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Side-hops challenge knee control in the frontal and transversal plane more than hops for distance or height among ACL-reconstructed individuals
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 Community Medicine and Rehabilitation, Section of Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-0366-4609
2023 (English)In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116, Vol. 22, no 1, p. 142-159Article in journal (Refereed) Published
Abstract [en]

We compared knee landing mechanics with presumed relation to risk of anterior cruciate ligament (ACL) injury among three single-leg hop tests and between legs in individuals with unilateral ACL reconstruction. Thirty-four participants (>10 months' post-surgery, 23 females) performed the standardised rebound side hop (SRSH), maximal hop for distance (OLHD) and maximal vertical hop (OLVH). We calculated the following knee outcomes from motion capture and force plate data: finite helical axis inclination angles (approximates knee robustness), frontal and transversal plane angles at initial contact, peak angles of abduction and internal rotation during landing, and peak external moments of flexion, abduction and internal rotation during landing. Repeated-measures MANOVA analysis ('sex' as covariate) confirmed that SRSH induced greater angles and moments, particularly in the frontal plane, compared to OLHD and OLVH. There was between-leg asymmetry for peak knee flexion moment for males during OLHD and OLVH, and for females during SRSH. Our results advocate the SRSH over OLHD and OLVH for assessment of knee landing control to screen for movement patterns potentially related to ACL injury risk. However, clear differences in both knee kinematics and kinetics between OLHD and SRSH motivate the use of both tests to evaluate different aspects of landing control.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023. Vol. 22, no 1, p. 142-159
Keywords [en]
Biomechanics, hop landing, non-contact knee injury, sports
National Category
Physiotherapy Sport and Fitness Sciences
Research subject
physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-159146DOI: 10.1080/14763141.2020.1869296ISI: 000618264000001PubMedID: 33586624Scopus ID: 2-s2.0-85100880478OAI: oai:DiVA.org:umu-159146DiVA, id: diva2:1316622
Funder
Swedish Research Council, 521-2013-2802Swedish Research Council, K2014-99X-21876-04-4Swedish Research Council, 2017-00892
Note

Previously included in thesis in manuscript form, with title: "One-leg lateral side-hops induce greater demands on knee landing control than hops in other directions as demonstrated in athletic and non-athletic females with or without injury of the anterior cruciate ligament"

Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2022-12-30Bibliographically 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, JonasTengman, EvaHäger, Charlotte

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