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Dennis JD, Holmes SC, Heredia C, Shumski EJ, Pamukoff DN. Lower extremity joint angle, moment, and coordination throughout a double limb drop vertical jump in individuals with anterior cruciate ligament reconstruction. Sports Biomech 2024:1-16. [PMID: 38767326 DOI: 10.1080/14763141.2024.2356845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Individuals with anterior cruciate ligament reconstruction (ACLR) utilise different landing biomechanics between limbs, but previous analyses have not considered the continuous or simultaneous joint motion that occurs during landing and propulsion. The purpose of this study was to compare sagittal plane ankle/knee and knee/hip coordination patterns as well as ankle, knee, and hip angles and moments and vertical ground reaction force (vGRF) between the ACLR and uninjured limbs during landing and propulsion. Fifteen females and thirteen males performed a drop vertical jump from a 30 cm box placed half their height from force platforms. Coordination was compared using a modified vector coding technique and binning analysis. Kinematics and kinetics were time normalised for waveform analyses. Coordination was not different between limbs. The ACLR limb had smaller dorsiflexion angles from 11 to 16% of landing and 24 to 75% of landing and propulsion, knee flexion moments from 5 to 15% of landing, 20 to 31% of landing, and 35 to 91% of landing and propulsion, and vGRF from 92 to 94% of propulsion compared with the uninjured limb. The ACLR limb exhibited smaller dorsiflexion angles to potentially reduce the knee joint moment arm and mitigate the eccentric and concentric demands on the ACLR knee during landing and propulsion, respectively.
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Affiliation(s)
- Justin D Dennis
- Department of Exercise and Sports Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| | - Caitlyn Heredia
- Department of Sports Medicine, New England Revolution, Foxborough, MA, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
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Sell TC, Zerega R, King V, Reiter CR, Wrona H, Bullock GS, Mills N, Räisänen A, Ledbetter L, Collins GS, Kvist J, Filbay SR, Losciale JM. Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2024; 10:49. [PMID: 38689130 PMCID: PMC11061071 DOI: 10.1186/s40798-024-00712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament reconstruction (ACLR). To improve our understanding of the extent of deficits in psychological readiness, a systematic review is necessary. OBJECTIVE To investigate psychological readiness (measured via the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI)) over time after ACL tear and understand if time between injury and surgery, age, and sex are associated with ACL-RSI scores. METHODS Seven databases were searched from the earliest date available to March 22, 2022. Articles reporting ACL-RSI scores after ACL tear were included. Risk of bias was assessed using the ROBINS-I, RoB-2, and RoBANS tools based on the study design. Evidence certainty was assessed for each analysis. Random-effects meta-analyses pooled ACL-RSI scores, stratified by time post-injury and based on treatment approach (i.e., early ACLR, delayed ACLR, and unclear approach). RESULTS A total of 83 studies were included in this review (78% high risk of bias). Evidence certainty was 'weak' or 'limited' for all analyses. Overall, ACL-RSI scores were higher at 3 to 6 months post-ACLR (mean = 61.5 [95% confidence interval (CI) 58.6, 64.4], I2 = 94%) compared to pre-ACLR (mean = 44.4 [95% CI 38.2, 50.7], I2 = 98%), remained relatively stable, until they reached the highest point 2 to 5 years after ACLR (mean = 70.7 [95% CI 63.0, 78.5], I2 = 98%). Meta-regression suggests shorter time from injury to surgery, male sex, and older age were associated with higher ACL-RSI scores only 3 to 6 months post-ACLR (heterogeneity explained R2 = 47.6%), and this reduced 1-2 years after ACLR (heterogeneity explained R2 = 27.0%). CONCLUSION Psychological readiness to return to sport appears to improve early after ACL injury, with little subsequent improvement until ≥ 2-years after ACLR. Longer time from injury to surgery, female sex and older age might be negatively related to ACL-RSI scores 12-24 months after ACLR. Due to the weak evidence quality rating and the considerable importance of psychological readiness for long-term outcomes after ACL injury, there is an urgent need for well-designed studies that maximize internal validity and identify additional prognostic factors for psychological readiness at times critical for return to sport decisions. REGISTRATION Open Science Framework (OSF), https://osf.io/2tezs/ .
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Affiliation(s)
- Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Ryan Zerega
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Victoria King
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Hailey Wrona
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK
| | - Nilani Mills
- University of New South Wales, Sydney, NSW, Australia
| | - Anu Räisänen
- Department of Physical Therapy Education-Oregon, College of Health Sciences-Northwest, Western University of Health Sciences, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, University of Linkoping, Linköping, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Stephanie R Filbay
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Justin M Losciale
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
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Momaya AM, Wood AS, Benson EM, Kwapisz AL. The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction. Sports Health 2024; 16:230-238. [PMID: 38297441 PMCID: PMC10916773 DOI: 10.1177/19417381231223560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. STUDY DESIGN Clinical review. EVIDENCE ACQUISITION A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. LEVEL OF EVIDENCE Level 5. RESULTS There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. CONCLUSION Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.
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Affiliation(s)
- Amit M Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Audria S Wood
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth M Benson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam L Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
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Keogh JAJ, Waddington EE, Masood Z, Mahmood S, Palanisamy AC, Ruder MC, Karsan S, Bishop C, Jordan MJ, Heisz JJ, Kobsar D. Monitoring lower limb biomechanical asymmetry and psychological measures in athletic populations-A scoping review. Scand J Med Sci Sports 2023; 33:2125-2148. [PMID: 37551046 DOI: 10.1111/sms.14460] [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: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Lower limb biomechanics, including asymmetry, are frequently monitored to determine sport performance level and injury risk. However, contributing factors extend beyond biomechanical and asymmetry measures to include psychological, sociological, and environmental factors. Unfortunately, inadequate research has been conducted using holistic biopsychosocial models to characterize sport performance and injury risk. Therefore, this scoping review summarized the research landscape of studies concurrently assessing measures of lower limb biomechanics, asymmetry, and introspective psychological state (e.g., pain, fatigue, perceived exertion, stress, etc.) in healthy, competitive athletes. METHODS A systematic search of MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science Core Collections was designed and conducted in accordance with PRISMA guidelines. Fifty-one articles were included in this review. RESULTS Significant relationships between biomechanics (k = 22 studies) or asymmetry (k = 20 studies) and introspective state were found. Increased self-reported pain was associated with decreased range of motion, strength, and increased lower limb asymmetry. Higher ratings of perceived exertion were related to increased lower limb asymmetry, self-reported muscle soreness, and worse jump performance. Few studies (k = 4) monitored athletes longitudinally throughout one or more competitive season(s). CONCLUSION This review highlights the need for concurrent analysis of introspective, psychological state, and biomechanical asymmetry measures along with longitudinal research to understand the contributing factors to sport performance and injury risk from biopsychosocial modeling. In doing so, this framework of biopsychosocial preventive and prognostic patient-centered practices may provide an actionable means of optimizing health, well-being, and sport performance in competitive athletes.
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Affiliation(s)
- Joshua A J Keogh
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma E Waddington
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sobia Mahmood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Anil C Palanisamy
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C Ruder
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sameena Karsan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Chris Bishop
- London Sports Institute, Middlesex University, London, UK
| | - Matthew J Jordan
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer J Heisz
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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Suzuki M, Ishida T, Matsumoto H, Kaneko S, Inoue C, Aoki Y, Tohyama H, Samukawa M. Psychological readiness at 9 months after anterior cruciate ligament reconstruction –which factors affect? Phys Ther Sport 2022; 58:74-79. [DOI: 10.1016/j.ptsp.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
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Peebles AT, Miller TK, Savla J, Ollendick T, Messier SP, Queen RM. Reduction of risk factors for ACL Re-injuries using an innovative biofeedback approach: A phase I randomized clinical trial. Phys Ther Sport 2022; 57:78-88. [PMID: 35940085 DOI: 10.1016/j.ptsp.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Determine the safety and initial efficacy of a novel biofeedback intervention to improve landing mechanics in patients following anterior cruciate ligament reconstruction (ACLR). METHODS Forty patients post-ACLR (age: 16.9 ± 2.0 years) were randomly allocated to a biofeedback intervention or an attention control group. Patients in the biofeedback group completed 12 sessions over six-weeks that included bilateral unweighted squats with visual and tactile biofeedback. Patients in the control group completed a six-week educational program. Lower extremity mechanics were collected during a bilateral stop jump at baseline, six-weeks, and 12-weeks post-intervention. Linear mixed-effects models adjusted for sex and graft type determined the main effects of and interactions between group and time. RESULTS No group by time interaction existed for peak knee extension moment symmetry. A group by time interaction existed for peak vertical ground reaction force symmetry (p = 0.012), where patients in the biofeedback group had greater improvements in symmetry between baseline and post-intervention that were not maintained through the retention assessments. CONCLUSION This novel biofeedback program did not reduce risk factors for second ACL injuries. Future work could develop and test multidisciplinary interventions for reducing second ACL injury risk factors. CLINICALTRIALS GOV IDENTIFIER: (NCT03273673).
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Affiliation(s)
- Alexander T Peebles
- Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA; Department of Engineering, Laurel Ridge Community College, Warrenton, VA, USA
| | - Thomas K Miller
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jyoti Savla
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - Thomas Ollendick
- Department of Psychology, Virginia Tech Child Study Center, VVirginia Tech, Blacksburg, VA, USA
| | - Stephen P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA; Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Rheumatology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robin M Queen
- Granata Biomechanics Lab, 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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Smeets A, Willems M, Gilson L, Verschueren S, Staes F, Vandenneucker H, Claes S, Vanrenterghem J. Neuromuscular and biomechanical landing alterations persist in athletes returning to sport after anterior cruciate ligament reconstruction. Knee 2021; 33:305-317. [PMID: 34741830 DOI: 10.1016/j.knee.2021.10.020] [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] [Received: 03/18/2021] [Revised: 08/18/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstructed (ACLR) athletes show increased hamstrings activation and decreased knee flexion moments (KFMs) during single leg landing tasks at time of return-to-sport (RTS). Although these landing alterations seem protective in the short term, they might become undesirable if they persist after RTS. Therefore, the main aim of this study was to investigate whether those landing alterations persist in the months following RTS. METHODS Sixteen athletes who had an ACLR performed five unilateral landing tasks at three different time points (at RTS, and at 3 and 6 months after RTS) while KFMs and hamstrings activation were recorded. The following clinical parameters were registered: isokinetic strength of quadriceps and hamstrings, ACL return-to-sport after injury scale (ACL-RSI), Tampa scale of kinesiophobia, self-reported instability and single leg hop distance. A one-way repeated measures analysis of variance (ANOVA) was used to assess whether landing deficits changed over time. Additionally, an explorative analysis was performed to assess whether those athletes whose deficits persisted the most could be identified based on baseline clinical parameters. RESULTS The ANOVA showed no differences in landing deficits between sessions, indicating persisting reduced KFMs and increased hamstrings activation in the injured leg compared with the contralateral leg. A significant improvement of the quadriceps concentric strength (at 120°/s), ACL-RSI score and jump distance of the single leg hop was found over time. CONCLUSIONS Landing alterations were not resolved 6 months after RTS. Additional interventions may be needed to normalize landing alterations prior to return to sport.
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Affiliation(s)
- Annemie Smeets
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Miel Willems
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Human Movement Biomechanics Research Group, Department of Movement Science, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Laurens Gilson
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Vandenneucker
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, Belgium
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Peebles AT, Williams B, Queen RM. Bilateral Squatting Mechanics Are Associated With Landing Mechanics in Anterior Cruciate Ligament Reconstruction Patients. Am J Sports Med 2021; 49:2638-2644. [PMID: 34236927 DOI: 10.1177/03635465211023761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Proper lower extremity biomechanics during bilateral landing is important for reducing injury risk in athletes returning to sports after anterior cruciate ligament reconstruction (ACLR). Although landing is a quick ballistic movement that is difficult to modify, squatting is a slower cyclic movement that is ideal for motor learning. HYPOTHESIS There is a relationship between lower extremity biomechanics during bilateral landing and bilateral squatting in patients with an ACLR. STUDY DESIGN Descriptive laboratory study. METHODS A total of 41 patients after a unilateral ACLR (24 men, 17 women; 5.9 ± 1.4 months after ACLR) completed 15 unweighted bilateral squats and 10 bilateral stop-jumps. Three-dimensional lower extremity kinematics and kinetics were collected, and peak knee abduction angle, knee abduction/adduction range of motion, peak vertical ground-reaction force limb symmetry index (LSI), vertical ground-reaction force impulse LSI, and peak knee extension moment LSI were computed during the descending phase of the squatting and landing tasks. Wilcoxon signed-rank tests were used to compare each outcome between limbs, and Spearman correlations were used to compare outcomes between the squatting and landing tasks. RESULTS The peak vertical ground reaction force, the vertical ground reaction force impulse, and the peak knee extension moment were reduced in the surgical (Sx) limb relative to the nonsurgical (NSx) limb during both the squatting and landing tasks (P < .001). The relationship between squatting and landing tasks was strong for the peak knee abduction angle (R = 0.697-0.737; P < .001); moderate for the frontal plane knee range of motion (NSx: R = 0.366, P = .019; Sx: R = 0.418, P = 0.007), the peak knee extension moment LSI (R = 0.573; P < .001), the vertical ground reaction force impulse LSI (R = 0.382; P < .014); and weak for the peak vertical ground reaction force LSI (R = 0.323; P = .039). CONCLUSION Patients who have undergone an ACLR continue to offload their surgical limb during both squatting and landing. Additionally, there is a relationship between movement deficits during squatting and movement deficits during landing in patients with an ACLR preparing to return to sports. CLINICAL RELEVANCE As movement deficits during squatting and landing were related before return to sports, this study suggests that interventional approaches to improve squatting biomechanics may translate to improved landing biomechanics in patients with an ACLR.
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Affiliation(s)
- Alexander T Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | | | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.,Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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