ACL Injury Rates Research Articles

Graft Type and Diameter Are Predictors of Reinjury After Transphyseal Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients

PurposeThe purpose of this study were to report the rate of ACL graft failure by physis status (open, closing, closed) and to analyze which factors were associated with higher risk of ACL graft failure. MethodsPatients under 18 years old who underwent transphyseal ACLR between 2000 and 2018 at a single institution were reviewed at minimum 2-years post-ACLR. Patient records were reviewed for anthropometrics, surgical techniques, and ACL graft failure. Patients were subsequently stratified based on physis status (open, closing, closed) and analyzed. ResultsA total of 272 patients (mean age of 15.4 ± 1.3 years) were assessed. Transtibial technique was used in 63.6% of cases. Hamstring autograft was used exclusively in the open physis group. A patellar tendon autograft was used in 65.9% of patients with a closing physis and 80.9% of closed physis patients. The overall graft failure rate was 13.2%, the contralateral ACL injury rate 11.0%. Kaplan-Maier analysis by physis status showed different injury free from ACL reinjury (P<.001). An open physis was associated with increased risk of ACL reinjury (HR 5.2, P<.001) when compared to a closed physis. A closing physis presented a higher hazard ratio, but was not statistically significant (HR 2.6, P = 0.08). Hamstring graft type (P = 0.03) and lower graft diameter (P = 0.04) were significantly related to higher ACL reinjury after adjusting for physis status. ConclusionTransphyseal ACLR is a safe procedure in pediatric patients. The rate of reinjury was 13.2%. This rate decreases with skeletal maturity, use of patellar tendon autograft, and a larger graft diameter. .

Predictors of Anterior Cruciate Ligament Re-tear and Return to Sport in Adolescent Athletes

Objectives: The purpose of this study was to characterize recent epidemiologic trends of ACL injuries and re-tear rates in high school adolescents and determine variables associated with sustaining secondary ACL injury. We hypothesized protective rehabilitation factors (i.e., greater time to return to sport, formal sport clearance, and physical therapy compliance) would decrease the risk of secondary ACL injury. Methods: A prospectively maintained database from a single institution with standardized data collection focused on ACL injuries was retrospectively reviewed for all patients 18 or younger who underwent primary ACL reconstruction between 2015 to 2020. Patients were eligible for inclusion in this study if they were between the ages of 13-18 years old, participated in sporting activity in high school, and underwent evaluation and primary ACLR at a single institution. Electronic medical records (EMR) were reviewed for patient demographic information and documentation review from prior injury/surgery. This information included the following: age, sex, body mass index (BMI), school grade (if documented), race, sport played, mechanism of injury (contact versus non-contact), time to return to sport (RTS), and number of post-operative physical therapy (PT) visits. Injury in contact and non-contact sport were defined based on the level of impact on the mechanism of injury sustained. Contact injury was defined as impacted collision with another person or object directly prior to injury onset. Non-contact injuries include isolated twisting movements of the knee without a sustained direct impact injury due to another player or object. Time to RTS was defined as the number of months following ACL reconstruction surgery until the patient was documented clear to return to sporting activity by the operating surgeon. Number of PT visits was calculated by EMR review of documented PT visits. Results: A total of 387 pediatric patients were included in statistical analysis. Of these patients, 72 (19%) sustained a secondary ACL injury and 315 (81%) did not. The overall mean age at primary ACLR and standard deviation was 16.0 ± 1.4 years (range 12-18 years). By univariable analysis, age at primary ACLR, time to RTS, and follow-up duration were all associated with secondary ACL injury (p &lt; 0.05). Patients with a secondary ACL injury were significantly younger than those who did not sustain a subsequent ACL tear (16.2 ± 1.3 versus 15.5 ± 1.6 years, respectively, p = 0.0026). Time to RTS following primary ACL injury was shorter in patients who sustained a secondary ACL injury (7.9 ± 2.0 months versus 8.9 ± 2.5 months, p = 0.0361). Cox regression analysis performed demonstrated as age at primary ACLR increases by 1 year, the rate of secondary ACL injury decreases by 29%. Similarly, a 1-month delay in return to sport decreases the rate of secondary ACL injury by 17%. Conclusions: Younger age and longer time to return to sport following ACL injury are significant variables associated with sustaining secondary ACL injury in the pediatric patient population. Counseling of young adolescent athletes should include adequate physical therapy compliance and allowing for adequate healing and time to return to sport.

Reconsideration of Return-to-Sport Decision-Making After Pediatric ACL Injury: A Scoping Review.

Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%. (1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes. PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature. Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies. Scoping review. Level 4. Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart. Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported. RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.

Sex, military occupation and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes

IntroductionAnterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis...

A THEORETICAL BASED PHYSIOTHERAPY GOAL SETTING MODEL FOR ANTERIOR CRUCIATE LIGAMENT REHABILITATION

ABSTRACT Background Anterior Cruciate Ligament rehabilitation is a lengthy process and requires appropriate goal setting strategies to help optimize patient and athlete outcomes. From a global perspective, ACL injury incidences are continuing to rise, with Australia and the USA having one of the highest incidences of ACL injury rates in the athletic population. In addition, physiotherapists are expected by their professional regulatory body to effectively use goal setting practices. Design Theoretical Goal Setting Model consisting of three phases: 1) Pre goal setting phase (empower); 2) goal implementation phase (strive); and 3) goal evaluation phase (attain). Discussion This model provides physiotherapists with a useful process so that key aspects of setting goals are considered and incoporporated. This model showcases a necessary path a physiotherapist and patient must journey together in order to enhance rehabilitation outcomes. This model will also advance the physiotherapists' awareness of the multi-stages of the patients goal desires, intentions and commitment to their rehabilitation. Conclusion This model is a preliminary attempt to guide both practice, teaching, and research to ensure that goal setting practices in ACL rehabilitation are given an appropriate rehabilitative platform. The next stage is to empirically validate the practical application of the model and how each phase manifests.

Biomechanical Changes During a 90º Cut in Collegiate Female Soccer Players With Participation in the 11.

BackgroundValgus collapse and high knee abduction moments have been identified as biomechanical risk factors for ACL injury. It is unknown if participation in the 11+, a previously established, dynamic warm-up that emphasizes biomechanical technique and reduces ACL injury rates, reduces components of valgus collapse during a 90º cut.Hypothesis/PurposeTo determine whether participation in the 11+ during a single soccer season reduced peak knee abduction moment and components of valgus collapse during a 90º cut in collegiate female soccer players.Study DesignProspective cohort studyMethodsForty-six participants completed preseason and postseason motion analysis of a 90º cut. During the season, 31 players completed the 11+ and 15 players completed their typical warm-up (control group). Peak knee abduction moment, components of valgus collapse (hip adduction, internal rotation, and knee abduction angles), and a novel measure of knee valgus collapse were analyzed with repeated-measures ANOVAs to determine differences between preseason and postseason. Smallest detectable change (SDC) and minimal important difference (MID) values were applied to contextualize results.ResultsThere was a significant main effect of time for non-dominant knee valgus collapse (p=0.03), but decreases in non-dominant knee valgus collapse only exceeded the SDC in the intervention team.ConclusionsClinically meaningful decreases in knee valgus collapse may indicate a beneficial biomechanical effect of the 11+. Participation in the 11+ may lower ACL injury risk by reducing valgus collapse during a 90º cut.Level of Evidence2b

Impact Of Fifa 11+ Program On Acl Injury Rates In Collegian Female Rugby Players

This is a preliminary study on the impact of a FIFA 11+ training program for collegiate female rugby players at a local college. The FIFA 11+ was developed to prevent lower extremity injuries among soccer athletes. Retrospective analysis of injured Rugby athletes suggested the non-contact (NC) ACL injuries were similar to soccer related NC ACL injures. Given the success the FIFA 11+ program on injury reduction, it was suggested as an intervention. PURPOSE: The purpose is to investigate the effects of the FIFA 11+ program on reducing NC ACL injuries in collegiate female athletes. METHODS: Historical injury data was obtained. FIFA 11+ training program was implemented at the start of the season and continued as part of the pre-practice/game warm up. Injury data was logged throughout the rugby season of approximately 25 weeks between September and May. A comparison was made between 2016 season’s injuries to the 2017 and 2018 years. RESULTS: In the 2016 season prior to intervention, 9 athletes were injured/unable to participate because of rugby related musculoskeletal injuries with 3 NC ACL injuries. In the two seasons that the FIFA 11+ program was implemented, 2017 and 2018, NC ACL injuries were reduced to 0. In the 2017 season, 9 athletes were injured specifically, 3 concussions, 1 (Contact) ACL injury, and 5 other injuries. In 2018, ACL injuries were reduced to 0, while concussions (5) and fractures (3), and other injuries limited participation.Twice a week, 2-hour practice sessions and games were included to estimate a team NC ACL injury rate per activity hour ratio. In 2016 the ratio was 3/3000 hrs. There were no NC ACL injuries in both 2017 (0/3472 hrs) and 2018 (0/3900 hrs) together equal 0/7372 hrs. If the injury rate from 2016 were maintained, NC ACL injures would be predicted to be >7. CONCLUSIONS: This preliminary study suggests the FIFA 11+ may have broader application to other field sports and that specific training programs may reduce the incident of ACL injuries in Rugby athletes.

Follow-up study on transphyseal ACL reconstruction in Irish adolescents with no cases of leg length discrepancy or angular deformity.

The rate of ACL injury in adolescents has been rising in recent years. Surgical options include transphyseal and physeal-sparing ACL reconstruction. In this study, we performed a transphyseal ACL reconstruction and followed up patients to assess functional outcomes and to assess for growth disturbance. There were 22 patients seen at follow-up between the age of 12 and 16. Skeletal age assessment was performed using an MRI atlas with an average skeletal age of 14.7 (range 12-16). The mean follow-up time was 36months (range 14-63months). Clinical examination was performed to assess for leg length discrepancy, and leg length radiographs were used to assess for angular deformity. Patients' post-surgery functionality was assessed with the IKDC score and the Tegner Lysholm score. The mean IKDC and Lysholm scores at follow-up were found to be 91 and 94, respectively. The median Tegner score prior to injury was 8.5 and postoperatively was 7.5. There were no cases of leg length discrepancy found on clinical examination, and there were no cases of significant angular deformity. Four patients ruptured again and went on to have repeat ACL reconstruction. Midterm results at an average follow-up of 3years after the surgery showed good functional outcomes using the transphyseal ACL reconstruction technique with good return to activity. There were no cases of leg length discrepancy or angular deformity. Transphyseal ACL reconstruction is a viable method of treatment for adolescent ACL tears.

Australian Footballers Returning from Anterior Cruciate Ligament Reconstruction Later than 12Months have Worse Outcomes.

There is evidence that early return to competition post-anterior cruciate ligament (ACL) injury increases risk of re-injury. To compare subsequent ACL and other injury risks following ACL reconstruction for Australian Football League (AFL) players returning to competition at different times post-injury. AFL players returning from ACL reconstruction in the 1992-2014 seasons were divided into three groups based on return to competition time (< 10, 10-12 and > 12months). Non-reconstructed injuries and artificial ligament reconstructions were excluded. Subsequent ACL injury rates were calculated based on time since injury and number of return matches played. Risk of other knee and hamstring muscle injuries was also calculated. There were 233 ACL reconstructions that returned to play in the AFL during the time period under study and met our inclusion criteria. The per-game risk of subsequent ACL injury decreased with a log decay from 1.2 to 0.15% during the first 20 games back (R 2 = 0.43). Players returning at > 12months had higher overall percentage of future career games missed through subsequent ACL injuries (4.8% vs. 2.4%), and through all hamstring and knee injuries combined (12.6% vs. 8.4%) than players who returned at ≤ 12months (both P < 0.001). Players returning at > 12months had higher risk of knee cartilage (3.7%) and patella tendon (0.6%) injury than those returning at 10-12months (1.5%, 0.1%, respectively). Players returning from ACL reconstruction at greater than 12months had significantly higher rates of future games missed through both subsequent ACL injuries and through all hamstring and knee injuries combined. It may be true that both early and late return to play lead to suboptimal outcomes compared to average return-to-play times.

Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury.

To determine whether articular cartilage damage noted at the time of primary anterior cruciate ligament reconstruction (ACLR) affects the likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6months after surgery or risk of recurrent ACL injury. Five hundred and eight patients underwent primary ACLR and diagnostic arthroscopy. All identified cartilage lesions were graded using the Outerbridge system. All patients underwent isokinetic strength testing. The association between cartilage Outerbridge grade and a ≥ 90% Limb Symmetry Index (LSI) and recurrent ACL injury risk at mean 38.7month follow-up (SD 31.8) was evaluated via multivariate regression analysis. Grade 2 or higher damage was present in 394 (77.5%) of patients, grade 3 or higher in 143 (28.1%) and grade 4 in 83 (16.4%) at time of ACLR. Ipsilateral ACLR graft rupture occurred in 31 (6.1%) of patients. Contralateral ACL injury occurred in 19 (3.7%). Patients with grade 2 or higher damage were significantly less likely to meet an LSI goal of ≥ 90% for fast (300°/s) isokinetic extension. There was no association with slow isokinetic extension. Cartilage lesion severity at or beyond grade 2 had a similar effect on isokinetic testing results regardless of compartment involvement or performance of microfracture. Patients with grade 2-4 cartilage damage were less likely to sustain a second ipsilateral ACL injury or a contralateral native ACL injury. Cartilage damage seen at time of ACL reconstruction is common and associated with lower likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6months after surgery. However, lower recurrent ACL injury rates are seen in patients with concurrent cartilage damage. These data may inform future clinical decisions regarding operative managment of recurrent ACL injuries. III.

The incidence of paediatric ACL injury is increasing in Finland

PurposeAnterior cruciate ligament (ACL) injury is a common knee injury in paediatric and adolescent patients. The population-based incidence of paediatric ACL injury is, however, unknown. Recent studies suggest increased ACL injury rates among adolescents, especially in active, sports-participating population. The purpose of this study was to investigate the population-based incidence rates of ACL injuries and trends in paediatric ACL reconstruction surgery.MethodAll ACL injuries were identified (ICD-10 diagnosis code S83.5) leading to hospitalisation or surgery using validated Finnish National Hospital Discharge Register (NHDR) data from 1997 to 2014. The sample comprised 19,961,205 Finnish residents aged less than 18 years at the time of injury. Hospital admissions with the diagnosis code S83.5 were analysed more thoroughly including, sex, age and the need for surgical interventions.ResultsDuring the 18-year study period, 4725 subjects of the study population had sustained an ACL injury. The total ACL injury incidence in study population was 23.3 per 100,000 person-years. The median age of the patients at the time of injury was 16 years (range 4–17). The incidence of ACL injury increased with age, and the highest incidence was observed among 17-year old (113.5 per 100,000 person-years). Incidence rate did not differ between genders. From the total ACL injury population of 4725 hospitalisations, 3168 (67.0%) underwent ACL reconstruction, of which 2988 (94.3%) were treated with arthroscopic reconstruction and 180 (5.6%) with open surgery. In addition, 1557 (33.0%) were treated non-operatively without ACL reconstruction. The annual incidence of ACL injuries in the Finnish paediatric population has increased during the past 15 years. The lowest incidence rate was seen in 1999 (incidence of 17.7 per 100,000 person-years, 195 ACL injuries) and the highest in 2011 (incidence of 31.5 per 100,000 person-years, 346 ACL injuries). The highest increase in ACL injuries was seen in girls aged 13–15 years, with an increase of 143%.ConclusionACL injury is not a negligible knee injury in the paediatric population. The incidence of paediatric ACL injury has increased during the past 15 years. Moreover, a twofold increase in incidence of paediatric ACL injury was noted during the last 10 years of the study period. Incidence rates among male and female paediatric patients were comparable.Level of evidenceIII.

IS EARLY EXCELLENT ISOKINETIC AND FUNCTIONAL TESTING FOLLOWING ACL RECONSTRUCTION IN PATIENTS WITH OPEN-PHYSES PREDICTIVE OF SUBSEQUENT ACL DISRUPTION?

Introduction: It is unknown whether functional and isokinetic testing at 6 months following ACL reconstruction in patients with open-physes correlates with longer term outcomes. The purpose of this study was to compare subsequent ACL rupture risk, knee function, and activity level in patients with open-physes who had excellent 6-month testing to those who did not. Methods: Between the years of 2000 and 2015, 86 patients with open-physes underwent ACL reconstruction and had functional and isokinetic testing performed at 6-months post-operatively. Thirty-four (40%) tested in the excellent range in all categories of both functional and isokinetic testing and were labeled the excellent group. The remaining 52 (60%) patients were labeled the delayed testing group. Data regarding patient, injury, and surgical characteristics were retrospectively collected. The rate of second ACL injury as well as clinical outcome scores were collected postoperatively. Results: Graft rupture rate was 23.4% (n = 8) in the excellent group and 15.4% (n = 8) in the delayed group (p = 0.51). In the excellent group, 20.5% (n = 7) had a contralateral ACL tear versus 11.5% (n = 6) in the delayed group (p = 0.40). Five patients in the excellent group and 4 patients in the delayed group sustained both graft failure and contralateral ACL tear. The overall prevalence of second ACL injury was 29% in the excellent group and 23% in the delayed group. The delayed group returned to sport at an average of 8.8 months whereas the excellent group returned at an average of 6.6 months (p &lt; 0.01). At mean follow up of 3.59 years, the excellent group had a higher Tegner activity level (8.9 versus 8.3) than the delayed group (p &lt; 0.02). Conclusion: Pediatric patients with open-physes who had excellent isokinetic strength and functional testing 6-months postoperatively returned to sport sooner than those who did not. There was no statistical difference in either graft failure or contralateral ACL disruption between these groups. However, both groups had unacceptably high rates of second ACL injury (29% for the excellent group and 23% for the delayed group). Significance: Excellent 6 month return of strength and function was not protective of subsequent ACL disruption, the rate of which remains dismal within this pediatric population. Development of more sensitive functional measures for children could help to change these poor outcomes and guide clinicians when to allow return to sport.

ACL injury incidence, severity and patterns in professional male soccer players in a Middle Eastern league

AimTo ascertain ACL injury incidence, severity (injury burden) and patterns (contact/non-contact and reinjuries) in a professional male football league in the Middle East over five consecutive seasons.MethodsProspective epidemiological study reporting...

TWO YEAR ACL REINJURY RATE OF 2.5%: OUTCOMES REPORT OF THE MEN IN A SECONDARY ACL INJURY PREVENTION PROGRAM (ACL-SPORTS)

The Anterior Cruciate Ligament-Specialized Post-Operative Return to Sports (ACL-SPORTS) randomized control trial (RCT) examined an evidence-based secondary ACL injury prevention training program, involving progressive strengthening, agility training, and plyometrics. The RCT examined the benefit of the training program with and without a neuromuscular training technique called perturbation training. The purpose of this study was to report the return to sport and second ACL injury incidence outcomes of the men in the ACL-SPORTS trial. Secondary analysis of a RCT. Forty cutting and pivoting sport male athletes participated in the ACL-SPORTS trial, return to sport testing, and in follow-up sessions at one and two years after ACL reconstruction. Variables of interest at one and two years were return to sport, return to preinjury level of sport, and second ACL injuries. Mean time to passing return to sport criteria, the number of athletes returning to sport and preinjury level of sport and the incidence proportion of second ACL injuries were calculated. Athletes passed return to sport criteria 232 ± 99 days after ACLR. One year after ACL reconstruction 95% had returned to sport, 78% at their preinjury level. Two years after ACL reconstruction all athletes had returned to sport, 95% at their preinjury level and only one athlete had a second ACL injury. The results of this study indicate that men in the ACL-SPORTS trial had much higher return to sport rates and much lower second ACL injury rates than those reported in the literature. 1b.

Peak Lower Extremity Landing Kinematics in Dancers and Nondancers.

Anterior cruciate ligament (ACL) injuries often occur during jump landings and can have detrimental short-term and long-term functional effects on quality of life. Despite frequently performing jump landings, dancers have lower incidence rates of ACL injury than other jump-landing athletes. Planned versus unplanned activities and footwear may explain differing ACL-injury rates among dancers and nondancers. Still, few researchers have compared landing biomechanics between dancers and nondancers. To compare the landing biomechanics of dancers and nondancers during single-legged (SL) drop-vertical jumps. Cross-sectional study. Laboratory. A total of 39 healthy participants, 12 female dancers (age = 20.9 ± 1.8 years, height = 166.4 ± 6.7 cm, mass = 63.2 ± 16.4 kg), 14 female nondancers (age = 20.2 ± 0.9 years, height = 168.9 ± 5.0 cm, mass = 61.6 ± 7.7 kg), and 13 male nondancers (age = 22.2 ± 2.7 years, height = 180.6 ± 9.7 cm, mass = 80.8 ± 13.2 kg). Participants performed SL-drop-vertical jumps from a 30-cm-high box in a randomized order in 2 activity (planned, unplanned) and 2 footwear (shod, barefoot) conditions while a 3-dimensional system recorded landing biomechanics. Overall peak sagittal-plane and frontal-plane ankle-, knee-, and hip-joint kinematics (joint angles) were compared across groups using separate multivariate analyses of variance followed by main-effects testing and pairwise-adjusted Bonferroni comparisons as appropriate ( P < .05). No 3-way interactions existed for sagittal-plane or frontal-plane ankle (Wilks λ = 0.85, P = .11 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 1.00, P = .93 and Wilks λ = 0.94, P = .36, respectively), or hip (Wilks λ = 0.99, P = .88 and Wilks λ = 0.97, P = .62, respectively) kinematics. We observed no group × footwear interactions for sagittal-plane or frontal-plane ankle (Wilks λ = 0.94, P = .43 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 0.97, P = .60 and Wilks λ = 0.97, P = .66, respectively), or hip (Wilks λ = 0.99, P = .91 and Wilks λ = 1.00, P = .93, respectively) kinematics, and no group × activity interactions were noted for ankle frontal-plane (Wilks λ = 0.92, P = .29) and sagittal- and frontal-plane knee (Wilks λ = 0.99, P = .81 and Wilks λ = 0.98, P = .77, respectively) and hip (Wilks λ = 0.88, P = .13 and Wilks λ = 0.85, P = .08, respectively) kinematics. A group × activity interaction (Wilks λ = 0.76, P = .02) was present for ankle sagittal-plane kinematics. Main-effects testing revealed different ankle frontal-plane angles across groups ( F2,28 = 3.78, P = .04), with male nondancers having greater ankle inversion than female nondancers ( P = .05). Irrespective of activity type or footwear, female nondancers landed with similar hip and knee kinematics but greater peak ankle eversion and less peak ankle dorsiflexion (ie, positions associated with greater ACL injury risk). Ankle kinematics may differ between groups due to different landing strategies and training used by dancers. Dancers' training should be examined to determine if it results in a reduced occurrence of biomechanics related to ACL injury during SL landing.

Generalized Hypermobility, Knee Hyperextension, and Outcomes After Anterior Cruciate Ligament Reconstruction: Prospective, Case-Control Study With Mean 6 Years Follow-up

To determine whether generalized hypermobility and contralateral knee hyperextension affect failure rates and patient-related outcomes after anterior cruciate ligament reconstruction (ACLR). A total of 226 consecutive patients presenting with acute ACL tears were prospectively evaluated for generalized hypermobility by a modified Beighton criteria. Minimum 2-year follow-up was achieved for 183 knees (81%). Patients underwent ACLR with either bone-patellar-tendon (BPTB) autograft (n= 46), quadrupled hamstring (HT) autograft (n= 85), or allograft tissue (n=52). KT-1000 measurements, International Knee Documentation Committee (IKDC), Cincinnati, and Lysholm scores were obtained. Forty-one of 183 consecutive patients were categorized as hypermobile. At mean 6years' follow-up (range 2-12.5years), IKDC (P= .003), Cincinnati (P= .001), and Lysholm scores (P < .001) were significantly better in the Non-Hypermobile group for patients with an intact graft. The failure rate was higher in the Hypermobile group (10knees, 24.4% failure rate) compared with the Nonhypermobile group (11 knees, 7.7% failure rate) (P= .006). The overall ACL injury rate (ACL graft injury, excessive graft laxity, plus contralateral ACL tear) was higher in the Hypermobile group (34.1%) compared with the Nonhypermobile group (12.0%) (P= .002). Heel height >5cm(P= .009) and fifth metacarpophalangeal (MCP) extension >90° (P= .006) were independently predictive of failure for the entire study population. Graft failure rates were higher and inferior subjective outcomes were observed after ACLR in patients with generalized hypermobility. Heel height and fifth MCP hyperextension were most predictive of ACL injury/reinjury and poorer outcome scores. Nearly one-third of hypermobile patients sustained a contralateral ACL tear, ipsilateral graft failure, or had excessive graft laxity. Level III, case control study.

Real-time optimized biofeedback utilizing sport techniques (ROBUST): a study protocol for a randomized controlled trial

BackgroundAnterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, and that hip-focused biofeedback will improve lower extremity biomechanics to a larger extent than knee-focused biofeedback during dynamic sport-specific tasks and long-term movement strategies.MethodsThis is an assessor-blind, randomized control trial of 150 adolescent competitive female (9–19 years) soccer players. Each participant receives 3x/week neuromuscular preventive training and 1x/week biofeedback, the mode depending on their randomization to one of 3 biofeedback groups (hip-focused, knee-focused, sham). The primary aim is to assess the impact of biofeedback training on knee abduction moments (the primary biomechanical predictor of future ACL injury) during double-leg landings, single-leg landings, and unplanned cutting. Testing will occur immediately before the training intervention, immediately after the training intervention, and 6 months after the training intervention to assess the long-term retention of modified biomechanics. Secondary aims will assess performance changes, including hip and core strength, power, and agility, and the extent to which maturation effects biofeedback efficacy.DiscussionThe results of the Real-time Optimized Biofeedback Utilizing Sport Techniques (ROBUST) trial will help complement current preventive training and may lead to clinician-friendly methods of biofeedback to incorporate into widespread training practices.Trial registrationDate of publication in ClinicalTrials.gov: 20/04/2016. ClinicalTrials.gov Identifier: NCT02754700.

ETHNIC DIFFERENCES IN LOWER EXTREMITY DYNAMIC POSTURAL MEASURES AS POTENTIAL RISK FACTOR FOR ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY

BackgroundACL injury rate for female is as much as eight times higher than male in the United States. However, based upon Korean Health Insurance Corporation, higher injury rate was reported...

A Wearable Neuromuscular Device Reduces ACL Injury Risk in Female Soccer Athletes

Objectives:Female soccer athletes have a three-fold greater risk of sustaining an ACL injury compared with their male counterparts yet only 1 in 5 teams engage in ACL risk reduction programs due to several participation barriers. The purpose of this study was to determine the effects of a wearable neuromuscular (WNM) device on postural control, performance and ACL injury risk in female soccer athletes.Methods:Seventy-nine elite youth and collegiate female soccer athletes (age range: 12-25 y) trained with a WNM device that applied bi-lateral, topical pressure to the medial quadriceps and hamstrings muscles (Topical Gear, Austin, TX). The athletes performed 7-9 weeks of pre-season training with the WNM device consisting of strength and conditioning exercises and on-field team practices (46-64 total hours of exposure). Postural control was measured in 15 athletes with and without the WNM device before and after the training program; and performance was measured in 25 athletes without the WNM device before and after the training program. Postural control was determined from a single-leg landing on a force plate from a horizontal distance normalized to leg length. The athletes were instructed to gain their balance as fast as possible upon landing and remain balanced for 5 seconds. The peak ground reaction forces (GRF) and the medial-lateral, anterior-posterior and net center of pressure (COP) velocities and displacement ranges were calculated during 2 seconds of single-leg stance. Performance measures including speed, power and endurance were measured from the 40 yard dash, vertical jump for height and the Beep test, respectively. A two-way repeated measures ANOVA and post-hoc comparisons were used to compare the postural variables; and t-tests were used to compare the performance tests (p=.05). ACL injury rates, the absolute risk reduction (ARR) and the number needed to treat (NNT) to prevent one ACL injury were calculated between the WNM intervention group and 11 control groups identified from 10 studies in the literature that followed female soccer athletes for an entire soccer season. The treatment effect of the WNM device was determined to be statistically significant at the .05 level if the 95% confidence interval for the ARR of an ACL injury did not include zero.Results:Training with the WNM device demonstrated 18% lower peak medial GRFs (p=.005), 12% lower medial-lateral COP velocities (p=.032) and 18% longer landing phase durations (p=.001). Landing and balance performance with, compared to without, the WNM device demonstrated 2% lower peak vertical GRF (p=.047), 6% lower net COP velocities (p=.044) and 10% lower medial-lateral COP displacements (p=.018). Speed, power and endurance significantly improved 7, 22 and 14% after training with the WNM device (all p<.05). No athletes in the current study sustained an ACL injury during training or over the course of the season. The ARR was on average lowered 1.5% and statistically improved in 9 of the 11 control group comparisons (p<.05) and corresponded to a RRR of 100%. From the NNT analysis, it was determined that 92 female soccer athletes would need to be trained with the WNM device to prevent one ACL injury over the course of one competitive season.Conclusion:Training with a WNM device improved postural control without limiting performance and reduced ACL injury risk in female soccer athletes. Wearable neuromuscular products may provide a solution to the current participation barriers of ACL injury risk reduction programs.

ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture

BackgroundStudies investigating the development of ACL injuries over time in football are scarce and more data on what happens before and after return to play (RTP) are needed.AimTo investigate (1)...