The effect of motor experience on knee stability and inter-joint coordination when cutting at different angles.

BACKGROUND: Most studies on cutting have focused on the biomechanics of the knee and lower-limb muscle activation characteristics, with less consideration given to the influence of motor experience on control strategies at the joint level. This study aimed to investigate the differences in knee stability and inter-joint coordination between high- and low-level athletes when cutting at different angles. METHODS: A Vicon motion capture system and a Kistler force table were used to obtain kinematic and ground reaction force data during cutting. Joint dynamic stiffness and vector coding were used to assess knee stability and inter-joint coordination. Uncontrolled manifold analysis was used to clarify whether there was synergy among lower-limb joints to maintain postural stability during cutting. RESULTS: During the load acceptance phase, skilled subjects had the smallest joint stiffness at 90° compared with novice subjects (P < 0.05). Compared with novice subjects, skilled subjects had smaller knee-hip ellipse areas at 90° and 135° (P < 0.05), but larger knee-ankle ellipse areas at 135° (P < 0.05). The synergy index in load acceptance was significantly higher (P < 0.05) for skilled subjects at 90° and 135°. CONCLUSIONS: Advanced subjects can adjust joint control strategies to adapt to the demands of large-angle cutting on the change of direction. Advanced subjects can reduce knee stability for greater flexibility during cutting compared with novice subjects. By increasing the degree of synergy among the lower-limb joints, advanced athletes can maintain high postural stability.

Effects of mental fatigue on biomechanical characteristics of lower extremities in patients with functional ankle instability during unanticipated side-step cutting.

Background: Functional ankle instability (FAI) is the primary classification of ankle injuries. Competitive activities have complicated movements that can result in ankle re-injury among patients with FAI. Unanticipated movement state (MS) and mental fatigue (MF) could also happen in these activities, which may further increase their joint injury risk. Objective: This study aimed to clarify the biomechanical characteristics difference of the lower extremity (LE) between the injured side and the uninjured side among patients with FAI when they perform unanticipated side-step cutting after MF. Methods: Fifteen males with unilateral FAI participated in this study (age: 20.7 ± 1.3 years, height: 173.6 ± 4.4 cm, weight: 70.1 ± 5.0 kg). They used the injured side and the uninjured side of LE to complete anticipated and unanticipated side-step cutting before and after MF. The kinematic and kinetics data were evaluated using three-way ANOVA with repeated measures. Results: During patients with FAI performed anticipated side-step cutting, the ankle stiffness of both sides showed no significant change after MF; During they performed unanticipated side-step cutting, their injured side presented significantly lower ankle stiffness after MF, while the uninjured side did not have such change. In addition, after MF, the injured side exhibited increased ankle inversion, knee valgus and LR, but the uninjured side did without these changes. Conclusion: Influenced by MF, when patients with FAI use their injured side of LE to perform side-step cutting, this side LE has a higher risk of musculoskeletal injuries such as lateral ankle sprains and anterior cruciate ligament injury. The ankle stiffness of the injured side will be further reduced when patients with FAI perform unanticipated side-step cutting, which increases ankle instability and the risk of re-injury.

Concurrent Validity and Reliability of Two-dimensional Frontal Plane Knee Measurements during Multi-directional Cutting Maneuvers.

BACKGROUND: Excessive knee valgus has been strongly suggested as a contributing key factor for anterior cruciate ligament (ACL) injuries. Three-dimensional (3D) motion analysis is considered the "gold standard" to assess joint kinematics, however, this is difficult for on-field assessments and for clinical setting. PURPOSE: To investigate the concurrent validity of 2D measurements of knee valgus angle during cutting in different directions and to explore intra-rater and inter-rater reliability of the 2D measurements. STUDY DESIGN: Descriptive laboratory study. METHOD: Seven recreational soccer players participated in this study. Participants performed three trials of cutting maneuvers in three different directions (30º, 60º, and 90º) with the dominant leg. Cutting maneuvers were recorded simultaneously with a video camera and a ViconTM motion capture system. Knee valgus angle from 2D and 3D measurements at initial contact and at peak vertical ground reaction force (vGRF) were extracted. The Pearson's correlation was used to explore the relationship between the 2D and 3D measurements, and reliability of the 2D measurements were performed using intraclass correlation coefficients (ICC). RESULT: Significant correlations between 2D and 3D knee valgus measurements were noted for 60º (r = 0.45) and 90º (r = 0.77) cutting maneuvers at initial contact. At peak vGRF, significant correlations between 2D and 3D knee valgus measurements were noted for 30º, 60º, and 90º cutting maneuvers (r=0.45, r=0.74, r=0.78), respectively. Good-to-excellent intra-rater and inter-rater reliability of the 2D knee valgus measurements was observed during cutting in all directions (ICCs: 0.821-0.997). CONCLUSION: Moderate-to-strong correlation between 2D and 3D knee valgus measurements during 60°-90° cutting maneuvers, and good-to-excellent intra-rater and excellent inter-rater reliability for the 2D measurements in the present study supports the use of 2D knee valgus measurements in the evaluation of targeted interventions, although the limitations of examining cutting maneuvers using 2D measurement in complex movement still need to be considered. LEVEL OF EVIDENCE: 3.

Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut.

BACKGROUND: Three-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good-to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST. STUDY DESIGN: Repeated Measures. METHODS: Ten videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of "1", or not present, which were given a score of "0". Video sequence was randomized in each rating session, and a two-week wash out period was given. RESULTS: The cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively). CONCLUSION: These findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers. LEVEL OF EVIDENCE: Level 2 Diagnosis.

Lower-limb stiffness mediates speed but not turning angle during unplanned side-step cutting.

An inability to pre-plan a side-step cutting maneuver results in a greater reduction in speed and shallower cut angle. Although leg stiffness has not been directly quantified in cutting, indirect evidence suggest that greater stiffness may benefit cutting speed, but lower stiffness may benefit cut angle. No studies have investigated if stiffness causally mediates the relationship between anticipation, cutting speed and angle. The aims of the present study were to determine the influence of anticipatory cues on leg stiffness, and quantify the mediation effects of stiffness on cutting speed and angle. Seventeen healthy participants performed a 45° cut at an approach speed of 4 m/s. Leg stiffness (% bodyweight/leg length [BW/LL]), cutting angle and change in running speed between initial contact and toe-off of the cut were calculated. Causal mediation analysis was performed with anticipatory cues as the independent variable, cutting speed and angle as the dependent variables, and stiffness as the mediator. Unanticipated cutting significantly increased leg stiffness (ß=3.82%BW/LL,P=0.005) compared to anticipated cutting. The average causal mediation effect of stiffness on cutting angle was not significant (P = 0.68). The average causal mediation effect of stiffness on cutting speed was significant (-0.02 m/s [95%CI -0.04 to 0.00 m/s, P = 0.016). Reduced preplanning time in cutting increased leg stiffness. Alterations in leg stiffness only explained the change in speed, and not angle, associated with cutting under different anticipatory cues. Loss of speed when cutting is unplanned may be mitigated by improving leg stiffness.

Mechanical work performed by distal foot-ankle and proximal knee-hip segments during anticipated and unanticipated cutting.

Side-step cutting is a common evasive maneuver which is typically performed without prior anticipation. Studies quantifying joint work and its inter-joint proportions in cutting have not accounted for work done by the foot, even though this segment has been shown to be an important source of mechanical work in walking, running, and landing. The aims of this study were to: (1) quantify the magnitude of foot work performed and provide a more precise account of percentage joint work during cutting, and (2) examine the effect, a lack of anticipation had on these variables. Three-dimensional motion capture with forceplates were used to assess the cutting behaviour of 17 healthy participants. All participants performed a 45° cut with an approach speed of 4 m/s. Hip, knee, and ankle joint work were calculated using inverse dynamics; whilst foot work was quantified using the Unified-Deformable foot method. The foot contributed up to 12.45% and 3.09% of total limb negative and positive work, respectively. Unanticipated cutting significantly reduced ankle positive work (-0.09 J/kg [95% CI -0.13 to -0.06], P < 0.001) and significantly reduced percentage ankle positive work (-2.17% [95% CI -3.47 to -0.86], P = 0.001). The foot performs as much negative work as the hip but had only a minor contribution to positive work during cutting. Anticipation had a negligible influence on joint work and its inter-joint proportions. The foot should not be neglected in understanding whole-body dynamics during cutting, with greater understanding of its function potentially useful for informing athletic footwear design and cutting technique modification.

Effects of 10-week eccentric overload training on kinetic parameters during change of direction in football players.

The aim of the current study was to analyse the effect of 10-week eccentric overload training on kinetic parameters during change of direction (COD) in U-19 football players. The outcome measured included relative peak braking (rPB) and propulsive force (rPF), contact time (CT), time spent during braking (BT) and propulsive phase (PT), relative total (rTOT_IMP), braking (rB_IMP) and propulsive (rP_IMP) impulses. Between-group results showed a substantial better improvement (likely) in CT (ES: 0.72) and BT (ES: 0.74) during side-step cutting, and in rPB (ES: 0.84) and rB_IMP (ES: 0.72) during crossover cutting, in the experimental group (EXP) in comparison to control group (CON). Within-group analysis showed a substantially better performance (likely to almost certain) in CT (ES: 1.19), BT (ES: 1.24), PT (ES: 0.70), rPB (ES: 0.75), rPF (ES: 0.68), rTOT_IMP (ES: 0.48) and rB_IMP (ES: 0.50) in EXP during side-step cutting. Regarding crossover cutting, within-group analysis showed a substantial better performance (likely to almost certain) in CT (ES: 0.75), rPB (ES: 0.75), rPF (ES: 1.34), rTOT_IMP (ES: 0.61), rB_IMP (ES: 0.76) and rP_IMP (ES: 0.46) in EXP. In conclusion, the eccentric overload-based programme led to an improvement in kinetic parameters during COD football tasks.

Shoe collar height effect on athletic performance, ankle joint kinematics and kinetics during unanticipated maximum-effort side-cutting performance.

Side-step cutting manoeuvres comprise the coordination between planting and non-planting legs. Increased shoe collar height is expected to influence ankle biomechanics of both legs and possibly respective cutting performance. This study examined the shoe collar height effect on kinematics and kinetics of planting and non-planting legs during an unanticipated side-step cutting. Fifteen university basketball players performed maximum-effort side-step cutting to the left 45° direction or a straight ahead run in response to a random light signal. Seven successful cutting trials were collected for each condition. Athletic performance, ground reaction force, ankle kinematics and kinetics of both legs were analysed using paired t-tests. Results indicated that high-collar shoes resulted in less ankle inversion and external rotation during initial contact for the planting leg. The high-collar shoes also exhibited a smaller ankle range of motion in the sagittal and transverse planes for both legs, respectively. However, no collar effect was found for ankle moments and performance indicators including cutting performance time, ground contact time, propulsion ground reaction forces and impulses. These findings indicated that high-collar shoes altered ankle positioning and restricted ankle joint freedom movements in both legs, while no negative effect was found for athletic cutting performance.

Altered lower extremity movement variability in female soccer players during side-step cutting after anterior cruciate ligament reconstruction.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction (ACLR) is common after an ACL tear and is thought to restore functional stability to the knee. A recent investigation demonstrated that individuals who have undergone ACLR exhibited increased lower extremity coupling variability during gait, suggestive of altered dynamic stability. However, little is known about whether they exhibit alterations in lower extremity variability during dynamic sport-specific tasks. PURPOSE: To determine if female soccer players who have had an ACLR demonstrate differences in lower extremity coupling variability as compared with athletes with no history of knee injury during a side-step cutting maneuver. STUDY DESIGN: Controlled laboratory study. METHODS: Ten female soccer players who had undergone ACLR served as the experimental group, and 10 female soccer players with no history of knee ligament injury composed the control group (CON). Three-dimensional kinematics and ground-reaction forces were collected while each participant performed a side-step cutting maneuver. Based on known ACL loading patterns, 7 lower extremity intralimb couplings were created. With use of a vector-coding technique, the coordination variability was calculated for each coupling. Independent t tests were used to determine group differences in variability for each coupling (P ≤ .05). RESULTS: Individuals who had undergone ACLR exhibited increased lower extremity variability during side-step cutting as compared with control subjects in the following couplings: hip rotation/knee abduction-adduction (27.2° ± 11.5° [ACLR] vs 19.7° ± 6.8° [CON]; P = .04), hip flexion-extension/knee abduction-adduction (26.0° ± 13.3° [ACLR] vs 18.6° ± 5.3° [CON]; P = .05), knee abduction-adduction/knee flexion-extension (13.5° ± 5.7° [ACLR] vs 7.3° ± 2.7° [CON]; P < .01), and knee abduction-adduction/knee rotation (26.4° ± 10.8° [ACLR] vs 19.3° ± 4.5° [CON]; P = .03). In addition, there was a trend toward increased variability in the hip rotation/ankle inversion-eversion coupling (22.9° ± 9.3° [ACLR] vs 18.0° ± 6.7° [CON]; P = .09) and knee abduction-adduction/ankle inversion-eversion coupling (25.9° ± 10.0° [ACLR] vs 20.2° ± 9.7° [CON]; P = .10). CONCLUSION: Female soccer players who have undergone ACLR and returned to sports participation exhibit altered lower extremity coupling variability during side-step cutting. CLINICAL RELEVANCE: While individuals who have had an ACLR exhibit mechanical knee stability before returning to sports, the observed increased movement variability during side-step cutting is likely reflective of altered neuromuscular control and may contribute to the known increased risk for ACL reinjury and knee osteoarthritis after return to sports participation. Improving the understanding of altered lower extremity coupling variability after ACLR will aid in the development of more effective rehabilitation programs.

Slipping during side-step cutting: anticipatory effects and familiarization.

The aim of the present study was to verify whether the expectation of perturbations while performing side-step cutting manoeuvres influences lower limb EMG activity, heel kinematics and ground reaction forces. Eighteen healthy men performed two sets of 90° side-step cutting manoeuvres. In the first set, 10 unperturbed trials (Base) were performed while stepping over a moveable force platform. In the second set, subjects were informed about the random possibility of perturbations to balance throughout 32 trials, of which eight were perturbed (Pert, 10cm translation triggered at initial contact), and the others were "catch" trials (Catch). Center of mass velocity (CoMVEL), heel acceleration (HAC), ground reaction forces (GRF) and surface electromyography (EMG) from lower limb and trunk muscles were recorded for each trial. Surface EMG was analyzed prior to initial contact (PRE), during load acceptance (LA) and propulsion (PRP) periods of the stance phase. In addition, hamstrings-quadriceps co-contraction ratios (CCR) were calculated for these time-windows. The results showed no changes in CoMVEL, HAC, peak GRF and surface EMG PRE among conditions. However, during LA, there were increases in tibialis anterior EMG (30-50%) concomitant to reduced EMG for quadriceps muscles, gluteus and rectus abdominis for Catch and Pert conditions (15-40%). In addition, quadriceps EMG was still reduced during PRP (p<.05). Consequently, CCR was greater for Catch and Pert in comparison to Base (p<.05). These results suggest that there is modulation of muscle activity towards anticipating potential instability in the lower limb joints and assure safety to complete the task.