scholarly journals Can Technique Modification Training Reduce Knee Moments in a Landing Task?

2014 ◽  
Vol 30 (2) ◽  
pp. 231-236 ◽  
Author(s):  
Alasdair R. Dempsey ◽  
Bruce C. Elliott ◽  
Bridget J. Munro ◽  
Julie R. Steele ◽  
David G. Lloyd
Keyword(s):  
Internal Rotation ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Inverse Dynamic ◽  
Acl Injuries ◽  
Can Technique ◽  
Before And After ◽  
Reaction Forces ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries are costly. Sidestep technique training reduces knee moments that load the ACL. This study examined whether landing technique training alters knee moments. Nineteen team sport athletes completed the study. Motion analysis and ground reaction forces were recorded before and after 6 weeks of technique modification. An inverse dynamic model was used to calculate three-dimensional knee loading. Pre- and postintervention scores were compared using pairedttests. Maximal knee flexion angle during landing was increased following training. There was no change in valgus or flexion moments, but an increase in peak internal rotation moment. This increase in internal rotation moment may increase the risk of ACL injury. However, the increased angle at which the peak internal rotation moment occurred at follow up may mitigate any increase in injury risk by reducing load transmission.

Knee Valgus Versus Knee Abduction Angle: Comparative Analysis of Medial Knee Collapse Definitions in Female Athletes

2020 ◽  
Vol 142 (12) ◽  
Author(s):  
Taylor Oldfather ◽  
Michael Zabala ◽  
Michael Goodlett ◽  
William (Hank) Murrah
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Reference Plane ◽  
Abduction Angle ◽  
Knee Valgus ◽  
Acl Injuries ◽  
Valgus Angle ◽  
Anterior Cruciate

Abstract The knee valgus angle (KVA) is heavily researched as it has been shown to correlate to anterior cruciate ligament (ACL) injuries when measured during jumping activities. Many different methods of KVA calculation are often treated as equivalent. The purpose of this study is to elucidate differences between these commonly used angles within and across activities to determine if they can indeed properly be treated as equivalent. The kinematics of 23 female athletes, D1 soccer, D1 basketball, and club soccer (height = 171.2 ± 88.9 cm, weight = 66.3 ± 8.6 kg, age = 19.8 ± 1.9 years), was analyzed using a motion capture system during activities related to their sport and daily living. The abduction KVA, measured using body fixed axes, only correlated to the two-dimensional (2D) global reference frame angle (KVA 2G) in three of the six activities (walking, squatting, and walking down stairs), and one out of six in the three-dimensional (3D) measurements (jogging). This suggests that the abduction KVA does not always relate to other versions of KVA. The KVA with reference to the pelvis coordinate system (KVA 2P) correlated to the KVA 2G in six out of six activities (r = 0.734  ±  0.037, P << 0.001) suggesting the pelvis can be utilized as a reference plane during rotating tasks, such as run-to-cut, when a fixed global system is less meaningful. Not all measures of KVA are equivalent and should be considered individually. A thorough understanding of the equivalence or nonequivalence of various measures of KVA is essential in understanding ACL injury risk.

Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk

2021 ◽  
pp. 1-8
Author(s):  
Dhruv Gupta ◽  
Jeffrey A. Reinbolt ◽  
Cyril J. Donnelly
Keyword(s):  
Internal Rotation ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Whole Body ◽  
Jump Landing ◽  
Peak Knee ◽  
Knee Abduction ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.

scholarly journals Return to Play (RTP) and Performance in the Women’s National Basketball Association (WNBA) Following Anterior Cruciate Ligament (ACL) Reconstruction (194)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Joseph Tramer ◽  
Lafi Khalil ◽  
Alexander Ziedas ◽  
Muhammad Abbas ◽  
Nima Mehran ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Post Injury ◽  
Acl Injuries ◽  
Post Surgery ◽  
Before And After ◽  
Playing Time ◽  
Anterior Cruciate ◽  
And Performance

Objectives: The incidence of ACL injuries in WNBA athletes has been on the rise, despite the high rates of ACL injury there is a paucity of recent research examining the effect of ACL reconstruction on RTP and performance in these athletes. This cohort study seeks to quantify the effect of ACL reconstruction on RTP and performance on WNBA athletes. Methods: All ACL tears sustained in the WNBA from 1997-2018 were identified. BMI, age and position at the time of injury were collected for each player. RTP rates were calculated and performance data was collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully RTP after ACL reconstruction were compared to a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at one year and three years’ post-injury were compared to assess acute and longitudinal changes in performance relative to pre-injury baseline. Results: A total of fifty-nine WNBA players sustained an isolated ACL tear during the study period. Forty-one (69.5%) were able to RTP. There was no difference in demographic characteristics between forty-one players and matched controls. Following RTP athletes played an average of 7.5±12.8 fewer games, 5.1±9.2 fewer minutes per game, and scored 3.7±5.0 less points per game in their first year compared to the year prior to injury. (Table1) When compared to matched controls, WNBA players returning from ACL reconstruction demonstrated a significant decline in games played, games started, minutes per game, rebounds, assists, and blocks per game in their first season after RTP. These differences resolved by year three post-surgery (Table 2). Conclusions: There is a high RTP rate following ACL reconstruction in WNBA athletes. Players may experience a decrease in playing time and performance initially when returning to play, however these variables were found to return to baseline over time.

Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals

2021 ◽  
pp. 036354652110504
Author(s):  
Grégoire Micicoi ◽  
Chistophe Jacquet ◽  
Raghbir Khakha ◽  
Sally LiArno ◽  
Ahmad Faizan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Reference Population ◽  
Acl Injuries ◽  
Notch Width ◽  
Injury Risk Factor ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature. Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics. Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width ( P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI ( P = .012) and MMPTA ( P = .02) were independent predictors according to ethnicity. Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.

scholarly journals First-time anterior cruciate ligament injury in adolescent female elite athletes: a prospective cohort study to identify modifiable risk factors

2021 ◽  
Author(s):  
M. K. Zebis ◽  
P. Aagaard ◽  
L. L. Andersen ◽  
P. Hölmich ◽  
M. B. Clausen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Adolescent Female ◽  
Acl Injuries ◽  
Team Handball ◽  
Acl Injury Risk ◽  
Anterior Cruciate ◽  
First Time

Abstract Purpose To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players. Methods Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis. Results Ninety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4–18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34–0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08–1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43–0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66–0.89]. Conclusion Four distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball. Level of evidence II.

scholarly journals The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Jessica Heil ◽  
Florian Loffing ◽  
Dirk Büsch
Keyword(s):  
Systematic Review ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Physical Load ◽  
Future Research ◽  
Before And After ◽  
Isokinetic Strength Testing ◽  
Anterior Cruciate ◽  
Limb Asymmetry ◽  
Exercise Induced

Abstract Background Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries. Objective The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review. Methods A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol. Results Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters. Conclusions Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.

scholarly journals Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Andrew Froehle ◽  
Joseph Cox ◽  
Jedediah May ◽  
Kimberly Grannis ◽  
Dana Duren
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Collegiate Athletes ◽  
Knee Laxity ◽  
Age At Menarche ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72, P

The Development of a Three Dimensional Anterior Cruciate Ligament Failure Locus: A Finite Element Analysis

2011 ◽  
Author(s):  
A. Orsi ◽  
N. H. Yang ◽  
H. N. Hashemi ◽  
P. K. Canavan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Sports Injuries ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Element Analysis ◽  
Acl Injuries ◽  
Ligament Failure ◽  
Failure Locus ◽  
Anterior Cruciate

A full or partial tear of the anterior cruciate ligament (ACL) is a common and painful injury that has been estimated to occur approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.

scholarly journals The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes

2012 ◽  
Vol 41 (1) ◽  
pp. 203-215 ◽  
Author(s):  
Gregory D. Myer ◽  
Dai Sugimoto ◽  
Staci Thomas ◽  
Timothy E. Hewett
Keyword(s):  
Injury Risk ◽  
Knee Injury ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Injury Reduction ◽  
Anterior Cruciate

Background: In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. Hypothesis/Purpose: The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations. Study Design: Meta-analysis; Level of evidence 1a. Methods: Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations. Results: A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval [CI]: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT. Conclusion: The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk.

scholarly journals The effect of anterolateral ligament integrity on the tibia displacement and reaction forces of anterior cruciate ligament

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Adem Aydın ◽  
Levent Uğur ◽  
Halil Atmaca
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Knee Flexion Angle ◽  
Anterior Drawer ◽  
Reaction Forces ◽  
Anterior Cruciate

Objective: Recent studies focused on rotational instability and remained positive pivot test in patients with anterior cruciate ligament (ACL) reconstruction. Clinical, radiological and biomechanical studies showed the importance of the anterolateral ligament (ALL) integrity. ALL is one of the stabilization structures against the internal rotation of the tibia under forces which was associated with Segond fracture previously. Even some authors claimed that ACL failure and risk of re-rupture increased if only ACL reconstruction performed in patients with simultaneous ALL injury. The aim of the study is to evaluate the importance of ALL on knee biomechanics during anterior drawer test and internal rotation forces with different flexion angles in terms of reaction forces on ACL and the amount of tibia displacement via finite element analysis. Methods: Three dimensional (3D) solid model of knee joint and ALL injured models were constructed based on DICOM formatted computed tomography (CT) images. 0°, 15°,30°,45°,60°,75° and 90° flexion angles were applied respectively to reference models. Then varied anterior drawer and internal rotational forces were used to investigate the effect of ALL. ANSYS ®Version 17 was used in analyses and same boundary conditions were used in all models. Results: In critical analyzing the all results; medial displacement and the amount of anterior drawer distance were increased in all ALL injured models when compared with references. Therewithal the rotational displacements were increased by increasing the knee flexion angle and rotational torque. But, it was not a significant change in the amount of displacement between the models with respect to anteroposterior displacement when the anterior drawer force was increased. Conclusion: ALL particular has an important role in the stability of the internal rotation occurs against the force and with increased contribution rate to the knee joint stability by increasing the knee flexion angle. But the reaction forces were not affected by ALL integrity. So this study do not support the previous studies which suggest simultaneously reconstruction of both ligaments to avoid re rupture of ACL in cases with ALL injured.

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