1
|
Stofberg JPJ, Aginsky K, van Aswegen M, Kramer M. Changes in isometric mid-thigh pull peak force and symmetry across anterior cruciate ligament reconstruction rehabilitation phases. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1418270. [PMID: 39036284 PMCID: PMC11258044 DOI: 10.3389/fresc.2024.1418270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/23/2024]
Abstract
Background Whether functionally relevant strength assessments, such as the isometric mid-thigh pull (IMTP), can be used either bilaterally or unilaterally to evaluate and guide rehabilitation progress in those with anterior cruciate ligament reconstruction (ACLR) is under-researched. This study assessed changes in peak force (PF) and asymmetry across 3 phases for bilateral and unilateral IMTP assessments in patients with ACLR. Peak isometric force from the IMTP was compared to peak torque from isokinetic dynamometry as well as against a cohort of healthy, uninjured individuals. Method Participants (ACLR, n = 15) completed bilateral and unilateral IMTP assessments at weeks 12 (baseline), 16 (phase 3), and 20 (phase 4) of rehabilitation to evaluate changes in PF and asymmetry. Asymmetry was evaluated using the asymmetry angle. Isometric data from the IMTP were compared to that from an isokinetic dynamometer as well as against a cohort of healthy, uninjured participants (n = 63) allowing for a detailed analysis of limb-specific force production. Results The PF during the bilateral IMTP increased for both the injured (0.94 N/kg) and uninjured (0.26 N/kg) limbs from baseline to phase 4, whereas the PF of the injured limb increased by 1.5 N/kg during the unilateral IMTP in the same time frame. Asymmetry values systematically reduced by ∼1% and ∼0.5% for the bilateral and unilateral IMTP tests from baseline to phase 4. Significant differences in PF of the injured limb were evident between those with ACLR and healthy controls across all phases (p = 0.022-0.001). The rate of progression in PF capacity was dependent on test type, amounting to 0.1 and 0.2 body weights per week for the bilateral and unilateral IMTP respectively. Small-to-large correlations (r = 0.12-0.88) were evident between IMTP PF and peak torque from the isokinetic dynamometer as well as between asymmetry metrics from both tests. Conclusion The findings suggest that IMTP PF has potential for monitoring changes in PF and asymmetry during the ACLR rehabilitation progress. Both injured limb and uninjured limb show improvement in force-generating capacity, implying a positive adaptation to rehabilitation protocols. The findings highlight that ACLR is a unilateral injury that requires bilateral rehabilitation.
Collapse
Affiliation(s)
- Johannes P. J. Stofberg
- Centre for Health and Human Performance (CHHP), North-West University, Potchefstroom, South Africa
| | - Kerith Aginsky
- Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Mariaan van Aswegen
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Mark Kramer
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
| |
Collapse
|
2
|
Flore Z, Hambly K, De Coninck K, Welsch G. A Rehabilitation Algorithm After Lateral Ankle Sprains in Professional Football (Soccer): An Approach Based on Clinical Practice Guidelines. Int J Sports Phys Ther 2024; 19:910-922. [PMID: 38966831 PMCID: PMC11221331 DOI: 10.26603/001c.120205] [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: 01/22/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024] Open
Abstract
Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5.
Collapse
Affiliation(s)
- Zacharias Flore
- School of Sport and Exercise SciencesUniversity of Kent
- Medical Department1. FC Magdeburg
| | - Karen Hambly
- School of Sport and Exercise SciencesUniversity of Kent
| | | | - Götz Welsch
- UKE-AthleticumUniversity Medical Center Hamburg-Eppendorf
- Department of Trauma and Orthopaedic SurgeryUniversity Medical Center Hamburg-Eppendorf
| |
Collapse
|
3
|
Gagnon SS, Birmingham TB, Dickey JP, Leitch K, O'Neill L, Bryant D, Robert Giffin J. Test-retest reliability and longitudinal validity of drop vertical jump biomechanics during rehabilitation after ACL reconstruction. J Biomech 2024; 170:112150. [PMID: 38797082 DOI: 10.1016/j.jbiomech.2024.112150] [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: 11/29/2022] [Revised: 03/31/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
Hip and knee biomechanics measured during a drop vertical jump (DVJ) can be used to assess patients undergoing rehabilitation after anterior cruciate ligament (ACL) reconstruction. To confidently interpret such data for use as outcome measures, additional information about reliability and validity is required. Therefore, the objective of this study was to estimate the test-retest reliability and longitudinal validity of selected lower limb biomechanics assessed during a DVJ in patients undergoing rehabilitation after ACL reconstruction. Biomechanical analysis of the DVJ in primary unilateral ACL reconstruction patients (22.3 ± 5.5y) were tested twice within 1 week at 6 months post-surgery (n = 46), and again at 12 months post-surgery (n = 36). Peak and initial contact knee angles and moments, hip impulse, vertical ground reaction forces (VGRF), isokinetic knee extension and flexion strength, and global ratings of change (GRC) were assessed. Reliability was evaluated based on the 6-month post-surgery data using intraclass correlation coefficients (ICC2,1), standard errors of measurement and minimum detectable change. Longitudinal validity was evaluated by assessing change from 6 to 12 months, using standardized response means (SRM), and by assessing the correlation (Pearson's r) of change in landing biomechanics with change in strength, and GRC. ICCs ranged from 0.58 to 0.90 for peak knee abduction and flexion moments, 0.44-0.85 for knee flexion and abduction angles, 0.82-0.93 for VGRFs, and 0.42-0.65 for hip impulse. SRMs and correlations of change ranged from 0.00 to 0.50. Reliability and longitudinal validity of DVJ measures varied, ranging from poor-to-excellent; the present results assist in their interpretation when assessed during rehabilitation after ACL reconstruction.
Collapse
Affiliation(s)
- Sheila S Gagnon
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - James P Dickey
- Bone and Joint Institute, University of Western Ontario, London, Canada; School of Kinesiology, University of Western Ontario, London, Canada
| | - Kristyn Leitch
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Lindsey O'Neill
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| |
Collapse
|
4
|
Knapik DM, Kamitani A, Smith MV, Motley J, Haas AK, Matava MJ, Wright RW, Brophy RH. Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study. J Knee Surg 2024. [PMID: 38677296 DOI: 10.1055/a-2315-8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. DESIGN Cohort study. METHODS Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. RESULTS A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. CONCLUSIONS Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
Collapse
Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Matthew V Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri
| | - Amanda K Haas
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Matthew J Matava
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert H Brophy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| |
Collapse
|
5
|
Poretti K, Ghoddosi N, Martin J, Eddo O, Cortes N, Clark NC. The Nature of Rehabilitation Programs to Improve Musculoskeletal, Biomechanical, Functional, and Patient-Reported Outcomes in Athletes With ACL Reconstruction: A Scoping Review. Sports Health 2024; 16:390-395. [PMID: 36929850 PMCID: PMC11025522 DOI: 10.1177/19417381231158327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
CONTEXT After anterior cruciate ligament (ACL) reconstruction (ACLR), athletes commonly undergo prolonged rehabilitation (eg, 9-12 months), but few actually return to preinjury sports activities. The nature (composition, configuration) of an ACL rehabilitation program (ACL-RP) is an important factor in determining rehabilitation outcomes; however, details about the nature of ACL-RPs are reported inconsistently in research studies. To guide future research reporting to support clinical translation and implementation of ACL-RPs, it is necessary to describe the nature, reporting, and outcomes of ACL-RPs in the current literature. OBJECTIVE The purpose of this scoping review was to understand the nature and reporting of various ACL-RPs that address musculoskeletal, biomechanical, functional, or patient-reported outcome measures in adult and pediatric athletes with ACLR. DATA SOURCES Articles were selected from searches in 5 electronic databases (PubMed, EbscoHost [MEDLINE, SportDiscus, CINAHL Plus], PROQuest, Cochrane, and Embase). STUDY SELECTION Studies were included if they evaluated a post-ACL-RP that implemented strength, balance, plyometric, change of direction running, and/or agility running and included self-reported physical function, quality of life, or pain outcomes. STUDY DESIGN Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Data were extracted and synthesized to evaluate the reporting of acute program variables (APVs) and exercise descriptors (EDs); 17 studies were included in the final synthesis. RESULTS Studies reported between 0% and 67% of the APVs and EDs combined. Only 2 studies were considered to have adequate reporting of both APVs and EDs. CONCLUSION Inadequate reporting of APVs and EDs in past studies restricts the translation and implementation of existing research-based ACL-RPs to present-day clinical contexts.
Collapse
Affiliation(s)
- Kelly Poretti
- School of Kinesiology, George Mason University, Manassas, Virginia
| | - Navid Ghoddosi
- School of Kinesiology, George Mason University, Manassas, Virginia
| | - Joel Martin
- School of Kinesiology, George Mason University, Manassas, Virginia
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, George Mason University, Virginia
| | - Oladipo Eddo
- School of Kinesiology, George Mason University, Manassas, Virginia
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, George Mason University, Virginia
| | - Nelson Cortes
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, Essex, UK
- Department of Bioengineering, George Mason University, Fairfax, Virginia
| | - Nicholas C. Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, Essex, UK
| |
Collapse
|
6
|
Welling W. Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review. Phys Ther Sport 2024; 67:141-148. [PMID: 38749349 DOI: 10.1016/j.ptsp.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024]
Abstract
A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".
Collapse
Affiliation(s)
- Wouter Welling
- Pro-F Fysiotherapie, Kotkampweg 65, 7531 AS, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Science, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| |
Collapse
|
7
|
Mayer MA, Deliso M, Hong IS, Saltzman BM, Longobardi RS, DeLuca PF, Rizio L. Rehabilitation and Return to Play Protocols After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review. Am J Sports Med 2024:3635465241233161. [PMID: 38622858 DOI: 10.1177/03635465241233161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Rehabilitation after anterior cruciate ligament ACL reconstruction (ACLR) is crucial for safe return to play (RTP) and reducing the chances of a reinjury. Yet, there is no consensus on the ideal functional tests to assess rehabilitation progress in soccer players after ACLR. PURPOSE The primary objective was to highlight the existing gap in the literature concerning the most effective standardized rehabilitation protocols and testing for facilitating successful RTP among soccer players. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Inclusion criteria encompassed original studies (level of evidence 1-4) that examined rehabilitation protocols, metrics of knee rehabilitation, and clinical outcomes after ACLR in soccer players. RESULTS This review incorporated 23 studies, predominantly retrospective case series, with a total number of 874 soccer players who underwent ACLR and rehabiliation. 5 (21.7%) studies utilized an accelerated rehabilitation protocol, while 7 (30.4%) of studies utilized a criterion-based rehabilitation. A wide heterogeneity of data was extracted including functional tests of rehabilitation and RTP such as strength test batteries, hop test batteries, and movement quality assessments. Of the 23 selected studies, 2 (8.7%) used all 3 test batteries, 8 (34.8%) used 2 test batteries, 12 (52.2%) used 1 test battery, and 1 (4.3%) used 0 of the test batteries. The mean time between surgery and RTP ranged from 3 to 8 months with only 2 (8.7%) studies reporting complications after ACLR. Lastly, out of the total studies examined, 9 (39.1%) assessed patient-reported outcome measures (PROMs), all of which demonstrated significant improvement from the initial assessment to the final follow up. CONCLUSION Soccer-specific rehabilitation after ACLR lacks standardization. Even though many studies have assessed protocols for optimal RTP and reduced secondary ACL injuries, there is a gap in the literature regarding the most effective protocols and RTP testing. The methodology reported by Kyritsis et al could serve as a foundation for future prospective randomized multicenter studies to establish a standard rehabilitation protocol and enable a successful return to soccer.
Collapse
Affiliation(s)
- McKenzie A Mayer
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Marisa Deliso
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Ian S Hong
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Raphael S Longobardi
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Peter F DeLuca
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Louis Rizio
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| |
Collapse
|
8
|
Pollen TR, Roe C, Johnson DL, Silfies SP, Noehren B. The Seated Trunk Control Test: Investigation of Reliability and Known-Groups Validity Using Individuals Post-Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:208-214. [PMID: 37978988 DOI: 10.1123/jsr.2022-0460] [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: 12/29/2022] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
CONTEXT Decreased trunk neuromuscular control is a risk factor for both upper- and lower-extremity injuries, yet there are few reliable and valid clinical tests to identify deficits. OBJECTIVE The purpose of this study was to determine the reliability and known-groups validity of a novel clinical test, the seated trunk control test (STCT). DESIGN Cross-sectional reliability and known-groups validity study. SETTING Laboratory. PARTICIPANTS 89 unique participants: 34 were 3 months postoperative anterior cruciate ligament reconstruction (ACLR) and 55 healthy controls. METHODS For the STCT, participants sat on a balance board with their eyes closed for three 30-second trials while investigators counted balance errors. Intraclass correlations (ICCs) were used to assess interrater reliability (N = 20) and test-retest reliability (N = 40). To assess known-groups validity, independent t tests were used to compare STCT errors at 3 months post-ACLR with healthy matched controls (N = 34/group). Area under a receiver operating characteristic curve identified an optimal cutoff for distinguishing between groups. RESULTS The STCT had perfect interrater reliability (ICC2,3 = 1.00) and good test-retest reliability (ICC3,3 = .79; 95% confidence interval = .61-.89). The ACLR group made significantly more errors on the STCT (mean [SD] = 15.5 [5.4]) than controls (mean [SD] = 8.2 [4.1]; P < .001, Cohen d = 1.52). The STCT's ability to distinguish between groups was excellent (area under a ROC curve = 0.86). A cutoff of 12 errors maximized sensitivity (76%) and specificity (85%). CONCLUSIONS The STCT is reliable between raters and across days. It also has excellent ability to distinguish between individuals with a recent ACLR and healthy matched controls, which provides initial evidence to suggest that the STCT may be clinically useful for identifying deficits in trunk neuromuscular control.
Collapse
Affiliation(s)
- Travis R Pollen
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Darren L Johnson
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Sheri P Silfies
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
9
|
McFadden C, Strike S, Daniels KAJ. Are inter-limb differences in change of direction velocity and angle associated with inter-limb differences in kinematics and kinetics following anterior cruciate ligament reconstruction? Gait Posture 2024; 109:1-8. [PMID: 38232543 DOI: 10.1016/j.gaitpost.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/17/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Quantifying inter-limb differences in kinematics and kinetics during change of direction is proposed as a means of monitoring rehabilitation following anterior cruciate ligament reconstruction (ACLR). Velocity and centre of mass (CoM) deflection angle are fundamental task descriptors that influence kinematics and kinetics during change of direction. Inter-limb differences in approach velocity and CoM deflection angle have been identified following ACLR and may contribute to the presence of inter-limb differences in kinematics and kinetics during change of direction. RESEARCH QUESTION The aim of this study was to quantify the proportion of variance in kinematic and kinetic inter-limb differences attributable to inter-limb differences in approach velocity and centre of mass deflection angle during a change of direction task. METHODS A cohort of 192 patients (male, 23.8 ± 3.6 years, 6.3 ± 0.4 months post primary ACLR) completed a pre-planned 90° change of direction task on both their operated and non-operated limb. Inter-limb differences in approach velocity and CoM deflection angle were calculated alongside lower-extremity kinematic and kinetic variables. The relationship between inter-limb differences in task-level variables and inter-limb differences in kinematic and kinetic variables was examined using linear regression models. Kinematic and kinetic inter-limb differences were adjusted for inter-limb differences in approach velocity and CoM deflection angle. Adjusted and unadjusted inter-limb differences were submitted to one sample t-tests. RESULTS Inter-limb differences in approach velocity and centre of mass deflection angle explained 3 - 60% of the variance in kinematic and kinetic inter-limb differences. Statistical inferences remained consistent between adjusted and unadjusted conditions with the exception of hip flexion angle. SIGNIFICANCE Inter-limb differences in task-level features explain a large proportion of the variance in inter-limb differences in several kinematic and kinetic variables. Accounting for this variation reduced the magnitude of kinematic and kinetic inter-limb differences comparable to those previously observed in normative cohorts.
Collapse
Affiliation(s)
- Ciarán McFadden
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK.
| | - Siobhán Strike
- Department of Life Sciences, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
10
|
Gardner EC, Podbielski C, Dunphy E. Telerehabilitation to Address the Rehabilitation Gap in Anterior Cruciate Ligament Care: Survey of Physical Therapists/Care Providers. TELEMEDICINE REPORTS 2024; 5:18-35. [PMID: 38469166 PMCID: PMC10927236 DOI: 10.1089/tmr.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 03/13/2024]
Abstract
Background While the importance of structured rehabilitation following anterior cruciate ligament reconstruction (ACLR), particularly in the return-to-sport phase, is known, for most patients, supervised physical therapy is often completed before this time point. The recent emergence of telerehabilitation and other digital health interventions has the potential to address this "rehabilitation gap." Methods The study was conducted as a cross-section, online survey collecting qualitative and quantitative data from open and closed questions. Inclusion criteria included local qualified physical therapists or other professionals working with ACLR patients. Results Eighty-three percent of respondents experienced a "rehabilitation gap" with their ACLR patients. Few reported currently utilizing apps or websites (9.74%). The majority (41/58) reported experience with telerehabilitation, and 84% felt that there was a role for digital rehabilitation strategies to address the "rehabilitation gap." The vast majority (94.74%) of participants felt that standard commercial insurance did not permit sufficient rehabilitation. Discussion While the majority of our respondents acknowledged the existence of a "rehabilitation gap," as well as familiarity with and confidence in telerehabilitation, few were using this technique at the time of our survey. This suggests an opportunity for development in this space.
Collapse
Affiliation(s)
- Elizabeth C. Gardner
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Corey Podbielski
- Outpatient Physical Therapy, Gaylord Speciality Healthcare, Wallingford, Connecticut, USA
| | - Emma Dunphy
- Research Department of Primary Care and Populational Health, Upper Third Floor, UCL Medical School (Royal Free Campus), London, United Kingdom
| |
Collapse
|
11
|
Ajdaroski M, Baek SY, Ashton-Miller JA, Esquivel AO. Predicting Leg Forces and Knee Moments Using Inertial Measurement Units: An In Vitro Study. J Biomech Eng 2024; 146:021006. [PMID: 38019183 PMCID: PMC10750790 DOI: 10.1115/1.4064145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
We compared the ability of seven machine learning algorithms to use wearable inertial measurement unit (IMU) data to identify the severe knee loading cycles known to induce microdamage associated with anterior cruciate ligament rupture. Sixteen cadaveric knee specimens, dissected free of skin and muscle, were mounted in a rig simulating standardized jump landings. One IMU was located above and the other below the knee, the applied three-dimensional action and reaction loads were measured via six-axis load cells, and the three-dimensional knee kinematics were also recorded by a laboratory motion capture system. Machine learning algorithms were used to predict the knee moments and the tibial and femur vertical forces; 13 knees were utilized for training each model, while three were used for testing its accuracy (i.e., normalized root-mean-square error) and reliability (Bland-Altman limits of agreement). The results showed the models predicted force and knee moment values with acceptable levels of error and, although several models exhibited some form of bias, acceptable reliability. Further research will be needed to determine whether these types of models can be modified to attenuate the inevitable in vivo soft tissue motion artifact associated with highly dynamic activities like jump landings.
Collapse
Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
| | - So Young Baek
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | | | - Amanda O. Esquivel
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
| |
Collapse
|
12
|
Bondarenko VV, Markus IS, Savchenko VM, Herashchenko SI, Khatuntseva SM, Sheremet IV, Lyakhova NA. The effectiveness of physical therapy in the rehabilitation of patients after arthroscopy of the knee joint. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:1167-1173. [PMID: 39106376 DOI: 10.36740/wlek202406109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
OBJECTIVE Aim: To determine the effectiveness of physical therapy on the functional state of law enforcement officers' knee joints after surgical intervention. PATIENTS AND METHODS Materials and Methods: The research involved law enforcement officers from different units of the National Police of Ukraine (n = 56) who had suffered knee joint injuries in the line of duty, and underwent surgical intervention and rehabilitation procedures. RESULTS Results: It was found that 78.2 % of respondents had suffered knee joint ligament injuries as a result of falls during rapid movement, while 43.9 % were in full gear (armored protection, helmet, etc.). It was determined that after surgical intervention, the functional state of the knee joint of law enforcement officers who followed the recommendations of physical therapy specialists and systematically performed special sets of physical exercises was significantly different (p < 0.001). Worse results were noted in people who partially followed the recommendations of rehabilitation therapists and performed part of the prescribed procedures and physical exercises. CONCLUSION Conclusions: The effectiveness of the complex use of physical rehabilitation means for restoring the functioning of the knee joint after surgical intervention, which included arthroscopy, partial menisectomy of the damaged areas, debridement, vaporization of damaged cartilage, etc. was revealed. The positive effect of physical exercises on the functional state of the knee joint was proven. The sets of exercises that are advisable to use to restore the functioning of the knee joint were determined.
Collapse
|
13
|
Zhang Y, Chen K, Liu K, Wang Q, Ma Y, Pang B, Huang L, Ma Y. New prediction equations for knee isokinetic strength in young and middle-aged non-athletes. BMC Public Health 2023; 23:2558. [PMID: 38129858 PMCID: PMC10734189 DOI: 10.1186/s12889-023-17478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to develop alternative prediction equations to predict isokinetic muscle strength at 60°/s based on anthropometric characteristics, including body mass, height, age, and sex for young and middle-aged non-athlete populations. METHODS Three hundred and thirty-two healthy non-athletic participants (174 females, 158 males) between 20 and 59 years underwent a 60°/s isokinetic knee joint concentric contraction test. Forty people were randomly selected for retesting to assess the reliability of the isokinetic instrument. Multivariate linear regression was used to establish extension peak torque (EPT) and flexion peak torque (FPT) prediction equations. Sixty extra participants were used individually to validate the prediction equations, and Bland Altman plots were constructed to assess the agreement of predicted values with actual measurements. RESULTS The result demonstrated that the instrument we used has excellent reliability. The multivariable linear regression model showed that body mass, age, and sex were significant predictors of PT (EPT: Adjusted R2 = 0.804, p < 0.001; FPT: Adjusted R2 = 0.705, p < 0.001). Furthermore, the equations we established had higher prediction accuracy than those of Gross et al. and Harbo et al. CONCLUSION: The equations developed in this study provided relatively low bias, thus providing a more suitable reference value for the knee isokinetic strength of young and middle-aged non-athletes.
Collapse
Affiliation(s)
- Ye Zhang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Kang Chen
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Kun Liu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Qingliang Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yuhui Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bo Pang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Lihua Huang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| |
Collapse
|
14
|
Sonesson S, Kuster RP, Kvist J. Accelerometer-assessed physical activity patterns during the first two years after a non-surgically treated ACL injury. Phys Ther Sport 2023; 64:123-132. [PMID: 37864852 DOI: 10.1016/j.ptsp.2023.09.011] [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: 06/29/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES To describe physical activity patterns and analyze changes during the first two years after a non-surgically treated ACL injury, and to assess correlations between accelerometer-assessed physical activity and self-reported knee function and knee-related quality of life. DESIGN Prospective cohort study. PARTICIPANTS 128 patients (61 females, 25.2 ± 7.1 years) with acute ACL injury. MAIN OUTCOME MEASURES Physical activity patterns were measured with accelerometry. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form, and knee-related quality of life was assessed using the Anterior Cruciate Ligament Quality of Life questionnaire. RESULTS Moderate to vigorous physical activity (MVPA) and steps per day increased from baseline to 3 months (p < .001), with no further increase from 3 to 24 months (p > .05). Time in MVPA did not correlate to patient-reported outcome measures at 3, 6, 12, or 24 months (p > .05). CONCLUSIONS Physical activity increased from acute phase to 3 months after non-surgically treated ACL injury, but almost one in four patients did not reach recommended levels of physical activity. Physical activity did not correlate with knee function or quality of life. Patients may need improved support to return to physical activity after ACL injury. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION NCT02931084.
Collapse
Affiliation(s)
- Sofi Sonesson
- Department of Health, Medicine and Caring Science, Division of Physiotherapy, Linköping University, Linköping, Sweden.
| | - Roman Peter Kuster
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
| | - Joanna Kvist
- Department of Health, Medicine and Caring Science, Division of Physiotherapy, Linköping University, Linköping, Sweden; Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Department of Molecular Medicine & Surgery, Karolinska Institute, Sweden; Center for Medical Image Science and Visualization (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| |
Collapse
|
15
|
Schifino AG, Raymond‐Pope CJ, Heo J, McFaline‐Figueroa J, Call JA, Greising SM. Resistance wheel running improves contractile strength, but not metabolic capacity, in a murine model of volumetric muscle loss injury. Exp Physiol 2023; 108:1282-1294. [PMID: 37526646 PMCID: PMC10543535 DOI: 10.1113/ep091284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
The primary objective of this study was to determine if low- or high-resistance voluntary wheel running leads to functional improvements in muscle strength (i.e., isometric and isokinetic torque) and metabolic function (i.e., permeabilized fibre bundle mitochondrial respiration) after a volumetric muscle loss (VML) injury. C57BL/6J mice were randomized into one of four experimental groups at age 12 weeks: uninjured control, VML untreated (VML), low-resistance wheel running (VML-LR) and high-resistance wheel running (VML-HR). All mice, excluding the uninjured, were subject to a unilateral VML injury to the plantar flexor muscles and wheel running began 3 days post-VML. At 8 weeks post-VML, peak isometric torque was greater in uninjured compared to all VML-injured groups, but both VML-LR and VML-HR had greater (∼32%) peak isometric torque compared to VML. All VML-injured groups had less isokinetic torque compared to uninjured, and there was no statistical difference among VML, VML-LR and VML-HR. No differences in cumulative running distance were observed between VML-LR and VML-HR groups. Because adaptations in VML-HR peak isometric torque were attributed to greater gastrocnemius muscle mass, atrophy- and hypertrophy-related protein content and post-translational modifications were explored via immunoblot; however, results were inconclusive. Permeabilized fibre bundle mitochondrial oxygen consumption was 22% greater in uninjured compared to VML, but there was no statistical difference among VML, VML-LR and VML-HR. Furthermore, neither wheel running group demonstrated a change in the relative protein content of the mitochondrial biogenesis transcription factor, peroxisome proliferator-activated receptor γ coactivator 1-α (PGC-1α). These results indicate that resistance wheel running alone only has modest benefits in the VML-injured muscle. NEW FINDINGS: What is the central question of the study? Does initiation of a resistance wheel running regimen following volumetric muscle loss (VML) improve the functional capacity of skeletal muscle? What is the main finding and its importance? Resistance wheel running led to greater muscle mass and strength in mice with a VML injury but did not result in a full recovery. Neither low- nor high-resistance wheel running was associated with a change in permeabilized muscle fibre respiration despite runners having greater whole-body treadmill endurance capacity, suggesting resilience to metabolic adaptations in VML-injured muscle. Resistance wheel running may be a suitable adjuvant rehabilitation strategy, but alone does not fully mitigate VML pathology.
Collapse
Affiliation(s)
| | | | - Junwon Heo
- Department of Physiology and PharmacologyUniversity of GeorgiaAthensGAUSA
| | | | - Jarrod A. Call
- Department of Physiology and PharmacologyUniversity of GeorgiaAthensGAUSA
- Regenerative Bioscience CenterUniversity of GeorgiaAthensGAUSA
| | | |
Collapse
|
16
|
Gsangaya MR, Htwe O, Selvi Naicker A, Md Yusoff BAH, Mohammad N, Soh EZF, Silvaraju M. Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: A prospective randomized controlled trial. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 34:28-37. [PMID: 37841643 PMCID: PMC10570631 DOI: 10.1016/j.asmart.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Anterior cruciate ligament injury (ACL) commonly occurs during sporting events. It causes pain, instability and reduction in range of movement of the knee which results in altered balance, reduced strength as well as loading to the involved knee. The challenge to get the patient back to competitive sports level much depends on the rehabilitation process. Post ACLR rehabilitation is challenging due to the long rehabilitation time as well as boring repetitive exercises. The aim of this study is to compare between the effectiveness of using immersive virtual reality (PlayStation VR) in addition to the conventional rehabilitation as an aid in rehabilitation of patients after ACLR in terms of objective functional assessment and pain and subjective knee function scoring. Methods This randomised controlled trial was undertaken in a tertiary hospital in Malaysia from July 2019 until July 2020. Thirty patients were randomised into a group undergoing purely conventional rehabilitation (Group 1) and a group undergoing both conventional rehabilitation and immersive virtual reality assisted rehabilitation (Group 2). The immersive virtual reality assisted rehabilitation was started at 3 months post operatively for 3 months duration. Limb loading, balance, range of motion, functional hop tests of the knee, pain and subjective scoring of the knee with the International Knee Documentation Committee (IKDC) Scores were measured preoperatively and at 6 months. Results There were significant differences in terms of improvement of pain scores (p = 0.012) as well as IKDC Scores (p = 0.024) in Group 2 as compared to Group 1. However, there were no significant differences with regards to limb loading, balance, range of motion and functional hop tests of the knee (p > 0.05). No adverse events were observed during the study period. Conclusion Immersive virtual reality can be used as an adjunct in rehabilitation of patients after ACL reconstruction in terms of improving their pain as well as their subjective knee evaluation. Large randomised control trial is recommended to further investigate the efficacy.
Collapse
Affiliation(s)
- Muhindra Rao Gsangaya
- Department of Orthopaedics, Hospital Serdang, Jalan Puchong, 43000, Kajang, Selangor, Malaysia
| | - Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Amaramalar Selvi Naicker
- Rehabilitation Medicine Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Badrul Akmal Hisham Md Yusoff
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Norlelawati Mohammad
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Elaine Zi Fan Soh
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Murugeaswaran Silvaraju
- Department of Orthopaedics, Hospital Serdang, Jalan Puchong, 43000, Kajang, Selangor, Malaysia
| |
Collapse
|
17
|
Räisänen AM, Benson LC, Whittaker JL, Emery CA. Evaluating a Wearable Solution for Measuring Lower Extremity Asymmetry During Landing. Physiother Can 2023; 75:271-275. [PMID: 37736414 PMCID: PMC10510545 DOI: 10.3138/ptc-2021-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 09/23/2023]
Abstract
Purpose Force plates can be used to monitor landing asymmetries during rehabilitation, but they are not widely available. Accelerometer-based wearable technology may be a more feasible solution. The purpose of this article was to determine the agreement between impact accelerations measured with force plates and accelerometer-derived measures of (1) centre of mass (COM) acceleration and (2) tibial acceleration asymmetries during bilateral landings. Method Participants completed three countermovement jumps (CMJ) and three squat jumps (SJ) on dual force plates with triaxial accelerometers attached to each tibia and lower back, near the COM. Bland and Altman 95% limits of agreement (95% LOA) were calculated. Results 19 adults (n = 11; 58% women, n = 8; 42% men) participated in the study. The mean differences between impact and COM accelerations were 0.24 g (95% LOA: -1.34 g to 1.82 g) and 0.38 g (95% LOA: -1.15 to 1.91 g) for the CMJ and SJ, respectively. The mean differences between the impact and tibial acceleration-based lower limb asymmetries in the CMJ and SJ were -6% (95% LOA: -32% to 19%) and 0% (95% LOA: -45% to 45%), respectively. Conclusions Our findings show acceptable agreement between impact acceleration and accelerometer-based COM acceleration and lack of agreement between impact accelerations and accelerometer-based tibial acceleration asymmetries. COM acceleration could be used to quantify landing impacts during rehabilitation, but we do not consider the accelerometer-based asymmetry measures to be a suitable alternative for force plate-based measures. Future work should focus on determining normative values for lower extremity asymmetries during landing tasks.
Collapse
Affiliation(s)
- Anu M. Räisänen
- From the:
Department of Physical Therapy Education, College of Health Sciences – Northwest, Western University of Health Sciences, Lebanon, Oregon, United States
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lauren C. Benson
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Tonal Strength Institute, Tonal, San Francisco, California, United States
| | - Jackie L. Whittaker
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Genç AS, Güzel N, Yılmaz AK, Ermiş E, Pekesen Kurtça M, Agar A, Ceritoğlu KU, Yasul Y, Eseoğlu İ, Kehribar L. Post-Operative Modified All-Inside ACL Reconstruction Technique's Clinical Outcomes and Isokinetic Strength Assessments. Diagnostics (Basel) 2023; 13:2787. [PMID: 37685325 PMCID: PMC10487178 DOI: 10.3390/diagnostics13172787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. MATERIALS AND METHODS A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). RESULTS There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. CONCLUSIONS Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports.
Collapse
Affiliation(s)
- Ahmet Serhat Genç
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Türkiye; (A.S.G.); (N.G.)
| | - Nizamettin Güzel
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Türkiye; (A.S.G.); (N.G.)
| | - Ali Kerim Yılmaz
- Faculty of Yasar Dogu Sport Sciences, Ondokuz Mayıs University, Samsun 55100, Türkiye;
| | - Egemen Ermiş
- Faculty of Yasar Dogu Sport Sciences, Ondokuz Mayıs University, Samsun 55100, Türkiye;
| | | | - Anıl Agar
- Department of Orthopaedics and Traumatology, Fırat University, Elazığ 23119, Türkiye;
| | | | - Yavuz Yasul
- Bafra Vocational School, Ondokuz Mayıs University, Samsun 55400, Türkiye;
| | - İsmail Eseoğlu
- Vocational School of Health Services, Dokuz Eylül University, İzmir 35210, Türkiye;
| | - Lokman Kehribar
- Department of Orthopaedics and Traumatology, Samsun University, Samsun 55090, Türkiye;
| |
Collapse
|
19
|
Mangine R, Tersak J, Palmer T, Hill-Lindsay A, Patton B, Eifert-Mangine M, Jacobs B, Colosimo AJ. The Longitudinal Neurophysiological Adaptation of a Division I Female Lacrosse Player Following Anterior Cruciate Rupture and Repair: A Case Report. Int J Sports Phys Ther 2023; 18:467-476. [PMID: 37020442 PMCID: PMC10069340 DOI: 10.26603/001c.73179] [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: 01/08/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Background Neurophysiological adaptation following anterior cruciate ligament (ACL) rupture and repair (ACLR) is critical in establishing neural pathways during the rehabilitation process. However, there is limited objective measures available to assess neurological and physiological markers of rehabilitation. Purpose To investigate the innovative use of quantitative electroencephalography (qEEG) to monitor the longitudinal change in brain and central nervous systems activity while measuring musculoskeletal function during an anterior cruciate ligament repair rehabilitation. Case Description A 19 year-old, right-handed, Division I NCAA female lacrosse midfielder suffered an anterior cruciate ligament rupture, with a tear to the posterior horn of the lateral meniscus of the right knee. Arthroscopic reconstruction utilizing a hamstring autograft and a 5% lateral meniscectomy was performed. An evidence-based ACLR rehabilitation protocol was implemented while using qEEG. Outcomes Central nervous system, brain performance and musculoskeletal functional biomarkers were monitored longitudinally at three separate time points following anterior cruciate injury: twenty-four hours post ACL rupture, one month and 10 months following ACLR surgery. Biological markers of stress, recovery, brain workload, attention and physiological arousal levels yielded elevated stress determinants in the acute stages of injury and were accompanied with noted brain alterations. Brain and musculoskeletal dysfunction longitudinally reveal a neurophysiological acute compensation and recovering accommodations from time point one to three. Biological responses to stress, brain workload, arousal, attention and brain connectivity all improved over time. Discussion The neurophysiological responses following acute ACL rupture demonstrates significant dysfunction and asymmetries neurocognitively and physiologically. Initial qEEG assessments revealed hypoconnectivity and brain state dysregulation. Progressive enhanced brain efficiency and functional task progressions associated with ACLR rehabilitation had notable simultaneous improvements. There may be a role for monitoring CNS/brain state throughout rehabilitation and return to play. Future studies should investigate the use of qEEG and neurophysiological properties in tandem during the rehabilitation progression and return to play.
Collapse
Affiliation(s)
- Robert Mangine
- Director of Residency Education NovaCare Rehabilitation
- Associate Director Sports Medicine University of Cincinnati
| | - Jim Tersak
- Sports Medicine Director of Rehabilitation NovaCare Rehabilitation
| | - Thomas Palmer
- Exercise Science and Integrative Health Mount St. Joseph University
| | | | - Bolton Patton
- Physical Therapy University of Alabama at Birmingham
| | | | - Bradley Jacobs
- Neuro-Visual Performance Institute
- Clinical Research Associate University of Cincinnati
| | | |
Collapse
|
20
|
Chaney GK, Krause DA, Hollman JH, Anderson VA, Heider SE, Thomez S, Vaughn SN, Schilaty ND. Recurrence quantification analysis of isokinetic strength tests: A comparison of the anterior cruciate ligament reconstructed and the uninjured limb. Clin Biomech (Bristol, Avon) 2023; 104:105929. [PMID: 36893524 PMCID: PMC10122704 DOI: 10.1016/j.clinbiomech.2023.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Despite widespread use of return to sport testing following anterior cruciate ligament reconstruction, studies suggest inadequacy in current testing criteria, such as limb symmetry index calculations, to determine athletes' readiness to return to play. Recurrence quantification analysis, an emerging non-linear data analysis tool, may reveal subtle neuromuscular differences between the injured and uninjured limb that are not captured by traditional testing. We hypothesized that isokinetic torque curve data of the injured limb would demonstrate lower determinism and entropy as compared to the uninjured limb. METHODS 102 patients (44 M, 58F, 10 ± 1 months post-anterior cruciate ligament reconstruction) underwent isokinetic quadriceps strength testing using a HumacNorm dynamometer. Patients completed maximum effort knee extension and flexion at 60°/sec. Data were post-processed with a MATLAB CRQA Graphical User Interface and determinism and entropy values were extracted. Paired-sample t-tests (α = 0.05) were used to compare data from the injured and uninjured limb. FINDINGS Determinism and entropy values in the torque curves were lower in the injured limb than the uninjured limb (p < 0.001). Our findings indicate there is less predictability and complexity present in the torque signals of injured limbs. INTERPRETATION Recurrence quantification analysis can be used to assess neuromuscular differences between limbs in patients who have undergone anterior cruciate ligament reconstruction. Our findings offer further evidence that there are changes to the neuromuscular system which persist following reconstruction. Further investigation is needed to establish thresholds of determinism and entropy values needed for safe return to sport and to evaluate the utility of recurrence quantification analysis as a return to sport criterion.
Collapse
Affiliation(s)
- Grace K Chaney
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - David A Krause
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - John H Hollman
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Vanessa A Anderson
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sarah E Heider
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sean Thomez
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Shaelyn N Vaughn
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA.
| |
Collapse
|
21
|
Nawasreh ZH, Yabroudi MA, Kassas MN, Daradkeh SM, Bashaireh KM. Hip Abductor and External Rotator Strengths Correlate With Hop Symmetry in Men Athletes 2 Years After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2023:1-9. [PMID: 36944366 DOI: 10.1123/jsr.2022-0018] [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: 01/12/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
CONTEXT Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR. DESIGN Cross-sectional study. METHODS Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs. RESULTS Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤ .018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r = .354) and 300°/s (r = .324, P ≤ .041), while triple-hop LSI correlated with hip ER-MVIC (r = .320), concentric ER-PKTQ at 180°/s (r = .355), eccentric ER-PKTQ at 60°/s (r = .314), and hip ABD-PKTQ at 60°/s (r = .364) and 300°/s (r = .336, P ≤ .049). CONCLUSIONS Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances.
Collapse
Affiliation(s)
- Zakariya H Nawasreh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid,Jordan
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid,Jordan
| | - Mohamed N Kassas
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid,Jordan
| | - Sharf M Daradkeh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid,Jordan
| | - Khaldoon M Bashaireh
- Department of Special Surgery, College of Medicine, Jordan University of Science and Technology (JUST), Irbid,Jordan
| |
Collapse
|
22
|
Dunphy E, Button K, Murray E, Hamilton FL. Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation. Musculoskeletal Care 2023; 21:117-129. [PMID: 35852464 DOI: 10.1002/msc.1673] [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: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
AIMS This study gathered expert perspectives in the management of anterior cruciate ligament (ACL) rehabilitation to explore current practice, variations in care and optimal management strategies. MATERIALS AND METHODS This was a qualitative semi-structured interview study. The participants' experiences were considered in terms of their roles as employees, managers, clinicians and professional gatekeepers. Purposive and snowball sampling were used to recruit physiotherapists and orthopaedic surgeons. Participants were included if they had a proven record in clinical management or research involving ACL patients. Persons were excluded if they could not speak English. Interviews were conducted in person, via skype or over the phone at a time convenient to the participant. Data was analysed using a framework analysis and critical realist approach. RESULTS Results included 24 interviews that were conducted with 19 physiotherapists and 5 surgeons. Themes of variation in current care and optimal care were explored including subthemes of patient centred practice, evidence based medicine, resources, self-management, multidisciplinary teamwork, training and expertise were explored. Participant's perceptions of current care were that it was a location 'lottery' that significantly varied for patients across the UK. CONCLUSIONS Stakeholders identified that optimal management should be patient centred and incorporate adequate equipment, specific training for physiotherapists and a closely communicating multidisciplinary team. Research is needed to explore cost effective models of optimal rehabilitation that include return to sport strategies.
Collapse
Affiliation(s)
- Emma Dunphy
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | - Fiona L Hamilton
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| |
Collapse
|
23
|
Martin J, Perraton L, Gupta A, Garofolini A, Malliaras P. The use of physical function capacity measures in the management of lower limb tendinopathy: A scoping review of expert recommendations. Phys Ther Sport 2023; 59:37-48. [PMID: 36502766 DOI: 10.1016/j.ptsp.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Physical function capacity measures are recommended as outcome measures for people with lower limb tendinopathy. OBJECTIVE (i) Explore measures of physical function capacity recommended by experts in lower limb tendinopathy (ii) the context they were used, (ii) identify recommended criteria for exercise progression and return to sport or activity. DESIGN Scoping Review. METHOD Three databases were searched using keywords for lower limb tendinopathy and physical function capacity to identify studies that outlined a progressive exercise rehabilitation program. A 15-item tool was used for data extraction. RESULTS 26 studies were included, only eight recommended a physical function capacity measure. There were 10 physical function capacity measures identified for a range of lower limb tendinopathies including patellar (50%), Achilles (13%), proximal hamstring (13%), gluteal (13%), combined patellar and Achilles (13%). Pain was the most common criterion that was used to determine the progression of rehabilitation (96%), with physical function capacity measures rarely used (12%). CONCLUSION Physical function capacity measures are used infrequently across expert recommended exercise rehabilitation programs. There remains a high reliance on pain as the criterion for progression of exercises during rehabilitation. There is a need to develop measures of physical function capacity to better inform and progress rehabilitation.
Collapse
Affiliation(s)
- Joel Martin
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
| | - Luke Perraton
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Amitabh Gupta
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | | | - Peter Malliaras
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Pre- and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes. J Clin Med 2022; 12:jcm12010063. [PMID: 36614863 PMCID: PMC9820843 DOI: 10.3390/jcm12010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare the pre- and 6-month post-operative isokinetic knee strengths in healthy (HK) and ACL knees of patients who underwent semitendinous/gracilis (ST/G) ACLR. Materials and Methods: A retrospective cohort of 21 recreational athletes who underwent ST/G ACLR by the same surgeon were evaluated. The pre- and 6-month post-operative isokinetic knee extension (Ex) and flexion (Flx) strengths of the HK and ACLR patients were evaluated in a series consisting of three different angular velocities (60, 180 and 240°/s). Of all the findings, peak torque (PT) and hamstring/quadriceps (H/Q) parameters were evaluated. Results: There was a significant improvement in post-operative Lysholm, Tegner and IKDC scores compared to pre-operative scores (p < 0.05). There were significant differences in pre-operative and post-operative knee Ex and Flx strengths at angular velocities of 60°, 180° and 240°/s in both the ACLR and HK groups (p < 0.001). There was no significance at 240°/s Flx for ACLR (p > 0.05). As for H/Q ratios, there was a significant difference between pre- and post-operative values only at 60°/s angular velocity in both ACLR and HC (p < 0.005). Conclusions: The pre-operative and 6-month post-operative results of the ST/G ACLR showed that there was a high level of recovery, particularly in quadriceps strength, while the increase in strength was less in the hamstring. The significance observed at 60°/s in H/Q ratios was within normal ranges. It can be argued that the ST/G ACLR method is feasible for people with high physical activity levels and for athletes.
Collapse
|
25
|
Lem HW, Cheng SC, Chang HY, Hung MH, Yeh WL. Single leg drop jump performance identifies functional deficit in collegiate athletes who have returned to sports after ACL reconstruction: A case-control study. Medicine (Baltimore) 2022; 101:e31790. [PMID: 36626457 PMCID: PMC9750644 DOI: 10.1097/md.0000000000031790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Despite its apparent functional importance, there is a general lack of data in explosive strength in individuals recovering from an anterior cruciate ligament reconstruction (ACLR). Hence, we wonder if single leg drop jump (SLDJ) can be an effective testing since drop jump is a commonly used testing which rely on adequate development of explosive strength and stretch shortening cycle function. The purpose of this study was to determine if SLDJ test can identify functional deficit in collegiate athletes who have returned to sports (RTS) after ACLR when comparing it with the common return to sport testing. Nine collegiate athletes who had undergone a unilateral ACLR and returned to their primary sport with at least 10 months post-surgery were recruited and assigned into the injured group and compared with 9 matched non-injured athletes as the control group. Both groups underwent an identical battery testing in 1 session with the sequence of first modified star excursion balance test (SEBT), second single hop and bound test, third SLDJ and lastly 1 repetition maximum (1RM) single leg press. A 2-way mixed model analysis of variance showed that there is no significant interaction effect on common RTS testing which include modified SEBT, single hop and bound tests, and 1RM single leg press, but significant interaction effect on SLDJ jump height (P = .03), reactive strength index (P = .03) and mean propulsion force (P = .03). For the injured group, ACLR leg jump height (10.35 ± 2.71 cm) was significantly lower than non-ACLR leg (12.86 ± 3.51 cm) with a mean difference of 2.51 (95% confidence interval [CI]: 0.55-4.47). ACLR leg reactive strength index (0.29 ± 0.10 m/s) was significantly < non-ACLR leg (0.39 ± 0.16 m/s) with a mean difference of 0.1 (95% CI: 0.03-0.17) and ACLR leg mean propulsion force (1087.49 ± 287.26 N) was significantly < non-ACLR leg (1157.40 ± 299.80 N) with a mean difference of 69.91 (95% CI: 16.04 to 123.78). SLDJ was able to identify jump height, reactive strength and propulsion force deficit in the involved limb of collegiate athletes who have returned to sports after ACLR.
Collapse
Affiliation(s)
- Han Wei Lem
- MSc and MPE Dual Programme in International Sport Coaching Science, University of Physical Education, Budapest, Hungary
- MSc and MPE Dual Programme in International Sport Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Shih-Chung Cheng
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Hsiao-Yun Chang
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan, Taiwan
| | - Min-Hao Hung
- Office of Physical Education, National Chin-Yi University of Technology, Taichung, Taiwan
| | - Wen-Ling Yeh
- Department of Orthopaedic Surgery, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * Correspondence: Wen-Ling Yeh, Department of Orthopaedic Surgery, Lotung Poh-Ai Hospital, No. 81, Nanchang St., Luodong Township, Yilan County 265501, Taiwan (e-mail: )
| |
Collapse
|
26
|
Flore Z, Hambly K, De Coninck K, Welsch G. Time-loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta-analysis. Scand J Med Sci Sports 2022; 32:1690-1709. [PMID: 35904448 PMCID: PMC9804772 DOI: 10.1111/sms.14217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 01/09/2023]
Abstract
A literature search was conducted to systematically review and meta-analyze time-loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time-loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case-control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time-loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time-loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta-analyzed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df = 12; Q = 19.53; I2 = 38.57%) based on the random-effects model was determined. A total of 7736 participants were part of the time-loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15-22.08; df = 11; Q = 158; I2 = 93%), so that the data on time-loss are only presented descriptively. There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%-12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.
Collapse
Affiliation(s)
- Zacharias Flore
- University of Kent, School of Sport and Exercise SciencesCanterburyUK,Hamburger SV, Fußball AGHamburgGermany,University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany
| | - Karen Hambly
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Kyra De Coninck
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Götz Welsch
- University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany,Department of Trauma and Orthopaedic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| |
Collapse
|
27
|
Dauty M, Menu P, Daley P, Grondin J, Quinette Y, Crenn V, Fouasson-Chailloux A. Knee Strength Assessment and Clinical Evaluation Could Predict Return to Running after Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Procedure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13396. [PMID: 36293974 PMCID: PMC9603555 DOI: 10.3390/ijerph192013396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Muscle knee strength is a major parameter that allows return to running. Isokinetic strength parameters may predict return to running 4 months after ACLR using the bone-patellar-tendon-bone procedure. MATERIALS AND METHODS The isokinetic knee strength of 216 patients (24.5 ± 5 years) was measured 4 months after surgery, and progressive return to running was allowed. The effectiveness of return to running was reported at 6 months. Return to running prediction was established using multivariate logistic regression. Predictive parameters were presented with a ROC curve area to define the best cut-off, with sensibility (Se) and specificity (Sp). RESULTS A model was established, including the limb symmetry index (LSI), and 103 patients (47.6%) were able to run between the fourth and the sixth month after surgery. These patients presented significantly fewer knee complications, a better Lysholm score, a better Quadriceps and Hamstring LSI and better quadriceps strength reported for body weight on the operated limb. The best model was established including the Quadriceps and Hamstring LSI at 60°/s and the Lysholm score. The cut-off for Quadriceps LSI was 60% (ROC curve area: 0.847; Se: 77.5%; Sp: 77%), for Hamstring LSI 90% (ROC curve area: 0.716; Se: 65.7%; Sp: 60.2%) and for Lyshom score 97 points (ROC curve area: 0.691; Se: 65%; Sp: 66%). CONCLUSION Four months after ACLR using a bone-patellar-tendon-bone procedure, the Quadriceps and Hamstring LSI associated to the Lysholm score could help make the decision to allow return to running.
Collapse
Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
| | - Yonis Quinette
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
| |
Collapse
|
28
|
Drole K, Paravlic AH. Interventions for increasing return to sport rates after an anterior cruciate ligament reconstruction surgery: A systematic review. Front Psychol 2022; 13:939209. [PMID: 36072023 PMCID: PMC9443932 DOI: 10.3389/fpsyg.2022.939209] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background An injury followed by surgery poses many challenges to an athlete, one of which is rehabilitation, with the goal of returning to sport. While total restoration of physical abilities is a primary goal for most athletes, psychosocial factors also play an important role in the success of an athlete's return to sport (RTS). The purpose of this review was to examine the effectiveness of exercise and psychosocial interventions on RTS rates, which might be one of the most important outcomes for elite athletes. Methods To carry out this review, PubMed, SAGE Journals, Web of Science, SPORTDiscus, ScienceDirect, and Google Scholar databases were searched from inception to July 2022. The inclusion criteria consisted exercise or psychosocial intervention for athletes after anterior cruciate ligament reconstruction (ACLR), with reporting RTS rates as an outcome. Results From 1032 identified articles, four reports (N = 130) met inclusion criteria, all of which examined the recovery after ACLR. The mean MINORS score for the included studies was 16.3 ± 6.1, of which non-comparative studies scored 11.0 ± 1.4, while comparative studies scored 21.5 ± 0.7. There were consistent findings for benefits of exercise and psychosocial interventions on RTS rates. Return to preinjury rates in the reviewed studies vary between 63 and 95% with lower % observed in female athletes and with shorter follow-up. Interventional studies reporting RTS rates with a larger sample size and longer follow-up are needed. Conclusion Physical and psychological function, as well as social support can be influenced by appropriate interventions, indicating future work on rehabilitation programs for return to preinjury might consider taking the holistic approach addressing those.
Collapse
Affiliation(s)
- Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
| | - Armin H Paravlic
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia.,Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia.,Faculty of Sports Studies, Masaryk University, Brno, Czechia
| |
Collapse
|
29
|
Hart LM, Izri E, King E, Daniels KAJ. Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts. Scand J Med Sci Sports 2022; 32:1781-1790. [PMID: 36062926 DOI: 10.1111/sms.14229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
After anterior cruciate ligament reconstruction (ACLR) there are differences in the neuromuscular deficits observed in patients with bone-patellar tendon-bone (BPTB) and with hamstring tendon (HT) autografts. Differences in knee extensor and flexor strength are commonly reported, but analyses have largely focused on peak torque metrics despite the requirement to generate torque through range when returning to sport. The aim of this study was to investigate the angle-specific strength and strength asymmetry differences between BPTB and HT around the time of return to play after ACLR. A total of 357 male field sport athletes with either a BPTB (n=297) or an HT (n=60) autograft underwent concentric knee flexor and extensor isokinetic strength testing nine months post-ACLR. Angle-specific torques were compared between grafts and limbs using 1D Statistical Parametric Mapping and discrete-point variables. Inter-limb extensor torque asymmetry was greater in BTPB than HT at knee angles of >30° (p=0.001, peak d=5.53), with flexor torque asymmetry lower in BPTB than HT at flexion angles of >25° (p=0.001, peak d=2.68). Angle of maximum asymmetry and angle of operated limb peak torque differed in knee extension for BPTB (p<0.001, d=0.32) but not HT, whereas knee flexion angle of maximum asymmetry and operated limb peak torque differed in both BTPB (p<0.001, d=0.75) and HT (p<0.001, d=0.43). Graft type affected extensor torque at knee angles of 67-85° and flexor torque at knee angles of 27-85°. Angle-specific strength analysis may inform the rehabilitation process and improve rehabilitation and return-to-play decision making strategies in comparison to the use of peak torque values alone.
Collapse
Affiliation(s)
- Luke M Hart
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Erwan Izri
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Enda King
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, UK
| |
Collapse
|
30
|
Brumitt J, Patterson C, Dudley R, Sorenson E, Cuddeford T, Cooke H, Froemming L. Correlations Between Preseason Functional Test Scores and Game Performance in Female Collegiate Volleyball Players. Int J Sports Phys Ther 2022; 17:896-906. [PMID: 35949390 PMCID: PMC9340847 DOI: 10.26603/001c.36805] [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: 04/13/2021] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Functional tests (FT) are assessment tools that attempt to evaluate balance, flexibility, strength, power, speed, or agility through performance of gross motor skills. FT are frequently administered by coaches or sports medicine professionals to evaluate athletic ability, to predict performance, to identify athletes at risk for injury, or to evaluate an athlete's ability to return to sport after injury. Functional tests which can provide accurate or predictive information regarding athletic ability would be advantageous to coaching staffs or medical professionals. Purpose The primary purpose of this study was to identify correlations between preseason FT scores and in-season game statistics in a cohort of female collegiate level volleyball (VB) players. A secondary purpose was to present FT descriptive data for this cohort based on level of competition, player position, and starter status. Study Design prospective cohort; correlational. Methods One hundred and thirty-one female collegiate VB players representing three levels of competition completed four FT [standing long jump (SLJ), single-leg hop (SLH), lower extremity functional test (LEFT), and the Y-Balance Test - Lower Quarter (YBT-LQ)] at the start of the preseason. Player statistics were collected from team records at the completion of the season. Results Starters performed significantly better on all tests. There were moderate negative correlations between LEFT scores and game statistics for liberos, defensive specialists, and outside hitters. There were moderate positive correlations between YBT-LQ composite scores and game statistics for liberos, defensive specialists, hitters, and middle blockers. There were also low to moderate level positive correlations between SLJ and SLH scores and game performance for outside hitters. There were low to moderate level positive correlations between SLH scores and game performance for middle blockers and opposite side hitters. Conclusions The results of this study indicate that there are low to moderate correlations between some preseason functional test scores and some game statistics. The SLJ, SLH, LEFT, and YBT-LQ tests may help coaches with talent identification and/or may influence training strategies. Level of Evidence 3.
Collapse
|
31
|
Blucher NC, Feller JA, Devitt BM, Klemm HJ, Whitehead TS, McClelland JA, Webster KE. Is There an Association in Young Patients Between Quadriceps or Hamstring Strength After ACL Reconstruction and Graft Rupture? Orthop J Sports Med 2022; 10:23259671221101003. [PMID: 35677023 PMCID: PMC9168858 DOI: 10.1177/23259671221101003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Younger patients who sustain anterior cruciate ligament (ACL) ruptures are at high risk for reinjury after ACL reconstruction. Restoring muscle strength before return to sports (RTS) is regarded as an important factor in reducing the reinjury risk, and quadriceps and hamstring strength assessment is commonly included in RTS testing. However, it is not clear whether reduced strength is a risk factor for subsequent graft rupture in this patient population. Purpose: To investigate the association between quadriceps and hamstring strength at 12 months after primary ACL reconstruction and ACL graft rupture in young patients. Study Design: Case-control study; Level of evidence, 3. Methods: The cohort consisted of 210 patients (100 men and 110 women) who were younger than 20 years at the time of primary ACL reconstruction with a hamstring tendon autograft and who had no previous contralateral ACL injury. Isokinetic strength testing (60 and 180 deg/s) of knee flexors and extensors was performed at 12 months postoperatively, and the limb symmetry index (LSI) for each strength outcome was calculated. RTS rates and the incidence of further ACL graft ruptures were recorded. Results: Measures of central tendency (mean and median) of LSI values ranged from 88 to 98. The percentage of patients with LSI ≥90 was 57% to 69% for quadriceps strength and 45% to 47% for hamstring strength. Overall, 19 patients (9%) sustained an ACL graft rupture. No significant differences were found between the patients who sustained an ACL graft rupture and those who did not in terms of quadriceps and hamstring strength at 12 months. No significant associations were found between achieving LSI ≥90 for quadriceps peak torque and subsequent ACL graft rupture. Conclusion: In young patients who underwent an ACL reconstruction, no association was noted between quadriceps and hamstring strength at 12 months postoperatively and subsequent graft ruptures. The role of strength testing as part of the RTS criteria after ACL reconstruction, and specifically the use of limb symmetry thresholds, warrants further investigation and clarification.
Collapse
Affiliation(s)
| | - Julian A. Feller
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Brian M. Devitt
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
| | - Haydn J. Klemm
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
| | | | - Jodie A. McClelland
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| |
Collapse
|
32
|
Kim Y, Kubota M, Sato T, Inui T, Ohno R, Ishijima M. Psychological Patient-reported outcome measure after anterior cruciate ligament reconstruction: Evaluation of subcategory in ACL-Return to Sport after Injury (ACL-RSI) scale. Orthop Traumatol Surg Res 2022; 108:103141. [PMID: 34763076 DOI: 10.1016/j.otsr.2021.103141] [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: 12/07/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND It has been recognized that psychological factors influence the return to sports after anterior cruciate ligament reconstruction (ACLR). The ACL-return to sports after injury (RSI) scale was developed based on subcategories of emotions, confidence in physical performance and risk appraisal. However, it has not been clarified describing which is the most influential psychological factor of the ACL-RSI scale. HYPOTHESIS Risk appraisal is the most influent for return to sports in the subcategories of the ACL-RSI scale. PATIENTS AND METHODS A total of 85 competitive patients who had undergone ACLR were evaluated at 6, 12 and 24 months after surgery. They were classified the return to sports (RTS) group and non-return to sports (NRTS) group. Evaluations were several clinical and functional scores including Cincinnati knee rating system, Knee Osteoarthritis Outcome Score (KOOS), Lysholm score, limitation in activities of daily living (ADL) and sports which estimated by Visual Analog Scale (VAS) score, Isokinetic Muscle Strength (quadriceps and hamstrings), single hop test and anterior laxity. They were investigated their relationship with the ACL-RSI scale including each subcategory. RESULTS The total ACL-RSI scale significantly improved at each point. Of the subcategories, only risk appraisal was not significantly different at each point (p=0.21 and p=0.13). There was a significant difference at 24 months after ACLR between the RTS group and NRTS group. In terms of risk appraisal, compared with emotion and performance confidence, the difference in the mean value was the most divergent (RTS group: 55.9±22.7 and NRTS group: 23.8±19.3) and took time to improve through 24 months. Among various clinical and functional scores, there were significant differences in the VAS score for sports, KOOS-symptoms, sports and QOL, Cincinnati Knee Rating System-cut, and single hop test values between two groups. Of these, the KOOS-QOL and VAS score for sports showed particularly strong correlations with ACL-RSI risk appraisal (r=0.75 and -0.68, respectively). CONCLUSION Of the ACL-RSI scale, risk appraisal took the longest time to improve and strongly affected the return to sports. The KOOS-QOL and VAS score for sports were most strongly correlated with the ACL-RSI risk appraisal. It seems that it is important to reduce the psychological risk as soon as possible after ACL injury in ACLR patients. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Youngji Kim
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan; Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Mitsuaki Kubota
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan; Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan.
| | - Taisuke Sato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan; Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Tetsuya Inui
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan; Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ryuichi Ohno
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan; Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
33
|
Lawson D, Jordan MJ, Herzog W. Effects of lead leg selection on bilateral landing force-time characteristics: Return to sport testing implications. Scand J Med Sci Sports 2022; 32:1192-1200. [PMID: 35441730 DOI: 10.1111/sms.14168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
We quantified the effect of lead leg selection on landing force-time characteristics during a vertical drop landing (VDL) initiated with a step-off. Plyometric-trained subjects (male: n = 8; female: n = 5; age =23 ± 3.3 years; body mass =74.4 ± 11.2 kg) performed 6 step-off-initiated VDLs from a 45-cm box (n = 3/lead leg). Pooled and lead leg stratified between-limb comparisons of limb-specific initial ground contact timing, peak vertical ground reaction force (Fzpeak ), and early landing-phase impulse (Impulse100ms ) were assessed by a two-factor, within-subject ANOVA, and limb symmetry indexes were calculated (α = 0.05). Pooled data showed that the lead leg made contact prior to the trail leg and contributed a greater fraction to Fzpeak compared with the trail leg. Stratifying trials by lead leg selection led to significant between-limb differences in Fzpeak (p < 0.05) and Impulse100ms (p < 0.01) with the right leg leading but not with the left leg leading. Lead leg selection in step-off-initiated VDLs influenced landing performance and limb symmetry indexes of variables associated with lower limb injury risk, suggesting the need to control for lead leg selection in these tasks. A step-off may not be a suitable technique to initiate landing tasks when assessing limb symmetry.
Collapse
Affiliation(s)
- Drew Lawson
- Canadian Sport Institute Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Jordan
- Canadian Sport Institute Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
34
|
Miles JJ, McGuigan PM, King E, Daniels KAJ. Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction. Scand J Med Sci Sports 2022; 32:1236-1248. [PMID: 35419809 DOI: 10.1111/sms.14166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Nine months after anterior cruciate ligament (ACL) reconstruction, athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft demonstrate higher loading asymmetries during vertical jumping than those with a hamstring tendon (HT) autograft. These asymmetries may transfer into sporting movements with a greater ACL injury risk. The aim of this study was to compare between-limb asymmetries in knee mechanics and task performance during an unplanned 90° change-of-direction (CoD) task in male field sport athletes reconstructed with BPTB or HT autografts. Seventy-eight male multidirectional field sport athletes with either a BPTB (n = 39) or HT (n = 39) autograft completed maximal unplanned CoD trials in a three-dimensional motion capture laboratory at approximately 9 months post-surgery. A mixed-model 2x2 ANOVA (autograft type x limb) was used to compare variables related to ACL injury risk (e.g., internal knee moments) and performance (e.g., completion time) between autografts and limbs. Statistical parametric mapping was used for a waveform comparison throughout stance, supplemented with a discrete point analyses of peak knee moments and performance variables. Interaction effects were found at the knee joint, with BPTB demonstrating greater asymmetries than HT in knee extension moment (p < 0.001); resultant ground reaction force (p < 0.001); peak knee external rotation moment (p = 0.04); and knee adduction (p = 0.05), medial rotation (p < 0.001), and flexion (p < 0.001) angles. No differences were found between autografts for any performance variable. BPTB demonstrated greater lower-limb biomechanical asymmetries than HT during CoD, which may influence knee loading and longer-term outcomes and should thus be targeted during rehabilitation prior to return to play.
Collapse
Affiliation(s)
- Joshua J Miles
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department for Health, University of Bath, Bath, UK
| | | | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
| | - Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
35
|
Anatomical and Neuromuscular Factors Associated to Non-Contact Anterior Cruciate Ligament Injury. J Clin Med 2022; 11:jcm11051402. [PMID: 35268493 PMCID: PMC8911271 DOI: 10.3390/jcm11051402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 12/11/2022] Open
Abstract
The majority of anterior cruciate ligament (ACL) injuries occur during non-contact mechanisms. Knowledge of the risk factors would be relevant to help prevent athletes’ injuries. We aimed to study risk factors associated with non-contact ACL injuries in a population of athletes after ACL reconstruction. From a cohort of 307 athletes, two populations were compared according to the non-contact or contact mechanism of ACL injury. Gender, age and body mass index (BMI) were reported. Passive knee alignment (valgus and extension), knee laxity (KT-1000 test), and isokinetic knee strength were measured on the non-injured limb. The relationship between these factors and the non-contact sport mechanism was established with models using logistic regression analysis for the population and after selection of gender and cut-offs of age, BMI and knee laxity calculated from Receiver Operating Characteristics curve area and Youden index. Age, BMI, antero-posterior laxity, isokinetic knee strength, passive knee valgus and passive knee extension were associated with non-contact ACL injury. According to the multivariate model, a non-contact ACL injury was associated with non-modifiable factors, age (OR: 1.05; p = 0.001), passive knee extension (OR: 1.14; p = 0.001), and with one modifiable factor (Hamstring strength: OR: 0.27; p = 0.01). For women, only passive knee valgus was reported (OR: 1.27; p = 0.01). Age, passive knee extension and weak Hamstring strength were associated with a non-contact ACL injury. Hamstring strengthening could be proposed to prevent ACL injury in young male athletes or in case of knee laxity.
Collapse
|
36
|
Zampeli F, Pappas E, Velonakis G, Roumpelakis IM, Poulou LS, Papagiannis GI, Kelekis AD, Mastrokalos DS. Development of new cartilage lesions after ACL reconstruction is associated with abnormal knee rotation. Knee Surg Sports Traumatol Arthrosc 2022; 30:842-851. [PMID: 33528592 DOI: 10.1007/s00167-020-06387-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to examine the association between the development of articular cartilage pathology and knee rotation after single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Seventeen patients that underwent single-bundle ACL reconstruction and did not have any cartilage lesions at the time of surgery based on the Outerbridge classification or meniscal injury that required meniscectomy > 20% were examined by MRI and in the biomechanics laboratory at a 6-year minimum follow-up. Cartilage lesions that occurred after reconstruction were graded on MRI according to a modified Noyes scale. For cartilage evaluation, the lateral and medial femoral condyles were divided into 9 segments each (lateral, central, and medial third and each third was divided into anterior, central, and posterior segment). Tibial rotation during a pivoting task was measured with optoelectronic motion analysis system and side-to-side differences of tibial rotation between the reconstructed and contralateral intact knees were calculated. The association between the total modified Noyes scale score (outcome variable) and side-to-side differences of tibial rotation after controlling for meniscectomy and meniscal repair was investigated with hierarchical regression models. RESULTS Side-to-side difference of tibial rotation was associated with total modified Noyes scale score (p = 0.015, β = 0.667, adjusted R2 = 42.1%). All patients developed new cartilage lesions in MRI located mainly at the central region of the lateral femoral condyle and less frequently in the central and anterior regions of the medial femoral condyle. CONCLUSION Abnormally increased tibial rotation that persists after ACL-R is significantly associated with the development of new articular cartilage lesions at mean 8.4 years after reconstruction which were located mainly at the central region of the LFC and secondarily in the central and anterior regions of the MFC (more superficial lesions). These findings suggest that there is emerging evidence that abnormal rotational kinematics is a potential risk factor for the pathogenesis and onset of posttraumatic articular cartilage degeneration after ACLR. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- F Zampeli
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Pappas
- Discipline of Physiotherapy - Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - G Velonakis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - I M Roumpelakis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - L S Poulou
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - G I Papagiannis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A D Kelekis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - D S Mastrokalos
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
37
|
The Effects of Virtual Reality Nonphysical Mental Training on Coordination and Skill Transfer in Healthy Adults. J Sport Rehabil 2022; 31:442-451. [PMID: 35078153 DOI: 10.1123/jsr.2021-0198] [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: 05/26/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Mental training is a promising method to improve motor skills. However, transfer of these improvements to different skills or functional activities is still unclear. The purpose of this study was to investigate the effects of mental balance training programs on motor coordination and skill transfer. DESIGN Randomized controlled trial. METHODS Fifty-seven healthy adults (28 females and 29 males) aged between 18 and 25 years participated in this study. Participants were randomly assigned to 3 groups: virtual reality (VR) mental training group, conventional mental training group, and control group. The training program included action observation and motor imagery practice with balance exercise videos. The VR mental training group trained with a VR head-mounted display and the conventional mental training group trained with a nonimmersive computer monitor for 30 minutes, 3 days per week, for 4 weeks. Coordination skills were tested with 2 separate custom-made obstacle course tests (OCT-1 and OCT-2). OCT tests included crouching, turning, leaning, stepping over, changing direction, walking on various surfaces, or using repeated hand and arm movement tasks. OCT-1 was used to investigate the effects of mental exercises on coordination skills, and OCT-2 to investigate transfer effects for novel tasks. Test time (total and corrected) and error types (minor, major, and total) were recorded. Touching an obstacle without changing its position was classified as a minor error, and changing its position was a major error. RESULTS OCT-1 test time and number of errors significantly decreased in the VR mental training and conventional mental training groups, but not in the control group. The number of minor errors was only decreased in the VR mental training group. For OCT-2, total and corrected time were not significantly different between the groups. However, both training groups were significantly superior to the control group for all types of errors. CONCLUSIONS Our findings suggest that both training interventions can significantly improve coordination and skill transfer test results. In addition, VR mental training may have some advantages over conventional mental training. These findings are promising for the use of mental training for prevention and rehabilitation in special populations.
Collapse
|
38
|
Welling W, Frik L. On-Field Tests for Patients After Anterior Cruciate Ligament Reconstruction: A Scoping Review. Orthop J Sports Med 2022; 10:23259671211055481. [PMID: 35005045 PMCID: PMC8727834 DOI: 10.1177/23259671211055481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: After anterior cruciate ligament reconstruction (ACLR), a patient’s physical capacities, such as (repeated) sprint performance, agility performance, and intermittent endurance performance, are often reduced because of detraining effects. Monitoring the progression of these physical capacities is essential for specific training goals before patients return to complex team sports. Purpose: To map the existing literature regarding on-field tests for (repeated) sprint performance, agility performance, and intermittent endurance performance in patients after ACLR. Study Design: Scoping review; Level of evidence, 4. Methods: A search was performed in 4 electronic databases, PubMed, Embase, CINAHL, and PsycInfo, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. Results: There were 11 studies that met the inclusion criteria and described a total of 14 on-field tests for patients after ACLR. Overall, 2 tests were described for sprint performance, 11 tests were related to agility performance, and 1 test was performed for intermittent endurance performance. Conclusion: The results of this scoping review provide an overview of on-field tests to monitor sport-specific progression and to set performance-specific training goals for patients after ACLR before returning to complex team sports.
Collapse
Affiliation(s)
- Wouter Welling
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Medisch Centrum Zuid, Groningen, the Netherlands
| | - Laurens Frik
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Frix Fysiotherapie, Elburg, the Netherlands
| |
Collapse
|
39
|
A Compound Hop Index for Assessing Soccer Players' Performance. J Clin Med 2022; 11:jcm11010255. [PMID: 35011996 PMCID: PMC8745790 DOI: 10.3390/jcm11010255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 02/01/2023] Open
Abstract
Athletes regularly have to pass a series of tests, among which one of the most frequently used functional performance measures are single-leg hop tests. As the collected individual results of tests constitute a large amount of data, strategies to decrease the amount of data without reducing the number of performed tests are being searched for. Therefore, the study aimed to present an effective method to reduce the hop-test battery data to a single score, namely, the Compound Hop Index (CHI) in the example of a soccer team. A male, first-league soccer team performed a battery of commonly used single-leg hop tests, including single hop and triple hop for distance tests and the six-meter timed hop test. Gathered data, including Limb Symmetry Indexes of the three tests, normalized to body height for the single- and triple-hop-tests distance separately for right and left legs, and the time of the six-meter timed hop test separately for right and left legs were standardized to z-scores. Consecutively, the z-scores were averaged and formed CHI. The developed CHI represents a novel score derived from the average of z-scores that significantly reduces, clarifies, and organizes the hop performance-measures data.
Collapse
|
40
|
Keller M, Diemer F, Kurz E. [Judging movement quality in patients who sustained a knee ligament injury: a systematic review]. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:38-48. [PMID: 34983071 DOI: 10.1055/a-1551-4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Knee joint injury statistics are dominated by ruptures of the capsular ligament structures. Post-traumatic deficits in dynamic movement patterns are assessed quantitatively as well as qualitatively. The aim of this review was to compile tools that are used to assess the quality of movement after knee ligament injuries in adults. METHODS A systematic search for original papers was carried out in the following primary sources: Ovid, PubMed, Scopus and Web of Science. Both conservative and surgical treatment options were considered. PROSPERO registration of the study protocol: CRD42020175359. RESULTS A total of 1153 papers were identified. Eleven original papers from four different working groups were included in this work. All papers assessed the quality of movement in adults after anterior cruciate ligament (ACL) injury. A total of 348 (70 deficient, 278 reconstructed) patients after an ACL injury and 119 adults with an intact ACL were examined in the studies included. CONCLUSION It is possible to assess movement quality after a knee ligament injury with a low temporal and technical effort. The changes recorded result in a functional valgus, which, based on the study results, may be further differentiated into isolated knee valgus, medial collapse or postural collapse.
Collapse
Affiliation(s)
| | - Frank Diemer
- DIGOTOR GbR, Fortbildungen für Orthopädische Medizin und Manuelle Therapie, Brackenheim, Germany
| | - Eduard Kurz
- OSINSTITUT ortho & sport, München, Germany.,Universitätsklinikum Halle, Halle (Saale), Germany
| |
Collapse
|
41
|
Farmer B, Anderson D, Katsavelis D, Bagwell JJ, Turman KA, Grindstaff TL. Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction. J Orthop Res 2022; 40:200-207. [PMID: 33934379 PMCID: PMC8560653 DOI: 10.1002/jor.25073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/25/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Following anterior cruciate ligament (ACL) reconstruction limb dominance for performing tasks is not considered when making rehabilitation progression decisions. The purpose of this study was to determine if strength and functional outcomes differ between individuals who injured their preferred or nonpreferred jumping limb and to determine if these same outcomes differ between individuals who injured their preferred or nonpreferred limb used to kick a ball. A secondary purpose was to determine the association of quadriceps strength and single-leg forward hop performance with patient self-reported function. Forty individuals with ACL reconstruction (age = 20.0 ± 4.6 years, height = 174.2 ± 12.7 cm, mass = 71.2 ± 12.7 kg, time since surgery = 5.3 ± 0.8 months) were included in the study. Primary outcome measures included, International Knee Documentation Committee Subjective Knee Form (IKDC) scores, quadriceps limb symmetry index (LSI) values, and single-leg forward hop LSI values. Limb preference was defined two ways, kicking a ball and performing a unilateral jump. There were no significant differences between groups based on injury to the preferred limb to kick a ball for any of the outcome variables. Individuals who injured their nonpreferred jumping limb demonstrated significantly (p = 0.05, d = 0.77) lower single-leg forward hop LSI values (81.1% ± 19.5%) compared to individuals who injured their preferred jumping limb (94.1% ± 12.6%), but demonstrated no differences in IKDC scores or quadriceps LSI values. Quadriceps LSI and single-leg forward hop LSI explained 73% of the variance in IKDC scores, but quadriceps LSI had the strongest association (r = 0.790). These findings suggests that limb preference influences single forward hop LSI values and should be considered following ACL reconstruction.
Collapse
Affiliation(s)
- Brooke Farmer
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | | | - Dimitrios Katsavelis
- Department of Exercise Science and Pre-Health Professions, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Jennifer J. Bagwell
- Department of Physical Therapy, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA, USA
| | | | - Terry L. Grindstaff
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE, USA
| |
Collapse
|
42
|
Perry A, DeFroda S, Leporace G, Metsavaht L, Coxe CR, Bierman AM, Chahla J. ACL Rehabilitation: How Can We Lessen Injury Rates? OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Šarabon N, Kozinc Ž, Perman M. Establishing Reference Values for Isometric Knee Extension and Flexion Strength. Front Physiol 2021; 12:767941. [PMID: 34721087 PMCID: PMC8554160 DOI: 10.3389/fphys.2021.767941] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 01/23/2023] Open
Abstract
Single-joint isometric and isokinetic knee strength assessment plays an important role in strength and conditioning, physical therapy, and rehabilitation. The literature, however, lacks absolute reference values. We systematically reviewed the available studies that assessed isometric knee strength. Two scientific databases (PubMed and PEDro) were searched for the papers that are published from the inception of the field to the end of 2019. We included studies that involved participants of both genders and different age groups, regardless of the study design, that involved isometric knee extension and/or flexion measurement. The extracted data were converted to body-mass-normalized values. Moreover, the data were grouped according to the knee angle condition (extended, mid-range, and flexed). A meta-analysis was performed on 13,893 participants from 411 studies. In adult healthy males, the pooled 95% confidence intervals (CI) for knee extension were 1.34–2.23Nm/kg for extended knee angle, 2.92–3.45Nm/kg for mid-range knee angle, and 2.50–3.06Nm/kg for flexed knee angle, while the CIs for flexion were 0.85–1.20, 1.15–1.62, and 0.96–1.54Nm/kg, respectively. Adult females consistently showed lower strength than adult male subgroups (e.g., the CIs for knee extension were 1.01–1.50, 2.08–2.74, and 2.04–2.71Nm/kg for extended, mid-range, and flexed knee angle condition). Older adults consistently showed lower values than adults (e.g., pooled CIs for mid-range knee angle were 1.74–2.16Nm/kg (male) and 1.40–1.64Nm/kg (female) for extension, and 0.69–0.89Nm/kg (male) and 0.46–0.81Nm/kg (female) for flexion). Reliable normative for athletes could not be calculated due to limited number of studies for individual sports.
Collapse
Affiliation(s)
- Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Andrej Marušič Institute, University of Primorska, Koper, Slovenia.,Human Health Department, InnoRenew CoE, Izola, Slovenia.,Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Ljubljana, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Andrej Marušič Institute, University of Primorska, Koper, Slovenia
| | - Mihael Perman
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia.,Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
44
|
Sonesson S, Kvist J. Rehabilitation after ACL injury and reconstruction from the patients' perspective. Phys Ther Sport 2021; 53:158-165. [PMID: 34656448 DOI: 10.1016/j.ptsp.2021.10.001] [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: 07/13/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe and compare patients' appraisal of the rehabilitation and adherence to the rehabilitation program after acute ACL injury treated with (ACLR) or without (non-ACLR) reconstruction. DESIGN Prospective cohort study. PARTICIPANTS 275 patients (143 females; mean age 25 ± 7 years) with acute ACL injury, of whom 166 patients had ACLR within 24 months. MAIN OUTCOME Adherence to rehabilitation was assessed using the modified Sports Injury Rehabilitation Adherence Scale (SIRAS). RESULTS Appraisal of rehabilitation was higher in the post-ACLR group compared to the non-ACLR group at 3 months (91% compared to 70% scored rehabilitation as necessary, p = 0.025) and at 6 months (87% compared to 70% scored it as necessary, p = 0.017). SIRAS score did not differ between 3 and 6 months for the non-ACLR group (median (IQR) 13 (2) vs 13 (2)) or the post-ACLR group (14 (1) vs 14 (2), p > 0.05). The post-ACLR group had a higher SIRAS score than the non-ACLR group at 3 and 6 months (p ≤ 0.001). CONCLUSION Patients treated with ACLR reported valuing their rehabilitation more and rated greater adherence to the rehabilitation programme than non-surgically treated patients. As rehabilitation is essential for good knee function, strategies to improve adherence after non-ACLR treatment should be implemented. LEVEL OF EVIDENCE Prospective cohort study, level II.
Collapse
Affiliation(s)
- Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| |
Collapse
|
45
|
Costley JAE, Miles JJ, King E, Daniels KAJ. Vertical jump impulse deficits persist from six to nine months after ACL reconstruction. Sports Biomech 2021; 22:123-141. [PMID: 34546153 DOI: 10.1080/14763141.2021.1945137] [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: 10/20/2022]
Abstract
Later-stage rehabilitation following anterior cruciate ligament (ACL) reconstruction (ACLR) provides a valuable opportunity to target performance deficits before return to sport. This study aimed to: (1) evaluate bilateral counter-movement jump (CMJ) phase-specific impulse and isokinetic strength inter-limb asymmetry progression from 6 to 9 months post-ACLR; and (2) examine the extent to which individual changes in strength asymmetry could explain changes in impulse asymmetry. Male athletes (n = 44) with a hamstring tendon or bone-patellar tendon-bone autograft were tested 6 and 9 months post-ACLR. Two-way mixed-model ANOVAs were used to identify inter-session and inter-graft differences in CMJ phase-specific impulse asymmetries and knee isokinetic flexor and extensor strength asymmetries, as well as in absolute impulse and strength values of independent (ACLR/uninvolved) limbs. Linear regression models were used to assess the relationship between changes in impulse asymmetry and strength asymmetry. Reductions in strength asymmetry arose from improved ACLR-limb performance, whereas concentric impulse asymmetry reduced consequent to decreased uninvolved-limb performance and eccentric deceleration impulses decreased bilaterally. Graft type did not modulate findings. Changes in strength asymmetry had little or no ability to explain changes in impulse asymmetry. Consideration of approaches that may influence persisting deficits observed bi-laterally throughout vertical jumping performance post-ACLR may enhance rehabilitation practice.
Collapse
Affiliation(s)
- Jill A E Costley
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland
| | - Joshua J Miles
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Department for Health, University of Bath, Bath, UK
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Department of Life Sciences, Roehampton University, London, UK
| | - Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Republic of Ireland.,Queen's School of Engineering, University of Bristol, Bristol, UK.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
46
|
McAmis NE, Hardisty AV, Feinn RS, Garbalosa JC. A comparison of kinematic demands placed on the knee and hip during two ACL return-to-sport screening maneuvers and an agility test. Phys Ther Sport 2021; 52:155-161. [PMID: 34530211 DOI: 10.1016/j.ptsp.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study's purpose was to compare the kinematic demands placed on the knee and the hip during various biomechanical tests. DESIGN Retrospective cross-sectional design. SETTING A university research laboratory. PARTICIPANTS The study sample consisted of 70 NCAA Division I female athletes. MAIN OUTCOME MEASURES During the performance of three test maneuvers, a drop vertical jump (DVJ), single leg cross over hop (COH) and modified T-test (AT), the hip and knee joint angles at maximum knee valgus were obtained from marker displacement data collected using a 20-camera motion analysis system. A linear mixed model was used to compare the effect of test on joint angle. RESULTS A significant difference (p < 0.001) in the frontal and sagittal plane position of the knee and hip was noted between the DVJ, COH, and AT tests at maximum knee valgus. CONCLUSIONS The DVJ, COH, and AT maneuvers do not appear to place the same kinematic stress on the knee, supporting the need for the development of return to sport tests that mimic on field demands.
Collapse
Affiliation(s)
- Nicole E McAmis
- Stanford Health Care, 300 Pasteur Dr, Palo Alto, CA, USA; Quinnipiac University, Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT, USA.
| | - Alexis V Hardisty
- Quinnipiac University, Motion Analysis Laboratory, 370 Bassett Rd, North Haven, CT, USA; Quinnipiac University, School of Health Sciences, 370 Bassett Rd, North Haven, CT, USA.
| | - Richard S Feinn
- Quinnipiac University, Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT, USA.
| | - Juan C Garbalosa
- Quinnipiac University, Motion Analysis Laboratory, 370 Bassett Rd, North Haven, CT, USA; Quinnipiac University, School of Health Sciences, 370 Bassett Rd, North Haven, CT, USA.
| |
Collapse
|
47
|
Roe C, Jacobs C, Kline P, Lucas K, Johnson D, Ireland ML, Lattermann C, Noehren B. Correlations of Single-Leg Performance Tests to Patient-Reported Outcomes After Primary Anterior Cruciate Ligament Reconstruction. Clin J Sport Med 2021; 31:e265-e270. [PMID: 32032156 PMCID: PMC7415502 DOI: 10.1097/jsm.0000000000000780] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between patient-reported outcomes (PROs) to the single-leg step-down test (SLSD) and the Y-balance anterior reach (YB-A) 6 months after primary anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Sixty-six patients 6 months after ACLR participated. INTERVENTIONS Patients performed the SLSD, YB-A, and completed PROs after ACLR. MAIN OUTCOME MEASURES Patients completed the International Knee Documentation Committee Score (IKDC), the Lysholm Activity Scale, the Tampa Scale of Kinesiophobia (TSK-11), and the Knee Injury and Osteoarthritis Outcome Score (KOOS)-Symptom, -Sport, and -Quality of Life (QOL) subscales. The SLSD requires subjects to complete as many single-leg step-downs as possible in 60 seconds, and the YB-A involves reaching anteriorly on a single limb. Pearson product moment correlations were used to assess relationships between the YB-A and SLSD performance to each PRO. RESULTS Single-leg step-down test symmetry was significantly correlated with the TSK-11 (r = -0.70), KOOS-Sport (r = 0.40), -Symptom (r = 0.46), and -QOL (r = 0.42). The YB-A symmetry was significantly correlated with the KOOS-Symptom (r = 0.30) and KOOS-Sport (r = 0.30). CONCLUSIONS Single-leg step-down test performance demonstrated stronger relationships to patient-reported knee function than the YB-A. Furthermore, the SLSD symmetry was strongly correlated with fear of movement. The SLSD provides a robust method for clinicians to assess dynamic knee function and may aid in identifying patients who could benefit from intervention to reduce fear of movement or reinjury.
Collapse
Affiliation(s)
- Chelsey Roe
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Paul Kline
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Denver, Colorado
| | - Kathryn Lucas
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Mary Lloyd Ireland
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham and Women’s Hospital, Chestnut Hill, MA
| | - Brian Noehren
- Division of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| |
Collapse
|
48
|
Małecki K, Niedzielski K, Flont P, Fabis-Strobin A, Fabis J. Bilateral Hidden Isokinetic Quadriceps Performance before and after MPFL Reconstruction in Pediatric Patients. J Knee Surg 2021; 34:906-912. [PMID: 31905414 DOI: 10.1055/s-0039-3402031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We perform prospective study to evaluate the isokinetic performance of quadriceps before and 1 year after medial patella-femoral ligament (MPFL) reconstruction with the adductor magnus tendon in the case of recurrent patellar dislocation. The present study is the first to describe the isokinetic function of the quadriceps of the involved and uninvolved extremity, in such a wide range. The MPFL is a crucial passive stabilizer of patella and, along with the conditions of the anatomical shape of the femoral-patellar joint and the function of quadriceps, influences the overall patellar stability. However, only a few studies have examined indirectly or directly the function of quadriceps. A total of 27 patients (average age at surgery was 15.8 years) with recurrent monolateral patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. In the study group, healthy and operated quadriceps were evaluated for the following parameters at the velocities of 60 and 180 deg/s before surgery and in the follow-up examination: peak torque, peak torque to body weight, time to peak torque, peak torque angle, torque in 30 degree of the knee flexion (TQ 30 degree), and the torque in the first 180 milliseconds (TQ 180). Preoperative patellar instability and its normalization after MPFL reconstruction have no impact on the isokinetic quadriceps index value which depends on the time and degree of inactivity as well as implementation of appropriate physiotherapy. The increase in the quadriceps muscle strength of a healthy limb is responsible for the persistence of muscle isokinetic imbalance after MPFL reconstruction in pediatric patients. This is a level 2b study.
Collapse
Affiliation(s)
- Krzysztof Małecki
- Clinic of Orthopaedic and Traumatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Kryspin Niedzielski
- Clinic of Orthopaedic and Traumatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paweł Flont
- Clinic of Orthopaedic and Traumatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Anna Fabis-Strobin
- Clinic of Orthopaedic and Traumatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Jarosław Fabis
- Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
49
|
Bromley T, Turner A, Read P, Lake J, Maloney S, Chavda S, Bishop C. Effects of a Competitive Soccer Match on Jump Performance and Interlimb Asymmetries in Elite Academy Soccer Players. J Strength Cond Res 2021; 35:1707-1714. [PMID: 34027923 DOI: 10.1519/jsc.0000000000002951] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Bromley, T, Turner, A, Read, P, Lake, J, Maloney, S, Chavda, S, and Bishop, C. Effects of a competitive soccer match on jump performance and interlimb asymmetries in elite academy soccer players. J Strength Cond Res 35(6): 1707-1714, 2021-The purpose of this study was to investigate the effects of a competitive soccer match on jump performance and interlimb asymmetries over incremental time points during a 72-hour period. Fourteen elite adolescent players from a professional English category 3 academy performed single-leg countermovement jumps pre, post, 24-, 48-, and 72-hour post-match on a single force platform. Eccentric impulse, concentric impulse, peak propulsive force, jump height, peak landing force, and landing impulse were monitored throughout. Interlimb asymmetries were also calculated for each metric as the percentage difference between limbs. Significant negative changes (p < 0.05) in jump performance were noted for all metrics at all time points, with the exception of jump height. Interlimb asymmetries were metric-dependent and showed very large increases, specifically post-match, with a trend to reduce back toward baseline values at the 48-hour time point for propulsive-based metrics. Asymmetries for landing metrics did not peak until the 24-hour time point and again reduced toward baseline at 48-hour time point. This study highlights the importance of monitoring distinct jump metrics, as jump height alone was not sensitive enough to show significant changes in jump performance. However, interlimb asymmetries were sensitive to fatigue with very large increases post-match. More frequent monitoring of asymmetries could enable practitioners to determine whether existing imbalances are also associated with reductions in physical performance or increased injury risk.
Collapse
Affiliation(s)
- Tom Bromley
- Department of Sport Science and Medicine, MK Dons Football Club, Milton Keynes, United Kingdom
| | - Anthony Turner
- School of Science and Technology, London Sport Institute, Middlesex University, London, United Kingdom
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jason Lake
- Department of Sport and Exercise Sciences, University of Chichester, West Sussex, United Kingdom ; and
| | - Sean Maloney
- Department of Sport Science and Physical Activity, University of Bedfordshire, Bedford, United Kingdom
| | - Shyam Chavda
- School of Science and Technology, London Sport Institute, Middlesex University, London, United Kingdom
| | - Chris Bishop
- School of Science and Technology, London Sport Institute, Middlesex University, London, United Kingdom
| |
Collapse
|
50
|
Abstract
The body composition phenotype of an athlete displays the complex interaction among genotype, physiological and metabolic demands of a sport, diet, and physical training. Observational studies dominate the literature and describe the sport-specific physique characteristics (size, shape, and composition) of adult athletes by gender and levels of competition. Limited data reveal how body composition measurements can benefit an athlete. Thus, the objective is to identify purposeful measurements of body composition, notably fat and lean muscle masses, and determine their impact on the health and performance of athletes. Areas of interest include relationships among total and regional body composition measurements, muscle function, sport-specific performance, risk of injury, return to sport after injury, and identification of activity-induced fluid shifts. Discussion includes the application of specific uses of dual X-ray absorptiometry and bioelectrical impedance including an emphasis on the need to minimize measurement errors and standardize protocols, and highlights opportunities for future research. This focus on functional body composition can benefit the health and optimize the performance of an athlete.
Collapse
Affiliation(s)
- Henry Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, United States
| | | |
Collapse
|