Three-Dimensional Motion Analysis Validation of a Clinic-Based Nomogram Designed to Identify High ACL Injury Risk in Female Athletes
ABSTRACT Aims: Prospective measures of high knee abduction moment (KAM) during landing identify female athletes at increased risk for anterior cruciate ligament (ACL) injury. Laboratory-driven measurements predict high KAM with 90% accuracy. This study aimed to validate the clinic-based variables against 3-dimensional motion analysis measurements. Methods: Twenty female basketball, soccer, and volleyball players (age, 15.9 ± 1.3 years; height, 163.6 ± 9.9 cm; body mass, 57.0 ± 12.1 kg) were tested using 3-dimensional motion analysis and clinic-based techniques simultaneously. Multiple logistic regression models have been developed to predict high KAM (a surrogate for ACL injury risk) using both measurement techniques. Clinic-based measurements were validated against 3-dimensional motion analysis measures, which were recorded simultaneously, using within- and between-method reliability as well as sensitivity and specificity comparisons. Results: The within-variable analysis showed excellent inter-rater reliability for all variables using both 3-dimensional motion analysis and clinic-based methods, with intraclass correlation coefficients (ICCs) that ranged from moderate to high (0.60-0.97). In addition, moderate-to-high agreement was observed between 3-dimensional motion analysis and clinic-based measures, with ICCs ranging from 0.66 to 0.99. Bland-Altman plots confirmed that each variable provided no systematic shift between 3-dimensional motion analysis and clinic-based methods, and there was no association between difference and average. A developed regression equation also supported model validity with > 75% prediction accuracy of high KAM using both the 3-dimensional motion analysis and clinic-based techniques. Conclusion: The current validation provides the critical next step to merge the gap between laboratory identification of injury risk factors and clinical practice. Implementation of the developed prediction tool to identify female athletes with high KAM may facilitate the entry of female athletes with high ACL injury risk into appropriate injury-prevention programs.
- SourceAvailable from: Benoit Pairot de Fontenay
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- "The return to sport occurs an average of 7.3 months after surgery, but only 63% of the patient returned to their pre-injury sport level after ACL-R (Ardern et al., 2011). Many authors have reported a lower jumping performance on the injured leg (IL) compared with the non-IL (NIL) (Gustavsson et al., 2006; Orishimo et al., 2010; Xergia et al., 2013), and many studies have demonstrated deficits during the performance of multijoint tasks, especially in jumping activities (Ernst et al., 2000; Gokeler et al., 2010; Orishimo et al., 2010; Paterno et al., 2010; Webster & Gribble, 2010; Castanharo et al., 2011; Myer et al., 2011; Xergia et al., 2013). "
ABSTRACT: After anterior cruciate ligament reconstruction (ACL-R), many studies have reported a deficit of performance on the injured leg during multi-joint tasks. However, the total mechanical joint work (WTotal), parameter best related to the vertical displacement of the body mass center during vertical jumping, has not yet been studied. The aim of this research was to compare asymmetries between ACL-R subjects and healthy matched subjects, through the analysis of the kinematics and kinetics during a single-leg squat jump. Asymmetries are defined by the Limb Symmetry Index (LSI). A greater LSI was observed for WTotal in the ACL-R group than in the healthy group. There was no difference in LSI for knee joint work between the two groups, while the LSI for hip and ankle joint work was significantly larger in the ACL-R group. This was explained by greater LSI for the hip and ankle joint range of motion in the ACL-R group than in the healthy group. After ACL-R, patients exhibited greater asymmetries than healthy subjects during single-leg squat jump. Physiotherapists should focus on quality execution of multi-joint movement, especially on hip and ankle joints range of motion in order to reduce asymmetries and to improve vertical jumping performance.Scandinavian Journal of Medicine and Science in Sports 04/2014; 24(6). DOI:10.1111/sms.12207 · 2.90 Impact Factor
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ABSTRACT: Background Female athletes are 4-6 times more likely to suffer an ACL injury than males in comparable sports. A link between landing biomechanics and ACL injury has led to the development of injury prevention focused training protocols. It is often difficult to measure the protocols’ efficacy of different protocols on reduction of ACL injury-related factors.Clinics in sports medicine 10/2011; 30(4):825-40. DOI:10.1016/j.csm.2011.07.001 · 1.22 Impact Factor