1
|
Andreyo E, Unverzagt C, Dos’Santos T, Dawes JJ. Clinical Utility of Qualitative Change of Direction Movement Assessment in ACL Injury Risk Evaluation. Int J Sports Phys Ther 2024; 19:1263-1278. [PMID: 39371188 PMCID: PMC11446736 DOI: 10.26603/001c.123483] [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: 04/18/2024] [Accepted: 08/28/2024] [Indexed: 10/08/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are complex and influenced by numerous internal and external risk factors that should be considered to effectively mitigate injury and facilitate informed return to sport decision-making. Among these risk factors, movement quality exhibited during sport-specific tasks has been identified as a significant predictor of injury occurrence. Particularly, change of direction (COD) movements, when performed with sub-optimal movement quality, such as knee valgus and lateral trunk flexion, are prominent mechanisms of ACL injury in multidirectional sports. Unfortunately, the formal and objective assessment of COD movement quality is underutilized in clinical and sports practice, with existing methods often confined to expensive, sophisticated laboratory settings impractical for everyday clinicians. The purpose of this clinical commentary is to demonstrate the necessity of integrating COD movement assessments to screen for potential ACL injury risk, particularly among higher-risk populations. The authors will review cost-effective and clinic-friendly objective tests used to qualitatively screen COD movements, such as the Cutting Movement Assessment Score and The Expanded Cutting Alignment Tool. Additionally, this commentary will discuss key considerations when assessing COD movement. Level of Evidence 5.
Collapse
Affiliation(s)
- Evan Andreyo
- Health SciencesRocky Mountain University of Health Professions
| | | | | | | |
Collapse
|
2
|
Alimoradi M, Hosseini E, Sahebozamani M, Dos’Santos T, Sheikhbahaie S, Bigtashkhani R, Kabiri A. The effects of two different fatigue protocols on movement quality during anticipated and unanticipated change of directions in female soccer players. PLoS One 2024; 19:e0302144. [PMID: 38776356 PMCID: PMC11111049 DOI: 10.1371/journal.pone.0302144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/28/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE This study compared neuromuscular control under two fatigue protocols during anticipated and unanticipated change of direction (COD) maneuvers and evaluated their effects on the risk of non-contact ACL injuries. METHOD Forty-five female soccer players (mean age: 22.22 ± 2.24 years; mean height: 166.24 ± 3.33 cm; mean mass: 59.84 ± 5.03 kg) were divided into three groups: functional fatigue (Soccer specific fatigue ptotocol-SOFT90), non-functional fatigue (Bruce protocol), and control group. Before and after the implementation of neuromuscular control fatigue protocols were evaluated using the cutting motion assessment score tool (CMAS). Two-dimensional (2D) videos were recorded during anticipated and unanticipated COD trials for both dominant and non-dominant legs. RESULTS Significant time effects (p < 0.05) and group-time interactions (p < 0.05) were observed in both anticipated and unanticipated conditions for both dominant and non-dominant legs after the fatigue protocols. The functional fatigue group exhibited higher CMAS changes, indicating poorer movement quality following fatigue. Notably, the non-dominant leg displayed amplified deficits during unanticipated COD maneuvers following the functional fatigue protocol. CONCLUSIONS Fatigue significantly impairs neuromuscular control, particularly in unanticipated COD situations, which increases the risk of non-contact ACL injuries. To mitigate this risk, coaches, trainers, and medical professionals should prioritize targeted training and injury prevention strategies, focusing on the non-dominant leg during unanticipated COD maneuvers.
Collapse
Affiliation(s)
- Mohammad Alimoradi
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Elham Hosseini
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Mansour Sahebozamani
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Thomas Dos’Santos
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Shima Sheikhbahaie
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Roya Bigtashkhani
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Aryan Kabiri
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| |
Collapse
|
3
|
Epstein E, Huse C, Link M, Greenberg E. Reliability of a qualitative movement assessment tool during a single-leg triple hop landing. Phys Ther Sport 2024; 67:104-109. [PMID: 38643732 DOI: 10.1016/j.ptsp.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Assess inter- and intra-rater reliability of the Qualitative Analysis of Single Leg Squat (QASLS) during a single-leg triple hop landing in subjects following anterior cruciate ligament reconstruction (ACLR). Explore if differences in reliability existed between novice and experienced clinicians. Determine if QASLS scores differed between the surgical and nonsurgical limbs. DESIGN Repeated Measures. PARTICIPANTS 20 subjects ≥6 months post-ACLR. METHODS Subjects were recorded performing a single-leg triple hop bilaterally. Videos were independently rated by five raters (2 physical therapists and 3 physical therapy students). Intraclass correlation coefficient (ICC) was calculated to measure reliability of the QASLS on the surgical limb. Wilcoxon signed-rank test was utilized to assess if differences in QASLS scores existed between limbs. RESULTS The cumulative inter-rater reliability was moderate (ICC (2,1): 0.703) and the cumulative intra-rater reliability was good (ICC (3,1): 0.857). Little difference was found between experienced and novice raters for inter- and intra-rater reliability. There was no statistically significant difference in QASLS scores between limbs (P = 0.64). CONCLUSION The QASLS tool offers moderate inter- and good intra-rater reliability for evaluating movement quality during a single-leg triple hop landing, irrespective of rater experience. Additionally, there was no observed difference in QASLS scores between surgical and nonsurgical limbs.
Collapse
Affiliation(s)
- Eli Epstein
- Children's Hospital of Philadelphia, PA, USA.
| | - Casey Huse
- Children's Hospital of Philadelphia, PA, USA
| | | | - Elliot Greenberg
- Children's Hospital of Philadelphia, PA, USA; Arcadia University, Department of Physical Therapy, PA, USA
| |
Collapse
|
4
|
Ekdahl M, Ulman S, Butler L. Relationship of Knee Abduction Moment to Trunk and Lower Extremity Segment Acceleration during Sport-Specific Movements. SENSORS (BASEL, SWITZERLAND) 2024; 24:1454. [PMID: 38474989 DOI: 10.3390/s24051454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
The knee abduction moment (KAM) has been identified as a significant predictor of anterior cruciate ligament (ACL) injury risk; however, the cost and time demands associated with collecting three-dimensional (3D) kinetic data have prompted the need for alternative solutions. Wearable inertial measurement units (IMUs) have been explored as a potential solution for quantitative on-field assessment of injury risk. Most previous work has focused on angular velocity data, which are highly susceptible to bias and noise relative to acceleration data. The purpose of this pilot study was to assess the relationship between KAM and body segment acceleration during sport-specific movements. Three functional tasks were selected to analyze peak KAM using optical motion capture and force plates as well as peak triaxial segment accelerations using IMUs. Moderate correlations with peak KAM were observed for peak shank acceleration during single-leg hop; peak trunk, thigh, and shank accelerations during a deceleration task; and peak trunk, pelvis, and shank accelerations during a 45° cut. These findings provide preliminary support for the use of wearable IMUs to identify peak KAM during athletic tasks.
Collapse
Affiliation(s)
| | - Sophia Ulman
- Scottish Rite for Children, Frisco, TX 75034, USA
- Department of Orthopaed Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lauren Butler
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL 33199, USA
- Nicklaus Children's Hospital, Miami, FL 33155, USA
| |
Collapse
|
5
|
Butler L, Martinez A, Erdman A, Sugimoto D, Loewen A, Milian E, Wyatt C, Hayden K, DeVerna A, Tulchin-Francis K, Ulman S. Concurrent Validity of The Expanded Cutting Alignment Scoring Tool (E-CAST). Int J Sports Phys Ther 2023; 18:1147-1155. [PMID: 37795331 PMCID: PMC10547067 DOI: 10.26603/001c.87633] [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: 01/12/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background The Expanded Cutting Alignment Scoring Tool (E-CAST) has been previously shown to be reliable when assessing lower extremity alignment during a 45-degree sidestep cut, however, the validity of this tool remains unknown. The purpose of this study was to assess the concurrent validity of the E-CAST by comparing visually identified movement errors from two-dimensional (2D) video with three-dimensional (3D) biomechanical variables collected using motion capture. Study Design Cross Sectional. Methods Sixty female athletes (age 14.1 ± 1.5 years) who regularly participated in cutting/pivoting sports performed a sidestep cut with 2D video and 3D motion capture simultaneously recording. One clinician scored the 2D videos for each limb using the E-CAST criteria. Joint angles and moments captured in 3D were computed for the trunk and knee. Receiver operating characteristic (ROC) curve analyses were performed to determine the accuracy of each E-CAST item and to provide cut-off points for risk factor identification. Results ROC analyses identified a cut-off point for all biomechanical variables with sensitivity and specificity ranging from 70-85% and 55-89%, respectively. Across items, the area under the curve ranged from 0.67 to 0.91. Conclusion The E-CAST performed with acceptable to outstanding area under the curve values for all variables except static knee valgus. Level of evidence 3b.
Collapse
Affiliation(s)
- Lauren Butler
- Physical Therapy Florida International University
- Rehabilitation, Nicklaus Children's Hospital
| | | | | | - Dai Sugimoto
- Waseda University
- The Micheli Center for Sports Injury Prevention
| | | | | | - Charles Wyatt
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
| | | | | | | | - Sophia Ulman
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
| |
Collapse
|
6
|
Butler L, Wyatt C, Martinez A, Erdman A, Milian E, Sugimoto D, Loewen A, Fernandez J, Hayden K, DeVerna A, Tulchin-Francis K, Ulman S. No Difference in Two-Dimensional Kinematic Assessment of a 45-Degree Sidestep Cut Compared to Qualitative Assessment. Int J Sports Phys Ther 2023; V18:587-595. [PMID: 37425108 PMCID: PMC10324343 DOI: 10.26603/001c.74366] [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: 12/20/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Purpose The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. Study Design Observational cohort, repeated measures reliability study. Methods Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (α<0.05). Results Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Zobs(intra)= -0.38, p=0.352 and Zobs(inter)= -0.30, p=0.382). Conclusion The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. Level of evidence 3b.
Collapse
Affiliation(s)
| | - Charles Wyatt
- Scottish Rite Hospital
- University of Texas Southwestern
| | | | | | - Eryn Milian
- Faculty of Sport Sciences University of Miami
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Butler LS, Janosky JJ, Sugimoto D. Pediatric and Adolescent Knee Injuries. Clin Sports Med 2022; 41:799-820. [DOI: 10.1016/j.csm.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Butler LS, Martinez AR, Sugimoto D, Wyatt CW, Milian EK, Ulman S, Erdman A, Loewen A, Hayden K, DeVerna A, Tulchin-Francis K, Research Interest Group PRIP. Reliability of the Expanded Cutting Alignment Scoring Tool (E-CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut. Int J Sports Phys Ther 2022; 17:456-465. [PMID: 35391867 PMCID: PMC8975584 DOI: 10.26603/001c.33045] [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: 06/03/2021] [Accepted: 01/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Current clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle. Hypothesis/Purpose To assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut. Study Design Repeated Measures. Methods Participants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of "1", with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable. Results The cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90). Conclusion The addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability. Level of Evidence Level 2, Diagnosis.
Collapse
Affiliation(s)
| | | | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Charles W Wyatt
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | | | - PRiSM Injury Prevention Research Interest Group
- Nicklaus Children's Hospital, Miami, FL, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
- University of Miami, Miami, FL, USA
- Scottish Rite for Children, Dallas, TX, USA
| |
Collapse
|