Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

scholarly journals Clinical Tests Can Be Used to Screen for Second Anterior Cruciate Ligament Injury in Younger Patients Who Return to Sport

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986300 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Acl Injury ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Clinical Measures ◽  
Anterior Knee

Background: Younger athletes have high rates of second anterior cruciate ligament (ACL) injury. Return-to-sport criteria have been proposed to enable athletes to make a safe return, but they frequently lack validation. It is unclear whether commonly recorded clinical measures can help to identify high-risk athletes. Purpose: To explore the association between commonly recorded clinical outcome measures and second ACL injury in a young, active patient group. Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 329 athletes (200 males, 129 females) younger than 20 years at the time of first primary ACL reconstruction surgery who had subsequently returned to sport participation. Clinical examination included range of knee motion (passive flexion and extension deficits), instrumented anterior knee laxity, and single- and triple-crossover hop for distance. Patients also completed the subjective International Knee Documentation Committee form. All measures were collected prospectively at a 12-month postoperative clinical review. Patients were evaluated for a minimum 3 years to determine the incidence of subsequent ACL injury. Results: A total of 95 patients (29%) sustained a second ACL injury following clinical assessment and return to sport. There were 50 graft ruptures and 45 contralateral ACL injuries. Patients with a flexion deficit of 5° had over 2 times the odds of sustaining a graft rupture (odds ratio, 2.3; P < .05), and patients with a side-to-side difference in anterior knee laxity of 3 mm or greater had over 2 times the odds of sustaining a contralateral ACL injury (odds ratio, 2.4; P < .05). Overall, 29% (94 of 329) of patients met the threshold for satisfactory function on all 6 clinical measures; these patients had a 33% reduction in the risk of sustaining a second ACL injury ( P = .05) as compared with those who did not meet all clinical thresholds. Conclusion: Clinical measures of knee flexion and stability may have utility to screen for and identify patients who are at greater risk for a second ACL injury in an already high-risk group (ie, age and activity level).

scholarly journals Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?

2020 ◽  
Vol 48 (2) ◽  
pp. 298-309 ◽  
Author(s):  
◽  
Kurt P. Spindler ◽  
Laura J. Huston ◽  
Alexander Zajichek ◽  
Emily K. Reinke ◽  
...  
Keyword(s):  
High School ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Activity Level ◽  
Hamstring Autograft ◽  
Acl Graft ◽  
Normal Knee ◽  
Baseline Activity ◽  
Anterior Cruciate

Background: Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.

Effect of the FIFA 11+ on Landing Patterns and Baseline Movement Errors in Elite Male Youth Soccer Players

2020 ◽  
Vol 29 (6) ◽  
pp. 730-737 ◽  
Author(s):  
Hadi Akbari ◽  
Mansour Sahebozamani ◽  
Ablolhamid Daneshjoo ◽  
Mohammadtaghi Amiri-Khorasani ◽  
Yohei Shimokochi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Soccer Players ◽  
Control Group ◽  
Ligament Injuries ◽  
Male Youth ◽  
Warm Up ◽  
Youth Soccer ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate

Context: There is no evidence regarding the effect of the FIFA 11+ on landing kinematics in male soccer players, and few studies exist regarding the evaluating progress of interventions based on the initial biomechanical profile. Objective: To investigate the effect of the FIFA 11+ program on landing patterns in soccer players classified as at low or high risk for noncontact anterior cruciate ligament injuries. Design: Randomized controlled trial. Setting: Field-based functional movement screening performed at the soccer field. Participants: A total of 24 elite male youth soccer players participated in this study. Intervention: The intervention group performed the FIFA 11+ program 3 times per week for 8 weeks, whereas the control group performed their regular warm-up program. Main Outcome Measures: Before and after the intervention, all participants were assessed for landing mechanics using the Landing Error Scoring System. Pretraining Landing Error Scoring System scores were used to determine risk groups. Results: The FIFA 11+ group had greater improvement than the control group in terms of improving the landing pattern; there was a significant intergroup difference (F1,20 = 28.86, P < .001, ). Soccer players categorized as being at high risk displayed greater improvement from the FIFA 11+ program than those at low risk (P = .03). However, there was no significant difference in the proportion of risk category following the routine warm-up program (P = 1.000). Conclusions: The present study provides evidence of the usefulness of the FIFA 11+ program for reducing risk factors associated with noncontact anterior cruciate ligament injuries. The authors’ results also suggest that soccer players with the higher risk profile would benefit more than those with lower risk profiles and that targeting them may improve the efficacy of the FIFA 11+ program.

Return to sport testing after anterior cruciate ligament reconstruction has marginal psychological impact: a randomised controlled trial

2018 ◽  
Vol 4 (1) ◽  
pp. 4-8
Author(s):  
Daphne I Ling ◽  
Theresa A Chiaia ◽  
Polly deMille ◽  
Robert G Marx
Keyword(s):  
Anterior Cruciate Ligament ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Intervention Group ◽  
Return To Sport ◽  
Return To Play ◽  
Control Group ◽  
Anterior Cruciate ◽  
Randomised Controlled

ObjectivesThe psychological and physical recovery after anterior cruciate ligament (ACL) reconstruction (ACLR) may or may not occur in parallel. A common scenario is the uninformed athlete who lacks awareness of physical deficiencies and returns to sport prematurely. There is increasing evidence that most patients do not meet return to play criteria at 6 months and physical deficits may still persist 1 year after surgery. We hypothesise that a Quality of Movement Assessment for Return to Sport (QMA-RTS) testing programme may have a negative impact on athletes’ perception of psychological readiness to return.MethodsA total of 30 athletes who had ACLR and underwent the QMA-RTS 4–10 months after ACLR were recruited. They were randomised to one of two groups that both completed a baseline ACL Return to Sport after Injury (ACL-RSI) scale before their QMA-RTS appointment. In the intervention group, participants completed a second ACL-RSI after the QMA-RTS. In the control group, participants completed their second survey before the session. The mean difference in scores between the two groups was compared using an independent samples t-test.ResultsThe groups were balanced for sex (9/15 female), mean age (16 years) and average time since surgery (6 months). The baseline ACL-RSI scores were not statistically different between groups (4.6 (95% CI −10.6 to 19.8), p=0.54). In the controls, there was an increase in scores (+4.4) between the first and second surveys, while there was a decrease in the intervention group (−3.4). This difference between groups was not statistically significant (7.8 (95% CI −1.7 to 17.3), p=0.10).ConclusionsThe QMA-RTS programme did not significantly reduce patients’ mean scores on the ACL-RSI compared with controls. The limited effect on psychological responses may be due to the athletes’ self-awareness of their physical deficits at 6 months after ACLR.Level of evidenceLevel II, randomised controlled trial.

scholarly journals Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

2016 ◽  
Vol 51 (6) ◽  
pp. 460-465 ◽  
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Randy J. Schmitz
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Resonance Imaging ◽  
Notch Angle ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee ◽  
Femoral Notch

Context: Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. Objective: To determine the relationship of ACL width and femoral notch angle to AKL. Design: Cross-sectional study. Setting: Controlled laboratory. Patients or Other Participants: Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). Main Outcome Measure(s): Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. Results: Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R2 = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. Conclusions: A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.

Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110218
Author(s):  
Anne Gro Heyn Faleide ◽  
Liv Heide Magnussen ◽  
Bård Erik Bogen ◽  
Torbjørn Strand ◽  
Ingunn Fleten Mo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

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