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Individuals With an Anterior Cruciate Ligament-Reconstructed Knee Display Atypical Whole Body Movement Strategies but Normal Knee Robustness During Side-Hop Landings: A Finite Helical Axis Analysis
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-6339-9544
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
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: 0000-0002-0366-4609
2020 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 48, no 5, p. 1117-1126Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Atypical knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) are common. It is, however, unclear whether knee robustness (ability to tolerate perturbation and maintain joint configuration) and whole body movement strategies are compromised after ACLR.

PURPOSE: To investigate landing control after ACLR with regard to dynamic knee robustness and whole body movement strategies during sports-mimicking side hops, and to evaluate functional performance of hop tests and knee strength.

STUDY DESIGN: Controlled laboratory study.

METHODS: An 8-camera motion capture system and 2 synchronized force plates were used to calculate joint angles and moments during standardized rebound side-hop landings performed by 32 individuals with an ACL-reconstructed knee (ACLR group; median, 16.0 months after reconstruction with hamstring tendon graft [interquartile range, 35.2 months]) and 32 matched asymptomatic controls (CTRL). Dynamic knee robustness was quantified using a finite helical axis approach, providing discrete values quantifying divergence of knee joint movements from flexion-extension (higher relative frontal and/or transverse plane motion equaled lower robustness) during momentary helical rotation intervals of 10°. Multivariate analyses of movement strategies included trunk, hip, and knee angles at initial contact and during landing and hip and knee peak moments during landing, comparing ACLR and CTRL, as well as legs within groups.

RESULTS: Knee robustness was lower for the first 10° motion interval after initial contact and then successively stabilized for both groups and legs. When landing with the injured leg, the ACLR group, as compared with the contralateral leg and/or CTRL, demonstrated significantly greater flexion of the trunk, hip, and knee; greater hip flexion moment; less knee flexion moment; and smaller angle but greater moment of knee internal rotation. The ACLR group also had lower but acceptable hop and strength performances (ratios to noninjured leg >90%) except for knee flexion strength (12% deficit).

CONCLUSION: Knee robustness was not affected by ACLR during side-hop landings, but alterations in movement strategies were seen for the trunk, hip, and knee, as well as long-term deficits in knee flexion strength.

CLINICAL RELEVANCE: Knee robustness is lowest immediately after landing for both the ACLR group and the CTRL and should be targeted in training to reduce knee injury risk. Assessment of movement strategies during side-hop landings after ACLR should consider a whole body approach.

Place, publisher, year, edition, pages
Sage Publications, 2020. Vol. 48, no 5, p. 1117-1126
Keywords [en]
biomechanics, kinematics, kinetics, helical axis
National Category
Physiotherapy Orthopaedics
Identifiers
URN: urn:nbn:se:umu:diva-159145DOI: 10.1177/0363546520910428ISI: 000523869700001PubMedID: 32168459Scopus ID: 2-s2.0-85082127552OAI: oai:DiVA.org:umu-159145DiVA, id: diva2:1316621
Funder
Swedish Research Council, K2014Swedish Research Council, 2016-02763Region Västerbotten, ALFVLL7002689Swedish National Centre for Research in Sports, CIF 2015/11 P2016-0042
Note

Previosly included in thesis in manuscript form, with title: "Individuals with anterior cruciate ligament reconstruction adopt different movement strategies but display robust knees during side hop landings"

Följande två forskningsfinansiärer fanns inte bland de valbara och gick därför inte att lägga till:

1. Young Researcher Awardee to C.K.H. (Dnr 223-514-09) (dvs. karriärbidrag, Umeå universitet)

2. Umeå University School of Sport Science (Dnr IH 5.3-13 2015)

Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2023-09-05Bibliographically approved
In thesis
1. Movement strategies and dynamic knee control after anterior cruciate ligament injury: a three-dimensional biomechanical analysis
Open this publication in new window or tab >>Movement strategies and dynamic knee control after anterior cruciate ligament injury: a three-dimensional biomechanical analysis
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Rupture of the anterior cruciate ligament (ACL) is common and mainly occurs in non-contact situations in sports, often due to momentarily poor movement control. Assessment of movement quality during sport-like tasks iscrucial to understand how to decrease the high risk of reinjury for ACL-injured persons, but also how to prevent primary injury. This thesis addresses movement quality after ACL injury and includes development and evaluation of a novel standardized rebound side hop test (SRSH) for reliability and agreement of landing mechanics, and compares these outcomes between asymptomatic persons with different athletic levels, and between different hop tests.

Methods: This thesis involves five papers based on two separate data collections performed in a motion analysis laboratory. Paper I is a long-term follow up of ACL-injured persons treated with or without ACL reconstruction (ACLR) compared to asymptomatic persons (total N = 99, age 35-63), while papers II-V included ACLR persons, and asymptomatic elite athletes and non-athletes (total N = 79, age 17-34). A motion capture system synchronized with force plates and surface electromyography (EMG) registered trunk, hip and knee angles and moments and knee muscle activity during the hop for distance, vertical hop, and SRSH. Novel measures of dynamic knee robustness were also evaluated using finite helical axis inclination angles extracted from knee rotation intervals of 10˚.

Results: On average 23 years after injury, ACL injured persons performed the vertical hop with diverse angles compared to controls and their non-injured leg.The younger groups of ACLR persons and controls generally displayed excellent reliability and agreement for SRSH landing mechanics. These outcomes differed between the groups, and between legs for ACLR persons, despite similar dynamic knee robustness and acceptable knee function outcomes. Curve analyses further displayed differences between athletes and non-athletes, mainly with greater hip moments for athletes, although with similar values for dynamic knee robustness. Finally, greater knee angles and moments considered strenuous for the ACL were evident during the first rebound landing in SRSH compared to the other landings.

Conclusions: Persons who have suffered an ACL injury, regardless of whether treated with ACLR or not, appear to use task-coping strategies in preparation for and during landings to decrease knee joint loading, probably to preserve dynamic knee robustness. More attention should be given to the trunk and hip in clinics when evaluating movement quality after ACL injury to reduce the risk of future injuries due to movement compensation. High-level athletic training may also improve the ability to maintain dynamic knee robustness whilst performing a sport-like side-to-side task more efficiently through increased engagement of the hip. Finally, side hop landings should be assessed when evaluating and correcting for erroneous landing mechanics to improve knee landing control.

Abstract [sv]

Bakgrund: Främre korsbandsskada (ACL-skada) är en vanlig idrottsskada som huvudsakligen uppstår i situationer utan kontakt med annan spelare till följd aven tillfälligt dålig rörelsekontroll. Utvärdering av rörelsekvalitet under idrottsliknande tester behövs för att bättre förstå hur risken för ACL-skador och återskador kan minskas. Denna avhandling är inriktad på rörelsekvalitet efter ACL-skada och behandlar utveckling samt utvärdering av ett nytt standardiserat sidohopp (SRSH). Tillförlitlighet och överensstämmelse av ledvinklar och moment utvärderas och jämförs mellan personer med och utan ACL-skada, mellan personer med olika atletbakgrund, samt mellan olika hopptester.

Metoder: Denna avhandling omfattar fem studier, vilka är baserade på två separata datasamlingar utförda i ett rörelsesanalyslaboratorium. Studie I är en långtidsuppföljning av personer med ACL-skada behandlade både med och utan ACL-rekonstruktion, vilka jämförs med knäfriska kontroller (totala N = 99, 35-63 år). Studie II-V inkluderade personer med ACL-rekonstruktion, knäfriska kontroller och elitatleter (totala N = 79, 17-34 år). Ett rörelseanalyssystem synkroniserat med kraftplattor och ytelektromyografi registrerade bål, höft och knävinklar och moment, samt lårmuskelaktivitet under enbenshopp (på längden, på höjden, samt SRSH). Även nya utfallsmått som utvärderar knäets robusthet under rörelse analyserades med helixvinklar från intervaller av knärörelse på 10˚.

Resultat: I genomsnitt 23 år efter ACL-skada utförde båda grupperna ett enbenshopp på höjden med olika ledvinklar, både jämfört med kontroller samt deras oskadade ben. De yngre ACL-skadade personerna och kontrollerna visade generellt utmärkt tillförlitlighet och överensstämmelse av ledvinklar och moment under SRSH. Dessa utfallsmått skiljde sig mellan grupperna och mellan benen för ACL-skadade personer, trots att lika resultat av knäets robusthet samt acceptabla knäfunktionsresultat visades. Kurvanalyser visade även på skillnader mellan atleter och icke-atleter, främst med större höftmoment för atleter, trots lika resultat av knäets robusthet. Den första landningen i SRSH visade större knävinklar och moment som anses belasta ACL jämfört med övriga landningar.

Slutsatser: Personer med ACL-skada, oavsett om de behandlats med ACLrekonstruktion eller ej, verkar tillämpa rörelsestrategier för att hantera landningar från enbenshopp genom att minska belastningen på knäleden, troligen för att bevara knäets robusthet. I klinik bör ett större fokus läggas på bål och höftrörelser vid utvärdering av rörelsekvaliteten efter ACL-skada. Detta för att minska risken för framtida skador på grund av rörelsekompensation. Vidare förbättrar idrottsträning på hög nivå troligen förmågan att upprätthålla knäets robusthet samtidigt som utförandet av sidohoppstester blir effektivare genom ett ökat engagemang av höften. Slutligen bör sidhoppslandningar användas vid utvärdering och korrigering av landningsmekanik för en förbättrad knäkontroll.

Place, publisher, year, edition, pages
Umeå University, 2019. p. 88
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2040
Keywords
Anterior cruciate ligament, biomechanics, kinematics, kinetics, finite helical axis, injury prevention, sports, reliability, agreement, one-leg hops, functional data analysis
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-159136 (URN)978-91-7855-066-1 (ISBN)
Public defence
2019-06-14, Aulan, Vårdvetarhuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2019-05-24 Created: 2019-05-20 Last updated: 2019-05-21Bibliographically approved

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Markström, Jonas L.Grip, HelenaSchelin, LinaHäger, Charlotte K.

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