Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.

PurposeThe purpose was to calculate the incidence of osteoarthritis in individuals following Anterior Cruciate Ligament Reconstruction (ACLR) in a large, national database and to examine the risk factors associated with OA development. Methods A commercially available insurance database was queried to identify new diagnoses of knee OA in patients with ACLR. The cumulative incidence of knee OA diagnoses in patients after ACLR was calculated and stratified by time from reconstruction. Odds ratios were calculated using logistic regression to describe factors associated with a new OA diagnosis including age, sex, BMI, meniscus involvement, osteochondral graft use, and tobacco use. Results A total of 10,565 patients with ACLR were identified that did not have an existing diagnosis of OA, 517 of which had a documented new diagnosis of knee OA 5 years after ACL reconstruction. When stratified by follow-up time points, the incidence of a new OA diagnosis within 6 months was 2.3%; within a 1-year follow-up was 4.1%; within 2 years, follow-up was 6.2%, within 3 years, follow-up was 8.4%; within 4 years, follow-up was 10.4%; and within 5 years, follow-up was 12.3%. Risk factors for new OA diagnoses were age (OR 2.44, P < 0.001), sex (OR 1.2, P = 0.002), obesity (OR 1.4, P < 0.001), tobacco use (OR = 1.3, P = 0.001), and meniscal involvement (OR 1.2, P = 0.005). Conclusion Approximately 12% of patients presenting within 5 years following ACLR are diagnosed with OA. Demographic factors associated with an increased risk of a diagnosis of PTOA within 5 years after ACLR are age, sex, BMI, tobacco use, and concomitant meniscal surgery. Clinicians should be cognizant of these risk factors to develop risk profiles in patients with the common goal to achieve optimal long-term outcomes after ACLR. Level of evidence III.

Slater, LV, and Hart, JM. Muscle activation patterns during different squat techniques. J Strength Cond Res 31(3): 667-676, 2017-Bilateral squats are frequently used exercises in sport performance programs. Lower extremity muscle activation may change based on knee alignment during the performance of the exercise. The purpose of this study was to compare lower extremity muscle activation patterns during different squat techniques. Twenty-eight healthy, uninjured subjects (19 women, 9 men, 21.5 ± 3 years, 170 ± 8.4 cm, 65.7 ± 11.8 kg) volunteered. Electromyography (EMG) electrodes were placed on the vastus lateralis, vastus medialis, rectus femoris, biceps femoris, and the gastrocnemius of the dominant leg. Participants completed 5 squats while purposefully displacing the knee anteriorly (AP malaligned), 5 squats while purposefully displacing the knee medially (ML malaligned) and 5 squats with control alignment (control). Normalized EMG data (MVIC) were reduced to 100 points and represented as percentage of squat cycle with 50% representing peak knee flexion and 0 and 99% representing fully extended. Vastus lateralis, medialis, and rectus femoris activity decreased in the medio-lateral (ML) malaligned squat compared with the control squat. In the antero-posterior (AP) malaligned squat, the vastus lateralis, medialis, and rectus femoris activity decreased during initial descent and final ascent; however, vastus lateralis and rectus femoris activation increased during initial ascent compared with the control squat. The biceps femoris and gastrocnemius displayed increased activation during both malaligned squats compared with the control squat. In conclusion, participants had altered muscle activation patterns during squats with intentional frontal and sagittal malalignment as demonstrated by changes in quadriceps, biceps femoris, and gastrocnemius activation during the squat cycle.

Background:Many clinicians release patients to return to activity after anterior cruciate ligament reconstruction (ACLR) based on time from surgery despite deficits in muscle strength and function. It is unclear whether symmetry or unilateral performance is the best predictor of subjective outcomes after ACLR.Purpose:To determine physical performance predictors of patient-reported outcomes after reconstruction.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 88 participants (49 males, 39 females; mean ± SD height, 174.0 ± 9.6 cm; weight, 76.1 ± 18.5 kg; age, 19.4 ± 3.7 years) who underwent primary, unilateral ACLR volunteered for this study. Participants had undergone reconstruction a mean of 6.9 ± 1.8 months (range, 5.0-14.1 months) before the study. All participants underwent strength testing as well as hop testing and then completed the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Stepwise linear regression models were used for symmetry and unilateral performance to identify the proportion of variance explained in the IKDC score, KOOS total score, KOOS-sport subscale, and time from surgery, as well as receiver operating characteristic (ROC) curve analyses on those variables that explained the most variance in patient-reported outcomes to determine cutoff thresholds.Results:No significant correlations were found between time from surgery and objective performance. The only significant predictors of IKDC score were single-hop limb symmetry index (LSI) and age (R 2 = 0.177) and unilateral triple-hop performance and age (R 2 = 0.228). The cutoff for single-hop symmetry was 0.92 (area under the curve [AUC], 0.703; P = .012), and the cutoff for normalized triple-hop distance was 3.93 (AUC, 0.726; P = .005). When stratified by age, the cutoff for single-hop symmetry was 0.81 (AUC, 0.721; P = .051) for younger patients (age <19.1 years) and was not significant for older patients (age ≥19.1 years). The cutoff for normalized triple-hop distance was 3.85 (AUC, 0.832; P = .005) in older patients and was not significant for younger patients. The only significant predictors of KOOS-sport subscale were single-hop LSI (R 2 = 0.140) and normalized knee extensor power at 180 deg/s (R 2 = 0.096). When subjective outcomes were predicted based on KOOS-sport subscale, the cutoff for single-hop symmetry was 0.85 (AUC, 0.692; P = .018).Conclusion:Hopping performance is the most predictive functional variable of subjective outcomes after reconstruction. Single-hop symmetry was most important for younger patients and unilateral triple-hop distance was most important for older patients. Clinicians should consider hopping performance when making return-to-activity decisions after ACLR.

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