Anterior cruciate ligament (ACL) injury classification system using support vector machine (SVM)

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate—based on dynamic valgus stress—the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial–anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

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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

Applied Sciences ◽

10.3390/app11114958 ◽

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.

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Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211029583 ◽

2021 ◽

pp. 194173812110295

Author(s):

Patrick Ward ◽

Peter Chang ◽

Logan Radtke ◽

Robert H. Brophy

Keyword(s):

Magnetic Resonance Imaging ◽

Anterior Cruciate Ligament ◽

Magnetic Resonance ◽

Functional Outcomes ◽

Cruciate Ligament ◽

Acl Injury ◽

Bone Bruise ◽

Resonance Imaging ◽

Bone Bruises ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Study Design: Clinical review. Level of Evidence: Level 4. Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. Strength of Recommendation Taxonomy: 2.

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Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

Sensors ◽

10.3390/s21072331 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2331

Author(s):

Stefano Di Paolo ◽

Nicola Francesco Lopomo ◽

Francesco Della Villa ◽

Gabriele Paolini ◽

Giulio Figari ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Excellent Agreement ◽

High Speed ◽

Cruciate Ligament ◽

Wearable Sensors ◽

Return To Sport ◽

Acl Injury ◽

Wearable Sensor ◽

Anterior Cruciate ◽

Full Body

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

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Measuring the force perception in knee flexor/ extensor muscles in patients with anterior cruciate ligament injury and healthy subjects

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200208 ◽

2021 ◽

pp. 1-8

Author(s):

Bahram Amirshakeri ◽

Minoo Khalkhali Zavieh ◽

Mandana Rezaei ◽

Hakimeh Adigozali

Keyword(s):

Anterior Cruciate Ligament ◽

Healthy Subjects ◽

Cruciate Ligament ◽

Acl Injury ◽

Injured Limb ◽

Knee Flexor ◽

Force Perception ◽

Extensor Muscles ◽

Anterior Cruciate ◽

Flexion And Extension

BACKGROUND: Force perception as a contributor to the neuromuscular control of the knee joint may be altered after anterior cruciate ligament (ACL) injury. OBJECTIVE: This study aimed to compare the force perception accuracy in the knee joints of patients with ACL injury and healthy subjects. METHODS: Twenty-six patients with ACL injury and 26 healthy subjects participated in this case-control study. Participants were asked to produce 50% of the maximum voluntary isometric contraction of the knee muscles as a target force and reproduce it in their limbs in flexion and extension directions. RESULTS: There were significant interactions between group and condition as well as group, condition, and limb in the force perception error respectively (P< 0.05). The highest amount of error was seen in the contralateral limb of the ACL injury group when the reference force was produced in the injured limb (P< 0.05). CONCLUSION: The findings revealed that the force perception accuracy in the knee flexor/extensor muscles of individuals with ACL injury is impaired. Moreover, error is most evident when the patient produces force in the injured limb and replicates it in the uninjured limb in both flexion and extension directions. Therefore, the rehabilitation programs should encompass neuromuscular training in both quadriceps and hamstrings after ACL injury.

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Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211025307 ◽

2021 ◽

pp. 194173812110253

Author(s):

Christopher Kuenze ◽

Katherine Collins ◽

Karin Allor Pfeiffer ◽

Caroline Lisee

Keyword(s):

Physical Activity ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Young Patients ◽

Return To Sport ◽

Acl Injury ◽

Noncommunicable Diseases ◽

Successful Recovery ◽

Patient Reported ◽

Anterior Cruciate

Context: Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation. Evidence Acquisition: Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL. Study Design: Clinical review. Level of Evidence: Level 5. Results: We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population. Conclusion: Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

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The Effect of Anterior Cruciate Ligament Reconstruction on the Progression of Osteoarthritis

The Open Orthopaedics Journal ◽

10.2174/1874325001206010506 ◽

2012 ◽

Vol 6 (1) ◽

pp. 506-510 ◽

Cited By ~ 10

Author(s):

Rory Norris ◽

Pete Thompson ◽

Alan Getgood

Keyword(s):

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Acl Injury ◽

Current Evidence ◽

Indirect Trauma ◽

Ligament Rupture ◽

Recent Developments ◽

Anterior Cruciate ◽

Enzymatic Pathways

Anterior cruciate ligament rupture (ACL) is a common injury, particularly among young sporting adults. Early onset osteoarthritis (OA) can be a devastating and difficult to manage consequence of such an injury. The techniques for reconstructing the ACL are advancing all the time, but the effect that this has on the progression of OA is less well understood. Many factors affect the development of OA following an ACL injury, including direct and indirect trauma to the articular cartilage, associated meniscal injuries, chronic tibiofemoral joint instability, and multiple enzymatic pathways. This review will summarize the current evidence surrounding each of these areas, and describe some of the recent developments that may have an impact on the management of these injuries in the future.

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Measuring Strain Distributions in the Anterior Cruciate Ligament Using Ultrasound

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19625 ◽

2010 ◽

Author(s):

Amy Cochran ◽

Yingxin Gao ◽

Ursula Krotscheck ◽

Margret Thompson ◽

James Stouffer ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Treatment Strategies ◽

Acl Injury ◽

Physiological Factors ◽

Detailed Understanding ◽

Prevention And Treatment ◽

Anterior Cruciate ◽

Tissue Motion

Optimal prevention and treatment strategies of anterior cruciate ligament (ACL) injury can be realized with a detailed understanding of how physiological factors impact the ACL. A noninvasive, in vivo method that assesses the ACL’s mechanical integrity is needed to help clarify this multi-factorial pathophysiology. We investigated the use of the noninvasive, in vivo technique, ultrasound strain elastography (USE) (1), to distinguish between normal and injured ACLs. USE is used as a diagnostic tool in oncological (2), hepatic (3), and cardiovascular (4) applications. This technique uses ultrasonic RF data to track tissue motion in order to estimate strain within the tissue.

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Effects of Anterior Cruciate Ligament (ACL) Injury on Muscle Activity of Head, Neck and Trunk Muscles: A Cross-Sectional Evaluation

CRANIO® ◽

10.1179/crn.2007.028 ◽

2007 ◽

Vol 25 (3) ◽

pp. 177-185 ◽

Cited By ~ 3

Author(s):

Simona Tecco ◽

Vincenzo Salini ◽

Stefano Teté ◽

Felice Festa ◽

Christian Colucci

Keyword(s):

Anterior Cruciate Ligament ◽

Muscle Activity ◽

Cruciate Ligament ◽

Acl Injury ◽

Trunk Muscles ◽

Cross Sectional ◽

Anterior Cruciate ◽

Head Neck

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Diagnostic of Injury Risk in the Anterior Cruciate Ligament Based On Shape Context Description of the Intercondylar Notch Curvature

Journal of Engineering and Science in Medical Diagnostics and Therapy ◽

10.1115/1.4053063 ◽

2021 ◽

Author(s):

Joao Paulo Dias ◽

Ariful Bhuiyan ◽

Nabila Shamim

Keyword(s):

Anterior Cruciate Ligament ◽

Injury Risk ◽

Cruciate Ligament ◽

Acl Injury ◽

False Positives ◽

Intercondylar Notch ◽

Mr Images ◽

Shape Context ◽

Similarity Factor ◽

Anterior Cruciate

Abstract An estimated number of 300,000 new anterior cruciate ligament (ACL) injuries occur each year in the United States. Although several magnetic resonance (MR) imaging-based ACL diagnostics methods have already been proposed in the literature, most of them are based on machine learning or deep learning strategies, which are computationally expensive. In this paper, we propose a diagnostics framework for the risk of injury in the anterior cruciate ligament (ACL) based on the application of the inner-distance shape context (IDSC) to describe the curvature of the intercondylar notch from MR images. First, the contours of the intercondylar notch curvature from 91 MR images of the distal end of the femur (70 healthy and 21 with confirmed ACL injury) were extracted manually using standard image processing tools. Next, the IDSC was applied to calculate the similarity factor between the extracted contours and reference standard curvatures. Finally, probability density functions of the similarity factor data were obtained through parametric statistical inference, and the accuracy of the ACL injury risk diagnostics framework was assessed using receiver operating characteristic analysis (ROC). The overall results for the area under the curve (AUC) showed that method reached a maximum accuracy of about 66%. Furthermore, the sensitivity and specificity results showed that an optimum discrimination threshold value for the similarity factor can be pursued that minimizes the incidence of false positives and false positives simultaneously.

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