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Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: a longitudinal investigation with curve analyses throughout and after rehabilitation
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-6715-6208
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-6339-9544
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0001-7917-5687
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-0366-4609
2024 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 34, no 1, article id e14524Article in journal (Refereed) Published
Abstract [en]

Investigations of kinetic asymmetries during bilateral squats following anterior cruciate ligament reconstruction (ACLR) are limited to mainly cross-sectional studies and discrete value data extracted at specific knee angles. We assessed loading asymmetries during squats longitudinally throughout rehabilitation using curve analysis and compared patient-reported outcome measures (PROMs) between those with and without asymmetry. Bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: (1) Early 2.9 (1.1) months; (2) Mid 8.8 (3.1) months; (3) at Return to Sport (RTS) 13.1 (3.6) months; and 29 asymptomatic controls (22 females) once. Time-normalized between-leg asymmetry curves of sagittal plane hip, knee, and ankle moments and vertical ground reaction forces were compared using functional data analysis methods. Individual asymmetrical loading for ACLR was classified when exceeding the 95% confidence interval of controls during ≥50% of the squat. At Early, ACLR had greater asymmetry than controls for knee (15%–100% eccentric phase; 0%–100% concentric) and ankle flexion moments (56%–65% concentric). At Mid, ACLR had greater asymmetry for knee (41%–72% eccentric) and ankle flexion moments (56%–69% concentric). No between-group differences were found at RTS. From Early to RTS, ACLR reduced asymmetry for hip (21%–46% eccentric), knee (27%–58% concentric), and ankle flexion moments (21%–57% eccentric). At Early, 11/24 underloaded their ACLR knee and 1 overloaded compared with controls. At RTS, 4 underloaded and 6 overloaded. No differences in PROMs were found based on loading asymmetry. Beyond the early phase of rehabilitation from ACLR, individual-level analyses are required to reveal differing loading strategies during bilateral squats.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024. Vol. 34, no 1, article id e14524
Keywords [en]
ACL, athletic training, biomechanics, general sports trauma, knee, ligaments, motion analysis/kinesiology, physical therapy/rehabilitation
National Category
Physiotherapy Sport and Fitness Sciences
Identifiers
URN: urn:nbn:se:umu:diva-215837DOI: 10.1111/sms.14524ISI: 001085713200001PubMedID: 37853508Scopus ID: 2-s2.0-85174402425OAI: oai:DiVA.org:umu-215837DiVA, id: diva2:1809425
Funder
Swedish Research Council, 2017‐00892Swedish Research Council, 2022‐0077Region Västerbotten, VLL‐358901Region Västerbotten, 7002795Region Västerbotten, RV966109Region Västerbotten, RV 967112Swedish National Centre for Research in Sports, FO‐2018‐0034Swedish National Centre for Research in Sports, FO20190008Swedish National Centre for Research in Sports, 2020/9 P2020‐0035Swedish National Centre for Research in Sports, 2021/9 P2022Swedish National Centre for Research in Sports, 2022/10 P2023‐0030Available from: 2023-11-03 Created: 2023-11-03 Last updated: 2025-02-11Bibliographically approved

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Strong, AndrewMarkström, JonasSchelin, LinaHäger, Charlotte

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