1
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Prill R, Briem K, Karlsson J, Hirschmann MT, Nyland J. Teamwork is needed now: Time to focus on collaboration, rehabilitation and patients' needs! Knee Surg Sports Traumatol Arthrosc 2024; 32:1641-1644. [PMID: 38751086 DOI: 10.1002/ksa.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Kristin Briem
- Department of Physical Therapy, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Michael T Hirschmann
- Basel University, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - John Nyland
- Norton Orthopedic Institute, Louisville, Kentucky, USA
- Department of Orthopaedic Surgery, University of Louisville, Kentucky, USA
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2
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Shankar DS, Milton HA, Mojica ES, Buzin S, Strauss EJ, Campbell KA, Alaia MJ, Gonzalez-Lomas G, Jazrawi LM. Force plate jump testing metrics are predictive of performance on a multimodal return to sport testing protocol among anterior cruciate ligament reconstruction patients at minimum six-month follow-up. J Sports Med Phys Fitness 2023; 63:1208-1217. [PMID: 37526491 DOI: 10.23736/s0022-4707.23.14850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Force plate-based jump testing may serve as a potential alternative to traditional return to sport (RTS) testing batteries. The purpose of our study was to identify force plate jump metrics that were predictive of RTS test findings in patients who were at least six months postoperative following anterior cruciate ligament reconstruction (ACLR). METHODS We conducted a cross-sectional study of patients who underwent ACLR at our center and were at least six months postoperative. Subjects completed a multimodal Institutional RTS (IRTS) testing battery which included range of motion (ROM) testing and isokinetic quadriceps strength testing. Subjects also completed a countermovement jump testing protocol on a commercially-available force plate. Jump metrics predictive of IRTS test findings were identified using multivariable linear and logistic regression with stepwise selection. Model significance was assessed at α=0.002. RESULTS Sixteen patients (7M, 9F) were enrolled in our study with median age of 29 years (range 20-47). Relative concentric impulse was positively predictive of knee flexion active ROM (β=7.07, P=0.01) and passive ROM (β=9.79, P=0.003). Maximum power was positively predictive of quadriceps strength at 60 deg/s (β=3.27, P<0.001) and 180 deg/s (β=2.46, P<0.001). Center-of-pressure (COP) shift acceleration along the force plate X-axis was negatively predictive of Bunkie lateral test score (β=-945, P<0.001) and medial test score (β=-839, P=0.03). CONCLUSIONS Force plate-derived vertical jump testing metrics are predictive of certain components of a multimodal RTS physical assessment for ACLR patients, including knee flexion ROM, quadriceps strength on isokinetic testing, and Bunkie Test performance.
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Affiliation(s)
- Dhruv S Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA -
| | - Heather A Milton
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Edward S Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Scott Buzin
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Whiteley I, Sideris V, Kotsifaki R, King E, Whiteley R. The MyJump App is a Valid Method of Assessing and Classifying Limb Symmetry During Recovery from Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2023; 18:1156-1165. [PMID: 37795318 PMCID: PMC10547091 DOI: 10.26603/001c.88005] [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: 03/08/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
Background Jump testing performance and limb symmetry measures are important metrics for clinicians to monitor during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction, however they require hardware and software which is not commonly available in clinical practice. Video-based solutions may present a feasible alternative, but their veracity in classifying patients using limb-symmetry of 90% has not been established, nor have the clinimetric values for the performance measures been reported in this population. Purpose To describe the diagnostic accuracy (pass/fail using 90% LSI) and clinimetrics of an iPad-based app ("MyJump") compared to reference force plate analyses for limb symmetry, jump/hop height, contact time, flight time, and reactive strength index. Study design Prospective cohort, diagnostic accuracy. Methods Fifty-one consecutive patients recovering from ACL reconstruction undertaking routine independent clinical evaluation of their hop and jump performance were concurrently and independently examined using force plates and the MyJump app. Diagnostic accuracy of MyJump was compared to reference force plate analyses using a criterion of 90% limb symmetry. Results Diagnostic accuracy of the MyJump app was very good: positive predictive value for jump height was 0.83 and 1.0 for reactive strength index, and negative predictive value was 0.95 and 1.0 for the same metrics, respectively. Of the 131 classifications made using the MyJump app, there were five false positives and three false negatives - all of these were in classification of jump height with no misclassifications of RSI. Irrespective of jump type, the MyJump app displayed excellent reliability (ICC>0.95) for both height and reactive strength index. Minimum detectable changes were approximately 1cm for height, 0.1 for reactive strength index, 0.02s for contact time, and 0.3s for flight time. Conclusion Where force plates are unavailable, the MyJump app is a valid and reliable substitute for criteria assessment of jump/hop height and reactive strength index in those recovering from ACL surgery using a 90% limb symmetry threshold. The minimum detectable changes vary by metric but are likely sufficiently accurate to detect clinical changes. Level Of Evidence Level 3.
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Affiliation(s)
- Isaac Whiteley
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
| | | | - Roula Kotsifaki
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
| | - Enda King
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
| | - Rod Whiteley
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
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4
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Bæktoft van Weert M, Skovdal Rathleff M, Eppinga P, Møller Mølgaard C, Welling W. Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study. Knee 2023; 42:390-399. [PMID: 37230002 DOI: 10.1016/j.knee.2023.04.016] [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: 12/13/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the potential difference in jump-landing techniques between IF and EF instructions in patients after ACLR. METHODS Thirty patients (12 females, mean age 23.26 ± 4.91 years) participated after ACLR. Patients were randomly assigned into two groups that each followed a different testing sequence. Patients performed a drop vertical jump-landing test after receiving instructions with varying types of focus of attention. The Landing Error Scoring System (LESS) assessed the jump-landing technique. RESULTS EF was associated with a significantly better LESS score (P < 0.001) compared with IF. Only EF instructions led to improvements in jump-landing technique. CONCLUSION Using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. This indicates that increased use of EF could or might result in a better treatment outcome during ACLR rehabilitation.
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Affiliation(s)
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Centre for General Practice at Aalborg University, Aalborg, Denmark; Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Peter Eppinga
- Medisch Centrum Zuid (MCZ), Groningen, The Netherlands
| | - Carsten Møller Mølgaard
- Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Groningen, The Netherlands; Pro-F Fysiotherapie, Enschede, The Netherlands.
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5
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Read PJ, Davies WT, Bishop C, McAuliffe S, Wilson MG, Turner AN. Residual Deficits in Reactive Strength After Anterior Cruciate Ligament Reconstruction in Soccer Players. J Athl Train 2023; 58:423-429. [PMID: 37523420 PMCID: PMC11220905 DOI: 10.4085/0169-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
CONTEXT Deficits in plyometric abilities are common after anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. OBJECTIVE To examine the utility of a vertical hop test for assessing function after ACLR and establishing factors associated with performance. DESIGN Cross-sectional study. SETTING Rehabilitation program. PATIENTS OR OTHER PARTICIPANTS Soccer players with a history of ACLR (n = 73) and matched control individuals (n = 195). MAIN OUTCOME MEASURE(S) The 10-second vertical hop test provided measures of jump height, the Reactive Strength Index (RSI), and asymmetry. We also examined possible predictors of hop performance, including single-legged vertical drop jump, isokinetic knee-extension strength, and the International Knee Documentation Committee questionnaire score. RESULTS Between-limbs differences were identified only for the ACLR group, and asymmetry scores increased in those with a history of ACLR (P < .001) compared with the control group. The single-legged vertical drop jump, RSI, and knee-extension torque were significant predictors of 10-second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). CONCLUSIONS Vertical hop deficits were present after ACLR, even after participants completed a comprehensive rehabilitation program. This may have been due to reduced knee-extension and reactive strength. Vertical hop tests warrant inclusion as part of the return-to-sport test battery.
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Affiliation(s)
- Paul J. Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Kim H, Onate JA, Criss CR, Simon JE, Mischkowski D, Grooms DR. The relationship between drop vertical jump action-observation brain activity and kinesiophobia after anterior cruciate ligament reconstruction: A cross-sectional fMRI study. Brain Behav 2023; 13:e2879. [PMID: 36602922 PMCID: PMC9927857 DOI: 10.1002/brb3.2879] [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: 08/02/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Injury and reconstruction of anterior cruciate ligament (ACL) result in central nervous system alteration to control the muscles around the knee joint. Most individuals with ACL reconstruction (ACLR) experience kinesiophobia which can prevent them from returning to activity and is associated with negative outcomes after ACLR. However, it is unknown if kinesiophobia alters brain activity after ACL injury. OBJECTIVES To compare brain activity between an ACLR group and matched uninjured controls during an action-observation drop vertical jump (AO-DVJ) paradigm and to explore the association between kinesiophobia and brain activity in the ACLR group. METHODS This cross-sectional study enrolled 26 individuals, 13 with ACLR (5 males and 8 females, 20.62 ± 1.93 years, 1.71 ± 0.1 m, 68.42 ± 14.75 kg) and 13 matched uninjured controls (5 males and 8 females, 22.92 ± 3.17 years, 1.74 ± 0.10 m, 70.48 ± 15.38 kg). Individuals were matched on sex and activity level. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) to evaluate the level of movement-related fear. To assay the brain activity associated with a functional movement, the current study employed an action-observation/motor imagery paradigm during functional magnetic resonance imaging (fMRI). RESULTS The ACLR group had lower brain activity in the right ventrolateral prefrontal cortex relative to the uninjured control group. Brain activity of the left cerebellum Crus I and Crus II, the right cerebellum lobule IX, amygdala, middle temporal gyrus, and temporal pole were positively correlated with TSK-11 scores in the ACLR group. CONCLUSION Brain activity for the AO-DVJ paradigm was different between the ACLR group and uninjured controls. Secondly, in participants with ACLR, there was a positive relationship between TSK-11 scores and activity in brain areas engaged in fear and cognitive processes during the AO-DVJ paradigm.
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Affiliation(s)
- HoWon Kim
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Translational Biomedical Sciences Program, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - James A Onate
- Division of Athletic Training, School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Cody R Criss
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Heritage Fellow, Translational Biomedical Sciences Program, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Janet E Simon
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Dominik Mischkowski
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Psychology Department, College of Arts and Sciences, Ohio University, Athens, Ohio, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
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7
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Geldenhuys AG, Burgess T, Roche S, Hendricks S. Return to rugby following musculoskeletal injuries: A survey of views, practices and barriers among health and sport practitioners. Phys Ther Sport 2023; 59:49-59. [PMID: 36508771 DOI: 10.1016/j.ptsp.2022.11.009] [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: 10/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
STUDY DESIGN AND SETTING Returning rugby players to the sport following musculoskeletal injuries is a multi-factorial and challenging process. A cross-sectional observational study was conducted among health and sport practitioners involved with injured rugby players in South Africa. OBJECTIVES AND OUTCOME MEASURES The views, current practices and barriers encountered by health and sport practitioners during return to rugby were investigated using a self-developed online survey. RESULTS 64 practitioners participated in the survey including physiotherapists, orthopaedic surgeons, biokineticists and sports physicians. Return to sport (RTS) protocols were considered important, however, participants also indicated that they were slightly more likely to use anecdotal protocols compared to published protocols. Time frames, stages of healing, pain and subjective ratings along with functional outcome measures (such as range of motion, muscle function and proprioception) and sport-specific skills were rated as important and commonly utilised in different RTS phases (i.e., return to non-contact, return to contact and return to matches). The most commonly perceived barriers encountered were related to lack of access and time-constraints. CONCLUSION Return to rugby guidelines with consideration of a broad range of criteria and common barriers encountered should be developed to facilitate safe, practical and time-efficient return to rugby following musculoskeletal injuries.
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Affiliation(s)
- A Grethe Geldenhuys
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Theresa Burgess
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Health through Physical Activity, Lifestyle and Sport (HPALS) Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Carnegie Applied Rugby Research (CARR) Centre, Institute for Sport Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
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8
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Bakal DR, Morgan JJ, Lyons SM, Chan SK, Kraus EA, Shea KG. Analysis of limb kinetic asymmetry during a drop vertical jump in adolescents post anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2022; 100:105794. [PMID: 36270179 DOI: 10.1016/j.clinbiomech.2022.105794] [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: 04/12/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limb asymmetry after ACL reconstruction is often cited as a risk factor for ACL reinjury. We assessed ground reaction forces on each limb during a drop vertical jump, and compared kinetic symmetry between limbs in adolescents post-ACL reconstruction versus healthy controls. METHODS Forty-four participants who underwent an ACL reconstruction (16 male/28 female, mean age 16.1 ± 1.5, mean 7.3 ± 0.9 months post-ACL reconstruction) and 34 controls (20 male/14 female, mean age 14.9 ± 1.1) completed a drop vertical jump captured on a Vicon system and Bertec force plates. Kinetic variables were calculated individually for each limb. Inter-limb asymmetry was calculated as an index between each limb (involved versus uninvolved for the ACL reconstruction group, and left versus right for controls), and was compared between groups using independent t-tests. FINDINGS Asymmetry was significantly more pronounced in the ACL reconstruction group versus the controls for peak contact ground reaction force (11.6% vs 4.4%, p = 0.009), eccentric impulse (8.8% vs 3.8%, p = 0.009), eccentric mean force (8.0% vs 3.4%, p = 0.006), concentric peak ground reaction force (4.1% vs 0.8%, p = 0.003), concentric impulse (5.1% vs 1.1%, p = 0.001), and peak landing ground reaction force (12.7% vs 1.7%, p < 0.001). INTERPRETATION Limb kinetic asymmetry during a drop vertical jump was more pronounced in adolescents post-ACL reconstruction versus controls for both eccentric- and concentric-phase variables, which may indicate the use of compensatory strategies to offload the post-operative limb. Targeted interventions to produce more symmetric loading and unloading during jumping tasks should be developed, tested, and monitored to determine the impact on rehabilitation programs, return-to-sport evaluations, and injury prevention outcomes.
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Affiliation(s)
- David R Bakal
- Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, USA.
| | - Jeffery J Morgan
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Samuel M Lyons
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Salinda K Chan
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Emily A Kraus
- Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, USA; Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Kevin G Shea
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
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9
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Lampros RE, Tanaka MJ. Return to Play Considerations After Patellar Instability. Curr Rev Musculoskelet Med 2022; 15:597-605. [PMID: 36367684 PMCID: PMC9789273 DOI: 10.1007/s12178-022-09792-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW To discuss the treatment options and rehabilitation protocols after non-operative and operative treatment of patellar instability, and to discuss expected return to play outcomes and functional performance with non-operative and operative treatment of patellar instability. RECENT FINDINGS A criterion-based program assessing range of motion, joint effusion, strength, neuromuscular control, proprioception, agility, and power are critical measures to assess when rehabilitating this population. A series of functional tests including quadriceps strength testing, single-limb hop testing, lateral step-down test, the side hop test, the lateral leap and catch test, the Y-balance test, and the depth jump should be considered when determining an athlete's return to sport clearance. These objective measures combined with psychological readiness and a comprehensive understanding of the sports-specific tasks required for participation should be considered when evaluating an athlete's ability to safely and successfully return to sport. We discuss rehabilitation management when working with non-operative and operative management of patellar instability and provide considerations for clinicians working with these athletes to facilitate safe return to sport.
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Affiliation(s)
- Rachel E Lampros
- Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
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10
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Hirohata K, Aizawa J, Ohmi T, Ohji S, Mitomo S, Ohara T, Koga H, Yagishita K, Jinno T, Okawa A. Reactive strength index during single-limb vertical continuous jumps after anterior cruciate ligament reconstruction: cross-sectional study. BMC Sports Sci Med Rehabil 2022; 14:150. [PMID: 35918729 PMCID: PMC9344617 DOI: 10.1186/s13102-022-00542-x] [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: 01/07/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The association of the reactive strength index (RSI) during single-limb vertical continuous jumps (SVCJs) with single-limb hop tests in athletes after anterior cruciate ligament reconstruction (ACLR) is unclear. Thus, this study aimed to confirm the measurement properties of the RSI during SVCJs in athletes with ACLR at the phase of determining the timing of their return to sport. METHODS RSI during SVCJs and single-limb hop (single, triple, and crossover) tests were measured for post-ACLR and healthy athletes. The limb symmetry index (LSI) was calculated using the measurements of each parameter. For each test, patients were divided into two subgroups according to their LSI score (≥ 90%, satisfactory; < 90%, unsatisfactory). Fisher's exact test was used to examine the association of single-limb hop tests with RSI during the SVCJs. RESULTS A total of 21 post-ACLR and 17 healthy athletes completed all the tests. RSI during SVCJs was significantly lower on the involved limb than on the uninvolved limb in post-ACLR athletes (P < 0.001). The LSI of RSI during SVCJs of post-ACLR athletes was significantly lower than that of the healthy athletes (P < 0.01). Among the post-ACLR athletes, < 30% of those with LSIs > 90% in the single-limb hop tests had an LSI > 90% of the RSI during SVCJs. CONCLUSIONS RSI during SVCJs of post-ACLR athletes was significantly lower on the involved limb than on the uninvolved limb, and the asymmetry was more remarkable in the SVCJs than in the single-limb hop tests.
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Affiliation(s)
- Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshiyuki Ohara
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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11
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Quantifying the relationship between quadriceps strength and aerobic fitness following anterior cruciate ligament reconstruction. Phys Ther Sport 2022; 55:106-110. [DOI: 10.1016/j.ptsp.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
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12
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Read PJ, Pedley JS, Eirug I, Sideris V, Oliver JL. Impaired Stretch-Shortening Cycle Function Persists Despite Improvements in Reactive Strength After Anterior Cruciate Ligament Reconstruction. J Strength Cond Res 2022; 36:1238-1244. [PMID: 35482544 DOI: 10.1519/jsc.0000000000004208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Read, PJ, Pedley, JS, Eirug, I, Sideris, V, and Oliver, JL. Impaired stretch-shortening cycle function persists despite improvements in reactive strength followingafter anterior cruciate ligament reconstruction. J Strength Cond Res 36(5): 1238-1244, 2022-Reactive strength index (RSI) during a single-leg drop jump (SLDJ) has been indicated to determine return-to-sport readiness after anterior cruciate ligament (ACL) reconstruction, but only cross-sectional studies are available. Ground reaction force data and characterization of stretch-shortening cycle (SSC) function also remain sparse. Single-leg drop jump performance, ground reaction force, and SSC function were examined in soccer players with ACL reconstruction (n = 26) and matched controls (n = 25). Injured players were tested at 2 time points (32 and 42 weeks postsurgery). Stretch-shortening cycle function was classified as good (no impact peak and spring like), moderate (impact peak but still spring like or no impact peak and not spring like), or poor (impact peak and not spring like). The involved limb displayed lower-jump height, poorer RSI, less spring-like behavior, earlier peak landing force, and a greater ratio of landing peak to take-off peak force compared with the uninvolved limb and controls at the initial assessment (p < 0.001). Proportionally, more involved limbs were categorized as poor or moderate at the initial assessment (69.2%) and follow-up (50%) in comparison with the control limbs (14%). The reactive strength index was the only variable to change significantly between the initial assessment and follow-up on the involved limb (p < 0.05). No changes in the proportion of ACL reconstructed individuals categorized as poor or moderate SSC function at the follow-up assessment were observed. Residual deficits are present in SLDJ performance, SSC function, and ground reaction force characteristics after ACL reconstruction. The reactive strength index should not be the sole metric, as observed increases did not correspond with changes in SSC function.
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Affiliation(s)
- Paul J Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Institute of Sport Exercise and Health, London, United Kingdom
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Jason S Pedley
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
| | - Ifan Eirug
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
| | | | - Jon L Oliver
- Youth Physical Development Center, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom ; and
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
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Johnston PT, Feller JA, McClelland JA, Webster KE. Knee strength deficits following anterior cruciate ligament reconstruction differ between quadriceps and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2022; 30:1300-1310. [PMID: 33876272 DOI: 10.1007/s00167-021-06565-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/06/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare patient reported outcomes and functional knee recovery following anterior cruciate ligament (ACL) reconstruction using either a quadriceps tendon (QT) or hamstring tendon (HT) autograft. METHODS Thirty-five QT patients (age 20; range 15-34 years) participated in this study and were matched for gender, age and pre-injury activity level to 70 HT (age 20; range 15-32 years) patients. The following assessments were performed at 6 and 12 months post-operatively; standardized patient-reported outcome measures (IKDC, KOOS-QOL, ACL-RSI, Marx activity, anterior knee pain), knee range of motion (passive and active), anterior knee laxity, hop tests (single and triple crossover hop for distance), and isokinetic strength of the knee extensors and flexors. All dependent variables were analysed using a two-way mixed ANOVA model, with within (Time; 6 and 12 months) and between-subject (Graft; QT and HT) factors. RESULTS Patient reported outcome measures and hop performance improved between 6 and 12 months (p < 0.001), however no significant differences in either patient-reported outcomes or hop performance were found between the two grafts. Isokinetic strength testing showed both groups improved their peak knee extensor strength in the operated limb between 6 and 12 months (p < 0.001), but the QT group had significantly lower knee extensor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.001) and 180 deg/s (p < 0.01). In contrast, the QT group had significantly greater knee flexor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.01) and 180 deg/s (p = 0.01), but knee flexor strength limb symmetry did not significantly improve over time in either group. CONCLUSION Recovery of knee function following either QT or HT ACL reconstruction continues between 6 and 12 months after surgery. However, knee extensor strength deficits in the QT group and knee flexor strength deficits in the HT persisted at 12 months. This may have implications for decisions regarding return to sport. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peta T Johnston
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| | | | - Jodie A McClelland
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
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Observation on the Rehabilitation Effect of Athletes with Anterior Cruciate Ligament Injury of the Knee Based on Multidisciplinary Combined Nondrug Therapy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9528354. [PMID: 35222899 PMCID: PMC8865994 DOI: 10.1155/2022/9528354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
This study analyzes the rehabilitation effects of athletes with anterior cruciate ligament injury of the knee based on multidisciplinary combined nondrug therapy. For this purpose, 70 athletes with anterior cruciate ligament injury of the knee admitted from September 2019 to December 2020, who were randomly selected, were the subjects of the study. According to the random number table method, they were divided into the control group and observation group, with 35 cases in each group. The control group was given conventional conservative treatment such as braces braking, local physiotherapy, and routine rehabilitation exercise after injury. For the observation group, multidisciplinary combined nondrug therapy was implemented on the basis of the control group. After receiving the intervention, the balance function score of the observation group was significantly higher than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). After receiving the intervention, the functional recovery scores of the knee joint of the observation group were significantly higher than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Before treatment, there was no significant difference in knee flexion extension, internal rotation, and external rotation between the two groups (P > 0.05). After treatment, flexion extension, internal rotation, and external rotation of the knee joint in the observation group were significantly higher than those in the control group (P < 0.05). There was no significant difference in VAS scores between the two groups before treatment (P > 0.05). After treatment, the VAS score of the observation group was significantly lower than that of the control group (P < 0.05). Multidisciplinary combined nondrug therapy has a good therapeutic effect in the treatment of anterior cruciate ligament injury of the knee for athletes. It can be used as a conservative treatment method to improve the score of balance function and recovery of lacquer joint function, enhance the range of motion of the knee joint, and reduce the VAS.
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Robinson JD, Hannon J, Goto S, Singleton SB, Garrison JC. Adolescent Athletes Demonstrate Inferior Objective Profiles at the Time of Return to Sport After ACLR Compared With Healthy Controls. Orthop J Sports Med 2022; 10:23259671211063576. [PMID: 35083359 PMCID: PMC8785315 DOI: 10.1177/23259671211063576] [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: 07/11/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Athletes display persistent muscle deficits and altered limb-loading mechanics at the time of return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). Purpose: To compare an objective profile of adolescent athletes at RTS after ACLR to matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 124 participants; 62 patients who underwent ACLR (15.4 ± 1.7 years) and 62 healthy controls (15.3 ± 1.7 years). Motion capture and force plates were used to capture joint motions during jump landing (JL) and single-limb squat (SLS) tasks. Energy absorption contribution (EAC) was calculated, and repeated-measures analysis of variance was used to assess for EAC differences between groups. Participants completed an International Knee Documentation Committee (IKDC) Subjective Knee Form, and isokinetic quadriceps and hamstring strength testing was performed on each limb. Independent t tests were run to examine age, height, weight, and IKDC scores as well as compare differences between groups for quadriceps and hamstring strength. Results: A significant group × joint interaction was found for JL (P < .001) and SLS (P < .001). For JL, patients who underwent ACLR utilized significantly greater hip (P < .001) and significantly less knee (P < .001) EAC on the surgical limb compared with controls. During SLS, patients who underwent ACLR utilized significantly greater hip (P < .001) and significantly less knee (P < .001) EAC on the surgical limb compared with controls. The ACLR cohort demonstrated lower IKDC scores (P < .001) and significantly lower quadriceps strength on the surgical limb (P < .001) than controls. There were no differences in surgical limb hamstring strength between the ACLR cohort and healthy controls (P = .701). Conclusion: Compared with matched healthy controls, the participants who underwent ACLR in this study demonstrated an inferior objective profile at RTS, consisting of deficits in surgical limb loading, self-reported outcomes, and strength.
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Affiliation(s)
| | - Joseph Hannon
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | - Shiho Goto
- Texas Health Sports Medicine, Fort Worth, Texas, USA
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Peebles AT, Miller TK, Queen RM. Landing biomechanics deficits in anterior cruciate ligament reconstruction patients can be assessed in a non-laboratory setting. J Orthop Res 2022; 40:150-158. [PMID: 33738820 DOI: 10.1002/jor.25039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
Landing biomechanics provide important information pertaining to second anterior cruciate ligament (ACL) injury risk in patients following ACL reconstruction (ACLR). While traditional motion analysis technologies are often impractical for use in non-laboratory settings, methods to assess landing biomechanics which are inexpensive, portable, and user-friendly have recently been developed and validated. The purpose of this study was to compare landing kinematics and kinetics between ACLR patients and uninjured controls in a non-laboratory setting. Sixteen ACLR patients (7 male/9 female, 6-12 months post-ACLR) and 16 gender-matched controls completed seven bilateral drop vertical jumps and seven unilateral drop landings on each limb. Plantar force was measured bilaterally using force sensing insoles and frontal and sagittal-plane knee kinematics were measured using two tablets, six reflective markers, and automated point tracking software. Plantar force impulse normalized symmetry index (NSI) and knee frontal plane projection angle (FPPA) range of motion were computed during bilateral landing, and knee flexion range of motion NSI was computed during unilateral landing and compared between groups using independent samples t tests. ACLR patients had larger NSIs (reflecting less symmetry) for plantar force impulse during bilateral landing (p < 0.001) and knee flexion range of motion during unilateral landing (p = 0.004). No between-group differences were observed for knee FPPA range of motion (p = 0.111). This study is an important step towards assessing landing biomechanics in non-research settings with the goal of providing quantitative injury risk metrics in a clinical setting that can be used for return to sport decision making.
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Affiliation(s)
- Alexander T Peebles
- Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Thomas K Miller
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Robin M Queen
- Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.,Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Influence of Patient Demographics and Surgical Characteristics on Pass Rates of Return-to-Activity Tests in Anterior Cruciate Ligament-Reconstructed Patients Before Physician Clearance. Clin J Sport Med 2021; 31:e354-e362. [PMID: 32073476 DOI: 10.1097/jsm.0000000000000790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the frequency of passing return-to-activity tests after anterior cruciate ligament reconstruction (ACLR) and to investigate the influence of patient-specific factors on pass rates. We hypothesized that isolated strength tests would be most difficult to pass and that graft type would be the most influential factor. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Eighty patients with a history of primary, unilateral ACLR, and 80 healthy controls participated. INTERVENTIONS Bilateral isokinetic strength, isometric strength, and single-leg hop tests were recorded during a single visit. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation measured subjective knee function, and the Tegner Activity Scale measured physical activity level. MAIN OUTCOME MEASURES Pass rates were calculated for 3 thresholds of absolute between-limb asymmetry: 0% to 10%, 11% to 15%, and 16% to 20%. Pass rates were compared by sex (male and female), graft type (patellar and hamstrings), meniscal procedure (yes and no), physical activity level (</≥ median Tegner), and time from surgery (</≥ 6 months). RESULTS Isokinetic quadriceps strength was consistently most difficult to pass, whereas the 6-meter timed hop and crossover hop tests were easiest. Graft type had the greatest influence on pass rates (isometric quadriceps and hamstring strength, hamstrings-to-quadriceps ratio), followed by time from surgery (6-meter timed hop and crossover hop), physical activity (IKDC), and meniscal procedure (6-meter timed hop). CONCLUSIONS Isokinetic quadriceps strength was the most difficult test to pass, and single-leg hop tests were the easiest. Patient-specific factors including graft type, time from surgery, physical activity level, and meniscal procedure may influence the ability to meet return-to-activity criterion after ACLR.
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18
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Cahanin R, Esleck B, Hardy J, Bass B, Rogers T, Looney K. Development of the Butterfly Agility Test. Phys Ther Sport 2021; 52:38-44. [PMID: 34404023 DOI: 10.1016/j.ptsp.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop a PPT that incorporates multiple components of athletic ability and to assess its reliability. DESIGN Test-retest experimental design. SETTING Indoor basketball court in southern Alabama, USA. PARTICIPANTS A convenient sample of 21 asymptomatic subjects (14 male, 7 female). MAIN OUTCOME MEASURES Subjects performed the Butterfly Agility Test (BAT), the modified Star Excursion Balance Test (mSEBT), a standing double-legged broad jump (BJ), the Pro Agility Test (PAT), and a forty-yard sprint (40 YS). RESULTS Overall, the BAT was found to have good reliability (ICC = 0.89, 95 % CI = 0.023-0.97), strong correlation with the PAT (r = 0.73-0.77), moderate correlations with the BJ and 40 YS (r = 0.50-0.60), and moderate correlations with the mSEBT (r = 0.37-0.62). CONCLUSION The BAT appears to be a promising composite assessment of athletic ability among young asymptomatic adults, but it is not recommended for clinical use at this time. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Richard Cahanin
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA.
| | - Brandon Esleck
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA
| | - Jonathan Hardy
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA
| | - Brianna Bass
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA
| | - Taylor Rogers
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA
| | - Kyle Looney
- University of South Alabama, Department of Physical Therapy, 5721 USA North, Mobile, AL, 36688, USA
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Mesisca JK, Peebles AT, Queen RM. Including jump height when normalizing single hop impact kinetics can change the directionality of findings. Clin Biomech (Bristol, Avon) 2021; 88:105443. [PMID: 34388652 DOI: 10.1016/j.clinbiomech.2021.105443] [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: 03/05/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessing landing kinetics during hop testing could improve return to sport decisions following anterior cruciate ligament reconstruction (ACL) reconstruction. However, different methods for normalizing kinetic outcomes could influence the interpretation of landing kinetics and therefore the clinical recommendations. METHODS Twenty-one females who had returned to sport following primary unilateral ACL reconstructed completed two single hops for maximum distance on each limb. Hop distance, hop height, peak impact force, and impulse were computed for each hop, and peak impact force and impulse magnitudes were assessed when 1) non-normalized 2) normalized by bodyweight, and 3) normalized by peak potential energy during the hop. FINDINGS Along with hop distance and height, peak impact force and impulse were found to be lower on the surgical limb relative to the non-surgical limb for both non-normalized data and when normalized to bodyweight only (p < 0.001, d > 0.95). However, peak impact force and impulse were found to be higher on the surgical limb relative to the non-surgical limb when normalizing outcomes to peak potential energy (p < 0.001, d > 1.03). INTERPRETATION Different normalization methods result in different interpretations of single hop kinetics. ACL reconstruction patients have shorter hop distances, lower hop heights, lower force magnitudes, and worse energy absorption when hopping on their surgical limb, relative to their non-surgical limb. We believe that normalizing landing kinetics using bodyweight and using peak potential energy provide different information, and as such, we suggest that future research use both methods based on the research question.
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Affiliation(s)
- Jenna K Mesisca
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Alexander T Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA; Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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20
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Negrete R, Simms S, Gross J, Nunes Rabello L, Hixon M, Zeini IM, Jenkins WL, Davies GJ. The Test Re-Test Reliability of A Novel Single Leg Hop Test (T-Drill Hop Test). Int J Sports Phys Ther 2021; 16:724-731. [PMID: 34123525 PMCID: PMC8169018 DOI: 10.26603/001c.23677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Functional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person's athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner. PURPOSE/HYPOTHESIS The purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments. STUDY DESIGN Cross-sectional reliability study. METHODS Fifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. "T" shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability. RESULTS The inter-rater reliability (ICC's) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05). CONCLUSION This study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test. LEVELS OF EVIDENCE Level 2.
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Biomechanical Symmetry during Drop Jump Landing and Takeoff in Adolescent Athletes Following Recent Anterior Cruciate Ligament Reconstruction. Symmetry (Basel) 2021. [DOI: 10.3390/sym13040639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated asymmetry between lower extremities during the landing and takeoff phases of a vertical drop jump (VDJ) in adolescent athletes following anterior cruciate ligament reconstruction (ACLR) and examined if performance was affected by reducing jump height. Thirty-three athletes who underwent ACLR and were referred for 3D biomechanical assessment before returning to play (mean age 15.9, SD 1.3 years; 16/33 female; mean time since surgery 7.4, SD 1.2 months) completed the VDJ while kinematics and kinetics were collected using motion capture. Lower extremity symmetry was compared between phases using paired t-tests. Jump height was calculated to measure performance. Asymmetries in ankle inversion, ankle adduction, knee adduction, hip adduction, hip adduction moment, and hip rotation moment were observed in both phases. Asymmetry was also observed in both phases for sagittal moments and power integrals at the knee and ankle and total power integral, with the magnitude of asymmetry being smaller during takeoff for power absorption/generation. Jump height was related to power generation integrals during takeoff but not to the asymmetry of power generation. Since asymmetries are translated from landing through takeoff, rehabilitation should address both phases to decrease injury risk and maximize performance after return to play.
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22
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Davies WT, Myer GD, Read PJ. Is It Time We Better Understood the Tests We are Using for Return to Sport Decision Making Following ACL Reconstruction? A Critical Review of the Hop Tests. Sports Med 2021; 50:485-495. [PMID: 31745732 PMCID: PMC7018781 DOI: 10.1007/s40279-019-01221-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There has been a move towards a criterion-based return to play in recent years, with 4 single-leg hop tests commonly used to assess functional performance. Despite their widespread integration, research indicates that relationships between ‘passing’ ‘hop test criteria and successful outcomes following rehabilitation are equivocal, and, therefore, require further investigation. This critical review includes key information to examine the evolution of these tests, their reliability, relationships with other constructs, and sensitivity to change over time. Recommendations for how measurement and administration of the tests can be improved are also discussed. The evidence presented in this review shows that hop tests display good reliability and are sensitive to change over time. However, the use of more than 2 hop tests does not appear to be necessary due to high collinearity and no greater sensitivity to detect abnormality. The inclusion of other hop tests in different planes may give greater information about the current function of the knee, particularly when measured over time using both relative and absolute measures of performance. It is recommended that the contralateral limb be tested prior to surgery for a more relevant benchmark for performance, and clinicians are strongly advised to measure movement quality, as hop distance alone appears to overestimate the recovery of the knee.
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Affiliation(s)
- William T Davies
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar.
| | - Gregory D Myer
- Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Paul J Read
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
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Read PJ, Auliffe SM, Thomson A. Commonly used clinical criteria following ACL reconstruction including time from surgery and isokinetic limb symmetry thresholds are not associated with between-limb loading deficits during running. Phys Ther Sport 2021; 49:236-242. [PMID: 33812124 DOI: 10.1016/j.ptsp.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We included objective measures of gait and functional assessments to examine their associations in athletes who had recently commenced running after ACL reconstruction. DESIGN Cross-sectional. SETTING Sports medicine. PARTICIPANTS 65 male athletes with a history of ACL reconstruction. MAIN OUTCOME MEASURES Time from surgery, isokinetic knee extension/flexion strength (60°/s), and peak vertical ground reaction force (pVGRF) measured during running using an instrumented treadmill. We also investigated if a range of recommended isokinetic thresholds (e.g. > 70% quadriceps limb symmetry index) affected the magnitude of pVGRF asymmetry during running. RESULTS There were significant relationships between quadriceps (r = 0.50) and hamstrings (r = 0.46) peak torque and pVGRF. Quadriceps peak torque explained a quarter of the variance in pVGRF (R2 = 0.24; p < 0.001). There was no association was between running pVGRF and time from surgery. Between-group differences in running pVGRF LSI% were trivial (d < 0.20) for all quadriceps and hamstring peak torque LSI thresholds. CONCLUSIONS Current clinical criteria including time from surgery and isokinetic strength limb symmetry thresholds were not associated with lower pVGRF asymmetry measured during running. Quadriceps strength is important, but 'minimum symmetry thresholds' should be used with caution.
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Affiliation(s)
- Paul J Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports, Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, London, UK; Division of Surgery & Interventional Science, University College London, UK; School of Sport and Exercise Sciences, University of Gloucestershire, UK
| | - Sean Mc Auliffe
- Qatar University, Physiotherapy Program, Qatar University, Doha, Qatar
| | - Athol Thomson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports, Medicine Hospital, Doha, Qatar; La Trobe University, Discipline of Podiatry, College of Science, Health and Engineering, La Trobe Sport and Exercise Medicine Research Centre, Victoria, Australia.
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GALI JULIOCESAR, FADEL GUILIAWENDT, MARQUES MARCOSFELIPE, ALMEIDA TYAGOARAÚJO, GALI FILHO JULIOCESAR, FARIA FELIPEALEXANDRESEPAROVIC. THE NEW INJURIES' RISK AFTER ACL RECONSTRUCTION MIGHT BE REDUCED WITH FUNCTIONAL TRAINING. ACTA ORTOPEDICA BRASILEIRA 2021; 29:21-25. [PMID: 33795964 PMCID: PMC7976865 DOI: 10.1590/1413-785220212901240903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The objective of our study was to evaluate if functional training with the Functional Movement Screen (FMS) can reduce the risk of a new injury for patients that underwent an anterior cruciate ligament reconstruction (ACLR). Our hypothesis was that the functional training might reduce the risk of a new injury. Methods: Our training protocol consisted of six phases, each one lasting six weeks. It began two months after surgery. The study group was composed of 10 individuals that completed our protocol after ACLR. The control group consisted of 10 people that completed a regular ACLR rehabilitation protocol. The FMS was used to compare the study and control group performance. Patients with a score of 14 or less on the FMS were considered more likely to suffer an injury than those with a score higher than 14. Results: The study group average FMS score was 16.6 compared to the control group at 12.3. Functional training for ACLR rehabilitation added a statistically significant benefit (p < 0.0002) to reduce the risk of a new injury compared to regular protocol. Conclusion: Functional training may be considered an alternative to the regular ACLR rehabilitation to reduce the risk of a new injury before returning to sports. Level of Evidence III, Case control study.
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Pontillo M, Hines SM, Sennett BJ. Prediction of ACL Injuries from Vertical Jump Kinetics in Division 1 Collegiate Athletes. Int J Sports Phys Ther 2021; 16:156-161. [PMID: 33604145 PMCID: PMC7872458 DOI: 10.26603/001c.18819] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 07/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The incidence of ACL injuries continues to rise secondary to an increase in sport participation. Evidence supports the use of force plate testing to quantify kinetics during rehabilitation after injury and recovery; however, there is limited current research regarding if jump kinetics can identify athletes who are at higher risk for injury. Altered kinetics could potentially lead to abnormal force dissipation and resultant injury. PURPOSE The purpose of this investigation was to identify whether the force-time variables from vertical jumps could predict ACL injuries in collegiate athletes. STUDY DESIGN Retrospective cohort. METHODS Vertical jump testing is performed by all healthy varsity collegiate athletes at several intervals throughout the athletic year at a Division I institution using a commercially available force plate system with dedicated software. Athletes who sustained an ACL injury between 1/1/15 and 6/1/19 were identified (n=16) and compared to healthy athletes who participated in the same sports (n = 262). ACL injuries were considered for this study if they occurred no more than 10 weeks after a jump test. The outcome variables were load, explode, and drive, operationally defined as the average eccentric rate of force development, average relative concentric force, and concentric relative impulse, respectively, which the system normalized to T scores. Mann-Whitney U tests were used to assess group differences for load, explode, drive, and the ratio between the variables. Logistic regression was used to determine if the battery of variables could predict whether or not an athlete would sustain an ACL injury. The p-value was set to 0.10 for the Mann-Whitney U tests, and 0.05 for the logistic regression. RESULTS Significant differences between the ACL and healthy groups were seen for explode (p=0.08), drive (p=0.06), load:explode ratio (p=0.06), and explode:drive ratio (p=0.03). Explode and drive, when entered into the regression equation, showed the ability to predict injury, χ 2 = 6.8, df = 2, p=0.03. CONCLUSIONS The vertical jump force plate variables were able to identify athletes who sustained an ACL injury within 66 days of testing. Athletes who sustained an ACL injury demonstrated altered kinetics and less ability to transmit forces during the vertical jump. LEVEL OF EVIDENCE 3.
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Hughes G, Musco P, Caine S, Howe L. Lower Limb Asymmetry After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: A Systematic Review and Meta-Analysis. J Athl Train 2021; 55:811-825. [PMID: 32607546 DOI: 10.4085/1062-6050-0244-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To identify reported (1) common biomechanical asymmetries in the literature after anterior cruciate ligament (ACL) reconstruction in adolescents during landing and (2) timescales for asymmetry to persist postsurgery. DATA SOURCES We identified sources by searching the CINAHL, PubMed, Scopus, and SPORTDiscus electronic databases using the following search terms: asymmetry OR symmetry AND landing AND biomechanics OR kinematics OR kinetics. STUDY SELECTION We screened the titles and abstracts of 85 articles using our inclusion criteria. A total of 13 articles were selected for further analysis. DATA EXTRACTION Three reviewers independently assessed the methodologic quality of each study. We extracted the effect sizes directly from studies or calculated them for biomechanical variables assessing asymmetry between limbs of participants with ACL reconstruction. We conducted meta-analyses on variables that were assessed in multiple studies for both double- and single-limb landings. DATA SYNTHESIS Asymmetry was more commonly identified in kinetic than kinematic variables. Anterior cruciate ligament reconstruction appeared to have a large effect on asymmetry between limbs for peak vertical ground reaction force, peak knee-extension moment, and loading rate during double-limb landings, as well as mean knee-extension moment and knee energy absorption during both double- and single-limb landings. CONCLUSIONS Our findings suggested that return-to-sport criteria after ACL reconstruction should incorporate analysis of the asymmetry in loading experienced by each limb rather than movement patterns alone.
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Affiliation(s)
- Gerwyn Hughes
- Department of Kinesiology, University of San Francisco, CA
| | - Perry Musco
- Department of Kinesiology, University of San Francisco, CA
| | - Samuel Caine
- Department of Kinesiology, University of San Francisco, CA
| | - Lauren Howe
- Department of Business Administration, University of Zurich, Switzerland
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Murphy D, Louw QA, Moloney C, Leibbrandt D, Clifford AM. Hop Performance After Return to Sport in Anterior Cruciate Ligament-Reconstructed Gaelic Football and Hurling Athletes. J Sport Rehabil 2021; 30:707-716. [PMID: 33418539 DOI: 10.1123/jsr.2019-0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/03/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. METHODS A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. RESULTS In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. CONCLUSIONS The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.
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Gupta R, Singhal A, Malhotra A, Soni A, Masih GD, Raghav M. Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR). Malays Orthop J 2021; 14:50-56. [PMID: 33403062 PMCID: PMC7752004 DOI: 10.5704/moj.2011.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction. Material and Methods: Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association. Results: A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels. Conclusion: Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.
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Affiliation(s)
- R Gupta
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
| | - A Singhal
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
| | - A Malhotra
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
| | - A Soni
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
| | - G D Masih
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
| | - M Raghav
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Chandigarh, India
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Read PJ, McAuliffe S, Bishop C, Oliver JL, Graham-Smith P, Farooq MA. Asymmetry Thresholds for Common Screening Tests and Their Effects on Jump Performance in Professional Soccer Players. J Athl Train 2021; 56:46-53. [PMID: 33264407 PMCID: PMC7863609 DOI: 10.4085/1062-6050-0013.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Arbitrary asymmetry thresholds are regularly used in professional soccer athletes, notwithstanding the sparse literature available to examine their prevalence. OBJECTIVE To establish normative and positional asymmetry values for commonly used screening tests and investigate their relationships with jumping performance. DESIGN Cross-sectional study. SETTING Elite soccer screening. PATIENTS OR OTHER PARTICIPANTS A total of 203 professional male soccer players. MAIN OUTCOME MEASURE(S) Bilateral and unilateral jumping; range of motion; and hamstrings (HAM), quadriceps (QUAD), and hip-adductor and -abductor strength tests were used to quantify asymmetry. Players were divided into 4 quartiles (Q1-Q4) based on the magnitude of their asymmetry for each test. Single composite scores were also developed to group tests by range of motion and HAM, QUAD, hip-adduction, and hip-abduction strength, and differences in jump performance were examined among players in each quartile. RESULTS Large variability (range = 5.2%-14.5%) was evident in asymmetry scores across the different tests and physical qualities. Forwards displayed greater asymmetry in concentric quadriceps and eccentric hip-abduction strength (P < .05). The HAM and QUAD composite scores indicated that Q4 players' jumps were shorter than those in other quartiles during a single-legged countermovement jump and 10-second hop (P < .05). No decrements in unilateral jump performance were shown among players in each quartile for range of motion or hip-adduction and -abduction strength, and no composite measures of asymmetry affected bilateral jump performance. CONCLUSIONS No single asymmetry threshold was present for all tests; the outcomes were task, variable, and population specific. Larger asymmetries in HAM and QUAD strength appeared to be detrimental to unilateral jump performance.
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Affiliation(s)
- Paul J. Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Seán McAuliffe
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Bishop
- London Sport Institute, Middlesex University, United Kingdom
| | - Jon L. Oliver
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, United Kingdom
| | | | - Mohammed Abdulaziz Farooq
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Nyland J, Doral MN, Caborn DNM. Anterior cruciate ligament surgery and rehabilitation: does anybody really know what time it is? Knee Surg Sports Traumatol Arthrosc 2021; 29:1015-1017. [PMID: 33219390 PMCID: PMC7678772 DOI: 10.1007/s00167-020-06364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022]
Affiliation(s)
- John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA. .,Department of Orthopaedics and Traumatology, Dr. Rıdvan EGE Hospital, T.C. Ufuk University, Ankara, Turkey.
| | - Mahmut Nedim Doral
- grid.412829.40000 0001 1034 2117Department of Orthopaedics and Traumatology, Dr. Rıdvan EGE Hospital, T.C. Ufuk University, Ankara, Turkey
| | - David N. M. Caborn
- grid.266623.50000 0001 2113 1622Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY USA
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CRITERION-BASED REHABILITATION PROGRAM WITH RETURN TO SPORT TESTING FOLLOWING ACL RECONSTRUCTION: A CASE SERIES. Int J Sports Phys Ther 2020; 15:1151-1173. [PMID: 33344032 DOI: 10.26603/ijspt20201151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Less than 50% of those sustaining an anterior cruciate ligament (ACL) injury return to their preinjury level of sports participation or participate in competitive sport at two to seven years post ACL reconstruction (ACLR). After ACLR, it has been reported that frequency of subsequent ACL tears has reached as high as 31%. Purpose The purpose of this case series was to evaluate return to sport and reinjury rates following the use of a criterion-based rehabilitation protocol with a final return to sport test that utilizes minimal equipment following ACL reconstruction. Study Design Case series. Methods Following ACL reconstruction, participants were included if they had a goal of returning to their pre-injury sport or level of activity, were between 16 and 50 years of age at the time of evaluation, had at least 25 physical therapy visits covered by insurance, and planned to complete physical therapy until clearance for return to sport. Results Forty-three participants met the inclusion criteria and enrolled in the study. Twenty-one participants completed the full course of rehabilitation including passing their return to sport test and nineteen participants completed the two-year follow-up. Data obtained at two years indicated that 84% were able to return to their preinjury level of sports competition. A smaller percentage (16%) were able to return to a reduced level of sport and only one participant reported a second ACL injury. Conclusion Participants that completed the full course of rehabilitation and passed return to sport testing had a larger percentage that were able to return to preinjury participation levels than currently reported in the literature. This case series did not exclude participants based on graft type, single vs double bundle procedure, ACL revision surgeries, nor concomitant procedures or injuries. Level of Evidence Level 4.
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The 6-m Timed Hop Is Not a Suitable Clinical Assessment Tool for Use Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2020; 30:595-600. [PMID: 33160279 DOI: 10.1123/jsr.2020-0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/20/2020] [Accepted: 09/05/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Single-leg hop tests are used to assess functional performance following anterior cruciate ligament (ACL) reconstruction. Recording 6-m timed hop scores using a stopwatch increases the potential for misclassification of patient status due to the number of error sources present. OBJECTIVE To examine the consistency of pass/fail (>90% limb symmetry index [LSI]) decisions in athletes tested at discharge following ACL reconstruction during the 6-m timed hop and the agreement between different human raters using a stopwatch and an electronic timing system. SETTING Clinic, rehabilitation. PARTICIPANTS A total of 20 professional soccer players (age 24.6 [4.2] y; height 175.3 [10.2] cm; mass 73.6 [14.5] kg; 36 [10.5] wk following ACL reconstruction) volunteered to take part in this study. MAIN OUTCOME MEASURES Two individual raters recorded each trial of the 6-m timed hop test on each limb with a stopwatch and an electronic timing system acted as the criterion measure. LSI scores were also computed with a pass score >90% LSI. RESULTS No significant differences were observed between limbs for any scoring method (P > .05). Mean differences indicated the electronic timing system was slower than both human raters (P < .05). Five participants failed the test (<90% LSI) but on each occasion this was only recorded by one method of rating. Kappa statistics showed no agreement in LSI scores across all 3 methods of scoring (κ = -.13) and no agreement when comparing the light gates to individual raters and rater 1 versus 2 (κ < 0). 95% limits of agreement in LSI scores recorded values of approximately ±20%. CONCLUSIONS The 6-m timed hop test recorded using a stopwatch is not a valid measure to make clinical decisions following ACL reconstruction. Systematic bias between methods also suggests that a stopwatch and electronic timing system cannot be used interchangeably.
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Effects of 2 Different External Loads on Joint Position Sense and the Relationship Between Muscle Strength and Force Sense. J Sport Rehabil 2020; 29:1115-1120. [PMID: 31816596 DOI: 10.1123/jsr.2019-0025] [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: 01/18/2019] [Revised: 08/28/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Joint position sense (JPS) tests of proprioception lack ecological validity because the testing conditions are so different from the normal function that they can contribute little to understanding the role proprioception plays in daily and sporting activities. OBJECTIVE To evaluate the effect of low and high external load on the knee JPS and to investigate the relationship between maximum voluntary isometric contraction and force sense (FS). DESIGN Experimental study. SETTING Research laboratory. PARTICIPANTS A total of 47 volunteers with no history of knee pathology. INTERVENTIONS Three active JPS tests performed with no load, low load, and high load were compared at the 45° target angle. For isometric FS test, 50% load was used. For isotonic low load and high load JPS tests, 30% and 70% loads were applied, respectively. MAIN OUTCOME MEASURES To analyze obtained data set 2-way multiple analysis of variance, repeated measures of analysis of variance, paired sample t test, and the Pearson correlation coefficient were used. RESULTS JPS was not affected by gender (male and female) and activity levels (sedentary, recreational, and trained). Results of the repeated measure of analysis of variance demonstrated the significant main effect of loads (P = .001). Significant differences were found between no load, low load, and high load JPS (P = .001). A positive and significant correlation was found between maximum voluntary isometric contraction and FS error values (r = .41, P = .001). CONCLUSIONS The results suggest that as the load level increases, the knee JPS improves. Knee JPS assessed under external load may be a more appropriate alternative to the nature of the sport. Those with higher muscle strength have a worse FS.
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Dietvorst M, Brzoskowski MH, van der Steen M, Delvaux E, Janssen RPA, Van Melick N. Limited evidence for return to sport testing after ACL reconstruction in children and adolescents under 16 years: a scoping review. J Exp Orthop 2020; 7:83. [PMID: 33063128 PMCID: PMC7561621 DOI: 10.1186/s40634-020-00298-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 01/07/2023] Open
Abstract
Specific return to sport criteria for children and adolescents after anterior cruciate ligament injury and reconstruction are unknown. The aim of this scoping review is to provide an overview of current tests regarding return to sport for children and adolescents. This scoping review was performed according to the PRISMA statement. A systematic search was performed on PubMed and EMBASE. The inclusion criteria were diagnostic and prognostic studies evaluating tests regarding return to sport after ACL injury and reconstruction in children/adolescents (age < 18 years). Twenty-six studies were included, of which 22 studies evaluated tests in the age category of 16 to 18 years. All studies evaluated tests after ACL reconstruction, no studies have been conducted in non-operative patients. Strength tests, movement quality and patient reported outcomes measures (PROMs) are investigated most frequently. Clearance for return to sport should be based on a test battery including strength tests, movement quality during sport-specific tasks and (paediatric) patient reported outcome measures. There are no recommendations on which specific tests regarding quantity and quality of movement should be used. Future research should aim at at developing and validating a test battery including movement quality and neuromotor control in a sport-specific context for both younger children and adolescents after both operative and non-operative treatment.
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Affiliation(s)
- Martijn Dietvorst
- Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands.
| | | | - Marieke van der Steen
- Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands.,Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Rob P A Janssen
- Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands.,Fontys University of Applied Sciences, Eindhoven, the Netherlands.,Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Nicky Van Melick
- Knee Expert Center Eindhoven, St. Anna hospital Geldrop, Geldrop, the Netherlands
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Simon JE, Yom J, Grooms DR. Symmetry does not Indicate Recovery: Single-leg Hop Before and After a Lower Extremity Injury. Int J Sports Med 2020; 42:344-349. [PMID: 33017852 DOI: 10.1055/a-1244-9959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current recommendations for return-to-play decision-making involve comparison of the injured limb to the uninjured limb. However, the use of the uninjured limb as a comparison for hop testing lacks empirical evidence. Thus, the purpose of this study was to determine the effects of lower extremity injury on limb symmetry and performance on the single-leg hop for distance. Two-hundred thirty-six adolescent athletes completed the single-leg hop for distance before the beginning of the season (pre-injury). Forty-four adolescent athletes sustained a lower extremity injury (22 ankle and 12 knee) and missed at least three days of sports participation. All individuals had completed the single-leg hop for distance before the beginning of the season (pre-injury) and at discharge (post-injury). Injured limb single-leg hop for distance significantly decreased at return-to-play from pre-injury with a mean decrease of 48.9 centimeters; the uninjured limb also significantly decreased, with a mean decrease of 33.8 centimeters. Limb symmetry did not significantly change pre- to post-injury with a mean difference of 1.5%. Following a lower extremity injury, single-leg hop for distance performance degrades not only for the injured limb but also the uninjured limb. However, limb symmetry did not change following a lower extremity injury.
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Affiliation(s)
- Janet E Simon
- Division of Athletic Training, School of Applie 00d Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens
| | - Jae Yom
- Allied Health, University of Illinois at Springfield, Springfield
| | - Dustin R Grooms
- Division of Athletic Training, School of Applie 00d Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens.,Division of Physical Therapy, School of Rehabilitation and Communications Science, College of Health Sciences and Professions, Ohio University, Athens
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Sugimoto D, Whited AJ, Brodeur JJ, Liotta ES, Williams KA, Kocher MS, Micheli LJ, Heyworth BE. Long-Term Follow-up of Skeletally Immature Patients With Physeal-Sparing Combined Extra-/Intra-articular Iliotibial Band Anterior Cruciate Ligament Reconstruction: A 3-Dimensional Motion Analysis. Am J Sports Med 2020; 48:1900-1906. [PMID: 32519583 DOI: 10.1177/0363546520927399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The physeal-sparing iliotibial band (ITB) anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established technique for treating skeletally immature patients with ACL rupture. However, the long-term implications of the procedure on the intricacies of kinetic and kinematic function of the knee have not been comprehensively investigated. PURPOSE To assess the short-, mid-, and long-term effects of ITB ACLR on kinetic and kinematic parameters of knee functions. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 38 patients who had undergone an ITB ACLR as a skeletally immature child were recruited to participate in a 3-dimensional (3D) motion analysis testing protocol at an institutional injury prevention center between 1 and 20 years after reconstruction. Exclusion criteria were congenital ACL deficiency and any other major knee injury (defined as an injury requiring surgery or rehabilitation >3 months) on either knee. 3D and force plate parameters included in the analysis were knee moment, ground-reaction force, and vertical jump height measured during drop vertical jump and vertical single-limb hop. Paired t tests and equivalency analyses were used to compare the parameters between cases (ITB ACLR limb) and controls (contralateral/nonsurgical limbs). RESULTS Paired t tests showed no statistically significant differences between limbs, and equivalency analyses confirmed equivalency between limbs for all tested outcome variables. CONCLUSION The ITB ACLR appears to restore normal, symmetric, physiologic kinetic and kinematic function in the growing knee by 1 year after reconstruction, with maintenance of normal parameters for up to 20 years.
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Affiliation(s)
- Dai Sugimoto
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Amy J Whited
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Jeff J Brodeur
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Elizabeth S Liotta
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn A Williams
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Chaker Jomaa M, Gultekin S, Orchard J, Driscoll T, Orchard J. Australian Footballers Returning from Anterior Cruciate Ligament Reconstruction Later than 12 Months have Worse Outcomes. Indian J Orthop 2020; 54:317-323. [PMID: 32399151 PMCID: PMC7205950 DOI: 10.1007/s43465-020-00092-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is evidence that early return to competition post-anterior cruciate ligament (ACL) injury increases risk of re-injury. AIMS To compare subsequent ACL and other injury risks following ACL reconstruction for Australian Football League (AFL) players returning to competition at different times post-injury. METHODS AFL players returning from ACL reconstruction in the 1992-2014 seasons were divided into three groups based on return to competition time (< 10, 10-12 and > 12 months). Non-reconstructed injuries and artificial ligament reconstructions were excluded. Subsequent ACL injury rates were calculated based on time since injury and number of return matches played. Risk of other knee and hamstring muscle injuries was also calculated. RESULTS There were 233 ACL reconstructions that returned to play in the AFL during the time period under study and met our inclusion criteria. The per-game risk of subsequent ACL injury decreased with a log decay from 1.2 to 0.15% during the first 20 games back (R 2 = 0.43). Players returning at > 12 months had higher overall percentage of future career games missed through subsequent ACL injuries (4.8% vs. 2.4%), and through all hamstring and knee injuries combined (12.6% vs. 8.4%) than players who returned at ≤ 12 months (both P < 0.001). Players returning at > 12 months had higher risk of knee cartilage (3.7%) and patella tendon (0.6%) injury than those returning at 10-12 months (1.5%, 0.1%, respectively). CONCLUSION Players returning from ACL reconstruction at greater than 12 months had significantly higher rates of future games missed through both subsequent ACL injuries and through all hamstring and knee injuries combined. It may be true that both early and late return to play lead to suboptimal outcomes compared to average return-to-play times.
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Affiliation(s)
| | - Sinem Gultekin
- School of Medicine, The University of Sydney, Sydney, Australia
| | - Jessica Orchard
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tim Driscoll
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - John Orchard
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Schilling D, Radwan A. Are athletes ready to return to competitive sports following ACL reconstruction and medical clearance? COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1723822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Dave Schilling
- Physical Therapy Program, Utica College 1600 Burrstone Road Utica NY 13502 USA
| | - Ahmed Radwan
- Physical Therapy Program, Utica College 1600 Burrstone Road Utica NY 13502 USA
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40
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O'Connor RF, King E, Richter C, Webster KE, Falvey ÉC. No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:78-84. [PMID: 31877093 DOI: 10.1177/0363546519887952] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychological factors including self-reported readiness to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) measured with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale have been shown to correlate with RTS. Physical deficits have been shown to exist in the later stages after ACLR rehabilitation. No previous studies have investigated the relationship between self-reported readiness to RTS and objective physical measures of power and strength. PURPOSE To investigate the relationship between ACL-RSI scores and measures of strength and power scores after ACLR. STUDY DESIGN Case control study; Level of evidence, 3. METHODS This study recruited 452 male athletes who had undergone primary ACLR. Each athlete completed the ACL-RSI questionnaire, isokinetic strength testing, and jump testing approximately 9 months after surgery. RESULTS ACL-RSI scores showed a trivial or weak correlation with strength and power measures at 9 months after surgery (r = 0.06-0.16). Similar results were found for the relationship between ACL-RSI scores and limb symmetry index for strength and power measures (r = 0.04-0.15). Comparing the strength and power measures of athletes with higher (≥90) ACL-RSI scores (n = 93) versus athletes with lower (≤75) ACL-RSI scores (n = 92) showed no significant differences except for isokinetic hamstring strength, but with a trivial effect size (P = .040; effect size = 0.15). CONCLUSION Self-reported readiness to RTS as measured by the ACL-RSI had little or no relationship with athletes' strength and power measures, and there was no meaningful difference in strength and power between athletes with higher and lower ACL-RSI scores at 9 months after ACLR. The findings suggest that psychological recovery and physical recovery after ACLR are different constructs, and strategies to measure and address each construct separately may be necessary to ensure successful RTS after ACLR.
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Affiliation(s)
- Richard F O'Connor
- Department of Medicine, University College Cork, Cork, Republic of Ireland.,Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Éanna Cian Falvey
- Department of Medicine, University College Cork, Cork, Republic of Ireland.,Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
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Setuain I, Bikandi E, Amú Ruiz FA, Urtasun F, Izquierdo M. Horizontal jumping biomechanics among elite female handball players with and without anterior cruciate ligament reconstruction: an ISU based study. BMC Sports Sci Med Rehabil 2019; 11:30. [PMID: 31832206 PMCID: PMC6859617 DOI: 10.1186/s13102-019-0142-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
Background Handball is a strenuous body-contact team sport that places high loads on the knee joint. Anterior cruciate ligament (ACL) tear is one of the most devastating injuries that any handball player can suffer, and female athletes are at particular risk due to their intrinsic anatomical, hormonal, neuromuscular and biomechanical characteristics. The purpose of this study was to analyze the horizontal jumping biomechanics of female elite handball players with or without previous ACL reconstruction. Methods Twenty-one female participants (6 with previous ACL reconstruction and 15 uninjured controls) were recruited. Two horizontal hopping tasks were evaluated using inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. Results The athletes with previous ACL reconstruction demonstrated a significant (P < 0.05) reduction in the unilateral triple hop for distance compared with the healthy controls. Furthermore, during the initial propulsive phase of the unilateral cross-over hop, the control participants generated significantly (P < 0.05) higher force values in the mediolateral direction (the X axis) with their dominant limb compared with the ACL-reconstructed (ACL-R) limb of previously injured participants. Conclusions Three-dimensional horizontal jumping biomechanics analyses using ISU-based technologies could provide clinicians with more accurate information regarding the horizontal jumping biomechanical patterns among elite handball female athletes. Furthermore, several mechanical alterations could still be observed among those players who had undergone previous ACL reconstruction, even when several years have passed since the original ACL injury.
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Affiliation(s)
- Igor Setuain
- 1Department of Health Sciences, Public University of Navarra, Campus of Tudela, Av. de Tarazona s/n, 31500 Tudela, Navarra Spain.,Clinical Research Department, TDN. Advanced Rehabilitation Center, Pamplona, Spain
| | - Eder Bikandi
- Athletic Club Football team. Medical Service, Bilbao, Spain
| | - Francisco Antonio Amú Ruiz
- 1Department of Health Sciences, Public University of Navarra, Campus of Tudela, Av. de Tarazona s/n, 31500 Tudela, Navarra Spain.,Clinical Research Department, TDN. Advanced Rehabilitation Center, Pamplona, Spain.,4Department of Physical Education and Sports, Universidad del Valle, Cali, Colombia
| | - Fernando Urtasun
- 1Department of Health Sciences, Public University of Navarra, Campus of Tudela, Av. de Tarazona s/n, 31500 Tudela, Navarra Spain
| | - Mikel Izquierdo
- 1Department of Health Sciences, Public University of Navarra, Campus of Tudela, Av. de Tarazona s/n, 31500 Tudela, Navarra Spain
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Ithurburn MP, Paterno MV, Thomas S, Pennell ML, Evans KD, Magnussen RA, Schmitt LC. Change in Drop-Landing Mechanics Over 2 Years in Young Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2608-2616. [PMID: 31373856 DOI: 10.1177/0363546519864688] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While between-limb landing asymmetries after anterior cruciate ligament reconstruction (ACLR) are linked with poor function and risk of additional injury, it is not currently understood how landing symmetry changes over time after ACLR. PURPOSE/HYPOTHESIS The purpose was to investigate how double-legged drop vertical jump (DVJ) landing and single-legged drop-landing symmetry changed from the time of return-to-sport (RTS) clearance to 2 years later in a prospective cohort of young athletes after ACLR. It was hypothesized that double-legged DVJ landing and single-legged drop-landing symmetry would improve from the time of RTS to 2 years later. STUDY DESIGN Descriptive laboratory study. METHODS The authors followed 64 young athletes with primary, unilateral ACLR for 2 years after RTS clearance. At the time of RTS and 2 years later, between-limb symmetry values for biomechanical variables of interest (VOIs) were calculated with 3-dimensional motion analysis during double-legged DVJ and single-legged drop-landing tasks. VOIs included knee flexion excursion, peak internal knee extension moment, peak vertical ground-reaction force, and peak trunk flexion (for single-legged task only). Symmetry values and proportions of participants meeting 90% symmetry cutoffs were compared between time points. RESULTS For double-legged DVJ landing, symmetry values for all VOIs and the proportions meeting 90% cutoffs for peak internal knee extension moment and peak vertical ground-reaction force were higher at 2 years after RTS as compared with RTS. For single-legged drop-landing, symmetry values were higher for knee flexion excursion and lower for peak trunk flexion at 2 years after RTS as compared with RTS, but the proportions meeting 90% cutoffs for all VOIs did not differ between time points. CONCLUSION Double-legged DVJ landing symmetry improved across VOIs over the 2 years after RTS following ACLR, while single-legged drop-landing did not improve as consistently. The implications of longitudinal landing asymmetry after ACLR should be further studied.
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Affiliation(s)
- Matthew P Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Robert A Magnussen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, The Ohio State University, Columbus, Ohio, USA
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43
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Agarwalla A, Puzzitiello RN, Liu JN, Cvetanovich GL, Gowd AK, Verma NN, Cole BJ, Forsythe B. Timeline for Maximal Subjective Outcome Improvement After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2501-2509. [PMID: 30419175 DOI: 10.1177/0363546518803365] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are one of the most common traumatic knee injuries experienced by athletes. Return to sport is considered the pinnacle endpoint among patients receiving ACL reconstruction. However, at the time of return to sport, patients may not be participating at their previous levels of function, as defined by clinical metrics. PURPOSE To establish when patients perceive maximal subjective medical improvement according to patient-reported outcome measures (PROMs). STUDY DESIGN Systematic review. METHODS A systematic review of the PubMed database was conducted to identify studies that reported sequential PROMs up to a minimum of 2 years after ACL reconstruction. Pooled analysis was conducted for PROMs at follow-up points of 3 months, 6 months, 1 year, and 2 years. Clinically significant improvement was determined between pairs of intervals with the minimal clinically important difference. RESULTS This review contains 30 studies including 2253 patients who underwent ACL reconstruction. Clinically significant improvement in the KOOS (Knee injury and Osteoarthritis Outcome Score) was seen up to 1 year after ACL reconstruction, but no clinical significance was noted from 1 to 2 years. Clinically significant improvement in the IKDC (International Knee Documentation Committee) and Lysholm questionnaires was seen up to 6 months postoperatively, but no clinical significance was noted beyond that. CONCLUSION After ACL reconstruction, maximal subjective medical improvement is established 1 year postoperatively, with no further perceived clinical improvement beyond this time point according to current PROMs. The KOOS may be a more responsive metric to subjective improvements in this patient cohort than other patient-reported outcomes, such as the IKDC and Lysholm. CLINICAL RELEVANCE After ACL reconstruction, patients perceive interval subjective improvements until 1 year postoperatively.
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Affiliation(s)
- Avinesh Agarwalla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard N Puzzitiello
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Dan MJ, Lun KK, Dan L, Efird J, Pelletier M, Broe D, Walsh WR. Wearable inertial sensors and pressure MAT detect risk factors associated with ACL graft failure that are not possible with traditional return to sport assessments. BMJ Open Sport Exerc Med 2019; 5:e000557. [PMID: 31354961 PMCID: PMC6615852 DOI: 10.1136/bmjsem-2019-000557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is associated with poor return to sport and high graft re-rupture rates. This study explored the use of a wearable inertial sensor (ViMove) that incorporates an accelerometer and gyroscope, and MatScan pressure sensing mat (TekScan, South Boston, Massachusetts, USA) to provide objective return-to-sport measures. Methods Three cohorts’ ACLR patients, non-athletic controls and elite athletes (Australian seven’s rugby Olympic Gold medallist). Patients performed biometric and functional tests (thigh circumference and triple hop) and the ViMove knee module (consisting of single and double leg squats, hops and box drops) for lower limb alignment assessment, concurrently with force plate. Results Elite athletes had less varus/valgus (VV) movement during ViMove exercises compared with the ACLR cohort, who in turn had less VV malalignment than controls. When analysing side-to-side differences, single leg squats and box drop were asymmetrical in the ACL group, with greater malalignment in the reconstructed leg (p<0.05). Subgroup analysis failed to differentiate who passed or failed current return to sport assessment. TekScan pressure plate detected differences in double leg landing and flight time while hopping not detected with ViMove, suggesting ACL patients compensate by offloading the reconstructed leg to improve coronal alignment during double leg activity. Conclusion The inertial sensor detected differences in motion for patients following ACLR, which are known to be associated with graft rupture and were not detected with functional return to sport testing. Coupling the device with data from a pressure plate provides a powerful assessment tool detecting alignment differences known to be associate with graft failure only previously detected in formal gait analysis.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Kimberly Kai Lun
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Luke Dan
- Sports Medicine Department, Narrabeen Sports Medicine Faculty, Narrabeen, New South Wales, Australia
| | - Jimmy Efird
- HRMI, University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Pelletier
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - David Broe
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
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Nyland J, Taniyama D. Editorial Commentary: Rehabilitation and Return-to-Sports Readiness, the "Black Box" of Anterior Cruciate Ligament Reconstruction Patient Recovery. Arthroscopy 2019; 35:2080-2082. [PMID: 31272627 DOI: 10.1016/j.arthro.2019.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
When progressing patients who have undergone anterior cruciate ligament reconstruction through rehabilitation and deciding whether they are ready to safely return to sports, the health care team needs to consider what they know and what they do not know about each patient. Although increased postsurgical time without related functional improvement is of limited value, greater time postsurgery that leads to enhanced neuromuscular control and dynamic knee stability restoration may be of considerable value, particularly when soft tissue grafts are combined with extracortical suspensory devices or other forms of indirect fixation.
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Affiliation(s)
- John Nyland
- Kosair Charities College of Health and Natural Sciences, Spalding University (D.T.), and the College of Sport and Health Sciences, Ritsumeikan University (D.T.)
| | - Daiki Taniyama
- Kosair Charities College of Health and Natural Sciences, Spalding University (D.T.), and the College of Sport and Health Sciences, Ritsumeikan University (D.T.)
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46
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Setuain I, Bikandi E, Amú-Ruiz FA, Izquierdo M. Horizontal jumping biomechanics among elite male handball players with and without anterior cruciate ligament reconstruction. An inertial sensor unit-based study. Phys Ther Sport 2019; 39:52-63. [PMID: 31254917 DOI: 10.1016/j.ptsp.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Anterior cruciate ligament (ACL) tears are one of the most devastating injuries that any handball player can suffer during landing and pivoting actions. The aim of this study was to analyze the horizontal jumping biomechanics among male elite handball players with or without previous ACLR. DESIGN Descriptive study. SETTING Spanish elite male handball players. PARTICIPANTS Twenty-six male participants (6 ACL-R and 20 uninjured controls) were recruited. MAIN OUTCOME MEASURES Two horizontal hopping tasks were evaluated using an inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. RESULTS Non-significant differences were found in relation to any of the biomechanical or performance related analyzed variables. CONCLUSIONS Previously ACL-R elite male handball players who have returned to the top level of sports participation do not seem to possess lasting biomechanical and/or performance deficits 6 years after the original surgical ligament repair.
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Affiliation(s)
- Igor Setuain
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; TDN. Advanced Rehabilitation Center, Clinical Research Department. Calle V, 3. 31192 Mutilva Baja, Navarra, Spain.
| | - Eder Bikandi
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; Athletic Club, Mazarredo Zumarkalea, 23. 48009, Bilbao, Bizkaia, Spain.
| | - Francisco Antonio Amú-Ruiz
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain; Department of Sports Science, Universidad del Valle, Cali, Colombia.
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain.
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47
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Kaynak H, Altun M, Tok S. Effect of Force Sense to Active Joint Position Sense and Relationships between Active Joint Position Sense, Force Sense, Jumping and Muscle Strength. J Mot Behav 2019; 52:342-351. [PMID: 31204891 DOI: 10.1080/00222895.2019.1627280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We aimed to investigate the effect of external load on the joint position sense (JPS) accuracy and its relation to the target jump height. The present study also aimed to explore the relationship between force sense (FS) and maximum voluntary isometric contraction (MVIC). Participants' MVIC levels were determined during the 45-degree knee extension task. Then, participants were asked to execute a knee JPS task with external load (EL-JPS) and with no-load (EL-JPS). To assess jumping accuracy participants were instructed to jump with their 50% of maximum jump height. Results indicated that EL-JPS error values were lower than NL-JPS. EL-JPS was correlated to jumping errors. However, the relationship between NL-JPS and jumping errors was not significant. A significant correlation was found between MVIC and FS errors.
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Affiliation(s)
- Haydar Kaynak
- Manisa Celal Bayar University Sport Sciences Faculty, Manisa, Turkey
| | - Muammer Altun
- Manisa Celal Bayar University Sport Sciences Faculty, Manisa, Turkey
| | - Serdar Tok
- Manisa Celal Bayar University Sport Sciences Faculty, Manisa, Turkey
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48
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Ithurburn MP, Paljieg A, Thomas S, Hewett TE, Paterno MV, Schmitt LC. Strength and Function Across Maturational Levels in Young Athletes at the Time of Return to Sport After ACL Reconstruction. Sports Health 2019; 11:324-331. [PMID: 31173697 DOI: 10.1177/1941738119849070] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impact of maturation on lower extremity strength and function after anterior cruciate ligament reconstruction (ACLR) may help guide future studies of age-specific rehabilitation. HYPOTHESIS Pediatric ACLR patients would demonstrate higher thigh strength symmetry and knee-related function at return to sport (RTS) compared with adolescent and young adult participants who underwent traditional ACLR. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 2. METHODS A total of 144 young athletes at the time of RTS clearance post-ACLR were classified into 3 maturational groups (pediatric, n = 16 with physeal-sparing ACLR [mean age = 12.3 years; range = 9.2-14.6 years]; adolescent, n = 113 [mean age = 16.5 years; range = 14.1-19.8 years]; young adult, n = 15 [mean age = 22.0 years; range = 20.5-24.9 years]). Quadriceps and hamstring strength were measured using an electromechanical dynamometer. Knee-related function was measured using the International Knee Documentation Committee (IKDC) subjective form and single-leg hop tests. The Limb symmetry Index (LSI) was used in calculations for hop and strength tests. Group differences were compared with Kruskal-Wallis tests and Mann-Whitney U post hoc tests. Proportions of participants meeting literature-recommended RTS criterion cutoffs were compared among the groups using chi-square tests. RESULTS The pediatric group demonstrated higher quadriceps LSI (P = 0.01), IKDC scores (P < 0.01), single-hop LSI (P < 0.01), and crossover-hop LSI (P = 0.02) compared with the young adult group. In addition, the pediatric group demonstrated higher IKDC scores (P < 0.01) and single-hop LSI (P = 0.02) compared with the adolescent group. The adolescent group demonstrated higher IKDC scores (P < 0.01), single-hop LSI (P = 0.02), and crossover-hop LSI (P = 0.03) compared with the young adult group. The proportions of participants meeting all RTS criterion cutoffs were highest in the pediatric group and lowest in the young adult group (P = 0.03). CONCLUSION Young athletes at RTS clearance after pediatric ACLR demonstrated higher quadriceps strength symmetry and knee-related function than adolescents and young adults after traditional ACLR. CLINICAL RELEVANCE These findings demonstrate the need for further study regarding the impact of these group differences on longitudinal outcomes after ACLR, including successful RTS and risk of second ACL injury.
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Affiliation(s)
- Matthew P Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Paljieg
- Doctor of Physical Therapy Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy E Hewett
- Biomechanics Laboratories and Sports Medicine, Departments of Orthopedic Surgery, Physical Medicine, and Physiology and Biomedical Engineering, Mayo Clinic, Rochester and Minneapolis, Minnesota
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Laura C Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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49
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McPherson AL, Feller JA, Hewett TE, Webster KE. Smaller Change in Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injury Among Younger Patients. Am J Sports Med 2019; 47:1209-1215. [PMID: 30786247 DOI: 10.1177/0363546519825499] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lower psychological readiness to return to sport has been reported for younger patients (≤20 years) who go on to a second anterior cruciate ligament (ACL) injury. However, changes in psychological readiness and specific psychological responses associated with second injury have not been identified. PURPOSE/HYPOTHESIS To identify changes in psychological readiness over time associated with a second ACL injury. It was hypothesized that younger patients who suffered a second injury would have smaller changes in psychological readiness to return to sport when compared with those who did not have a second injury. STUDY DESIGN Case-control study; Level of evidence, 2. METHODS Patients ≤20 years old at the time of surgery who had a primary ACL reconstruction procedure between June 2014 and June 2016 were recruited for this study. The short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was completed by patients before their ACL reconstruction and repeated at 12 months after surgery to assess psychological readiness to return to sport. The primary outcome of interest was the relationship between the change in psychological readiness and second ACL injuries. RESULTS Among 115 young patients who returned to sport after ACL reconstruction, 21 (18%) experienced a second ACL injury. Injured patients did not show improvement in their ACL-RSI score between the preoperative assessment and 12-month time point (58.5 vs 60.8 points, P = .60) and had a significantly smaller change when compared with noninjured patients (9.2 vs 24.9 points, P = .01). When compared with the noninjured group, the injured group reported they were more nervous about playing sport, less confident in playing sport without concern for the knee, more frustrated with having to consider the knee with respect to sport, and more fearful of reinjuring the knee by playing sport ( P≤ .05). CONCLUSION Injured patients exhibited less improvement in psychological readiness at a group level and reported different psychological characteristics with regard to return to sport at 12 months after ACL reconstruction as monitored by the ACL-RSI scale.
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Affiliation(s)
- April L McPherson
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Julian A Feller
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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King E, Richter C, Franklyn-Miller A, Wadey R, Moran R, Strike S. Back to Normal Symmetry? Biomechanical Variables Remain More Asymmetrical Than Normal During Jump and Change-of-Direction Testing 9 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:1175-1185. [PMID: 30943079 DOI: 10.1177/0363546519830656] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), athletes have demonstrated performance asymmetries as compared with healthy cohorts, but little research has investigated if biomechanical asymmetries are also different during jump and change-of-direction (CoD) tasks between groups. PURPOSE To identify if differences in magnitude of asymmetry of biomechanical and performance variables exist between these groups. STUDY DESIGN Controlled laboratory study. METHODS Analysis was conducted between 156 male patients 9 months after surgery and 62 healthy participants. Three-dimensional motion capture and analysis were carried out on a double-legged drop jump, a single-legged drop jump, a single-legged hop for distance, and planned and unplanned CoD. Asymmetry between limbs was calculated for each variable with root mean square difference between limbs. Statistical parametric mapping was used to identify the between-group differences in magnitude of asymmetry of performance and biomechanical variables. RESULTS There were differences in asymmetry of biomechanical variables across all jump and CoD tests, with greater asymmetries in the ACLR group. The majority of differences between groups were in the sagittal and frontal planes, with more differences found in the jump than CoD tests. The single-legged drop jump demonstrated large differences in performance asymmetry (effect size, 0.94) with small differences for both CoD tests (0.4) and none for the single-legged hop for distance. CONCLUSION This study demonstrated greater asymmetry of biomechanical variables 9 months after ACLR as compared with healthy participants across all tests, suggesting insufficient rehabilitation. CLINICAL RELEVANCE This study highlights the importance of including biomechanical as well as performance variables when assessing rehabilitation status after ACLR. REGISTRATION NCT02771548 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland.,Department of Life Sciences, Roehampton University, London, UK
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Ross Wadey
- School of Sport, Health, and Applied Sciences, St Mary's University, Twickenham, UK
| | - Ray Moran
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Siobhan Strike
- Department of Life Sciences, Roehampton University, London, UK
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