Article

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
The American Journal of Sports Medicine (Impact Factor: 4.7). 10/2010; 38(10):1968-78. DOI: 10.1177/0363546510376053
Source: PubMed

ABSTRACT 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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Available from: Bin Huang, Aug 14, 2014
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    • "Surgeons focus on the restoration of this instability during ACLR; however , up to 25% of ACLR patients suffer secondary injuries within two years of returning to sport (Paterno et al., 2010). This rate far exceeds that of primary injury and may indicate that knee mechanics are altered following repair (Baer and Harner, 2007; Gianotti et al., 2009; Hewett et al., 1999). "
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    Clinical biomechanics (Bristol, Avon) 01/2015; 30(1):1-13. DOI:10.1016/j.clinbiomech.2014.12.006 · 1.88 Impact Factor
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    • "For example, Impellizzeri et al. [15] proved the significant accuracy and reliability of the vertical jump test. Paterno et al. [16] used drop vertical jump (DVJ) as a diagnostic test, on the basis of which they predicted the risk of second anterior cruciate ligament injury (either reinjury or contralateral injury) in athletes who had returned to systematic training after an endoscopic reconstruction of the ligament. In another study on second division female volleyball players, Buśko et al. [5] determined correlations between jump height in CMJ and somatotype. "
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    • "The success of this process is the result of coordination and synergy between the vestibular, visual, and somatosensory systems [1] [2] [3]. Decrements in postural stability have been shown to have a relationship with a history of musculoskeletal and/or neurological injury [4] [5] [6] and have been able to predict lower extremity injury [2] [7]. However, the complex nature of postural stability, specifically dynamic postural stability, has made it difficult to measure in a clinical setting. "
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