Knee Ligament Sprain Research Articles

An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk

Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant ‘training x group’ interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.

Knee Ligament Sprains: Diagnosing Anterior Cruciate Ligament Injuries by Patient Interview. Development and Evaluation of the Anterior Cruciate Ligament Injury Score (ACLIS)

BackgroundKnee ligament sprains are a common reason for emergency-room visits. Initially, the often difficult physical examination provides limited information, creating a risk of missing cruciate-ligament injuries, which can result in substantial functional impairments. No simple tool is available to emergency and primary-care physicians for decisions regarding specialist referral of patients with knee ligament sprains. An easy to use clinical score for the emergency setting would help identify patients at high risk of anterior cruciate ligament (ACL) tears after knee ligament sprains. The primary objective of this study, in two separate cohorts with acute knee injuries, was to develop, then validate a score for assessing the probability of ACL tear and, therefore, the need for specialist referral. HypothesisA score based on patient-interview information with a cut-off associated to good sensitivity and positive predictive value (PPV) for ACL tears can be developed. Material and MethodsA literature review identified seven items to be used in the score: pivoting and contact activity at the time of injury, perceived cracking sound, sensation of dislocation, joint effusion, suggestive mechanism, inability to resume the activity, and immediate sensation of instability upon walking. To select the most relevant items, we recruited a development cohort of 228 patients (127 males and 101 females) with a mean age of 32±9 years who were seen for knee injuries between November 2017 and November 2018 at three healthcare institutions; 183 (80%) had ACL tears. The score was then tested in a validation cohort of 121 patients (79 males and 42 females) with a mean age of 28±2.5 years seen at two healthcare institutions between November 2019 and November 2020; 81 (67%) had ACL tears. In all patients, the diagnosis of ACL tear was confirmed by a specialist examination and magnetic resonance imaging. ResultsFour items proved both sensitive and specific for ACL injury and were combined into the score: an immediate sensation of knee instability, an inability to resume the sports activity, a sensation of dislocation, and injury during a pivoting-contact activity. Patient report of two or more of these four criteria had 96% sensitivity and 66% specificity for ACL tear, with a PPV of 91% and an NPV of 83%. Results were similar in the validation cohort, confirming that a cut-off of at least two of the four items strongly suggested an ACL tear, with 94% sensitivity, 56% specificity, a PPV of 82% and an NPV of 82%. ConclusionThe ACLIS score performs well for the emergency-room diagnosis of ACL tear, with 95% sensitivity, 62% specificity, an 88% PPV, and an 82% NPV. Patients with ACLIS scores of 2 or more probably require specialist referral with or without magnetic resonance imaging. The ACLIS score could be used routinely in emergency departments to decrease the proportion of patients with undiagnosed ACL tears. Level of evidenceIII, prospective case-control study of a diagnostic score.

Risk factors for ACL, hamstring strain, and hip/groin injuries in elite Australian female footballers: A prospective study.

Introduction: Female footballers are at high risk of sustaining lower limb injuries, with some of the most prevalent and severe injuries being hamstring strains, hip/groin pain, and knee ligament sprains. However, there is currently limited evidence to guide injury prevention strategies and injury risk assessment testing in female footballers. The aim of this study was to assess risk factors for ACL, hamstring, and hip/groin injuries in elite female footballers. Methods: Data were collected from 321 elite female Australian Football, soccer, and Rugby League players during pre-season. Players underwent field-based assessments of isometric hip adductor and abductor strength (ForceFrame), eccentric knee flexor strength during the Nordic hamstring exercise (NordBord), countermovement jump (CMJ) on dual forceplates (ForceDecks), and a single-leg triple vertical hop (TVH) using a makerless motion capture system (HumanTrak). Players were subsequently followed for injuries for 18 months. Risk factors were identified prospectively using simple and multiple logistic regression and decision tree learning. Results: A total of 12 anterior cruciate ligament (ACL) ruptures, 17 hamstring strains, and 12 hip/groin injuries were recorded. Risk factors for ACL injury included prior ACL injury (standardised odds ratio [OR]=12.3, P<.001), lower body weight normalised adductor torque (OR=2.1, P=.028), greater body weight normalised CMJ peak force (OR=1.9, P=.013), lower CMJ impulse (OR=2.0, P=.037), greater triple vertical hop knee frontal plane projection angle (OR=2.3, P=.014), and greater triple vertical hop lateral trunk flexion (OR=1.7, P=.038). Multiple logistic regression and decision tree models classified ACL injured players with high accuracy (sensitivity=67% and 75% respectively, and specificity=88% and 100% respectively). Risk factors for time-loss hamstring injury included smaller stature (OR=1.8, P=.030), greater between-leg asymmetry in CMJ peak force (OR=2.0, P=.011) and eccentric impulse (OR=1.9, P=.016). There were no statistically significant risk factors for hip/groin injury. Discussion: This is the first study to explore risk factors for lower limb injury in elite female Australian football codes. These results provide insight into the potential modifiable factors associated with subsequent injury in elite female footballers, which may inform player testing batteries and the design of targeted injury risk reduction strategies. Conflict of interest statement: Funding for travel was provided by Vald Performance (Brisbane, Australia) and SMA Research Foundation. My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

MRI-Detected Knee Ligament Sprains and Associated Internal Derangement in Athletes Competing at the Rio de Janeiro 2016 Summer Olympics.

PurposeDescribe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.Patients and MethodsAll knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport.Results11,274 athletes participated in the 2016 Olympic Games: 113 athletes received at least one knee MRI with some having bilateral or repeat MRI on the same knee. Anterior cruciate and medial collateral ligament (ACL/MCL) sprains were most common, accounting for 32 of the 43 sprains (74.4%). Wrestling (10), hockey (7), athletics (7), and judo (5) accounted for over half of ligament sprains. ACL sprains showed a significant positive correlation with medial, lateral meniscal tears and bone contusions. The positive correlation between posterior cruciate ligament (PCL) sprains with MCL/lateral collateral ligament sprain, and popliteus tendon tear was statistically significant with 50% of total PCL sprains occurring in hockey. When athletes were stratified by gender, ligament sprains had a similar occurrence and distribution between men and women.ConclusionKnee ligament sprains, at the Rio 2016 Games, were most common in wrestling, hockey, athletics and judo with ACL and MCL sprains most frequent. Meniscal tears and bone contusions occurred often with ACL sprains. PCL sprains tended to be multi-ligamentous injuries. Sustained ligament sprains had similar occurrence between genders, while men had a peak incidence of sprains at a younger age and women at an older age.

Appraisal of Clinical Practice Guideline: Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain.

Appraisal of Clinical Practice Guideline: Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain.

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.

Knee Ligament Sprain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice.

Knee ligament sprain is one of the most common orthopaedic and sports injuries. Knee stability and movement coordination impairments can be improved by physical therapists during nonoperative and operative management. Implementation recommendations from clinical practice guidelines (CPGs), such as the revised guidelines on knee ligament sprains published in the November 2017 issue of JOSPT, can help to reduce unwarranted variation in clinical physical therapy practice, support evidence-informed practice, and add value at the point of care. J Orthop Sports Phys Ther 2017;47(11):822-823. doi:10.2519/jospt.2017.0510.

Knee Ligament Sprains and Tears: Clinical Practice Guidelines-Ensuring Best Care.

Knee injuries can sideline anyone. Physical therapists are leading the way to ensure that people with knee ligament injuries, including competitive and recreational athletes, receive the best care to optimize their recovery. JOSPT and the Orthopaedic Section of the American Physical Therapy Association first published clinical practice guidelines about knee ligament sprains in 2010. Now, revised guidelines in JOSPT's November 2017 issue provide updated recommendations based on best practices for evaluating, diagnosing, and treating knee ligament injuries. They also suggest how to determine when patients are ready to return to activities after injury. J Orthop Sports Phys Ther 2017;47(11):824. doi:10.2519/jospt.2017.0511.

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain

The Orthopaedic Section of the American Physical Therapy Association presents this fourth set of clinical practice guidelines on knee ligament sprain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010;40(4):A1–A37. doi:10.2519/jospt.2010.0303

The Epidemiology of US High School Basketball Injuries, 2005–2007

Background With more than a million high school athletes playing during the 2006–2007 academic year, basketball is one of the most popular sports in the United States. Hypothesis Basketball injury rates and patterns differ by gender and type of exposure. Study Design Descriptive epidemiology study. Methods Basketball-related injury data were collected during the 2005–2006 and 2006–2007 academic years from 100 nationally representative US high schools via Reporting Information Online. Results High school basketball players sustained 1518 injuries during 780 651 athlete exposures for an injury rate of 1.94 per 1000 athlete exposures. The injury rate per 1000 athlete exposures was greater during competition (3.27) than during practice (1.40; rate ratio, 2.33; 95% confidence interval, 2.10–2.57) and was greater among girls (2.08) than among boys (1.83; rate ratio, 1.14; 95% confidence interval, 1.03–1.26). The ankle/foot (39.7%), knee (14.7%), head/face/neck (13.6%), arm/hand (9.6%), and hip/thigh/upper leg (8.4%) were most commonly injured. The most frequent injury diagnoses were ligament sprains (44.0%), muscle/tendon strains (17.7%), contusions (8.6%), fractures (8.5%), and concussions (7.0%). Female basketball players sustained a greater proportion of concussions (injury proportion ratio, 2.41; 95% confidence interval, 1.49–3.91) and knee injuries (injury proportion ratio, 1.71; 95% confidence interval, 1.27–2.30), whereas boys more frequently sustained fractures (injury proportion ratio, 1.87; 95% confidence interval, 1.27–2.77) and contusions (injury proportion ratio, 1.52; 95% confidence interval, 1.00–2.31). The most common girls’ injury requiring surgery was knee ligament sprains (47.9%). Conclusion High school basketball injury patterns vary by gender and type of exposure. This study suggests several areas of emphasis for targeted injury prevention interventions.

The Epidemiology of United States High School Soccer Injuries, 2005–2007

Background United States high school soccer participation increased 5 fold over the last 30 years. With increased participation comes increased injury incidence. Hypothesis High school soccer injury patterns will vary by gender and type of exposure. Study Design Descriptive epidemiologic study. Methods Soccer-related injury data were collected over the 2005–2006 and 2006–2007 school years from 100 nationally representative United States high schools via Reporting Information Online (RIO, an Internet-based sports-related injury surveillance system). Results Participating certified athletic trainers reported 1524 soccer injuries during 637 446 athlete exposures (AEs), for an injury rate of 2.39 per 1000 AEs, corresponding to a nationally estimated 807 492 soccer-related injuries during the 2005–2006 and 2006–2007 seasons. The injury rate per 1000 AEs was greater during competition (4.77) than practice (1.37) (rate ratio [RR] = 3.49; 95% confidence interval [CI], 3.15–3.87). Overall, the most frequent diagnoses were incomplete ligament sprains (26.8%), incomplete muscle strains (17.9%), contusions (13.8%), and concussions (10.8%). The most commonly injured body sites were the ankle (23.4%), knee (18.7%), head/face (13.7%), and thigh/upper leg (13.1%). Similar proportions of boys (57.9%) and girls (53.9%) returned to activity in <1 week. During competition, girls sustained complete knee ligament sprains requiring surgery at a rate of 26.4 per 100 000 AEs, higher than the rate among boys during competition (1.98 per 100 000 AEs) (RR = 13.3; 95% CI, 3.15–56.35) and among girls during practice (2.34 per 100 000 AEs) (RR = 11.3; 95% CI, 4.31–29.58). Player-to-player contact was more common among competition injuries (injury proportion ratio [IPR] = 2.42; 95% CI, 2.01–2.92), while noncontact mechanisms were more common among practice injuries (IPR = 2.39; 95% CI, 1.90–3.01). Conclusions High school soccer injury patterns vary by gender and type of exposure. Identifying such differences in injury patterns is the important first step in the development of evidence-based, targeted injury prevention efforts.

The role of insurance data in setting priorities for netball injury prevention strategies

The aim of this study was to investigate insurance records for a one-year period to determine the injury frequencies and costs associated with different age groups in netball. The insurance records for all netball claims made during 1999 in Victoria were obtained from the insurer and entered into a database. The overall injury rate was 9.49 injuries per 1000 players, with 829 claims for injuries filed with the insurance company. Of all injuries claimed for, 85.3% were to the lower limb, 8.7% to the upper limb, 3.1% to the spine/torso and 2.9% to the head and face. Lower limb injuries accounted for 85.4% of costs, upper limb injuries 10.7% and head/neck/torso injuries 3.9% of total injury costs. Knee injuries accounted for 56.9% of total costs, with ankle and calf/Achilles injuries costing 12.7 and 11.8% of total costs, respectively. Injury prevention strategies should therefore be directed to three main injuries taking into account costs and incidence. These injuries were: ankle sprains, knee ligament sprains and Achilles tendon strains. Specifically, the prevention program for Achilles injuries should be directed to the >25 years age groups.

A grade II medial collateral knee ligament sprain in a professional football player

This article proposes a mathematical model that predicts the wound healing process of the ligament after a sprain, grade II. The model describes the swelling, expression of the platelet-derived growth factor (PDGF), formation and migration of fibroblasts into the injury area and the expression of collagen fibers. Additionally, the model can predict the effect of ice treatment in reducing inflammation and the action of mechanical stress in the process of remodeling of collagen fibers. The results obtained from computer simulation show a high concordance with the clinical data previously reported by other authors.

Cross-country skiing injuries and biomechanics.

Cross-country skiing exercises most of the joints, muscles and tendons in the body giving the skier an all around workout. This, in combination with a low incidence of injury, makes cross-country skiing an ideal recreational and competitive sport. The new skating techniques developed during the last decade have resulted in greater velocity. The maximum speed during the diagonal stride technique is 6 m/sec compared to 8 to 9 m/sec when skating and double poling. Top-level skiers today use strong and ultra light skis of fiberglass and graphite. The ski weight is less than 500g. Today's skating technique does not require any waxing and only the cambered portion of the ski is waxed when performing the diagonal stride. The preparation of the ski course has improved with the development of special track machines. This allows top-level skiers to reach 60 to 80 km/h on downhill slopes, which has resulted in an increased risk of injury. Because cross-country skiing takes place wherever snow is available, it is difficult to establish accurate injury rates in comparison to alpine skiing which is performed on very specialised terrain at ski areas. Studies estimate the cross-country ski injury rate in Sweden to be around 0.2 to 0.5 per thousand skier days. A prospective study of cross-country ski injuries conducted in Vermont revealed an injury rate of 0.72 per thousand skier days. 75% of the injuries sustained by members of the Swedish national cross-country ski team during 1983 and 1984 were overuse injuries while 25% resulted from trauma. The most common overuse injuries included medial-tibial stress syndrome, Achilles tendon problems and lower back pain. Most common among traumatic injuries were ankle ligament sprains and fractures, muscle ruptures, and knee ligament sprains. Shoulder dislocation, acromioclavicular separation and rotator cuff tears are not infrequent in cross-country skiing. Injuries to the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb (Stener's lesion) is the most common ski injury involving the upper extremity. Cross-country skiers 16 to 21 years of age complained more frequently of mild lower back pain than similarly aged non-skiers. This may result from repetitive hyperextension motions during the kick phase and the recurring spinal flexion and extension during the double poling phase. Repeated slipping on hard and icy tracks infrequently produce partial tears or microtrauma in the muscle tendinous units of the groin.(ABSTRACT TRUNCATED AT 400 WORDS)

Soccer injuries and their mechanisms: a prospective study.

In order to study the incidence and mechanisms of injury in soccer and to recommend prophylactic measures, 180 players in a senior male soccer division were followed prospectively for 1 yr. Attendance records for games and practice sessions were kept, and all injuries were examined and treated by the same orthopaedic surgeon. One hundred twenty-four players incurred 256 injuries, mostly sprains and strains of the lower extremities. Of these, 62% were considered minor with ankle sprains being the most common (17%), while 11% were considered major with knee ligament sprains being the most frequent (32%). Overuse injuries were most frequent in the preseason training period. Traumatic leg injuries involved players with inadequate or no shin guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred during a collision; non-contact knee injuries were frequently seen in those players with a history of knee injury and existing instability. Study of injury sequence disclosed that a minor injury was often followed within two months by a major one. In addition, with severe injuries incurred during fouls, the individual causing the penalty was injured. This prospective study suggested that those with knee instability and those allowed to resume play with poorly rehabilitated or clinically unhealed injuries are more apt to sustain further injury. Some injuries can be avoided by using better equipment and by observance of the rules.

Hemathrosis treated by aspiration and casting. How to condemn the knee.

Eighty-eight athletes treated for an acute hemarthrosis of the knee without any demonstrable ligament tear were evaluated. Analysis of the clinical data from these cases, all treated between 1970 and 1975 with aspiration and casting, revealed that the injury was apparently worse than had been thought at the time of first treatment. Surgery was subsequently performed in 32 (37%) because of meniscus tear, and 28 demonstrated anterior cruciate ligament insufficiency. In the 56 who did not have surgical treatment, 38 (43% of the entire group) had significant symptoms and disability causing them to decrease sports participation, and only 18 (20% of the overall group) returned to sports without symptoms or disability. Objective findings at followup suggested that in 70% of the patients injury of the anterior cruciate ligament occurred during the original trauma. A precise diagnosis is needed in every knee ligament sprain with hemarthrosis before one decides upon conservative treatment such as aspiration and casting.