Abstract Anterior Cruciate Ligament Injury Research Articles

Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players.

Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1–97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3–88.2%) with moderate reliability (κ = 0.452–0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521–0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = −0.047–0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.

Leveraging explainable machine learning to identify gait biomechanical parameters associated with anterior cruciate ligament injury

Anterior cruciate ligament (ACL) deficient and reconstructed knees display altered biomechanics during gait. Identifying significant gait changes is important for understanding normal and ACL function and is typically performed by statistical approaches. This paper focuses on the development of an explainable machine learning (ML) empowered methodology to: (i) identify important gait kinematic, kinetic parameters and quantify their contribution in the diagnosis of ACL injury and (ii) investigate the differences in sagittal plane kinematics and kinetics of the gait cycle between ACL deficient, ACL reconstructed and healthy individuals. For this aim, an extensive experimental setup was designed in which three-dimensional ground reaction forces and sagittal plane kinematic as well as kinetic parameters were collected from 151 subjects. The effectiveness of the proposed methodology was evaluated using a comparative analysis with eight well-known classifiers. Support Vector Machines were proved to be the best performing model (accuracy of 94.95%) on a group of 21 selected biomechanical parameters. Neural Networks accomplished the second best performance (92.89%). A state-of-the-art explainability analysis based on SHapley Additive exPlanations (SHAP) and conventional statistical analysis were then employed to quantify the contribution of the input biomechanical parameters in the diagnosis of ACL injury. Features, that would have been neglected by the traditional statistical analysis, were identified as contributing parameters having significant impact on the ML model’s output for ACL injury during gait.

Measurement of Medial Tibial Eminence Dimensions for the Clinical Evaluation of ACL-Injured Knees: A Comparison between CT and MRI.

Anterior cruciate ligament (ACL) injuries commonly lead to translational and rotational tibiofemoral instability. The morphology of the medial tibial eminence (MTE) has received increased attention regarding its role in tibiofemoral stability in ACL-injured knees. Therefore, quantification of MTE dimensions on clinical imaging may help clinicians predict knee stability after ACL injury. Although magnetic resonance imaging (MRI) is routinely obtained in patients with ACL injuries, whether the dimensions of the MTE can be accurate quantified on MRI is unknown. The purpose of this study was to assess the degree of correlation between measurements of MTE height and width on computed tomography (CT) versus MRI. An institutional picture archiving and communication system imaging database was used to identify patients aged between 15 and 60 years who received concurrent MRI and CT of the same knee within a 1-year interval. Knees with significant arthrosis, deformity, intraarticular fracture, or hardware-related artifact that obscured visualization of the MTE were excluded. Mean differences and interstudy agreement between CT and MRI MTE measurements were compared using concordance correlation coefficient (r c) and Bland-Altman analysis. A total of 41 knees in 38 patients (mean age, 37 years; 82% male) were analyzed. Interrater reliability for CT and MRI measurements was high (intraclass correlation coefficient = 0.740-0.954). On coronal CT and MRI, mean MTE height measurements were 10.4 ± 1.9 and 10.4 ± 1.8 mm, respectively; mean MTE width measurements were 14.6 ± 3.6 and 14.2 ± 3.0 mm, respectively. On sagittal CT and MRI, mean MTE height measurements were 11.6 ± 1.7 and 11.7 ± 1.7 mm, respectively; mean MTE width measurements were 36.5 ± 4.8 and 36.2 ± 5.0 mm, respectively. Good agreement was observed between CT and MRI measurements of MTE height and width on coronal and sagittal planes (r c = 0.947-0.969). Measurements of MTE height and width were similar on MRI relative to CT on both coronal and sagittal planes. MRI may be suitable for characterizing the dimensions of the MTE when clinically evaluating patients with ACL injuries, potentially allowing for individualized patient care.

Correlation of Kinematics and Kinetics of Changing Sagittal Plane Body Position during Landing and the Risk of Non-Contact Anterior Cruciate Ligament Injury

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that negatively affect athletes’ future performance and return to play. The purpose of this study was to examine the correlation of kinematics and kinetics of changing sagittal plane body position during landing and the risk of non-contact ACL injury. Seven university female (age 19.57 ± 0.79 y, height 164.21 ± 8.11 m, weight 60.43 ± 5.99 kg) athletes playing soccer and handball, and with ≥ two years of training volunteered for this research. Three trunk positions: Lean Forward Landing (LFL), Self-selected Landing (SSL), and Upright Landing (URL)—via double/single-leg landing—were captured by a high-speed VICON motion capture system. A 3 × 2 two-way within-subjects ANOVA and Multiple Bonferroni corrected pairwise were used to test for condition (LFL, SSL, URL) and task (single/double-leg) effects (p≤ 0.05). The findings indicated that landing with a deeper knee flexion angle (LFL) would lead to smaller impact forces when compared to upright landing.

Effect of Cognitive Loading on Single-Leg Jump Landing Biomechanics of Elite Male Volleyball Players

Anterior cruciate ligament (ACL) injury is prevalent during the single-leg jump landing in various sports. The effects of cognitive loading and how it affects risk of ACL injury are not well understood. The purpose of this study is to examine how landing kinetics change in the presence of cognitive loading during a volleyball block. Cognitive loading decreased activations in vastus lateralis and rectus femoris, and increased activation in biceps femoris and medial gastrocnemius muscles. During landing, the first and second peaks of ground reaction forces were 13% and 11% lower under cognitive loading, suggesting that cognitive loading alters landing biomechanics and muscle activations.

Influence of hip strength on acl injury related biomechanics during the cutting maneuver in preadolescent students (practical implication for physical education teachers and sports pedagogues)

Anterior cruciate ligament (ACL) injuries are one of the most serious injuries of the lower limb and can result in a relatively low rate of return to sport and decreased quality of life in later years, as well as to the psychological attitude towards sports among young people. Previous research has investigated the interaction between the hip muscles and knee valgus moments where some studies have concluded that decreased hip abductor and external rotator strength is a risk factor for ACL injury, but no research has been conducted on preadolescent population. Data from 271 students (174 girls), age 9-12 where collected while performing cutting manoeuvre and the isometric maximal voluntary contraction of hip external rotators and abductors. Our results show that no significant correlation where found between the hip strength does not influence the knee VM during the cutting manoeuvre in this age group which is in line with many previous studies conducted on older population.

An Innovative Physiotherapeutic Approach Towards the Rehabilitation of a Post-operative Case of Anterior Cruciate Ligament Reconstruction - A Case Report

Anterior Cruciate Ligament injuries are one of the commonest injuries related to the knee joint. They can either be a ligament tear or a ligament sprain. They usually occur due to landing from a jump incorrectly, rapidly changing the direction of motion, sports injuries (direct collisions), and stopping suddenly. This type of injury requires conservative treatment and/or Anterior Cruciate Ligament Reconstruction (ACLR) surgery. In both cases, physiotherapy has been proven to be useful in the treatment and rehabilitation of the condition. Physiotherapy treatment aids in relieving the symptoms, strengthening, endurance and gait training. The patient came to the hospital with the complaints of there being a difficulty in walking without support. The pain was present as the patient tried to bend his right knee, the swelling was also present on the right knee and there was a restricted range of motion. All these complaints were present for 15 days. The patient was a post-operative case of ACLR. An X-ray and MRI scan showed these results. Physiotherapy interventions included educating the patient, reducing the swelling, reducing the pain using electrotherapy modalities, Range of Motion exercises for the right knee, strengthening and endurance exercises, and teaching normal gait pattern. The patient eventually gained an improved range of right knee movement, decreased pain, swelling and tenderness, and learned to walk with a normal gait pattern. The questionnaires and tests carried out pre and post-treatment showed a positive result.

Lower Extremity Biomechanical Differences Between Female Dancers and Soccer Players

Anterior cruciate ligament (ACL) injury in female athletes is common. Team sport athletes experience more ACL injuries than ballet and modern dancers. Examining biomechanical differences between these two groups may help to explain the discrepancy in ACL injury rates. The purpose of this study was to examine lower extremity kinematic differences between collegiate dancers and National Collegiate Athletic Association Division I soccer athletes during a rebound jump-landing task. Peak hip, knee, and ankle kinematics were collected during a jump-landing task. Results showed more knee flexion and less ankle eversion in the dancers compared to the soccer athletes. Differences in training and strategies used during landing may explain the kinematic differences between groups.

Evaluation of the Stability of the Subjects with Anterior Cruciate Injuries Reconstruction.

Anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is often injured during sport-related activities. ACL injuries influence the abilities of the subjects during standing and walking. Although early surgical intervention is preferred treatment for the majority of knee surgeons, the effect of this approach on postural stability of patients is not fully understood. Therefore, the aim of this study was to determine the difference between stability of ACL-reconstructed subjects before and after surgery. A group of 15 consecutive ACL injured patients participated in this study. Postural stability of the patients was evaluated 1 week before and 6 months after surgery (ACL reconstruction with hamstring autograft). A Kistler force plate was used to evaluate center of pressure (COP) sway during quiet standing. The mean values of the COP parameters were obtained in pre and postsurgery conditions. Paired sample t-test was used to evaluate the difference between the stability parameters of the two conditions. The significant point was set at 0.05. The mean value of path length of COP velocity in mediolateral (ML) direction was 1,485.57 ± 479.42 mm and 2,641.33 ± 996.26 mm before and after surgery, respectively (p-value = 0.01). Although the mean value of COP velocity in anteroposterior and ML directions increased after surgery, the difference was only significant for velocity in ML direction (p-value = 0.049). The results of this study showed that the standing stability of those with ACL reconstruction decreased significantly after ACL reconstruction, which may be due to the effects of the surgery on sensory mechanism of ACL and inability of patients to return to their previous deep sense perception and knee proprioception.

Theoretical and Numerical Analysis of Anterior Cruciate Ligament Injury and its Prevention

Anterior cruciate ligament (ACL) injury is one of major risks for most athletes. ACL injury can be caused by many risk factors such as anatomic risk factors, biomechanical risk factors and environmental risk factors. In this article, numerical and theoretical analysis are conducted to investigate biomechanical risk factors. An entire three-dimensional finite element knee model was built based on MRI data. Anterior Tibial Translations (ATT) at different knee flexion angles are simulated by finite element models. In the simulations, more attentions are given to material properties of different knee components and their effects on ACL injury. Mechanical response of ACL during sport activities is highly determined by its viscoelastic properties. Unfortunately, viscoelastic properties of two bundles of ACL will change dramatically even with several hours’ physical aging. As a consequence, ACL will experience mechanical ductile to brittle transition due to daily physical aging. Theory of physical aging from polymer science is, for the first time, introduced to understand ACL injury and its prevention. By analogy to physical aging of amorphous polymer materials, we think physical aging of two bundles of ACL will largely increase risk of ACL injury. Besides, physical aging will also build a heterogeneous stress and strain in ACL due to its natural anatomic structure, which is a large risk for athletes. The specific designed prevention programs for ACL injury such as plyometrics, strengthening and other neuromuscular training exercises [1] are believed to erase physical aging of ACL. ACL with less physical aging is less likely to get injured in sport activities. In this article, a virtual physical aging simulation is built to validate current hypothesis. Erasing physical aging of ACL may provide an accurate and quantitative way to prevent ACL injury.

Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking.

Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees (P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5-1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.

1. Investigating the Link Between Kinematic, Kinetic and Muscular Symmetry in Young Adults 12 or More Months post-ACL Reconstruction

Anterior cruciate ligament (ACL) injury after primary reconstruction and return-to-sport clearance is common. Since research indicates asymmetry as a valid predictor of injury, it is proposed that inter-limb asymmetry following ACL reconstruction contributes to the elevated incidence of re-injury in this population. Current return-to-sport protocol include objective tests such as joint laxity and strength tests, as well as single leg hop and drop landing tests. Since these assessments are based on visual observation, or simple kinematics measurements, it is unclear how visual asymmetry reflects the underlying joint forces and muscular effort responsible for the performance in these tasks. This study aims to assess the asymmetry present at the kinematic, kinetic, and motor control levels to clarify the after-effects of ACL reconstruction. This pilot study will help us appreciate if additional work exploring screening measures as effective tools for predicting ACL injury following primary reconstruction is warranted. Standard techniques will be used to measure the kinematics, joint kinetics and muscle activation during this 25-repetition squat protocol. Correlations will compare the left and right lower limbs for joint angular displacement, joint angular velocity, joint power, vertical ground reaction forces, and muscle activation amplitude.

Study of isokinetic strength training's rehabilitating effects on elite athletes after knee joint ACL reconstruction surgery

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries for most athletes and sports-active people. Arthroscopic reconstruction is the preferred treatment. Rebuilding ACL for the rapid return to pre-injury level movement and function is an important goal for athletes. In this paper, the use of isokinetic strength training methods for athletes after ACL injury rehabilitation effect is reported. Thirty-one knee anterior cruciate ligament reconstruction athletes were divided into two groups and were respectively subjected to 12 weeks' traditional rehabilitation training and isokinetic strength training. It was found that constant strength training of the knee joint could improve the muscle strength of the athletes more quickly which provides better rehabilitation training for the postoperative recovery of athletes to return to the track.

Influence of ground reaction force perturbations on anterior cruciate ligament loading during sidestep cutting

Anterior cruciate ligament (ACL) injury risk is likely increased under unexpected loading conditions. Such situations may arise from mid-air contact with another athlete, or misjudgments in landing height, stride length or surface compliance resulting in an unbalanced landing and unexpected changes in the ground reaction forces (GRFs). The purpose this study was to identify how GRF perturbations influence ACL loading during sidestep cutting. Muscle-actuated simulations of sidestep cutting were generated and analyzed for 20 subjects. Perturbations of 20, 40 and 60% of the nominal value were applied to the posterior, vertical, and medial GRF. Open-loop, forward dynamics simulations were run with no feedback or correction mechanism which allowed deviations from the experimentally measured kinematics as a result of the GRF perturbations. Posterior and vertical GRF perturbations significantly increased ACL loading, although the change was more pronounced with posterior perturbations. These changes were primarily due to the sagittal plane component of ACL loading regardless of perturbation direction. Peak ACL loading occurred almost immediately after initial ground contact, and was thus predicated on initial joint configuration. The results of this study give merit to including knee flexion angle at initial ground contact in the evolving neuromuscular training modalities aimed at preventing non-contact ACL injury.

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

Abstract Anterior cruciate ligament (ACL) injuries are increasing amongst professional and recreational athletes, and creating prevention programs to reduce the occurrence of ACL damages is becoming a necessity. To prevent an ACL tear, it is necessary to comprehend the mechanisms and the risk factors of injury. Biomechanical and clinical studies try to understand these complex mechanisms in order to identify factors that can be improved and to develop training programs to prevent at least non-contact ACL injuries. There are several promising programs, but there are still many questions to answer. This paper analyzes the risk factors for ACL injuries and some aspects of the modern programs developed to decrease the rate of ACL tears.

DETERMINANTS OF QUALITY OF LIFE RELATED TO ACL RECONSTRUCTION: MALES OF ONE REHABILITATION CENTER

Anterior cruciate ligament injury is extremely common in athletics and recreational sport. The emphasis of physiotherapy rehabilitation in post-ACL reconstruction is to enhance quality of life. The purpose of the study was to identify determinants of quality of life after ACL reconstruction rehabilitation. Sixty male patients who undergone 12 to 16 weeks of rehabilitation completed the background data, ACL quality of life (ACL-QOL), Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tanpa Scale Kinesiophhobia (TSK). Multiple linear regression showed that KOOS-pain and KOOS-sport/recreation explained 59.5% of the variation in quality of life. Thus, pain and recreation were the determinants of quality of life. This finding is useful in identifying potential factors that enhance quality of life in ACL reconstruction rehabilitation.

A Comparison of Ligament Tensions Between Intra- and Extra-Articular Measurement in Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the treatments of ACL injuries. In the surgery, the reconstructed ligament should be properly tensioned to provide a normal ligament behavior. However, the ligament tension has been measured with an extra-articular technique in past studies, while the intra-articular ligament tension is still unknown. The purpose of this study is to compare the ligament tensions between intra- and extra-articular measurements in the ACL reconstruction. Intra-articular measurement employs a micro-force sensor designed with a width and thickness same as those of the reconstructed ligament. This study performed two experiments (i.e., sensor accuracy and cadaveric study). In the sensor accuracy experiment, the accuracy of the sensor was about 3% until an applied force of 100 N. In the cadaveric study, the results of the intra- and extra-articular measurement tensions were 13.6±3.9 N and 18.7±1.3 N (n= 6), respectively. The significant difference in student t-test (p-value was 0.026) between the intra- and extra- articular measurements was observed. The bending angle and friction between the graft and bone tunnel, and the shape of the intra-articular edge of tibial bone tunnel affected the intra-articular measurement in ACL reconstruction.

Risk of Reinjury or Subsequent Injury After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) tears are one of the most common injuries seen by orthopaedic surgeons. The standard of care following an ACL tear in a physiologically young, active patient is an ACL reconstruction. This can be accomplished with one of a variety of grafts through a multitude of techniques. With the growing number of ACL tears that are treated with reconstruction, the number of failures, including both graft rerupture and functional instability, is increasing. Reinjury following an ACL reconstruction places a significant physical and physiological burden on the patient, but also creates a societal burden with lost time at work as well as use of health care resources. To better educate patients and to prevent subsequent ACL injuries, it is imperative that orthopaedic surgeons understand the risk factors for reinjury or an injury to the contralateral knee. These include patient-related factors such as age, gender, and activity level, as well as technical considerations such as graft type, size, and position. Furthermore, treating physicians must be able to council patients on ways to avoid a reinjury through rehabilitation, functional sports assessments, and others.

11 Epidemiology of anterior cruciate ligament (ACL) injuries and functional outcomes following rehabilitation in south tees

ACL injury can affect activities of daily living and participation in sports. ACL rehabilitation can improve patient’s symptoms. Our aim was to study the epidemiology of ACL injuries and functional outcomes following rehabilitation. Patients undergoing ACL rehabilitation between 2009 and 2014 were identified from a prospective physiotherapy database. Demographic details, number of physiotherapy sessions, length of treatment, discharge destination and functional outcomes were studied. The Knee Injury and Outcome (KOOS) Score and International knee Documentation Committee (IKDC) Score was recorded at the start of rehabilitation and at the last follow up visit. Total number of patients referred for physiotherapy following ACL injuries was 445. 86 (20%) were female and 358 (80%) male with a mean age of 28 y (12–60). The mean number of physiotherapy session was 6 (0–45). The mean length of rehabilitation was 1.6 months (0–14). 98 patients (22%) successfully completed their rehabilitation and were discharged, 93 patients (21%) were listed for surgery, 9 patients (2%) had their care transferred elsewhere and 243 patients (55%) did not attend (DNA) to complete their rehabilitation. The mean KOOS score on referral to physiotherapy was 46 (4–98) and at last follow up was 73 (21–100) with improvement of 27 points. The mean IKDC score was 42 (4.6–81.6) at the start of treatment and 68 (24–100) at the last follow up with improvement of 26 points. There was improvement in functional scores following rehabilitation for the ACL injuries. Only 21% patients underwent ACL reconstruction following their rehabilitation. 55% patients did not attend to complete their rehabilitation. We recommend a flexible rehabilitation programme with the help of written instructions and an open access policy for patients with ACL Injuries. This approach can help to reduce the number of physiotherapy sessions required and also the number of patients who DNA their appointments.

Preventing ACL Injuries in Females: What Physical Educators Need to Know

Anterior cruciate ligament (ACL) injuries happen at a frequent rate, especially in girls and women. While there are many factors that contribute to ACL tears, teaching proper landing techniques and strengthening certain muscles can decrease the incidence of ACL tears, especially in women. This article reviews some of the high-risk factors that contribute to this debilitating injury and examines what physical educators can do to help prevent it. A visual checklist of proper joint landing positions is included.