Differential Effects of 2 Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction.

CONTEXT: The muscular function restoration related to the type of physical rehabilitation followed after anterior cruciate ligament reconstruction (ACLR) using autologous hamstring tendon graft in terms of strength and cross-sectional area (CSA) remain controversial. OBJECTIVE: To analyze the CSA and force output of quadriceps and hamstring muscles in subjects following either an Objective Criteria-Based Rehabilitation (OCBR) algorithm or the usual care (UCR) for ACL rehabilitation in Spain, before and 1 year after undergoing an ACLR. DESIGN: Longitudinal clinical double-blinded randomized controlled trial. SETTING: Sports-medicine research center. PATIENTS: 40 recreational athletes (30 male, 10 female [24 ± 6.9 y, 176.55 ± 6.6 cm, 73.58 ± 12.3 kg]). INTERVENTION: Both groups conducted differentiated rehabilitation procedures after ACLR. Those belonging to OCBR group were guided in their recovery according to the current evidence-based principles. UCR group followed the national conventional approach for ACL rehabilitation. MAIN OUTCOME MEASURES: Concentric isokinetic knee joint flexor-extension torque assessments at 180°/s and Magnetic Resonance Imaging (MRI) evaluations were performed before and 12 months after ACLR. Anatomical muscle CSA (mm2) was assessed, in Quadriceps, Biceps femoris, Semitendinous, Semimembranosus, and Gracilis muscles at 50% and 70% femur length. RESULTS: Reduced muscle CSA was observed in both treatment groups for Semitendinosus and Gracilis 1 year after ACLR. At 1-year follow-up, subjects allocated to the OCBR demonstrated greater knee flexor and extensor peak torque values in their reconstructed limbs in comparison with patients treated by UCR. CONCLUSIONS: Objective atrophy of Semitendinosus and Gracilis muscles related to surgical ACLR was found to persist in both rehabilitation groups. However, OCBR after ACLR lead to substantial gains on maximal knee flexor strength and ensured more symmetrical anterior-posterior laxity levels at the knee joint.

The burden of injuries according to maturity status and timing: A two-decade study with 110 growth curves in an elite football academy.

Injuries have a negative impact on the development of football players. Maturation is a potential risk factor for football injuries but available data on this topic provide limited evidence due to methodological shortcomings. The aim of this study was to describe the injury burden of male academy football players according to growth curve-derived maturity status and timing. Injury and growth data were collected from 2000 to 2020. Longitudinal height records for 110 individual players were fitted with the Super-Imposition by Translation and Rotation model to estimate age at peak height velocity (PHV). Players were clustered according to maturity status (pre-, circa-, post-PHV, or adults) and timing (early, on-time, late maturers). Overall and specific injury burdens (days lost/player-season) and rate ratios for comparisons between groups were calculated. Overall injury burden increased with advanced maturity status; pre-PHV players had 3.2-, 3.7-, and 5.5-times lower burden compared with circa-PHV, post-PHV, and adult players, respectively. Growth-related injuries were more burdensome circa-PHV, while muscle and joint/ligament injuries had a higher impact post-PHV and in adults. Further, in the pre-PHV period, late maturers showed lower burden of overall, growth-related, anterior inferior iliac spine osteochondrosis, and knee joint/ligament injuries compared with on-time maturers. In adult players, however, injuries were less burdensome for early maturers than on-time and late maturers. In addition, joint/ligament injuries of adult late maturers were 4.5-times more burdensome than those of early maturers. Therefore, monitoring maturity seems crucial to define each player's maturation profile and facilitate design of targeted injury prevention programmes.Highlights Injury burden is significantly lower in football players at pre-peak height velocity (PHV). Growth-related injuries are most burdensome circa-PHV, while muscle and joint/ligament injuries are more burdensome post-PHV and especially in adults.Before PHV, growth-related and knee joint/ligament injuries have lower burden in players who mature late than those who mature on-time. Adult late maturers have greater burden of overall and joint/ligament injuries than early maturers.Football academies should regularly assess the maturity status and timing of young football players, as the impact of injuries varies with maturation status and timing.Management of the maturity-related injury risk profile, in combination with other relevant factors (training load, neuromuscular and biomechanical factors, physiotherapy, coaching, communication, psychosocial factors …), might help improve the success of player development programmes and protect the health of young football players.

Functional and Anthropometrical Screening Test among High Performance Female Football Players: A Descriptive Study with Injury Incidence Analysis, the Basque Female Football Cohort (BFFC) Study.

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women's football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1-5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

Horizontal jumping biomechanics among elite male handball players with and without anterior cruciate ligament reconstruction. An inertial sensor unit-based study.

OBJECTIVES: Anterior cruciate ligament (ACL) tears are one of the most devastating injuries that any handball player can suffer during landing and pivoting actions. The aim of this study was to analyze the horizontal jumping biomechanics among male elite handball players with or without previous ACLR. DESIGN: Descriptive study. SETTING: Spanish elite male handball players. PARTICIPANTS: Twenty-six male participants (6 ACL-R and 20 uninjured controls) were recruited. MAIN OUTCOME MEASURES: Two horizontal hopping tasks were evaluated using an inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. RESULTS: Non-significant differences were found in relation to any of the biomechanical or performance related analyzed variables. CONCLUSIONS: Previously ACL-R elite male handball players who have returned to the top level of sports participation do not seem to possess lasting biomechanical and/or performance deficits 6 years after the original surgical ligament repair.

Horizontal jumping biomechanics among elite female handball players with and without anterior cruciate ligament reconstruction: an ISU based study.

BACKGROUND: Handball is a strenuous body-contact team sport that places high loads on the knee joint. Anterior cruciate ligament (ACL) tear is one of the most devastating injuries that any handball player can suffer, and female athletes are at particular risk due to their intrinsic anatomical, hormonal, neuromuscular and biomechanical characteristics. The purpose of this study was to analyze the horizontal jumping biomechanics of female elite handball players with or without previous ACL reconstruction. METHODS: Twenty-one female participants (6 with previous ACL reconstruction and 15 uninjured controls) were recruited. Two horizontal hopping tasks were evaluated using inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. RESULTS: The athletes with previous ACL reconstruction demonstrated a significant (P < 0.05) reduction in the unilateral triple hop for distance compared with the healthy controls. Furthermore, during the initial propulsive phase of the unilateral cross-over hop, the control participants generated significantly (P < 0.05) higher force values in the mediolateral direction (the X axis) with their dominant limb compared with the ACL-reconstructed (ACL-R) limb of previously injured participants. CONCLUSIONS: Three-dimensional horizontal jumping biomechanics analyses using ISU-based technologies could provide clinicians with more accurate information regarding the horizontal jumping biomechanical patterns among elite handball female athletes. Furthermore, several mechanical alterations could still be observed among those players who had undergone previous ACL reconstruction, even when several years have passed since the original ACL injury.