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      Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction.

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          Abstract

          Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport after anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the effect of QF strength asymmetry on knee landing biomechanics at the time of return to sport after ACL reconstruction.

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          Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

          Clare L. Ardern, Kate E. Webster, Nicholas F Taylor … (2011)
          An athlete's intention to return to sport following anterior cruciate ligament (ACL) injury is a major indication for surgical intervention. The purpose of this review was to determine postoperative return-to-sport outcomes after ACL reconstruction surgery. Meta-analysis and systematic review Electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from the earliest possible entry to April 2010. Studies were included that reported the number of patients returning to sports participation following ACL reconstruction surgery. The results were presented using the World Health Organization's International Classification of Functioning, Disability and Health as a framework and combined using proportion meta-analyses. Forty-eight studies evaluating 5770 participants at a mean follow-up of 41.5 months were included for review. Overall, 82% of participants had returned to some kind of sports participation, 63% had returned to their preinjury level of participation, and 44% had returned to competitive sport at final follow-up. Approximately 90% of participants achieved normal or nearly normal knee function when assessed postoperatively using impairment-based outcomes such as laxity and strength, and 85% when using activity-based outcomes such as the International Knee Documentation Committee knee evaluation form. Fear of reinjury was the most common reason cited for a postoperative reduction in or cessation of sports participation. The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes.
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            Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.

            Mark Paterno, Laura Schmitt, Kevin R. Ford … (2010)
            Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes. Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Cohort study (prognosis); Level of evidence, 2. Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.
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              The influence of abnormal hip mechanics on knee injury: a biomechanical perspective.

              Christopher M Powers (2010)
              During the last decade, there has been a growing body of literature suggesting that proximal factors may play a contributory role with respect to knee injuries. A review of the biomechanical and clinical studies in this area indicated that impaired muscular control of the hip, pelvis, and trunk can affect tibiofemoral and patellofemoral joint kinematics and kinetics in multiple planes. In particular, there is evidence that motion impairments at the hip may underlie injuries such as anterior cruciate ligament tears, iliotibial band syndrome, and patellofemoral joint pain. In addition, the literature suggests that females may be more disposed to proximal influences than males. Based on the evidence presented as part of this clinical commentary, it can be argued that interventions which address proximal impairments may be beneficial for patients who present with various knee conditions. More specifically, a biomechanical argument can be made for the incorporation of pelvis and trunk stability, as well as dynamic hip joint control, into the design of knee rehabilitation programs. Aetiology/therapy, level 5.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Med Sci Sports Exerc
                Title: Medicine and science in sports and exercise
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Electronic): 1530-0315
                ISSN (Print): 0195-9131
                Publication date (Electronic): Jul 2015
                Volume: 47
                Issue: 7
                Affiliations
                [1 ] 1Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH; 2Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 3Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 4Division of Occupational Therapy and Physical Therapy Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; 6Department of Physical Therapy, High Point University, High Point, NC; 7Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH; 8Sports Health & Performance Institute, Ohio State University, Columbus, OH; 9Department of Physiology and Cell Biology, Ohio State University, Columbus, OH; 10Department of Orthopaedic Surgery, Ohio State University, Columbus, OH; 11Department of Family Medicine, Ohio State University, Columbus, OH; 12Department of Biomedical Engineering, Ohio State University, Columbus, OH; and 13School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH.
                Article
                Mid ID: NIHMS638642
                DOI: 10.1249/MSS.0000000000000560
                PMC ID: 4418954
                PubMed ID: 25373481
                SO-VID: 81ca3d10-4e57-4127-98fc-03aee5104c56
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