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: 4.36). 10/2010; 38(10):1968-78. DOI: 10.1177/0363546510376053
Source: PubMed


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.

  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The aim of this study was to investigate relationships between functional asymmetry of lower limbs, taking into account morphological features of the feet, and jumping ability in men and women. Methods: The study population consisted of 56 subjects, 30 women (age: 20.29 ± 0.59 years; body mass: 58.13 ± 4.58 kg, body height: 165.60 ± 5.03 cm) and 26 men (age: 20.41 ± 0.78 years, body mass: 78.39 ± 8.42 kg, body height: 181.15 ± 6.52 cm). The measurements of longitudinal arches were performed with the plan- tographic method on the basis of Clarke's angle mapped on a computer foot print. The measurements of jumping performance during bilateral (two legs) and unilateral (single-leg) counter movement jump (CMJ) were done on force plate. All subjects jumped three times each type of jump (total 9 jumps): three right leg, three left leg and three two legs. We put the test results through a detailed statistical analysis with the Statistica 8.0. The t-test for dependent variables and the Wilcoxon signed-rank test for divergent variances of the fea- tures compared. The analysis of relationships between the chosen podometric and plantographic features and jumping performance was conducted on the basis of the Pearson product-moment correlation coefficient (for the features which presented normal distribution, according to the Shapiro-Wilk test). Results: The correlations between values of height of single-leg jumps (right and left) and bilateral jumps, and foot indices were found in few cases only in men who had greater values of jump height with the non-dominant limb. We did not find a significant difference in jumping ability between the dominant limb and the non-dominant limb in women. We found bilateral deficits in jumping ability in the study groups, though we did not find significant differences (P ≤ 0.05) between the values for women (a mean of 6.5%) and for men (a mean of 8.4%). Conclusion: We found significant gender differences of the correlations between the values of height of jumps (single-leg and bilateral jumps) and foot indices.
    Full-text · Article · May 2015 · Acta of bioengineering and biomechanics / Wroclaw University of Technology
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jan 2015 · Clinical biomechanics (Bristol, Avon)
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Postural stability is an important measure in both research and clinical practice. A portable, easy to use device that can provide higher resolution than current clinical tests may allow for better identification of patients or athletes with postural stability deficits. The purpose of this study was to evaluate the ability of a tri-axial accelerometer to quantify postural stability in a healthy athletic population. Ten subjects were recruited to determine the reliability of the accelerometer to measure dynamic postural stability and thirteen were recruited to compare the accelerometer measures across tasks of varying difficulty. Subjects were asked to complete four static postural stability tasks with eyes open and eyes closed and two dynamic postural stability tasks for a total of ten tasks. During each task postural stability was measured using a tri-axial accelerometer and force platform. Differences between postural stability scores between tasks and the correlation between the two measures were assessed. The accelerometer demonstrated moderate to good test-retest reliability (ICC=0.732 to 0.899). Only the medial-lateral axis of the accelerometer showed significant differences between static tasks but all directions were able to show significant differences between static and dynamic tasks. Additionally, Spearman's ranked correlations showed little to no correlation between the accelerometer and force platform scores. Accelerometers are a reliability tool for postural stability that measure low difficulty tasks best in the medial-lateral direction. Low correlation between the accelerometer and force platform suggest that these two methods are not measuring the same components of postural stability. Copyright © 2014 Elsevier B.V. All rights reserved.
    Full-text · Article · Dec 2014 · Gait & Posture
Show more