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  • 1.
    Arumugam, Ashokan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Strong, Andrew
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Röijezon, Ulrik
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 4, article id e027241Article, review/survey (Refereed)
    Abstract [en]

    Introduction: An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls.

    Methods and analysis: The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria.

    Ethics and dissemination: Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals.

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  • 2. Arumugam, Ashokan
    et al.
    Strong, Andrew
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Röjezon, Ulrik
    Luleå University of Technology, Luleå, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Knee proprioception deficits following an ACL injury: a myth or a reality2021Conference paper (Refereed)
  • 3.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Response to comment on: “return to sports: a risky business? a systematic review with meta-analysis of risk factors for graft rupture following acl reconstruction”2024In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 54, p. 779-780Article in journal (Refereed)
  • 4.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Return to sports: a risky business? a systematic review with meta-analysis of risk factors for graft rupture following acl reconstruction2023In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 53, no 1, p. 91-110Article, review/survey (Refereed)
    Abstract [en]

    Background: The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.

    Objective: The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.

    Methods: A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality.

    Results: Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.

    Conclusion: Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.

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  • 5.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A75-A76, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury.

    Objective:  To systematically review intrinsic risk factors for sustaining a C-ACL injury.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age with ACL injury.

    Assessment of Risk Factors: The review comprises longitudinal studies investigating any intrinsic risk factor for future C-ACL injury.

    Main Outcome Measurements: C-ACL injury

    Results: Thirty-five moderate-to-high quality studies were eligible for meta-analysis, including up to ~59 000 individuals. The following factors all independently increased the odds of sustaining a C-ACL: Returning to a high activity level (OR: 3.26, 95% CI: 2.10–5.06), BMI < 25 (OR: 2.73, 95% CI: 1.73–4.36), Age ≤ 18 years (OR: 2.42, 95% CI: 1.51–3.88), Family history of ACL injury (OR: 2.07, 95% CI: 1.54–2.80), Primary ACL reconstruction performed ≤ 3 months post injury (OR: 1.65, 95% CI: 1.32–2.06), Female sex (OR: 1.35, 95% CI: 1.14–1.61) and Concomitant meniscal injury (OR 1.21, 95% CI: 1.03–1.42). There were no associations between the odds of sustaining a C-ACL injury and Smoking status, Pre-injury activity level, Playing soccer compared to other sports or Timing of return to sport.

    Conclusions: Demographic factors such as female sex, young age and family history of ACL injury, as well as early reconstruction and returning to a high activity level all contribute to the risk of sustaining a C-ACL injury. Studies on modifiable sensorimotor risk factors are warranted.

  • 6.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Risk factors for graft rupture after anterior cruciate ligament reconstruction: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A76-A76, article id 194Article in journal (Refereed)
    Abstract [en]

    Background: Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described.

    Objective: To systematically review intrinsic risk factors for sustaining a graft rupture.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses (random effect model) were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age who have had ACLR.

    Assessment of Risk Factors: All longitudinal studies investigating any intrinsic risk factor for future graft rupture were included.

    Main Outcome Measurements: Graft rupture.

    Results: Seventy-seven studies were eligible for meta-analysis. The following factors all independently increased the odds of sustaining a graft rupture after ACLR: Age ≤ 18 years (OR: 3.87, 95% CI: 2.32–6.46), higher pre-primary injury activity level (OR: 2.43, 95% CI: 1.56–3.82), family history of ACL injury (OR: 1.98, 95% CI: 1.50–2.62), returning to a high activity level (OR: 1.87, 95% CI: 1.11–3.15), and increased lateral tibial slope (OR: 1.64, 95% CI: 1.13–2,38). None of the following factors were found to be associated with future graft rupture; sex, smoking status, generalized joint laxity, timing of surgery or return to sport (RTS), playing soccer compared to other sports, hop performance at time of RTS or concomitant meniscal or collateral ligament injuries.

    Conclusions: Young age, family history of ACL injury, high tibial slope and previous and current high activity level should be considered when screening for increased risk of graft rupture following ACLR. Future studies on the possible role of sensorimotor factors, e.g., muscle activation and/or strength and proprioception for future graft ruptures are warranted.

  • 7.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis2021In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 51, no 7, p. 1419-1438Article, review/survey (Refereed)
    Abstract [en]

    Background: The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-ACL injury.

    Objective: To systematically review instrinsic risk factors for sustaining a C-ACL injury.

    Methods: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Inclusion criteria were prospective or retrospective studies investigating any intrinsic risk factor for future C-ACL injury. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same risk factor.

    Results: 44 moderate-to-high quality studies were eventually included in this review, whereof 35 studies were eligible for meta-analysis, including up to 59 000 individuals. We identified seven factors independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest OR): (1) returning to a high activity level (OR 3.26, 95% CI 2.10–5.06); (2) Body Mass Index < 25 (OR 2.73, 95% CI 1.73–4.36); (3) age ≤ 18 years (OR 2.42, 95% CI 1.51–3.88); (4) family history of ACL injury (OR 2.07, 95% CI 1.54–2.80); (5) primary ACL reconstruction performed ≤ 3 months post injury (OR 1.65, 95% CI: 1.32–2.06); (6) female sex (OR 1.35, 95% CI 1.14–1.61); and (7) concomitant meniscal injury (OR 1.21, 95% CI 1.03–1.42). The following two factors were associated with decreased odds of a subsequent C-ACL injury: 1) decreased intercondylar notch width/width of the distal femur ratio (OR 0.43, 95% CI 0.25–0.69) and 2) concomitant cartilage injury (OR 0.83, 95% CI 0.69–1.00). There were no associations between the odds of sustaining a C-ACL injury and smoking status, pre-injury activity level, playing soccer compared to other sports or timing of return to sport. No studies of neuromuscular function in relation to risk of C-ACL injury were eligible for meta-analysis according to our criteria.

    Conclusion: his review provides evidence that demographic factors such as female sex, young age (≤ 18 years) and family history of ACL injury, as well as early reconstruction and returning to a high activity level increase the risk of C-ACL injury. Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries.

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  • 8.
    Cöster, Maria
    et al.
    Institutionen för kliniska vetenskaper, Lunds universitet; orto-pedkliniken, Skånes universitetssjukhus Malmö; Capio Movement, Halmstad.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Brax Olofsson, Lisbeth
    Rörelseorganens centrum, Norrlands universitetssjukhus, Umeå.
    Montgomery, Fredrik
    Institutionen för kliniska vetenskaper, Lunds universitet.
    Enkel senförflyttning kan ge ökad funktion vid droppfot efter stroke2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, no 34-35, article id 21071Article in journal (Refereed)
    Abstract [en]

    Foot drop (FD) can be caused by a variety of diseases and injuries. FD leads to walking difficulties and reduced balance which also can lead to a higher risk of falling. Patient with a stroke often have an equinovarus deformity of the foot together with the DF. There is a need to optimize and standardize the treatment for patients with FD across different medical specialities. Surgical interventions, with goals of producing a balanced functional foot, have been shown to improve the function and quality of life and decrease the use of braces and walking aids in patients with FD after a CVI. In Sweden data regarding FD surgery is collected in the National Quality Registry for Foot and Ankle Surgery (Riksfot), but there is also an ongoing multicentre study, investigating the patient-reported and functional results of surgery due to FD caused by a CVI.

  • 9.
    Grip, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Dynamic knee stability as estimated by finite helical axis methods during drop landing twenty years after anterior cruciate ligament injury2015In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 48, no 10, p. 1906-1914Article in journal (Refereed)
    Abstract [en]

    Finite helical axis (FHA) measures of the knee joint during weight-bearing tasks may capture dynamic knee stability following Anterior Cruciate Ligament (ACL) injury. The aim was to investigate dynamic knee stability during two-leg squat (TLS) and one-leg side hop (SH) in a long-term follow-up of ACL injury, and to examine correlations with knee laxity (KT-1000), osteoarthritis (OA, Kellgren–Lawrence) and knee function (Lysholm score). Participants were injured 17–28 years ago and then treated with surgery (n=33, ACLR) or physiotherapy only (n=37, ACLPT) and healthy-knee controls (n=33) were tested. Movements were registered with an optical motion capture system. We computed three FHA inclination angles, its' Anterior–Posterior (A–P) position, and an index quantifying directional changes (DI), during stepwise knee flexion intervals of ∼15°. Injured knees were less stable compared to healthy controls' and to contralateral non-injured knees, regardless of treatment: the A–P intersection was more anterior (indicating a more anterior positioning of tibia relative to femur) positively correlating with high laxity/low knee function, and during SH, the FHA was more inclined relative to the flexion–extension axis, possibly due to reduced rotational stability. During the TLS, A–P intersection was more anterior in the non-injured knee than the injured, and DI was higher, probably related to higher load on the non-injured knee. ACLR had less anterior A–P intersection than ACLPT, suggesting that surgery enhanced stability, although rotational stability may remain reduced. More anterior A–P intersection and greater inclination between the FHA and the knee flexion–extension axis best revealed reduced dynamic stability ∼23 years post-injury.

  • 10.
    Grip, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Quantifying motor control of the knee during side hops - healthy subjects and subjects ~20 years after anterior cruciate ligament injury2012Conference paper (Other academic)
  • 11.
    Grip, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte K
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Dynamic knee stability estimated by finite helical axis methods during functional performance approximately twenty years after anterior cruciate ligament injury2015In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 48, no 10, p. 1906-1914Article in journal (Refereed)
    Abstract [en]

    Finite helical axis (FHA) measures of the knee joint during weight-bearing tasks may capture dynamic knee stability following Anterior Cruciate Ligament (ACL) injury. The aim was to investigate dynamic knee stability during two-leg squat (TLS) and one-leg side hop (SH) in a long-term follow-up of ACL injury, and to examine correlations with knee laxity (KT-1000), osteoarthritis (OA, Kellgren-Lawrence) and knee function (Lysholm score). Participants were injured 17-28 years ago and then treated with surgery (n=33, ACL(R)) or physiotherapy only (n=37, ACL(PT)) and healthy-knee controls (n=33) were tested. Movements were registered with an optical motion capture system. We computed three FHA inclination angles, its' Anterior-Posterior (A-P) position, and an index quantifying directional changes (DI), during stepwise knee flexion intervals of similar to 15 degrees. Injured knees were less stable compared to healthy controls' and to contralateral non-injured knees, regardless of treatment: the A-P intersection was more anterior (indicating a more anterior positioning of tibia relative to femur) positively correlating with high laxity/low knee function, and during SH, the FHA was more inclined relative to the flexion-extension axis, possibly due to reduced rotational stability. During the TLS, A-P intersection was more anterior in the non-injured knee than the injured, and DI was higher, probably related to higher load on the non-injured knee. ACL(R) had less anterior A-P intersection than ACL(PT), suggesting that surgery enhanced stability, although rotational stability may remain reduced. More anterior A-P intersection and greater inclination between the FHA and the knee flexion-extension axis best revealed reduced dynamic stability similar to 23 years post-injury.

  • 12.
    Grip, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Liebermann, Dario G.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 10, article id e0224261Article in journal (Refereed)
    Abstract [en]

    The purpose was to evaluate the dynamic knee control during a drop jump test following injury of the anterior cruciate ligament injury (ACL) using finite helical axes. Persons injured 17-28 years ago, treated with either physiotherapy (ACLPT, n = 23) or reconstruction and physiotherapy (ACLR, n = 28) and asymptomatic controls (CTRL, n = 22) performed a drop jump test, while kinematics were registered by motion capture. We analysed the Preparation phase (from maximal knee extension during flight until 50 ms post-touchdown) followed by an Action phase (until maximal knee flexion post-touchdown). Range of knee motion (RoM), and the length of each phase (Duration) were computed. The finite knee helical axis was analysed for momentary intervals of ~15° of knee motion by its intersection (ΔAP position) and inclination (ΔAP Inclination) with the knee's Anterior-Posterior (AP) axis. Static knee laxity (KT100) and self-reported knee function (Lysholm score) were also assessed. The results showed that both phases were shorter for the ACL groups compared to controls (CTRL-ACLR: Duration 35±8 ms, p = 0.000, CTRL-ACLPT: 33±9 ms, p = 0.000) and involved less knee flexion (CTRL-ACLR: RoM 6.6±1.9°, p = 0.002, CTRL-ACLR: 7.5 ±2.0°, p = 0.001). Low RoM and Duration correlated significantly with worse knee function according to Lysholm and higher knee laxity according to KT-1000. Three finite helical axes were analysed. The ΔAP position for the first axis was most anterior in ACLPT compared to ACLR (ΔAP position -1, ACLPT-ACLR: 13±3 mm, p = 0.004), with correlations to KT-1000 (rho 0.316, p = 0.008), while the ΔAP inclination for the third axis was smaller in the ACLPT group compared to controls (ΔAP inclination -3 ACLPT-CTRL: -13±5°, p = 0.004) and showed a significant side difference in ACL injured groups during Action (Injured-Non-injured: 8±2.7°, p = 0.006). Small ΔAP inclination -3 correlated with low Lysholm (rho 0.391, p = 0.002) and high KT-1000 (rho -0.450, p = 0.001). Conclusions Compensatory movement strategies seem to be used to protect the injured knee during landing. A decreased ΔAP inclination in injured knees during Action suggests that the dynamic knee control may remain compromised even long after injury.

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  • 13. Hébert-Losier, Kim
    et al.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Strong, Andrew
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture2018In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 25, no 2, p. 226-239Article in journal (Refereed)
    Abstract [en]

    Background: Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop–jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts.

    Methods: Subjects with unilateral ACL ruptures treated more than two decades ago (17–28 years) conservatively with physiotherapy (ACLPT, n = 26) or in combination with reconstructive surgery (ACLR, n = 28) and healthy-knee controls (n = 25) performed 40-cm drop–jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACLPT and ACLR vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods.

    Results: Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACLR also showed less trunk flexion during Rebound. Between-leg differences were observed in ACLR only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACLR and ACLPT. However, compared to controls, deviations spanned a greater proportion of the drop–jump movement at the hip in ACLR and at the knee in ACLPT.

    Conclusions: Trunk and bilateral leg kinematics during double-leg drop–jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACLPT and ACLR compared to controls.

  • 14.
    Karlström, Josefin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Social Sciences, Umeå School of Sport Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury2022In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 23, no 1, article id 290Article in journal (Refereed)
    Abstract [en]

    Background: Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals' experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury.

    Methods: Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19–41 years) with an ACL rupture 2–25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis.

    Results: The results consisted of one overarching theme: 'A strenuous process towards regaining balance' which built on three categories 'Disrupted knee', 'Disrupted me' and 'Moving forward with new insights'. The overarching theme captures the participants' experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically 'disrupted knee', as well as facing mental challenges, identity challenges and a 'disrupted me'. By gradual acceptance and re-orientation they were moving forward with new insights – although still struggling with the consequences of the injury.

    Conclusions: Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual 'disruptions' and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted.

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  • 15.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A comparison of knee joint kinematics and kinetics during landings in three one-leg hop tests (hop for distance, vertical hop and side hop) performed by female elite floorball athletes2016In: XXI ISEK Congress: Bridges to Innovation, 2016Conference paper (Refereed)
  • 16.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 2, p. 358-367Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.

    METHODS: Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.

    RESULTS: Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.

    CONCLUSION: Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

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  • 17.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A kinematic analysis of one-leg vertical jump on average 23 years after injury of the anterior cruciate ligament2015In: Gait & Posture: 24th Annual Meeting of ESMAC 2015 Abstracts, 2015, Vol. 42, p. 1-2, article id Session OS01 Best-Paper-Session - OutcomesConference paper (Refereed)
  • 18.
    Markström, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Different dynamic knee stability and frontal plane kinematics and kinetics between landings in common one-leg hops for ACL-reconstructed women and knee-healthy controls2018In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018, 2018Conference paper (Other academic)
  • 19.
    Markström, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Side-hops challenge knee control in the frontal and transversal plane more than hops for distance or height among ACL-reconstructed individuals2023In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116, Vol. 22, no 1, p. 142-159Article in journal (Refereed)
    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.

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  • 20.
    Olofsson, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Lindgren, Lenita
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Association of depressive disorders and dementia with mortality among older people with hip fracture2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 135Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions.

    AIMS: To investigate whether dementia with depressive disorders (DDwD) affects the mortality risk at 12, 24, and 36 months after HF among older people.

    METHODS: Patients with acute HF (n = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates.

    RESULTS: In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DDwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75-12.51], 24 (OR 3.61, 95% CI 1.71-7.60), and 36 (OR 4.53, 95% CI 2.24-9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone.

    CONCLUSION: DDwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions.

    TRIAL REGISTRATION: RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119.

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  • 21.
    Schelin, Lina
    et al.
    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, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ryden, Patrik
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A statistically compiled test battery for feasible evaluation of knee function after rupture of the Anterior Cruciate Ligament - derived from long-term follow-up data.2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 5, article id e0176247Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Clinical test batteries for evaluation of knee function after injury to the Anterior Cruciate Ligament (ACL) should be valid and feasible, while reliably capturing the outcome of rehabilitation. There is currently a lack of consensus as to which of the many available assessment tools for knee function that should be included. The present aim was to use a statistical approach to investigate the contribution of frequently used tests to avoid redundancy, and filter them down to a proposed comprehensive and yet feasible test battery for long-term evaluation after ACL injury.

    METHODS: In total 48 outcome variables related to knee function, all potentially relevant for a long-term follow-up, were included from a cross-sectional study where 70 ACL-injured (17-28 years post injury) individuals were compared to 33 controls. Cluster analysis and logistic regression were used to group variables and identify an optimal test battery, from which a summarized estimator of knee function representing various functional aspects was derived.

    RESULTS: As expected, several variables were strongly correlated, and the variables also fell into logical clusters with higher within-correlation (max ρ = 0.61) than between clusters (max ρ = 0.19). An extracted test battery with just four variables assessing one-leg balance, isokinetic knee extension strength and hop performance (one-leg hop, side hop) were mathematically combined to an estimator of knee function, which acceptably classified ACL-injured individuals and controls. This estimator, derived from objective measures, correlated significantly with self-reported function, e.g. Lysholm score (ρ = 0.66; p<0.001).

    CONCLUSIONS: The proposed test battery, based on a solid statistical approach, includes assessments which are all clinically feasible, while also covering complementary aspects of knee function. Similar test batteries could be determined for earlier phases of ACL rehabilitation or to enable longitudinal monitoring. Such developments, established on a well-grounded consensus of measurements, would facilitate comparisons of studies and enable evidence-based rehabilitation.

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  • 22. Sole, G
    et al.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, H
    Selling, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Knee kinematics during stair descent more than 20 years following anterior cruciate ligament injury2014Conference paper (Other academic)
  • 23. Sole, Gisela
    et al.
    Pataky, Todd
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Institute of Fiber Engineering, Department of Bioengineering, Shinshu University, Tokida 3-15-1, Ueda, Nagano 386-8567, Japan.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture: Data revisited using statistical parametric mapping2017In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 32, p. 44-50Article in journal (Refereed)
    Abstract [en]

    Changes in movement patterns following knee injuries have generally used analyses of pre-defined discrete event-related variables, whereas Statistical Parametric Mapping (SPM) assesses continuous data over time. We applied SPM to test differences for knee trajectories during stair descent between participants with past anterior cruciate ligament (ACL) rupture who underwent reconstruction or only physical therapy compared to healthy controls. Three-dimensional knee joint kinematics during stair descent were registered for 31 subjects with ACL reconstruction (ACLR), 36 subjects with ACL rupture managed with physical therapy only (ACLPT) (∼23years post-injury), and 32 uninjured controls. SPM was used to assess differences between groups for the entire three-component knee trajectory. A significant difference between the three groups was found for the first ∼10% of stance phase. Post-hoc analyses showed between-group differences when comparing the ACLPT to the control groups. Analyses of ACLPT versus control groups for individual vector components suggested a combination of less flexion at initial foot contact, and less adduction during weight acceptance (∼40% of stance). Altered knee kinematics were confirmed during weight acceptance of stair descent for the ACLPT group compared to controls, but not for ACLR group. Further exploration of the use of SPM and agreement with clinical gait assessment is warranted.

  • 24. Sole, Gisela
    et al.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Knee kinematics during stair descent 20 years following anterior cruciate ligament rupture with and without reconstruction2016In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 32, p. 180-186Article in journal (Refereed)
    Abstract [en]

    Background: Changes and asymmetries for walking gait have been explored extensively following injuries of anterior cruciate ligaments within ten years of injury or reconstruction. We examined longer term knee joint kinematics of reconstructed and non-reconstructed knees during stair descent compared to controls. Methods: Three-dimensional knee kinematics during stair descent were registered for 33 subjects with ACL reconstruction, 36 subjects with ACL rupture managed with physiotherapy only and 31 uninjured controls. Injured subjects were 23.5 (2.1) years following injury. Linear mixed models were used to compare temporal variables and knee kinematics during stance phase between groups and contralateral sides. Findings: Walking speed was slower for the both ACL-injured groups compared to controls and stance duration was longer for the injured than the uninjured sides of the physiotherapy-only group. Compared to controls, the physiotherapy-only group had significantly less adduction at initial foot contact of the injured and uninjured knees. The uninjured side of the physiotherapy-only group also had less flexion than controls at initial foot contact and during weight acceptance. Compared to the surgically-managed group, the injured sides of the physiotherapy-only groups had significantly less adduction at initial contact, peak adduction during weight acceptance, and peak flexion during propulsion. Interpretation: Independent of treatment, altered knee kinematics exist more than 20 years following ACL injury during stair descent. We suggest that future studies investigating short and long-term kinematic outcomes of ACL injury could evaluate stair descent with particular emphasis on weight acceptance of stance, and potential associations to perceived knee function.

  • 25.
    Srinivasan, Divya
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury2018In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 53, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies highlight the need for understanding movement control of adjacent joints when evaluating knee function following anterior cruciate ligament (ACL) injury. However, while short-term adaptations to lower-extremity joint coupling have been studied, little is known about any potential long-term adaptations in neuromuscular control displayed by ACL-injured individuals. The aim of our study was to determine whether coordination variability of the hip-knee joint couplings during the one-leg hop is altered about 20 years after injury in two ACL-injured groups compared to healthy knee controls.

    Methods: Seventy persons performed one leg hops ~23 years after ACL injury and following different treatments: 33 participants treated with physiotherapy in combination with ACL-reconstruction (ACLR); 37 participants with physiotherapy alone (ACLPT). They were compared to 33 matched controls. A vector coding procedure was used to create joint couplings for knee and hip angles on all the cardinal planes for the Take-off and Landing phases. The standard deviation of each coupling was computed as a measure of coordination variability.

    Findings: Both the ACL groups differed significantly from controls on their injured side with ~50% higher knee abduction-adduction/hip internal-external rotation variability during the Take-off phase; ~33% higher knee abduction-adduction/knee flexion-extension variability and greater knee abduction-adduction/hip flexion-extension variability (ACLR 50%; ACLPT 80%) during the Landing phase. There were no major differences between injured and non-injured sides in any group.

    Interpretation: Increased variability in lower-extremity joint couplings has emerged as a conspicuous feature of ACL injured persons in the very long term compared to non-injured controls, independent of treatment. Further research of the processes leading to alterations in movement variability using longitudinal studies would facilitate better understanding of the functional adaptations leading to knee dysfunction in the short- and long-term after ACL injury.

  • 26.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Health Education and Social Work Physiotherapy, Sör-Trönderlag University College Trondheim.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Deficits in single-limb stance more than 20 years after ACL injury2013In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 15, no 2, p. 78-85Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the long-term effect on balance during single-limb stance after unilateral anterior cruciate ligament (ACL) injury across two groups who had rehabilitation including ACL reconstruction (ACLR) or a tailored physiotherapy program (ACLTPP), compared with knee-healthy controls.

    Methods: Single-limb stance was monitored for floor-supports with the contralateral foot. Single-limb stance without floor-supports was assessed with analyses of center of pressure (CoP) for further discrimination. Comparisons were made between ACLR (n = 28) and ACLTPP (n = 28) and with controls (n = 18). The injured and uninjured legs were compared within ACL-injured subjects.

    Results: Single-limb balance was equally inferior in both ACL-injured groups and on both legs compared with knee-healthy controls. In ACLR and ACLTPP, 39% and 50%, respectively, failed to stand on one leg without floor-supports with the contralateral foot. No contralateral supports occurred in knee-healthy controls. CoP measures for subjects who stood without contralateral floor-supports did not reveal any further differences. Older age and higher body mass index (BMI) correlated with larger migration of CoP.

    Conclusion: Inability to stand without contralateral supports showed that balance in single-limb stance was inferior in ACL-injured subjects, independently of which initial treatment that was given. Age and BMI need consideration in studies assessing balance in single-limb stance.

  • 27.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Faculty of Health and Social Sciences, Physiotherapy, Norwegian University of Science and Technology, NTNU, 7491 Trondheim, Norway.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Altered postural control strategies in quiet standing more than 20 years after rupture of the anterior cruciate ligament2016In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 46, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Aim: To explore long-term consequences of anterior cruciate ligament (ACL) rupture on postural sway and control strategies during bilateral quiet standing, in subjects treated with or without reconstructive surgery compared to uninjured controls. Method: 70 individuals who had unilateral ACL rupture 23 +/- 2.4 years ago (33 received ACL reconstructive surgery, ACL(R), and 37 had physiotherapy only, ACL(PT)) and 33 uninjured matched controls (CTRL) (mean age 46 +/- 5.3) stood quietly with eyes closed for 3 min on a firm and on a compliant surface, respectively. Center of pressure (CoP) was registered with a force plate and postural sway was calculated from center of mass (CoM) derived from 3D kinematics. Sway density (SD) analyses of CoP assessed distance and duration of stable phases. The torque controlling postural sway was estimated from CoP-CoM. Results: Comparisons across conditions to CTRL revealed larger CoP-CoM-area in ACLR (p = 0.017, Cl: 10.95, 143.10), but not in ACL(PT). Mean distance between SD-peaks was greater for ACLR (p < 0.001, Cl: 1.73, 5.31) than for ACLRT (p = 0.006, Cl: 0.56, 4.12) relative to CTRL. Duration of SD -peaks was smaller for both ACLR and ACLRT (p < 0.001, Cl: 4.04, 1.23 and 3.82, 1.03, respectively) compared to CTRL. CoM-area in the ACL-groups did not differ from CTRL. Conclusions: ACL-injured subjects demonstrated greater postural control efforts than CTRL but without significant differences in postural sway. Control efforts were thus not directly associated with sway and further research should be focused on variance in postural control strategies.

  • 28.
    Strong, Andrew
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Arumugam, Ashokan
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Röijezon, Ulrik
    Department of Health, Learning and Technology, Physiotherapy Section, Luleå University of Technology, Luleå, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis2022In: Journal of Orthopaedic Surgery and Research, E-ISSN 1749-799X, Vol. 17, no 1, article id 134Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Threshold to detect passive motion (TTDPM) tests of the knee joint are commonly implemented among individuals with anterior cruciate ligament (ACL) injury to assess proprioceptive acuity. Their psychometric properties (PMPs), i.e. reliability, validity and responsiveness, are however unclear. This systematic review aimed to establish the PMPs of existing knee joint TTDPM tests among individuals with ACL injury.

    METHODS: The databases PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL and ProQuest were searched to identify studies that assessed the properties of knee joint TTDPM tests in individuals with ACL injury. The risk of bias for each included study was assessed at the outcome level for each test. Overall quality and levels of evidence for each property were rated according to established criteria. Meta-analyses with mean differences were conducted using random-effects models when adequate data were available.

    RESULTS: Fifty-one studies covering 108 TTDPM tests and 1632 individuals with unilateral ACL injury were included. A moderate-to-strong level of evidence indicated insufficient quality for all of the following: convergent validity, known-groups validity, discriminative validity, responsiveness between subgroups, and responsiveness to intervention. Subgroup meta-analyses for known-groups validity did however find that a starting angle of 15° resulted in significantly worse TTDPM for knees with ACL injury compared to those of asymptomatic persons (mean difference 0.28°; 95% CI 0.03 to 0.53; P = 0.03), albeit based on only three studies. Due to the lack of evidence, it was not possible to estimate the quality of reliability, measurement error, and criterion validity, nor responsiveness from a criterion and construct approach.

    CONCLUSIONS: Among persons with ACL injury, existing tests of knee joint TTDPM lack either sufficient quality or evidence for their reliability, validity and responsiveness. Significantly worse thresholds for ACL-injured knees compared to those of asymptomatic controls from a 15° starting angle and trends towards significance for some validity measures nevertheless encourage the development of standardised tests. Further research investigating the influence of modifiable test components (e.g. starting angle and motion direction) on the PMPs of knee joint TTDPM tests following ACL injury is warranted.

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  • 29.
    Strong, Andrew
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Arumugam, Ashokan
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Röijezon, Ulrik
    Department of Health, Learning and Technology, Physiotherapy Section, Luleå University of Technology, Luleå, Sweden.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Properties of knee joint position sense tests after anterior cruciate ligament injury: A systematic review and meta-analysis2021In: The Orthopaedic Journal of Sports Medicine, ISSN 2325-9671, Vol. 9, no 8, article id 23259671211007878Article, review/survey (Refereed)
    Abstract [en]

    Background: Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown.

    Purpose: To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS tests targeting individuals with ACL injury.

    Study design: Systematic review; Level of evidence, 4.

    Methods: PubMed, Allied and Complementary Medicine, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL, and ProQuest databases were searched to identify studies that assessed PMPs of knee JPS tests in individuals with ACL injury. The risk of bias for each included study was assessed and rated at the outcome level for each knee JPS test. Overall quality and levels of evidence for each PMP were rated according to established criteria. Meta-analyses with mean differences were conducted using random effects models when adequate data were available.

    Results: Included were 80 studies covering 119 versions of knee JPS tests. Meta-analyses indicated sufficient quality for known-groups and discriminative validity (ACL-injured knees vs knees of asymptomatic controls and contralateral noninjured knees, respectively), owing to significantly greater absolute errors for ACL-injured knees based on a strong level of evidence. A meta-analysis showed insufficient quality for responsiveness, which was attributed to a lack of significant change over time after diverse interventions with a moderate level of evidence. Statistical heterogeneity (I 2 > 40%) was evident in the majority of meta-analyses. All remaining PMPs (reliability, measurement error, criterion validity, convergent validity, and other PMPs related to responsiveness) were assessed qualitatively, and they failed to achieve a sufficient quality rating. This was a result of either the study outcomes not agreeing with the statistical cutoff values/hypotheses or the level of evidence being rated as conflicting/unknown or based on only a single study.

    Conclusion: Knee JPS tests appear to have sufficient validity in differentiating ACL-injured knees from asymptomatic knees. Further evidence of high methodologic quality is required to ascertain the reliability, responsiveness, and other types of validity assessed here. We recommend investigations that compare the modifiable methodologic components of knee JPS tests on their PMPs to develop standardized evidence-based tests.

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  • 30.
    Strong, Andrew
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Arumugam, Ashokan
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Röjezon, Ulrik
    Luleå University of Technology, Luleå, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Psychometric properties of knee joint position sense test targeting individuals with anterior cruciate ligament injury: a systematic review and meta-analysis2021Conference paper (Refereed)
  • 31.
    Strong, Andrew
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Srinivasan, Divya
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    One-leg rise performance and associated knee kinematics in ACL-deficient and ACL-reconstructed persons 23 years post-injury2019In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 20, no 1, article id 476Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research indicates reduced knee function and stability decades after anterior cruciate ligament (ACL) injury. Assessment requires reliable functional tests that discriminate such outcomes from asymptomatic knees, while providing suitable loading for different populations. The One-leg rise (OLR) test is common in clinics and research but lacks scientific evidence for its implementation. Our cross-sectional study compared performance including knee kinematics of the OLR between ACL-injured persons in the very long term to controls and between legs within these groups, and assessed the within-session reliability of the kinematics.

    METHODS: Seventy ACL-injured individuals (mean age 46.9 ± 5.4 years) treated with either reconstructive surgery and physiotherapy (ACLR; n = 33) or physiotherapy alone (ACLPT; n = 37), on average 23 years post-injury, and 33 age- and sex-matched controls (CTRL) attempted the OLR. Participants completed as many repetitions as possible to a maximum of 50 while recorded by motion capture. We compared between all groups and between legs within groups for total repetitions and decomposed the OLR into movement phases to compare phase completion times, maximum and range of knee abduction and adduction angles, and mediolateral knee control in up to 10 repetitions per participant.

    RESULTS: ACLPT performed significantly fewer OLR repetitions with their injured leg compared to the CTRL non-dominant leg (medians 15 and 32, respectively) and showed significantly greater knee abduction than ACLR and CTRL (average 2.56°-3.69° depending on phase and leg). Distribution of repetitions differed between groups, revealing 59% of ACLPT unable to complete more than 20 repetitions on their injured leg compared to 33% ACLR and 36% CTRL for their injured and non-dominant leg, respectively. Within-session reliability of all kinematic variables for all groups and legs was high (ICC 3,10 0.97-1.00, 95% CI 0.95-1.00, SEM 0.93-1.95°).

    CONCLUSIONS: Negative outcomes of OLR performance, particularly among ACLPT, confirm the need to address aberrant knee function and stability even decades post-ACL injury. Knee kinematics derived from the OLR were reliable for asymptomatic and ACL-injured knees. Development of the OLR protocol and analysis methods may improve its discriminative ability in identifying reduced knee function and stability among a range of clinical populations.

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  • 32.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Long-term consequences of anterior cruciate ligament injury: knee function, physical activity level, physical capacity and movement pattern2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Knee function after more than 20 years post injury is rarely described and none of the few follow-up studies have evaluated functional performance tasks. This thesis investigated self-reported knee function, physical activity level, physical capacity and movement pattern in the long-term perspective (on average 23 years) in persons who had suffered a unilateral ACL injury, treated either with physiotherapy in combination with surgery (ACLR, n=33) or physiotherapy alone (ACLPT, n=37) and compared to age-and-gender matched controls (n=33).

     This thesis shows that regardless of treatment, there are significant negative long-term consequences on self-reported knee function and physical activity more than 20 years after injury. In comparison to the controls, the ACL-groups (ACLR and ACLPT) had lower knee function as measured by the Lysholm score and the Knee injury and Osteoarthritis Outcome Score (KOOS). The persons with an ACL injury also had a lower knee-specific physical activity level (Tegner activity scale), while no differences were seen in general physical activity level (International Physical Activity Questionnaire, IPAQ) compared to healthy controls. Regarding physical capacity, both ACL groups showed inferior jump capacity in the injured leg compared to the non-injured leg. However, compared to controls the ACL-injured had a relatively good jump performance. Knee extension peak torque, concentric and eccentric, was also lower for the injured leg compared to the non-injured leg for both ACLR and ACLPT. In addition, the ACLPT group showed reduced eccentric knee flexion torque of the injured leg. The non-injured leg, on the other hand, showed almost equal jump capacity and strength as controls. Balance in single-limb stance (30s) was inferior in persons who had an ACL injury. This was true for both the injured and non-injured leg and regardless of treatment. Movement pattern during the one-leg hop was analysed by a set of kinematic variables consisting of knee angles (flexion, abduction, rotation) and Centre of Mass (CoM) placement in relation to the knee and ankle joints. Both ACLR and ACLPT displayed movement pattern asymmetries between injured and non-injured legs. In comparison to controls, the ACLR group had a similar movement pattern with the exception of larger external knee rotation at Initial contact and less maximum internal rotation during the Landing. ACLPT showed several differences compared to controls both regarding knee angles and CoM placement. The ACL-injured persons with no-or-low knee osteoarthritis (OA) had better knee function as reflected by higher scores on Lysholm and KOOS subscale ‘symptom’ compared to those with moderate-to-high OA. The degree of OA had no influence on reported physical activity level, jump capacity, peak torque or the kinematic variables.

     In conclusion, this thesis indicates that persons with a unilateral ACL injury, regardless of treatment, have some negative long-term consequences e.g. self-reported knee function, knee-specific activity level, strength and balance deficits, when compared to age-and-gender matched controls. The results, however, also indicate that the ACL-injured can manage reasonably well in some jumps and general activity level but have an inferior performance in more knee-demanding tasks. The ACLR group had similar movement pattern with the exception of knee rotation, indicating that a reconstruction may restore the knee biomechanics to some extent. The ACLPT group on the other hand, seem to use compensatory movement strategies showing several differences compared to controls.

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    Eva Tengman
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    Spikblad Eva Tengman
  • 33.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Tegner, Yelverton
    Luleå tekniska universitet .
    Lundgren, Lars
    Luleå tekniska universitet.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 6, p. e491-e500Article in journal (Refereed)
    Abstract [en]

    Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR), and 37 treated with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6–25%,P < 0.001–P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

  • 34.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Sor-Trondelag University College, Trondheim, Norge.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Anterior cruciate ligament injury after more than 20 years: II. Concentric and eccentric knee muscle strength2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 6, p. e501-e509Article in journal (Refereed)
    Abstract [en]

    The long-term consequences on knee muscle strength some decades after rupture of the anterior cruciate ligament (ACL) are not established. The aims of our study were to examine peak torque more than 20 years after ACL injury and to compare their knee muscle strength to that of healthy controls. We tested 70 individuals with unilateral ACL injury 23 ± 2 years after injury, whereof 33 (21 men) were treated with physiotherapy in combination with ACL reconstruction (ACLR) and 37 (23 men) with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls (21 men). A Kin-Com® dynamometer (90°/s) was used to measure peak torque in knee flexion and extension in both concentric and eccentric contractions. Knee extension peak torque, concentric and eccentric, was ∼10% lower for the injured leg compared with the non-injured leg for both ACLR (P < 0.001; P < 0.001) and ACLPT (P = 0.007; P = 0.002). The ACLPT group also showed reduced eccentric knee flexion torque of the injured leg (P = 0.008). The strength of the non-injured leg in both ACL groups was equal to that of controls. No difference was seen for those with no-or-low degree of knee osteoarthritis compared to those with moderate-to-high degree of osteoarthritis. ACL injury may lead to a persistent reduction of peak torque in the injured leg, which needs to be considered across the lifespan.

  • 35.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Motor control aspects in the understanding of knee disorders – implications for rehabilitation2014Conference paper (Other academic)
  • 36.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    One-leg hop – kinematic analysis ~ 20 years after anterior cruciate ligament injury.2012Conference paper (Other academic)
  • 37.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, A.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Kinematic analysis of one-leg hop more than 20 years after anterior cruciate ligament injury2014In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer, 2014, Vol. 22, p. S291-S291, article id P15-2121Conference paper (Refereed)
  • 38.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Sør-Trøndelag University College, Trondheim Norway.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    One-leg hop more than 20 years after ACL injury: kinematic analysis of persons treated with physiotherapy with or without surgery compared to healthy controlsManuscript (preprint) (Other academic)
  • 39.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Faculty of Health Education and Social Work, Physiotherapy, Sør-Trøndelag University College, Trondheim, Norway.
    Häger, Charlotte K
    Anterior cruciate ligament injury about 20 years post-treatment: a kinematic analysis of one-leg hop2015In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 25, no 6, p. 818-827Article in journal (Refereed)
    Abstract [en]

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 +/- 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R).

  • 40.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Angle-specific torque profiles of concentric and eccentric thigh muscle strength 20 years after anterior cruciate ligament injury2022In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116Article in journal (Refereed)
    Abstract [en]