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed. RESULTS Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients. CONCLUSION This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jim D Georgoulis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece.
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Patras
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Trikoupis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
43
|
Mifsud B, Stephens JM, Warmenhoven J, Ball N. Curves and kinematics: Relationship between the force-time curve and landing ability. Scand J Med Sci Sports 2023; 33:420-432. [PMID: 36408795 DOI: 10.1111/sms.14272] [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: 06/19/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
Anterior cruciate ligament (ACL) injuries have a significant impact on athletic performance and long-term quality of life. Force plates and qualitative screening tools are feasible and effective screening methods to identify abnormal movement quality associated with increased injury risk. Comparing qualitative assessments of landing ability with force-time curves, may detect unique differences between safe and high-risk athletic movement patterns. The aim of this study was to determine low- and high-risk landing ability from qualitive landing assessments and to examine the resulting force-time curves using functional principal component analysis (fPCA). Thirty-one healthy academy athletes (10 males and 21 females) completed double- and single-leg dominant and non-dominant jump-landing-rebound tasks. All movements were filmed in multiple-planes, and vertical ground reaction forces (vGRF) were simultaneously collected. The Landing Error Scoring System (LESS) and Single-Leg Landing Error Scoring System (SL-LESS) were used to score landing footage. From these scores, athletes were categorized into low-risk and high-risk groups for further analysis. fPCA was used to examine differences between landing quality groups force-time curves. Compared to high-risk landers, low-risk landers demonstrated significantly longer contact times across all movements. Scores from fPC1 revealed safe and high-risk landing techniques expose athletes to significantly different loading patterns during double- and single-leg dominant movements. A significant positive relationship was observed between fPC1 and LESS scores, however this relationship was not observed in both single-leg landing scores. Where possible incorporating curve analysis methods like fPCA into multi-faceted screening approaches may help practitioners uncover unique insights into athletic loading strategies.
Collapse
Affiliation(s)
- Brayden Mifsud
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,ACT Academy of Sport (ACTAS), Bruce, Australian Capital Territory, Australia.,Australian Institute of Sport (AIS), Bruce, Australian Capital Territory, Australia
| | - Jessica M Stephens
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,ACT Academy of Sport (ACTAS), Bruce, Australian Capital Territory, Australia
| | - John Warmenhoven
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,School of Sport, Exercise and Rehabilitation, University of Technology, Sydney, New South Wales, Australia
| | - Nick Ball
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
44
|
Preobrazenski N, Seigel J, Halliday S, Janssen I, McGlory C. Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:684-696. [PMID: 36883219 PMCID: PMC10067508 DOI: 10.1002/jcsm.13201] [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: 08/17/2022] [Revised: 12/01/2022] [Accepted: 02/02/2023] [Indexed: 03/09/2023] Open
Abstract
We aimed to quantify declines from baseline in lower limb skeletal muscle size and strength of uninjured adults following single-leg disuse. We searched EMBASE, Medline, CINAHL, and CCRCT up to 30 January 2022. Studies were included in the systematic review if they (1) recruited uninjured participants; (2) were an original experimental study; (3) employed a single-leg disuse model; and (4) reported muscle strength, size, or power data following a period of single-leg disuse for at least one group without a countermeasure. Studies were excluded if they (1) did not meet all inclusion criteria; (2) were not in English; (3) reported previously published muscle strength, size, or power data; or (4) could not be sourced from two different libraries, repeated online searches, and the authors. We used the Cochrane Risk of Bias Assessment Tool to assess risk of bias. We then performed random-effects meta-analyses on studies reporting measures of leg extension strength and extensor size. Our search revealed 6548 studies, and 86 were included in our systematic review. Data from 35 and 20 studies were then included in the meta-analyses for measures of leg extensor strength and size, respectively (40 different studies). No meta-analysis for muscle power was performed due to insufficient homogenous data. Effect sizes (Hedges' gav ) with 95% confidence intervals for leg extensor strength were all durations = -0.80 [-0.92, -0.68] (n = 429 participants; n = 68 aged 40 years or older; n ≥ 78 females); ≤7 days of disuse = -0.57 [-0.75, -0.40] (n = 151); >7 days and ≤14 days = -0.93 [-1.12, -0.74] (n = 206); and >14 days = -0.95 [-1.20, -0.70] (n = 72). Effect sizes for measures of leg extensor size were all durations = -0.41 [-0.51, -0.31] (n = 233; n = 32 aged 40 years or older; n ≥ 42 females); ≤7 days = -0.26 [-0.36, -0.16] (n = 84); >7 days and ≤14 days = -0.49 [-0.67, -0.30] (n = 102); and >14 days = -0.52 [-0.74, -0.30] (n = 47). Decreases in leg extensor strength (cast: -0.94 [-1.30, -0.59] (n = 73); brace: -0.90 [-1.18, -0.63] (n = 106)) and size (cast: -0.61[-0.87, -0.35] (n = 41); brace: (-0.48 [-1.04, 0.07] (n = 41)) following 14 days of disuse did not differ for cast and brace disuse models. Single-leg disuse in adults resulted in a decline in leg extensor strength and size that reached a nadir beyond 14 days. Bracing and casting led to similar declines in leg extensor strength and size following 14 days of disuse. Studies including females and males and adults over 40 years of age are lacking.
Collapse
Affiliation(s)
| | - Joel Seigel
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Sandra Halliday
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Chris McGlory
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
45
|
Kuliński K, Waśko MK, Tramś E, Malesa K, Pomianowski S, Kamiński R. Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study. Am J Sports Med 2023; 51:615-626. [PMID: 36856280 DOI: 10.1177/03635465221149738] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. PURPOSE To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. RESULTS Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. CONCLUSION This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. TRIAL REGISTRATION clinicaltrials.gov: NCT03626883.
Collapse
Affiliation(s)
- Krzysztof Kuliński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Marcin K Waśko
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Tramś
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Kamila Malesa
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Stanisław Pomianowski
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Rafał Kamiński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| |
Collapse
|
46
|
Abstract
Acute knee injury ranges among the most common joint injuries in professional and recreational athletes. Radiographs can detect joint effusion, fractures, deformities, and malalignment; however, MR imaging is most accurate for radiographically occult fractures, chondral injury, and soft tissue injuries. Using a structured checklist approach for systematic MR imaging evaluation and reporting, this article reviews the MR imaging appearances of the spectrum of traumatic knee injuries, including osteochondral injuries, cruciate ligament tears, meniscus tears and ramp lesions, anterolateral complex and collateral ligament injuries, patellofemoral translation, extensor mechanism tears, and nerve and vascular injuries.
Collapse
|
47
|
ARIMAA A, SALMINEN T, KNIFSUND J, KYTÖ V, LANKINEN P, LAAKSONEN I. Anterior cruciate ligament reconstruction and concomitant procedures in Finland between 2004 and 2018 based on national registers. Acta Orthop 2023; 94:45-50. [PMID: 36728095 PMCID: PMC9893838 DOI: 10.2340/17453674.2023.8481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to assess the incidence of anterior cruciate ligament reconstruction (ACLR) and concomitant procedures in Finland. PATIENTS AND METHODS We identified all the patients who underwent ACLR between 2004 and 2018 in Finland using national registry data. Patients with an ICD-10 diagnosis code S83.5 and the NOMESCO operation codes NGE30 or NGE35 were included. We recorded the patient's age, sex, Charlson comorbidity index, and concomitant procedures. NGE30 or NGE35 was defined as the main procedure and all other procedures attached to this procedure were included as concomitant procedures. RESULTS Our study included 37,224 ACLRs. The overall incidence of ACLR was 46 (95%CI 34-62) per 105 person-years. This increased from 38 per 105 person-years in 2004 to its peak of 53 in 2014 before decreasing to 47 by 2018. Male patients had a higher overall incidence of ACLR than female patients (61 [CI 47-78] vs. 32 [CI 22-45] per 105 person-years, respectively). However, this difference changed over time: for the males, a decrease in ACLR incidence was observed after 2014, whereas for the females, the trend increased throughout the study period. For both sexes, the highest incidence of ACLRs was in the age group 16-29 years (159 and 71 per 105 person-years, respectively). Concomitant procedures were performed at the time of ACLR in 32% of cases. CONCLUSION While the total incidence of ACLR decreased slightly from 2014 to 2018, it increased among women over the full study period, which might be due to increased female participation in contact sports. Special attention should be given to girls' and women's ACL rupture prevention and treatment.
Collapse
Affiliation(s)
- Anssi ARIMAA
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku
| | - Tommi SALMINEN
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku
| | - Jani KNIFSUND
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku
| | - Ville KYTÖ
- Heart Center, Turku University Hospital and University of Turku, Turku,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku,Center for Population Health Research, Turku University Hospital and University of Turku, Turku,Clinical Research Center, Turku University Hospital, Turku
| | | | - Inari LAAKSONEN
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku
| |
Collapse
|
48
|
Gong H, Wang H, Zhang X, Fu L, Chen L. Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study. Arch Orthop Trauma Surg 2023; 143:927-934. [PMID: 35230503 DOI: 10.1007/s00402-022-04366-9] [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: 08/28/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.
Collapse
Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Haijun Wang
- Peking University Third Hospital, Beijing, China
| | - Xiaofei Zhang
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Ligong Fu
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China. .,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China.
| |
Collapse
|
49
|
Philpott C, Donovan B, Belton S, Lester D, Chambers F, O’Brien W. Motor Competence Among Irish Adolescents: An Investigation of Sex Differences and Relatedness Between Fundamental Movement Skills and Functional Movement. Percept Mot Skills 2023; 130:27-53. [PMID: 36314278 PMCID: PMC10014897 DOI: 10.1177/00315125221137182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In prior research, Irish youth displayed poor motor competence across fundamental movement skills (FMS) and functional movements (FM). Our purpose in this study was to compare FMS and FM across male and female Irish adolescents and to determine whether there are associations between these movement domains. We collected data on 373 adolescents (178 females; M age = 14.38, SD = 0.87 years) from six Irish secondary schools, including motor competence testing of 10 FMS, and 7 FM. Overall levels of motor competence of both FMS and FM were low, and certain levels of dysfunctional movement were high. We observed significant sex-based differences in both FMS and FM, and there was a moderate association between FMS and FM that warrants further investigation. There is a need for societal intervention and policy changes to address low levels of motor competence among adolescent youth.
Collapse
Affiliation(s)
- Conor Philpott
- School of Education, Sports Studies
and Physical Education, University College Cork, Cork, Ireland
| | - Brian Donovan
- School of Education, Sports Studies
and Physical Education, University College Cork, Cork, Ireland
| | - Sarahjane Belton
- School of Health and Human
Performance, Dublin City University, Dublin, Ireland
| | - Diarmuid Lester
- School of Education, Sports Studies
and Physical Education, University College Cork, Cork, Ireland
| | - Fiona Chambers
- School of Education, Sports Studies
and Physical Education, University College Cork, Cork, Ireland
| | - Wesley O’Brien
- School of Education, Sports Studies
and Physical Education, University College Cork, Cork, Ireland
| |
Collapse
|
50
|
Ferguson H, Piquet J, Jemni M, Delextrat A. Effects of a Football Simulated Exercise on Injury Risk Factors for Anterior Cruciate Ligament (ACL) Injury in Amateur Female Players. BIOLOGY 2023; 12:biology12010124. [PMID: 36671816 PMCID: PMC9855934 DOI: 10.3390/biology12010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Females are more at risk of Anterior Cruciate Ligament (ACL) injuries than males; however, there is limited literature on neuromuscular risk factors such as angle-specific hamstring/quadriceps functional strength ratios (Hecc/Qcon) and rate of torque development (RTD) in female footballers. The aim of this study was to investigate the effects of fatigue on these neuromuscular risk factors. Thirty-three amateur players (20.3 ± 2.0 years old, 1.67 ± 9.31 m, 63.4 ±8.1 kg, 23.6 ± 5.7% body fat) performed strength assessments of the quadriceps (concentrically, Qcon) and hamstrings (eccentrically, Hecc) on both legs on an isokinetic dynamometer, before and immediately after a football-specific exercise. Results showed significantly lower peak Hecc (-15.1 to -15.5%), peak Hecc/Qcon (-8.8 to -12.9%) and RTD (-14.0 to -17.0%) for hamstring eccentric contractions after fatigue in the dominant and non-dominant legs. Furthermore, significant decreases in Hecc/Qcon were observed at 10° only in the dominant leg (-15.5%), and at 10°, 20° and 30° in the non-dominant leg (-15.1 to -21.8%). These results suggest a reduced capacity of the hamstrings to stabilise the knee joint with fatigue. Unlike results previously shown on men, the non-dominant leg seemed more affected, highlighting the need to consider specific prevention measures in females.
Collapse
Affiliation(s)
- Harriet Ferguson
- Department of Sport and Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 8HU, UK
| | - Jessica Piquet
- Department of Sport and Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 8HU, UK
| | - Monèm Jemni
- The Carrick Institute of Neuroscience, Cap Canaveral, FL 32920, USA
| | - Anne Delextrat
- Department of Sport and Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 8HU, UK
- Correspondence: ; Tel.: +44-(0)-1865-48-3610
| |
Collapse
|