Age Influences Biomechanical Changes After Participation in an Anterior Cruciate Ligament Injury Prevention Program

2017 ◽  
Vol 46 (3) ◽  
pp. 598-606 ◽  
Author(s):  
Julie A. Thompson-Kolesar ◽  
Corey T. Gatewood ◽  
Andrew A. Tran ◽  
Amy Silder ◽  
Rebecca Shultz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Prevention ◽  
Female Athletes ◽  
Acl Injury ◽  
Prevention Programs ◽  
Extensor Muscle ◽  
Knee Valgus ◽  
Adolescent Athletes ◽  
Valgus Angle ◽  
Peak Knee

Background: The prevalence of anterior cruciate ligament (ACL) injuries increases during maturation and peaks during late adolescence. Previous studies suggested an age-related association between participation in injury prevention programs and reduction of ACL injury. However, few studies have investigated differences in biomechanical changes after injury prevention programs between preadolescent and adolescent athletes. Purpose/Hypothesis: The purpose was to investigate the influence of age on the effects of the FIFA Medical and Research Centre (F-MARC) 11+ injury prevention warm-up program on differences in biomechanical risk factors for ACL injury between preadolescent and adolescent female soccer players. It was hypothesized that the ACL injury risk factors of knee valgus angle and moment would be greater at baseline but would improve more after training for preadolescent athletes than adolescent athletes. It was further hypothesized that flexor-extensor muscle co-contraction would increase after training for both preadolescent and adolescent athletes. Study Design: Controlled laboratory study. Methods: Institutional Review Board–approved written consent was obtained for 51 preadolescent female athletes aged 10 to 12 years (intervention: n = 28, 11.8 ± 0.8 years; control: n = 23, 11.2 ± 0.6 years) and 43 adolescent female athletes aged 14 to 18 years (intervention: n = 22, 15.9 ± 0.9 years; control: n = 21, 15.7 ± 1.1 years). The intervention groups participated in 15 in-season sessions of the F-MARC 11+ program 2 times per week. Pre- and postseason motion capture data were collected during 4 tasks: preplanned cutting, unanticipated cutting, double-legged jump, and single-legged jump. Lower extremity joint angles and moments were estimated through biomechanical modeling. Knee flexor-extensor muscle co-contraction was estimated from surface electromyography. Results: At baseline, preadolescent athletes displayed greater initial contact and peak knee valgus angles during all activities when compared with the adolescent athletes, but knee valgus moment was not significantly different between age groups. After intervention training, preadolescent athletes improved and decreased their initial contact knee valgus angle (–1.24° ± 0.36°; P = .036) as well as their peak knee valgus moment (–0.57 ± 0.27 percentage body weight × height; P = .033) during the double-legged jump task, as compared with adolescent athletes in the intervention. Compared with adolescent athletes, preadolescent athletes displayed higher weight acceptance flexor-extensor muscle co-contraction at baseline during all activities ( P < .05). After intervention training, preadolescent athletes displayed an increase in precontact flexor-extensor muscle co-contraction during preplanned cutting as compared with adolescent intervention athletes (0.07 ± 0.02 vs –0.30 ± 0.27, respectively; P = .002). Conclusion: The F-MARC 11+ program may be more effective at improving some risk factors for ACL injury among preadolescent female athletes than adolescent athletes, notably by reducing knee valgus angle and moment during a double-legged jump landing. Clinical Relevance: ACL prevention programs may be more effective if administered early in an athlete’s career, as younger athletes may be more likely to adapt new biomechanical movement patterns.

scholarly journals Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 294-301 ◽  
Author(s):  
Julie A. Thompson ◽  
Andrew A. Tran ◽  
Corey T. Gatewood ◽  
Rebecca Shultz ◽  
Amy Silder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Prevention ◽  
Injury Risk ◽  
Intervention Group ◽  
Acl Injury ◽  
Prevention Programs ◽  
Control Group ◽  
Knee Valgus ◽  
Acl Injuries ◽  
Peak Knee

Background: Anterior cruciate ligament (ACL) injuries are common, and children as young as 10 years of age exhibit movement patterns associated with an ACL injury risk. Prevention programs have been shown to reduce injury rates, but the mechanisms behind these programs are largely unknown. Few studies have investigated biomechanical changes after injury prevention programs in children. Purpose/Hypothesis: To investigate the effects of the F-MARC 11+ injury prevention warm-up program on changes to biomechanical risk factors for an ACL injury in preadolescent female soccer players. We hypothesized that the primary ACL injury risk factor of peak knee valgus moment would improve after training. In addition, we explored other kinematic and kinetic variables associated with ACL injuries. Study Design: Controlled laboratory study. Methods: A total of 51 female athletes aged 10 to 12 years were recruited from soccer clubs and were placed into an intervention group (n = 28; mean [±SD] age, 11.8 ± 0.8 years) and a control group (n = 23; mean age, 11.2 ± 0.6 years). The intervention group participated in 15 in-season sessions of the F-MARC 11+ program (2 times/wk). Pre- and postseason motion capture data were collected during preplanned cutting, unanticipated cutting, double-leg jump, and single-leg jump tasks. Lower extremity joint angles and moments were estimated using OpenSim, a biomechanical modeling system. Results: Athletes in the intervention group reduced their peak knee valgus moment compared with the control group during the double-leg jump (mean [±standard error of the mean] pre- to posttest change, –0.57 ± 0.27 %BW×HT vs 0.25 ± 0.25 %BW×HT, respectively; P = .034). No significant differences in the change in peak knee valgus moment were found between the groups for any other activity; however, the intervention group displayed a significant pre- to posttest increase in peak knee valgus moment during unanticipated cutting ( P = .044). Additional analyses revealed an improvement in peak ankle eversion moment after training during preplanned cutting ( P = .015), unanticipated cutting ( P = .004), and the double-leg jump ( P = .016) compared with the control group. Other secondary risk factors did not significantly improve after training, although the peak knee valgus angle improved in the control group compared with the intervention group during unanticipated cutting ( P = .018). Conclusion: The F-MARC 11+ program may be effective in improving some risk factors for an ACL injury during a double-leg jump in preadolescent athletes, most notably by reducing peak knee valgus moment. Clinical Relevance: This study provides motivation for enhancing injury prevention programs to produce improvement in other ACL risk factors, particularly during cutting and single-leg tasks.

scholarly journals Injury Risk Factors Integrated Into Self-Guided Real-Time Biofeedback Improves High-Risk Biomechanics

2019 ◽  
Vol 28 (8) ◽  
pp. 831-839 ◽  
Author(s):  
Scott Bonnette ◽  
Christopher A. DiCesare ◽  
Adam W. Kiefer ◽  
Michael A. Riley ◽  
Kim D. Barber Foss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Prevention ◽  
Real Time ◽  
Injury Risk ◽  
Female Athletes ◽  
Acl Injury ◽  
Feedback System ◽  
Prevention Programs ◽  
Acl Injuries ◽  
The Real

Context:Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes.Objective:This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries.Design:Cross-over study.Setting:Medical center laboratory.Participants:A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study.Methods:Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first.Results:Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus.Conclusions:This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.

scholarly journals The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis

2017 ◽  
Vol 46 (6) ◽  
pp. 1492-1499 ◽  
Author(s):  
Thiago Jambo Alves Lopes ◽  
Milena Simic ◽  
Gregory D. Myer ◽  
Kevin R. Ford ◽  
Timothy E. Hewett ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Knee Flexion ◽  
Meta Analysis ◽  
Acl Injury ◽  
Prevention Programs ◽  
Initial Contact ◽  
Landing Biomechanics ◽  
Peak Knee ◽  
Knee Abduction ◽  
Hip Flexion

Background: Anterior cruciate ligament (ACL) tear is a common injury in sports and often occurs during landing from a jump. Purpose: To synthesize the evidence on the effects of injury prevention programs (IPPs) on landing biomechanics as they relate to the ligament, quadriceps, trunk, and leg dominance theories associated with ACL injury risk. Study Design: Meta-analysis. Methods: Six electronic databases were searched for studies that investigated the effect of IPPs on landing task biomechanics. Prospective studies that reported landing biomechanics at baseline and post-IPP were included. Results from trunk, hip, and knee kinematics and kinetics related to the ACL injury theories were extracted, and meta-analyses were performed when possible. Results: The criteria were met by 28 studies with a total of 466 participants. Most studies evaluated young females, bilateral landing tasks, and recreational athletes, while most variables were related to the ligament and quadriceps dominance theories. An important predictor of ACL injury, peak knee abduction moment, decreased ( P = .01) after the IPPs while other variables related to the ligament dominance theory did not change. Regarding the quadriceps dominance theory, after the IPPs, angles of hip flexion at initial contact ( P = .009), peak hip flexion ( P = .002), and peak knee flexion ( P = .007) increased, while knee flexion at initial contact did not change ( P = .18). Moreover, peak knee flexion moment decreased ( P = .005) and peak vertical ground-reaction force did not change ( P = .10). Conclusion: The exercises used in IPPs might have the potential to improve landing task biomechanics related to the quadriceps dominance theory, especially increasing peak knee and hip flexion angles. Importantly, peak knee abduction moment decreased, which indicates that IPPs influence a desired movement strategy to help athletes overcome dangerous ligament dominance loads arising from lack of frontal plane control during dynamic tasks. The lack of findings for some biomechanical variables suggests that future IPPs may be enhanced by targeting participants’ baseline profile deficits, highlighting the need to deliver an individualized and task-specific IPP.

Preliminary Evaluation of Knee Kinetics in Female Athletes on Hormonal Contraceptives

2019 ◽  
Vol 41 (02) ◽  
pp. 113-118
Author(s):  
Gabrielle Gilmer ◽  
Gretchen D. Oliver
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Acl Injury ◽  
Hormonal Contraceptives ◽  
Preliminary Evaluation ◽  
Knee Valgus ◽  
Time Points ◽  
Acl Injury Risk

AbstractRecently, an emphasis has been placed on understanding how ovarian sex hormones and hormonal contraceptives affect risk for anterior cruciate ligament (ACL) injury. The literature presents large discrepancies in whether or not hormonal contraceptives affect ACL injury risk; therefore, the purpose of this study was to evaluate whether vertical ground reaction force (GRF) and knee valgus force are different between athletes who do and do not use hormonal contraceptives. Twenty-two female athletes volunteered to participate and were divided into two groups based on their answers to a health history questionnaire: those who use hormonal contraceptives and those who do not. Participants performed a drop vertical jump (DVJ) and single leg crossover dropdown (SCD) at two different time points in their menstrual cycle (pre-ovulatory phase and mid-luteal phase). Kinetic data were collected at 1000 Hz. Independent samples t-tests revealed no significant differences between groups in vertical GRF and knee valgus force at both time points. Findings from this study suggest that hormonal contraceptives do not elicit detectable changes in vertical GRF and knee valgus force. Ultimately, this calls for further studies on the relationship between hormones and ACL injury risk and physicians to consider hormonal screening in addition to neuromuscular and biomechanical screening.

Implementation Strategies for ACL Injury Prevention Programs

2018 ◽  
pp. 625-639
Author(s):  
Lindsay J. DiStefano ◽  
Hayley J. Root ◽  
Barnett S. Frank ◽  
Darin A. Padua
Keyword(s):  
Injury Prevention ◽  
Implementation Strategies ◽  
Acl Injury ◽  
Prevention Programs ◽  
Acl Injury Prevention

scholarly journals The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome

2019 ◽  
Vol 11 (3) ◽  
pp. 223-237 ◽  
Author(s):  
Mahsa Emamvirdi ◽  
Amir Letafatkar ◽  
Mehdi Khaleghi Tazji
Keyword(s):  
Injury Prevention ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Knee Valgus ◽  
Valgus Angle ◽  
Significant Difference ◽  
Hop Test ◽  
Control Instruction ◽  
Dynamic Valgus

Background: Patellofemoral pain syndrome (PFPS) is sometimes related to excessive hip adduction and internal rotation, as well as knee valgus during weightbearing activities in females. Research on injury prevention and rehabilitation strategies has shown the positive effects of valgus control instruction (VCI) exercise programs in training. Hypothesis: A VCI program would result in a positive change in pain, eccentric hip muscle torque, and performance in females with PFPS. Study Design: Controlled laboratory study. Level of Evidence: Level 1. Methods: Sixty-four amateur female volleyball players from our university (age, 18-25 years) with PFPS and equal years of exercise experience were randomly divided into VCI (n = 32; age, 22.1 ± 5.88 years) and control (n = 32; age, 23.1 ± 6.49 years) groups. Function (single, triple, and crossover hops), strength (hip abductor and external rotators), pain (visual analog scale), and knee valgus angle (single-leg squat) were assessed at baseline and after intervention. Results: There was a significant difference before and after implementation of the VCI program with regard to pain (49.18% ↓, P = 0.000), single-leg hop test (24.62% ↑, P = 0.000), triple-hop test (23.75% ↑, P = 0.000), crossover hop test (12.88% ↑, P = 0.000), single-leg 6-m timed hop test (7.43% ↓, P = 0.000), knee dynamic valgus angle (59.48% ↓, P = 0.000), peak abductor to adductor eccentric torque ratio (14.60% ↑, P = 0.000), peak external (59.73% ↑, P = 0.023) and internal rotator (15.45% ↑, P = 0.028) eccentric torques, and the ratio of peak external to internal rotator eccentric torque (40.90% ↑, P = 0.000) ( P < 0.05). Conclusion: PFPS rehabilitation and prevention programs should consider VCI exercises to decrease pain, improve strength, and increase athletes’ functional performance. Clinical Relevance: This study investigated the effect of VCI exercises on knee valgus angle, pain, and functionality of individuals with PFPS. The VCI program improves performance, knee dynamic valgus angle, and strength in participants with PFPS. A controlled and optimal knee valgus angle during a functional task is the most important factor for injury prevention specialists. VCI training can be used as a supplemental method to prevent and treat lower extremity injury in patients with PFPS.

scholarly journals AGE, BODY MASS INDEX AND SEX RELATED TO DYNAMIC KNEE VALGUS AND SHOCK ABSORPTION DURING SINGLE LEG LANDING IN UNINJURED ADOLESCENT ATHLETES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0012
Author(s):  
Nicole Mueske ◽  
Bridget G. O’Callahan ◽  
Mia J. Katzel ◽  
Tracy Zaslow ◽  
Bianca Edison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Energy Absorption ◽  
Knee Flexion ◽  
Sagittal Plane ◽  
Acl Injury ◽  
Knee Valgus ◽  
Shock Absorption ◽  
Younger Age ◽  
Hip Abduction

BACKGROUND Dynamic limb valgus and poor shock absorption strategies have been implicated in anterior cruciate ligament (ACL) injuries. Additionally, biomechanics during over ground and double leg landing tasks have been shown to differ depending on sex and age/maturation. However, there is limited evidence evaluating the effect of age, body mass index (BMI) and sex on single leg landing strategies. METHODS 51 uninjured athletes (ages 7-15 years, mean 12.2, SD 2.3; 45% female) completed the single leg hop (SLH) for distance task. 3-D motion analysis using a 6 degree-of-freedom model was used to collect lower extremity kinematics and kinetics from initial foot contact to peak knee flexion of landing limb; for each limb the hop with the longest distance and appropriate landing (stuck for >2 seconds) was used for analysis. Using multivariate regression with standardized coefficients, the effects of age, BMI and sex on biomechanical variables of interest were assessed. RESULTS When considering dynamic valgus components, younger age was associated with higher knee valgus (ß=0.251; p=0.038) and hip abduction (ß=0.250; p=0.038) angles, higher BMI was associated with higher knee valgus angles (ß=0.262; p=0.028), and females tended to have higher hip abduction moments (ß=0.301; p=0.003), but a more abducted (ß=0.281; p=0.005) and internally rotated hip position (ß=0.359; p=0.003) along with higher internal rotation hip moments (ß=0.298; p=0.001) and with higher ankle inversion moments (ß=0.304; p=0.003). Although differences were observed, R2 values were low ranging from 0.191 (hip ab/adduction angles) to 0.053 (knee valgus moment). Sagittal plane components of shock absorption were partially explained by age, BMI and sex (R2 values range from 0.685 to 0.013; vertical ground reaction force (vGRF) in multiples of body weight, ankle dorsi/plantarflexion moment, respectively). Younger age was associated with higher vGRF (ß=-0.520; p<0.0001) and knee flexion moments (ß=-0.225; p=0.034), but with lower knee flexion angles (ß=0.252; p=0.041), ankle dorsiflexion angles (ß=0.322; p=0.003) and hip flexion moments (ß=0.289; p=0.016). Higher BMI was associated with lower GRF (ß=-0.387; p<0.0001), lower knee (ß=-0.277; p=0.009) and hip (ß=-0.289; p=0.043) flexion moments and lower sagittal plane energy absorption at the knee (ß=-0.267; p=0.016). Females tended to have lower vGRF (ß=0.147; p=0.017), more sagittal plane hip (ß=0.282; p=0.007) and knee (ß =0.250; p=0.010) energy absorption and less ankle dorsiflexion (ß=-0.283; p=0.002). CONCLUSION/SIGNIFICANCE Biomechanical risk factors for ACL injury during single leg hop landings are influenced by age, BMI and sex. Female sex and higher BMI are associated with dynamic limb valgus while younger age is associated with both dynamic limb valgus and poor shock absorption during single leg hop landings. These are important findings due to the known ACL injury risk in female athletes and the high re-tear rate in pediatric athletes. Identifying these biomechanical risk factors related to demographics and anthropometrics may provide objective direction needed to contribute to effective intervention strategies and eventual injury reduction in these high risk groups.

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