ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury

Abstract

PurposeLittle is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.MethodsSixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.ResultsSignificant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.ConclusionDifferent kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.Level of evidenceProspective cohort study, Level II.

Anterior cruciate ligament deficiency: rotational instability in the transverse plane. A preliminary laboratory in vivo study

“…First, compensatory mechanisms can be acting to avoid knee rotation, regardless of the amount of rotation torque calculated by inverse dynamics. These compensations may include complex neuromuscular adaptations, which lead to multilevel protective strategies (20,21). Secondly, it is possible that the method used to collect and calculate knee rotation was not sensitive enough.…”

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

“…In addition, another question arises, namely, what the consequences of the altered between-limb symmetry during hop landing may be. Altered loadings of the knee joint may trigger the development of osteoarthritis and therefore influence quality of life [13,28]. Some authors also suggest that altered movement strategies in ACL-reconstructed patients are partially responsible for the high second-injury rates in this population [45].…”

“…The vertical hop is a multi-joint movement task that is commonly used in the clinical environment, and is considered an important dynamic movement in physical activity [13,14]. The current literature highlights the landing strategies analysis during standardized jump tasks as an interesting assessment tool, and several studies have reported an asymmetric landing pattern among patients after ACLR [15][16][17].…”

“…Short-term post-ACL reconstruction alterations in limb symmetry during double-leg vertical jump landing, dependent on postoperative physiotherapy supervision duration, have been reported [27]. The issue seems clinically important, as the altered loading of the knee joint may trigger the development of osteoarthritis, and therefore influence quality of life [13,28]. Some studies have also suggested that abnormalities in the knee function during dynamic movements may increase the risk of subsequent ipsilateral and contralateral ACL injuries [29][30][31].…”

A novel standardised side hop test reliably evaluates landing mechanics for anterior cruciate ligament reconstructed persons and controls

“…Thus, for a successful return post-injury to sports or leisure activities that place considerable load on the lower limb (and in particular the knee joint), individuals should demonstrate sufficient lower limb control during tasks that involve cutting and side-to-side manoeuvres. This requires tests that are specifically designed to evaluate landing mechanics during such conditions, both of the lower limb but also of the trunk due to interrelationship of joint motion (Markström, Tengman, & Häger, 2017;Shimokochi et al, 2013). However, no study to date have evaluated reliability and agreement of trunk, hip, and knee landing mechanics during such side-to-side tasks for ACLR persons.…”