Abstract

PurposeLittle 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.MethodsSixty-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.ResultsSignificant 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.ConclusionDifferent 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 evidenceProspective cohort study, Level II.

Highlights

  • Anterior cruciate ligament (ACL) injuries are very common in sports and occur mainly in non-contact situations with multidirection knee loading in eccentric movements [12]

  • The main aim of the present study was to for the first time present an investigation of combined kinematics for the trunk, hip, and knee in the long term (>20 years on average) post-unilateral ACL injury for persons treated with either surgery and physiotherapy (ACLR) or with solely physiotherapy (ACLPT), and compared to a control group (CTRL), when performing the vertical hop (VH)

  • Both treatment groups had significantly greater laxity for the affected compared to the non-affected leg (p < 0.001 for both groups), with ACLPT showing a significantly greater difference compared to ACLR

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Summary

Introduction

Anterior cruciate ligament (ACL) injuries are very common in sports and occur mainly in non-contact situations with multidirection knee loading in eccentric movements [12]. Some of these variables will be related to each other, providing a set of n variables that may reflect underlying dimensions [5] These dimensions may be detected using multivariate analyses, providing a more accurate description of consequences after ACL injury than if using univariate methods. Such analyses are warranted in the long term post-ACL injury during demanding knee tasks related to everyday life in order to fully understand the impact of an injury. Despite a high hop height and acceptable limb symmetry index (LSI) for the knee, there might be a changed combined movement strategy that may be possible to detect and characterize by using kinematics and applying multivariate statistics

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