scholarly journals Symmetry in Triple Hop Distance Hides Asymmetries in Knee Function After ACL Reconstruction in Athletes at Return to Sports

2021 ◽  
pp. 036354652110631
Author(s):  
Argyro Kotsifaki ◽  
Sam Van Rossom ◽  
Rodney Whiteley ◽  
Vasileios Korakakis ◽  
Roald Bahr ◽  
...  

Background: After anterior cruciate ligament reconstruction (ACLR), a battery of strength and hop tests is frequently used to determine the readiness of an athlete to successfully return to sports. However, the anterior cruciate ligament reinjury rate remains alarmingly high. Purpose: To evaluate the lower limb function of athletes after ACLR at the time when they had been cleared to return to sports (RTS). We aimed to evaluate if passing discharge criteria ensures restoration of normal lower limb biomechanics in terms of kinematics, kinetics, work, and percentage work contribution during a triple hop for distance. Study Design: Controlled laboratory study. Methods: Integrated 3-dimensional motion analysis was performed in 24 male athletes after ACLR when cleared to RTS and 23 healthy male controls during the triple-hop test. The criteria for RTS were (1) clearance by the surgeon and the physical therapist, (2) completion of a sports-specific on-field rehabilitation program, and (3) limb symmetry index >90% after quadriceps strength and hop battery tests. Lower limb and trunk kinematics, as well as knee joint moments and work, were calculated. Between-limb differences (within athletes after ACLR) and between-group differences (between ACLR and control groups) were evaluated using mixed linear models. Results: Although achieving 97% limb symmetry in distance hopped and displaying almost 80% symmetry for knee work absorption in the second rebound and third landing, the ACLR cohorts demonstrated only 51% and 66% limb symmetry for knee work generation in the first and second rebound phases, respectively. During both work generation phases of the triple hop, the relative contribution of the involved knee was significantly smaller, with a prominent compensation from the hip joint ( P < .001, for all phases) as compared with the uninvolved limb and the controls. In addition, patients deployed a whole body compensatory strategy to account for the between-limb differences in knee function, mainly at the hip, pelvis, and trunk. Conclusion: Symmetry in the triple hop for distance masked important deficits in the knee joint work. These differences were more prominent during work generation (concentric-propulsive) than work absorption (eccentric-landing). Clinical Relevance: Symmetry in hop distance during the triple hop test masked significant asymmetries in knee function after ACLR and might not be the appropriate outcome to use as a discharge criterion. Differences between limbs in athletes after ACLR were more prominent during the power generation than the absorption phase.

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004
Author(s):  
F García-Bol ◽  
V Posada-Franco ◽  
A Roldán-Valero ◽  
R Del Caño-Espinel

Hop Tests (unipodal horizontal jumps) have been recommended as one of the reliable assessment tests when allowing a return to competition for a sportsperson after an anterior cruciate ligament injury1,2,3,4. Currently, comparison is made of the results with the contralateral limb through the symmetry index, a method which might not provide sufficient security upon the return to competitive sport5. Hop tests can be used in preseason to gain reference values prior to a possible injury. The objective of this review is to analise the scientific literature such as the F-Marc6 (reference manual of FIFA) to confirm whether include said tests in preseason for football teams. A search was conducted in the Pubmed y Cochrane databases (17/04/17) with the search terms “Hop Test”, “Football”, “Soccer”, and “Preseason”. Articles in English and Spanish were both accepted. Articles excluded were those that did not make reference to the knee, to football, and those that did not conduct tests during preseason. From a total of 33 articles, 4 with these search criteria were included, 5 articles were added trough the bibliography of other studies, and the F-Marc manual was analised. 4 of the articles used the hop tests in preseason for some type of study, of which 3 were used as part of a prospective assessment for the season. On the other hand, the F-Marc does not consider Hop Tests as an assessment test. Hop tests were not found to be used in preseason as reference values prior to possible future injuries, data which could be beneficial for a safe return to sport. Harris J, Abrams G, Bach B, Williams D, Heidloff D, Bush-Joseph C, Verma N, Forsythe B, Cole B. Return to Sport After ACL Reconstruction. ORTHOPEDICS. 2014; 37: e103-e108. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011 Dec;27(12):1697-705. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther. 1997 Sep;26(3):138-42. Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 Mar 29:1-18. F-MARC. Football Medicine Manual. 2nd Edition. Available from: http://f-marc.com . 2017.


2020 ◽  
Author(s):  
Azadeh Nasseri ◽  
David G Lloyd ◽  
Adam L Bryant ◽  
Jonathon Headrick ◽  
Timothy Sayer ◽  
...  

AbstractThis study determined anterior cruciate ligament (ACL) force and its contributors during a standardized drop-land-lateral jump task using a validated computational model. Healthy females (n=24) who were recreationally active performed drop-land-lateral jump and straight run tasks. Three-dimensional whole-body kinematics, ground reaction forces, and muscle activation patterns from eight lower limb muscles were collected concurrently during both tasks, but only the jump was analyzed computationally, with the run included for model calibration. External biomechanics, muscle-tendon unit kinematics, and muscle activation patterns were used to model lower limb muscle and ACL forces. Peak ACL force (2.3±0.5 BW) was observed at 13% of the stance phase during the drop-land-lateral jump task. The ACL force was primarily developed through the sagittal plane, and muscle was the dominant source of ACL loading. The gastrocnemii and quadriceps were main ACL antagonists (i.e., loaders), while hamstrings were the main ACL agonists (i.e., supporters).


2020 ◽  
Vol 2020 ◽  
pp. 1-14 ◽  
Author(s):  
Adérito Seixas ◽  
Borja Sañudo ◽  
Danúbia Sá-Caputo ◽  
Redha Taiar ◽  
Mário Bernardo-Filho

Background. ACL ruptures are a prevalent condition, affecting daily living activities, associated with high financial burden. Objective. To assess the effect of whole-body vibration (WBV) in the rehabilitation of patients with reconstructed anterior cruciate ligament. Methodology. An electronic search in Pubmed, Scopus, Web of Science, and PEDro databases was conducted and randomized controlled trials (RCTs) in humans that analysed the effects of WBV in patients with ACL injury subjected to reconstruction surgery, published in English, Portuguese, Spanish, Italian, or French were included. Records were identified through database search and reference screening by two reviewers, which independently examined titles and abstracts and irrelevant studies were excluded based in eligibility criteria. Relevant full texts were analysed for eligibility, and all relevant studies were included in the systematic review. Results. Ten studies were included in the systematic review with a mean methodological quality score of 6. Results demonstrate positive effects of WBV in relevant outcomes such as knee function, electromyographic activity, balance, and muscle strength. Conclusions. WBV demonstrated a positive effect in strength, balance, electromyographic activity, and knee function.


2018 ◽  
Vol 1 (84) ◽  
Author(s):  
Vilma Jurevičienė ◽  
Albertas Skurvydas ◽  
Juozas Belickas ◽  
Giedra Bušmanienė ◽  
Dovilė Kielė ◽  
...  

Research  background  and  hypothesis.  Proprioception  is  important  in  the  prevention  of  injuries  as  reduced proprioception  is  one  of  the  factors  contributing  to  injury  in  the  knee  joint,  particularly  the  ACL.  Therefore, proprioception appears not only important for the prevention of ACL injuries, but also for regaining full function after ACL reconstruction.Research aim. The aim of this study was to understand how proprioception is recovered four and five months after anterior cruciate ligament (ACL) reconstruction.Research methods. The study included 15 male subjects (age – 33.7 ± 2.49 years) who had undergone unilateral ACL reconstruction with a semitendinosus/gracilis (STG) graft in Kaunas Clinical Hospital. For proprioceptive assessment, joint position sense (JPS) was measured on both legs using an isokinetic dynamometer (Biodex), at knee flexion of 60° and 70°, and at different knee angular velocities of 2°/s and 10°/s. The patients were assessed preoperatively and after 4 and 5 months, postoperatively.Research results. Our study has shown that the JPS’s (joint position sense) error scores  to a controlled active movement is significantly higher in injured ACL-deficient knee than in the contralateral knee (normal knee) before surgery and after four and five months of rehabilitation.  After 4 and 5 months of rehabilitation we found significantly lower values in injured knees compared to the preoperative data. Our study has shown that in injured knee active angle reproduction errors after 4 and 5 months of rehabilitation were higher compared with the ones of the uninjured knee. Proprioceptive ability on the both legs was  independent of all differences angles for target and starting position for movement. The knee joint position sense on both legs depends upon the rate of two different angular velocities and the mean active angle reproduction errors at the test of angular velocity slow speed was the highest compared with the fast angular velocity. Discussion and conclusions. In conclusion, our study shows that there was improvement in mean JPS 4 and 5 months after ACL reconstruction, but it did not return to normal indices.Keywords: knee joint, joint position sense, angular velocity, starting position for movement.


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