Effective Attentional Focus Strategies after Anterior Cruciate Ligament Reconstruction: A Commentary

Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review

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".

Relationships Between Task Constraints, Visual Constraints, Joint Coordination and Football-Specific Performance in Talented Youth Athletes: An Ecological Dynamics Approach

Individual performance in team sports is a multifactorial reflection of how well a player can cope and accomplish tasks in varied playing situations. Thus, performance analysis should not only focus on outcomes, but also on underlying mechanisms of those outcomes. We adopted principles of the ecological dynamics approach (EDA) to investigate the effect of introducing constraints on players' joint coordination responses for a football-specific performance drill outcome. Seventeen talented youth football (soccer) players performed a football-specific drill under different conditions: basic constraints, additional defender dummies, stroboscopic glasses, and a combination of the latter two constraints. We recorded these players' execution time, passing accuracy, and lower extremity joint kinematics. We calculated joint coordination for hip-knee, knee-ankle, and trunk-hip couplings. The added constraints negatively affected execution time and passing accuracy, and caused changes in joint coordination. Furthermore, we identified a relationship between execution time and joint coordination. This study serves as an example how the EDA can be adopted to investigate mechanisms that underlie individual performance in team sports.

Positive influence of neuromuscular training on knee injury risk factors during cutting and landing tasks in elite youth female handball players

Anterior cruciate ligament (ACL) ruptures are frequent in the age group of 15–19 years, particularly for female athletes. Although injury-prevention programs effectively reduce severe knee injuries, little is known about the underlying mechanisms and changes of biomechanical risk factors. Thus, this study analyzes the effects of a neuromuscular injury-prevention program on biomechanical parameters associated with ACL injuries in elite youth female handball players. In a nonrandomized, controlled intervention study, 19 players allocated to control (n = 12) and intervention (n = 7) group were investigated for single- and double-leg landings as well as unanticipated side-cutting maneuvers before and after a 12-week study period. The lower-extremity motion of the athletes was captured using a three-dimensional motion capture system consisting of 12 infrared cameras. A lower-body marker set of 40 markers together with a rigid body model, including a forefoot, rearfoot, shank, thigh, and pelvis segment in combination with two force plates was used to determine knee joint angles, resultant external joint moments, and vertical ground reaction forces. The two groups did not differ significantly during pretesting. Only the intervention group showed significant improvements in the initial knee abduction angle during single leg landing (p = 0.038: d = 0.518), knee flexion moment during double-leg landings (p = 0.011; d = −1.086), knee abduction moment during single (p = 0.036; d = 0.585) and double-leg landing (p = 0.006; d = 0.944) and side-cutting (p = 0.015;d = 0.561) as well as vertical ground reaction force during double-leg landing (p = 0.004; d = 1.482). Control group demonstrated no significant changes in kinematics and kinetics. However, at postintervention both groups were not significantly different in any of the biomechanical outcomes except for the normalized knee flexion moment of the dominant leg during single-leg landing. This study provides first indications that the implementation of a training intervention with specific neuromuscular exercises has positive impacts on biomechanical risk factors associated with ACL injury risk and, therefore, may help prevent severe knee injuries in elite youth female handball players.