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Khoygani MR, Esmaeili H. Hop distance to body height ratio outperforms limb symmetry index in predicting second anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39132709 DOI: 10.1002/ksa.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE The ability of current return-to-sport (RTS) tests to predict second anterior cruciate ligament (ACL) injuries (ACLI) in athletes with a history of ACL reconstruction (ACLR) is unclear. This study aimed to prospectively assess the risk of a second ACLI by identifying the most significant deviation in hop test results in professional athletes after ACLR compared to healthy peers. METHODS A total of 30 professional athletes with a history of ACLR and 30 healthy professional athletes participated in this study. Participants performed 10 functional hop tests, and the subsequent limb symmetry index (LSI) was compared between the groups. After a 3-year follow-up, the re-injury rate was assessed among the ACLR group. Fourteen ACLR athletes who sustained a second ACLI were included and matched with 14 controls from the healthy group. The LSI and the hop distance to body height percentage (D/H) were compared between the groups. RESULTS Statistical analyses confirmed a significant decrease in LSI in the ACLR group compared to the healthy group in the triple hop for distance (p = .023). In re-injured ACLR athletes, seven different hop tests showed a significant decrease in the D/H index compared to the healthy controls. Meanwhile, for LSI, only the triple cross-over hop for distance (p = .045) showed a significant increase in the healthy group. CONCLUSION Before clearing athletes for RTS, assessing functional hop test results using the hop distance to body height ratio, aligned with normative data from healthy controls, could further enhance the prediction of reduced graft rupture risk. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Mohammad Rahimi Khoygani
- Departments of Experimental Medicine and Surgery, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Hamed Esmaeili
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
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Donelon TA, Edwards J, Brown M, Jones PA, O'Driscoll J, Dos'Santos T. Differences in Biomechanical Determinants of ACL Injury Risk in Change of Direction Tasks Between Males and Females: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:29. [PMID: 38561438 PMCID: PMC10984914 DOI: 10.1186/s40798-024-00701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. OBJECTIVE The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. METHODS Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. RESULTS This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. CONCLUSION No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.
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Affiliation(s)
- Thomas A Donelon
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK.
| | - Jamie Edwards
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Mathew Brown
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Paul A Jones
- School of Health Sciences, C702 Allerton Building, University of Salford, Salford, M6 6PU, UK
| | - Jamie O'Driscoll
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences | Manchester Metropolitan University, 2.01 Institute of Sport, 99 Oxford Road, Manchester, M1 7EL, UK
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Gögele C, Hahn J, Schulze-Tanzil G. Anatomical Tissue Engineering of the Anterior Cruciate Ligament Entheses. Int J Mol Sci 2023; 24:ijms24119745. [PMID: 37298698 DOI: 10.3390/ijms24119745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
The firm integration of anterior cruciate ligament (ACL) grafts into bones remains the most demanding challenge in ACL reconstruction, since graft loosening means graft failure. For a functional-tissue-engineered ACL substitute to be realized in future, robust bone attachment sites (entheses) have to be re-established. The latter comprise four tissue compartments (ligament, non-calcified and calcified fibrocartilage, separated by the tidemark, bone) forming a histological and biomechanical gradient at the attachment interface between the ACL and bone. The ACL enthesis is surrounded by the synovium and exposed to the intra-articular micromilieu. This review will picture and explain the peculiarities of these synovioentheseal complexes at the femoral and tibial attachment sites based on published data. Using this, emerging tissue engineering (TE) strategies addressing them will be discussed. Several material composites (e.g., polycaprolactone and silk fibroin) and manufacturing techniques (e.g., three-dimensional-/bio-printing, electrospinning, braiding and embroidering) have been applied to create zonal cell carriers (bi- or triphasic scaffolds) mimicking the ACL enthesis tissue gradients with appropriate topological parameters for zones. Functionalized or bioactive materials (e.g., collagen, tricalcium phosphate, hydroxyapatite and bioactive glass (BG)) or growth factors (e.g., bone morphogenetic proteins [BMP]-2) have been integrated to achieve the zone-dependent differentiation of precursor cells. However, the ACL entheses comprise individual (loading history) asymmetric and polar histoarchitectures. They result from the unique biomechanical microenvironment of overlapping tensile, compressive and shear forces involved in enthesis formation, maturation and maintenance. This review should provide a road map of key parameters to be considered in future in ACL interface TE approaches.
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Affiliation(s)
- Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
| | - Judith Hahn
- Workgroup BioEngineering, Department Materials Engineering, Institute of Polymers Materials, Leibniz-Institut für Polymerforschung Dresden e.V. (IPF), Hohe Straße 6, 01069 Dresden, Germany
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
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Prelanding Knee Kinematics and Landing Kinetics During Single-Leg and Double-Leg Landings in Male and Female Recreational Athletes. J Appl Biomech 2023; 39:34-41. [PMID: 36649716 DOI: 10.1123/jab.2022-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 01/19/2023]
Abstract
Biomechanical behavior prior to landing likely contributes to anterior cruciate ligament (ACL) injuries during jump-landing tasks. This study examined prelanding knee kinematics and landing ground reaction forces (GRFs) during single-leg and double-leg landings in males and females. Participants performed landings with the dominant leg or both legs while kinematic and GRF data were collected. Single-leg landings demonstrated less time between prelanding minimal knee flexion and initial ground contact, decreased prelanding and early-landing knee flexion angles and velocities, and increased peak vertical and posterior GRFs compared with double-leg landings. Increased prelanding knee flexion velocities and knee flexion excursion correlated with decreased peak posterior GRFs during both double-leg and single-leg landings. No significant differences were observed between males and females. Prelanding knee kinematics may contribute to the increased risk of ACL injuries in single-leg landings compared with double-leg landings. Future studies are encouraged to incorporate prelanding knee mechanics to understand ACL injury mechanisms and predict future ACL injury risks. Studies of the feasibility of increasing prelanding knee flexion are needed to understand the potential role of prelanding kinematics in decreasing ACL injury risk.
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Identification of Sex Differences within Lunge Decelerations via Lower Extremity Support Movements; Implications for ACL Injury Disparity, Prevention, and Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Loading characteristics and lower extremity injury mechanisms, such as the non-contact mechanism of cruciate ligament injury, differ between sexes. The Limb Support Moment (LSM) quantifies hip, knee, and ankle moment contribution to the net moment required to prevent limb collapse during deceleration tasks. In total, 10 males and 10 females performed single limb deceleration landings within three knee flexion ranges: 0–25°, 25–50°, and 50–75°. Lower extremity joint moments and LSMs were calculated for all planes at initial contact (IC) through 50 ms. A two-way multivariate ANOVA compared LSMs and joint moments between sexes for all planes. Female LSMs were significantly greater at IC in the sagittal and transverse planes due to the generation of hip and ankle extensor moments and larger hip, knee, and ankle internal rotation moments. Males demonstrated significantly greater LSMs in the frontal plane due to the generation of hip abductor moments. Results suggest that females have a more rigid lower limb than males at landing, with less shock absorption capacity and greater potential for frontal plane collapse due to an unsupportive hip adductor moment. Quantifying the contribution of joint moments to limb support via LSMs suggests that there are landing characteristic sex differences, which may provide insight into injury disparity while guiding injury prevention/rehabilitation methodology.
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Kaplan JT, Ramsay JW, Cameron SE, Seymore KD, Brehler M, Thawait GK, Zbijewski WB, Siewerdsen JH, Brown TN. Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load. Am J Sports Med 2020; 48:1389-1397. [PMID: 32255657 DOI: 10.1177/0363546520911608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a military occupational hazard that may be attributed to an individual's knee biomechanics and joint anatomy. This study sought to determine if greater flexion when landing with load resulted in knee biomechanics thought to decrease ACL injury risk and whether knee biomechanics during landing relate to knee anatomic metrics. HYPOTHESIS Anatomic metrics regarding the slope and concavity of the tibial plateau will exhibit a significant relation to the increased anterior shear force on the knee and decreased knee flexion posture during landing with body-borne load. STUDY DESIGN Descriptive laboratory study. METHODS Twenty male military personnel completed a drop landing task with 3 load conditions: light (~6 kg), medium (15% body weight), and heavy (30% body weight). Participants were divided into groups based on knee flexion exhibited when landing with the heavy load (high- and low-Δflexion). Tibial slopes and depth were measured on weightbearing volumetric images of the knee obtained with a prototype cone beam computed tomography system. Knee biomechanics were submitted to a linear mixed model to evaluate the effect of landing group and load, with the anatomic metrics considered covariates. RESULTS Load increased peak proximal anterior tibial shear force (P = .034), knee flexion angle (P = .024), and moment (P = .001) during landing. Only the high flexion group increased knee flexion (P < .001) during weighted landings with medium and heavy loads. The low flexion group used greater knee abduction angle (P = .030) and peak proximal anterior tibial shear force (P = .034) when landing with load. Anatomic metrics did not differ between groups, but ratio of medial-to-lateral tibial slope and medial tibial depth predicted peak proximal anterior tibial shear force (P = .009) and knee flexion (P = .034) during landing, respectively. CONCLUSION Increasing knee flexion is an attainable strategy to mitigate risk of ACL injury, but certain individuals may be predisposed to knee forces and biomechanics that load the ACL during weighted landings. CLINICAL RELEVANCE The ability to screen individuals for anatomic metrics that predict knee flexion may identify soldiers and athletes who require additional training to mitigate the risk of lower extremity injury.
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Affiliation(s)
- Jonathan T Kaplan
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | - John W Ramsay
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | | | - Kayla D Seymore
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
| | - Michael Brehler
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gaurav K Thawait
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wojciech B Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey H Siewerdsen
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tyler N Brown
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
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Fox A, Bonacci J, Hoffmann S, Nimphius S, Saunders N. Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You're asking the wrong question. BMJ Open Sport Exerc Med 2020; 6:e000778. [PMID: 32341803 PMCID: PMC7173994 DOI: 10.1136/bmjsem-2020-000778] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women’s Australian Football League (AFLW), eliciting headlines of a ‘knee crisis’ surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football (AF) as being dangerous predominantly due to female biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of women and girls in the sport. We propose that an approach addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of women in AF, and question how to address inequities for the benefit of the athletes.
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Affiliation(s)
- Aaron Fox
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jason Bonacci
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Samantha Hoffmann
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sophia Nimphius
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Saunders
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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8
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Pryor JL, Burbulys ER, Root HJ, Pryor RR. Movement Technique During Jump-Landing Differs Between Sex Among Athletic Playing Surfaces. J Strength Cond Res 2020; 36:661-666. [PMID: 32108723 DOI: 10.1519/jsc.0000000000003520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pryor, JL, Burbulys, ER, Root, HJ, and Pryor, RR. Movement technique during jump-landing differs between sex among athletic playing surfaces. J Strength Cond Res XX(X): 000-000, 2020-Whether athletic surface type affects movement technique, a causal factor for lower extremity injury, is unclear. This study evaluated the influence of 4 common athletic surfaces on movement technique using the Landing Error Scoring System (LESS). Secondarily, we aimed to evaluate differences in movement technique between men and women among surfaces. Recreationally active men and women (n = 38) completed jump-landing tests on 4 common athletic surfaces in a quasi-randomized crossover fashion. Vertical jump height, perceptual fatigue, and muscle soreness were evaluated before jump-landing movement analyses and were similar across testing sessions (p > 0.05). Men achieved higher LESS scores on hardwood and artificial pellet turf compared with women (p ≤ 0.037). Women exhibited lower LESS scores on grass and artificial turf vs. concrete (p ≤ 0.048). Data indicate differential lower extremity movement technique and therefore injury risk across athletic surface types and sex, challenging the generalizability of the LESS construct. Athletic playing surface should be considered during movement technique assessment and implementation of injury prevention programs.
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Affiliation(s)
- J Luke Pryor
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York.,Department of Kinesiology, California State University, Fresno, California
| | - Emily R Burbulys
- Department of Kinesiology, California State University, Fresno, California
| | - Hayley J Root
- Department of Athletic Training, Monmouth University, West Long Branch, New Jersey
| | - Riana R Pryor
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York.,Department of Kinesiology, California State University, Fresno, California
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Abstract
Sex differences in biomechanics may provide one explanation for the greater incidence of knee injuries in women, but few studies have compared internal forces. In this study, a musculoskeletal model was used to compare male and female, bilateral and unilateral landings based on motion capture and force plate data. Participants were classified as landing medially or laterally loaded based upon the mediolateral load share at the knee (bilateral: p < 0.001, η2=0.452; unilateral: p < 0.001, η2 = 0.444). Knee kinematics and ground reaction forces were not different between the two groups (p > 0.05, η2 = 0.001 - 0.059), but there were differences in muscular recruitment. Landing strategy did not appear to be dependent on sex. However, for both medially and laterally loaded bilateral landings men had greater gluteal (p = 0.017, η2 = 0.085) and hamstrings forces (p < 0.001, η2 = 0.183), whereas women had greater quadriceps forces (p = 0.004, η2 = 0.116). This study demonstrates an association between muscular recruitment and medially loaded landings. Landing strategy seems to be a function of skill not sex; however, within a particular landing strategy there may be sex differences in muscular activation that contribute to the difference in injury rates.
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Kajiwara M, Kanamori A, Kadone H, Endo Y, Kobayashi Y, Hyodo K, Takahashi T, Arai N, Taniguchi Y, Yoshioka T, Yamazaki M. Knee biomechanics changes under dual task during single-leg drop landing. J Exp Orthop 2019; 6:5. [PMID: 30729344 PMCID: PMC6367493 DOI: 10.1186/s40634-019-0170-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/17/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Masaya Kajiwara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami-machi, Inashiki-gun, Japan
| | - Yasuto Kobayashi
- Department of Sport Management, Faculty of Business and Public Administration, Sakushin Gakuin University, Utsunomiya, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Norihito Arai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yu Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Yoshioka
- Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Mejane J, Faubert J, Romeas T, Labbe DR. The combined impact of a perceptual-cognitive task and neuromuscular fatigue on knee biomechanics during landing. Knee 2019; 26:52-60. [PMID: 30583887 DOI: 10.1016/j.knee.2018.10.017] [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] [Received: 02/07/2018] [Revised: 10/12/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A large majority of anterior cruciate ligament (ACL) injuries are non-contact, most often occurring during a landing or change of direction. Recent research indicates that cognitive factors may be involved in non-contact ACL injuries. The aim of this study was to determine if a game-situation perceptual-cognitive load leads to altered landing kinematics in physically fatigued female athletes. METHODS Nineteen female recreational athletes were recruited to perform a series of jumping and landing trials. In a first phase, eight trials were performed in an isolated condition and eight were performed while participants performed a perceptual-cognitive task. Before a second identical phase, participants underwent a muscular fatigue protocol. Knee-joint kinematics were recorded and compared between conditions using paired t-tests. RESULTS Muscle fatigue led to statistically significant increases in peak knee abduction and peak internal knee rotation as well as a decrease in maximum knee flexion, when comparing conditions without the perceptual-cognitive task. The perceptual-cognitive task had no statistically significant effect on any knee rotations, either pre- or post-fatigue. However, a subgroup of 12 athletes showed a significant increase in knee abduction in the presence of the perceptual-cognitive task, only in the fatigued condition. CONCLUSION A perceptual-cognitive task combined with muscle fatigue alters knee kinematics of landing for a subset of recreational athletes, potentially increasing the risk of ACL rupture. Further studies are necessary to confirm this finding and to identify characteristics of at-risk individuals to target them for injury prevention protocols.
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Affiliation(s)
- Jeremy Mejane
- Laboratoire de recherche en imagerie et orthopedie, Ecole de technologie superieure, Montreal, Canada; CHUM Research Center, University of Montreal, Montreal, Canada
| | - Jocelyn Faubert
- Psychophysics and Visual Perception Laboratory, School of Optometry, University of Montreal, Montreal, Canada
| | - Thomas Romeas
- Laboratoire de recherche en imagerie et orthopedie, Ecole de technologie superieure, Montreal, Canada; CHUM Research Center, University of Montreal, Montreal, Canada
| | - David R Labbe
- Laboratoire de recherche en imagerie et orthopedie, Ecole de technologie superieure, Montreal, Canada; CHUM Research Center, University of Montreal, Montreal, Canada; Psychophysics and Visual Perception Laboratory, School of Optometry, University of Montreal, Montreal, Canada.
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12
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The Effect of Strength Training on the Jump-Landing Biomechanics of Young Female Athletes: Results of a Randomized Controlled Trial. Clin J Sport Med 2017; 27:127-132. [PMID: 27347863 DOI: 10.1097/jsm.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effect of leg-focused strength training on the jump-landing mechanics of young female athletes. DESIGN Single-blind, randomized controlled clinical trial. SETTING University-based training program. PARTICIPANTS Forty female athletes, 10 to 14 years old, were randomly allocated to intervention or active control. INTERVENTIONS Twice weekly training was performed by the leg strengthening group [intervention group (IG); n = 19] and the active control group (CG; n = 17), for 12 weeks. Control group participants performed upper body strengthening exercises. MAIN OUTCOME MEASURE Jump-landing performance was assessed by a blinded observer using the Landing Error Scoring System (LESS). RESULTS There was no difference between the IG and CG postintervention (IG mean LESS score 6.0 ± SD 1.8 vs CG mean 6.1 ± SD 1.8; P = 0.85). CONCLUSIONS Strength training of the legs does not seem to improve jump-landing abilities in young female athletes compared with active controls who strength-trained their arms. CLINICAL RELEVANCE Leg strengthening may not provide an advantage over arm strengthening for improving jump-landing movement patterns in young female athletes. This has implications for the design of conditioning programs if injury prevention is a goal.
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13
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Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research Retreat VII: An Update on Anterior Cruciate Ligament Injury Risk Factor Identification, Screening, and Prevention. J Athl Train 2015; 50:1076-93. [PMID: 26340613 PMCID: PMC4641546 DOI: 10.4085/1062-6050-50.10.06] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Anne Benjaminse
- The Department of Human Movement Sciences, University of Groningen, and The School of Sports Studies, Hanze University, Groningen, The Netherlands
| | - Malcolm Collins
- Department of Human Biology, University of Cape Town, South Africa
| | - Kevin Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Anthony S. Kulas
- Department of Health Education and Promotion, Eastern Carolina University, Greenville, NC
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14
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The impact of sex and knee injury history on jump-landing patterns in collegiate athletes: a clinical evaluation. Clin J Sport Med 2014; 24:373-9. [PMID: 24284948 DOI: 10.1097/jsm.0000000000000053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether jump-landing patterns, as assessed by the Landing Error Scoring System (LESS), differ based on sex and knee injury history. DESIGN Cross-sectional. SETTING College. PARTICIPANTS Two hundred fifteen intercollegiate athletes were grouped by sex (male = 116 and female = 99) and self-reported knee injury history (no = 148, mild = 31, and severe = 36). INTERVENTIONS Participants performed 3 trials of a standardized jump-landing task that were videotaped and later scored using the LESS. MAIN OUTCOME MEASURES Overall, individual item, sagittal total error, and frontal total error scores of the LESS. RESULTS An interaction effect was reported for trunk flexion at initial ground contact. Main effects for sex indicated that males demonstrated more at-risk landing movement patterns on the sagittal plane (ie, limited trunk, knee and hip flexion at initial contact, and limited hip flexion throughout the landing), whereas females demonstrated more at-risk landing movement patterns on the frontal plane (ie, knee valgus at initial ground contact and maximum knee flexion, and more frontal plane movement throughout the landing). No main effects were reported for injury history. CONCLUSIONS Jump-landing patterns seem to be impacted by sex but not knee injury history. Findings related to sex differences corroborate with previous laboratory-based investigations. Furthermore, findings support the clinical use of the LESS to screen for individuals who may be at risk for a lower extremity injury. Future studies should further investigate the clinical utility of the LESS, particularly its ability to predict lower extremity injuries.
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Gender differences following computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22:2145-52. [PMID: 24037261 DOI: 10.1007/s00167-013-2649-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Female patients not only demonstrate an increased risk for injury, but also a poorer response following anterior cruciate ligament (ACL) rupture. However, no study has investigated gender-related differences between computer-navigated single-bundle (SB) and double-bundle (DB) ACL reconstruction. The aim of this study was to evaluate the effects of gender on the outcome of computer-navigated SB and DB ACL reconstruction and to present reference values. METHODS A retrospective review of 55 consecutive patients who underwent SB (15 males, 12 females) and DB (18 males, 10 females) ACL reconstruction with autogenous hamstring tendon grafts and showed a minimum follow-up of 24 months was conducted. Intraoperatively, the anteroposterior and rotational laxity were measured and the follow-up examination included pivot-shift testing, KT-1000 arthrometer testing, International Knee Documentation Committee (IKDC) form, the Lysholm score and Tegner score. RESULTS Pre-operatively, female patients showed a significant higher internal rotation in (p < 0.001) both the SB and DB group. Regarding the post-operative reduction in internal rotation, females in the SB group revealed a greater reduction compared to males (p < 0.001), whereas females in the DB group revealed a significantly greater post-operative reduction in anterior-posterior translation (p = 0.04). Female patients following DB ACL reconstruction presented a significant worse IKDC score, Lysholm score and Tegner score compared to male patients. All score values of the female DB group were worse than in the female SB group. In contrast, male patients showed better results of all examined clinical scores following DB procedure compared to SB technique. CONCLUSION Female patients who underwent computer-navigated DB ACL reconstruction exhibited significantly worse outcome scores than males who underwent DB ACL reconstruction. The gender-based relationship between joint function and outcome after ACL reconstruction remains unclear and requires further investigation. LEVEL OF EVIDENCE Retrospective case-control series, Level III.
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Kaneko M, Sakuraba K. Association between Femoral Anteversion and Lower Extremity Posture upon Single-leg Landing: Implications for Anterior Cruciate Ligament Injury. J Phys Ther Sci 2013; 25:1213-7. [PMID: 24259760 PMCID: PMC3820182 DOI: 10.1589/jpts.25.1213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/10/2013] [Indexed: 01/13/2023] Open
Abstract
[Purpose] Increased femoral anteversion may occur with hip internal rotation and valgus
knee alignment upon landing and is considered a risk factor for anterior cruciate ligament
injury. We examined the relationship between femoral anteversion and joint motion and
muscle activity of the lower extremity in terms of the risk factors for anterior cruciate
ligament injury. [Subjects] Sixteen healthy females were divided on the basis of femoral
anteversion into low and high groups. [Methods] Femoral anteversion was assessed using
Craig's test. We performed kinematic analysis and measured the electromyography activity
of the lower extremity upon left single-leg landing. [Results] The high group had a
significantly lower hip flexion angle and higher knee flexion and valgus angles than the
low group. The rectus femoris showed significantly greater electromyography activities in
the high group than in the low group. [Conclusion] These results suggest that increased
femoral anteversion results in lower hip flexion angle, higher knee valgus alignment, and
greater rectus femoris muscle activity, leading to anterior tibial displacement upon
single-leg landing. Increased femoral anteversion may be a potential risk factor for
anterior cruciate ligament injury.
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Affiliation(s)
- Masaaki Kaneko
- Department of Sports Medicine, Graduate School of Medicine, Juntendo University, Japan ; Department of Rehabilitation, Tohoku University Hospital, Japan
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Kang H, Jung J, Yu J. Comparison of Strength and Endurance between Open and Closed Kinematic Chain Exercises after Anterior Cruciate Ligament Reconstruction: Randomized Control Trial. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University
| | - Jaeho Yu
- Department of Physical Therapy, Kangwon National University
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