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Garcia SA, Kahan S, Gallegos J, Balza I, Krishnan C, Palmieri-Smith RM. Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls. Clin Biomech (Bristol, Avon) 2023; 108:106059. [PMID: 37562332 DOI: 10.1016/j.clinbiomech.2023.106059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Walking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. METHODS We recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FINDINGS We observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13-0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13-0.25, p < 0.05). INTERPRETATION Overall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Seth Kahan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Jovanna Gallegos
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Isabella Balza
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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Collins K, Fajardo R, Harkey M, Knake J, Lisee C, Wilcox L, Tasco J, Kuenze C. Knee symptoms do not affect walking biomechanics among women 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2240-2247. [PMID: 35001419 DOI: 10.1002/jor.25265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Women with anterior cruciate ligament reconstruction report worse pain and knee-related symptoms, and also exhibit biomechanical changes that may be related to knee osteoarthritis (OA) development. This is particularly concerning as symptom state has been previously associated with knee OA development. The purpose of this study was to compare lower extremity walking biomechanics between women (age: 21.40 ± 8.54 years) experiencing clinically significant knee-related symptoms and women with acceptable symptoms 6 months following surgery. Twenty-eight women with history of primary, unilateral anterior cruciate ligament reconstruction who completed a lower extremity walking biomechanics assessment 6 months following surgery were included in this analysis. Women were dichotomized as experiencing acceptable or clinically significant knee symptoms according to Knee injury and OA Outcomes Score cut-offs described by Englund et al. Walking biomechanics were compared between women with clinically significant and acceptable symptoms using one-way analysis of covariances for involved limb biomechanics. Biomechanical variables of interest were: peak vertical ground reaction forces (vGRFs), vGRF loading rates, knee flexion angles, knee extension moments, knee adduction angles, and knee adduction moments, and gait speed. Nearly 60% of women reported clinically significant knee symptoms 6 months postoperative. There were no statistically significant differences between symptom groups for walking biomechanics and gait speed outcomes. These findings suggest patient reported knee symptoms may not be a primary influence on walking biomechanics 6 months following anterior cruciate ligament reconstruction. Though, longitudinal assessment of changes in symptom state and walking biomechanics may be warranted as poorer walking biomechanics and symptoms are indicators of knee OA.
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Affiliation(s)
- Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Ryan Fajardo
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jeffrey Knake
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luke Wilcox
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Jamie Tasco
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.,Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
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Association Between the Functional Movement Screen and Landing Kinematics in Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2022; 31:842-848. [PMID: 35413683 DOI: 10.1123/jsr.2021-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to compare functional movement screen (FMS) scores and drop vertical jump (DVJ) kinematics between those with and without anterior cruciate ligament reconstruction (ACLR), and to evaluate the association between FMS composite score and DVJ kinematics. DESIGN Cross-sectional. PARTICIPANTS Sixty individuals with and without a history of ACLR. MAIN OUTCOME MEASURES Composite FMS score and the dorsiflexion, knee-flexion, hip-flexion, knee abduction, hip adduction, and trunk-flexion angles during a DVJ. RESULTS The FMS scores did not differ between groups (P > .05). There were smaller peak and initial contact hip-flexion angles in the ACLR and contralateral limbs compared with controls, and smaller peak dorsiflexion angles in the ACLR compared with contralateral limbs (P < .05). Lower FMS score was associated with a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the ACLR limb (ΔR2 = .14-.23); a smaller peak dorsiflexion angle and smaller peak knee-flexion angle in the contralateral limb (ΔR2 = .17-.19); and a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the control limb (ΔR2 = .16-.22). CONCLUSION The FMS scores did not differ between groups, but were associated with DVJ kinematics and should be a complementary rather than substitute assessment.
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Chaaban CR, Hearn D, Goerger B, Padua DA. Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME). Int J Sports Phys Ther 2022; 17:445-455. [PMID: 35391856 PMCID: PMC8975580 DOI: 10.26603/001c.32529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Elite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries. Purpose To compare elite collegiate female athletes who were able to successfully return to sport for at least one season following ACLR to their teammates with no history of ACLR with regard to self-reported knee function, kinetics, and kinematics during a double limb jump-landing task. Study Design Cross-Sectional Study. Level of Evidence Level 3. Methods Eighty-two female collegiate athletes (17 ACLR, 65 control) completed the knee-specific SANE (single assessment numeric evaluation) and three trials of a jump-landing task prior to their competitive season. vGRF data on each limb and the LESS (Landing Error Scoring System) score were collected from the jump-landing task. Knee-SANE, vGRF data, and LESS scores were compared between groups. All athletes were monitored for the duration of their competitive season for ACL injuries. Results Athletes after ACLR reported worse knee-specific function. Based on vGRF data, they unloaded their involved limb during the impact phase of the landing, and they were more asymmetrical between limbs during the propulsion phase as compared to the control group. The ACLR group, however, had lower LESS scores, indicative of better movement quality. No athletes in either group sustained ACL injuries during the following season. Conclusion Despite reporting worse knee function and demonstrating worse kinetics, the ACLR group demonstrated better movement quality relative to their uninjured teammates. This functional profile may correspond to short-term successful outcomes following ACLR, given that no athletes sustained ACL injuries in the competition season following assessment.
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Affiliation(s)
| | - Darren Hearn
- Human Performance and Sports Medicine, Fort Bragg
| | - Benjamin Goerger
- Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Exercise and Sport Science, University of North Carolina at Chapel Hill
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Aberrant gait biomechanics in individuals with ACL reconstruction are magnified during treadmill walking. J Biomech 2022; 134:110989. [PMID: 35152158 PMCID: PMC8976749 DOI: 10.1016/j.jbiomech.2022.110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/12/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Aberrant gait biomechanics following anterior cruciate ligament reconstruction (ACLR) likely contribute to post-traumatic osteoarthritis (PTOA) development. Gait biomechanics are typically assessed overground, but the use of instrumented/force-measuring treadmills is increasingly common. The purpose of this study was to compare gait biomechanics overground and on an instrumented treadmill in individuals with ACLR and healthy controls. Twenty-four individuals with ACLR and 24 healthy controls completed overground and gait biomechanics assessments. Biomechanical outcomes included peak vertical ground reaction force (vGRF), internal knee extension (KEM) and abduction (KAM) moments, and knee flexion (KFA) and adduction angles; KFA at heel strike; knee flexion displacement; and inter-limb symmetry for each outcome. Peak KEM (P < 0.001, 95%CI [-0.016, -0.007 xBW*Ht]) and vGRF (P < 0.001, 95%CI [-0.09. -0.03 xBW]) were significantly less symmetrical in the ACLR group compared to the control group on the treadmill but not overground. Additionally, peak KEM was smaller in the ACLR limb compared to the contralateral limb both overground (P = 0.005, 95%CI [-0.010, -0.001 xBW*Ht]) and on the treadmill (P < 0.001, 95%CI [-0.015, -0.007 xBW*Ht]), but this difference was 1.8x larger on the treadmill compared to overground. Peak KFA (P = 0.001, 95%CI [-4.2, -1.2°]) and vGRF (P < 0.001, 95%CI [-0.07, -0.03 xBW]) were smaller in the ACLR limb on the treadmill but not overground. These findings suggest aberrant gait biomechanics are exacerbated during treadmill walking post-ACLR and that evaluating kinematics and kinetics on instrumented treadmills may be valuable for assessing risk factors of PTOA development.
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Mok AC, Fancher AJ, Vopat ML, Baker J, Tarakemeh A, Mullen S, Schroeppel JP, Templeton K, Mulcahey MK, Vopat BG. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221076883. [PMID: 35224122 PMCID: PMC8873558 DOI: 10.1177/23259671221076883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Despite the significant difference between men and women in incidence of anterior cruciate ligament (ACL) injuries, there is a paucity of consistent information on the influence of patient sex on outcomes after ACL reconstruction. A previous meta-analysis has demonstrated that female patients have worse outcomes with regard to laxity, revision rate, Lysholm score, and Tegner activity score and are less likely to return to sports (RTS). Purpose: To conduct a systematic review and meta-analysis to evaluate and compare sex-specific outcomes after ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using PubMed, PubMed Central, Embase, OVID, and Cochrane databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following search terms were used: “anterior cruciate ligament reconstruction” OR “ACL reconstruction” OR “anterior cruciate ligament” OR “ACL” AND “gender” OR “sex” OR “male” OR “female” AND “outcome” AND “2015-Present” to gather all relevant articles between 2015 and 2020. A risk-of-bias assessment and quality assessment was conducted on included studies. Results: Of 9594 studies initially identified, 20 studies with 35,935 male and 21,455 female patients were included for analysis. The 7 studies reporting International Knee Documentation Committee (IKDC) scores showed that male patients had statistically significantly higher postoperative scores (mean difference, 3.02 [95% CI, 1.19-4.84]; P< .01; I2 = 66%), and 7 studies that reported the rate of ACL revision showed there was no significant difference between male and female patients (odds ratio, 0.85 [95% CI, 0.45-1.60]; P = .61; I2 = 94%). The 7 studies that reported rates of rerupture showed that males were significantly more likely than females to have a graft rerupture (odds ratio, 1.35 [95% CI, 1.22-1.50]; P < .01; I2 = 0%). Male patients reported a higher RTS rate than did their female counterparts (59.82% compared with 42.89%); however, no formal statistical analysis could be done because of the variability in reporting techniques. Conclusion: Male and female patients with ACL injuries demonstrated similar outcomes regarding their rates of revision; however, male patients were found to have statistically significantly higher postoperative IKDC scores but at the same time higher rerupture rates. Our findings suggest that sex-based differences in outcomes after ACL reconstruction vary based on which metric is used. These results must be considered when counseling patients with ACL injuries.
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Affiliation(s)
- Anthony C. Mok
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Matthew L. Vopat
- Department of Orthopaedics, The Steadman Clinic, Vail, Colorado, USA
| | - Jordan Baker
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Scott Mullen
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - John P. Schroeppel
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kim Templeton
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Mary K. Mulcahey
- Department of Orthopaedics, Tulane University, New Orleans, Louisiana, USA
| | - Bryan G. Vopat
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Garcia SA, Brown SR, Koje M, Krishnan C, Palmieri-Smith RM. Gait asymmetries are exacerbated at faster walking speeds in individuals with acute anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:219-230. [PMID: 34101887 PMCID: PMC8651805 DOI: 10.1002/jor.25117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (age = 20.6 ± 5.4 years, body mass index [BMI] = 23.9 ± 3.3 kg/m2 ) and 15 controls (age = 23.1 ± 4.5 years, BMI = 23.6 ± 2.7 kg/m2 ) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < .05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > .05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. Statement of Clinical Significance: Evaluating both preferred and fast walking speeds may aid in characterizing biomechanical asymmetries in individuals with ACL reconstruction which may be valuable in earlier rehabilitative time points when more difficult tasks like hopping and running are not feasible.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott R Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, Michigan, USA
| | - Mary Koje
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Robotics Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Kinetic measurement system use in individuals following anterior cruciate ligament reconstruction: a scoping review of methodological approaches. J Exp Orthop 2021; 8:81. [PMID: 34568996 PMCID: PMC8473525 DOI: 10.1186/s40634-021-00397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs). Methods We followed the PRISMA extension for scoping reviews and Arksey and O’Malley’s 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included. Results In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs. Conclusion Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00397-0.
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Pfeiffer SJ, Spang JT, Nissman D, Lalush D, Wallace K, Harkey MS, Pietrosimone LS, Padua D, Blackburn T, Pietrosimone B. Association of Jump-Landing Biomechanics With Tibiofemoral Articular Cartilage Composition 12 Months After ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211016424. [PMID: 34368382 PMCID: PMC8299897 DOI: 10.1177/23259671211016424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Excessively high joint loading during dynamic movements may negatively influence articular cartilage health and contribute to the development of posttraumatic osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Little is known regarding the link between aberrant jump-landing biomechanics and articular cartilage health after ACLR. PURPOSE/HYPOTHESIS The purpose of this study was to determine the associations between jump-landing biomechanics and tibiofemoral articular cartilage composition measured using T1ρ magnetic resonance imaging (MRI) relaxation times 12 months postoperatively. We hypothesized that individuals who demonstrate alterations in jump-landing biomechanics, commonly observed after ACLR, would have longer T1ρ MRI relaxation times (longer T1ρ relaxation times associated with less proteoglycan density). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 27 individuals with unilateral ACLR participated in this cross-sectional study. Jump-landing biomechanics (peak vertical ground-reaction force [vGRF], peak internal knee extension moment [KEM], peak internal knee adduction moment [KAM]) and T1ρ MRI were collected 12 months postoperatively. Mean T1ρ relaxation times for the entire weightbearing medial femoral condyle, lateral femoral condyle (global LFC), medial tibial condyle, and lateral tibial condyle (global LTC) were calculated bilaterally. Global regions of interest were further subsectioned into posterior, central, and anterior regions of interest. All T1ρ relaxation times in the ACLR limb were normalized to the uninjured contralateral limb. Linear regressions were used to determine associations between T1ρ relaxation times and biomechanics after accounting for meniscal/chondral injury. RESULTS Lower ACLR limb KEM was associated with longer T1ρ relaxation times for the global LTC (ΔR 2 = 0.24; P = .02), posterior LTC (ΔR 2 = 0.21; P = .03), and anterior LTC (ΔR 2 = 0.18; P = .04). Greater ACLR limb peak vGRF was associated with longer T1ρ relaxation times for the global LFC (ΔR 2 = 0.20; P = .02) and central LFC (ΔR 2 = 0.15; P = .05). Peak KAM was not associated with T1ρ outcomes. CONCLUSION At 12 months postoperatively, lower peak KEM and greater peak vGRF during jump landing were related to longer T1ρ relaxation times, suggesting worse articular cartilage composition.
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Affiliation(s)
- Steven J. Pfeiffer
- Ohio Musculoskeletal & Neurological Institute, Athens, Ohio, USA
- Division of Exercise Physiology, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Athens, Ohio, USA
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Kyle Wallace
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew S. Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Laura S. Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Darin Padua
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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de Britto MA, Lemos AL, Dos Santos CS, Maroneze BM, Stoelben KJ, Carpes FP. Effects of a rebound shoe to reduce impact forces in jump-landing tasks. J Bodyw Mov Ther 2021; 26:77-83. [PMID: 33992301 DOI: 10.1016/j.jbmt.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/01/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Impact forces are risk factors for injuries during jump-landing tasks. Rebound shoes could reduce impact forces and show potential applications in training and rehabilitation programs. Here, we determine the capacity of a rebound shoe in attenuating impact forces during different motor tasks involving foot landing. DESIGN Crossover laboratory research design. SETTINGS Women not trained for jump-landing tasks performed different exercises while the vertical ground reaction force impact peak, time to peak, and asymmetries were determined. They were wearing a commercial rebound shoe and a control running shoe. Paired t-tests were used to compare the shoes and asymmetries. PARTICIPANTS Fifteen physically active women (average age of 23 years old, height of 1.64 m, and body mass of 63 kg). MAIN OUTCOME MEASURES Ground reaction forces. RESULTS The rebound shoe reduced the impact peak force and elicited slight asymmetries between the legs. The rebound shoe also showed a longer time to peak. CONCLUSIONS The rebound shoe tested reduced impact forces during jump-landing tasks, which is a potential application in training sessions and rehabilitation programs, requiring lower impact forces to the lower extremity. The effects of long-term use of these shoes still need to be investigated.
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Affiliation(s)
- Morgana A de Britto
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Andressa L Lemos
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | | | - Bruno M Maroneze
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Karine Jv Stoelben
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil.
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Ito N, Capin JJ, Arhos EK, Khandha A, Buchanan TS, Snyder-Mackler L. Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR. J Orthop Res 2021; 39:1123-1132. [PMID: 32761919 PMCID: PMC7864984 DOI: 10.1002/jor.24822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
Early-onset knee osteoarthritis (OA) is associated with gait asymmetries after anterior cruciate ligament reconstruction (ACLR). Women have higher risks of sustaining non-contact injuries, and are more likely to present with aberrant movement patterns associated with the mechanism of injury (MOI). We hypothesized that sex and MOI would influence gait after ACLR. Seventy participants, grouped by sex and MOI, completed biomechanical testing during over-ground walking when they had full knee range of motion, trace or less knee effusion, greater than 80% quadriceps strength limb symmetry index, ability to hop on each leg without pain, and initiated running. Bilateral knee kinetics, kinematics, and joint contact forces were compared using mixed-model analysis of variance (α = .05). There was a three-way interaction effect of sex × MOI × limb for peak medial compartment contact force (P = .002), our primary outcome measure previously associated with OA development. Men with non-contact injuries walked with asymmetry characterized by underloading of the involved limb. Men with contact injuries walked with the most symmetrical loading. In women, no clear pattern emerged based on MOI. Targeting, and possibly prioritizing interventions for athletes who present with gait asymmetries after ACLR based on sex and MOI, may be necessary to optimize outcomes. Statement of Clinical Significance: Sex and MOI may influence walking mechanics, and could be considered in future interventions to target gait symmetry, as a response to interventions may vary based on differences in sex and MOI.
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Affiliation(s)
- Naoaki Ito
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Jacob J. Capin
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado Veterans Affairs (VA) Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Elanna K. Arhos
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Mechanical Engineering, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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12
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Morikawa M, Maeda N, Komiya M, Hirota A, Mizuta R, Kobayashi T, Kaneda K, Nishikawa Y, Urabe Y. Contribution of Plantar Fascia and Intrinsic Foot Muscles in a Single-Leg Drop Landing and Repetitive Rebound Jumps: An Ultrasound-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094511. [PMID: 33922807 PMCID: PMC8123000 DOI: 10.3390/ijerph18094511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
The plantar fascia and intrinsic foot muscles (IFM) modulate foot stiffness. However, it is unclear whether the corresponding ultrasonography findings reflect it. This study aimed to examine the effect of the plantar fascia and IFM morphologies on force attenuation during landing and reactivity when jumping in healthy adults (n = 21; age, 21-27 years). Thickness, cross-sectional area (CSA), and hardness of the plantar fascia, abductor hallucis (AbH), and flexor hallucis brevis (FHB) muscles were measured using ultrasonography. Single-leg drop landing and repetitive rebound jumping tests assessed the ground reaction force (GRF) and reactive jump index (RJI), respectively. The CSA of FHB was negatively correlated with maximum vertical GRF (r = -0.472, p = 0.031) in the single-leg drop landing test. The CSA of AbH was negatively correlated with contact time (r = -0.478, p = 0.028), and the plantar fascia thickness was positively correlated with jump height (r = 0.615, p = 0.003) and RJI (r = 0.645, p = 0.002) in the repetitive bound jump test. In multivariate regression analysis, only the plantar fascia thickness was associated with RJI (β = 0.152, 95% confidence interval: 7.219-38.743, p = 0.007). The CSA of FHB may contribute to force attenuation during landing. The thickness of the plantar fascia and CSA of AbH may facilitate jumping high with minimal contact time.
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Affiliation(s)
- Masanori Morikawa
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Noriaki Maeda
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Makoto Komiya
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Arisu Hirota
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Rami Mizuta
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, China;
| | - Kazuki Kaneda
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
| | - Yuichi Nishikawa
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa 076-264-5111, Japan;
| | - Yukio Urabe
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (M.M.); (N.M.); (M.K.); (A.H.); (R.M.); (K.K.)
- Correspondence:
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13
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Alterations in Quadriceps Neurologic Complexity After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2021; 30:731-736. [PMID: 33440341 DOI: 10.1123/jsr.2020-0307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/08/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Traditionally, quadriceps activation failure after anterior cruciate ligament reconstruction (ACLR) is estimated using discrete isometric torque values, providing only a snapshot of neuromuscular function. Sample entropy (SampEn) is a mathematical technique that can measure neurologic complexity during the entirety of contraction, elucidating qualities of neuromuscular control not previously captured. OBJECTIVE To apply SampEn analyses to quadriceps electromyographic activity in order to more comprehensively characterize neuromuscular deficits after ACLR. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS ACLR: n = 18; controls: n = 24. INTERVENTIONS All participants underwent synchronized unilateral quadriceps isometric strength, activation, and electromyography testing during a superimposed electrical stimulus. MAIN OUTCOME MEASURES Group differences in strength, activation, and SampEn were evaluated with t tests. Associations between SampEn and quadriceps function were evaluated with Pearson product-moment correlations and hierarchical linear regressions. RESULTS Vastus medialis SampEn was significantly reduced after ACLR compared with controls (P = .032). Vastus medialis and vastus lateralis SampEn predicted significant variance in activation after ACLR (r2 = .444; P = .003). CONCLUSIONS Loss of neurologic complexity correlates with worse activation after ACLR, particularly in the vastus medialis. Electromyographic SampEn is capable of detecting underlying patterns of variability that are associated with the loss of complexity between key neurophysiologic events after ACLR.
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14
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Pfeiffer SJ, Spang J, Nissman D, Lalush D, Wallace K, Harkey MS, Pietrosimone LS, Schmitz R, Schwartz T, Blackburn T, Pietrosimone B. Gait Mechanics and T1ρ MRI of Tibiofemoral Cartilage 6 Months after ACL Reconstruction. Med Sci Sports Exerc 2019; 51:630-639. [PMID: 30444797 DOI: 10.1249/mss.0000000000001834] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Aberrant walking biomechanics after anterior cruciate ligament reconstruction (ACLR) are hypothesized to be associated with deleterious changes in knee cartilage. T1ρ magnetic resonance imaging (MRI) is sensitive to decreased proteoglycan density of cartilage. Our purpose was to determine associations between T1ρ MRI interlimb ratios (ILR) and walking biomechanics 6 months after ACLR. METHODS Walking biomechanics (peak vertical ground reaction force (vGRF), vGRF loading rate, knee extension moment, knee abduction moment) were extracted from the first 50% of stance phase in 29 individuals with unilateral ACLR. T1ρ MRI ILR (ACLR limb/uninjured limb) was calculated for regions of interest in both medial and lateral femoral (LFC) and medial and lateral tibial condyles. Separate, stepwise linear regressions were used to determine associations between biomechanical outcomes and T1ρ MRI ILR after accounting for walking speed and meniscal/chondral injury (P ≤ 0.05). RESULTS Lesser peak vGRF in the ACLR limb was associated with greater T1ρ MRI ILR for the LFC (posterior ΔR = 0.14, P = 0.05; central ΔR = 0.15, P = 0.05) and medial femoral condyle (central ΔR = 0.24, P = 0.01). Lesser peak vGRF loading rate in the ACLR limb (ΔR = 0.21, P = 0.02) and the uninjured limb (ΔR = 0.27, P = 0.01) was associated with greater T1ρ MRI ILR for the anterior LFC. Lesser knee abduction moment for the injured limb was associated with greater T1ρ MRI ILR for the anterior LFC (ΔR = 0.16, P = 0.04) as well as the posterior medial tibial condyle (ΔR = 0.13, P = 0.04). CONCLUSION Associations between outcomes related to lesser mechanical loading during walking and greater T1ρ MRI ILR were found 6 months after ACLR. Although preliminary, our results suggest that underloading of the ACLR limb at 6 months after ACLR may be associated with lesser proteoglycan density in the ACLR limb compared with the uninjured limb.
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Affiliation(s)
- Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Lalush
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC
| | - Kyle Wallace
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Laura S Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randy Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro NC
| | - Todd Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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15
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Norouzi S, Esfandiarpour F, Mehdizadeh S, Yousefzadeh NK, Parnianpour M. Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria. BMC Musculoskelet Disord 2019; 20:492. [PMID: 31656192 PMCID: PMC6815439 DOI: 10.1186/s12891-019-2893-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Return to sport (RTS) criteria are widely being used to identify anterior cruciate ligament reconstructed (ACLR) athletes ready to return to sportive activity and reduce risk of ACL re-injury. However, studies show a high rate of ACL re-injury in athletes who passed RTS criteria. This indicates that the current RTS criteria might not be sufficient to determine return to sport time in ACLR athletes. Previous studies have reported a close association between altered lower limb kinematics and ACL re-injury. However, it is not clear how lower extremity kinematics differs between ACLR athletes who passed the RTS-criteria and who failed. This study compared lower extremity kinematics in a jump-landing task between ACLR athletes who passed the RTS criteria (Limb symmetry in hop tests, quadriceps strength and questionnaires) to those who failed and to the healthy individuals. Methods Participants were 27 male football players with unilateral ACLR including 14 who passed -RTS criteria and 13 failed, and 15 healthy football players. A 3D motion capture system recorded participants’ lower extremity motion while performing 10 trials of a bilateral jump-landing task. Hip, knee and ankle angular motion were examined at initial contact. Two-way mixed analysis of variances (2 limbs × 3 groups) and Bonferroni post-hoc tests were performed to compare the joint angles between the limbs and groups. Results lower hip abduction angle was found in the failed (involved limb 4.1 ° ± 4.2) and passed RTS (involved limb 6.8° ± 3.3) groups compared to the healthy group (non-dominant limb 10.7° ± 3.7). Ankle inversion in the failed RTS (0.4° ± 4.9) group was significantly lower than both passed RTS (4.8° ± 4.8, p = 0.05) and healthy (8.2° ± 8.1, p < 0.001) groups. There were no significant differences between the groups in knee kinematics. Conclusions Our findings indicate reduced hip abduction during initial contact phase of landing in athletes returned to sport. Reduced hip abduction during the complex multiplanar movement of jump-landing is a risk factor for ACL re-injury. Current RTS criteria may not be sufficient to identify ACLR athletes at high risk of re-injury. The kinematic analysis in conjunction with current RTS criteria can provide additional insight into the return to sport decision making.
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Affiliation(s)
- Sadegh Norouzi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fateme Esfandiarpour
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Department of Family Medicine, University of Alberta, Edmonton, Canada.
| | - Sina Mehdizadeh
- Toronto Rehabilitation Institute, University of Health Network, Toronto, Canada
| | - Nasim Kiani Yousefzadeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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16
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Luc-Harkey BA, Franz JR, Losina E, Pietrosimone B. Association between kinesiophobia and walking gait characteristics in physically active individuals with anterior cruciate ligament reconstruction. Gait Posture 2018; 64:220-225. [PMID: 29933185 PMCID: PMC6355249 DOI: 10.1016/j.gaitpost.2018.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with anterior cruciate ligament reconstruction (ACLR) demonstrate persistent alterations in walking gait characteristics that contribute to poor long-term outcomes. Higher kinesiophobia, or fear of movement/re-injury, may result in the avoidance of movements that increase loading on the ACLR limb. RESEARCH QUESTION Determine the association between kinesiophobia and walking gait characteristics in physically active individuals with ACLR. METHODS We enrolled thirty participants with a history of unilateral ACLR (49.35 ± 27.29 months following ACLR) into this cross-sectional study. We used the Tampa Scale for Kinesiophobia (TSK-11) to measure kinesiophobia. We collected walking gait characteristics during a 60-s walking trial, which included gait speed, peak vertical ground reaction force (vGRF), instantaneous vGRF loading rate, peak internal knee extension moment (KEM), and knee flexion excursion. We calculated lower extremity kinetic and kinematic measures on the ACLR limb, and limb symmetry indices between ACLR and contralateral limbs (LSI= [ACLR/contralateral]*100). We used linear regression models to determine the association between TSK-11 score and each walking gait characteristic. We determined the change in R2 (ΔR2) when adding TSK-11 scores into the linear regression model after accounting for demographic covariates (sex, Tegner activity score, graft type, time since reconstruction, history of concomitant meniscal procedure). RESULTS We did not find a significant association between kinesiophobia and self-selected gait speed (ΔR2 0.038, P = 0.319). Kinesiophobia demonstrated weak, non-significant associations with kinetic and kinematic outcomes on the ACLR limb and all LSI outcomes (ΔR2 range = 0.001-0.098). SIGNIFICANCE These data do not support that kinesiophobia is a critical factor contributing to walking gait characteristics in physically active individuals with ACLR.
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Affiliation(s)
- Brittney A. Luc-Harkey
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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