scholarly journals Acute effects of the Prevent injury and Enhance Performance warm-up on potential reinjury risk factors associated with unanticipated jump landings: Study protocol for a crossover randomized controlled trial in individuals cleared for return to sports after anterior cruciate ligament reconstruction.

2020 ◽  
Author(s):  
Evans Y. K. Ashigbi ◽  
Florian Giesche ◽  
Winfried Banzer ◽  
David A. Groneberg ◽  
Daniel Niederer
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Moderate Intensity ◽  
Return To Sports ◽  
Acute Effects ◽  
Warm Up ◽  
Randomized Controlled ◽  
Anterior Cruciate

Abstract BackgroundIn team-sports such as football or basketball, athletes need to rapidly adapt their motor plans and actions to unanticipated changes in the environment. Unanticipated jump-landing tasks have been found to elevate the risk of non-contact anterior cruciate ligament (ACL) injuries compared to an anticipated condition. ACL-reconstructed individuals may have greater difficulties to maintain neuromuscular control under unanticipated conditions exposing them to a higher reinjury risk during the game. The planned trial aims to investigate the acute effects of a team-sport specific injury prevention programme on potential ACL reinjury risk factors under anticipated and unanticipated jump-landings.Methods and design:Single center randomized controlled crossover trial. Female and male ACL-reconstructed participants cleared for return to sports (≥ 6 months and ≤ 24 months post-reconstruction) will be included. In a randomized sequence and with a washout phase of one week in between, the participants will perform an injury preventive warm-up protocol (PEP; strengthening, flexibility, plyometry and agility) and a standard warm-up program (bicycle ergometer). Both interventions will last for 12 minutes and will be conducted at moderate intensity (BORG scale: 12 to 14). After each warm-up, participants will perform counter movement jumps with single-leg landings on a force plate. Prior to the jump, a left or right footprint (equally distributed) will be indicated on a screen. Under the anticipated condition, the participants will be informed before the jump that the displayed footprint will not change after take-off. Under the unanticipated condition, the participants will not know whether the target landing side will remain the same (consistent with pre-movement expectations) or change (inconsistent). Under both unanticipated conditions, this information will be displayed 0.1 second after take-off and thus approximately 0.3 seconds before landing.Parametric/non-parametric crossover-analyses (carryover-tests and crossover test) for between-conditions comparisons will be applied. Trial registration: German Clinical Trials Register, identification number DRKS00016942. Registered on May 24, 2019.

scholarly journals Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 216-224 ◽  
Author(s):  
Timothy E. Hewett ◽  
Stephanie L. Di Stasi ◽  
Gregory D. Myer
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Injury Incidence ◽  
Anterior Cruciate

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes.

scholarly journals Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review

2021 ◽  
Vol 18 (24) ◽  
pp. 13351
Author(s):  
Jesús Olivares-Jabalera ◽  
Alberto Fílter-Ruger ◽  
Thomas Dos’Santos ◽  
Jose Afonso ◽  
Francesco Della Villa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Core Stability ◽  
Cochrane Library ◽  
Football Players ◽  
Injury Incidence ◽  
Warm Up ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.

scholarly journals Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Angela Blasimann ◽  
Irene Koenig ◽  
Isabel Baert ◽  
Heiner Baur ◽  
Dirk Vissers
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Acl Injury ◽  
Risk Of Bias ◽  
Ligament Injury ◽  
Return To Sports ◽  
Anterior Cruciate

Abstract Background Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. Methods This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. Results From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. Conclusions Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.

Quadriceps Control: A Key Factor in Coping With Anterior Cruciate Ligament Deficiency

2003 ◽  
Author(s):  
Glenn N. Williams ◽  
Peter J. Barrance ◽  
Lynn Snyder-Mackler ◽  
Thomas S. Buchanan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Activity Patterns ◽  
Neuromuscular Control ◽  
Acl Injury ◽  
The United States ◽  
Circular Statistics ◽  
Return To Sports ◽  
Acl Injuries ◽  
Anterior Cruciate

Approximately 250,000 anterior cruciate ligament (ACL) injuries occur in the United States each year. Most people cannot return to sports after an ACL injury without surgical intervention (Non-copers), but some can (Copers). Recent research suggests that the ability to cope with ACL injury is most likely related to neuromuscular function. The purpose of this study was to evaluate the neuromuscular control strategies of ACL deficient (ACL-D) Non-copers, ACL-D Copers, and people with uninjured knees using an established target-matching protocol, electromyography (EMG) of 10 muscles acting at the knee, and circular statistics methods. Thirty-two people (12 Non-Copers, 8 Copers, and 12 people without a history of knee injury) volunteered to participate in the study. The ACL-D subjects demonstrated diminished neuromuscular control when their muscle activity patterns were compared to those of the uninjured subjects. The key difference between the Copers and Non-copers was that Copers demonstrated better quadriceps control than the Non-copers. This study may have important implications for the treatment of people who sustain ACL injuries.

Anterior cruciate ligament injury risk factors in football

2019 ◽  
Vol 59 (10) ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Andrea Bisciotti ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Injury Risk Factors ◽  
Anterior Cruciate

scholarly journals Anterior Cruciate Ligament Injury Prevention Exercises: Could a Neuromuscular Warm-Up Improve Muscle Pre-Activation before a Soccer Game? A Proof-of-Principle Study on Professional Football Players

2021 ◽  
Vol 11 (11) ◽  
pp. 4958
Author(s):  
Alessandro de Sire ◽  
Andrea Demeco ◽  
Nicola Marotta ◽  
Lucrezia Moggio ◽  
Arrigo Palumbo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Football Players ◽  
Professional Football ◽  
Activation Time ◽  
Exercise Protocol ◽  
Warm Up ◽  
Anterior Cruciate ◽  
Proof Of Principle

Neuromuscular warm-up has been shown to decrease the risk of anterior cruciate ligament (ACL) injury improving muscular firing patterns. All preventive training programs described in the literature have a duration of several weeks. To date, no studies have explored the immediate effect of a neuromuscular warm-up exercise on pre-activation time of the knee stabilizer muscles. Thus, this proof-of-principle study aimed at evaluating the acute effects of a neuromuscular warm-up exercises on the electromyographic activation of knee stabilizer muscles’ activation pattern. We included 11 professional football players, mean aged 23.2 ± 4.5 years, from a Southern Italy football team. All of them underwent a standard warm-up exercise protocol at the first day of the evaluation. At 1 week, they underwent a structured neuromuscular warm-up exercise protocol. We assessed as outcome measure the pre-activation time (ms) of rectus femoris (RF), vastus medialis (VM), biceps femoris (BF), and medial hamstrings (MH) upon landing. Outcomes were assessed before and after the standard warm-up and neuromuscular warm-up. Pre-activation time of RF, VM, BF and MH significantly improved only after neuromuscular warm-up (p < 0.05); moreover, there was a significant (p < 0.05) between-group difference in pre-activation time of all muscles after the neuromuscular warm-up compared with the standard warm-up. These findings suggested that physical exercise consisting of a structured injury prevention neuromuscular warm-up might have an immediate effect in improving the activation time of the knee stabilizer muscles, thus potentially reducing the risk of ACL injury.

scholarly journals Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199116
Author(s):  
Nicholas J. Lemme ◽  
Daniel S. Yang ◽  
Brooke Barrow ◽  
Ryan O’Donnell ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Adult Patients ◽  
Collateral Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) in pediatric patients is becoming increasingly common. There is growing yet limited literature on the risk factors for revision in this demographic. Purpose: To (1) determine the rate of pediatric revision ACLR in a nationally representative sample, (2) ascertain the associated patient- and injury-specific risk factors for revision ACLR, and (3) examine the differences in the rate and risks of revision ACLR between pediatric and adult patients. Study Design: Case-control study; Level of evidence, 3. Methods: The PearlDiver patient record database was used to identify adult patients (age ≥20 years) and pediatric patients (age <20 years) who underwent primary ACLR between 2010 and 2015. At 5 years postoperatively, the risk of revision ACLR was compared between the adult and pediatric groups. ACLR to the contralateral side was also compared. Multivariate logistic regression was used to determine the significant risk factors for revision ACLR and the overall reoperation rates in pediatric and adult patients; from these risk factors, an algorithm was developed to predict the risk of revision ACLR in pediatric patients. Results: Included were 2055 pediatric patients, 1778 adult patients aged 20 to 29 years, and 1646 adult patients aged 30 to 39 years who underwent ACLR. At 5 years postoperatively, pediatric patients faced a higher risk of revision surgery when compared with adults (18.0 % vs 9.2% [adults 20-29 years] and 7.1% [adults 30-39 years]; P < .0001), with significantly decreased survivorship of the index ACLR ( P < .0001; log-rank test). Pediatric patients were also at higher risk of undergoing contralateral ACLR as compared with adults (5.8% vs 1.6% [adults 20-29 years] and 1.9% [adults 30-39 years]; P < .0001). Among the pediatric cohort, boys (odds ratio [OR], 0.78; 95% CI, 0.63-0.96; P = .0204) and patients >14 years old (OR, 0.62; 95% CI, 0.45-0.86; P = .0035) had a decreased risk of overall reoperation; patients undergoing concurrent meniscal repair (OR, 1.84; 95% CI, 1.43-2.38; P < .0001) or meniscectomy (OR, 2.20; 95% CI, 1.72-2.82; P < .0001) had an increased risk of revision surgery. According to the risk algorithm, the highest probability for revision ACLR was in girls <15 years old with concomitant meniscal and medial collateral ligament injury (36% risk of revision). Conclusion: As compared with adults, pediatric patients had an increased likelihood of revision ACLR, contralateral ACLR, and meniscal reoperation within 5 years of an index ACLR. Families of pediatric patients—especially female patients, younger patients, and those with concomitant medial collateral ligament and meniscal injuries—should be counseled on such risks.

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