NON-CONTACT ANTERIOR CRUCIATE LIGAMENT AND LOWER EXTREMITY INJURY RISK PREDICTION USING FUNCTIONAL MOVEMENT SCREEN AND KNEE ABDUCTION MOMENT: AN EPIDEMIOLOGICAL OBSERVATION OF FEMALE INTERCOLLEGIATE ATHLETES

Abstract Objective: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. Background: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. Differential Diagnosis: Partial or complete tear of the ACL. Measurements: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. Findings: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. Conclusions: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

Download Full-text

Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0407 ◽

2021 ◽

pp. 1-8

Author(s):

Dhruv Gupta ◽

Jeffrey A. Reinbolt ◽

Cyril J. Donnelly

Keyword(s):

Internal Rotation ◽

Injury Risk ◽

Cruciate Ligament ◽

Acl Injury ◽

Whole Body ◽

Jump Landing ◽

Peak Knee ◽

Knee Abduction ◽

Acl Injury Risk ◽

Anterior Cruciate

Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.

Download Full-text

Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study

The American Journal of Sports Medicine ◽

10.1177/0363546504269591 ◽

2005 ◽

Vol 33 (4) ◽

pp. 492-501 ◽

Cited By ~ 1609

Author(s):

Timothy E. Hewett ◽

Gregory D. Myer ◽

Kevin R. Ford ◽

Robert S. Heidt ◽

Angelo J. Colosimo ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Injury Risk ◽

Female Athletes ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Ligament Injury ◽

Knee Abduction ◽

Anterior Cruciate ◽

Dynamic Valgus

Background Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. Hypothesis Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. Study Design Cohort study; Level of evidence, 2. Methods There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. Results Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P <. 05) at landing was 8° greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P <. 001) and 20% higher ground reaction force (P <. 05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. Conclusion Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. Clinical Relevance Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.

Download Full-text

Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03552-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Anna Cronström ◽

Mark W. Creaby ◽

Eva Ageberg

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Prospective Studies ◽

Injury Risk ◽

Cruciate Ligament ◽

Meta Analysis ◽

Ligament Injury ◽

Knee Abduction ◽

Anterior Cruciate ◽

Kinematics And Kinetics

Download Full-text

Association between the Functional Movement Screen and Noncontact Lower Extremity Injury in Collegiate Football Players

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000479338.53426.25 ◽

2015 ◽

Vol 47 ◽

pp. 957

Author(s):

Peter J. Lisman ◽

Nathan Wilder ◽

Mary Nadelen ◽

Michael Higgins ◽

Robert Livezey ◽

...

Keyword(s):

Lower Extremity ◽

Lower Extremity Injury ◽

Football Players ◽

Functional Movement Screen ◽

Extremity Injury ◽

Functional Movement ◽

Collegiate Football

Download Full-text

The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes

Journal of Sport Rehabilitation ◽

10.1123/jsr.21.4.371 ◽

2012 ◽

Vol 21 (4) ◽

pp. 371-377 ◽

Cited By ~ 10

Author(s):

Jeffrey Paszkewicz ◽

Tristen Webb ◽

Brian Waters ◽

Cailee Welch McCarty ◽

Bonnie Van Lunen

Keyword(s):

Cruciate Ligament ◽

Acl Injury ◽

Lower Extremity Injury ◽

Clinical Scenario ◽

Clinical Question ◽

Extremity Injury ◽

Adolescent Athletes ◽

Acl Injuries ◽

Injury Rates ◽

Anterior Cruciate

Clinical Scenario:There is a high incidence of anterior cruciate ligament (ACL) injury in adolescents participating in pivoting sports such as soccer, basketball, and handball. Most ACL injuries in athletes are noncontact injuries, with a mechanism of sudden deceleration, change in direction, or landing from a jump. These mechanisms coupled with an increase in contraction of the quadriceps have been shown as risk factors for ACL injuries. Injuries to the ACL may require surgery, a long rehabilitation, and the potential for reinjury. Studies have shown reductions in lower extremity injury rates using training protocols that focus on landing mechanics, balance training, strength training, and/or agility training. There has been some thought that starting preventive training programs with adolescent athletes may be the most effective approach to reducing adolescent ACL injuries.Focused Clinical Question:Can lower extremity injury-prevention programs effectively reduce ACL injury rates in adolescent athletes?

Download Full-text

EMG Power Spectra of Intercollegiate Athletes and Anterior Cruciate Ligament Injury Risk in Females

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000053703.65057.31 ◽

2003 ◽

Vol 35 (3) ◽

pp. 371-376 ◽

Cited By ~ 39

Author(s):

KLANE K. WHITE ◽

STEVEN S. LEE ◽

ADNAN CUTUK ◽

ALAN R. HARGENS ◽

ROBERT A. PEDOWITZ

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Injury Risk ◽

Cruciate Ligament ◽

Power Spectra ◽

Ligament Injury ◽

Intercollegiate Athletes ◽

Anterior Cruciate

Download Full-text

THE NEW INJURIES’ RISK AFTER ACL RECONSTRUCTION MIGHT BE REDUCED WITH FUNCTIONAL TRAINING

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212901240903 ◽

2021 ◽

Vol 29 (1) ◽

pp. 21-25

Author(s):

JULIO CESAR GALI ◽

GUILIA WENDT FADEL ◽

MARCOS FELIPE MARQUES ◽

TYAGO ARAÚJO ALMEIDA ◽

JULIO CESAR GALI FILHO ◽

...

Keyword(s):

Group Performance ◽

Cruciate Ligament ◽

Control Group ◽

Study Group ◽

Functional Movement Screen ◽

Level Of Evidence ◽

Functional Movement ◽

Functional Training ◽

Anterior Cruciate ◽

And Control

ABSTRACT Objective: The objective of our study was to evaluate if functional training with the Functional Movement Screen (FMS) can reduce the risk of a new injury for patients that underwent an anterior cruciate ligament reconstruction (ACLR). Our hypothesis was that the functional training might reduce the risk of a new injury. Methods: Our training protocol consisted of six phases, each one lasting six weeks. It began two months after surgery. The study group was composed of 10 individuals that completed our protocol after ACLR. The control group consisted of 10 people that completed a regular ACLR rehabilitation protocol. The FMS was used to compare the study and control group performance. Patients with a score of 14 or less on the FMS were considered more likely to suffer an injury than those with a score higher than 14. Results: The study group average FMS score was 16.6 compared to the control group at 12.3. Functional training for ACLR rehabilitation added a statistically significant benefit (p < 0.0002) to reduce the risk of a new injury compared to regular protocol. Conclusion: Functional training may be considered an alternative to the regular ACLR rehabilitation to reduce the risk of a new injury before returning to sports. Level of Evidence III, Case control study.

Download Full-text