This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for ...REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
Motion analysis systems are widely employed to identify movement deficiencies-e.g. patterns that potentially increase the risk of injury or inhibit performance. However, findings across studies are ...often conflicting in respect to what a movement deficiency is or the magnitude of association to a specific injury. This study tests the information content within movement data using a data driven framework that was taught to classify movement data into the classes: NORM, ACLOP and ACLNO OP, without the input of expert knowledge. The NORM class was presented by 62 subjects (124 NORM limbs), while 156 subjects with ACL reconstruction represented the ACLOP and ACLNO OP class (156 limbs each class). Movement data from jumping, hopping and change of direction exercises were examined, using a variety of machine learning techniques. A stratified shuffle split cross-validation was used to obtain a measure of expected accuracy for each step within the analysis. Classification accuracies (from best performing classifiers) ranged from 52 to 81%, using up to 5 features. The exercise with the highest classification accuracy was the double leg drop jump (DLDJ; 81%), the highest classification accuracy when considering only the NORM class was observed in the single leg hop (81%), while the DLDJ demonstrated the highest classification accuracy when considering only for the ACLOP and ACLNO OP class (84%). These classification accuracies demonstrate that biomechanical data contains valuable information and that it is possible to differentiate normal from rehabilitating movement patterns. Further, findings highlight that a few features contain most of the information, that it is important to seek to understand what a classification model has learned, that symmetry measures are important, that exercises capture different qualities and that not all subjects within a normative cohort utilise 'true' normative movement patterns (only 27 to 71%).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
Previous studies examining jump tasks after anterior cruciate ligament reconstruction (ACLR) have focused on performance measures without examining joint kinematic and kinetic variables. ...The aim of this study was to identify differences in biomechanical and performance measures between limbs across tests 9 months after surgery.
Methods
Four jump tests (double‐leg drop jump (DLDJ), single‐leg drop jump (SLDJ), single‐leg hop for distance (SLHD) and hurdle hop (HH)) were carried out on 156 male subjects in a 3D motion capture laboratory 9 months after surgery. Statistical parametric mapping was used to identify differences in jump performance and biomechanical variables between limbs.
Results
Biomechanical measures were lower on the ACLR side across all four tests for internal knee valgus moment (effect size (ES) 0.77‐0.92), knee internal rotation angle (ES 0.59‐0.8), and ankle external rotation moment (ES 0.59‐0.73), with the center of mass less posterior to the knee during the single‐leg tests (ES 0.61‐0.82). The timing of the largest difference between limbs was not at the same % stance between variables within a test or for any variable across tests. Large ES differences were observed in performance in the SLDJ (ES 0.73‐0.81; LSI 78%) and small differences in the SLHD (ES 0.36; LSI 94%) between the limbs.
Conclusion
Findings highlighted biomechanical differences between limbs which are consistent across jump tasks suggesting insufficient rehabilitation at 9 months post surgery. Results indicate that the SLDJ may identify greater performance deficits between limbs than SLHD, which may over‐estimate rehabilitation status.
Despite an increase in the literature, few definitive guidelines are available to determine when an athlete has been fully rehabilitated after anterior cruciate ligament reconstruction (ACLR).
To ...examine countermovement jump and isokinetic dynamometry measures to (1) identify which measures can best distinguish between ACLR and control participants and (2) provide normative values for identified measures in young adult male multidirectional field-sport athletes.
Cross-sectional study.
Orthopaedic hospital.
Young adult male multidirectional field-sport athletes (n = 118) who had undergone unilateral patellar-tendon graft ACLR at least 6 months earlier and healthy male participants (n = 44) with no previous knee injury.
Single-legged countermovement jump (SL CMJ).
Three-dimensional biomechanical analysis of the SL CMJ and mean peak concentric knee-extension and -flexion torque using isokinetic dynamometry (ISO) were compared in the 2 groups. A stepwise logistic regression was carried out to identify the best predictors of ACLR- or control-group membership (SL CMJ height, limb symmetry index, peak power, joint power contribution, ISO peak torque, limb symmetry index variables).
The control group differed strongly from the ACLR group in isokinetic knee-extension peak torque (d = -1.33), SL CMJ performance (d > 0.4), and limb symmetry measures in both ISO and jump outcomes (d > 1.1). The combination of measures from both ISO and SL CMJ identified group membership with an accuracy of 89%.
Rehabilitation of ACLR patients may be complete when they achieve isokinetic knee-extension peak torque of 260% (±40%) body mass, SL CMJ performance of >17 cm (±4 cm), and reach-limb symmetry measures of >90% in both strength and jump outcomes. The outcomes in the control group can inform return-to-play criteria for young adult male multidirectional field-sport athletes after ACLR.
Background:
Despite the importance of return-to-play (RTP) rates, second anterior cruciate ligament (ACL) injury rates, and patient-reported outcomes of athletes returning to sports after ACL ...reconstruction (ACLR), these outcomes have not been evaluated together across a single cohort nor the pre- and intraoperative factors influencing outcomes explored.
Purpose:
To prospectively report outcomes after ACLR relating to RTP, second ACL injury, and International Knee Document Committee (IKDC) scores in a large cohort of athletes at a single center to examine the influence of pre- and intraoperative variables on these outcomes.
Design:
Cohort study; Level of evidence, 3.
Methods:
A consecutive cohort of 1432 athletes undergoing primary ACLR by 2 orthopaedic surgeons was followed up prospectively more than 2 years after surgery. Pre- and intraoperative findings were reported with outcomes at follow-up relating to RTP, second ACL injury, and IKDC. Between-group differences for each outcome were reported and the predictive ability of pre- and intraoperative variables relating to each outcome assessed with logistic regression.
Results:
There was >95% follow-up 2 years after surgery. The RTP rate was 81%, and of those who returned, 1.3% of those with patellar tendon grafts and 8.3% of those with hamstring grafts experienced ipsilateral rerupture (hazard ratio, 0.17). The contralateral ACL injury rate was 6.6%, and the IKDC score at follow-up was 86.8, with a greater proportion of patients with patellar tendon grafts scoring <80 on the IKDC (odds ratio, 1.56; 95% CI, 1.15-3.12). There was no relationship between time to RTP and second ACL injury, and there was a moderate correlation between ACL–Return to Sport After Injury score and RTP at follow-up (P < .001, rho = 0.46). There were a number of differences in pre- and intraoperative variables between groups for each outcome, but they demonstrated a poor ability to predict outcomes in level 1 athletes at 2-year follow-up.
Conclusion:
Findings demonstrated high overall RTP rates, lower reinjury rates with patellar tendon graft after 2-year follow-up in level 1 athletes, and no influence of time to RTP on second ACL injury. Despite differences between groups, there was poor predictive ability of pre- and intraoperative variables. Results suggest pre- and intraoperative variables for consideration to optimize outcomes in level 1 athletes after ACLR, but future research exploring other factors, such as physical and psychological recovery, may be needed to improve outcome prediction after ACLR.
Registration:
NCT02771548 (ClinicalTrials.gov identifier).
ABSTRACTMarshall, BM, Franklyn-Miller, AD, King, EA, Moran, KA, Strike, SC, and Falvey, ÉC. Biomechanical factors associated with time to complete a change of direction cutting maneuver. J Strength ...Cond Res 28(10)2845–2851, 2014—Cutting ability is an important aspect of many team sports, however, the biomechanical determinants of cutting performance are not well understood. This study aimed to address this issue by identifying the kinetic and kinematic factors correlated with the time to complete a cutting maneuver. In addition, an analysis of the test-retest reliability of all biomechanical measures was performed. Fifteen (n = 15) elite multidirectional sports players (Gaelic hurling) were recruited, and a 3-dimensional motion capture analysis of a 75° cut was undertaken. The factors associated with cutting time were determined using bivariate Pearsonʼs correlations. Intraclass correlation coefficients (ICCs) were used to examine the test-retest reliability of biomechanical measures. Five biomechanical factors were associated with cutting time (2.28 ± 0.11 seconds)peak ankle power (r = 0.77), peak ankle plantar flexor moment (r = 0.65), range of pelvis lateral tilt (r = −0.54), maximum thorax lateral rotation angle (r = 0.51), and total ground contact time (r = −0.48). Intraclass correlation coefficient scores for these 5 factors, and indeed for the majority of the other biomechanical measures, ranged from good to excellent (ICC >0.60). Explosive force production about the ankle, pelvic control during single-limb support, and torso rotation toward the desired direction of travel were all key factors associated with cutting time. These findings should assist in the development of more effective training programs aimed at improving similar cutting performances. In addition, test-retest reliability scores were generally strong, therefore, motion capture techniques seem well placed to further investigate the determinants of cutting ability.
Sensorimotor dysfunction is thought to occur following anterior cruciate ligament (ACL) injury which may have implications on future reinjury risk. Dysfunction has been demonstrated within the ...efferent component of the sensorimotor system. However, no reviews have examined the two main components of the afferent system: the visual and somatosensory systems.
This study aimed to report differences in function (central processing and local processing) within the (1) somatosensory and (2) visual systems between individuals following anterior cruciate ligament reconstruction (ACLR) and healthy controls (between-subject). The study also aimed to report differences in function within the two systems between the two limbs of an individual following ACLR (within-subject).
Scoping review.
A search was conducted in PubMed, SPORTDiscus, CINAHL, Medline and Embase up until September 2021. Level I-IV studies assessing somatosensory and visual systems were included if they compared ACLR limbs to the uninjured contralateral limb (within-subject) or a healthy control limb (between-group). The function of somatosensory and visual systems was assessed across both central processing (processing of information in the central cortex) and local processing (all other assessments outside of central processing of information).
Seventy studies were identified (52 somatosensory, 18 visual). Studies examining somatosensory central processing demonstrated significant differences; 66% of studies exhibited within-subject differences and 100% of the studies exhibited between-group differences. Studies examining local somatosensory processing had mixed findings; 40% of the 'joint position sense (JPS)' and 'threshold to detect motion (TTDM)' studies showed significant within-subject differences (JPS=0.8°-3.8° and TTDPM=0.2°-1.4°) and 42% demonstrated significant between-group differences (JPS=0.4°-5° and TTDPM=0.3°-2.8°). Eighty-three percent of visual central processing studies demonstrated significant dysfunction between-groups with no studies assessing within-subject differences. Fifty percent of the studies examining local visual processing demonstrated a significant between-group difference.
Significant differences in central processing exist within somatosensory and visual systems following ACLR. There is mixed evidence regarding local somatosensory and visual processing. Increased compensation by the visual system and local visual processing dysfunction may occur in conjunction with somatosensory dysfunction.
Background
Jump testing performance and limb symmetry measures are important metrics for clinicians to monitor during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction, however ...they require hardware and software which is not commonly available in clinical practice. Video-based solutions may present a feasible alternative, but their veracity in classifying patients using limb-symmetry of 90% has not been established, nor have the clinimetric values for the performance measures been reported in this population.
Purpose
To describe the diagnostic accuracy (pass/fail using 90% LSI) and clinimetrics of an iPad-based app (“MyJump”) compared to reference force plate analyses for limb symmetry, jump/hop height, contact time, flight time, and reactive strength index
Study design
Prospective cohort, diagnostic accuracy
Methods
Fifty-one consecutive patients recovering from ACL reconstruction undertaking routine independent clinical evaluation of their hop and jump performance were concurrently and independently examined using force plates and the MyJump app. Diagnostic accuracy of MyJump was compared to reference force plate analyses using a criterion of 90% limb symmetry.
Results
Diagnostic accuracy of the MyJump app was very good: positive predictive value for jump height was 0.83 and 1.0 for reactive strength index, and negative predictive value was 0.95 and 1.0 for the same metrics, respectively. Of the 131 classifications made using the MyJump app, there were five false positives and three false negatives – all of these were in classification of jump height with no misclassifications of RSI. Irrespective of jump type, the MyJump app displayed excellent reliability (ICC>0.95) for both height and reactive strength index. Minimum detectable changes were approximately 1cm for height, 0.1 for reactive strength index, 0.02s for contact time, and 0.3s for flight time.
Conclusion
Where force plates are unavailable, the MyJump app is a valid and reliable substitute for criteria assessment of jump/hop height and reactive strength index in those recovering from ACL surgery using a 90% limb symmetry threshold. The minimum detectable changes vary by metric but are likely sufficiently accurate to detect clinical changes.
Level Of Evidence
Level 3
The validity of an inertial sensor-based motion capture system (IMC) has not been examined within the demands of a sports-specific field movement test
This study examined the validity of an IMC ...during a field test (VU®) by comparing it to an optical marker-based motion capture system (MMC). Expected accuracy and precision benchmarks were computed by comparing the outcomes of a linear and functional joint fitting model within the MMC. The kinematics from the IMC in sagittal plane demonstrated correlations (r
) between 0.76 and 0.98 with root mean square differences (RMSD) < 5, only the knee bias was within the benchmark. In the frontal plane, r
ranged between 0.13 and 0.80 with RMSD < 10, while the knee and hip bias was within the benchmark. For the transversal plane, r
ranged 0.11 to 0.93 with RMSD < 7, while the ankle, knee and hip bias remained within the benchmark. The findings indicate that ankle kinematics are not interchangeable with MMC, that hip flexion and pelvis tilt higher in IMC than MMC, while other measures are comparable to MMC. Higher pelvis tilt/hip flexion in the IMC can be explained by a one sensor tilt estimation, while ankle kinematics demonstrated a considerable level of disagreement, which is likely due to four reasons: A one sensor estimation, sensor/marker attachment, movement artefacts of shoe sole and the ankle model used.
After anterior cruciate ligament reconstruction (ACLR), return to sprint is poorly documented in the literature. In soccer, return to sprint is an essential component of return to play and ...performance after ACLR. The characteristics of running in soccer are specific (velocity differences, nonlinear, intensity). It is important to address these particularities, such as curvilinear running, acceleration, deceleration, changes of direction, and variations in velocity, in the patient's rehabilitation program. Force, velocity, and acceleration capacities are key elements to sprint performance. Velocity-based training (VBT) has gained much interest in recent years and may have a role to play in optimizing return to play and return to sprint after ACLR. Force, velocity, and acceleration can be assessed using force-velocity-power and acceleration-speed profiles, which should inform rehabilitation. The purpose of this commentary is to describe a velocity-based return to sprint program which can be used during ACLR rehabilitation.
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