DESEMPENHO DE ATLETAS PROFISSIONAIS DE FUTEBOL FEMININO NA EXECUÇÃO DOS TESTES STEP DOWN E SINGLE LEG HOP TEST

Introdução: As atletas profissionais de futebol são alvo de lesões musculoesqueléticas de forma proporcional a intensidade e ao nível de competitividade. Apresentam maior prevalência de lesões em membros inferiores, que estão relacionadas ao valgo de joelho. As avaliações através dos testes funcionais como o Step Down e o Single Leg Hop Test são um método importante para identificação do movimento que poderá interferir no desempenho das atletas durante os jogos. Objetivo: Avaliar o desempenho das atletas de futebol feminino durante a execução dos testes funcionais Step Down e Single Leg Hop Test. Métodos: O delineamento do estudo foi do tipo transversal. A amostra foi composta por 26 atletas de futebol feminino e foi caracterizada por uma ficha de caracterização da amostra. A avaliação funcional realizada pelo índice de simetria nos testes Single Hop Test e Step Down. Resultados: As atletas tinham idade média 21,38 (±3,82), praticavam o esporte a 10 (±5,02) anos e treinavam 2 (±1) horas por dia ao longo de 6 (±2) dias da semana, (57,7%) apresentam histórico de lesão relacionada ao esporte. Não houve diferença estatisticamente significante entre o membro dominante e não dominante para a distância média (p=0,773) e normalizada (p=0,678) no Single Leg Hop Test. Não foram encontradas diferenças estatisticamente significantes entre o membro dominante e não dominante quanto ao grau das alterações para a queda da pelve (p=0,442) e adução do quadril (p=0,390) no Step Down Test. Conclusão: As atletas obtiveram bom desempenho com ISM no Single Leg Hop Test e baixo desempenho no Step Down pelas alterações de equilíbrio em queda pélvica e adução de joelho. Não houve diferença significativa na melhora do desempenho em relação dominância de membros inferiores em ambos os testes. Palavras-chave: Futebol. Mulheres. Fisioterapia. Traumatismos em Atletas.

Age, time from injury to surgery and hop performance after primary ACLR affect the risk of contralateral ACLR

Purpose To evaluate factors affecting the risk of contralateral anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR. Methods Primary ACLRs performed at Capio Artro Clinic, Stockholm, Sweden, during the period 2005–2014, were reviewed. The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for contralateral ACLR. Results A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age ≥ 25 years, BMI ≥ 25 kg/m2, time from injury to surgery ≥ 12 months and the presence of a cartilage injury reduced the odds, whereas female gender, pre-injury Tegner activity level ≥ 6, quadriceps and hamstring strength and a single-leg-hop test LSI of ≥ 90% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age ≥ 25 years (OR 0.40; 95% CI 0.28–0.58; P < 0.001), time from injury to surgery ≥ 12 months (OR 0.48; 95% CI 0.30–0.75; P = 0.001) and a single-leg-hop test LSI of ≥ 90% (OR 1.56; 95% CI 1.04–2.34; P = 0.03). Conclusion Older age (≥ 25 years) and delayed primary ACLR (≥ 12 months) reduced the odds, whereas a symmetrical (LSI ≥ 90%) 6-month single-leg-hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR. Level of evidence Level III.

Eight-Months After Anterior Cruciate Ligament Reconstruction: Is It Time to Return to Physical Activity?

Background. Return to participation in sport is an important outcome when evaluating the success of anterior cruciate ligament (ACL) reconstruction surgery. A review by Arden et al. (2014) demonstrates that just because an athlete has surgery, it does not automatically mean that they will return to sport. So, the purpose of this study was to assess if patients could return to their pre-injury activity level 8 months after ACLR. Methods. Patients completed IKDC-2000, ACL-RSI questionnaires, underwent FMS, YBT, HOP test sets and drop jump tests, which were evaluated with the LESS. ACL laxity was measured by using a GNRB® device. Participants were 81 patients. They were divided into two groups based on single leg HOP test results. The first group included 30 persons who all had their four single leg HOP test scores above 90%. The second group consisted of 51 persons for whom at least one of the single leg HOP tests scored lower than 90%. Results. IKDC and HOP test results in the first group scored higher than in the second group. Psychological confidence was higher in the first group, who had better HOP test results. For the first group, FMS and LESS results were better than those for the second group. Moderate positive correlation was found between LESS scores and laxity results, FMS, three HOP sub-tests. IKDC had the biggest number of correlations with other tests. Results showed negative and weak correlation with laxity results using 134 N power, as well as positive and moderate correlation with HOP sub-tests, FMS, ACL-RSI. Single HOP for distance, triple HOP for distance, crossover HOP for distance and LESS increased the odds of achieving RTS criteria. No other factors were found to be associated with the accomplishment of reaching RTS criteria after ACLR. Conclusions. The main factor which can help decide if a person can return to their pre-injury level of physical activity are the single leg HOP test and LESS. The use of single leg HOP tests and LESS along with psychological and self-reported evaluations is the best test combination for assessment 8 months after ACLR. Keywords: ACL reconstruction, function tests, return to play, jump tests, psychological readiness.

Análise funcional e comparativa da reconstrução do ligamento cruzado anterior utilizando autoenxerto patelar ipsilateral e contralateral

A reconstrução cirúrgica do ligamento cruzado anterior pode levar à diminuição dodesempenho muscular, da funcionalidade das atividades de vida diária e da simetria bilateraldos membros inferiores. O presente estudo teve como objetivo comparar a simetria atingidapor pacientes submetidos a essa cirurgia utilizando o autoenxerto patelar ipsilateral econtralateral à lesão quatro meses após o procedimento para identificar o tratamento maisadequado a ser seguido. Método: Foi realizado um ensaio clínico randomizado cego com umaamostra de 88 participantes do gênero masculino com idade entre 18 e 35 anos praticantesamadores de futebol. Foi feita uma divisão aleatória em dois grupos (contralateral: n = 44;ipsilateral: n = 44), que foram avaliados de forma cega antes e quatro meses após a cirurgiaquanto à presença de sinais inflamatórios, amplitude de movimento, estabilidade articularobjetiva (KT-1000®), desempenho muscular (pico de torque e relação I/Q) e funcionalidadeobjetiva ( Single Leg Hop Test e Y Balance Test ) e subjetiva (Escala de Atividades de VidaDiária e Questionário de Lysholm). Resultados: As variáveis de amplitude de movimento,desempenho muscular e funcionalidade apresentaram alterações significativas entre osgrupos, sendo as diferenças entre os membros menores no grupo contralateral. Conclusão: Ogrupo contralateral apresentou maior simetria bilateral quatro meses após a intervençãocirúrgica quando comparado ao grupo ipsilateral, demonstrando que a reconstrução doligamento cruzado anterior com o autoenxerto patelar contralateral à lesão é um método eficaz para uma recuperação rápida da funcionalidade do paciente e seu retorno às atividades de vida diária

Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction

Purpose To identify preoperative, intraoperative and postoperative factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 2 years of primary ACLR. Methods Patients who underwent primary ACLR at our institution, from January 2005 to March 2017, were identified. The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side-to-side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for revision ACLR. Results A total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age < 25 years, BMI < 25 kg/m2, time from injury to surgery < 12 months, pre-injury Tegner activity level ≥ 6, LM repair, STS laxity > 5 mm, quadriceps strength and single-leg-hop test LSI of ≥ 90% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age < 25 years (OR 6.25; 95% CI 3.57–11.11; P < 0.001), time from injury to surgery < 12 months (OR 2.27; 95% CI 1.25–4.17; P = 0.007) and quadriceps strength LSI of ≥ 90% (OR 1.70; 95% CI 1.16–2.49; P = 0.006). Conclusion Age < 25 years, time from injury to surgery < 12 months and 6-month quadriceps strength LSI of ≥ 90% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery. Level of evidence III.

A PRÁTICA DE UM PROGRAMA PREVENTIVO MELHORA A CAPACIDADE FUNCIONAL DE MEMBROS INFERIORES EM ATLETAS

O objetivo desse estudo foi analisar os efeitos de um programa preventivo sobre a capacidade funcional de membros inferiores em atletas jovens de handebol feminino. Este estudo experimental incluiu uma amostra por conveniência de 17 atletas com idade de 12 a 16 anos, integrantes de um time de handebol feminino amador. As jovens foram divididas em dois grupos, sendo, o grupo intervenção (GI), integrando as atletas que praticaram o programa preventivo associado ao treino regular do handebol (n=9), e o grupo controle (GC), cujas jovens praticaram apenas o treinamento esportivo na equipe (n=8). Foi aplicado um questionário inicial, mensurado os dados antropométricos e a capacidade funcional dos membros inferiores foi avaliada através do Single Leg Hop Test, Timed Hop Test e Side Hop Test. O programa consistiu de aproximadamente 20 minutos de exercícios de aquecimento, força, agilidade e pliometria e equilíbrio, antes do treino regular do esporte, duas vezes por semana, durante oito semanas, totalizando 16 sessões. O GI apresentou melhorias significativas pós-intervenção em todos os testes realizados (p<0,05), em ambos os membros inferiores, diferentes do GC, no qual os resultados foram mais limitados. Oito semanas de treinamento de um programa preventivo melhorou significativamente a capacidade funcional de jovens atletas de handebol feminino, indicando que este tipo de intervenção é capaz de modificar positivamente os fatores de risco para o desenvolvimento de lesões de membros inferiores destas atletas.

Comparison of ankle range of motion and functional performance between practitioners of resistance exercise with free-weight vs. Machine

The purpose of this investigation was to compare ankle functional performance and ankle range of motion (ROM) between practitioners of resistance exercise (RE) with free-weights versus machines. Twenty-five men participated in this study. They were separated into two groups: (a) Free-weights; and (b) Machines. All subjects practiced regularly RE 5.3±0.7 d∙wk-1 and low aerobic training of 1.2±0.5 d∙wk-1 with a total time volume of 254.9±9.4 min∙wk-1. ROM measurements were taken in both ankles with a digital goniometer. Active ankle-dorsiflexion and plantar flexion range of motion were measured with subjects lying prone with an extended knee on a standard treatment table. The rising on the heel and the rising on toes were used to assess endurance of the ankle dorsiflexor and plantar flexor muscles, respectively. Ankle functional stability was assessed with the Single Leg Hop Test in both limbs. Ankle-dorsiflexion ROM showed a significant difference (Δ% left=21.1%; Δ% right=25.8%; P<0.01) between the Machines Group when compared to the Free-weights Group. Rising on the heel and rising on the toes showed no significant differences between the 2 groups (i.e., free-weights versus machines) (P>0.05). On the other hand, the Single Leg Hop Test (Δ% left=16.3%; Δ% right=15.4%; P<0.05) and number of jumps (Δ% left=27.9 %; Δ% right=26.1 %; P<0.05) recorded were lower in the Free-weights Group compared to the Machines Group. This study found a greater ankle-dorsiflexion ROM and performance during the Single Leg Hop Test in practitioners of RE with free-weights, showing a better control of sagittal plane movements.

Effects of Kinesiotape vs Soft and Semirigid Ankle Orthoses on Balance in Patients With Chronic Ankle Instability: A Randomized Controlled Trial

Background: Chronic ankle instability (CAI) is a frequent complication of ankle sprain that may be associated with long-term consequences. Although taping and bracing are common interventions that are widely used by clinicians and athletic trainers for patients with CAI, no studies have compared the effects of kinesiotaping and bracing on balance performance in these patients. The present study aimed to compare the effects of ankle kinesiotaping, a soft ankle orthosis, and a semirigid ankle orthosis on balance performance in patients with CAI. Methods: Sixty patients with CAI were randomly assigned to 4 groups that received kinesiotaping, a soft orthosis, a semirigid orthosis, or no treatment (control group). Dynamic and static balance were measured with the modified Star Excursion Balance Test, single leg hop test, and single leg stance test before and after a 4-week intervention period. Results: Significant between-group differences were seen in all evaluated outcomes ( P ≤ .003). The lowest reach distances in all directions in the modified Star Excursion Balance Test were found in the control group, and these patients also had a significantly shorter measured distance in the single leg hop test, and more errors in the single leg stance test compared with the 3 intervention groups. No significant differences were found among the 3 intervention groups. Conclusion: Use of kinesiotaping and a soft or a semirigid ankle brace for 4 weeks were all beneficial in improving static and dynamic balance in individuals with CAI. None of the interventions was superior to the other 2. Level of Evidence: Level I, randomized controlled trial.