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Bashaireh KM, Yabroudi MA, Logerstedt D, Snyder-Mackler L, Nawasreh ZH. Reasons for Not Returning to Pre-injury Sport Level After ACL-Reconstruction. Int J Sports Med 2024; 45:698-704. [PMID: 38718825 DOI: 10.1055/a-2270-3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48-27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Jordan University of Science and Technology, Irbid central post o, Jordan
| | - Mohammad A Yabroudi
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - David Logerstedt
- Physical Therapy, Saint Joseph's University, Philadelphia, United States
| | | | - Zakariya H Nawasreh
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Franklin E, Stebbings GK, Morse CI, Runacres A, Dos’Santos T. Between-Session Reliability of Athletic Performance and Injury Mitigation Measures in Female Adolescent Athletes in the United States. Life (Basel) 2024; 14:892. [PMID: 39063645 PMCID: PMC11278427 DOI: 10.3390/life14070892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Adolescence is a fundamental period for female athletes to develop athletic performance, mitigate injury risk, and gain collegiate sport scholarships, but there is also a high incidence of sport-related injuries. Physical profiling and athlete screening can support the individualisation of training programmes; however, there is a lack of data pertaining to the reliability of athletic performance and injury surrogate measures in adolescent female athletes. The aim of this study was to quantify the between-session reliability of an athletic performance and injury mitigation testing battery in female adolescent athletes. A total of 31 post-peak height velocity (PHV) (3.00 ± 0.82 years) female athletes (age: 16.20 ± 1.20 years; standing height: 166.00 ± 6.00 cm; mass: 65.5 ± 10.70 kg) from various sports (track and field = 1; lacrosse = 2; basketball = 2; soccer = 3; softball = 11; volleyball = 12) completed two sessions of a multicomponent testing battery 48 h to 1 week apart including the assessment of 33 measures addressing lower-limb isometric strength, eccentric strength, reactive strength, linear sprint and change of direction speed, and lower limb control. Of the 33 measures, between sessions, 29 had a high to nearly perfect intraclass correlation coefficient (ICC) (0.508-0.979), and 26 measures were not statistically significantly different between sessions (p ≤ 0.05). All measures demonstrated low to acceptable coefficient variation (CV%) (0.61-14.70%). The testing battery used can be utilised for recruitment and longitudinal monitoring within sports organisations for female adolescent athletes.
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Affiliation(s)
| | | | | | | | - Thomas Dos’Santos
- Department of Sport and Exercise Sciences, Manchester Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK; (E.F.); (G.K.S.); (C.I.M.); (A.R.)
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Gao F, Li H, He C, Qian Y, Guo S, Zhao Z, Gong Y, Zhao Y, Zhang X, Li L, Zhou J. Epidemiology of injuries among snowboarding athletes in the talent transfer program: A prospective cohort study of 39,880 athlete-exposures. PLoS One 2024; 19:e0306787. [PMID: 38990847 PMCID: PMC11239072 DOI: 10.1371/journal.pone.0306787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Talent transfer (TT) program is an appropriate approach to address the talent gap evident in specific sports activities, while little is known about the injury characteristics of snowboarding athletes involved in the TT program. OBJECTIVE To determine the epidemiology of injuries among snowboarders involved in the TT program. METHODS A total of 244 athletes who were not previously engaged in winter sports were selected for training in snowboarding that lasted for 109 days. The injuries and at-risk exposures (A-Es) data were recorded by physicians. Injury rates (IRs), incidence rate ratios (IRRs), and injury proportion ratios (IPRs) were calculated and compared by sex and age groups. RESULTS The overall and time loss (TL) IR were 32.4/1000 A-Es and 12.2/1000 A-Es respectively. The overall and non-time loss (NTL) IRR were higher for female athletes than for male athletes. Additionally, the overall IRR and TL-IRR for female athletes were higher in those athletes who aged ≤15 years old. Over 93% of TL injuries resulted in participation restriction time of ≤7 days (male athletes, 93.94%; female athletes, 94.10%). Trunk (28.43%), knee joints (21.33%), and hand/wrist (16.53%) were found as the common sites of injury in both female and male athletes. The most frequent type of injury was contusion (male athletes: 53.00%, female athletes: 59.10%) resulted from ground/apparatus contact (male athletes: 75.10%, female athletes: 75.20%). CONCLUSION The risk injury among snowboarding athletes involved in the TT program during the first snow season training was found noticeable, especially for younger female athletes. The high incidence of ground/apparatus contact-related injuries suggested the necessity of specifically designed training programs and braces for snowboarding athletes involved in the TT program.
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Affiliation(s)
- Feng Gao
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Haiwei Li
- School of Physical Education, Shanxi Normal University, Taiyuan, China
| | - Chen He
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Yi Qian
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Sen Guo
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Zhihong Zhao
- Department of Orthopedics, Beijing Second Hospital, Beijing, China
| | - Yawei Gong
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Yingqi Zhao
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Xiaohan Zhang
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Lei Li
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Jingbin Zhou
- Department of Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
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Aldhilan MM, Alshahrani AH, Almogbil IH. Heterotopic ossification postsuperficial medial collateral ligament pie-crusting: a case report. J Surg Case Rep 2024; 2024:rjae305. [PMID: 39011292 PMCID: PMC11247377 DOI: 10.1093/jscr/rjae305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/25/2024] [Indexed: 07/17/2024] Open
Abstract
Anterior cruciate ligament and meniscus tears are common among sports injuries. There are different techniques for addressing anterior cruciate ligament and meniscus tears, with distinct indications, advantages, and disadvantages. We present the case of a 23-year-old male who underwent right anterior cruciate ligament reconstruction and posterior horn medial meniscus repair using an all-inside technique via superficial medial collateral ligament (sMCL) pie-crusting. Clinical examination and radiological investigations a few months later identified calcifications on the medial side of the right knee. We diagnosed the patient with heterotopic ossification post-sMCL pie-crusting; no apparent causal factors were present. To our knowledge, there have been no documented instances of heterotopic ossification following sMCL pie-crusting. In conclusion, heterotopic ossification may occur after sMCL pie-crusting; further studies are needed on this subject.
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Affiliation(s)
- Mansour M Aldhilan
- Department of Orthopedic Surgery, Ar Rass General Hospital, Ar rass 58872, Saudi Arabia
| | - Abdullah H Alshahrani
- Department of Orthopedic Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Ismail H Almogbil
- Department of Orthopedic Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
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Avedesian JM, Covassin T, Baez S, Nash J, Dufek JS. The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes. Scand J Med Sci Sports 2024; 34:e14698. [PMID: 38984660 DOI: 10.1111/sms.14698] [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: 03/28/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Department of Athletics, Clemson University, Clemson, South Carolina, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer Nash
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Costello II JP, Stauber ZM, Luxenburg D, Cohen JL, Tandron MC, Rizzo Jr MG, Kaplan LD. Video analysis of anterior cruciate ligament tears of professional basketball players in the National Basketball Association. J Sports Med Phys Fitness 2024; 64:668-675. [PMID: 38916090 DOI: 10.23736/s0022-4707.24.15724-6] [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: 06/26/2024]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are devastating for elite athletes, including those in the National Basketball Association (NBA). The purpose of this study was to describe common in-game mechanisms of injury, playing situations, and anatomic positioning of players who sustained an ACL injury in the NBA. METHODS ACL tears which occurred in NBA games during the previous 16 seasons (2007-2022) and had accessible video clips were identified through publicly available reports. RESULTS Thirty-one ACL tears were identified with quality videos available. Nearly all players were on offense (93.5%, 29/31). Most ACL tears (29/31, 93.5%) did not involve direct contact to the injured extremity. The most common physical activity at the time of injury was landing from any type of jump (45.2%, 14/31). Anatomically, the knee was frequently in early flexion (58.8%, 10/17) and abducted (77.4%, 24/31); the foot was commonly abducted (87.1%, 27/31); and the hip was usually abducted (64.5%, 20/31) and flexed (80.6%, 25/31). Almost all players had another individual near them at the time of injury, with 90.3% (28/31) and 96.8% (30/31) having someone within 2ft and 5ft. CONCLUSIONS Most ACL tears occurred inside the lane, regardless of mechanism of injury (26/31, 83.9%). ACL tears in the NBA were primarily not due to direct contact of the injured extremity but did have common anatomic patterns. The findings of this study can be used in the future to help reduce the risk of injury through the adaptation of current training activities.
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Affiliation(s)
| | | | - Dylan Luxenburg
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jacob L Cohen
- Department of Orthopedic Surgery, University of Miami, Miami, FL, USA
| | - Marissa C Tandron
- Department of Orthopedic Surgery, University of Miami, Miami, FL, USA
| | | | - Lee D Kaplan
- UHealth Sports Medicine Institute, University of Miami, Miami, FL, 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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Beron-Vera F, Lemus SA, Mahmoud AO, Beron-Vera P, Ezzy A, Chen CB, Mann BJ, Travascio F. Asymmetry in kinematics of dominant/nondominant lower limbs in central and lateral positioned college and sub-elite soccer players. PLoS One 2024; 19:e0304511. [PMID: 38848409 PMCID: PMC11161049 DOI: 10.1371/journal.pone.0304511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing these dynamic movements, clinicians recognize abnormal kinematic patterns that contribute to ACL tears such as increased knee valgus or reduced knee flexion. Different motions and physical demands are observed across playing positions, which may result in varied lower limb kinematic patterns. In the present study, 28 college and sub-elite soccer players performed four dynamic motions (change of direction with and without ball, header, and instep kick) with the goal of examining the effect of on-field positioning, leg dominance, and gender in lower body kinematics. Motion capture software monitored joint angles in the knee, hip, and ankle. A three-way ANOVA showed significant differences in each category. Remarkably, centrally positioned players displayed significantly greater knee adduction (5° difference, p = 0.013), hip flexion (9° difference, p = 0.034), hip adduction (7° difference, p = 0.016), and dorsiflexion (12° difference, p = 0.022) when performing the instep kick in comparison to their laterally positioned counterparts. These findings suggest that central players tend to exhibit a greater range of motion when performing an instep kicking task compared to laterally positioned players. At a competitive level, this discrepancy could potentially lead to differences in lower limb muscle development among on-field positions. Accordingly, it is suggested to implement position-specific prevention programs to address these asymmetries in lower limb kinematics, which can help mitigate dangerous kinematic patterns and consequently reduce the risk of ACL injury in soccer players.
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Affiliation(s)
- Francisco Beron-Vera
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States of America
| | - Sergio A. Lemus
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States of America
| | - Ahmed O. Mahmoud
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States of America
| | - Pedro Beron-Vera
- Department of Physics, University of Miami, Coral Gables, FL, United States of America
| | - Alexander Ezzy
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States of America
| | - Cheng-Bang Chen
- Department of Industrial Engineering, University of Miami, Coral Gables, FL, United States of America
| | - Bryan J. Mann
- Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, United States of America
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States of America
- Department of Orthopaedics, University of Miami, Miami, FL, United States of America
- Max Biedermann Institute for Biomechanics at Mount Sinai Medical Center, Miami Beach, FL, United States of America
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Nardon M, Ferri U, Caffi G, Bartesaghi M, Perin C, Zaza A, Alessandro C. Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury. Front Sports Act Living 2024; 6:1418598. [PMID: 38832309 PMCID: PMC11144872 DOI: 10.3389/fspor.2024.1418598] [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: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Neuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness. Methods Twenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65-70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg. Results Following the fatiguing exercise, the hip joint was more extended (landing: Δ=-2.17°, p = 0.005; propulsion: Δ=-1.83°, p = 0.032) and more abducted (landing: Δ=-0.72°, p = 0.01; propulsion: Δ=-1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=-2.67°, p < 0.001; dominant: Δ=-1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=-0.99°, p < 0.001) and stabilization (both legs: Δ=-1.71°, p < 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=-0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly. Conclusion The increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.
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Affiliation(s)
- Mauro Nardon
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Umberto Ferri
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Caffi
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Manuela Bartesaghi
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cecilia Perin
- School of Medicine and Surgery/Physical and Rehabilitative Medicine, University of Milano-Bicocca, Milan, Italy
- Istituti Clinici Zucchi - GDS, Carate Brianza, Monza e Brianza, Italy
| | - Antonio Zaza
- Department of Biotechnology and Biosciences/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cristiano Alessandro
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
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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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Wang S, Ma J, Tian C, Feng Z, Xiang D, Tang Y, Geng B, Xia Y. Decreased sagittal slope of the medial tibial spine and deep concavity of the lateral tibial spine are risk factors for noncontact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2024; 32:1113-1122. [PMID: 38469920 DOI: 10.1002/ksa.12136] [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: 11/23/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE This study aimed to assess the relationship between the geometric features of tibial eminence and susceptibility to noncontact anterior cruciate ligament (ACL) injuries. METHODS Patients with unilateral noncontact knee injuries between 2015 and 2021 were consecutively enroled in this study. Based on knee magnetic resonance imaging (MRI) and arthroscopic visualisation, patients were categorised into the case group (ACL rupture) and control group (ACL intact). Using MRI, the geometric features of tibial eminence were characterised by measuring the sagittal slopes, depth of concavity and coronal slopes of the inclined surfaces of the tibial spines. Univariate and multivariate logistic regressions were conducted to explore independent associations between quantified geometric indices of tibial eminence and the risk of noncontact ACL injuries. RESULTS This study included 187 cases and 199 controls. A decreased sagittal slope of the medial tibial spine (MTSSS) (combined group: odds ratio [OR]: 0.87 [0.82, 0.92], p < 0.001; females: OR: 0.88 [0.80, 0.98], p = 0.020; males: OR: 0.87 [0.81, 0.93], p < 0.001) and an increased depth of concavity in the lateral tibial spine (LTSD) (combined group: OR: 1.51 [1.24, 1.85], p < 0.001; females: OR: 1.65 [1.12, 2.43], p = 0.012; males: OR: 1.44 [1.11, 1.89], p = 0.007) were independent risk factors for noncontact ACL injuries. Moreover, a steeper coronal slope of the inclined surface of the medial tibial spine was a significant predictor of noncontact ACL injuries for males (MTSCS: OR: 1.04 [1.01, 1.08], p = 0.015) but not for females. CONCLUSION Geometric features of tibial eminence, particularly a decreased MTSSS and an increased LTSD, were identified as independent risk factors for noncontact ACL injuries. These findings will help clinicians identify individuals at high risk of ACL injury and facilitate the development of targeted prevention strategies. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shenghong Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Jie Ma
- The Second Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Cong Tian
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Zhiwei Feng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Dejian Xiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Yuchen Tang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Clinical Medicine Research Center of Gansu Province, Lanzhou, China
- Intelligent Orthopedics Industry Technology Center of Gansu Province, Lanzhou, China
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12
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Syed RIB, Hangody LR, Frischmann G, Kós P, Kopper B, Berkes I. Comparative Effectiveness of Supervised and Home-Based Rehabilitation after Anterior Cruciate Ligament Reconstruction in Competitive Athletes. J Clin Med 2024; 13:2245. [PMID: 38673520 PMCID: PMC11051221 DOI: 10.3390/jcm13082245] [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: 03/06/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR (p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.
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Affiliation(s)
| | | | - Gergely Frischmann
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Petra Kós
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Bence Kopper
- Department of Biomechanics, Hungarian University of Sports Science, 1123 Budapest, Hungary;
| | - István Berkes
- Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Traumatology, Semmelweis University, 1085 Budapest, Hungary;
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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13
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Donelon TA, Edwards J, Brown M, Jones PA, O'Driscoll J, Dos'Santos T. Differences in Biomechanical Determinants of ACL Injury Risk in Change of Direction Tasks Between Males and Females: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:29. [PMID: 38561438 PMCID: PMC10984914 DOI: 10.1186/s40798-024-00701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. OBJECTIVE The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. METHODS Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. RESULTS This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. CONCLUSION No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.
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Affiliation(s)
- Thomas A Donelon
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK.
| | - Jamie Edwards
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Mathew Brown
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Paul A Jones
- School of Health Sciences, C702 Allerton Building, University of Salford, Salford, M6 6PU, UK
| | - Jamie O'Driscoll
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences | Manchester Metropolitan University, 2.01 Institute of Sport, 99 Oxford Road, Manchester, M1 7EL, UK
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14
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Gulati A, Desai V. Return to Play in the Professional Athlete. Semin Musculoskelet Radiol 2024; 28:107-118. [PMID: 38484763 DOI: 10.1055/s-0043-1778028] [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: 03/19/2024]
Abstract
The management of any injury in elite athletes poses unique challenges distinct from the general population because the goal is rapid recovery and return to play (RTP) while simultaneously managing residual symptoms and minimizing risk of reinjury. The time required for treatment, recovery, and return to peak performance can have consequences for both the athlete and his or her team: financial implications, psychological stressors, team dynamics, and future performance. RTP after an injury in the professional athlete requires a complex decision-making process with many stakeholders. Several factors influence this decision, not the least of which is the type and mechanism of injury. This article provides an overview of the RTP process including nonmedical factors that may influence this decision, common injuries seen in professional athletes, injury patterns particular to certain popular sports, and imaging guidelines for such injuries.
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Affiliation(s)
- Aishwarya Gulati
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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15
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Maricot A, Lathouwers E, Verschueren J, De Pauw K, Meeusen R, Roelands B, Tassignon B. Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability. Front Neurol 2024; 15:1320043. [PMID: 38434204 PMCID: PMC10906270 DOI: 10.3389/fneur.2024.1320043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet. Methods We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures. Results The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690). Conclusion Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.
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Affiliation(s)
- Alexandre Maricot
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Verschueren
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sports, Recreation, Exercise and Sciences (SRES), Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Ajdaroski M, Baek SY, Ashton-Miller JA, Esquivel AO. Predicting Leg Forces and Knee Moments Using Inertial Measurement Units: An In Vitro Study. J Biomech Eng 2024; 146:021006. [PMID: 38019183 PMCID: PMC10750790 DOI: 10.1115/1.4064145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
We compared the ability of seven machine learning algorithms to use wearable inertial measurement unit (IMU) data to identify the severe knee loading cycles known to induce microdamage associated with anterior cruciate ligament rupture. Sixteen cadaveric knee specimens, dissected free of skin and muscle, were mounted in a rig simulating standardized jump landings. One IMU was located above and the other below the knee, the applied three-dimensional action and reaction loads were measured via six-axis load cells, and the three-dimensional knee kinematics were also recorded by a laboratory motion capture system. Machine learning algorithms were used to predict the knee moments and the tibial and femur vertical forces; 13 knees were utilized for training each model, while three were used for testing its accuracy (i.e., normalized root-mean-square error) and reliability (Bland-Altman limits of agreement). The results showed the models predicted force and knee moment values with acceptable levels of error and, although several models exhibited some form of bias, acceptable reliability. Further research will be needed to determine whether these types of models can be modified to attenuate the inevitable in vivo soft tissue motion artifact associated with highly dynamic activities like jump landings.
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Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
| | - So Young Baek
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | | | - Amanda O. Esquivel
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
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Chen P, Wang L, Dong S, Ding Y, Zuo H, Jia S, Wang G, Chen C, Zheng C. Abnormal Lower Limb Biomechanics During a Bilateral Vertical Jump Despite the Symmetry in Single-Leg Vertical Hop Height in Athletes After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241230989. [PMID: 38414664 PMCID: PMC10898320 DOI: 10.1177/23259671241230989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 02/29/2024] Open
Abstract
Background A limb symmetry index (LSI) of >90% for single-leg horizontal hop distance is recommended as a cutoff point for safe return to sports after anterior cruciate ligament reconstruction (ACLR). Despite achieving this threshold, abnormal lower limb biomechanics continue to persist in athletes after ACLR. Symmetry in single-leg vertical hop height appears to be more difficult to achieve and can be a better representation of knee function than single-leg horizontal hop distance. Purpose To explore whether an LSI of >90% for single-leg vertical hop height can represent normal lower limb biomechanics in athletes during a bilateral vertical jump after ACLR. Study Design Controlled laboratory study. Methods According to the LSI for single-leg vertical hop height, 46 athletes who had undergone ACLR with an autologous ipsilateral bone-patellar tendon-bone or hamstring tendon graft were divided into a low symmetry group (LSI <90%; n = 23) and a high symmetry group (LSI >90%; n = 23), and 24 noninjured athletes were selected as the control group. The kinematic and kinetic characteristics during a bilateral vertical jump were compared between the low symmetry, high symmetry, and control groups. Results During the propulsion phase of the bilateral vertical jump, the operated side in the high symmetry group showed a lower knee extension moment than the nonoperated side (P = .001). At peak vertical ground-reaction force, the operated side in the high symmetry group showed a lower knee internal rotation moment compared with the control group (P = .016). Compared with the nonoperated side, the operated side in the high symmetry group showed a higher hip extension moment (P = .002), lower knee extension moment (P < .001), lower ankle plantarflexion moment (P < .001), and lower vertical ground-reaction force (P = .023). Conclusion Despite achieving an LSI of >90% for single-leg vertical hop height, athletes after ACLR showed abnormal lower limb biomechanical characteristics during the bilateral vertical jump. Clinical Relevance Symmetrical single-leg vertical hop height may not signify ideal biomechanical or return-to-sports readiness in this population.
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Affiliation(s)
- Peng Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Key Laboratory of Sports Engineering of the General Administration of Sport of China, Wuhan Sports University, Wuhan, China
| | - Ling Wang
- Key Laboratory of Sports Engineering of the General Administration of Sport of China, Wuhan Sports University, Wuhan, China
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Shiyu Dong
- College of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Yue Ding
- Key Laboratory of Sports Engineering of the General Administration of Sport of China, Wuhan Sports University, Wuhan, China
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Huiwu Zuo
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Mulligan CM, Johnson ST, Pollard CD, Hannigan KS, Athanasiadis D, Norcross MF. Deceleration Profiles Between the Penultimate and Final Steps of Planned and Reactive Side-Step Cutting. J Athl Train 2024; 59:173-181. [PMID: 37648221 PMCID: PMC10895398 DOI: 10.4085/1062-6050-0007.23] [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: 09/01/2023]
Abstract
CONTEXT Noncontact anterior cruciate ligament injury often occurs during rapid deceleration and change-of-direction maneuvers. These activities require an athlete to generate braking forces to slow down the center of mass and change direction in a dynamic environment. During preplanned cutting, athletes can use the penultimate step for braking before changing direction, resulting in less braking demand during the final step. During reactive cutting, athletes use different preparatory movement strategies during the penultimate step when planning time is limited. However, possible differences in the deceleration profile between the penultimate and final steps of preplanned and reactive side-step cuts remain unknown. OBJECTIVE To comprehensively evaluate deceleration during the penultimate and final steps of preplanned and reactive cutting. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-six women (age = 20.9 ± 1.7 years, height = 1.66 ± 0.07 m, mass = 62.4 ± 8.7 kg). INTERVENTION Participants completed 90° side-step cutting maneuvers under preplanned and reactive conditions. MAIN OUTCOME MEASURE(S) Approach velocity, velocity at initial contact, and cutting angle were compared between conditions. Stance time, deceleration time, and biomechanical indicators of deceleration were assessed during the penultimate and final steps of preplanned and reactive 90° cuts. Separate repeated-measures analysis-of-variance models were used to assess the influence of step, condition, and their interaction on the biomechanical indicators of deceleration. RESULTS Approach velocity (P = .69) and velocity at initial contact of the penultimate step (P = .33) did not differ between conditions. During reactive cutting, participants achieved a smaller cutting angle (P < .001). We identified a significant step-by-condition interaction for all biomechanical indicators of deceleration (P values < .05). CONCLUSIONS A lack of planning time resulted in less penultimate step braking and greater final step braking during reactive cutting. As a result, participants exhibited a decreased cutting angle and longer stance time during the final step of reactive cutting. Improving an athlete's ability to respond to an external stimulus may facilitate a more effective penultimate step braking strategy that decreases the braking demand during the final step of reactive cutting.
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Affiliation(s)
- Colin M.S. Mulligan
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Samuel T. Johnson
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Christine D. Pollard
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Kim S. Hannigan
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Dimitrios Athanasiadis
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Marc F. Norcross
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
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Farid AR, Pradhan P, Stearns SA, Kocher MS, Fabricant PD. Association Between Posterior Tibial Slope and ACL Injury in Pediatric Patients: A Systematic Review and Meta-analysis. Am J Sports Med 2024:3635465231199649. [PMID: 38275009 DOI: 10.1177/03635465231199649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients. PURPOSE This systematic review and meta-analysis was performed to investigate any association between PTS and ACL tears in the pediatric population. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review was performed to identify studies that examined the relationship between PTS, medial tibial slope (MTS), and lateral tibial slope (LTS) and ACL tears in children and adolescents aged ≤18 years. Full-text observational studies comparing PTS, MTS, and/or LTS values between pediatric (≤18 years of age) patients with and without ACL injury were included in this analysis. Review articles and case series were excluded. The authors calculated the mean difference (MD) via a restricted maximum-likelihood estimator for tau square and a Hartung-Knapp adjustment for random-effects model. RESULTS A total of 348 articles were identified in the initial database search, yielding 10 for final inclusion and analysis. There was no statistically significant association between PTS (MD, 1.13°; 95% CI, -0.55° to 2.80°; P = .10), MTS (MD, 0.36°; 95% CI, -0.37° to 1.10°; P = .27), or LTS (MD, 1.41°; 95% CI, -0.20° to 3.02°; P = .075) and risk for ACL injury in this population. CONCLUSION The current study found that unlike what has been shown in adult populations, increased PTS may not be a significant risk factor for ACL tears in pediatric and adolescent patents. LTS was the only measured parameter that neared statistical significance, perhaps suggesting a potential role for this measurement in determining ACL risk if further research is done in this population.
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Affiliation(s)
| | - Pratik Pradhan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Mininder S Kocher
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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20
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Baghban Baghdadabad M, Mohaghegh S. Balance test results in different hormonal statuses of the menstruation cycle. Are females more susceptible to lower extremities injuries on different days of their menstruation cycles? Phys Ther Sport 2024; 65:54-58. [PMID: 38043451 DOI: 10.1016/j.ptsp.2023.11.003] [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: 09/27/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The Star Excursion Balance Test (SEBT) and its modification(mSEBT) as dynamic tests have been shown to have high reliability and validity for the prediction of lower extremities injuries including ACL ones. No previous study has compared mSEBT performance measures in different hormonal statuses of the menstrual cycle in naturally menstruating women. So aim of the study was comparison of mSEBT performance measures in days of the menstruation cycle with the peak of estrogen and progesterone hormones in naturally menstruating women. METHODS After a pilot study for estimation of sample size, mSEBT performance measures in a sample of 18 healthy women with regular menstrual cycles were compared two times in their cycles, first in the peak of estrogen (mid-cycle) and second in time of peak of progesterone (one week later). The test was performed 2 times using either the right or left leg as the stance and reach limb. FINDINGS No significant difference between days with estrogen and progesterone peaks with right or left reach limb was seen for the percentage of reach in any direction or the composite reach on the mSEBT performance. CONCLUSION It seems that there is the same risk for lower extremities injuries in estradiol and progesterone peak days of normal menstruating women.
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Affiliation(s)
- Masoumeh Baghban Baghdadabad
- Department of Sports Physiology and Biomechanics, School of Physical Education and Sport Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Shahram Mohaghegh
- Research Center For Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran; Iran-Helal Institute of Applied-Science and Technology, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.
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Daniel SJ, Timothy J, Kandagaddala M, Reka K, Poonnoose PM, Oommen AT. Decreased femur tunnel widening after augmented suspensory fixation compared to suspensory fixation for single bundle hamstring ACL reconstruction. J Clin Orthop Trauma 2024; 48:102331. [PMID: 38274644 PMCID: PMC10806195 DOI: 10.1016/j.jcot.2023.102331] [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: 09/27/2023] [Revised: 11/15/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Background Tunnel widening after Anterior cruciate ligament (ACL) reconstruction using a hamstring graft is known to occur at follow-up. Our study aimed to investigate the effect of suspensory fixation augmentation using an interference screw on tunnel widening in single-bundle hamstring ACL reconstruction. Methods 48 patients who had single bundle ACL reconstruction with femoral fixed loop fixation technique in 15 knees, and, fixed loop with augmented aperture (bio screw) fixation in 33 knees were analyzed. The width of the tunnel was measured using radiographs immediate post-op and at follow-up within 1 year. Computerized Tomogram (CT) measurements of the tunnels and functional scores were also done with overall follow-up for the fixed loop group being 21.33 months (Standard Deviation (SD)11.14) and the Augmentation group 9.12 months (SD 3.83). Results Midpoint femur tunnel widening was reduced in the augmentation group, with measurements of 0.74 (SD 1.05) mm Antero Posterior (AP) and 1.01 (SD 1.04) mm in the Lateral view, compared to 1.54 (SD 1.48) mm AP and 1.79 (SD1.47 mm) in the Lateral for the fixed button group. The radiological widening was considerably less in the augmentation group with a p-value of 0.07. AP aperture widening in the augmentation group was 1.25(SD 1.10 mm), and 1.09(SD0.98) mm in the lateral view. The fixed button-only group measured 1.53 (SD1.30) mm in the AP, and 1.65 (SD 1.29) mm in the lateral view, both of which were not statistically significant. The follow-up Lysholm and International Knee Documentation Committee (IKDC) scores were similar for the 2 groups. Conclusion Femoral tunnel midpoint and aperture widening were reduced with the fixed loop with aperture (bio screw) augmentation technique for hamstring grafts in single bundle ACL fixation within 1 year with comparable functional scores. Level of evidence 4.
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Affiliation(s)
- Sam James Daniel
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Jozy Timothy
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Madhavi Kandagaddala
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - K. Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - Pradeep Mathew Poonnoose
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anil Thomas Oommen
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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Brantberg I, Grooten WJA, Essner A. The Effect of Therapeutic Exercise on Body Weight Distribution, Balance, and Stifle Function in Dogs following Stifle Injury. Animals (Basel) 2023; 14:92. [PMID: 38200827 PMCID: PMC10778569 DOI: 10.3390/ani14010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Stifle injury is common in the companion dog population, affecting weight bearing, neuromuscular control, and balance. Therapeutic exercises after stifle injury seem to be effective, but high-quality research evaluating the effects is lacking. This randomized controlled trial evaluated the effects of a 12-week progressive therapeutic home exercise protocol on three-legged standing, targeting balance and postural- and neuromuscular control and disability in dogs with stifle injury. Thirty-three dogs with stifle injury were randomly allocated to intervention (n = 18) and control groups (n = 15), both receiving a standard rehabilitation protocol. Additionally, the intervention group received a progressive therapeutic exercise protocol. The outcome measures were static body weight distribution between hindlimbs, balance control, the canine brief pain inventory, and the Finnish canine stifle index. Both groups improved after the intervention period, but the group using the progressive therapeutic exercise protocol improved to a greater extent regarding static body weight distribution between the hindlimbs (I: median = 2.5%, IQR = 1.0-4.5; C: median = 5.5%, IQR = 3.0-8.8), pain-related functional disability (I: median = 0.0, IQR = 0.0-0.2; C: median = 0.9, IQR = 0.1-1.8), and stifle function (I: median = 25.0, IQR = 9.4-40.6; C: median = 75.0, IQR = 31.3-87.5), with intermediate to strong effects. These clinically relevant results indicate that this home exercise program can improve hindlimb function and restore neuromuscular control.
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Affiliation(s)
- Ida Brantberg
- School of Veterinary Science, The University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, Wirral, UK
- Djursjukhuset Malmö, IVC Evidensia, Cypressvägen 11, SE-213 63 Malmö, Sweden
| | - Wilhelmus J. A. Grooten
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83 Huddinge, Sweden;
- Women’s Health and Allied Health Professionals’ Theme, Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna N1:00, SE-171 76 Stockholm, Sweden
| | - Ann Essner
- Djurkliniken Gefle, IVC Evidensia, Norra Gatan 1, SE-803 21 Gävle, Sweden;
- Department of Women’s and Children’s Health, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
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23
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Kharaz YA, Zamboulis DE, Fang Y, Welting TJM, Peffers MJ, Comerford EJ. Small RNA signatures of the anterior cruciate ligament from patients with knee joint osteoarthritis. Front Mol Biosci 2023; 10:1266088. [PMID: 38187089 PMCID: PMC10768046 DOI: 10.3389/fmolb.2023.1266088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction: The anterior cruciate ligament (ACL) is susceptible to degeneration, resulting in joint pain, reduced mobility, and osteoarthritis development. There is currently a paucity of knowledge on how anterior cruciate ligament degeneration and disease leads to osteoarthritis. Small non-coding RNAs (sncRNAs), such as microRNAs and small nucleolar RNA (snoRNA), have diverse roles, including regulation of gene expression. Methods: We profiled the sncRNAs of diseased osteoarthritic ACLs to provide novel insights into osteoarthritis development. Small RNA sequencing from the ACLs of non- or end-stage human osteoarthritic knee joints was performed. Significantly differentially expressed sncRNAs were defined, and bioinformatics analysis was undertaken. Results and Discussion: A total of 184 sncRNAs were differentially expressed: 68 small nucleolar RNAs, 26 small nuclear RNAs (snRNAs), and 90 microRNAs. We identified both novel and recognized (miR-206, -365, and -29b and -29c) osteoarthritis-related microRNAs and other sncRNAs (including SNORD72, SNORD113, and SNORD114). Significant pathway enrichment of differentially expressed miRNAs includes differentiation of the muscle, inflammation, proliferation of chondrocytes, and fibrosis. Putative mRNAs of the microRNA target genes were associated with the canonical pathways "hepatic fibrosis signaling" and "osteoarthritis." The establishing sncRNA signatures of ACL disease during osteoarthritis could serve as novel biomarkers and potential therapeutic targets in ACL degeneration and osteoarthritis development.
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Affiliation(s)
- Yalda A. Kharaz
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Danae E. Zamboulis
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Yongxiang Fang
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Tim J. M. Welting
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mandy J. Peffers
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Eithne J. Comerford
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Chou TY, Huang YL, Leung W, Brown CN, Kaminski TW, Norcross MF. Does prior concussion lead to biomechanical alterations associated with lateral ankle sprain and anterior cruciate ligament injury? A systematic review and meta-analysis. Br J Sports Med 2023; 57:1509-1515. [PMID: 37648411 DOI: 10.1136/bjsports-2023-106980] [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] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus and CiNAHL) were searched in April 2023. ELIGIBILITY CRITERIA Included studies involved (1) concussed participants, (2) outcome measures of spatiotemporal, kinematic or kinetic data and (3) a comparison or the data necessary to compare biomechanical variables between individuals with and without concussion history or before and after a concussion. RESULTS Twenty-seven studies were included involving 1544 participants (concussion group (n=757); non-concussion group (n=787)). Individuals with a recent concussion history (within 2 months) had decreased postural stability (g=0.34, 95% CI 0.20 to 0.49, p<0.001) and slower locomotion-related performance (g=0.26, 95% CI 0.11 to 0.41, p<0.001), both of which are associated with LAS injury risk. Furthermore, alterations in frontal plane kinetics (g=0.41, 95% CI 0.03 to 0.79, p=0.033) and sagittal plane kinematics (g=0.30, 95% CI 0.11 to 0.50, p=0.002) were observed in individuals approximately 2 years following concussion, both of which are associated with ACL injury risk. The moderator analyses indicated cognitive demands (ie, working memory, inhibitory control tasks) affected frontal plane kinematics (p=0.009), but not sagittal plane kinematics and locomotion-related performance, between the concussion and non-concussion groups. CONCLUSION Following a recent concussion, individuals display decreased postural stability and slower locomotion-related performance, both of which are associated with LAS injury risk. Moreover, individuals within 2 years following a concussion also adopt a more erect landing posture with greater knee internal adduction moment, both of which are associated with ACL injury risk. While adding cognitive demands to jump-landing tasks affected frontal plane kinematics during landing, the altered movement patterns in locomotion and sagittal plane kinematics postconcussion persisted regardless of additional cognitive demands. PROSPERO REGISTRATION NUMBER CRD42021248916.
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Affiliation(s)
- Tsung-Yeh Chou
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Yu-Lun Huang
- Department of Physical Education and Sport, National Taiwan Normal University, Taipei, Taiwan
| | - Willie Leung
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, Florida, USA
| | - Cathleen N Brown
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Marc F Norcross
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
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Kim S, Glaviano NR, Park J. Exercise-induced fatigue affects knee proprioceptive acuity and quadriceps neuromuscular function more in patients with ACL reconstruction or meniscus surgery than in healthy individuals. Knee Surg Sports Traumatol Arthrosc 2023; 31:5428-5437. [PMID: 37787863 DOI: 10.1007/s00167-023-07596-5] [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: 05/18/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To observe how knee proprioceptive acuity and quadriceps neuromuscular function change during and after repeated isokinetic knee-extension exercise in patients with anterior cruciate ligament reconstruction (ACLR) or meniscus surgery. METHODS Patients with ACLR or meniscus surgery and matched controls (n = 19 in each group) performed knee-flexion replication at 15° and 75°, and quadriceps peak torque (PT), central activation ratio (CAR) and rate of torque development (RTD) at baseline and immediately after every five sets of isokinetic knee-extension exercise (times 1-5). RESULTS Compared to the baseline, the ACLR and control groups displayed errors in knee-flexion replication at 75° only at time 5 (115.9-155.6%; p ≤ 0.04, d ≥ 0.97), whereas the meniscus surgery group exhibited errors at all time points (142.5-265.6%; p ≤ 0.0003, d ≥ 1.4). Significant percentage reductions in quadriceps CAR were observed between times 4 and 5 in the ACLR group (-5.8%; p = 0.0002, d = 0.96), but not in the meniscus surgery (-1.4%; n.s.) and control (0.1%; n.s.) groups. Significant percentage reductions in quadriceps RTD were observed between times 4 and 5 in the ACLR (-24.2%; p = 0.007, d = 0.99) and meniscus surgery (-23.0%; p = 0.01, d = 0.85) groups, but not in the control group (-0.2%; n.s.). CONCLUSION Patients with ACLR or meniscus surgery displayed a greater loss in knee proprioceptive acuity and quadriceps neuromuscular function during and after exercise than healthy individuals. Evidence-based interventions to enhance exercise-induced fatigue resistance should be implemented following ACLR or meniscus surgery, aiming to prevent proprioceptive and neuromuscular changes within the knee joint and quadriceps. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea.
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Wilson WT, Kennedy MJ, MacLeod D, Hopper GP, MacKay GM. Outcomes of Anterior Cruciate Ligament Reconstruction With Independently Tensioned Suture Tape Augmentation at 5-Year Follow-up. Am J Sports Med 2023; 51:3658-3664. [PMID: 37975527 PMCID: PMC10691290 DOI: 10.1177/03635465231207623] [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: 04/27/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Reconstruction using autograft remains the gold standard surgical treatment for anterior cruciate ligament (ACL) injuries. However, up to 10% to 15% of patients will suffer a graft failure in the future. Cadaveric studies have demonstrated that the addition of suture tape augmentation to ACL autograft constructs can increase graft strength and reduce elongation under cyclical loading. PURPOSE/HYPOTHESIS This study aimed to investigate the clinical outcomes and rerupture rates after ACL reconstruction (ACLR) with suture tape augmentation. We hypothesized that augmentation with suture tape would lead to lower rerupture rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients undergoing primary ACLR using hamstring or patellar tendon autografts augmented with suture tape between 2015 and 2019 were recruited prospectively. Patients with multiligament injuries or a concomitant lateral extra-articular procedure were excluded. Patients were observed in person for 6 months, and patient-reported outcome measures (PROMs) were collected at 2 and 5 years postoperatively. All patients were contacted, and records were reviewed to determine the incidence of graft failure. PROMs collected were as follows: Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Tegner and Marx activity scores, and visual analog scale for pain (VAS). RESULTS A total of 97 patients, with a mean age of 34.7 (±13.4) years, were included (76% men; 52 hamstring and 45 patellar tendon grafts). The mean graft diameter was 8 (±1) mm. There was 1 rerupture (1.1%) out of the 90 patients who were contactable at a mean of 5 years postoperatively. Median KOOS scores at 2 years were as follows: Pain, 94; Symptoms, 86; Activities of Daily Living, 99; Sport and Recreation, 82; and Quality of Life, 81. The postoperative scores were significantly higher than the preoperative scores (P < .001). The VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remained at 56 at 5 years. The VAS pain, Tegner, and Marx scores were 0, 6, and 9, respectively, at 2 years postoperatively. There was no difference in PROMs between graft types. CONCLUSION This study demonstrates encouraging results of suture tape augmentation of autograft ACLR for both hamstring and patellar tendon grafts. The failure rate of 1.1% at a mean follow-up of 5 years is lower than published rates for reconstruction, and PROMs results are satisfactory. The technique is safe to use and may permit a return to the preinjury sporting level with a lower chance of reinjury.
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Affiliation(s)
- William T. Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
- Department of Orthopaedics, NHS Ayrshire & Arran, Glasgow, UK
| | | | - Douglas MacLeod
- Department of Orthopaedics, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Graeme P. Hopper
- Department of Orthopaedics, NHS Lanarkshire, Glasgow, UK
- Rosshall Hospital, Glasgow, UK
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Aldag L, Dallman J, Henkelman E, Herda A, Randall J, Tarakemeh A, Morey T, Vopat BG. Various Definitions of Failure Are Used in Studies of Patients Who Underwent Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100801. [PMID: 37766857 PMCID: PMC10520319 DOI: 10.1016/j.asmr.2023.100801] [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: 03/04/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature. Methods A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of Science was conducted by a university librarian to identity level I-IV clinical studies on ACLR failure. Inclusion criteria consisted of patients who underwent ACLR and included a definition of failure of ACLR. Patients who underwent anterior cruciate ligament (ACL) repairs, animal/cadaver studies, review studies, non-English language articles, and non-full text articles were excluded. Failure data were extracted from each study and categorized. Other data that were extracted included follow-up time after ACLR, failure reoperation rate, and failure reoperation procedure. Descriptive statistics was used to analyze the data. Results Out of 2,775 studies, 104 (3.75%) met inclusion criteria and were analyzed in this review. The most common definition of ACLR failure included the use of a physical examination, specifically Lachman's test (21/104 [20.2%]), anterior laxity assessment, or a Pivot-Shift test (24/104 [35.2%]) or undergoing or requiring revision ACLR (39/104 [37.5%]). Although some studies used quantitative tests or imaging to help define "failure," others simply defined it as graft rerupture that was otherwise not defined (22/104 [22.5%]). Other common definitions included: the use of imaging (magnetic resonance imaging/radiographs) to confirm graft re-rupture (37/104 [35.6%]), patient-reported outcomes (recurrent instability)/patient reported outcomes measures (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner) (18/104 [17.3%]), and the use of an arthrometer (KT-1000/2000, Rollimeter, or Kneelax) (17/104 [16.3%]). The least common definitions included graft failure or rerupture confirmed by arthroscopy (13/104 [12.5%]) and nonrevision surgery (2/104 [1.0%]). The failure rate of this procedure ranged from 0% to 100% depending on the definition of "failure." Conclusion In this study, we found that a variety of definitions of failure are used among studies published in the orthopaedic literature. The most common criteria for failure of ACLR were the results of physical examination tests (35%), the need for undergoing a revision ACLR (36%), and the use of imaging to diagnose the failure (34%). About 17% of studies included in this review used patient-reported outcomes, specifically recurrent instability, or PROMs (IKDC, KOOS, Tegner) in their assessment of failure of ACLR. The least used definitions of "failure" of ACLR included nonrevision ACLR surgery (2%). Although some studies used similar tests or categories in their definition of failure, there were a variety of score and grade cutoff points between them. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Levi Aldag
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Johnathan Dallman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Erik Henkelman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Ashley Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, U.S.A
| | - Jeffrey Randall
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Armin Tarakemeh
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Tucker Morey
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Bryan G. Vopat
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
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Gureck AE, Crockett Z, Barsky BW, Samuels S, Frank JS, Storer SK, Fazekas ML. Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury? Healthcare (Basel) 2023; 11:2764. [PMID: 37893838 PMCID: PMC10606848 DOI: 10.3390/healthcare11202764] [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: 09/13/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.
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Affiliation(s)
- Ashley E. Gureck
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Zack Crockett
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Brandon W. Barsky
- Department of Sports Medicine, Kettering Health, Kettering, OH 45429, USA
| | - Shenae Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, FL 33021, USA
| | - Jeremy S. Frank
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Stephen K. Storer
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Matthew L. Fazekas
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
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Shibata S, Takemura M, Miyakawa S. Kinematics, Kinetics and Muscle Activity Analysis during Single-leg Drop-jump Landing Followed by an Unanticipated Task: Focusing on Differences in Neurocognitive Function. Int J Sports Phys Ther 2023; 18:1085-1093. [PMID: 37795316 PMCID: PMC10547070 DOI: 10.26603/001c.86124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Lower neurocognitive function is a risk factor for anterior cruciate ligament (ACL) injury. However, the mechanism by which lower neurocognitive function increases the risk of ACL injury remains unclear. Purpose To clarify the effect of differences in neurocognitive function on landing mechanics during a single-leg drop-jump landing motion followed by an unanticipated task. Study Design Cross-sectional study. Methods Fifteen collegiate female athletes were recruited (20.1 ± 1.3 years, 166.6 ± 7.3 cm, 60.6 ± 6.9 kg) and were divided into two groups (the high-performance (HP) group and the lower-performance (LP) group) using the median Symbol Digit Modalities Test (SDMT) score. Three-dimensional motion analysis was employed for the analysis during the experimental task of a single-leg drop-jump followed by an unanticipated landing task from a 30-cm high box. Joint angular changes of the trunk, pelvis, hip, and knee were calculated within the interval from initial contact (IC) to 40ms. Knee and hip moments were calculated as the maximum values within the interval from IC to 40ms. Surface electromyography data from key muscles were analyzed 50ms before and after IC. Independent t-tests were used to compare the effects of different neurocognitive function on the measurement items. Statistical significance was set at p < 0.05. Results The SDMT score was significantly higher in HP group (HP: 77.9 ± 5.5; LP: 66.0 ± 3.4; p < 0.001). The LP group had a significantly greater trunk rotation angular change to the stance leg side (HP: 0.4 ± 0.8; LP: 1.2 ± 0.4; p = 0.020). There were no significant differences between the two groups in terms of joint moments, and muscle activities. Conclusion Differences in neurocognitive function by SDMT were found to be related to differences in motor strategies of the trunk in the horizontal plane. Although trunk motion in the sagittal and frontal planes during single-leg drop-jump landing increases the ACL injury risk by affecting knee joint motion, the effect of trunk motion in the horizontal plane remains unclear. Level of Evidence 3© The Authors.
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Abstract
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ayman Gabr
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Bora M, Deshmukh P. Clinical and Patient-Reported Functional Outcome of Semitendinosus Autograft Anterior Cruciate Ligament Reconstruction With FiberTape® InternalBrace™ All-Inside Technique: A Prospective Study. Cureus 2023; 15:e44700. [PMID: 37809145 PMCID: PMC10552062 DOI: 10.7759/cureus.44700] [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] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
AIM The purpose of this study is to report the early one-year clinical and patient-reported functional outcomes of semitendinosus autograft anterior cruciate ligament reconstruction with the FiberTape® InternalBrace™ all-inside technique. MATERIALS AND METHODS The patient-reported functional outcomes and clinical outcomes were analyzed prospectively following the treatment of 324 unilateral ACL rupture cases with the FiberTape® InternalBrace™ Technique. Patient-reported outcome measures (KOOS scores, WOMAC scores, VAS score, and IKDC score) and clinical examinations like pre-operative and post-operative pivot shift, Lachman test, and range of motion (ROM) were conducted. These tests and examinations were recorded for each patient before surgery and at 3, 6, and 12 months after surgery. Secondary outcomes like re-rupture, infection, synovitis, or limited range of motion were noted. The mean follow-up period was 18±4.5 months (range: 12-24 months). RESULTS Out of a total of 324 cases, 37 cases (11.4%) could not be followed up. 158 patients (55.1%) were male and 129 were female (44.9%). Preoperative mean KOOS pain value, KOOS symptoms, KOOS ADLs, KOOS sport and recreation, and KOOS quality of life were 77.05, 78.69, 84, 21, 89.7, and 57, respectively. All KOOS subsections increased significantly at one-year to 98.37, 99.09, 98.95, 99.02, and 99.30 (p<0.0001), respectively. Mean preoperative WOMAC pain, WOMAC stiffness, and WOMAC function were 76.4, 65.2, and 74.1 and increased significantly at one-year to 94.5, 89.6, and 98.2 (p<0.0001), respectively. There was a significant decrease in VAS for pain from 2.93 before surgery to 0.12 (p<0.0001) at one year. The IKDC score significantly changed from a pre-treatment value of 50.9 to 96.2 (94.5-97.8) at a follow-up of one year. The Lysholm score at 12-months was significant at 95 (93.1-96.9), p<0.05. Post-operative Lachman test values decreased significantly, which meant decreased laxity, from 1.98 (1.89-2.07) pre-operative to 1.60 (1.57-1.62) p<0.05 at one-year post-operative. At one-year follow-up, 276 patients (96%) had fully recovered. CONCLUSION It was concluded that the FiberTape® InternalBrace™ technique for ACL reconstruction provides orthopedic surgeons with an effective alternative technique to conventional methods of surgery and also reduces the overall time to recovery for patients, thereby allowing them to return to sports faster. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Manu Bora
- Orthopedic Surgery, Nexus Day Surgery Center, Mumbai, IND
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Ajdaroski M, Esquivel A. Can Wearable Sensors Provide Accurate and Reliable 3D Tibiofemoral Angle Estimates during Dynamic Actions? SENSORS (BASEL, SWITZERLAND) 2023; 23:6627. [PMID: 37514921 PMCID: PMC10383318 DOI: 10.3390/s23146627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
The ability to accurately measure tibiofemoral angles during various dynamic activities is of clinical interest. The purpose of this study was to determine if inertial measurement units (IMUs) can provide accurate and reliable angle estimates during dynamic actions. A tuned quaternion conversion (TQC) method tuned to dynamics actions was used to calculate Euler angles based on IMU data, and these calculated angles were compared to a motion capture system (our "gold" standard) and a commercially available sensor fusion algorithm. Nine healthy athletes were instrumented with APDM Opal IMUs and asked to perform nine dynamic actions; five participants were used in training the parameters of the TQC method, with the remaining four being used to test validity. Accuracy was based on the root mean square error (RMSE) and reliability was based on the Bland-Altman limits of agreement (LoA). Improvement across all three orthogonal angles was observed as the TQC method was able to more accurately (lower RMSE) and more reliably (smaller LoA) estimate an angle than the commercially available algorithm. No significant difference was observed between the TQC method and the motion capture system in any of the three angles (p < 0.05). It may be feasible to use this method to track tibiofemoral angles with higher accuracy and reliability than the commercially available sensor fusion algorithm.
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Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, College of Engineering and Computer Science, University of Michigan-Dearborn, Dearborn, MI 48128, USA
| | - Amanda Esquivel
- Department of Mechanical Engineering, College of Engineering and Computer Science, University of Michigan-Dearborn, Dearborn, MI 48128, USA
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Spolaor F, Guiotto A, Ciniglio A, Cibin F, Sawacha Z. Effects of a proprioceptive focal stimulation (Equistasi®) on reducing the biomechanical risk factors associated with ACL injury in female footballers. Front Sports Act Living 2023; 5:1134702. [PMID: 37521101 PMCID: PMC10382620 DOI: 10.3389/fspor.2023.1134702] [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: 12/30/2022] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Football presents a high rate of lower limb injuries and high incidence of Anterior Cruciate Ligament (ACL) rupture, especially in women. Due to this there is the need to optimize current prevention programs. This study aims to verify the possibility to reduce the biomechanical risk factors associated with ACL injury, through the application of proprioceptive stimulation by means of the Equistasi® device. Methods Ten elite female footballers were enrolled and received the device for 4 weeks (5 days/week, 1h/day). Athletes were assessed directly on-field at four time points: T0 and T1 (evaluation without and with the device), T2 (after 2 weeks), T4 (after 4 weeks) while performing two different tasks: Romberg Test, and four sidestep cutting maneuvers bilaterally. Seven video cameras synchronized with a plantar pressure system were used, thirty double colored tapes were applied on anatomical landmarks, and three dimensional coordinates reconstructed. Vertical ground reaction forces and center of pressure data were extracted from the plantar pressure insoles. Hip, knee, and ankle flexion-extension angles and moments were computed as well as abd-adduction joint torques. From the Romberg Test both center of pressure descriptive variables and frequency analysis parameters were extracted. Each variable was compared among the different time frames, T1, T2 and T4, through Friedman Test for non-parametric repeated measures (p<0.05); Wilcoxon Signed Rank Test was used for comparing variables between T0 and T1 (p<0.05) and across the different time frames as follows: T1-T2, T2-T4 and T1-T4. Results Statistically significant differences in both posturographic and biomechanical variables between the assessment at T0 and T1 were detected. Reduced hip and knee abduction torques were revealed in association with reduced both ground reaction forces and ankle dorsiflexion torque from T1 up to T4. Discussion The proprioceptive stimuli showed to have the potential to improve cutting biomechanics mainly with respect to the ligament and quadriceps dominance theories. Results of the present study, even if preliminary and on a small sample size, could be considered promising towards the inclusion of proprioceptive training in injury prevention programs.
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Affiliation(s)
- Fabiola Spolaor
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Annamaria Guiotto
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Alfredo Ciniglio
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Zimi Sawacha
- Department of Information Engineering, University of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
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Massidda M, Flore L, Scorcu M, Monteleone G, Tiloca A, Salvi M, Tocco F, Calò CM. Collagen Gene Variants and Anterior Cruciate Ligament Rupture in Italian Athletes: A Preliminary Report. Genes (Basel) 2023; 14:1418. [PMID: 37510322 PMCID: PMC10379389 DOI: 10.3390/genes14071418] [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: 05/23/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Several studies have investigated the role of genetics in anterior cruciate ligament (ACL) rupture, often returning conflicting results. The present pilot study aimed to analyze the association between six Single Nucleotide Polymorphisms (SNPs) (rs1800012; rs12722; rs13946; rs240736; rs970547; and rs4870723, located on the COL1A1, COL5A1, COL12A1, and COL14A1 genes), and ACL rupture, among Italian athletes. A hypothesis-driven association study was conducted. In total, 181 male and female athletes (n = 86 injured; n = 96 non-injured) were genotyped for the prioritized variants. All polymorphisms were genotyped using PCR RFLP, with the only exception being the rs1800012 on the COL1A1 gene, which was detected using MTPA PCR. The allele frequency distribution fell within the worldwide range. Despite the evident population variability, no selective pressure signals were recorded using PBS analysis. No significant difference was detected between the cases and controls for any of the SNPs (rs1800012; rs13946; rs240736; rs970547, and rs4870723) included in the analyses (p > 0.008, Bonferroni-adjusted for multiple comparisons). Moreover, no significant differences were found when males and females were assessed separately. Further investigations based on a larger sample size are needed, in order to draw solid conclusions for the influence between collagen genes and ACL rupture.
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Affiliation(s)
- Myosotis Massidda
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Laura Flore
- Department of Sciences of Life and Environment, University of Cagliari, 09042 Monserrato, Italy
| | - Marco Scorcu
- Italian Federation of Sports Medicine (FIMS), CR Sardegna, 00196 Rome, Italy
| | - Giovanni Monteleone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alessandra Tiloca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | | | - Filippo Tocco
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Carla M Calò
- Department of Sciences of Life and Environment, University of Cagliari, 09042 Monserrato, Italy
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Baek SY, Beaulieu ML, Wojtys EM, Ashton-Miller JA. Relationship Between Lateral Tibial Posterior Slope and Tibiofemoral Kinematics During Simulated Jump Landings in Male Cadaveric Knees. Orthop J Sports Med 2023; 11:23259671231160213. [PMID: 37347020 PMCID: PMC10280540 DOI: 10.1177/23259671231160213] [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: 10/21/2022] [Accepted: 01/01/2023] [Indexed: 06/23/2023] Open
Abstract
Background It is not known mechanistically whether a steeper lateral posterior tibial slope (LTS) leads to an increase in anterior tibial translation (ATT) as well as internal tibial rotation (ITR) during a given jump landing. Hypothesis A steeper LTS will result in increased ATT and ITR during simulated jump landings when applying knee compression, flexion, and internal tibial torque of increasing severity. Study Design Descriptive laboratory study. Methods Seven pairs of cadaveric knees were harvested from young male adult donors (mean ± SD; age, 25.71 ± 5.53 years; weight, 71.51 ± 4.81 kg). The LTS of each knee was measured by a blinded observer from 3-T magnetic resonance images. Two sets of 25 impact trials of ∼700 N (1× body weight [BW] ±10%) followed by 2 sets of 25 trials of 1400 N (2× BW ±10%) were applied to a randomly selected knee of each pair. Similarly, on the contralateral knee, 2 sets of 25 impact trials of ∼1800 N (2.5× BW ±10%) followed by 2 sets of 25 trials of ∼2100 N (3× BW ±10%) were applied. Three-dimensional knee kinematics, including ATT and ITR, were measured at 400 Hz using optoelectronic motion capture. Two-factor linear mixed effect models were used to determine the relationship of LTS to ATT and ITR as impact loading increased. Results As LTS increased, so did ATT and ITR during increasingly severe landings. LTS had an increasing effect on ATT (coefficient, 0.50; 95% CI, 0.29-0.71) relative to impact force (coefficient, 0.52; 95% CI, 0.50-0.53). ITR was proportional to LTS (coefficient, 1.36; 95% CI, 0.80-1.93) under increasing impact force (coefficient, 0.49; 95% CI, 0.47-0.52). For steeper LTS, the increase in ITR was proportionally greater than the increase in ATT. Conclusion In male knee specimens, a steeper LTS significantly increased ATT and ITR during jump landings. Clinical Relevance Increases in ITR and ATT during jump landings lead to increased strain on the anterior cruciate ligament and are therefore associated with greater risk of ligament failure.
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Affiliation(s)
- So Young Baek
- Department of Mechanical Engineering,
University of Michigan, Ann Arbor, Michigan, USA
| | - Mélanie L. Beaulieu
- Department of Orthopedic Surgery,
University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M. Wojtys
- Department of Orthopedic Surgery,
University of Michigan, Ann Arbor, Michigan, USA
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Khatri NP, Bharali I, Khan I, Borgohain GS. Arthroscopic Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Quadrupled Hamstring Tendon Graft: A Single-Institution Experience From North-Eastern India. Cureus 2023; 15:e40547. [PMID: 37465795 PMCID: PMC10350651 DOI: 10.7759/cureus.40547] [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] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Background There is a lack of literature regarding the arthroscopic approach to a single-bundle anterior cruciate ligament (ACL) reconstruction using the quadrupled hamstring tendon graft in the north-eastern Indian population. Methodology A prospective, single-center study was planned for patients with ACL tears according to the eligibility criteria and with a defined surgical protocol. Patients were followed up from the preoperative period for at least one year, and knee function was evaluated using the International Knee Documentation Committee (IKDC) subjective knee score and the Lysholm knee score. Results A total of 29 patients were followed up for a mean of 14.6 months (12-22 months). The mean age of patients was 26.83 ± 7.50 years, with a male:female ratio of 4.8:1 and almost equal involvement of both knees. There was statistically significant improvement (p<0.001) in results in the Lachman test, anterior drawer test, pivot shift test, IKDC score, and Lysholm score. No intraoperative or postoperative complications were found in the present study. Discussion The study shows that arthroscopic anatomical single-bundle ACL reconstruction using quadrupled hamstring tendon grafts is a minimally invasive, safe, and effective procedure that provides anteroposterior and rotational stability and good to excellent functional outcomes.
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Affiliation(s)
| | | | - Imran Khan
- Orthopaedics, Down Town Hospital, Guwahati, IND
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Sanjay N, Shanthappa AH, Kurahatti A, Kumaar A. Comparison of Clinical, Magnetic Resonance Imaging (MRI) and Arthroscopic Findings in Assessment of Cartilage Defects and Internal Derangement of Knee. Cureus 2023; 15:e40110. [PMID: 37425579 PMCID: PMC10329210 DOI: 10.7759/cureus.40110] [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] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The knee is the most commonly injured joint because of its anatomical structure, its exposure to external forces, and its functional demands. Orthopaedic surgeons previously relied on clinical evaluation for diagnosing any internal derangement of the knee joint. With the advent of new clinical methods for diagnosing ligament injuries and cartilage defects, there are very less studies comparing the accuracy of all three methods, clinical examination, magnetic resonance imaging (MRI) and arthroscopy to reach a definitive diagnosis. OBJECTIVE This study aims to compare the sensitivity, specificity, accuracy and predictive values of clinical examination and MRI with that of arthroscopy which is the ideal investigation of choice for cartilage defects and internal derangements of the knee. MATERIAL AND METHODS A prospective, observational and hospital-based study was done on patients with internal derangement of knee and cartilage defects. Clinical examination (based on the clinical tests for each ligament), MRI (1.5 T) and arthroscopy were done on all patients, the findings of which were compared using the Chi-square test. The following parameters were assessed while using arthroscopy as the gold standard of reference: accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Anterior cruciate ligament (ACL) was the most common ligament to be injured followed by the medial meniscus. The overall accuracy of clinical evaluation and MRI to diagnose meniscal injuries was found to be 94% and 91% respectively. The clinical examination had sensitivity and specificity of 96% and 82% in diagnosing ACL tears, respectively, whereas MRI had sensitivity and specificity of 88% and 76% respectively. For the medial meniscus, the clinical examination had sensitivity and specificity of 93% and 96% respectively whereas MRI had a sensitivity of 100% and specificity of 89%. We observed that the accuracy of MRI for grading ACL and meniscal tears was similar i.e. 79% and 78% respectively, but was slightly low (70%) for grading of chondromalacia patellae. CONCLUSION This study supports the use of MRI and clinical assessment in the diagnosis of chondral defects and internal knee derangement. Clinical tests are reliable and have high sensitivity in diagnosing ACL tears and chondral defects when compared to MRI. Not all lesions should routinely undergo MRI for diagnostic purposes; only a few circumstances warrant its usage. MRI is less reliable in grading ACL tears, meniscal tears and chondral injuries.
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Affiliation(s)
- Nandini Sanjay
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Ajay Kurahatti
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun Kumaar
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Alyami AH, Darraj H, Hamdi S, Saber A, Bakri N, Maghrabi R, Hakami KM, Darraj A. Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs among Saudi Athletes. Clin Pract 2023; 13:656-665. [PMID: 37366929 DOI: 10.3390/clinpract13030060] [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: 04/01/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is a common medical condition that entails a stretch or sprain of the ACL, which is present in the knee joint. The incidence of ACL injury in the Kingdom of Saudi Arabia is estimated to be 31.4%. Prevention training programs (PTPs) can be used to reduce ACL injuries sustained during physical activity, as they primarily focus on improving strength, balance, and lower limb biomechanics and reducing landing impact. This study aimed to assess Saudi athletes' awareness of ACL injury PTPs. METHODS A cross-sectional survey in the form of a self-administered questionnaire in the Arabic language was carried out from 22 December 2022 to 7 March 2023 and included 1169 Saudi athletes. Statistical analyses were performed on the collected data using frequency and percentages. Binary logistic regression was used for the adjusted analysis and determining associations between athletes playing high- and low-risk sports. RESULTS Overall, 52% of participants were female athletes, and 48% were male athletes. The western region of the country had the highest response rate (28.9%). The most common sport played was football at 36.6%. Most participants (70.97%) reported that their information on ACL injury was taken by their coaches. When assessing whether participants were familiar with the concept of an ACL injury PTP, the majority of the participants answered no, representing 971 (662 high-risk, 309 low-risk), compared to those who answered yes, representing only 198 (167 high-risk, 31 low-risk), with a statistically significant difference (adjusted OR: 2.106; 95% confidence interval: 1.544-2.873; p-value < 0.001). CONCLUSION In general, the level of awareness of ACL injury PTPs among Saudi athletes was poor.
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Affiliation(s)
- Ali H Alyami
- Department of Surgery, Ministry of the National Guard Health Affairs, Jeddah 21423, Saudi Arabia
- Department of Surgery, King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
| | - Hussam Darraj
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sulaiman Hamdi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Abdulaziz Saber
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
| | - Nawaf Bakri
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Rawan Maghrabi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalid M Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Anwar Darraj
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Bæktoft van Weert M, Skovdal Rathleff M, Eppinga P, Møller Mølgaard C, Welling W. Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study. Knee 2023; 42:390-399. [PMID: 37230002 DOI: 10.1016/j.knee.2023.04.016] [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: 12/13/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the potential difference in jump-landing techniques between IF and EF instructions in patients after ACLR. METHODS Thirty patients (12 females, mean age 23.26 ± 4.91 years) participated after ACLR. Patients were randomly assigned into two groups that each followed a different testing sequence. Patients performed a drop vertical jump-landing test after receiving instructions with varying types of focus of attention. The Landing Error Scoring System (LESS) assessed the jump-landing technique. RESULTS EF was associated with a significantly better LESS score (P < 0.001) compared with IF. Only EF instructions led to improvements in jump-landing technique. CONCLUSION Using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. This indicates that increased use of EF could or might result in a better treatment outcome during ACLR rehabilitation.
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Affiliation(s)
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Centre for General Practice at Aalborg University, Aalborg, Denmark; Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Peter Eppinga
- Medisch Centrum Zuid (MCZ), Groningen, The Netherlands
| | - Carsten Møller Mølgaard
- Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Groningen, The Netherlands; Pro-F Fysiotherapie, Enschede, The Netherlands.
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Zhang Y, Hu Z, Li B, Qiu X, Li M, Meng X, Kim S, Kim Y. Gender Differences in Lower Extremity Stiffness during a Single-Leg Landing Motion in Badminton. Bioengineering (Basel) 2023; 10:631. [PMID: 37370562 DOI: 10.3390/bioengineering10060631] [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: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
In general, at the same level of exercise, female athletes are three to six times more likely to injure an anterior cruciate ligament (ACL) than male athletes. Female athletes also had higher rates of ACL injury than males in a single-leg landing task after a backcourt backhand side overhead stroke in badminton. In many previous studies, stiffness of the musculoskeletal system in the lower limbs has been reported as a potential factor contributing to differences in ACL injury rates between genders. The purpose of this study was to describe the differences between genders in leg and knee stiffness in male and female athletes during a single-leg landing action after the backhand side overhead shot in the backcourt. Eight male athletes and eight female athletes participated in this test. Leg stiffness and knee stiffness were calculated separately for male and female athletes during the landing phase. The results showed that both absolute and normalized leg stiffness were lower in female athletes than in male athletes (p < 0.05). And both absolute and normalized knee stiffness were also lower than male athletes (p < 0.05). The low leg stiffness and knee stiffness demonstrated by females in this single-leg drop task compared to male athletes may indicate that females have lower dynamic leg stability than males during the drop, which may lead to hypermobility of the knee joint and may put females at a higher risk of injury in this high-risk maneuver for non-contact cruciate ligament injuries.
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Affiliation(s)
- Yanan Zhang
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Zhe Hu
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Bairan Li
- Department of Physical Education, Putian University, Putian 351100, China
| | - Xuan Qiu
- Department of Physical Education, Yichun University, Yichun 336000, China
| | - Ming Li
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Xiangwei Meng
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Sukwon Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Youngsuk Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
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Seyedi M, Zarei M, Daneshjoo A, Rajabi R, Shirzad E, Mozafaripour E, Mohammadpour S. Effects of FIFA 11 + warm-up program on kinematics and proprioception in adolescent soccer players: a parallel‑group randomized control trial. Sci Rep 2023; 13:5527. [PMID: 37016130 PMCID: PMC10073194 DOI: 10.1038/s41598-023-32774-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/02/2023] [Indexed: 04/06/2023] Open
Abstract
This study aimed to compare the effects of 8 weeks 11 + warm-up injury prevention program on kinematics and proprioception in adolescent male and female soccer players. Forty adolescent soccer players (20 males, 20 females) aged between 14-16 years old were randomly assigned into four groups. The experimental group performed the 11 + program for 8 weeks and the control group did their warm-up program. The kinematic variable in a cutting maneuver was measured using VICON motion analysis and ankle and knees' proprioception by joint position sense (JPS) was measured using a digital inclinometer. For kinematic variables only significant differences in knee valgus among females 11 + compared with female and male control groups were found (P < 0.05). Moreover, there were significant improvements in joint position sense variables in 11 + groups compared to control groups (P < 0.05). In conclusion, the 11 + program was proven to be a useful warm-up protocol in improving knee valgus and JPS among female and male adolescent soccer players. We suggest adding more training elements to the 11 + program that aimed to enhance the proper alignment of lower extremities which may consequently improve joint kinematics.
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Affiliation(s)
- Mohammadreza Seyedi
- Department of Sport Medicine, Sport Sciences Research Institute, Tehran, Iran.
| | - Mostafa Zarei
- Sport Rehabilitation and Health Department, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abdolhamid Daneshjoo
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Reza Rajabi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Elham Shirzad
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Esmaeil Mozafaripour
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Shadan Mohammadpour
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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Huddleston WE, Probasco MO, Reyes MA. The Kinetic Chain Has a Brain: Could Adding Cognitive Demands in Lower Limb Injury Prevention Programs Improve Outcomes? J Orthop Sports Phys Ther 2023; 53:159-161. [PMID: 36939287 DOI: 10.2519/jospt.2023.11403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
SYNOPSIS: The most effective lower limb injury prevention programs include strength training, balance exercises, and instructions on how to land safely from a jump or hop. Yet, the programs are not 100% effective-lower extremity noncontact injuries continue to be a significant problem. We suggest that adding cognitive training to motor tasks that currently comprise current lower limb injury prevention programs might help clinicians, athletes, and coaches continue to make inroads into preventing knee injuries. We ground our hypotheses in robust findings from cognitive neuroscience and rehabilitation, suggesting that when task demands exceed the attentional capacity of an individual, the risk for noncontact lower extremity injuries increases. In this editorial, we explain the concepts of attentional capacity and attentional demands, and the interplay of the two in sport, to justify including cognitive tasks to injury prevention programs to improve outcomes. J Orthop Sports Phys Ther 2023;53(4):1-3. doi:10.2519/jospt.2023.11403.
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Affiliation(s)
- Wendy E Huddleston
- Doctor of Physical Therapy Program, Department of Rehabilitation Sciences & Disorders, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Mark O Probasco
- Doctor of Physical Therapy Program, Department of Rehabilitation Sciences & Disorders, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Michaela A Reyes
- Doctor of Physical Therapy Program, Department of Rehabilitation Sciences & Disorders, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
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Wang Y, Liu H, Wei H, Wu C, Yuan F. The Effect of a Knee Brace on Muscle Forces during Single-Leg Landings at Two Heights. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4652. [PMID: 36901663 PMCID: PMC10002319 DOI: 10.3390/ijerph20054652] [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: 12/31/2022] [Revised: 02/18/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Single-leg landing is one of the maneuvers that has been linked to non-contact anterior cruciate ligament (ACL) injuries, and wearing knee braces has been shown to reduce ACL injury incidence. The purpose of this study was to determine whether wearing a knee brace has an effect on muscle force during single-leg landings at two heights through musculoskeletal simulation. Eleven healthy male participants, some braced and some non-braced were recruited to perform single-leg landings at 30 cm and 45 cm. We recorded the trajectories and ground reaction forces (GRF) using an eight-camera motion capture system and a force platform. The captured data were imported into the generic musculoskeletal model (Gait2392) in OpenSim. Static optimization was used to calculate the muscle forces. The gluteus minimus, rectus femoris, vastus medialis, vastus lateralis, vastus medialis medial gastrocnemius, lateral gartrocnemius, and soleus muscle forces were all statistically significant different between the braced and non-braced participants. Simultaneously, increasing the landing height significantly affected the gluteus maximums, vastus medialis, and vastus intermedia muscle forces. Our findings imply that wearing a knee brace may alter muscle forces during single-leg landings, preventing ACL injuries. Additionally, research demonstrates that people should avoid landing from heights due to the increased risk of knee injuries.
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Affiliation(s)
- Yubin Wang
- School of Sport and Health Science, Dalian University of Technology, Dalian 116024, China
- College of General Aviation and Flight, Nanjing University of Aeronautics and Astronautics, Nanjing 213300, China
| | - Haibin Liu
- School of Sport and Health Science, Dalian University of Technology, Dalian 116024, China
| | - Huidong Wei
- College of General Aviation and Flight, Nanjing University of Aeronautics and Astronautics, Nanjing 213300, China
| | - Chenxiao Wu
- School of Sport and Health Science, Dalian University of Technology, Dalian 116024, China
| | - Feijie Yuan
- School of Sport and Health Science, Dalian University of Technology, Dalian 116024, China
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [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: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chan JJ, Xiao RC, Hasija R, Huang HH, Kim JM. Epidemiology of Hand and Wrist Injuries in Collegiate-Level Athletes in the United States. J Hand Surg Am 2023; 48:307.e1-307.e7. [PMID: 34895779 DOI: 10.1016/j.jhsa.2021.10.011] [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: 06/07/2020] [Revised: 08/26/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Hand and wrist injuries are common among competitive athletes and can have a substantial impact on playing time and future participation. The purpose of this study was to provide epidemiological data from the National Collegiate Athletic Association Injury Surveillance Program to correlate injury diagnosis with the need for surgery and time loss. METHODS Using the National Collegiate Athletic Association Injury Surveillance Program, this retrospective study extracted data of hand and wrist injuries for all 25 National Collegiate Athletic Association sports from the academic years 2004-2005 to 2013-2014. The "severe" category was defined as injuries resulting in the following: (1) surgery, (2) season-ending status, or (3) more than 30 days of playing time loss. The epidemiologic data included injury rate per 100,000 athlete exposures (defined as 1 athlete participating in 1 practice or competition) based on diagnoses and demographic information such as sports and sex. We used a Poisson regression model to estimate the incidence rate and 95% confidence interval. RESULTS Overall, 4,851 hand injuries were identified, with an injury rate of 41.2 per 100,000 athlete exposures. The most common diagnoses were metacarpal or phalangeal fractures (19.9%), lacerations or contusions (15.4%), and wrist sprains (14.7%). The surgical rate was 9.6%, and the season-ending rate was 5.8%. Severe injuries occurred in 17.5% of the hand and wrist injuries; within this subset, the most common diagnoses included metacarpal or phalangeal fractures (43.8%), scaphoid fractures (12.8%), and thumb ulnar collateral ligament tears (8.7%). Scaphoid fractures and metacarpal or phalangeal fractures had the highest surgical rate and season-ending rate among all the injuries. CONCLUSIONS The injury rate of hand and wrist injuries is comparable with those of other common sports injuries. Approximately one fifth of the injuries were considered severe, which led to a high surgical rate, and these had a considerable impact on the athletes' ability to finish the season. TYPE OF STUDY/LEVEL OF EVIDENCE Outcome research level II.
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Affiliation(s)
- Jimmy J Chan
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan C Xiao
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rohit Hasija
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaehon M Kim
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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Hao K, Niu Y, Kong L, Wang F. The patient with patellar instability has a stenotic intercondylar notch and a thin anterior cruciate ligament: a retrospective comparative study. J Orthop Surg Res 2023; 18:144. [PMID: 36849936 PMCID: PMC9972627 DOI: 10.1186/s13018-023-03632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/22/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Patellar instability (PI) usually combines with morphological abnormalities of femoral condyles that may affect the morphology of the intercondylar notch and anterior cruciate ligament (ACL), which are important in individualized ACL reconstruction. This study aimed to investigate the morphological characteristics of the intercondylar notch and ACL in patients with PI. METHODS 80 patients with PI and 160 age- and gender-matched controls from January 2014 to June 2022 were studied. Morphological measurements of the femoral condyles included intercondylar notch height, notch width, medial condylar width, lateral condylar width, bicondylar width, notch width index, notch angle, lateral femoral condyle ratio (LFCR), condyle flexion angle, and posterior tibial slope. Morphological measurements of the ACL included ACL length, inclination angle, and ACL size. The measurements were compared between PI and control groups, and between males and females in PI group. The independent samples t-test was performed to examine differences in continuous variables. The chi-square test was used for comparing categorical variables. RESULTS The intercondylar notch width, bicondylar width, notch width index, and notch angle were significantly smaller, while the LFCR was significantly larger in PI group than those of control group (p < 0.05). The ACL thickness (0.70 ± 0.16 cm vs 0.80 ± 0.21 cm, p = 0.023) and width (0.54 ± 0.14 cm vs 0.60 ± 0.13 cm, p = 0.029) were significantly smaller in PI group. The notch width was significantly smaller in female patients than males in PI group, but no significant difference was observed in the notch width index and notch angle (p > 0.05). No sex difference related to the morphology of the ACL was found. CONCLUSIONS The patient with PI had a stenotic intercondylar notch and a thin ACL. No significant sex difference in the intercondylar notch stenosis and ACL size was observed. The morphology of the intercondylar notch and ACL should be taken into consideration when planning individualized ACL reconstruction in the presence of PI.
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Affiliation(s)
- Kuo Hao
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Yingzhen Niu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Lingce Kong
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Nawasreh ZH, Yabroudi MA, Al-Shdifat AB, Obaidat SM, Daradkeh SM, Kassas MN, Bashaireh KM. Patient-Reported Measures Associated with the Return to Pre-Injury Levels of Sport 2 Years after Anterior Cruciate Ligament Reconstruction. J Funct Morphol Kinesiol 2023; 8:jfmk8010028. [PMID: 36976125 PMCID: PMC10057626 DOI: 10.3390/jfmk8010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Abstract
The International Knee Documentation Committee Subjective Knee Form (IKDC2000) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) are knee-specific measures. However, their association with a return to sports after anterior cruciate ligament reconstruction (ACLR) is unknown. This study aimed to investigate the association between the IKDC2000 and the KOOS subscales and the return to the same pre-injury level of sport two years after ACLR. Forty athletes that were two years post-ACLR participated in this study. Athletes provided demographic information, filled out the IKDC2000 and KOOS subscales, and indicated whether they returned to any sport and whether they returned to the same pre-injury level (same duration, intensity, and frequency). In this study, 29 (72.5%) athletes returned to play any sport and eight (20%) returned to the same pre-injury level. The IKDC2000 (r: 0.306, p = 0.041) and KOOS quality of life (KOOS-QOL) (r: 0.294, p = 0.046) significantly correlated with the return to any sport, but it was age (r: -0.364, p = 0.021), BMI (r: -0.342, p = 0.031), IKDC2000 (r: 0.447, p = 0.002), KOOS-pain (r: 0.317, p = 0.046), KOOS sport and recreation function (KOOS-sport/rec)(r: 0.371, p = 0.018), and KOOS QOL (r: 0.580, p > 0.001) that significantly correlated with a return to the same pre-injury level. High KOOS-QOL and IKDC2000 scores were associated with returning to any sport, and high KOOS-pain, KOOS-sport/rec, KOOS-QOL, and IKDC2000 scores were all associated with returning to the same pre-injury level of sport.
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Affiliation(s)
- Zakariya H Nawasreh
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Mohammad A Yabroudi
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Anan B Al-Shdifat
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Sakher M Obaidat
- Department of Physical Therapy and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Sharf M Daradkeh
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Mohamed N Kassas
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Khaldoon M Bashaireh
- Department of Special Surgery, College of Medicine, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
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Ma Y, Wu X, Shen S, Hong W, Qin Y, Sun M, Luan Y, Zhou X, Zhang B. Relationship between Locomotive Syndrome and Musculoskeletal Pain and Generalized Joint Laxity in Young Chinese Adults. Healthcare (Basel) 2023; 11:healthcare11040532. [PMID: 36833063 PMCID: PMC9956093 DOI: 10.3390/healthcare11040532] [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: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
This study aims to investigate the prevalence of locomotive syndrome (LS) and to examine the relationship of LS with musculoskeletal symptoms (pain, generalized joint laxity (GJL)) in young Chinese adults. Our study population (n = 157; mean age of 19.8 ± 1.2 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Musculoskeletal pain was assessed by self-report and visual analog scale (VAS), and joint body laxity was evaluated using the GJL test. The prevalence of LS was 21.7% of all participants. Musculoskeletal pain affected 77.8% of the college students with LS and was strongly associated with LS. A total of 55.0% of college students with LS had four or more site joints that were positive for GJL, and higher scores of GJL were associated with a higher prevalence rate of LS. Young Chinese college students have a relatively high prevalence of LS, and musculoskeletal pain and GJL were significantly related to LS. The present results suggest that we need early screening of musculoskeletal symptoms and LS health education in young adults to prevent the mobility limitations of LS in the future.
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Affiliation(s)
- Yixuan Ma
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xinze Wu
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi 980-8574, Japan
| | - Shaoshuai Shen
- School of Education and Welfare, Aichi Prefectural University, 1522-3 Ibaragabasama, Nagakute, Aichi 480-1198, Japan
| | - Weihao Hong
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Ying Qin
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Mingyue Sun
- Department of Physiotherapy, Planet Rehabilitation Center, Planet Rehabilitation Technology Co., Ltd., Guangzhou 510623, China
| | - Yisheng Luan
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xiao Zhou
- School of Physical Education, Huazhong University of Science and Technology, Wuhan 430074, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
| | - Bing Zhang
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
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Dalvandpour N, Zareei M, Abbasi H, Abdoli B, Mohammadian MA, Rommers N, Rössler R. Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial. J Strength Cond Res 2023; 37:337-342. [PMID: 36696258 DOI: 10.1519/jsc.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.
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Affiliation(s)
- Nazanin Dalvandpour
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mostafa Zareei
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Hamed Abbasi
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Sciences in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | | | - Nikki Rommers
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland; and
| | - Roland Rössler
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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50
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Boey D, Lee M. The Association Between Functional Movement Screen Scores and Knee Valgus Moments During Unplanned Sidestep Cutting in Netball. Int J Sports Phys Ther 2023; 18:113-121. [PMID: 36793577 PMCID: PMC9897044 DOI: 10.26603/001c.57678] [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: 02/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Regular employment of three-dimensional (3D) motion analyses to assess and monitor knee valgus moments; a contributor to non-contact anterior cruciate ligament (ACL) injury; during unplanned sidestep cutting (USC) is costly and time-consuming. An alternative quick-to-administer assessment tool to infer an athlete's risk for this injury could allow prompt and targeted interventions to mitigate this risk. Purpose This study investigated whether peak knee valgus moments (KVM) during weight-acceptance phase of an unplanned sidestep cut were correlated with composite and component scores of the Functional Movement Screen (FMS™). Study Design Cross-sectional, Correlation. Methods Thirteen female national-level netballers performed six movements of the FMS™ protocol and three trials of USC. A 3D motion analysis system captured lower limb kinetics and kinematics of each participant's non-dominant leg during USC. Averages of peak KVM across USC trials were calculated and examined for correlations with composite and component scores of the FMS™. Results No correlations were found between FMS™ composite or any of its component scores with peak KVM during USC. Conclusions The current FMS™ did not show any correlations with peak KVM during USC on the non-dominant leg. This suggests that the FMS™ has limited utility in screening for non-contact ACL injury risks during USC. Level of Evidence 3.
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Affiliation(s)
| | - Marcus Lee
- Sport Biomechanics Singapore Sport Institute
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