Single-leg Hop Test Research Articles

Comparison of balance and function in the long term after all arthroscopic ATFL repair surgery.

We compared the balance, ROM, clinical scores, kinesiophobia and functional outcomes of patients after all-arthroscopic ATFL repair surgery with the non-operated side and healthy control group. Twenty-five patients with follow up time 37.32 ± 12.51months and twenty-five healthy controls participated in the study. Postural stability was evaluated with the Biodex® balance system by measuring overall (OSI), anterior-posterior (API), and mediolateral (MLI) stability index. Dynamic balance and function were measured using the Y-balance test (YBT) and single-leg hop test (SLH). Limb symmetry index for SLH and contralateral comparisons (YBT, OSI, API, MLI) was performed. The AOFAS score and the Tampa Scale of Kinesiophobia (TSK) were applied. Two subgroups were created (with OLT and without OLT). There was no statistically significant difference between subgroups. There was no statistically significant difference between bilateral OSI, API, MLI values and YBT anterior reach distances of all groups. Single leg OSI (0.78 ± 0.27/0.55 ± 0.12), API (0.55 ± 0.22/0.41 ± 0.10), and MLI (0.40 ± 0.16/ 0.26 ± 0.08) values were significantly worse and YBT posteromedial (73.88 ± 15.70/89.62 ± 12.25), posterolateral reach (78.03 ± 14.08/92.62 ± 8.25) and the SLH distance (117.14 ± 27.84/165.90 ± 20.91) were significantly lower on the patients than controls (p < 0.05), respectively. In contralateral comparisons, all reach distances on YBT were similar and SLH limb symmetry index of the operated side was 98.25%. AOFAS scores of the patients were 92.62 ± 11.13, TSK scores were 46.45 ± 11.32, and 21 patients (84%) had kinesiophobia. AOFAS score, limb symmetry index, and bilateral balance of the patients were successful; however, there is single-leg postural stability insufficiency and kinesiophobia. Although the extremity symmetry index of the operated side of the patients was 98.25, the fact that these values are lower than those of the healthy control may have been caused by kinesiophobia. During the long-term rehabilitation, kinesiophobia should be considered and single-leg balance exercises should be monitored during the rehabilitation period. Level III.

Isolated lateral extra-articular tenodesis in ACL-deficient knees: in vivo knee kinematics and clinical outcomes.

To carry out an in vivo kinematic analysis of isolated modified Lemaire lateral extra-articular tenodesis (LET) to explore its ability to modify the stability of anterior cruciate ligament (ACL) deficient knees. The secondary aim was to look at the clinical outcomes of the isolated LET to analyze whether biomechanical changes have an influence on clinical improvement or not. A total of 52 patients who underwent an isolated modified Lemaire LET were prospectively studied. Twenty-two were over 55-year-old patients with ACL rupture and subjective instability (group 1). They were followed up for 2years postoperatively. Thirty were patients underwent a two-stage ACL revision (group 2). They were followed up for 4months postoperatively (up to the second stage of the ACL revision). Preoperative, intraoperative, and postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test (SLVJT) and the single-leg hop test (SLHT). Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores. A significant reduction of both rotational and anteroposterior instability was detected. It was present both with the patient under anesthesia (p < 0.001 and p = 0.007 respectively) as well as with the patient awake (p = 0.008 and p = 0.018 respectively). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the SLVJT and SLHT improved significantly at the last follow-up (p < 0.001 and p = 0.011 respectively). The mean values of both the IKDC and Lysholm and Tegner scores showed an improvement (p = 0.008; p = 0.012; p < 0.001). The modified Lemaire LET improves the kinematics of ACL-deficient knees. The improvement in the kinematics leads to an improvement in subjective stability as well as in the function of the knee and in the clinical outcomes. At the 2-year follow-up, these improvements were maintained in a cohort of patients over 55years. Following our findings, to reduce knee instability, an isolated LET in ACL-deficient knees may be used when ACL reconstruction in patients over 55years is not indicated. Level IV.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction.

The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients "think" (add a secondary cognitive task) outside the "box" (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete's ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes' biomechanics and performance.

Comparison of the Immediate Effect of Active Stretching Techniques and Self-myofascial Release on the Flexibility of the Iliotibial Band and Functional Activities in Semi-Elite Athletes: A Randomized Clinical Trial

Background: The iliotibial band (ITB) is prone to shortening in sports activities. Correcting the lack of flexibility can be a factor in improving the overall biomechanics of the body and preventing future injuries. Methods: A total of 51 semi-elite athletes (age range: 20 - 40 years) with ITB shortness confirmed by the modified Ober’s test participated in this study. The participants were randomly divided into three groups, including foam roller, proprioceptive neuromuscular facilitation (PNF) active stretching, and a combination of foam roller and PNF stretching. Results: The mean of the active hip adduction range of motion (ROM), single-leg hop test, lateral hop test, and vertical jump in all three groups increased significantly after the intervention compared to before (P &lt; 0.05). All three studied groups had similar changes over time, and no group was superior to the others. Conclusions: Using a foam roller, PNF active stretching technique, and a combination of both can improve hip ROM in patients with ITB shortness. As a result, the functional activities of athletes, including vertical jump, lateral hop, and single-leg hop, can be improved. Flexibility and ROM increased significantly in all three treatment groups. There is no priority between different interventions.

Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength.

OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.

Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features.

This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level. Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level. Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.

Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction.

[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.

Variables Associated With Knee Valgus in Male Professional Soccer Players During a Single-Leg Vertical Landing Task.

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was .43 during the landing phase (P = .04) and with peak hip internal rotation was -.68 (P < .001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r = .40, P = .05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test.

Effects of both hip and traditional strengthening exercises on early outcomes post anterior cruciate ligament reconstruction

Background. Lower extremity muscles weakness occur after the reconstruction of the anterior cruciate ligament (ACLR), specifically the hip muscles. The literature suggests that decreased hip strength which results from ACLR can lead to biomechanical changes in lower extremity. Objective. The aim of the current study was to assess effects of adding hip strengthening exercises with traditional strengthening exercises on early outcomes after ACLR. Materials and methods. Randomized controlled study was conducted on 50 male participants with primary unilateral ACLR, they were tested pre-operative and after 12 weeks postoperative; for pain intensity by visual analog scale (VAS), side to side difference knee extension limitation range of motion (ROM) by goniometer, and lower extremity function tests by side-to-side single-leg hop test and 10-yards test. They were assigned into two groups; group A (hip strengthening exercises with traditional strengthening exercises) and group B (traditional strengthening exercises only). Both groups received the treatment 3 sessions/week for 12 weeks. Results. The results of independent t-test showed that there were significant improvements (p &lt; 0.05) in all variables (pain intensity, side to side difference knee extension limitation ROM, side-to-side single-leg hop test and 10-yards test) in both groups with superiority of group A. Conclusion. Adding of hip strengthening exercises to traditional strengthening exercises were effective on early outcomes post ACLR.

Changes in Performance on Common Return-to-Sport Tests During a Collegiate Women's Soccer Season: Implications for Baseline Testing.

Baseline testing of objective lower limb function may help clinicians make more informed return-to-sport (RTS) decisions in the event of an anterior cruciate ligament (ACL) injury. However, as these tests are based on physical performance, it is possible that they improve during the season as athletes get stronger and fitter. Hence, it may be difficult to ascertain the patient's preinjury status and have an accurate reference for comparison when determining readiness for RTS. The purpose of this study was to examine changes in common ACL RTS tests during a college soccer season to determine the most appropriate time to perform baseline testing. Hop test performance will improve across the season. Descriptive laboratory; prospective cohort. Level 4. A total of 31 women's soccer players from 1 NCAA Division I university agreed to participate this study. Participants performed 4 single-leg hop tests and the 505-agility test to measure cutting speed on 3 occasions: preseason (PRE), midseason (MID), and end-of-season (END). Performance on each test was compared across days to determine whether performance increased during the season. As a secondary analysis, limb symmetry index (LSI) was also compared across the season. A total of 23 participants (age, 19.7 ± 1.3 years; height, 1.69 ± 0.07 m; weight 60.9 ± 7.2 kg) completed all 3 testing sessions during the season. Performance during PRE was better than MID and END for all hop tests (all P < 0.01). LSI did not change during the season (P value range, 0.18-0.79). Performance on the hop tests was best during preseason and declined thereafter, which may be reflective of cumulative fatigue. Baseline testing of RTS tests performed during preseason may provide an accurate representation of an athlete's best abilities over the course of a collegiate soccer season. Preseason testing would also enable athletic trainers to acquire baseline data for all athletes before they are injured.

Isometric Knee Strength is Greater in Individuals Who Score Higher on Psychological Readiness to Return to Sport After Primary Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) injury is extremely common among athletes. Rate of second ACL injury due to surgical graft rupture or contralateral limb ACL injury is approximately 15-32%. Psychological readiness to return to sport (RTS) may be an important predictor of successful RTS outcomes. Psychological readiness can be quantified using the ACL Return to Sport after Injury (ACL-RSI) questionnaire, with higher scores demonstrating greater psychological readiness. The purpose of this study was to investigate differences in functional performance and psychological readiness to return to sport among athletes who have undergone primary ACL reconstruction (ACLR). Descriptive cohort study. Eighteen athletes who had undergone primary ACLR were tested at time of RTS clearance. The cohort was divided into two groups, high score (HS) and low score (LS), based on median ACL-RSI score, and performance on static and dynamic postural stability testing, lower extremity isokinetic and isometric strength testing, and single leg hop testing was compared between the groups using an independent samples t-test. The median ACL-RSI score was 74.17. The average ACL-RSI score was 83.1±6.2 for the HS group and 61.8±8.0 for the LS group. High scorers on the ACL-RSI performed significantly better on isometric knee flexion as measured via handheld dynamometry (22.61% ±6.01 vs.12.12% ±4.88, p=0.001) than the low score group. The findings suggest that increased knee flexion strength may be important for psychological readiness to RTS after primary ACLR. Further research is indicated to explore this relationship, however, a continued emphasis on improving hamstring strength may be appropriate during rehabilitation following ACLR to positively impact psychological readiness for RTS. III.

Preseason Integrative Neuromuscular Training Improves Selected Measures of Physical Fitness in Highly Trained, Youth, Male Soccer Players.

Hammami, R, Negra, Y, Nebigh, A, Ramirez-Campillo, R, Moran, J, and Chaabene, H. Preseason integrative neuromuscular training improves selected measures of physical fitness in highly trained, youth, male soccer players. J Strength Cond Res 37(6): e384-e390, 2023-This study examined the effects of an 8-week integrative neuromuscular training (INT) program, including balance, strength, plyometric, and change of direction exercises, on measures of physical fitness in youth male soccer players. Twenty-four male soccer players participated in this study. They were randomly allocated into an INT (n = 12; age = 15.7 ± 0.6 years, body height = 179.75 ± 6.54 cm, body mass = 78.20 ± 7.44 kg, maturity-offset = +2.2 ± 0.6 years) or an active control (CG, n = 12; age = 15.4 ± 0.8 years, body height = 178.4 ± 6.4 cm, body mass = 72 ± 8.3 kg, maturity-offset = +1.9 ± 0.7 years) group. Before and after training, tests to measure dynamic balance (Y-Balance test [YBT]), muscle strength (one repetition maximum [1RM]), muscle power (five jump test [FJT], single-leg hop test [SLHT], and countermovement jump [CMJ] height), linear sprint time (10 and 30-m), and change of direction with ball (CoDball) were performed. The analysis of covariance was used to test between-group differences (INT vs. CG) at posttest using baseline values as covariates. Significant, large, between-group differences at posttest were noted for the YBT (p = 0.016; d = 1.1), 1RM (p = 0.011; d = 1.2), FJT (p = 0.027; d = 1.0), SLHT (p = 0.04; d = 1.4), CMJ height (p < 0.001; d = 1.9), 10-m sprint (p < 0.01; d = 1.6), and CoDball (p < 0.05; d = 0.9) in favor of the INT group. Significant moderate-to-large pre-to-post changes were detected in the INT group for YBT, 1RM, CMJ height, SLHT, FJT, 10-m and 30-m sprint time, and CoDball test (d = 0.7 to 3.07, p < 0.05). No significant pre-to-post changes were observed in the CG (p > 0.05), except for 10-m sprint time (d = 1.3; p < 0.05). Exposure to INT twice weekly is effective and time efficient to improve various measures of physical fitness in highly trained youth male soccer players.

Quadriceps Strength and Knee Function After Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Bone Autograft: A Preliminary Report.

The purpose of this study was to evaluate quadriceps strength and knee function after anterior cruciate ligament (ACL) reconstruction using a quadriceps tendon bone (QTB) autograft. Preliminary data were extracted from an ongoing prospective cohort study in which the operative extremity was compared to non-operative extremity. Patients from 14 to 40 years of age who had an ACL reconstruction with QTB autograft volunteered to have knee assessment including quadriceps isokinetic strength measures and functional knee testing at 6 and 12 months post-operatively. Paired t-tests were conducted to compare post-operative strength and function scores on participants who had minimum one-year post-surgical follow-up. Patients had a significant recovery of quadriceps strength as determined by isokinetic testing and single leg hop test. For 31 participants, quadriceps strength of the operative leg measured at 60 deg/sec was 63% of the non-operative leg at six months, increasing to 79% at one year (p < 0.001); when measured at 180 deg/sec, these values were 68% at six months, increasing to 82% at one year (p < 0.001). For 30 participants, single leg hop functional scores of the operative leg were 80% of the non-operative leg at six months, increasing to 91% at one year (p < 0.001). After QTB autograft for ACL reconstruction, there were significant gains in quadriceps strength and knee function from six months to one year post-operative. These findings indicated the QTB is an acceptable ACL reconstruction option.

Predictions of total work based on measures of muscle strength and hop performance in individuals after ACL reconstruction

ObjectivesThe purpose of this study was to determine the ability to utilize clinical measures of hop performance and thigh muscle strength to predict total limb work, a measure of cumulative single leg power, in young athletes at the time of return to sport after ACLR. We hypothesized that hop test performance and thigh muscle strength would predict total limb work during a maximal effort repeated vertical single-leg jump and that hop test performance would better predict total limb work during a maximal effort repeated vertical single-leg jump than measures of thigh strength. DesignCross-sectional study. ParticipantsAnalysis on data from 50 individuals after unilateral ACLR (74% women, age 14-23 years) Main outcome measuresPerformed 10-s repeated vertical single-leg jump test on a force platform where single limb power and resultant total work were calculated. At the same session, participants completed a clinical single leg hop test battery and thigh strength testing. ResultsAll clinical measures were associated with total work during the repeated vertical single-leg jump test on the involved and uninvolved limbs, respectfully. After controlling for height and weight, quadriceps femoris peak torque at 180°/s was the strongest predictor of total work for both limbs. On the involved limb, performance on the triple hop test for distance also uniquely contributed to the prediction of total work. ConclusionsQuadriceps femoris muscle strength and distance hop test performance predict total limb work capacity of the involved limb during a single-leg dynamic task. Optimizing both measures after ACLR may positively impact vital components of sports performance.

Analysis of the Anaerobic Power Output, Dynamic Stability, Lower Limb Strength, and Power of Elite Soccer Players Based on Their Field Position.

Soccer players require a high degree of aerobic and anaerobic fitness to perform well throughout the game as per their position in the field. This study aimed to investigate the differences in anaerobic power output, dynamic stability, lower limb strength, and power among elite soccer players based on their field position. A cross-sectional population of 96 elite soccer players with average age 23.10 ± 4.35 years, weight 69.99 ± 9.71 kg, height 174.84 ± 6.64 cm, and body mass index 22.84 ± 2.39 kg/m2 from various soccer clubs in Saudi Arabia was tested for their anaerobic power output, dynamic stability, lower limb strength, and power performance. All the participants have more than 4 years of experience in competitive soccer events. Tests included a measure of single-leg vertical jump, star excursion balance test, and single-leg triple hop test for distance. The players were divided into four groups (goalkeepers, defenders, midfielders, and attackers) based on their self-reported position on the field. One-way ANOVA was used to determine the differences between all variables according to the players' position. In addition, partial eta-squared (ηp2) was used to report effect sizes. The results revealed significant differences between positions in the anaerobic power output (p = 0.012, ηp2 = 0.312), dynamic stability {Anterior (p = 0.004, ηp2 = 0.235), Anteromedial (p = 0.007, ηp2 = 0.622), Anterolateral (p = 0.011, ηp2 = 0.114)}, and lower limb strength, and power (p = 0.008, ηp2 = 0.421). At the same time, goalkeepers' performance was significantly superior to midfielders (p = 0.006) in the anaerobic power output. In addition, lower limb strength and power was significantly higher (p = 0.004) for goalkeepers than for midfielders, with a similar trend in dynamic stability (p = 0.007). These results exhibited differences in anaerobic power output, dynamic stability, lower limb strength, and power performance based on the players' positions. The investigation may assist the practitioner in designing training programs for the players according to their position for performance improvement.

Comparing the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability: Randomized controlled trial

Objective To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). Design Two-arm, parallel-group, randomized, double-blind, controlled trial. Participants 60 patients with unilateral CAI. Intervention integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). Outcomes Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. Results The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95–25.37), meanConventional = 29.46 (24.09–34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). Conclusion Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients’ functional ability.

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Is Not Superior to Anatomic Single-Bundle Reconstruction at 10-Year Follow-up: A Randomized Clinical Trial

Background: The anatomic double-bundle (DB) technique is purported to be a superior technique due to its mimicking of the double-stranded anatomic formation of the anterior cruciate ligament (ACL). Previous studies with 2-, 5- and 10-year follow-up are conflicted as to whether this technique is superior to the previous gold standard method of ACL reconstruction, the anatomic single-bundle (SB) reconstruction. Purpose/Hypothesis: The aim of this prospective randomized study was to compare the outcomes of the anatomic DB technique and anatomic SB technique with independent drilling at 10 years after anterior cruciate ligament (ACL) reconstruction. We hypothesized that DB ACL reconstruction would result in a better outcome in terms of the pivot-shift test. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 105 patients (33 women, 72 men; median age, 27 years [range, 18-52 years]) were randomized and underwent ACL reconstruction (DB group: n = 53; SB group: n = 52). All reconstruction procedures were performed anatomically by identifying the ACL footprint, using the anteromedial portal for femoral tunnel drilling, and utilizing interference screws for tibial and femoral fixation. One blinded observer examined the patients both preoperatively and at follow-up (median, 120 months [range, 112-134 months]). Multiple subjective and objective clinical evaluations were used to assess the outcomes. Radiographic assessments of osteoarthritis were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank classification systems early postoperatively and at the final follow-up. Results: Preoperatively, no differences were found between the study groups. Overall, 70 patients (67%; DB group: n = 39; SB group: n = 31) were available for analysis at 10-year follow-up. No significant difference could be shown between the groups in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, single-leg hop test result, range of motion measurements, Lysholm knee score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score (KOOS) score. Correspondingly, no differences were found between the groups regarding the presence of radiographic osteoarthritis at follow-up. Both groups improved at follow-up compared with preoperatively in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, Lysholm knee score, and KOOS score (P < .05 [highest P value for any comparison]). Conclusion: The anatomic DB technique was not superior to the anatomic SB technique with independent drilling at 10-year follow-up in regard to objective and subjective measurements. As such, one could argue that there is no need for the continued use of the anatomic DB technique in an unselected population.

Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 ​years

ObjectivesTo compare clinical and functional outcomes of patients after primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon- (QT-A) and hamstring tendon (HT-A) autograft with a minimum follow-up (FU) of 5 years. MethodsBetween 2010 and 2014, all patients undergoing ACLR were recorded in a prospectively administered database. All patients with primary, isolated QT-A ACLR and without any concomitant injuries or high grade of osteoarthritis were extracted from the database and matched to patients treated with HT-A. Re-rupture rates, anterior–posterior (ap) knee laxity, single-leg hop test (SLHT) performance, distal thigh circumference (DTC) and patient-reported outcome measures (PROMs) were recorded. Between group comparisons were performed using chi-square-, independent-samples T- or Mann–Whitney–U tests. Results45 QT-A patients were matched to 45 HT-A patients (n ​= ​90). The mean FU was 78.9 ​± ​13.6 months. 18 patients (20.0%/QT-A: N ​= ​8, 17.8%; HT-A: n ​= ​10, 22.2%; p ​= ​.60) sustained a graft rupture and 17 subjects (18.9%/QT-A: n ​= ​9, 20.0%; HT-A: n ​= ​8, 17.8%; p ​= ​.79) suffered a contralateral ACL injury. In high active patients (Tegner activity level ≥ 7) rerupture rates increased to 37.5% (HT-A) and 22.2% (QT-A; p ​= ​.32), respectively. Patients with graft failure did not differ between both groups in terms of mean age at surgery (QT-A: 26.5 ​± ​11.6 years, HT-A: 23.3 ​± ​9.5 years, p ​= ​.63) or graft thickness (mean graft square area: QT-A: 43.6 ​± ​4.7 mm2, HT-A: 48.1 ​± ​7.9 mm2, p ​= ​.27). No statistical between-group differences were found in ap knee laxity side-to-side (SSD) measurements (QT-A: 1.9 ​± ​1.2 ​mm, HT-A: 2.1 ​± ​1.5 ​mm; p ​= ​.60), subjective IKDC- (QT-A: 93.8 ​± ​6.8, HT-A: 91.2 ​± ​7.8, p ​= ​.17), Lysholm- (QT-A 91.9 ​± ​7.2, HT-A: 91.5 ​± ​9.7, p ​= ​.75) or any of the five subscales of the KOOS score (all p ​> ​.05). Furthermore, Tegner activity level (QT-A: 6(1.5), HT-A: 6(2), p ​= ​.62), VAS for pain (QT-A: 0.5 ​± ​0.9, HT-A: 0.6 ​± ​1.0, p ​= ​.64), Shelbourne–Trumper score (QT-A: 96.5 ​± ​5.6, HT-A: 95.2 ​± ​8.2, p ​= ​.50), Patient and Observer Scar -Assessment scale (POSAS) (QT-A: 9.4 ​± ​3.2, HT-A: 10.7 ​± ​4.9, p ​= ​.24), SSD-DTC (QT-A: 0.5 ​± ​0.5, HT.- A: 0.5 ​± ​0.6, p ​= ​.97), return to sports rates (QT-A: 82.1%, HT-A: 86.7%) and SLHT (QT -A: 95.9 ​± ​3.8%, HT-A: 93.7 ​± ​7.0%) did not differ between groups. Donor-site morbidity (HT-A n ​= ​14, 46.7%; QT-A n ​= ​3, 11.5%; p ​= ​.008) was statistically significantly lower in the QT-A group. Five patients (11.1%) of the HT-group and three patients (6.7%) in the QT-group required revision surgery (p ​= ​.29). ConclusionPatient-reported outcome measures, knee laxity, functional testing results and re-rupture rates are similar between patients treated with QT- and HT- autografts. However, patients with QT-autograft have a smaller tibial postoperative scar length and lower postoperative donor-site morbidity. There is a tendency towards higher graft rupture rates in highly active patients treated with HT autograft. Level of evidenceII.

Neuromuscular Training following Anterior Cruciate Ligament reconstruction – Pain, Function, Strength, Power &amp; Quality of Life Perspective: A Randomized Control Trial

To determine the effectiveness of neuromuscular physical Therapy as compared to strength training following anterior cruciate ligament reconstruction in terms of pain, function, quality of life, strength and power of participants. A randomized clinical trial was conducted at Kanaan Physiotherapy & Spine Clinic, Lahore, Pakistan from July 2020 to December 2020. Seventy-six patients were selected by non-probability convenience sampling technique and randomly divided into either neuromuscular training or strength training group. Sample included 20-40 years aged adults with unilateral anterior cruciate ligament injury who had undergone surgical reconstruction of ACL two months ago using hamstring graft. Patients were assessed using the Cincinnati Knee Score for function, Numeric Pain Rating Scale (NPRS) for pain, SF-36 for quality of life, and Single Leg Hop, Triple Hop, Crossover Hop and 6-meter Hop test for power and strength. Data was analyzed using SPSS Version-21. A t-test was used to assess difference between groups. P<0.05 was considered significant. Results revealed that neuromuscular training is statistically significant in reducing pain (p<0.001) and improving function (p<0.001), power & strength (p<0.001) and quality of life (p=0.001). Study concludes that compared to strength training, neuromuscular training was significantly more effective in reducing pain; improving function, quality of life, strength and power.