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Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [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] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
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Hosseininejad SM, Emami Meybodi MK, Raei M, Rahimnia A. Prevalence and mechanisms of anterior cruciate ligament tears in military personnel: A cross-sectional study in Iran. PLoS One 2024; 19:e0303326. [PMID: 38905203 PMCID: PMC11192309 DOI: 10.1371/journal.pone.0303326] [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: 05/23/2023] [Accepted: 04/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is common in military setting; such an injury increase institutional costs and workforce strain, however, few studies have investigated the mechanism and associated factors of ACL tear specifically in a military setting. The aim of this study was to investigate the prevalence and mechanisms of ACL tears in military personnel at a military referral hospital in Iran. MATERIAL AND METHODS This cross-sectional study examined 402 military personnel who presented with knee complaints at a single referral Iranian military hospital. The ACL injury prevalence and mechanisms were assessed by physical examination, medical records, and magnetic resonance imaging (MRI) of the knee. Data were collected by an orthopedic resident. RESULTS Of the total 402 patients, 285 were diagnosed with ACL tears; the prevalence was 70.9%. The most common mechanism leading to ACL tear was noncontact events. The knee changing direction-knee pivoting (54%) was the most frequent lower limb status, followed by a fall with the knee in valgus position (20.7%). The most commonly associated activity was military training (63.9%) and sports activities (32.6%). The incidence of ACL injuries was higher in soldiers compared with officers during military training, but higher in officers during sports exercises (P = 0.002). Common associated injuries involved the knee meniscus and cartilage. CONCLUSION The findings support those of previous studies, that in military personnel, the most common knee injury is damage to the ACL, most frequently through noncontact events, specifically knee pivoting, during military activities rather than sports and among soldiers. These findings help develop ACL injury prevention programs.
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Affiliation(s)
- Seyyed-Mohsen Hosseininejad
- Baqiyatallah University of Medical Sciences, Tehran, Iran
- Orthopedic Department, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mehdi Raei
- Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Rahimnia
- Baqiyatallah University of Medical Sciences, Tehran, Iran
- Orthopedic Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Blanke F, Boljen M, Oehler N, Lutter C, Tischer T, Vogt S. An anteromedial stabilization procedure has the most protective effect on the anterior cruciate ligament in tibial external rotation. A human knee model study. Arch Orthop Trauma Surg 2024; 144:2703-2710. [PMID: 38727813 PMCID: PMC11211157 DOI: 10.1007/s00402-024-05357-8] [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: 12/23/2023] [Accepted: 04/28/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction remains associated with the risk of re-rupture and persisting rotational instability. Additional extraarticular anterolateral stabilization procedures stabilize the tibial internal rotation and lead to lower ACL failure rate and improved knee stability. However, data for additional stabilization of tibial external rotation is lacking and the importance of an anteromedial stabilization procedure is less well evaluated. Aim of this study is to investigate the influence of an extraarticular anteromedial stabilization procedure for the stabilization of the tibial external rotation and protection of the ACL from these rotational forces. METHODS Internal and external rotations of the tibia were applied to a finite element (FE) model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Five additional anatomic structures (Anteromedial stabilization/anteromedial ligament, AML, augmented superficial medial collateral ligament, sMCL, posterior oblique ligament, POL, anterolateral ligament, ALL, and popliteal tendon, PLT) were added to the FE model separately and then combined. The force histories within all structures were measured and determined for each case. RESULTS The anteromedial stabilization or imaginary AML was the main secondary stabilizer of tibial external rotation (90% of overall ACL force reduction). The AML reduced the load on the ACL by 9% in tibial external rotation which could not be achieved by an augmented sMCL (-1%). The AML had no influence in tibial internal rotation (-1%). In the combined measurements with all additional structures (AML, ALL, PLT, POL) the load on the ACL was reduced by 10% in tibial external rotation. CONCLUSION This study showed that an additional anteromedial stabilization procedure secures the tibial external rotation and has the most protective effect on the ACL during these external rotational forces.
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Affiliation(s)
- Fabian Blanke
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München Harlaching, München, Germany.
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany.
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany.
| | - Matthias Boljen
- Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institut, EMI, Freiburg i, Breisgau, Germany
| | - Nicola Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - Christoph Lutter
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - Stephan Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
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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.
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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
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Xu D, Zhou H, Quan W, Ma X, Chon TE, Fernandez J, Gusztav F, Kovács A, Baker JS, Gu Y. New Insights Optimize Landing Strategies to Reduce Lower Limb Injury Risk. CYBORG AND BIONIC SYSTEMS 2024; 5:0126. [PMID: 38778877 PMCID: PMC11109754 DOI: 10.34133/cbsystems.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Single-leg landing (SL) is often associated with a high injury risk, especially anterior cruciate ligament (ACL) injuries and lateral ankle sprain. This work investigates the relationship between ankle motion patterns (ankle initial contact angle [AICA] and ankle range of motion [AROM]) and the lower limb injury risk during SL, and proposes an optimized landing strategy that can reduce the injury risk. To more realistically revert and simulate the ACL injury mechanics, we developed a knee musculoskeletal model that reverts the ACL ligament to a nonlinear short-term viscoelastic mechanical mechanism (strain rate-dependent) generated by the dense connective tissue as a function of strain. Sixty healthy male subjects were recruited to collect biomechanics data during SL. The correlation analysis was conducted to explore the relationship between AICA, AROM, and peak vertical ground reaction force (PVGRF), joint total energy dissipation (TED), peak ankle knee hip sagittal moment, peak ankle inversion angle (PAIA), and peak ACL force (PAF). AICA exhibits a negative correlation with PVGRF (r = -0.591) and PAF (r = -0.554), and a positive correlation with TED (r = 0.490) and PAIA (r = 0.502). AROM exhibits a positive correlation with TED (r = 0.687) and PAIA (r = 0.600). The results suggested that the appropriate increases in AICA (30° to 40°) and AROM (50° to 70°) may reduce the lower limb injury risk. This study has the potential to offer novel perspectives on the optimized application of landing strategies, thus giving the crucial theoretical basis for decreasing injury risk.
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Affiliation(s)
- Datao Xu
- Faculty of Sports Science,
Ningbo University, Ningbo, China
| | - Huiyu Zhou
- Faculty of Sports Science,
Ningbo University, Ningbo, China
| | - Wenjing Quan
- Faculty of Sports Science,
Ningbo University, Ningbo, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital,
Fudan University, Shanghai, China
| | - Teo-Ee Chon
- Faculty of Sports Science,
Ningbo University, Ningbo, China
- School of Chemical and Biomedical Engineering,
Nanyang Technological University, Singapore 639798, Singapore
| | - Justin Fernandez
- Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand
- Department of Engineering Science,
University of Auckland, Auckland, New Zealand
| | - Fekete Gusztav
- Department of Material Science and Technology, Audi Hungaria Faculty of Automotive Engineering,
Széchenyi István University, Gyor, Hungary
| | - András Kovács
- Faculty of Engineering,
University of Pannonia, Veszprém, Hungary
| | - Julien S. Baker
- Faculty of Sports Science,
Ningbo University, Ningbo, China
- Department of Sport and Physical Education,
Hong Kong Baptist University, Hong Kong, China
| | - Yaodong Gu
- Faculty of Sports Science,
Ningbo University, Ningbo, China
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Koh J, Mungalpara N, Kim S, Bedi A, Hutchinson M, Amirouche F. Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints. J Orthop Surg Res 2024; 19:280. [PMID: 38711149 DOI: 10.1186/s13018-024-04744-6] [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: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION The escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies. METHODS We conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2-4 months). They were stored at - 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively. RESULT The 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis. CONCLUSIONS The porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament's susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention.
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Affiliation(s)
- Jason Koh
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA
| | - Nirav Mungalpara
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Sunjung Kim
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Asheesh Bedi
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA
| | - Mark Hutchinson
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Farid Amirouche
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA.
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA.
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Aoki A, Tamura T, Hoshi K, Gamada K. Effect of unpredictable timing on the hip, knee, and ankle kinematics and center of mass during deceleration tasks. J Sports Med Phys Fitness 2024; 64:425-431. [PMID: 38445844 DOI: 10.23736/s0022-4707.23.15344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Unpredictable stopping or deceleration tasks are crucial to prevent ACL injury. The purpose of this study was to reveal differences and relationships in kinematics during different deceleration tasks with and without anticipation. METHODS Twenty-four collegiate athletes were recruited. Three commercial video cameras were used to capture frontal and sagittal lower-extremity kinematics. Participants were instructed to perform three deceleration tasks: 1) anticipated stopping and running backward at a point indicated previously (SRB-P); 2) anticipated stopping and running backward in front of a badminton net (SRB-N); and 3) unanticipated stopping and running backward upon random flashing of a light (SRB-U). Differences and relationships between hip, knee, and ankle kinematics at stopping (SS) and deceleration steps (DS) and the height of the great trochanter (HGT) at SS were analyzed. RESULTS For all tasks, the knee flexion angle was less than 25° at SS. There were no significant differences in hip, knee, and ankle kinematics between tasks. HGT during SRB-U was higher than that in the other tasks at DS. Hip flexion angle at SS and DS was significantly correlated with HGT at SS. During SRB_P and SRB_N, only knee flexion angle at DS was significantly correlated with HGT at SS. CONCLUSIONS The deceleration task in this study, SRB, causes a low knee-flexion angle at SS. The COM remained higher during unanticipated stopping, which is related only to hip flexion angle during the task. Knee flexion movement does not contribute to lowering COM during an unpredictable deceleration task.
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Affiliation(s)
- Akino Aoki
- Department of Physical Therapy, International University of Health and Welfare, Narita, Japan -
| | - Tomoyo Tamura
- Graduate School of Medical Technology and Health Welfare Science, Hiroshima International University, Higashihiroshima, Japan
| | - Kenji Hoshi
- Department of Rehabilitation, Kato Orthopedic Sports Clinic, Hiroshima, Japan
| | - Kazuyoshi Gamada
- Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan
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Ogasawara I, Ohta K, Revankar GS, Konda S, Shimokochi Y, Koga H, Nakata K. The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in early phase of cutting maneuvers in female athletes. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:376-386. [PMID: 38030065 PMCID: PMC11116999 DOI: 10.1016/j.jshs.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Combined knee valgus and tibial internal rotation (VL + IR) moments have been shown to stress the anterior cruciate ligament (ACL) in several in vitro cadaveric studies. To utilize this knowledge for non-contact ACL injury prevention in sports, it is necessary to elucidate how the ground reaction force (GRF) acting point (center of pressure (CoP)) in the stance foot produces combined knee VL + IR moments in risky maneuvers, such as cuttings. However, the effects of the GRF acting point on the development of the combined knee VL + IR moment in cutting are still unknown. METHODS We first established the deterministic mechanical condition that the CoP position relative to the tibial rotational axis differentiates the GRF vector's directional probability for developing the combined knee VL + IR moment, and theoretically predicted that when the CoP is posterior to the tibial rotational axis, the GRF vector is more likely to produce the combined knee VL + IR moment than when the CoP is anterior to the tibial rotational axis. Then, we tested a stochastic aspect of our theory in a lab-controlled in vivo experiment. Fourteen females performed 60° cutting under forefoot/rearfoot strike conditions (10 trials each). The positions of lower limb markers and GRF data were measured, and the knee moment due to GRF vector was calculated. The trials were divided into anterior- and posterior-CoP groups depending on the CoP position relative to the tibial rotational axis at each 10 ms interval from 0 to 100 ms after foot strike, and the occurrence rate of the combined knee VL + IR moment was compared between trial groups. RESULTS The posterior-CoP group showed significantly higher occurrence rates of the combined knee VL + IR moment (maximum of 82.8%) at every time point than those of the anterior-CoP trials, as theoretically predicted by the deterministic mechanical condition. CONCLUSION The rearfoot strikes inducing the posterior CoP should be avoided to reduce the risk of non-contact ACL injury associated with the combined knee VL + IR stress.
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Affiliation(s)
- Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Toyonaka 560-0043, Japan.
| | - Ken Ohta
- Sports Sensing Co., LTD., Fukuoka 815-0035, Japan
| | - Gajanan S Revankar
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Toyonaka 560-0043, Japan
| | - Yohei Shimokochi
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, Sennan-gun 590-0496, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Toyonaka 560-0043, Japan
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Ishida T, Koshino Y, Yamanaka M, Ueno R, Taniguchi S, Ino T, Kasahara S, Samukawa M, Tohyama H. Larger hip external rotation motion is associated with larger knee abduction and internal rotation motions during a drop vertical jump. Sports Biomech 2024; 23:640-654. [PMID: 33663352 DOI: 10.1080/14763141.2021.1881151] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023]
Abstract
Associations among hip motions, knee abduction and internal rotation motion during a drop vertical jump (DVJ), which increases the risk of anterior cruciate ligament injury, remain unclear. The purpose of this study was to examine associations among knee abduction, internal rotation and hip joint motions during a DVJ. Fifty-seven young female participants performed a DVJ from a 30-cm height. Hip and knee kinematics and kinetics were analysed using a three-dimensional motion analysis system and force plates. Multiple regression analysis showed that peak knee abduction angle was negatively associated with knee internal rotation and hip internal rotation excursions from initial contact (IC) to peak knee flexion, and positively associated with peak knee abduction moment (R2 = 0.465, P< 0.001). Peak knee internal rotation angle was negatively associated with the hip flexion excursion from IC to peak knee flexion and peak hip adduction moment (R2 = 0.194, P= 0.001). In addition, hip internal rotation excursion was negatively associated with knee abduction and internal rotation excursion from IC to 50 ms after IC. To avoid a large knee abduction and internal rotation motion during jump-landing training, it might be beneficial to provide landing instructions to avoid a large hip external rotation motion.
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Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Ryo Ueno
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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10
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Gopinatth V, Smith MV, Matava MJ, Brophy RH, Knapik DM. Most Anterior Cruciate Ligament Injuries in Professional Athletes Occur Without Contact to the Injured Knee: A Systematic Review of Video Analysis Studies. Arthroscopy 2024:S0749-8063(24)00275-5. [PMID: 38663569 DOI: 10.1016/j.arthro.2024.03.047] [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] [Received: 10/29/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To systematically review studies using video analyses to evaluate anterior cruciate ligament (ACL) injury mechanisms in athletes during sport to better understand risk factors and the potential for injury prevention. METHODS A literature search was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines statement using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through June 2023. Inclusion criteria included studies reporting on ACL injury mechanisms occurring in athletes based on video analysis. Athlete demographics, injury mechanisms, position of the lower extremity, and activity at the time of injury were recorded. RESULTS A total of 13 studies, consisting of 542 athletes, met inclusion criteria. Most athletes competed at the professional level (91%, n = 495/542), with 79% (n = 422/536) of athletes being male. The most common sports were soccer (33%, n = 178/542) and American football (26%, n = 140/542). The most common injury mechanism was noncontact in 42.9% (n = 230/536) of athletes, followed by indirect contact (32.6%, n = 175/536) and direct contact (22.4%, n = 120/536). The most common position of injury was with a planted foot (91.7%, n = 110/120), full or near-full knee extension (84.4%, n = 49/58), and axial loading (81.3%, n = 87/107). Injuries commonly involved a deceleration/shift in momentum (50.4%, n = 123/244) or pivoting maneuver (36.1%, n = 77/213). At the time of injury, the knee commonly fell into valgus (76.8%, n = 225/293) with associated internal (53.5%, n = 46/86) or external tibiofemoral rotation (57.7%, n = 101/175). CONCLUSIONS Most ACL injuries, when evaluated by video analysis, involve professional athletes participating in soccer and American football. The most common injury mechanism occurred without contact with the knee in extension during a deceleration or momentum shift, with resultant valgus and rotational force across the knee. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A..
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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11
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Smeets A, Ghafelzadeh Ahwaz F, Bogaerts S, Berger P, Peers K. Comparison of immediate versus optional delayed surgical repair for treatment of acute anterior cruciate ligament injury through a parallel, multicentric, pragmatic randomized controlled trial - IODA trial. BMC Sports Sci Med Rehabil 2024; 16:22. [PMID: 38238809 PMCID: PMC10797880 DOI: 10.1186/s13102-024-00816-6] [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: 09/05/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Standard care for anterior cruciate ligament (ACL) injuries often includes surgical reconstruction of the ACL. However, two randomized controlled trials [1, 2] (RCT) concluded that conservative treatment does not result in inferior clinical outcomes compared to immediate ACL reconstruction. More research is needed to verify these results and assess whether patient-specific parameters determine if a patient would benefit from one treatment option over the other. METHODS This is a pragmatic, multi-center RCT with two parallel groups. Patients with an acute ACL injury will be recruited from Belgian hospitals. Patients will be randomized to conservative treatment (rehabilitation + optional delayed surgery) or immediate ACL reconstruction (< 12 weeks). The primary outcome is the Knee injury and Osteoarthritis Outcome Score (KOOS) at 7 months (short term) and 1-year long term) post-injury. These following additional outcomes will be administered at 4 and 7 months (short term) and 1, 2, and 3 years post-injury (long term): patient-reported outcomes concerning knee symptoms, knee function and quality of life, functional knee tests, time to return to pre-injury activity level and return to work, structural knee joint damage and cartilage health (only at 4 months and 3 years post-injury), as well as adverse events such as re-rupture rates. Furthermore, the secondary objective is to identify (through a predictive analysis) individuals who would benefit the most from early reconstruction versus those who should rather be treated conservatively. DISCUSSION This large RCT will assess the clinical effectiveness of both surgical and conservative treatment. In addition, it will be the first study that provides insights into which patient-specific factors predict successful outcomes after conservative treatment of ACL injuries. These results will be the first step toward early patient identification regarding treatment decisions. This is urgently needed to avoid (1) delayed surgeries and prolonged rehabilitation and (2) unnecessary surgeries. TRIAL REGISTRATION this trial was registered on ClinicalTrials.gov (NCT05747079) on 10/02/2023.
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Affiliation(s)
- Annemie Smeets
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Research group of Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences & Physiotherapy, KU Leuven, Leuven, Belgium
| | - Feryal Ghafelzadeh Ahwaz
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
| | - Stijn Bogaerts
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Physical & Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Berger
- Department of Orthopaedic Surgery, University of Leuven, Leuven, Belgium
| | - Koen Peers
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Physical & Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
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Carabasa García L, Lorca-Gutiérrez R, Vicente-Mampel J, Part-Ferrer R, Fernández-Ehrling N, Ferrer-Torregrosa J. Relationship between Anterior Cruciate Ligament Injury and Subtalar Pronation in Female Basketball Players: Case-Control Study. J Clin Med 2023; 12:7539. [PMID: 38137608 PMCID: PMC10744164 DOI: 10.3390/jcm12247539] [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: 10/28/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries are a common issue in basketball. Several studies point to subtalar pronation as a relevant risk factor for these injuries, despite their multiarticular and multiplanar nature. This study evaluated the correlation between subtalar pronation and ACL injuries in female basketball players. A total of 30 players were recruited and divided into two groups: 15 with previous ACL injury and 15 without injury. The navicular drop test (NDT) and drop vertical jump test were applied to quantify parameters such as navicular drop, calcaneal eversion, ankle dorsiflexion, knee flexion, and dynamic valgus. The results showed significantly higher NDT values (6.93 ± 1.64 mm vs. 5.41 ± 1.96 mm, p = 0.029) and maximum calcaneal eversion angle (10.94 ± 3.22° vs. 5.30 ± 3.33°, p < 0.001) in the injured group. There were also significant differences in maximum dynamic valgus (152.73 ± 15.00° vs. 165.26 ± 5.628°, p = 0.005) and knee flexion (93.70 ± 7.47° vs. 82.92 ± 11.14°, p = 0.004) between groups. These findings suggest that subtalar pronation, assessed by NDT, and calcaneal eversion could be indicators of higher susceptibility to ACL injuries in female basketball players.
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Affiliation(s)
- Laura Carabasa García
- Sport Podiatry Department, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Rubén Lorca-Gutiérrez
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Juan Vicente-Mampel
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Roser Part-Ferrer
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
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13
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular control in males and females 1 year after an anterior cruciate ligament rupture or reconstruction during stair descent and artificial tibial translation. Sci Rep 2023; 13:15316. [PMID: 37714980 PMCID: PMC10504317 DOI: 10.1038/s41598-023-42491-6] [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: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
Neuromuscular alterations are reported in patients with anterior cruciate ligament reconstruction (ACL-R) and conservative treatment (copers with ACL deficiency, ACL-C). However, it is unclear whether sex influences neuromuscular control. The objective was to investigate differences in neuromuscular control regarding sex and treatment type one year after ACL rupture in comparison to a group with an intact ACL (ACL-I). Electromyography of vastus medialis (VM) and lateralis, biceps femoris (BF) and semitendinosus (ST) was recorded in ACL-R (N = 38), ACL-C (N = 26), and ACL-I (N = 38) during stair descent and reflex activity by anterior tibial translation while standing. The movements of stair descent were divided into pre-activity, weight-acceptance and push-off phases, reflex activity in pre-activation, short, medium (MLR), and long latency responses (LLR). Normalized root mean squares for each muscle of involved and matched control limb per phase were calculated and analyzed with two-way ANOVA (α = 0.05). During stair descent, neuromuscular differences of BF were significant during push-off only (p = 0.001). Males of ACL-R and ACL-C had higher BF activity compared to ACL-I (p = 0.009, 0.007 respectively). During reflex activity, VM and BF were significantly different between treatment groups for pre-activation (p = 0.013, 0.035 respectively). VM pre-activation of females was higher in ACL-R compared to ACL-C (p = 0.018), and lower in ACL-C compared to ACL-I (p = 0.034). Males of ACL-R showed higher VM and less BF pre-activation (p = 0.025, p = 0.003 respectively) compared to ACL-I. Males of ACL-C had less BF pre-activation compared to ACL-I (p = 0.019). During MLR, intra-group differences in ST were found for treatment (p = 0.011) and females of ACL-R compared to ACL-I (p = 0.015). During LLR, overall intra-group differences in VM were present for treatment (p = 0.034) and in females (ACL-R versus ACL-C (p = 0.015), ACL-I (p = 0.049), respectively). One year after an ACL rupture, neuromuscular alterations persist regardless of treatment and sex. Standard rehabilitation protocols may not be able to restore neuromuscular control. Future research should include long-term follow up and focus on exercises targeting neuromuscular function.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Aglaja Busch
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock, Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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14
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Heering T, Rolley TL, Lander N, Fox A, Barnett LM, Duncan MJ. Identifying modifiable risk factors and screening strategies associated with anterior cruciate ligament injury risk in children aged 6 to 13 years: A systematic review. J Sports Sci 2023; 41:1337-1362. [PMID: 37930935 DOI: 10.1080/02640414.2023.2268900] [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: 03/17/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles (n = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.
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Affiliation(s)
- Theresa Heering
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Victoria, Australia
| | - Tess L Rolley
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Michael J Duncan
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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15
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Hébert-Losier K, Boswell-Smith C, Hanzlíková I. Effect of Footwear Versus Barefoot on Double-Leg Jump-Landing and Jump Height Measures: A Randomized Cross-Over Study. Int J Sports Phys Ther 2023; 18:845-855. [PMID: 37547838 PMCID: PMC10399122 DOI: 10.26603/001c.81107] [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: 10/28/2022] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Assessing individuals in their own athletic footwear in clinics is common, but can affect movement, performance, and clinical measures. Purpose The aim was to compare overall Landing Error Scoring System (LESS) scores, injury risk categorization, specific LESS errors, and jump heights between habitual athletic footwear and barefoot conditions. Study design Randomized cross-over laboratory study. Methods Eighty healthy individuals (55% male) completed the LESS following standard procedures (i.e., land from a 30-cm box to a distance of 50% of body height and then jump upwards maximally). Participants performed the LESS three times in two randomized conditions: footwear and barefoot. LESS data were extracted from 2D videos to compare group-level mean LESS scores, group-level and individual-level injury risk categorization (5-error threshold), specific landing errors, and jump heights between conditions. Results LESS scores were significantly greater (0.3 errors, p=0.022) and jump heights were significantly lower (0.6 cm, p=0.029) in footwear than barefoot, but differences were trivial (d = 0.18 and -0.07, respectively) and not clinically meaningful. Although the number of high injury-risk participants was not statistically different at a group level (p=1.000); 27 individuals (33.8%) exhibited a clinically meaningful difference between conditions of one error or more in LESS score, categorization was inconsistent for 16.3% of individuals, and four of the 17 landing errors significantly differed between conditions. Conclusion At a group level, habitual athletic footwear does not meaningfully influence LESS scores, risk categorization, or jump height. At an individual level, footwear can meaningfully affect LESS scores, risk categorization, and alter landing strategies. Use of consistent protocol and footwear is advised for assessing movement patterns and injury risk from the LESS given the unknown predictive value of this test barefoot. Level of Evidence Level 3.©The Author(s).
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16
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Kellis E, Sahinis C, Baltzopoulos V. Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:343-358. [PMID: 35065297 DOI: 10.1016/j.jshs.2022.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/11/2021] [Accepted: 12/08/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND For the past 30 years, the hamstring (H)-to-quadriceps (Q) (H:Q) torque ratio has been considered an important index of muscle strength imbalance around the knee joint. The purpose of this systematic review was to examine the value of H:Q torque ratio as an independent risk factor for hamstring and anterior cruciate ligament (ACL) injuries. METHODS Database searches were performed to identify all relevant articles in PubMed, MEDLINE, Cochrane Library, and Scopus. Prospective studies evaluating the conventional (concentric H:Q), functional (eccentric H: concentric Q), and mixed (eccentric H at 30°/s: concentric Q at 240°/s) H:Q ratios as risk factors for occurrence of hamstring muscle strain or ACL injury were considered. Risk of bias was assessed using the Quality In Prognosis Studies tool. RESULTS Eighteen included studies reported 585 hamstrings injuries in 2945 participants, and 5 studies documented 128 ACL injuries in 2772 participants. Best evidence synthesis analysis indicated that there is very limited evidence that H:Q strength ratio is an independent risk factor for hamstring and ACL injury, and this was not different between various ratio types. Methodological limitations and limited evidence for ACL injuries and some ratio types might have influenced these results. CONCLUSION The H:Q ratio has limited value for the prediction of ACL and hamstring injuries. Monitoring strength imbalances along with other modifiable factors during the entire competitive season may provide a better understanding of the association between H:Q ratio and injury.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres 62100, Greece.
| | - Chrysostomos Sahinis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres 62100, Greece
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool L3 5UX, UK
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17
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Akbari H, Kuwano S, Shimokochi Y. Effect of Heading a Soccer Ball as an External Focus During a Drop Vertical Jump Task. Orthop J Sports Med 2023; 11:23259671231164706. [PMID: 37101902 PMCID: PMC10123910 DOI: 10.1177/23259671231164706] [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: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 04/28/2023] Open
Abstract
Background Research has demonstrated that performing a secondary task during a drop vertical jump (DVJ) may affect landing kinetics and kinematics. Purpose To examine the differences in the trunk and lower extremity biomechanics associated with anterior cruciate ligament (ACL) injury risk factors between a standard DVJ and a DVJ while heading a soccer ball (header DVJ). Study Design Descriptive laboratory study. Methods Participants comprised 24 college-level soccer players (18 female and 6 male; mean ± SD age, 20.04 ± 1.12 years; height, 165.75 ± 7.25 cm; weight, 60.95 ± 8.47 kg). Each participant completed a standard DVJ and a header DVJ, and biomechanics were recorded using an electromagnetic tracking system and force plate. The difference (Δ) in 3-dimensional trunk, hip, knee, and ankle biomechanics between the tasks was analyzed. In addition, for each biomechanical variable, the correlation between the data from the 2 tasks was calculated. Results Compared to the standard DVJ, performing the header DVJ led to significantly reduced peak knee flexion angle (Δ = 5.35°; P = .002), knee flexion displacement (Δ = 3.89°; P = .015), hip flexion angle at initial contact (Δ = -2.84°; P = .001), peak trunk flexion angle (Δ = 13.11°; P = .006), and center of mass vertical displacement (Δ = -0.02m; P = .010), and increased peak anterior tibial shear force (Δ = -0.72 N/kg; P = .020), trunk lateral flexion angle at initial contact (Δ = 1.55°; P < .0001), peak trunk lateral flexion angle (Δ = 1.34°; P = .003), knee joint stiffness (Δ = 0.002 N*m/kg/deg; P = .017), and leg stiffness (Δ = 8.46 N/kg/m; P = .046) compared to those in standard DVJs. In addition, individuals' data for these variables were highly and positively correlated between conditions (r = 0.632-0.908; P < .001). Conclusion The header DVJ task showed kinetic and kinematic parameters that suggested increased risk of ACL injury as compared with the standard DVJ task. Clinical Relevance Athletes may benefit from acquiring the ability to safely perform header DVJs to prevent ACL injury. To simulate real-time competition situations, coaches and athletic trainers should incorporate such dual tasks in ACL injury prevention programs.
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Affiliation(s)
- Hadi Akbari
- Department of Sport Sciences, Faculty of Literature and Humanities, University of Zabol, Zabol, Iran
| | - Satoshi Kuwano
- Faculty of Business Information Science, Jobu University, Gunma, Japan
| | - Yohei Shimokochi
- Department of Health and Sport Management, School of Health and Sport Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
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Nishino K, Suzuki H, Tanaka M, Kikumoto T, Omori G. single-leg medial drop landing with trunk lean includes improper body mechanics related to anterior cruciate ligament injury risk: A comparison of body mechanics between successful trials and failed trials in the drop landing test among female basketball athletes. Clin Biomech (Bristol, Avon) 2023; 104:105942. [PMID: 36933396 DOI: 10.1016/j.clinbiomech.2023.105942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Improper body mechanics during landing is a typical risk factor of anterior cruciate ligament injury. Drop landing test is used to evaluate landing mechanics by observing not only successful trials but also failed trials. Leaning of the trunk, which is frequently observed during failed trials, may lead to improper body mechanics related to anterior cruciate ligament injury. This study aimed to elucidate the mechanisms of landing with trunk lean that may underlie the risks of anterior cruciate ligament injury by comparing body mechanics between failed and successful trials. METHODS Participants were 72 female basketball athletes. The athletic task was single-leg medial drop landing, and the body mechanics was recorded by a motion capture system and force plate. Participants fixed the landing pose for ≥3 s in successful trials but failed to do so in failed trials. FINDINGS Failed trials included the large lean of trunk. There were significant changes in thoracic and pelvic leans at initial contact in failed trials with medial trunk lean (p < 0.05). Kinematics and kinetics during the landing phase in failed trials were associated with the risks of anterior cruciate ligament injury. INTERPRETATION These findings suggest that landing mechanics with trunk lean involves many biomechanical factors related to anterior cruciate ligament injury and demonstrates the inappropriate pose of trunk from the dropping phase. Exercise programs aimed at the landing manoeuver without trunk lean may contribute to reduce the risks of anterior cruciate ligament injury in female basketball athletes.
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Affiliation(s)
- Katsutoshi Nishino
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata 950-0933, Japan.
| | - Hidetomo Suzuki
- J.F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo 194-0624, Japan
| | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata 950-0933, Japan
| | - Takanori Kikumoto
- Department of Rehabilitation, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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Uhlár Á, Ambrus M, Lacza Z. Dynamic valgus knee revealed with single leg jump tests in soccer players. J Sports Med Phys Fitness 2023; 63:461-470. [PMID: 36861880 DOI: 10.23736/s0022-4707.22.14442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Dynamic valgus knee occurs in sports that involve jumps and landing such as soccer and pose an increased risk for anterior cruciate ligament injury. Visual estimation is biased by the athlete's body type, the experience of the evaluator and the movement phase at which the valgus is assessed - thus the result is highly variable. The aim of our study was to accurately assess dynamic knee positions during single and double leg tests through a video-based movement analysis system. METHODS Young soccer players (U15, N.=22) performed single leg squat, single leg jump, and double leg jump tests while the knee medio-lateral movement was monitored with a Kinect Azure camera. Jumping and landing phases of the movement were determined within the continuous recording of the knee medio-lateral position over the ankle and the hip vertical position. Kinect measurements were validated by Optojump (Microgate, Bolzano, Italy). RESULTS Soccer players retained their predominantly varus knee positions in all phases of double-leg jumps, which was far less prominent in single leg tests. Interestingly, a marked dynamic valgus was observed in athletes who participated in traditional strengthening exercises, while this valgus shift was mostly prevented in those who participated in antivalgus training regimes. All these differences were only revealed during single leg tests, while the double leg jump tests masked all valgus tendencies. CONCLUSIONS We propose to use single-leg tests and movement analysis systems for evaluating dynamic valgus knee in athletes. These methods can reveal valgus tendencies even in soccer players who have a characteristic varus knee while standing.
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Affiliation(s)
- Ádám Uhlár
- Research Center for Sports Physiology, Hungarian University of Sports Science, Budapest, Hungary -
| | - Mira Ambrus
- Research Center for Sports Physiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Zsombor Lacza
- Research Center for Sports Physiology, Hungarian University of Sports Science, Budapest, Hungary
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20
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The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries. J Clin Med 2023; 12:jcm12031144. [PMID: 36769792 PMCID: PMC9917777 DOI: 10.3390/jcm12031144] [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: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.
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21
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Effects of Gluteus Medius and Biceps Femoris Stimulation on Reduction of Knee Abduction Moment During a Landing Task. J Appl Biomech 2023; 39:110-117. [PMID: 36870343 DOI: 10.1123/jab.2021-0107] [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: 03/30/2021] [Revised: 10/30/2022] [Accepted: 01/05/2023] [Indexed: 03/06/2023]
Abstract
Anterior cruciate ligament injury prevention should focus primarily on reduction of the knee abduction moment (KAM) in landing tasks. Gluteus medius and hamstring forces are considered to decrease KAM during landing. The effects of different muscle stimulations on KAM reduction were compared using 2 electrode sizes (standard 38 cm2 and half size 19 cm2) during a landing task. Twelve young healthy female adults (22.3 [3.6] y, 1.62 [0.02] m, 50.2 [4.7] kg) were recruited. KAM was calculated under 3 conditions of muscle stimulation (gluteus medius, biceps femoris, and both gluteus medius, and biceps femoris) using 2 electrode sizes, respectively versus no stimulation during a landing task. A repeated-measures analysis of variance determined that KAM differed significantly among stimulation conditions and post hoc analysis revealed that KAM was significantly decreased in conditions of stimulating either the gluteus medius (P < .001) or the biceps femoris (P < .001) with the standard electrode size, and condition of stimulating both gluteus medius and biceps femoris with half-size electrode (P = .012) when compared with the control condition. Therefore, stimulation on the gluteus medius, the biceps femoris, or both muscles could be implemented for the examination of anterior cruciate ligament injury potential.
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22
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Biomechanical Effects of Prophylactic Knee Bracing on Anterior Cruciate Ligament Injury Risk: A Systematic Review. Clin J Sport Med 2023; 33:78-89. [PMID: 36599362 DOI: 10.1097/jsm.0000000000001052] [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] [Received: 08/01/2021] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Prophylactic knee braces (PKBs) are widely used by athletes in pivoting and landing sports and have the potential to influence knee movement and alignment, thus modulating anterior cruciate ligament (ACL) injury risk. This systematic review analyses current evidence on the biomechanical effects that PKBs have in the prevention of ACL injuries. DATA SOURCES The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were conducted on PubMed, Web of Science, Scopus, Ovid MEDLINE, EMBASE, Cochrane, and CINAHL for studies published from inception until May 31, 2021. Included studies assessed the effects of PKBs on biomechanical variables associated with ACL injuries in landing or pivoting tasks, comparing between braced and unbraced conditions. MAIN RESULTS A total of 234 articles were identified; from which, 14 controlled, laboratory, biomechanical studies were included in this review. The effects of PKBs on knee biomechanics could be divided into kinematic variables in the coronal, sagittal, and transverse planes; and common kinetic variables, such as ground reaction force (GRF) and ACL load/strain. Also, PKBs were found to have protective effects in coronal and transverse plane kinematics, but results in the sagittal plane were inconclusive. Assessing knee kinetics, PKBs were advantageous in decreasing ACL load/strain but had no significant effect on GRF. CONCLUSIONS Prophylactic knee braces may serve to reduce ACL injury risk by modulating knee coronal and transverse plane movements and ACL load/strain during high-risk maneuvres. Precise recommendations are limited by study heterogeneity. More prospective studies are needed to assess ACL injury risk during high-risk sports using specific PKBs.
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23
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Akbari H, Shimokochi Y, Sheikhi B. Ankle dorsiflexion range of motion and landing postures during a soccer-specific task. PLoS One 2023; 18:e0283150. [PMID: 36928236 PMCID: PMC10019731 DOI: 10.1371/journal.pone.0283150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Ankle dorsiflexion range of motion (DF-ROM) has been shown to be associated with poor landing posture. However, previously used tasks have been controlled, and it is unclear whether clinical measurements of the ankle DF-ROM, are associated with landing positions during sport-specific task. This study sought to determine the relationship between ankle DF-ROM and landing positions. METHODS Thirty male soccer players participated in this study. The ankle DF-ROM was measured by the weight bearing lunge test in degrees using a cell phone app (TiltMeter). Landing patterns were assessed during a soccer-specific task using landing error scoring system items using Kinovea software. Simple correlations were used to evaluate the relationships between ankle DF-ROM and landing error scores. RESULTS Significant correlations were found between ankle DF-ROM and landing errors (r = -0.450, P = 0.006). A decreased ankle DF-ROM was associated with greater landing errors in a soccer specific situation. CONCLUSION These results suggest that ankle DF-ROM may serve a useful clinical measure for identifying poor landing posture in the real-world environment. Therefore, assessment of ankle DF-ROM could be included in the screening process, which could help identify the cause of the faulty motion.
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Affiliation(s)
- Hadi Akbari
- Department of Sport Sciences, University of Zabol, Zabol, Iran
- * E-mail:
| | - Yohei Shimokochi
- Department of Health and Sport Management, School of Health and Sport Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
| | - Bahram Sheikhi
- Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran
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Toyooka S, Tsukada K, Yasui Y, Saho Y, Okawa Y, Ando S, Nakagawa T, Kawano H, Miyamoto W. Association of medial arch support of foot orthoses with knee valgus angle at initial contact during cutting maneuvers in female athletes: a controlled laboratory study. BMC Sports Sci Med Rehabil 2022; 14:214. [PMID: 36536460 PMCID: PMC9762016 DOI: 10.1186/s13102-022-00608-w] [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: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The effect of medial arch support foot orthoses on kinematics and kinetics of the knee joint has remained unknown. METHODS Sixteen female collegiate-level athletes volunteered to participate. Participants were asked to perform a 30° sidestep cut using orthoses of 3 different medial arch heights, comprising of the following: (1) "low," a full flat foot orthosis without arch support, (2) "mid," a commercially available foot orthosis with general height arch support, and (3) "high," a foot orthosis with double the commercially available height for arch support to observe the effect on the knee when overcorrected. Kinematics and kinetics of the knee joint were collected by a markerless motion capture system with 2 force plates and compared between orthosis types using linear regression analysis, assuming a correlation between the measurements of the same cases in the error term. RESULTS The knee valgus angle at initial contact was 2.3 ± 5.2 degrees for "low" medial arch support height, 2.1 ± 5.8 degrees for "mid," and 0.4 ± 6.6 degrees for "high". Increased arch support height significantly decreased the knee valgus angle at initial contact (p = 0.002). Other kinematic and kinetic measurements did not differ between groups. CONCLUSIONS The valgus angle of the knee at initial contact was decreased by the height of the medial arch support provided by foot orthosis during cutting manoeuvres. Increasing the arch support height may decrease knee valgus angle at initial contact. Medial arch support of foot orthosis may be effective in risk reduction of ACL injury. Clinical trial registration numbers and date of registration: UMIN000046071, 15/11/2021.
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Affiliation(s)
- Seikai Toyooka
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Keisuke Tsukada
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Youich Yasui
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Yasuaki Saho
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan ,grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuaki Okawa
- grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Shuji Ando
- grid.143643.70000 0001 0660 6861Tokyo University of Science, Tokyo, Japan
| | - Takumi Nakagawa
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Wataru Miyamoto
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
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25
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Wakabayashi K, Ogasawara I, Suzuki Y, Nakata K, Nomura T. Exploring pre-impact landing kinematics associated with increase and decrease in the anterior cruciate ligament injury risk. J Biomech 2022; 145:111382. [PMID: 36446310 DOI: 10.1016/j.jbiomech.2022.111382] [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: 03/18/2022] [Revised: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to explore the single-legged landing kinematics that could lead to increase or decrease in the risk of anterior cruciate ligament (ACL) injury. Immediate pre-impact kinematics at the single-legged landing from 33 healthy young female handball players were evaluated. Thereafter, two-year follow-up for ACL injury incidence was conducted, in which six new ACL injuries in non-dominant leg were registered. The evaluation of pre-impact kinematics across participants was performed first by the principal component analysis to decompose them into the kinematic components (KCs), and then by the linear discrimination analysis (LDA) for a set of KC-scores to obtain important KCs for discriminating injured and non-injured legs. The result of LDA showed that the combination of second major KC (knee flexion/extension angle and angular velocity) and some minor KCs such as torso medial/lateral leaning accurately discriminated the injured and non-injured legs with the error rate of 12.5%. To examine the mechanisms of this discriminative ability, we generated hypothetical pre-impact kinematics in the subspaces spanned by eigenvectors of multiple KCs, and examined relationships between pre-impact kinematics and the corresponding knee valgus torque predicted by the motion-equation-based model. The result showed that the second major KC and the minor KCs representing torso medial/lateral leaning and/or hip adduction/abduction angle, which contributed in LDA to discriminating injured legs, also significantly affected the frontal-plane knee loading patterns. These findings suggested that KC-based postural characterization of the pre-impact landing kinematics and the motion-equation-based knee stress quantification possibly explain the future ACL injury risks of female athletes.
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Affiliation(s)
- Kaito Wakabayashi
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Issei Ogasawara
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan.
| | - Yasuyuki Suzuki
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Ken Nakata
- Health and Sports Sciences, Osaka University Medical School, Suita, Osaka, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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26
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Lei MK, Cheng KB. Biomechanical fidelity of athletic training using virtual reality head-mounted display: the case of preplanned and unplanned sidestepping. Sports Biomech 2022:1-22. [PMID: 36412262 DOI: 10.1080/14763141.2022.2146528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
Virtual reality has recently been recognised as an effective tool for investigating visual-perceptual tasks. To develop a sport-specific virtual environment with realistic locomotion, it is crucial to examine the effect of using virtual reality devices on athletes performing intense and complex movements. Twelve collegiate football players were instructed to perform pre-planned and unplanned sidestepping in both environments with the same dimension and experimental setup in the virtual environment as in the real one. Analysis of the performance and knee biomechanical parameters showed that movements performed in the two environments were generally comparable. Consistent changes in approach velocity and knee angle/moment under unplanned conditions (compared with preplanned conditions) were also found in the virtual environment as in the real one, except for the significantly larger peak flexion angle (p < .05) observed in the virtual environment. Interestingly, half of the participants changed from producing abduction to adduction moment at the weight acceptance phase in the preplanned condition (p < .05). These findings suggested that while it is generally feasible to use virtual reality head-mounted displays for designated experiments and training, the effect of wearing virtual reality devices could be somewhat subject-specific.
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Affiliation(s)
- Man Kit Lei
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan City, Taiwan
| | - Kuangyou B Cheng
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan City, Taiwan
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27
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Ogasawara I, Nambo M, Uno Y, Revankar GS, Umegaki K, Cheng H, Konda S, Matsuo T, Mae T, Hashizume K, Nakata K. The counteracting effect of the friction moment against the tibial rotational moment driven by the ground reaction force in an early stance phase of cutting maneuver among healthy male athletes. J Sports Sci 2022; 40:2072-2084. [DOI: 10.1080/02640414.2022.2133392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Issei Ogasawara
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka 565-0871, Suita, Osaka, Japan
| | - Megumi Nambo
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Yuki Uno
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Gajanan S. Revankar
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
- Institute for Transdisciplinary Graduate Degree Programs, Osaka University, Osaka, Japan
| | - Kaho Umegaki
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Haotian Cheng
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Shoji Konda
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka 565-0871, Suita, Osaka, Japan
| | - Tomoyuki Matsuo
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka 565-0871, Suita, Osaka, Japan
| | - Ken Hashizume
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
| | - Ken Nakata
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho 560-0043, Toyonaka, Osaka, Japan
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28
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Henderson FJ, Konishi Y, Shima N, Shimokochi Y. Effects of 8-Week Exhausting Deep Knee Flexion Flywheel Training on Persistent Quadriceps Weakness in Well-Trained Athletes Following Anterior Cruciate Ligament Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13209. [PMID: 36293790 PMCID: PMC9602677 DOI: 10.3390/ijerph192013209] [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: 09/21/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Persistent quadriceps weakness after anterior cruciate ligament (ACL) reconstruction is a common hurdle to efficient rehabilitation. Therefore, we evaluated a new treatment strategy for athletes with ACL reconstruction. Eleven athletes with unilateral ACL reconstruction performed one set of flywheel Bulgarian split squats to exhaustion with a maximum knee extension of 60°, over 16 sessions, on their reconstructed limb. Quadriceps rate of force development (RFD) 0-50 ms (RFD0-50 ms), and 0-150 ms (RFD0-150 ms), maximum voluntary isometric contraction (MVIC), and central activation ratio (CAR) were measured bilaterally on the week before and after the intervention. In the reconstructed limb, the RFD0-50 ms (p = 0.04; Cohen's d = 0.8) and RFD0-150 ms (p = 0.03; d = 0.9) increased after training. Before-after changes in MVIC and CAR were not significant (p > 0.05), but the lower the baseline MVIC, the greater the gain in MVIC (r = -0.71, p = 0.02). The between-leg difference in MVIC changed from large before (p = 0.01; d = 0.8) to small after training (p = 0.04; d = 0.4). One set of deep knee flexion flywheel Bulgarian split squats to exhaustion improved quadriceps deficits in well-trained athletes with ACL-reconstruction, particularly those with relatively low quadriceps force production.
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Affiliation(s)
- Frederick James Henderson
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, Sennan-gun 590-0496, Japan
| | - Yu Konishi
- Department of Physical Education, National Defense Academy of Japan, Yokosuka 239-8686, Japan
| | - Norihiro Shima
- Department of Sport and Health Science, Tokai Gakuen University, Miyoshi 470-0207, Japan
| | - Yohei Shimokochi
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, Sennan-gun 590-0496, Japan
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29
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Wang H, Tao M, Shi Q, He K, Cheng CK. Graft Diameter Should Reflect the Size of the Native Anterior Cruciate Ligament (ACL) to Improve the Outcome of ACL Reconstruction: A Finite Element Analysis. Bioengineering (Basel) 2022; 9:bioengineering9100507. [PMID: 36290477 PMCID: PMC9598161 DOI: 10.3390/bioengineering9100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 12/03/2022] Open
Abstract
The size of the anterior cruciate ligament (ACL) often varies between individuals, but such variation is not typically considered during ACL reconstruction (ACLR). This study aimed to explore how the size of the ACL affects the selection of a suitable graft diameter. A finite element model of a human knee was implanted with intact ACLs of different dimensions (0.95, 1 and 1.05 times the size of the original ACL) and with grafts of different diameters, to simulate ACLR (diameter 7.5–12 mm in 0.5 mm increments). The knee models were flexed to 30° and loaded with an anterior tibial load of 103 N, internal tibial moment of 7.5 Nm, and valgus tibial moment of 6.9 Nm. Knee kinematics (anterior tibial translation (ATT), internal tibial rotation (ITR) and valgus tibial rotation (VTR)) and ligament forces were recorded and compared among the different groups. The results showed that, compared with the intact knee, a graft diameter of 7.5 mm was found to increase the ATT and VTR, but reduce the graft force. Increasing the graft diameter reduced knee laxity and increased the graft force. A 10% increase in the size of the ACL corresponded to a 3 mm larger graft diameter required to restore knee stability and graft force after ACLR. It was concluded that the graft diameter should be selected according to the dimensions of the native ACL, for better restoration of knee functionality. This study may help to improve the clinical treatment of ACL ruptures.
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30
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Influence of Bone Morphology on In Vivo Tibio-Femoral Kinematics in Healthy Knees during Gait Activities. J Clin Med 2022; 11:jcm11175082. [PMID: 36079016 PMCID: PMC9457019 DOI: 10.3390/jcm11175082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
An improved understanding of the relationships between bone morphology and in vivo tibio-femoral kinematics potentially enhances functional outcomes in patients with knee disorders. The aim of this study was to quantify the influence of femoral and tibial bony morphology on tibio-femoral kinematics throughout complete gait cycles in healthy subjects. Twenty-six volunteers underwent clinical examination, radiographic assessment, and dynamic video-fluoroscopy during level walking, downhill walking, and stair descent. Femoral computer-tomography (CT) measurements included medial condylar (MC) and lateral condylar (LC) width, MC and LC flexion circle, and lateral femoral condyle index (LFCI). Tibial CT measurements included both medial (MTP) and lateral tibial plateau (LTP) slopes, depths, lengths, and widths. The influence of bony morphology on tibial internal/external rotation and anteroposterior (AP)-translation of the lateral and medial compartments were analyzed in a multiple regression model. An increase in tibial internal/external rotation could be demonstrated with decreasing MC width β: −0.30 (95% CI: −0.58 to −0.03) (p = 0.03) during the loaded stance phase of level walking. An increased lateral AP-translation occurred with both a smaller LC flexion circle β: −0.16 (95% CI: −0.28 to −0.05) (p = 0.007) and a deeper MTP β: 0.90 (95% CI: 0.23 to 1.56) (p = 0.01) during the loaded stance phase of level walking. The identified relationship between in vivo tibio-femoral kinematics and bone morphology supports a customized approach and individual assessment of these factors in patients with knee disorders and potentially enhances functional outcomes in anterior cruciate ligament injuries and total knee arthroplasty.
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Nakahira Y, Taketomi S, Kawaguchi K, Mizutani Y, Hasegawa M, Ito C, Uchiyama E, Ikegami Y, Fujiwara S, Yamamoto K, Nakamura Y, Tanaka S, Ogata T. Kinematic Differences Between the Dominant and Nondominant Legs During a Single-Leg Drop Vertical Jump in Female Soccer Players. Am J Sports Med 2022; 50:2817-2823. [PMID: 35850117 DOI: 10.1177/03635465221107388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In soccer, the roles of the dominant (kicking) and nondominant (supporting) legs are different. The kinematic differences between the actions of the dominant and nondominant legs in female soccer players are not clear. PURPOSE To clarify the kinematic differences between dominant and nondominant legs during a single-leg drop vertical jump (DVJ) in female soccer players. STUDY DESIGN Controlled laboratory study. METHODS A total of 64 female high school and college soccer players were included in this study. Participants performed a single-leg DVJ test utilizing video motion capture with artificial intelligence during the preseason period. This study assessed the knee flexion angles, knee valgus angles, hip flexion angles, and lower leg anterior inclination angle at 3 time points (initial contact, maximum flexion of the knee, and toe-off) and compared them between the dominant and nondominant legs. These angles were calculated from motion capture data and analyzed in 3 dimensions. A paired t test was used to analyze the differences between legs, and the significance level was set at P < .05. RESULTS The knee valgus angle at initial contact was greater in the nondominant leg (mean ± SD, 0.8°± 5.2°) than the dominant leg (-0.9°± 4.9°) (P < .01). There were no differences between legs for any other angles at any of the time points. CONCLUSION The kinematics of the dominant and nondominant legs of female soccer players in a single-leg DVJ differ in knee valgus angle. CLINICAL RELEVANCE Leg dominance is associated with the risk of sports injuries. Kinematic differences between the dominant and nondominant legs may be a noteworthy factor in elucidating the mechanisms and risk of sports injury associated with leg dominance.
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Affiliation(s)
- Yu Nakahira
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuri Mizutani
- Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan
| | - Masato Hasegawa
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chie Ito
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emiko Uchiyama
- The Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yosuke Ikegami
- The Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Yamamoto
- Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan; The Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yoshihiko Nakamura
- Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan; The Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Ogata
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Sports Science Initiative, The University of Tokyo, Tokyo, Japan.,Investigation performed at The University of Tokyo, Tokyo, Japan
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32
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Kikuchi N, Kanamori A, Kadone H, Kajiwara M, Okuno K, Hyodo K, Yamazaki M. Relationship Between Posterior Tibial Slope and Lower Extremity Biomechanics During a Single-Leg Drop Landing Combined With a Cognitive Task in Athletes After ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221107931. [PMID: 35837443 PMCID: PMC9274414 DOI: 10.1177/23259671221107931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A steeper posterior tibial slope (PTS) is an important risk factor for
anterior cruciate ligament (ACL) reinjury. The PTS may affect lower
extremity biomechanics under competition-like conditions for athletes with a
reconstructed ACL. Hypothesis: It was hypothesized that the PTS would be associated with lower extremity
biomechanics, which may increase ACL strain. Study Design: Descriptive laboratory study. Methods: Included were 10 athletes (mean age, 20.9 ± 1.8 years) who had undergone ACL
reconstruction. The authors recorded the 3-dimensional lower extremity
biomechanics while participants performed a single-leg drop jump with the
Stroop task (dual task). Kinematic and kinetic data were analyzed and
compared between the involved and contralateral limbs. The medial and
lateral PTSs were measured using magnetic resonance imaging scans of the
involved knee. The correlation between the biomechanical data and the PTS in
each knee was evaluated. Results: The lateral PTS was significantly correlated with the maximum hip adduction
moment (r = 0.64; P < .05) and maximum
internal tibial rotation angle (r = 0.71;
P < .05) in the involved limb. There were no
differences in kinematic and kinetic data between the involved and
contralateral limbs. Conclusion: In athletes after ACL reconstruction, the lateral PTS was directly associated
with the maximum internal tibial rotation angle during single-leg drop
landing with a cognitive task. Clinical Relevance: The findings in this study indicate that a steeper lateral PTS may cause
internal rotation of the tibia during landing, which may be associated with
reinjury in athletes with a reconstructed ACL.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaya Kajiwara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Dudley RI, Lohman EB, Patterson CS, Knox KG, Gharibvand L. The relationship between kinesiophobia and biomechanics in anterior cruciate ligament reconstructed females. Phys Ther Sport 2022; 56:32-37. [PMID: 35717878 DOI: 10.1016/j.ptsp.2022.06.002] [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: 03/08/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Kinesiophobia has been associated with deleterious biomechanical alterations during dual-limb landing tasks in anterior cruciate ligament (ACL) reconstructed females, however, no research has yet investigated single-limb tasks related to ACL injury. The aim of this investigation was to examine the relationship between kinesiophobia and biomechanics during a series of dual and single-limb functional tasks associated with ACL injury risk. DESIGN Cross-sectional study. PARTICIPANTS Fifteen females (age = 22.67 ± 2.58yrs, height = 1.65 ±0 .05m, mass = 65.28 ± 10.36 kg) with a history of ACL reconstruction (time post surgery = 3.40 ±0 .74yrs) were recruited for this investigation. MAIN OUTCOME MEASURES Kinesiophobia, measured via the Tampa Scale of Kinesiophobia (TSK-11). Kinematics and muscle activation were measured during three functional tasks: the drop jump (DJ), single-limb hop (SLH), and single-limb landing (SLL). RESULTS For the DJ task, there was a strong negative correlation between kinesiophobia and knee flexion (r = -.592, p = .20) and between kinesiophobia and trunk flexion (r = -0.724, p = .002). For the SLH task, there was a strong positive correlation between kinesiophobia and hip flexion (r = 0.560, p = .03). CONCLUSIONS These findings indicate that kinesiophobia is associated with movement alterations years after completion of ACL reconstruction and rehabilitation.
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Affiliation(s)
- Robert I Dudley
- Loma Linda University School of Allied Health Professions, USA; Pepperdine University Faculty of Sports Medicine, USA.
| | | | | | - Kyra G Knox
- Azusa Pacific University Department of Kinesiology, USA
| | - Lida Gharibvand
- Loma Linda University School of Allied Health Professions, USA
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34
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Age-Related Changes in Landing Mechanics in Elite Male Youth Soccer Players: A Longitudinal Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this longitudinal observational study was to examine the age differences in jump landing kinematics in 13–17-year-old male soccer players. Landing technique was evaluated in three consecutive seasons in U14 (n = 15) and the U16 (n = 10) competition age groups using the Landing Error Scoring System (LESS). For the LESS, ANOVA revealed no significant interaction effect (p = 0.81, η2 = 0.009) or main effect for groups (p = 0.15, η2 = 0.086), but a significant year effect was observed (p < 0.001, η2 = 0.265). The LESS score in the U14 group decreased significantly in the second year (5.7 ± 1.9, p = 0.006, d = 0.84) and in the third year (5.9 ± 2.0, p = 0.020, d = 0.70) compared to the first year (7.1 ± 1.7). The LESS score in the U16 group decreased significantly in the second year (5.1 ± 0.9 points, p = 0.034, d = 0.77) and in the third year (4.9 ± 1.4, p = 0.013, d = 0.92) compared to the first year (6.4 ± 1.2). This trend was supported by the results of the separate assessment of the sagittal plane joint displacement. These findings support previous limited findings from cross-sectional studies, which point to improved landing mechanics during maturation. However, the LESS scores in both groups indicate that players who were around and/or post-peak height velocity during the observed periods may be considered “at-risk”, and suggest that preventive training programs should be introduced at earlier stages of players’ development.
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35
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Arumugam A, Häger CK. Thigh muscle co-contraction patterns in individuals with anterior cruciate ligament reconstruction, athletes and controls during a novel double-hop test. Sci Rep 2022; 12:8431. [PMID: 35589937 PMCID: PMC9119948 DOI: 10.1038/s41598-022-12436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Efficient neuromuscular coordination of the thigh muscles is crucial in maintaining dynamic knee stability and thus reducing anterior cruciate ligament (ACL) injury/re-injury risk. This cross-sectional study measured electromyographic (EMG) thigh muscle co-contraction patterns during a novel one-leg double-hop test among individuals with ACL reconstruction (ACLR; n = 34), elite athletes (n = 22) and controls (n = 24). Participants performed a forward hop followed by a 45° unanticipated diagonal hop either in a medial (UMDH) or lateral direction (ULDH). Medial and lateral quadriceps and hamstrings EMG were recorded for one leg (injured/non-dominant). Quadriceps-to-Hamstring (Q:H) ratio, lateral and medial Q:H co-contraction indices (CCIs), and medial-to-lateral Q:H co-contraction ratio (CCR; a ratio of CCIs) were calculated for three phases (100 ms prior to landing, initial contact [IC] and deceleration phases) of landing. We found greater activity of the quadriceps than the hamstrings during the IC and deceleration phases of UMDH/ULDH across groups. However, higher co-contraction of medial rather than lateral thigh muscles during the deceleration phase of landing was found; if such co-contraction patterns cause knee adduction, a putative mechanism to decrease ACL injury risk, during the deceleration phase of landing across groups warrants further investigation.
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Affiliation(s)
- Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, P.O.Box: 27272, Sharjah, United Arab Emirates
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå, University, 901 87, Umeå, Sweden.
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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.
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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
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SINCLAIR JONATHAN, GRIMSHAW NIAMH, LATHAM OWEN, TAYLOR PAULJOHN, CHOCKALINGAM NACHIAPPAN. EFFECTS OF A PROPHYLACTIC KNEE SLEEVE ON THE ANTERIOR CRUCIATE LIGAMENT AND LOWER EXTREMITY BIOMECHANICS: AN EXAMINATION USING MUSCULOSKELETAL SIMULATION. J MECH MED BIOL 2022. [DOI: 10.1142/s021951942250018x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current study aimed using a two-experiment musculoskeletal simulation-based approach, measuring anterior cruciate ligament (ACL) biomechanics, knee joint kinematics, and lower extremity joint loading to examine the effects of both a prophylactic knee sleeve on (1) a sport-specific change of direction movement in female footballers and (2) a single leg landing in male footballers. Experiment 1 examined 12 female university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a [Formula: see text] cutting movement in sleeve and no-sleeve conditions. Experiment 2 examined 10 male university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a single leg drop jump landing in sleeve and no-sleeve conditions. In each experiment, data was collected in a biomechanics laboratory and three-dimensional (3D) motion capture and ground reaction force (GRF) information was collected. 3D kinematics, 3D knee kinetics, and ACL ligament forces/strains were measured using musculoskeletal simulation, and participants were also asked to subjectively rate the knee sleeve in terms of both comfort and stability. Experiment 1 showed that the sleeve condition was associated with greater ACL strain ([Formula: see text]% and no-[Formula: see text]%) and forces ([Formula: see text] BW and no-[Formula: see text] BW). In addition, the brace condition also enhanced lateral compressive tibiofemoral ([Formula: see text] BW and no-[Formula: see text] BW) and total compressive tibiofemoral force ([Formula: see text] BW and no-[Formula: see text] BW). Finally, for the subjective ratings, participants indicated that the knee sleeve significantly improved perceived comfort and stability. Experiment 2 did not reveal any statistical differences between knee sleeve and no-sleeve conditions nor any effects of the knee sleeve on subjective ratings of comfort or stability. Therefore, the findings from the current investigation suggest that the prophylactic knee sleeve examined in the current investigation does not appear to reduce the biomechanical parameters linked to the aetiology of knee pathologies in male/female footballers.
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Affiliation(s)
- JONATHAN SINCLAIR
- Research Centre for Applied Sport, Physical Activity and Performance School of Sport and Health Sciences, Faculty of Allied Health and Wellbeing University of Central Lancashire, Lancashire, UK
| | - NIAMH GRIMSHAW
- Research Centre for Applied Sport, Physical Activity and Performance School of Sport and Health Sciences, Faculty of Allied Health and Wellbeing University of Central Lancashire, Lancashire, UK
| | - OWEN LATHAM
- Research Centre for Applied Sport, Physical Activity and Performance School of Sport and Health Sciences, Faculty of Allied Health and Wellbeing University of Central Lancashire, Lancashire, UK
| | - PAUL JOHN TAYLOR
- School of Psychology, Faculty of Science and Technology, University of Central Lancashire, Lancashire, UK
| | - NACHIAPPAN CHOCKALINGAM
- School of Life Sciences and Education, Staffordshire University, City of Stoke, Stoke on Trent, UK
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Identification of Sex Differences within Lunge Decelerations via Lower Extremity Support Movements; Implications for ACL Injury Disparity, Prevention, and Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Loading characteristics and lower extremity injury mechanisms, such as the non-contact mechanism of cruciate ligament injury, differ between sexes. The Limb Support Moment (LSM) quantifies hip, knee, and ankle moment contribution to the net moment required to prevent limb collapse during deceleration tasks. In total, 10 males and 10 females performed single limb deceleration landings within three knee flexion ranges: 0–25°, 25–50°, and 50–75°. Lower extremity joint moments and LSMs were calculated for all planes at initial contact (IC) through 50 ms. A two-way multivariate ANOVA compared LSMs and joint moments between sexes for all planes. Female LSMs were significantly greater at IC in the sagittal and transverse planes due to the generation of hip and ankle extensor moments and larger hip, knee, and ankle internal rotation moments. Males demonstrated significantly greater LSMs in the frontal plane due to the generation of hip abductor moments. Results suggest that females have a more rigid lower limb than males at landing, with less shock absorption capacity and greater potential for frontal plane collapse due to an unsupportive hip adductor moment. Quantifying the contribution of joint moments to limb support via LSMs suggests that there are landing characteristic sex differences, which may provide insight into injury disparity while guiding injury prevention/rehabilitation methodology.
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39
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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.
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40
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Straub RK, Powers CM. Utility of 2D Video Analysis for Assessing Frontal Plane Trunk and Pelvis Motion during Stepping, Landing, and Change in Direction Tasks: A Validity Study. Int J Sports Phys Ther 2022; 17:139-147. [PMID: 35136682 PMCID: PMC8805121 DOI: 10.26603/001c.30994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Excessive frontal plane motion of the trunk and/or pelvis has been implicated in numerous clinical conditions. To date, it is unclear whether 2D video is an appropriate surrogate for assessing frontal plane trunk and pelvis motion as a comprehensive validity study across a wide range of movements using a consistent methodology has not been performed. HYPOTHESIS/PURPOSE The purpose of the current study was to assess the concurrent validity and agreement of frontal plane pelvis and trunk motion obtained with 2D video against the respective 3D angles during stepping, landing, and change in direction tasks. DESIGN Crossover Study Design. METHODS 3D kinematics and 2D frontal plane video were obtained from 39 healthy participants (15 males and 24 females) during five athletic tasks (step down, lateral shuffle, deceleration, triple hop, side-step-cut). Data were extracted at peak knee flexion. Pearson's correlation analysis was used to assess the association between the 2D and 3D frontal plane angles at the trunk and pelvis. Bland Altman plots were used to assess the level of agreement between the 2D and 3D frontal plane angles at the trunk and pelvis. RESULTS 2D and 3D frontal plane angles for all tasks were correlated in a positive direction at the pelvis (r = 0.54 to 0.73, all p < 0.001) and trunk (r = 0.81 to 0.92, all p < 0.001). Absolute agreement in the frontal plane for all tasks and angles was below 5°. However, the 95% limits of agreement across tasks ranged from -12.8° to 21.3° for the pelvis and -11.8° to 9.4° for the trunk. CONCLUSIONS The use of 2D video to assess frontal plane trunk and pelvis motion is appropriate during stepping, landing, and change of direction tasks, however caution is advised when high levels of agreement or accuracy is required.
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Affiliation(s)
- Rachel K Straub
- Division of Biokinesiology & Physical Therapy, University of Southern California
| | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California
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41
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Alizadeh S, Sarvestan J, Svoboda Z, Alaei F, Linduška P, Ataabadi PA. Hamstring and ACL injuries impacts on hamstring-to-quadriceps ratio of the elite soccer players: A retrospective study. Phys Ther Sport 2021; 53:97-104. [PMID: 34894617 DOI: 10.1016/j.ptsp.2021.12.001] [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: 07/17/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.
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Affiliation(s)
- Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Javad Sarvestan
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Zdeněk Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Fatemeh Alaei
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Linduška
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Peyman Aghaie Ataabadi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
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Adouni M, Faisal TR, Dhaher YY. Sensitivity analysis of the knee ligament forces to the surgical design variation during anterior cruciate ligament reconstruction: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:1063-1071. [PMID: 34821520 DOI: 10.1080/10255842.2021.2006647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to understand the effect of essential surgical design parameters on collateral and cruciate ligaments behavior for a Bone-Patellar-Tendon-Bone (BPTB) anterior cruciate ligament reconstruction (ACL-R) surgery. A parametric finite element model of biomechanical experiments depicting the ACL-R surgery associated with a global sensitivity analysis was adopted in this work. The model parameters were six intraoperative variables, two-quadrant coordinates of femoral tunnel placement, femoral tunnel sagittal and coronal angles, graft pretension, and the joint angle at which the BPTB graft is tensioned (fixation angle). Our results indicated that cruciate ligaments (posterior cruciate ligament (PCL) and graft) were mainly sensitive to graft pretension (23%), femoral tunnel sites (56%), and the angle at which the surgeon decided to fix the graft (14%). The collateral ligaments (medial and lateral) were also affected by the same set of surgical parameters as the cruciate ligaments except for graft pretension. The output data of this study may help to identify a better role for the ACL-R intraoperative variables in optimizing the knee joint ligaments' postsurgical functionality.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Mechanical Engineering department, Australian College of Kuwait, Kuwait City, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Yasin Y Dhaher
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, USA.,Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, USA.,Bioengineering, University of Texas Southwest, Dallas, TX, USA
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Ogasawara I, Shimokochi Y, Konda S, Mae T, Nakata K. Effect of Rearfoot Strikes on the Hip and Knee Rotational Kinetic Chain During the Early Phase of Cutting in Female Athletes. SPORTS MEDICINE - OPEN 2021; 7:75. [PMID: 34674077 PMCID: PMC8531138 DOI: 10.1186/s40798-021-00368-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Biomechanical factors affecting horizontal-plane hip and knee kinetic chain and anterior cruciate ligament (ACL) injury risk during cutting maneuvers remain unclear. This study aimed to examine whether different foot strike patterns alter horizontal-plane hip and knee kinetics and kinematics during a cutting maneuver in female athletes and clarify the individual force contribution for producing high-risk hip and knee loadings. Twenty-five healthy female athletes performed a 60° cutting task with forefoot and rearfoot first strike conditions. Horizontal-plane hip and knee moment components, angles, and angular velocities were calculated using synchronized data of the marker positions on the body landmarks and ground reaction forces (GRFs) during the task. The one-dimensional statistical parametric mapping paired t test was used to identify the significant difference in kinetic and kinematic time-series data between foot strike conditions. RESULTS In the rearfoot strike condition, large hip and knee internal rotation loadings were produced during the first 5% of stance due to the application of GRFs, causing a significantly larger hip internal rotation excursion than that of the forefoot strike condition. Dissimilarly, neither initial hip internal rotation displacement nor knee internal rotation GRF loadings were observed in the forefoot strike condition. CONCLUSIONS Rearfoot strike during cutting appears to increase noncontact ACL injury risk as the GRF tends to produce combined hip and knee internal rotation moments and the high-risk lower limb configuration. Conversely, forefoot strike during cutting appears to be an ACL-protective strategy that does not tend to produce the ACL-harmful joint loadings and lower extremity configurations. Thus, improving foot strike patterns during cutting should be incorporated in ACL injury prevention programs.
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Affiliation(s)
- Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan.
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yohei Shimokochi
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennan-gun, Osaka, 590-0496, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennan-gun, Osaka, 590-0496, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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Ueno R, Navacchia A, Schilaty ND, Myer GD, Hewett TE, Bates NA. Hamstrings Contraction Regulates the Magnitude and Timing of the Peak ACL Loading During the Drop Vertical Jump in Female Athletes. Orthop J Sports Med 2021; 9:23259671211034487. [PMID: 34604430 PMCID: PMC8485303 DOI: 10.1177/23259671211034487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury reduction training has focused on lower body strengthening and landing stabilization. In vitro studies have shown that quadriceps forces increase ACL strain, and hamstring forces decrease ACL strain. However, the magnitude of the effect of the quadriceps and hamstrings forces on ACL loading and its timing during in vivo landings remains unclear. Purpose To investigate the effect and timing of knee muscle forces on ACL loading during landing. Study Design Descriptive laboratory study. Methods A total of 13 young female athletes performed drop vertical jump trials, and their movements were recorded with 3-dimensional motion capture. Lower limb joint motion and muscle forces were estimated with OpenSim and applied to a musculoskeletal finite element (FE) model to estimate ACL loading during landings. The FE simulations were performed with 5 different conditions that included/excluded kinematics, ground-reaction force (GRF), and muscle forces. Results Simulation of landing kinematics without GRF or muscle forces yielded an estimated median ACL strain and force of 5.1% and 282.6 N. Addition of GRF to kinematic simulations increased ACL strain and force to 6.8% and 418.4 N (P < .05). Addition of quadriceps force to kinematics + GRF simulations nonsignificantly increased ACL strain and force to 7.2% and 478.5 N. Addition of hamstrings force to kinematics + GRF simulations decreased ACL strain and force to 2.6% and 171.4 N (P < .001). Addition of all muscles to kinematics + GRF simulations decreased ACL strain and force to 3.3% and 195.1 N (P < .001). With hamstrings force, ACL loading decreased from initial contact (time of peak: 1-18 milliseconds) while ACL loading without hamstrings force peaked at 47 to 98 milliseconds after initial contact (P = .024-.001). The knee flexion angle increased from 20.9° to 73.1° within 100 milliseconds after initial contact. Conclusion Hamstrings activation had greater effect relative to GRF and quadriceps activation on ACL loading, which significantly decreased and regulated the magnitude and timing of ACL loading during in vivo landings. Clinical Relevance Clinical training should focus on strategies that influence increased hamstrings activation during landing to reduce ACL loads.
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Affiliation(s)
- Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Alessandro Navacchia
- Smith & Nephew, San Clemente, California, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Smith & Nephew, San Clemente, California, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, Georgia, USA.,Emory Sports Medicine Center, Atlanta, Georgia, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Timothy E Hewett
- Hewett Global Consulting, Rochester, Minnesota, USA.,The Rocky Mountain Consortium for Sports Research, Edwards, Colorado, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Immediate Effect of Anterior Cruciate Ligament Protective Knee Taping on Knee Landing Mechanics and Muscle Activations during Side Hops. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910110. [PMID: 34639413 PMCID: PMC8508252 DOI: 10.3390/ijerph181910110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
Athletic taping is widely used in sports to prevent injury. However, the effect of anterior cruciate ligament (ACL) protective taping on neuromuscular control during dynamic tasks remains unclear. Therefore, this study aimed to investigate the immediate effect of ACL protective taping on landing mechanics and muscle activations during side hops in healthy individuals. Fifteen healthy individuals (11 males and 4 females; age, 23.1 ± 1.4 years; height, 175.1 ± 10.4 cm; weight, 66.3 ± 11.2 kg) volunteered to participate in this study. Landing mechanics and muscle activations were measured while each participant performed single-leg hops side-to-side for ten repetitions with and without taping. An optical motion capture system and two force plates were used to collect the kinematic and kinetic data during the side hops. Surface electromyogram recordings were performed using a wireless electromyography system. Paired t-tests were performed to determine the differences in landing mechanics and muscle activations between the two conditions (taping and non-taping). The level of significance was set at p < 0.05. Compared with the non-taping condition, participants landed with a smaller knee abduction angle, greater knee external rotation angle, and smaller knee extensor moment in the taping condition. Given that greater knee abduction, internal rotation, and knee extension moment are associated with a greater risk of ACL injury, our findings suggest that ACL protective taping can have an immediate effect on dynamic knee stability. Clinicians should consider using ACL protective taping to facilitate the use of favorable landing mechanics for ACL injuries.
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47
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Gong H, Qiao X, Chen L. [Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1200-1204. [PMID: 34523289 DOI: 10.7507/1002-1892.202104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. Methods The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed. Results The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury. Conclusion The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.
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Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Xinrong Qiao
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Radiology, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
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48
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Ficek K, Rajca J, Cholewiński J, Racut A, Gwiazdoń P, Przednowek K, Hajduk G. Analysis of intercondylar notch size and shape in patients with cyclops syndrome after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16:554. [PMID: 34496898 PMCID: PMC8425156 DOI: 10.1186/s13018-021-02706-w] [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: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cyclops lesion is the second most common cause of extension loss after anterior cruciate ligament reconstruction. This study focused on the correlation between the anatomy of the intercondylar notch and the incidence of cyclops lesion. To determine whether the size and shape of the intercondylar notch are related to cyclops lesion formation following anterior cruciate ligament reconstruction according to magnetic resonance imaging (MRI) findings. Methods One hundred twenty-five (125) patients were retrospectively evaluated. The notch width index (NWI) and notch shape index (NSI) were measured based on coronal and axial MRI sections in patients diagnosed with cyclops syndrome (n = 25), diagnosed with complete anterior cruciate ligament (ACL) tears (n = 50), and without cyclops lesions or ACL ruptures (n = 50). Results Imaging analysis results showed that the cyclops and ACL groups had lower mean NWI and NSI values than the control group. Significant between-group differences were found in NSI (p = 0.0140) based on coronal cross-sections and in NWI (p = 0.0026) and NSI (p < 0.0001) based on axial sections. Conclusions The geometry of the intercondylar notch was found to be associated with the risk of cyclops lesion formation and ACL rupture.
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Affiliation(s)
- Krzysztof Ficek
- Department of Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, 40-065, Katowice, Poland. .,Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland.
| | - Jolanta Rajca
- Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland
| | - Jerzy Cholewiński
- Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland.,Department of Orthopedics and Traumatology, Brothers Hospitallers Hospital, 40-211, Katowice, Poland.,Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Agnieszka Racut
- Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland
| | - Paweł Gwiazdoń
- Department of Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, 40-065, Katowice, Poland.,Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland.,Department of Biopharmacy, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, 40-055, Katowice, Poland
| | - Krzysztof Przednowek
- College of Medical Sciences, Institute of Physical Culture Studies, University of Rzeszow, 35-959, Rzeszow, Poland
| | - Grzegorz Hajduk
- Deparment of Science, Innovation and Development, Galen-Orthopaedics, 43-150, Bieruń, Poland
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49
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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.
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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.
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50
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Zee MJM, Keizer MNJ, Dijkerman L, van Raaij JJAM, Hijmans JM, Diercks RL. The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation. J Exp Orthop 2021; 8:71. [PMID: 34476648 PMCID: PMC8413430 DOI: 10.1186/s40634-021-00389-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study
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Affiliation(s)
- M J M Zee
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
| | - M N J Keizer
- Department of Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Dijkerman
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - J J A M van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - J M Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - R L Diercks
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands
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