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1.
Br J Sports Med ; 54(3): 139-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31142471

RESUMO

OBJECTIVE: To systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls. DESIGN: Systematic review with meta-analysis. DATA SOURCES: A systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits. RESULTS: The literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen. CONCLUSION: During SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR. PROSPERO trial registration number CRD42018087779.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Teste de Esforço , Joelho/fisiopatologia , Desempenho Físico Funcional , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Extremidade Inferior
2.
Sports Biomech ; 19(1): 76-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29902127

RESUMO

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.


Assuntos
Atletas/psicologia , Tomada de Decisões , Fadiga/psicologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Antecipação Psicológica , Traumatismos em Atletas/fisiopatologia , Humanos , Extremidade Inferior/fisiologia , Movimento/fisiologia , Fadiga Muscular/fisiologia , Fatores de Risco
3.
Medicine (Baltimore) ; 98(48): e17956, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770204

RESUMO

To investigate whether Kinesio tape (KT) application improves proprioception, balance, and functional performance in patients with anterior cruciate ligament rupture (ACLr).This retrospective analysis included 48 male patients with surgically-untreated ACLr who attended the Sports Medicine and Rehabilitation Center, Qingdao Municipal Hospital, China between June 2017 and June 2018. KT was applied to induce a detoning effect on the quadriceps muscle and toning effect on the ischiocrural muscles. Proprioception, balance, and functional performance were assessed before and 1 and 7 days after KT application using the Lysholm scale, anteroposterior shift of the tibia (APST), active angle reproduction test (AART), modified star excursion balance test (mSEBT), and single-hop distance (SHD).KT resulted in significant improvements in Lysholm scale at 1 day (83.00 [6.50] vs. 76.00 [5.25], P < .001) and APST (8.00 [2.00] vs. 10.00 [2.00] mm, P < .001), AART (3.00 [1.00] vs. 4.00 [1.75] degrees, P < .001), SEBT (96.08 [6.62] vs. 83.92 [7.31] %, P < .001) and SHD (120.96 [6.94] vs. 106.46 [9.03] %, P < .001) at 3 hours (median [interquartile range]). However, significant deficits remained when compared with the healthy side. Except for mSEBT posterolateral direction, those effects were maintained at 7 days.KT has benefits in people with ACLr but cannot fully compensate for functional deficits. KT could be used to assist knee strengthening during rehabilitation.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/terapia , Fita Atlética , Desempenho Físico Funcional , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia , Adolescente , Adulto , Humanos , Masculino , Estudos Retrospectivos , Ruptura , Resultado do Tratamento , Adulto Jovem
4.
Gait Posture ; 74: 87-93, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31491565

RESUMO

BACKGROUND: Partial meniscectomy dramatically increases the risk for post-traumatic, tibiofemoral osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Concomitant medial meniscus surgery influences walking biomechanics (e.g., medial tibiofemoral joint loading) early after ACLR; whether medial meniscus surgery continues to influence walking biomechanics two years after ACLR is unknown. RESEARCH QUESTION: Does medial meniscus treatment at the time of ACLR influence walking biomechanics two years after surgery? METHODS: This is a secondary analysis of prospectively collected data from a clinical trial (NCT01773317). Fifty-six athletes (age 24 ±â€¯8 years) with operative reports, two-year biomechanical analyses, and no second injury prior to two-year testing participated after primary ACLR. Participants were classified by concomitant medial meniscal status: no medial meniscus involvement (n = 36), partial medial meniscectomy (n = 9), and medial meniscus repair (n = 11). Participants underwent biomechanical analyses during over-ground walking including surface electromyography; a validated musculoskeletal model estimated medial compartment tibiofemoral contact forces. Gait variables were analyzed using 3 × 2 ANOVAs with group (medial meniscus treatment) and limb (involved versus uninvolved) comparisons. RESULTS: There was a main effect of group (p = .039) for peak knee flexion angle (PKFA). Participants after partial medial meniscectomy walked with clinically meaningfully smaller PKFAs in both the involved and uninvolved limbs compared to the no medial meniscus involvement group (group mean difference [95%CI]; involved: -4.9°[-8.7°, -1.0°], p = .015; uninvolved: -3.9°[-7.6°, -0.3°], p = .035) and medial meniscus repair group (involved: -5.2°[-9.9°, -0.6°], p = .029; uninvolved: -4.7°[-9.0°, -0.3°], p = .038). The partial medial meniscectomy group walked with higher involved versus uninvolved limb medial tibiofemoral contact forces (0.45 body weights, 95% CI: -0.01, 0.91 BW, p = 0.053) and truncated sagittal plane knee excursions, which were not present in the other two groups. SIGNIFICANCE: Aberrant gait biomechanics may concentrate high forces in the antero-medial tibiofemoral cartilage among patients two years after ACLR plus partial medial meniscectomy, perhaps explaining the higher osteoarthritis rates and offering an opportunity for targeted interventions. LEVEL OF EVIDENCE: Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos em Atletas/cirurgia , Meniscectomia/métodos , Meniscos Tibiais/cirurgia , Caminhada/fisiologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Atletas , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/prevenção & controle , Estudos Prospectivos , Adulto Jovem
5.
Knee ; 26(5): 978-987, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31431339

RESUMO

BACKGROUND: Single-leg hop tests are commonly performed in the forward direction to evaluate functional performance. However, athletes move in multiple directions during pivoting sports. The first aim of this study was to examine test-retest reliability of single-leg hop tests in the forward, medial and rotational direction in non-injured athletes. Second, the discriminative ability to detect leg asymmetries with these hop tests in anterior cruciate ligament (ACL) reconstructed athletes was determined. METHODS: Sixteen recreational non-injured participants (eight females, eight males; 22.4 ±â€¯1.9 years) were tested twice (one-week interval) and performed the single hop for distance (SH), triple hop for distance (TH), medial side triple hop for distance (MSTH) and 90° medial rotation hop for distance (MRH). Intraclass correlation coefficients (ICCs), standard errors of measurement (SEM) and smallest detectable differences (SDD) were calculated. Discriminative ability was determined in 32 ACL-reconstructed participants (four females, 28 males; 24.4 ±â€¯4.6 years; six months postoperative) who performed the same hop tests once. RESULTS: The ICCs ranged between 0.93 and 0.98. The SEM and SDD were respectively 2.6-4.1% and 7.2-11.3% of the mean hop distance of the group. The proportion (%) of ACL-reconstructed participants passing the ≥90% limb symmetry cut-off was 62.5 (SH), 59.4 (TH), 40.6 (MSTH) and 46.9 (MRH). CONCLUSION: Excellent test-retest reliability of forward, medial and rotational hop tests was found. This allows clinicians to make informed interpretations of changes in hop test distances when retesting athletes. Medial and rotational hop tests are more likely to show limb asymmetries in ACL-reconstructed participants compared to forward hop tests.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Desempenho Atlético/fisiologia , Teste de Esforço/normas , Articulação do Joelho/fisiopatologia , Joelho/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Teste de Esforço/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Período Pós-Operatório , Reprodutibilidade dos Testes , Rotação , Adulto Jovem
6.
Knee ; 26(5): 1003-1009, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31427244

RESUMO

BACKGROUND: To compare the biomechanical behavior of an anterolateral ligament (ALL) anatomical reconstruction and a semianatomical lateral extra-articular tenodesis (LET) in the context of an anterior cruciate ligament (ACL) reconstruction combined with an anterolateral lesion. METHODS: Twelve cadaveric knees were studied using a testing machine to assess the internal tibial rotation and anterior tibial translation across six surgical states: intact knee, ACL lesion, ACL + ALL lesion, ACL isolated reconstruction, ACL + ALL anatomical reconstruction and ACL + LET procedure. ALL and LET grafts were fixed at full knee extension and neutral rotation. RESULTS: Presented with combined ACL and ALL lesions, isolated ACL reconstruction failed to restore the internal tibial rotation to intact-knee values (P > 0.05 for all angles). The addition of both an ALL reconstruction and LET procedure significantly reduced the internal rotation, restoring the rotation laxity to intact-knee values at 0° and 30° of flexion (P < 0.05) and with a certain level of overconstraint at 60° and 90° (mean 3°â€¯±â€¯2SD). A higher tendency to overconstraint was observed with the LET, but there was no significant difference when comparing the ALL reconstruction with the LET (P > 0.05 for all angles). CONCLUSIONS: Residual rotational laxity was found after isolated ACL reconstruction in the presence of an anterolateral lesion. The combination of ACL reconstruction with anatomical ALL reconstruction or the LET procedure resulted in restoration to intact-knee values but with a certain degree of overconstraint in higher flexion angles. Both techniques showed optimal biomechanical results with no data supporting the advantage of one over the other.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Tenodese/métodos , Idoso , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Ligamentos Articulares/lesões , Masculino , Amplitude de Movimento Articular , Rotação
7.
J Pediatr Orthop ; 39(8): e566-e571, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393290

RESUMO

BACKGROUND: The purpose of this meta-analysis is to review clinical outcomes and complications following pediatric anterior cruciate ligament (ACL) reconstruction. METHODS: The PubMed and EMBASE databases were searched for studies on ACL ruptures in the skeletally immature from 1985 to 2016. Full-text studies in English and performed on humans were included (n=5718). Titles included discussed operative intervention on skeletally immature patients with ACL tears (n=160). Studies that reported rerupture and/or complications with ACL reconstruction specific to the pediatric population, specifically growth disturbance, were then included in a secondary analysis (n=45). Complications not specific to the pediatric population were excluded. Demographics, graft type, surgical technique, follow-up, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. RESULTS: In total, 45 studies were included with 1321 patients and 1392 knees. The average age was 13.0 years, 67% were male, and mean follow-up was 49.6 months. There were 115 (8.7%) reruptures in the initial 160 studies reviewed. In total, 94.6% of patients with rerupture required revision ACL surgery. There were 58 total growth disturbances (16 required corrective surgery, or 27.6%). Eighteen knees (3.7%) developed angular deformity, most commonly valgus. There were 37 patients (7.5%) had at least a 1 cm limb-length discrepancy. A total of 23 studies reported International Knee Documentation Committee scores (range, 81 to 100, 88% grade A or B). In total, 20 studies reported excellent Lysholm scores with mean scores of 94.6. CONCLUSIONS: Growth disturbance can occur with any of the reconstruction techniques. Proper surgical technique is likely more important than the specific reconstruction technique utilized. Patients with rerupture require surgery at much higher rates than those with growth disturbance. Although much attention has been focused on growth disturbance, we suggest that equal attention be given to the prevention of rerupture in this age group. LEVEL OF EVIDENCE: Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Geno Valgo/etiologia , Desigualdade de Membros Inferiores/etiologia , Adolescente , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Humanos , Articulação do Joelho/cirurgia , Escore de Lysholm para Joelho , Recidiva , Reoperação
8.
BMC Musculoskelet Disord ; 20(1): 318, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286929

RESUMO

BACKGROUND: Surgical treatment of young patients with recurrent lateral patella dislocation (RLDP) is often recommended because of loss of knee function that compromises their level of activity or even their daily life functioning. This situation is comparable to young patients with an anterior cruciate ligament (ACL) rupture. The purpose of this study was therefore to explore the time from injury to surgery and the pre-operative symptoms and knee function of young RLPD patients scheduled for stabilizing surgery and compare this group to age and sex-matched ACL-deficient patients. METHOD: Forty-seven patients with unilateral RLPD listed for isolated medial patellofemoral ligament reconstruction were included in the study (RLPD-group). This group was compared to an age, sex and BMI matched ACL patient group obtained from the Norwegian knee ligament registry (ACL-group) for the following outcome measures: the knee injury and osteoarthritis outcome score (KOOS) assessed on the day of surgery and time from injury to surgery. RESULTS: The RLPD-group scored significantly lower than the ACL-group for the three KOOS subscales "Pain" (73.6 vs. 79.8, p < 0.05), "Symptoms" (71.7 vs. 79.3, p < 0.05) and "ADL" (84.7 vs 89.5, p < 0.05). The lowest KOOS values were found for Sports/Recreation (53.5 vs. 51.3, p = 0.65) and Quality of life (37.6 vs. 36.7, p = 0.81). The average time from primary injury to surgery was 6 months for the ACL group and 31 months for the RLPD group. CONCLUSION: RLPD affected knee function as much as ACL deficiency, and was associated with more pain. Still the RLDP patients waited on average 5 times longer for surgery. TRIAL REGISTRATION: The patients with RLPD consisted of patients who were examined for possible recruitment for a concurrent prospective randomized controlled trial comparing conservative treatment and isolated surgical medial patellofemoral ligament (MPFL) reconstruction (Clinical trials no: NCT02263807 , October 2014).


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/cirurgia , Articulação do Joelho/fisiopatologia , Luxação Patelar/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Feminino , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Masculino , Luxação Patelar/complicações , Luxação Patelar/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Recidiva , Reoperação/estatística & dados numéricos , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 98(26): e16030, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261507

RESUMO

The purpose of this study was to analyze the mechanism of anterior cruciate ligament (ACL) injuries among male and female high school students across several different sports to understand ACL injury trends.A total of 1000 cases involving high school students who suffered ACL injuries during school activities (soccer, basketball, volleyball, handball, and judo) and who received insurance benefits through the Injury and Accident Mutual Aid Benefit System, were included to clarify the various mechanisms of ACL injuries. The mechanism of ACL injury was divided into contact and non-contact injuries. Contact injuries were further divided into direct and indirect contact injuries. Non-contact ACL injuries were also further divided into landing injuries, which involved jump-landing movements, and cutting and stopping injuries, which involved movement with a change of direction and deceleration.Overall, 99.0% of judo ACL injuries were categorized as contact ACL injuries. With regards to ball sports, the number of non-contact ACL injuries among basketball, volleyball, and handball players was significantly higher than the number of contact injuries (67.0%, 86.5%, and 68.5% respectively). With regards to female soccer and basketball players, the number of indirect ACL injuries was higher than direct injuries (72.2% and 76.7%, respectively).Volleyball was associated with a higher rate of non-contact injuries. Soccer, basketball, and handball were associated with more or similar rates of indirect and non-contact injuries than direct injuries. Judo was associated with a higher rate of contact injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/etiologia , Traumatismos em Atletas/epidemiologia , Adolescente , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Instituições Acadêmicas , Estudantes
10.
Gait Posture ; 73: 74-79, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31302335

RESUMO

BACKGROUND: Lower extremity movement asymmetries may lead to re-injury and knee osteoarthritis after anterior cruciate ligament (ACL) reconstruction surgery. However, there is no consensus regarding the effect of quadriceps strength asymmetry on lower extremity movement asymmetry after ACL reconstruction. RESEARCH QUESTION: What is the relationship between quadriceps strength asymmetry and asymmetries in lower extremity kinematics and kinetics during walking in individuals who underwent ACL reconstruction surgery?. METHODS: Isometric quadriceps strength, kinematic, and kinetic data during walking were collected from 24 men with unilateral ACL reconstruction. Knee joint angles and moments were reduced. Pearson correlation coefficients between asymmetry in selected knee biomechanics and isometric quadriceps strength asymmetry were determined. RESULTS: The isometric quadriceps strength of the injured leg was significantly lower than that of the uninjured leg (P < 0.001). Knee flexion angles and knee extension moments were smaller in the injured leg than that in the uninjured leg during both loading response (P = 0.007, P = 0.047) and mid-stance phases (P = 0.005, P = 0.028). Isometric quadriceps strength asymmetry was significantly correlated with asymmetry in the peak knee flexion angle during loading response and mid-stance phases (r = -0.48, P = 0.017, r = -0.48, P = 0.017). Isometric quadriceps strength asymmetry was also significantly correlated with asymmetry in the peak knee extension moment during the mid-stance phase (r = -0.44, P = 0.033). SIGNIFICANCE: Individuals with ACL reconstruction demonstrate knee movement asymmetry in the sagittal plane. Isometric quadriceps strength asymmetry is significantly correlated with asymmetry in knee flexion angles during the early stance phase and knee extension moments during the mid-stance phase. Rehabilitation programs should emphasise eccentric exercise to beneficially modify quadriceps neuromuscular control.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Articulação do Joelho/fisiologia , Força Muscular/fisiologia , Músculo Quadríceps/fisiologia , Caminhada/fisiologia , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Contração Isométrica/fisiologia , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Masculino , Suporte de Carga/fisiologia , Adulto Jovem
11.
Phys Ther Sport ; 38: 152-161, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153108

RESUMO

OBJECTIVE: To assess the validity of the cutting movement assessment score (CMAS) to estimate the magnitude of peak knee abduction moments (KAM) against three-dimensional (3D) motion analysis, while comparing whole-body kinetics and kinematics between subjects of low (bottom 33%) and high CMASs (top 33%). DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Forty-one participants (soccer, rugby, netball, and cricket). MAIN OUTCOME MEASURES: Association between peak KAM and CMAS during a 90° cut. Comparison of 3D whole-body kinetics and kinematics between subjects with low (bottom 33%) and high CMASs (top 33%). RESULTS: A very large significant relationship (ρ = 0.796, p < 0.001) between CMAS and peak KAM was observed. Subjects with higher CMASs displayed higher-risk cutting postures, including greater peak knee abduction angles, internal foot progression angles, and lateral foot plant distances (p ≤ 0.032, effect size = 0.83-1.64). Additionally, greater cutting multiplanar knee joint loads (knee flexion, internal rotation, and abduction moments) were demonstrated by subjects with higher CMASs compared to lower (p ≤ 0.047, effect size = 0.77-2.24). CONCLUSION: The CMAS is a valid qualitative screening tool for evaluating cutting movement quality and is therefore a potential method to identify athletes who generate high KAMs and "high-risk" side-step cutting mechanics.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico , Atletas , Imagem Tridimensional/métodos , Articulação do Joelho/fisiopatologia , Movimento/fisiologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Adulto Jovem
12.
Sports Health ; 11(4): 316-323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31194624

RESUMO

BACKGROUND: Individuals who experience a subsequent ipsilateral anterior cruci (cruciate)ate ligament (ACL) reinjury may use hazardous muscle activation strategies after primary ACL reconstruction (ACLR). The purpose of this study was to compare electromyograms (EMGs) of the quadriceps, hamstrings, and gastrocnemius muscles during a dynamic hopping task among individuals with a single ACL injury (ACLx1), individuals who went on to have secondary ipsilateral ACL injury (ACLx2), and individuals who have never sustained an ACL injury (ACLx0). HYPOTHESIS: We expected that individuals who went on to experience a secondary ACL injury would use less quadriceps muscle activity as compared with individuals who experienced a single ACL injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Fourteen individuals that were returned to play post-ACLR and 7 non-ACL-injured individuals participated. Individuals who had undergone an ACLR were placed into groups depending on whether they had experienced a secondary ipsilateral ACL reinjury postprimary ACLR. EMG data of the vastus lateralis, biceps femoris, and lateral gastrocnemius were measured during 2 phases of a single-leg dynamic hopping task: preactivity (100 ms prior to ground contact) and reactivity (250 ms post-ground contact). Processed EMG data were compared across groups using 1-way analyses of variance, with post hoc independent t tests where appropriate (P ≤ 0.05). RESULTS: At preactivity, ACLx1 (0.48% ± 0.2%max) was found to use significantly more hamstring activity than ACLx2 (0.20% ± 0.1%max, P = 0.018), but not than ACLx0 (0.38% ± 0.1%max, P > 0.05). At reactivity, both ACL groups were found to use less quadriceps activity than ACLx0 (ACLx1: 0.38% ± 0.1%max, P = 0.016; ACLx2: 0.40% ± 0.1%max, P = 0.033; ACLx0: 0.58% ± 0.1%max), but not than each other (P > 0.05). CONCLUSION: Quadriceps muscle activity during landing was diminished in all ACL participants as compared with participants who had never sustained an ACL injury. Individuals who did not experience a secondary ipsilateral ACL reinjury (ACLx1) used greater levels of hamstring activity prior to landing. CLINICAL RELEVANCE: The higher hamstring activity in patients who did not experience a secondary injury may be interpreted as a protective mechanism that is used to dynamically stabilize the reconstructed limb.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/cirurgia , Músculos Isquiotibiais/fisiologia , Músculo Esquelético/fisiologia , Músculo Quadríceps/fisiologia , Adolescente , Adulto , Estudos Transversais , Eletromiografia , Teste de Esforço , Feminino , Humanos , Masculino , Força Muscular , Recidiva , Volta ao Esporte , Adulto Jovem
13.
Phys Ther Sport ; 38: 179-183, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170646

RESUMO

OBJECTIVES: To report ACL-RSI scores in healthy athletes with no history of ACL injury. To measure ACL-RSI scores at nine-months post-ACL reconstruction and to assess the difference between healthy athlete and patient responses. DESIGN: Cross-sectional study. SETTING: Private sports clinic. PARTICIPANTS: 499 ACL reconstruction athletes completed the scale as they returned for their nine-month post-operative review appointment. A matched control group of 103 healthy athletes were selected for comparison. MAIN OUTCOME MEASURES: ACL-RSI for participants with controls completing a study-specific modified scale. RESULTS: The median response to the ACL-RSI for the control group was higher (80.0) (Interquartile Range (IRQ) 66.7-88.3) than that of the ACL reconstruction group (74.17) (IRQ 59.2-86.0), however the effect size was small (0.1). CONCLUSION: This study reports normative values for uninjured athletes using the ACL-RSI questionnaire giving a benchmark for recovery after ACLR but also reflecting awareness of injury risk in uninjured athletes. ACL-RSI scores nine-months post-operatively had not yet returned to levels seen in matched uninjured controls.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Atletas , Volta ao Esporte , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
14.
Sports Health ; 11(4): 324-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31173697

RESUMO

BACKGROUND: The impact of maturation on lower extremity strength and function after anterior cruciate ligament reconstruction (ACLR) may help guide future studies of age-specific rehabilitation. HYPOTHESIS: Pediatric ACLR patients would demonstrate higher thigh strength symmetry and knee-related function at return to sport (RTS) compared with adolescent and young adult participants who underwent traditional ACLR. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 144 young athletes at the time of RTS clearance post-ACLR were classified into 3 maturational groups (pediatric, n = 16 with physeal-sparing ACLR [mean age = 12.3 years; range = 9.2-14.6 years]; adolescent, n = 113 [mean age = 16.5 years; range = 14.1-19.8 years]; young adult, n = 15 [mean age = 22.0 years; range = 20.5-24.9 years]). Quadriceps and hamstring strength were measured using an electromechanical dynamometer. Knee-related function was measured using the International Knee Documentation Committee (IKDC) subjective form and single-leg hop tests. The Limb symmetry Index (LSI) was used in calculations for hop and strength tests. Group differences were compared with Kruskal-Wallis tests and Mann-Whitney U post hoc tests. Proportions of participants meeting literature-recommended RTS criterion cutoffs were compared among the groups using chi-square tests. RESULTS: The pediatric group demonstrated higher quadriceps LSI (P = 0.01), IKDC scores (P < 0.01), single-hop LSI (P < 0.01), and crossover-hop LSI (P = 0.02) compared with the young adult group. In addition, the pediatric group demonstrated higher IKDC scores (P < 0.01) and single-hop LSI (P = 0.02) compared with the adolescent group. The adolescent group demonstrated higher IKDC scores (P < 0.01), single-hop LSI (P = 0.02), and crossover-hop LSI (P = 0.03) compared with the young adult group. The proportions of participants meeting all RTS criterion cutoffs were highest in the pediatric group and lowest in the young adult group (P = 0.03). CONCLUSION: Young athletes at RTS clearance after pediatric ACLR demonstrated higher quadriceps strength symmetry and knee-related function than adolescents and young adults after traditional ACLR. CLINICAL RELEVANCE: These findings demonstrate the need for further study regarding the impact of these group differences on longitudinal outcomes after ACLR, including successful RTS and risk of second ACL injury.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Traumatismos em Atletas/cirurgia , Extremidade Inferior/fisiologia , Força Muscular , Volta ao Esporte , Maturidade Sexual , Adolescente , Fatores Etários , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Criança , Teste de Esforço/métodos , Feminino , Músculos Isquiotibiais/fisiologia , Humanos , Joelho/fisiologia , Masculino , Dinamômetro de Força Muscular , Músculo Quadríceps/fisiologia , Coxa da Perna/fisiologia , Adulto Jovem
15.
Int J Sports Med ; 40(7): 477-483, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31189191

RESUMO

The purpose of this study was to clarify the relationship between knee biomechanics and clinical assessments in ACL deficient patients. Subjects included 22 patients with unilateral ACL rupture and 22 healthy controls. Knee kinematics and kinetics during walking and running were examined using a 3-dimensional motion analysis system. The passive knee joint laxity, range of motion of knee joint, and knee muscle strength were also measured. Correlations between the knee kinematic and kinetic data and clinical assessments were evaluated. In the ACL deficient patients, there were no significant relationships between tibial translation during walking and running and passive knee joint laxity. The correlations between knee kinematics and kinetics and range of motion of knee joint were also not significant. Additionally, there were no significant correlations between knee kinematics during walking and knee muscle strength. However, there were several significant correlations between knee kinematics during running and knee muscle strength. The results demonstrate the importance of knee muscle strength for knee kinematics and kinetics during running in ACL deficient patients. Patients with stronger knee muscle strength may demonstrate more nearly normal knee joint movement during dynamic activities such as running.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Articulação do Joelho/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Humanos , Instabilidade Articular/fisiopatologia , Cinética , Força Muscular , Amplitude de Movimento Articular , Corrida/fisiologia , Estudos de Tempo e Movimento , Caminhada/fisiologia
16.
J Bone Joint Surg Am ; 101(12): 1085-1092, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31220025

RESUMO

BACKGROUND: Tibial geometry and knee laxity have been identified as risk factors for both noncontact anterior cruciate ligament (ACL) rupture and instability in the setting of ACL insufficiency via clinical studies; yet, their biomechanical relationships with tibiofemoral kinematics during compressive loading are less well understood. The purpose of this study was to identify the relative contributions of sagittal tibial slope, medial tibial eminence volume, and anterior knee laxity to tibiofemoral kinematics with axial compression in both ACL-intact and ACL-sectioned cadaveric knees. METHODS: Computed tomography (CT) data were collected from 13 human cadaveric knees (mean donor age, 45 ± 11 years; 8 male). Validated algorithms were used to calculate the sagittal slope of the medial and of the lateral tibial plateau as well as volume of the medial tibial eminence. Specimens were then mounted to a robotic manipulator. For both intact and ACL-sectioned conditions, the robot compressed the knee from 10 to 300 N at 15° of flexion; the net anterior tibial translation of the medial and lateral compartments and internal tibial rotation were recorded. Simple and multiple linear regressions were performed to identify correlations between kinematic outcomes and (1) osseous geometric parameters and (2) anterior laxity during a simulated Lachman test. RESULTS: In ACL-intact knees, anterior tibial translation of each compartment was positively correlated with the corresponding sagittal slope, and internal tibial rotation was positively correlated with the lateral sagittal slope and the sagittal slope differential (p ≤ 0.044). In ACL-sectioned knees, anterior tibial translation of the medial compartment was positively associated with medial sagittal slope as well as a combination of medial tibial eminence volume and anterior laxity; internal tibial rotation was inversely correlated with anterior knee laxity (p < 0.05). CONCLUSIONS: Under compressive loading, sagittal slope of the medial and of the lateral tibial plateau was predictive of kinematics with the ACL intact, while medial tibial eminence volume and anterior laxity were predictive of kinematics with the ACL sectioned. CLINICAL RELEVANCE: The relationships between tibial osseous morphology, anterior laxity, and knee kinematics under compression may help explain heightened risk of ACL injury and might predict knee instability after ACL rupture.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/fisiologia , Fêmur/fisiologia , Tíbia/fisiologia , Suporte de Carga/fisiologia , Adulto , Fenômenos Biomecânicos , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade
17.
Phys Ther Sport ; 38: 49-58, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31051428

RESUMO

OBJECTIVES: To evaluate postural regulation and stability among patients who underwent anterior cruciate ligament reconstruction (ACLR) and rehabilitation over a two-year follow-up period. DESIGN: Longitudinal; SETTING: Biomechanics laboratory; PARTICIPANTS: 30 ACLR patients (32.0 ±â€¯12.2 years, 14 males) with isolated ACL rupture. MAIN OUTCOME MEASURES: Postural regulation was tested before ACLR, as well as at six-weeks, twelve-weeks, six-months, one-year and two-years post-ACLR and standardized rehabilitation. Postural regulation was measured for stability indicator (ST), weight distribution index (WDI), synchronization (foot coordination) and sway intensities (postural subsystems). RESULTS: Significant time effects (pre-vs. two-years postoperative) were found for WDI (ηp2 = 0.466), synchronization (ηp2 = 0.368), mediolateral weight distribution (ηp2 = 0.349), ST (ηp2 = 0.205), visual/nigrostriatal systems (ηp2 = 0.179) and peripheral-vestibular system (ηp2 = 0.102). The largest difference (preoperative: ηp2 = 0.180) to the matched sample was calculated for WDI. The most significant differences to the matched sample were observed for ST (preoperative: ηp2 = 0.126; six-weeks postoperative: ηp2 = 0.103) and WDI (preoperative: ηp2 = 0.180; six-weeks postoperative: ηp2 = 0.174). CONCLUSION: ACLR and rehabilitation influence postural subsystems, postural stability, weight distribution and foot synchronization. Normalization of mediolateral weight distribution requires one year following ACLR. The ACLR leads to a suppression of the somatosensory and cerebellar system which was compensated by a higher activity of the visual and nigrostriatal systems.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Ligamento Cruzado Anterior/fisiopatologia , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Ruptura , Fatores de Tempo , Adulto Jovem
18.
Phys Ther Sport ; 38: 71-79, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055061

RESUMO

OBJECTIVE: The primary aim of this study was to determine the effect of NMT on female basketball players (performing at least 3 exercise sessions per week for at least 90 min) with inter limb asymmetry. DESIGN: Controlled laboratory study. SETTING: University research laboratory. PARTICIPANTS: 40 female basketball players (age 22.4 ±â€¯1.7 years, height 168.4 ±â€¯5.31 cm, weight 66.6 ±â€¯6.6 kg) who demonstrated neuromuscular deficits on the tuck jump test were allocated to a control group (n = 20), and the NMT group (n = 20). INTERVENTION: Experimental group participate in an 8-week NMT program including 6 weeks (18 sessions), each session almost lasted for 30 min. MAIN OUTCOME MEASURES: The peak torque as well as time to peak torques of hip abductors and external rotators as well as knee flexors and extensors muscles, and the performance were measured before and at the end of a 6-week NMT using the isokinetic dynamometer and the hop test battery respectively. RESULTS: A significant improvement was observed in the NMT group for the peak torque and time to peak torque in hip and knee muscles both concentric and eccentric states at 60 and 180ºsec. Also, they showed a significant improvement in the distance of single leg hop and single leg triple crossover hop tests. However, no significant 20 and 21. change was seen in the control group. CONCLUSIONS: An NMT program can significantly improve muscle strength, hop tests scores, and the inter limb asymmetry in female basketball players. The NMT may be used in ACL prevention in female basketball players with lower limb asymmetry.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Basquetebol/lesões , Terapia por Exercício/métodos , Articulação do Quadril/fisiopatologia , Articulação do Joelho/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Estudos de Casos e Controles , Exercício , Feminino , Humanos , Adulto Jovem
19.
J Sports Med Phys Fitness ; 59(10): 1724-1738, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31062538

RESUMO

INTRODUCTION: Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury. EVIDENCE ACQUISITION: Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. EVIDENCE SYNTHESIS: To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made. CONCLUSIONS: This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).


Assuntos
Lesões do Ligamento Cruzado Anterior/epidemiologia , Futebol Americano/lesões , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Futebol Americano/estatística & dados numéricos , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/fisiopatologia , Fatores de Risco
20.
Phys Ther Sport ; 38: 80-86, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31071659

RESUMO

OBJECTIVE: Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN: Cross-sectional case-control study. SETTING: Sports medicine clinic. SUBJECTS: Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES: Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS: Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION: Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/métodos , Atletas , Cuidados Pós-Operatórios/métodos , Volta ao Esporte , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Humanos
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