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Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
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Graham MC, Thompson KL, Hawk GS, Fry CS, Noehren B. Muscle Fiber Cross-Sectional Area Is Associated With Quadriceps Strength and Rate of Torque Development After ACL Injury. J Strength Cond Res 2024; 38:e273-e279. [PMID: 38349361 PMCID: PMC11116075 DOI: 10.1519/jsc.0000000000004743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Graham, MC, Thompson, KL, Hawk, GS, Fry, CS, and Noehren, B. Muscle fiber cross-sectional area is associated with quadriceps strength and rate of torque development after ACL injury. J Strength Cond Res 38(6): e273-e279, 2024-The purpose of this study was to investigate the relationship between muscle fiber type-specific properties of the vastus lateralis and quadriceps muscle performance in individuals after an anterior cruciate ligament (ACL) tear. 26 subjects (22.0 ± 5.4 years) were included in this cross-sectional study, and all data were collected before ACL reconstruction. Quadriceps peak torque (QPT) and early (0-100 ms) and late (100-200 ms) rate of torque development (RTD) were obtained from maximal voluntary isometric quadriceps strength testing. Muscle fiber cross-sectional area (fCSA) and percent fiber type distribution (FT%) were evaluated through immunohistochemical analysis of a muscle biopsy. Between-limb differences in fiber characteristics were assessed using paired t-tests (with α-level 0.05). Relationships between fiber-specific properties and quadriceps muscle performance were determined using separate multiple linear regression analyses for ACL-injured and noninjured limbs. There were significant differences in fCSA between ACL-injured and noninjured limbs across all fiber types, but no differences in FT%. Type 1 fCSA, type 2a fCSA, and their interaction effect were the explanatory variables with the strongest relationship to all performance outcomes for the ACL-injured limb. The explanatory variables in the ACL-injured limb had a significant relationship to QPT and late RTD, but not early RTD. These findings suggest that QPT and late RTD are more heavily influenced by fCSA than FT% in ACL-injured limbs. This work serves as a foundation for the development of more specific rehabilitation strategies aimed at improving quadriceps muscle function before ACL reconstruction or for individuals electing nonsurgical management.
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Affiliation(s)
- Megan C Graham
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | | | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky; and
| | - Christopher S Fry
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Graham MC, Reeves KA, Janatova T, Noehren B. The Relationship of Open- and Closed-Kinetic-Chain Rate of Force Development With Jump Performance Following Anterior Cruciate Ligament Reconstruction. Int J Sports Physiol Perform 2024; 19:585-592. [PMID: 38594016 DOI: 10.1123/ijspp.2023-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE To determine between-limbs differences in isometric rate of force development (RFD) measured during open- (OKC) and closed-kinetic-chain (CKC) strength testing and establish which method had the strongest relationship to single-leg vertical-jump performance and knee mechanics after anterior cruciate ligament (ACL) reconstruction. METHODS Subjects (n = 19) 1 to 5 years from ACL reconstruction performed isometric knee extensions (OKC), unilateral isometric midthigh pulls (CKC), and single-leg vertical jumps on the ACL-involved and -noninvolved limbs. Between-limbs differences were assessed using paired t tests, and the relationship between RFD, jump performance, and knee mechanics was assessed using correlation coefficients (r; P ≤ .05). RESULTS There were significant between-limbs differences in OKC RFD (P = .008, d = -0.69) but not CKC RFD. OKC RFD in the ACL-involved limb had a strong association with jump height (r = .64, P = .003), knee-joint power (r = .72, P < .001), and peak knee-flexion angle (r = .72, P = .001). CKC RFD in the ACL-involved limb had a strong association with jump height (r = .65, P = .004) and knee-joint power (r = .67, P = .002) but not peak knee-flexion angle (r = .40, P = .09). CONCLUSIONS While both OKC and CKC RFD were strongly related to jump performance and knee-joint power, OKC RFD was able to detect between-limbs RFD asymmetries and was strongly related to knee-joint kinematics. These findings indicate that isometric knee extension may be optimal for assessing RFD after ACL reconstruction.
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Affiliation(s)
- Megan C Graham
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Kelsey A Reeves
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA
| | - Tereza Janatova
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Sayer TA, van Melick N, Riera J, Jackson J, Bryant A, Bogie R, Cross N, Edouard P, Rambaud A. Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury. Phys Ther Sport 2024; 67:19-24. [PMID: 38457997 DOI: 10.1016/j.ptsp.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To determine return to running criteria currently used by physiotherapists following anterior cruciate ligament (ACL) injury. DESIGN Self-reported online international survey. METHODS An online survey of physiotherapists across Australia, the Netherlands and France. RESULTS A total of 476 respondants participated in the survey across Australia (n = 153), the Netherlands (n = 162), and France (n = 161). For return to running criteria following a non-operative approach, the majority of respondents chose swelling (40.55%, n = 193/476), pain (38.24%, n = 182/476), knee extensor strength (34.34%, n = 163/476), single leg squat (31.93%, n = 152/476) and knee flexor strength (29.83%, n = 142/476). After ACL reconstruction, the highest responses were also swelling (41.18%, n = 196/476), pain (37.18%, n = 177/476), knee extensor strength (37.18%, n = 177/476) and single leg squat (33.19%, n = 158/476). From the identified themes the most common cutoff variables were pain between 0 and 3/10, swelling < grade 1+ and limb symmetry on strength and hop tests >70 %. CONCLUSION Physiotherapists in Australia, France, and the Netherlands use many different return to running criteria and most of them use more than one criterion. Despite this, there was little consensus on the cut-off physiotherapists use to apply these criteria.
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Affiliation(s)
- Timothy A Sayer
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Nicky van Melick
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
| | - Jerome Riera
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Jeremy Jackson
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia
| | - Adam Bryant
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rob Bogie
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
| | - Nicholas Cross
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia
| | - Pascal Edouard
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Alexandre Rambaud
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
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Cohn BA, Valero-Cuevas FJ. Muscle redundancy is greatly reduced by the spatiotemporal nature of neuromuscular control. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1248269. [PMID: 38028155 PMCID: PMC10663283 DOI: 10.3389/fresc.2023.1248269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Animals must control numerous muscles to produce forces and movements with their limbs. Current theories of motor optimization and synergistic control are predicated on the assumption that there are multiple highly diverse feasible activations for any motor task ("muscle redundancy"). Here, we demonstrate that the dimensionality of the neuromuscular control problem is greatly reduced when adding the temporal constraints inherent to any sequence of motor commands: the physiological time constants for muscle activation-contraction dynamics. We used a seven-muscle model of a human finger to fully characterize the seven-dimensional polytope of all possible motor commands that can produce fingertip force vector in any direction in 3D, in alignment with the core models of Feasibility Theory. For a given sequence of seven force vectors lasting 300 ms, a novel single-step extended linear program finds the 49-dimensional polytope of all possible motor commands that can produce the sequence of forces. We find that muscle redundancy is severely reduced when the temporal limits on muscle activation-contraction dynamics are added. For example, allowing a generous ± 12% change in muscle activation within 50 ms allows visiting only ∼ 7% of the feasible activation space in the next time step. By considering that every motor command conditions future commands, we find that the motor-control landscape is much more highly structured and spatially constrained than previously recognized. We discuss how this challenges traditional computational and conceptual theories of motor control and neurorehabilitation for which muscle redundancy is a foundational assumption.
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Affiliation(s)
- Brian A. Cohn
- Department of Computer Science, University of Southern California, Los Angeles, CA, United States
| | - Francisco J. Valero-Cuevas
- Department of Computer Science, University of Southern California, Los Angeles, CA, United States
- Department of Biomedical Engineering, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Lee OT, Williams MA, Shaw CD, Delextrat A. The Role of Strength-Related Factors on Psychological Readiness for Return to Sport Following Anterior Cruciate Ligament (ACL) Reconstruction. Healthcare (Basel) 2023; 11:2787. [PMID: 37893861 PMCID: PMC10606503 DOI: 10.3390/healthcare11202787] [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: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Psychological readiness following anterior cruciate ligament reconstruction (ACLR) correlates with different return to sport outcomes. However, the relationship between strength and power and psychological readiness remains unexplored. The aim of this study was to investigate the relationship between anterior cruciate ligament return to sport after injury (ACL-RSI) scores and various hamstrings and quadriceps strength and power variables. Twelve participants (20.7 ± 2.5 years old; 174.2 ± 7.5 cm; 70.2 ± 8.5 kg; 18.2 ± 8.3% of body fat) who had an ACLR nine months or more before the study completed the ACL-RSI questionnaire and isokinetic strength testing of the hamstrings and quadriceps (60°·s-1 and 180°·s-1). Based on ACL-RSI scores, they were divided into "cases" and "controls", deemed not psychologically ready and psychologically ready to return to previous sport performance (PILOS), respectively. The main findings are that quadriceps' and hamstrings' rate of torque development (RTD) and time since surgery were determinants of psychological readiness following ACLR. Furthermore, compared to controls, cases showed significantly lower quadriceps torque at angles close to full knee extension (40 deg and 30 deg from extension). They also showed lower RTD than controls, but no difference in peak torque. These results suggest that physiotherapists should facilitate athletes' return to sport (RTS) by focusing on the restoration of RTD and strength at angles close to full knee extension.
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Affiliation(s)
| | | | | | - Anne Delextrat
- Department of Sport and Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK (M.A.W.); (C.D.S.)
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Taberner M, Spencer N, Murphy B, Antflick J, Cohen DD. Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball. J Orthop Sports Phys Ther 2023; 53:498–509. [PMID: 37555664 DOI: 10.2519/jospt.2023.11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND: Sport-specific training is an integral component of returning to sport following injury. Frameworks designed to guide sport-specific rehabilitation need to integrate and adapt to the specific context of elite sport. The control-chaos continuum (CCC) is a flexible framework originally designed for on-pitch rehabilitation in elite football (soccer). The concepts underpinning the CCC transfer to other elite sport rehabilitation environments. CLINICAL QUESTION: How can practitioners and clinicians transfer the CCC to elite basketball, to support planning and return to sport? On-court rehabilitation is a critical sport-specific rehabilitation component of return to sport, yet there are no frameworks to guide practitioners when planning and delivering on-court rehabilitation. KEY RESULTS: Based on our experience working in the National Basketball Association, we report how the CCC framework can apply to elite basketball. We focus on the design and delivery of progressive training in the presence of injury in this basketball-specific edition of the CCC. Given the challenges when quantifying "load" in basketball, we encourage practitioners and clinicians to consider the qualitative aspects of performance such as skill, sport-specific movement, contact, and decision making. CLINICAL APPLICATION: The 5-phase framework describes training progression from high control, a return to on-court running, to high chaos, a return to "live" unrestricted basketball. The model can be adapted to both short- and long-term injuries based on injury and progression criteria. Strength and power "diagnostics" can be strategically implemented to enhance decision making throughout the return to sport continuum. J Orthop Sports Phys Ther 2023;53(9):1-12. Epub: 9 August 2023. doi:10.2519/jospt.2023.11981.
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Bodkin SG, Pethick JT, Dooley EA, Russell SD, Hart JM. Torque complexity of maximal knee extensor isometric contraction in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105932. [PMID: 36931165 DOI: 10.1016/j.clinbiomech.2023.105932] [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: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Current rehabilitation goals following anterior cruciate ligament reconstruction are structured around the maximal force generating capabilities of the muscle. Force fluctuations, an index of force control, have been observed to alter post- anterior cruciate ligament reconstruction. The temporal structure, or "complexity" of force fluctuations may provide important insight into the post-operative muscular recovery. The aims of this study were 1) to compare quadriceps torque complexity in anterior cruciate ligament reconstructed patients to the contralateral limb and to healthy, controls and 2) to assess the relationships between torque complexity to patient outcomes. METHODS Data from 120 anterior cruciate ligament reconstructed participants (65 Females, 21.0 ± 8.3 years, 5.96 ± 0.48-months post-surgery) and 95 healthy controls (50 Females, 21.5 ± 2.9 years) were collected. A 30-s knee extensor maximal isometric contraction was completed to calculate approximate entropy, a measure of torque complexity. FINDINGS Approximate entropy was found to decrease throughout the 30-s trial (P < .001, Cohen's d = 1.87 [1.64,2.10]). The anterior cruciate ligament reconstructed limb demonstrated greater approximate entropy compared to the contralateral limb or to healthy controls (P < .001, Cohen's d = 0.64 [0.38,0.90]). approximate entropy at the end of the trial demonstrated weak, negatively relationships with peak torque, patient reported outcome measures, and knee extensor fatigue (r = -0.21 to -0.32, P < .05). INTERPRETATION A greater torque complexity in individuals following anterior cruciate ligament reconstruction was weakly related to lower quadriceps strength, lower subjective function, and quadriceps fatigue resistance. The complexity of force fluctuations during a sustained maximal task may draw clinical insight into the recovery of motor function following anterior cruciate ligament reconstruction.
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Affiliation(s)
- S G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - J T Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - E A Dooley
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - S D Russell
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - J M Hart
- Deparment of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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San Jose AT, Maniar N, Timmins RG, Beerworth K, Hampel C, Tyson N, Williams MD, Opar DA. Explosive hamstrings strength asymmetry persists despite maximal hamstring strength recovery following anterior cruciate ligament reconstruction using hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2023; 31:299-307. [PMID: 35999280 PMCID: PMC9859849 DOI: 10.1007/s00167-022-07096-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the differences in maximal (isometric and concentric peak torque) and explosive (rate of torque development (RTD)) hamstring and quadriceps strength symmetry between males and females during early- and late-phase rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts and to determine the interaction of time and sex on maximal and explosive strength symmetry. METHODS A total of 38 female and 51 male participants were assessed during early (3-6 months post-operative) and late (7-12 months post-operative) phases of rehabilitation following ACLR. Maximal (concentric and isometric peak torque) and explosive (isometric RTD) hamstring and quadriceps strength were assessed and presented as limb symmetry index (LSI). RESULTS Maximal concentric hamstrings asymmetry (Early: 86 ± 14; Late 92 ± 13; p = 0.005) as well as maximal concentric (Early, 73 ± 15; Late 91 ± 12; p < 0.001) and explosive (Early: 82 ± 30; Late: 92 ± 25; p = 0.03) quadriceps asymmetry decreased from early to late rehabilitation. However, there were no significant changes in maximal isometric quadriceps strength and explosive isometric hamstring strength in the same time period. Females had a larger asymmetry in maximal concentric (Females: 75 ± 17; Males: 81 ± 15; p = 0.001) and explosive (Females: 81 ± 32; Males: 89 ± 25; p = 0.01) quadriceps strength than males throughout rehabilitation. There were no sex differences in maximal and explosive hamstring strength. There were no sex by time interactions for any variables. CONCLUSION Explosive hamstring strength asymmetry did not improve despite recovery of maximal hamstring strength during rehabilitation following ACLR with HT autografts. While sex did not influence strength recovery, females had larger maximal and explosive quadriceps strength asymmetry compared to males throughout rehabilitation following ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Argell T. San Jose
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Ryan G. Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Kate Beerworth
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia ,Cricket Australia, Albion, QLD Australia
| | - Chris Hampel
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Natalie Tyson
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Morgan D. Williams
- School of Health, Sport and Professional Practice, University of South Wales, Pontypridd, Wales UK
| | - David A. Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
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Jordan MJ, Morris N, Barnert J, Lawson D, Aldrich Witt I, Herzog W. Forecasting neuromuscular recovery after anterior cruciate ligament injury: Athlete recovery profiles with generalized additive modeling. J Orthop Res 2022; 40:2803-2812. [PMID: 35194823 PMCID: PMC9790559 DOI: 10.1002/jor.25302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/28/2021] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
A retrospective analysis of longitudinally collected athlete monitoring data was conducted to generate a model of neuromuscular recovery after anterior cruciate ligament (ACL) injury and reconstruction (ACLR). Neuromuscular testing data including countermovement jump (CMJ) force-time asymmetries and knee extensor strength (maximum voluntary contractionext ) asymmetries (between-limb asymmetry index-AI) were obtained from athletes with ACLR using semitendinosus (ST) autograft (n = 29; AI measurements: n = 494), bone patellar tendon bone autograft (n = 5; AI measurements: n = 88) and noninjured controls (n = 178; AI measurements: n = 3188). Explosive strength measured as the rate of torque development was also calculated. CMJ force-time asymmetries were measured over discrete movement phases (eccentric deceleration phase, concentric phase). Separate additive mixed effects models (additive mixed effects model [AMM]) were fit for each AI with a main effect for the surgical technique and a smooth term for the time since surgery (days). The models explained between 43% and 91% of the deviance in neuromuscular recovery after ACLR. The mean time course was generated from the AMM. Comparative neuromuscular recovery profiles of an athlete with an accelerated progression and an athlete with a delayed progression after a serious multiligament injury were generated. Clinical Significance: This paper provides a new perspective on the utility of longitudinal athlete monitoring including routine testing to develop models of neuromuscular recovery after ACLR that can be used to characterize individual progression throughout rehabilitation.
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Affiliation(s)
- Matthew J. Jordan
- Canadian Sport Institute CalgaryCalgaryAlbertaCanada,Sport Medicine Centre, Faculty of KinesiologyThe University of CalgaryCalgaryAlbertaCanada,School of Medical and Health Science, Centre for Human PerformanceEdith Cowan UniversityJoondalupAustralia,Human Performance Laboratory, Faculty of KinesiologyThe University of CalgaryCalgaryCanada
| | | | | | - Drew Lawson
- Canadian Sport Institute CalgaryCalgaryAlbertaCanada
| | - Isabel Aldrich Witt
- Canadian Sport Institute CalgaryCalgaryAlbertaCanada,Human Performance Laboratory, Faculty of KinesiologyThe University of CalgaryCalgaryCanada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of KinesiologyThe University of CalgaryCalgaryCanada
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Rocha de Faria JL, Laett CT, Gavilão UF, Carvalho MDB, Mozella ADP, de Sousa EB, Cossich VRA. Modified Pulvertaft on Weave Technique Restores Full Active Knee Extension in Patients With Large Chronic Quadriceps Tendon Rupture: A Case Series. Arthroscopy 2022; 38:2268-2277. [PMID: 35114346 DOI: 10.1016/j.arthro.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to investigate the clinical and functional outcomes, including maximal and explosive strength, after chronic quadriceps tendon rupture repair with Modified Pulvertaft on Weave (MPW) technique METHODS: Knee joint range of motion (ROM), patella height, thigh circumference, and Lysholm and International Knee Documentation Committee (IKDC) scores were assessed preoperatively and postoperatively. The knee extensors maximal (isokinetic peak torque and isometric maximal voluntary contraction (MVC) torque) and explosive strength-rate of torque development (RTD) early [RTD50 and RTD100] and late [RTD250]-were performed. We assessed the thigh circumference and vastus lateralis muscle thickness (MT) as indicators of quadriceps muscle mass, and the voluntary quadriceps activation using surface electromyography (EMG50). RESULTS Nine patients (mean age: 53 ± 11 years) took part in the study. We observed a significant increase in the knee active ROM and a decreased extension deficit (both, P < .001), but not for pain (P = .07), IKDC (P = .07), and Lysholm (P = .21) after the surgery. We did not observe a difference between involved (n = 8) and uninvolved (n = 10) limbs for ROM, thigh circumference, and MT. We observed differences for extensors peak torque, MVC torque, and late RTD (all, P < .05). However, we did not observe differences for early RTD and EMG50. Significant positive correlations were observed for RTD50 (ρ = .80) and RTD100 (ρ = .81) vs EMG50. Both the IKDC and Lysholm were better correlated with the early than with later RTD. CONCLUSIONS The MPW reestablished the active knee extension. The same level of quadriceps muscle mass was observed in both limbs, suggesting a lack of hypotrophy due to the injury. Although the involved limb had demonstrated lower knee extensors maximal strength, they demonstrate an equivalent early RTD when compared to the uninvolved limb. The early RTD seems to be better correlated with the patient's functionality than the later RTD and maximal strength. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
| | - Conrado Torres Laett
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Ubiratã Faleiro Gavilão
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | | | - Alan de Paula Mozella
- Knee Surgery Center, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Eduardo Branco de Sousa
- Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Victor Rodrigues Amaral Cossich
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
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12
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Cowin J, Nimphius S, Fell J, Culhane P, Schmidt M. A Proposed Framework to Describe Movement Variability within Sporting Tasks: A Scoping Review. SPORTS MEDICINE - OPEN 2022; 8:85. [PMID: 35759128 PMCID: PMC9237196 DOI: 10.1186/s40798-022-00473-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 06/06/2022] [Indexed: 05/25/2023]
Abstract
Movement variability is defined as the normal variations in motor performance across multiple repetitions of a task. However, the term "movement variability" can mean different things depending on context, and when used by itself does not capture the specifics of what has been investigated. Within sport, complex movements are performed repeatedly under a variety of different constraints (e.g. different situations, presence of defenders, time pressure). Movement variability has implications for sport performance and injury risk management. Given the importance of movement variability, it is important to understand the terms used to measure and describe it. This broad term of "movement variability" does not specify the different types of movement variability that are currently being assessed in the sporting literature. We conducted a scoping review (1) to assess the current terms and definitions used to describe movement variability within sporting tasks and (2) to utilise the results of the review for a proposed framework that distinguishes and defines the different types of movement variability within sporting tasks. To be considered eligible, sources must have assessed a sporting movement or skill and had at least one quantifiable measure of movement variability. A total of 43 peer-reviewed journal article sources were included in the scoping review. A total of 280 terms relating to movement variability terminology were extracted using a data-charting form jointly developed by two reviewers. One source out of 43 (2%) supplied definitions for all types of movement variability discussed. Moreover, 169 of 280 terms (60%) were undefined in the source material. Our proposed theoretical framework explains three types of movement variability: strategic, execution, and outcome. Strategic variability describes the different approaches or methods of movement used to complete a task. Execution variability describes the intentional and unintentional adjustments of the body between repetitions within the same strategy. Outcome variability describes the differences in the result or product of a movement. These types emerged from broader frameworks in motor control and were adapted to fit the movement variability needs in sports literature. By providing specific terms with explicit definitions, our proposed framework can ensure like-to-like comparisons of previous terms used in the literature. The practical goal of this framework is to aid athletes, coaches, and support staff to gain a better understanding of how the different types of movement variability within sporting tasks contribute to performance. The framework may allow training methods to be tailored to optimise the specific aspects of movement variability that contribute to success. This review was retrospectively registered using the Open Science Framework (OSF) Registries ( https://osf.io/q73fd ).
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Affiliation(s)
- Jake Cowin
- School of Health Sciences, University of Tasmania, Newnham, TAS, Australia.
- Tasmanian Institute of Sport (Sports Performance Unit), Prospect, TAS, Australia.
| | - Sophia Nimphius
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, WA, Australia
| | - James Fell
- School of Health Sciences, University of Tasmania, Newnham, TAS, Australia
| | - Peter Culhane
- Tasmanian Institute of Sport (Sports Performance Unit), Prospect, TAS, Australia
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Hobart, TAS, Australia
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13
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Cossich VRA, Gavilão UF, Goes RA, Perini JA, Laett CT, Maffiuletti NA. Maximal vs. explosive knee extensor strength in professional soccer players: inter-limb asymmetries and relationship with knee function. Eur J Sport Sci 2022; 23:877-884. [PMID: 35475718 DOI: 10.1080/17461391.2022.2071636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractThe main aims of this study were to compare the magnitude of inter-limb asymmetry (ILA) and the relation with self-reported knee function between maximal and explosive knee extensor strength outcomes in professional soccer players. Forty-six male soccer players completed different maximal isokinetic and isometric contractions of the knee extensors for the assessment of maximal strength (peak torque and maximal voluntary contraction (MVC) torque) and explosive strength (early, intermediate, late, and peak rate of torque development (RTD)). Self-reported knee function was assessed with the International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales. Peak torque and MVC torque showed comparable ILAs (8-9%), both being significantly lower than all RTD ILAs (16% on average; p < 0.001). ILAs for early RTD (21%) and peak RTD (19%) were significantly higher than all the other variables (p < 0.05). Only early and intermediate RTD were significantly correlated - though weakly - with both IKDC (rho = 0.32 for both) and Lysholm (rho = 0.36 and 0.30, respectively) scores. We conclude that explosive knee extensor strength - early RTD in particular - exhibited larger ILAs and better relations with self-reported knee function than peak torque and MVC torque in professional soccer players. These results confirm the validity and functional relevance of early RTD and the need for its inclusion in routine performance testing for soccer players.
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Affiliation(s)
- Victor R A Cossich
- Neuromuscular Research Laboratory, Research Division - National Institute of Traumatology and Orthopedic (INTO), Rio de Janeiro, RJ, Brazil.,Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, RJ, Brazil
| | - Ubiratã F Gavilão
- Neuromuscular Research Laboratory, Research Division - National Institute of Traumatology and Orthopedic (INTO), Rio de Janeiro, RJ, Brazil.,Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, RJ, Brazil.,Biomechanics Laboratory, EEFD - Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rodrigo A Goes
- Sport Trauma Center, National Institute of Traumatology and Orthopedic, Rio de Janeiro, RJ, Brazil
| | - Jamila A Perini
- Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, RJ, Brazil.,Laboratório de Pesquisa de Ciências Farmacêuticas, Centro Universitário Estadual da Zona Oeste (UEZO), Rio de Janeiro, Brazil.,Programa de Pós-graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Conrado T Laett
- Neuromuscular Research Laboratory, Research Division - National Institute of Traumatology and Orthopedic (INTO), Rio de Janeiro, RJ, Brazil.,Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, RJ, Brazil.,Biomechanics Laboratory, EEFD - Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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14
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Zarro MJ, Stitzlein MG, Lee JS, Rowland RW, Gray VL, Taylor JB, Meredith SJ, Packer JD, Nelson CM. Single-Leg Vertical Hop Test Detects Greater Limb Asymmetries Than Horizontal Hop Tests After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. Int J Sports Phys Ther 2021; 16:1405-1414. [PMID: 34909247 PMCID: PMC8637251 DOI: 10.26603/001c.29595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knee function deficits may persist after anterior cruciate ligament reconstruction (ACLR). Return to sport (RTS) testing batteries assess recovery after ACLR and can guide RTS progression, but the ideal test components are debatable. The single leg vertical hop for height (SLVH) test using a commercially available jump mat may provide a valuable assessment of knee function. HYPOTHESIS/PURPOSE The purpose of this study was to compare the limb symmetry index (LSI) of SLVH to horizontal hop testing in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was the SLVH would elicit significantly lower LSI than horizontal hop tests. STUDY DESIGN Cross-Sectional Study. METHODS Eighteen National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 11 females) at 7.33 ± 2.05 months after ACLR were included in this retrospective study. LSI was calculated for single hop for distance (SHD), triple hop for distance (THD), cross-over hop for distance (CHD), timed 6-meter hop (T6H), and SLVH. A repeated measures ANOVA was performed to identify differences in LSI for each test. Spearman's Rho correlation coefficient was calculated to examine the relationship between LSIs for each test. RESULTS The LSI for SLVH (84.48% ± 11.41%) was significantly lower than LSI for SHD (95.48 ± 8.02%, p = 0.003), THD (94.40 ± 3.70%, p = 0.002), CHD (95.85 ± 7.00, p = 0.007), and T6H (97.69 ± 6.60%, p = 0.001). The correlation of LSI between SLVH and the horizontal hop tests was weak and non-significant for SHD (rs = 0.166, p = 0.509), CHD (rs = 0.199, p = 0.428), and T6H (rs = 0.211, p = 0.401) and moderate and non-significant for THD (rs = 0.405, p = 0.096). CONCLUSIONS Individuals after ACLR had lower LSI on the SLVH than on horizontal hop tests and weak to moderate correlations between the tests suggest SLVH detects performance deficits not identified by the horizontal hop tests. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael J Zarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine; Department of Orthopaedics, University of Maryland School of Medicine
| | - Matthew G Stitzlein
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | - Jason S Lee
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | - Robert W Rowland
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine; Department of Orthopaedics, University of Maryland School of Medicine
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
| | | | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine
| | - Christa M Nelson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine
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15
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Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial. Eur J Appl Physiol 2021; 121:3551-3559. [PMID: 34542671 DOI: 10.1007/s00421-021-04812-3] [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: 04/26/2021] [Accepted: 09/11/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of cross-education (CE) exercise on strength and performance at 10 and 24 weeks post anterior cruciate ligament (ACL) surgery. METHODS Design: randomised controlled trial. N = 44 ACL-reconstruction patients, randomly-allocated into: CE: strength training of the non-operative limb, or CON: sham exercise of upper limb stretching. Each patient underwent standardised ACL rehabilitation, plus 8 weeks of thrice weekly CE or CON, commencing at 2 weeks post surgery. The primary outcome was quadriceps peak force (QPF) of the ACL-reconstructed limb at 10 weeks post surgery. Secondary measures were hamstrings peak force (HPF), rate of force development (RFD) and International Knee Documentation Committee score (IKDC) at 10 and 24 weeks; QPF and hop for distance (HOP) at 24 weeks post surgery. RESULTS CE significantly attenuated the decline in QPF of the ACL-reconstructed limb at 10 weeks compared to CON (16.6% decrease vs. 32.0%, respectively); that advantage was not retained at 24 weeks. A training effect was observed in the trained limb for HPF and QPF, which was retained at 24 weeks. No significant differences were observed for IKDC, HOP, RFD, or HPF of the reconstructed limb. Inter-limb symmetry (ILS) ranged from 0.78 to 0.89 and was not significantly different between groups. CONCLUSION High-intensity CE strength training attenuated the post-operative decline in QPF and should be considered in early-phase ACL rehabilitation. ILS data showed good symmetry, but it masked significantly inferior performance between groups and should be used with caution. TRIAL REGISTRATION NUMBER NCT02722876.
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Nagai T, Schilaty ND, Bates NA, Bies NJ, McPherson AL, Hewett TE. High school female basketball athletes exhibit decreased knee-specific choice visual-motor reaction time. Scand J Med Sci Sports 2021; 31:1699-1707. [PMID: 33908068 DOI: 10.1111/sms.13978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
Weaker hamstrings muscular forces and lower ratio of the hamstrings/quadriceps muscular forces in female athletes have been identified as modifiable risk factors for anterior cruciate ligament (ACL) injuries. However, sex differences in athletes' ability to react to visual cues (Choice Visual-Motor Reaction Time: VMRT) and to generate knee muscular forces (rate of force development: RFD) immediately following the visual cues were largely unknown. Therefore, the purpose of the study was to examine sex differences in Choice VMRT and RFD. A total of 50 high school basketball athletes (26F/24 M) participated in the study. Subjects sat in the knee dynamometer chair with their knee secured at 70° of knee flexion and performed knee extension or flexion maximum voluntary isometric contractions immediately after they saw the visual cue: "UP" or "DOWN" arrows, respectively. Choice VMRT was defined as the time between the visual cue and the initiation of muscular force development (>5Newtons). RFD was calculated by dividing the changes in forces over the changes in time at four time points (0-50/100/150/200 ms). Peak muscular forces and RFD were normalized to their body mass. Average of three trials in each direction (flexion and extension) in each leg was used for statistical analyses. Females had significantly slower Choice VMRT (p < 0.001-0.027) and lower knee extension RFD at 100 ms (p = 0.005). In addition, females had significantly higher knee flexion/extension ratio than males in late RFD (150 ms and 200 ms) (p < 0.004). The current study has provided additional sensorimotor characteristics of athletes and sexes in addition to their knee muscular characteristics.
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Affiliation(s)
- Takashi Nagai
- United States Army Research Institute of Environmental Medicine, Natick, MA, USA.,Mayo Clinic, Rochester, MN, USA
| | | | | | | | - April L McPherson
- United States Olympic & Paralympic Committee, Colorado Springs, CO, USA
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17
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Buckthorpe M. Recommendations for Movement Re-training After ACL Reconstruction. Sports Med 2021; 51:1601-1618. [PMID: 33840081 DOI: 10.1007/s40279-021-01454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Marys University, Twickenham, London, TW1 4SX, UK.
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18
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Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 48:209-218. [PMID: 33529930 DOI: 10.1016/j.ptsp.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury. OBJECTIVE The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks. DESIGN Narrative review. RESULTS The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.
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Nielsen JL, Arp K, Villadsen ML, Christensen SS, Aagaard P. Rate of Force Development Remains Reduced in the Knee Flexors 3 to 9 Months After Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Autografts: A Cross-Sectional Study. Am J Sports Med 2020; 48:3214-3223. [PMID: 33079573 DOI: 10.1177/0363546520960108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a serious injury with a high prevalence worldwide, and subsequent ACL reconstructions (ACLR) appear to be most commonly performed using hamstring-derived (semitendinosus tendon) autografts. Recovery of maximal muscle strength to ≥90% of the healthy contralateral limb is considered an important criterion for safe return to sports. However, the speed of developing muscular force (ie, the rate of force development [RFD]) is also important for the performance of many types of activities in sports and daily living, yet RFD of the knee extensor and flexor muscles has apparently never been examined in patients who undergo ACLR with hamstring autograft (HA). PURPOSE To examine potential deficits in RFD, maximal muscle strength (ie, maximal voluntary isometric contraction [MVIC]), and functional capacity of ACLR-HA limbs in comparison with the healthy contralateral leg and matched healthy controls 3 to 9 months after surgery. STUDY DESIGN Cross-sectional study; Level of evidence: 3. METHODS A total of 23 young patients who had undergone ACLR-HA 3 to 9 months earlier were matched by age to 14 healthy controls; both groups underwent neuromuscular screening. Knee extensor and flexor MVIC and RFD, as well as functional capacity (single-leg hop for distance [SLHD] test, timed single-leg sit-to-stand [STS] test), were assessed on both limbs. Furthermore, patient-reported knee function (Knee injury and Osteoarthritis Outcome Score) was assessed. RESULTS Knee extensor and flexor MVIC and RFD were markedly compromised in ACLR-HA limbs compared with healthy contralateral limbs (MVIC for extensor and flexor, 13% and 26%, respectively; RFD, 14%-17% and 32%-39%) and controls (MVIC, 16% and 31%; RFD, 14%-19% and 30%-41%) (P < .05-.001). Further, ACLR-HA limbs showed reduced functional capacity (reduced SLHD and STS performance) compared with contralateral limbs (SLHD, 11%; STS, 14%) and controls (SLHD, 20%; STS, 31%) (P < .01-.001). Strength (MVIC) and functional (SLHD) parameters were positively related to the duration of time after surgery (P < .05), although this relationship was not observed for RFD and STS. CONCLUSION Knee extensor and flexor RFD and maximal strength, as well as functional single-leg performance, remained substantially reduced in ACLR-HA limbs compared with noninjured contralateral limbs and healthy controls 3 to 9 months after reconstructive surgery.
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Affiliation(s)
- Jakob Lindberg Nielsen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Kamilla Arp
- Department of Orthopedic Surgery, Vejle Hospital, Vejle, Denmark
| | - Mette Lysemose Villadsen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Stine Sommer Christensen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
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