Muscle activation timing and knee biomechanics during single leg hop in subjects with and without anterior cruciate ligament reconstruction: a case study

Abstract

The Single Leg Hop test (SLHT) is commonly performed to determine readiness to return to sport (RTS) after anterior cruciate ligament (ACL) injury and reconstruction [1]. Usually, the between-limb symmetry of hop distance is considered as a criterion to clear the athletes to RTS. However, athletes may pass this criterion despite ongoing biomechanical and neuromuscular deficits. Several works developed an instrumented approach of the SLHT to assess biomechanical parameters associated to ACL injury risk [1]. Although it is known that muscle pre-activation timing during landing can be altered in patients with ACL reconstruction (ACLR) [2], thus exposing them to a reinjury risk, very few studies have related biomechanical parameters with electromyographic (EMG) signals of the involved muscles. The aim of this preliminary study is to assess muscle pre-activation timing prior to SLHT landing in both ACLR and HC athletes and to associate this information with ACL injury-related kinematic and kinetic parameters. Two male soccer athletes (Tegner Activity Score ≥ 6) participated in the study, one healthy (HC) and one with ACLR (12 months before the test; injured limb: left). They performed three SLHT landing on a force plate (AMTI, USA, 1000 Hz) after standardized warm-up. The 3D trajectories of 52 markers were measured by an optoelectronic system (Vicon, 200 Hz) [3]. Eight wireless bipolar EMG electrodes (MiniWave, Cometa, Italy) were placed on Vastus Medialis (VM), Vastus Laterialis (VL), Semitendinous (ST) and Biceps femoris (BF) on both limbs according to the SENIAM guidelines [4]. All instruments were electronically synchronized. Foot-force plate contact was identified by setting a threshold of 20 N on the vertical GRF (vGRF) [5]. EMG onset prior to landing was identified according to [2]. A set of ACL injury risk-related parameters were then extracted: peak vGRF (vGRF peak ), peak knee flexion and abduction moment (KMflex peak KMabd peak ), and knee flexion at initial contact (KflexIC). Also, for each SLHT, the hop distance was assessed (SLH dist ). The Limb Symmetry Index (LSI) was then calculated for each parameter. For each athlete and each limb, the SLH with the greater hopping distance was considered for further data processing. Muscle pre-activation timing was shorter in ACLR subject than HC in all muscles (Table 1). ACLR subject also showed higher values in peak knee moments, especially in the injured limb, as well as greater asymmetry for most of the investigated parameters, especially knee angles and moments. In the ACLR subject, the lower muscle pre-activation timing prior to landing may lead to an uncoordinated movement and to a deficit in muscle force generation to stabilize the joint, thus increasing knee injury risk [2]. This timing was even shorter in the injured limb. From a biomechanical point of view, a greater asymmetry was found in the ACLR subject with respect to the HC in both kinematic and kinetic parameters. On the contrary, hop distance LSI did not show any clear difference between the two participants. These results corroborate the hypothesis that evaluating only hop distance is reductive.