Effect of Fatigue on Functional Stability of the Knee: Particularities of Female Handball Players

Abstract

The risk of anterior cruciate ligament injury in female handball players is high. Fatigue of active stabilizers and increases in joint laxity are often mentioned in the literature as causal factors. However, no studies have been carried out on this population. Our objective is to determine the effect of muscle fatigue on active and passive knee stability in female handball players. This prospective study assessed tibiofemoral joint laxity, as well as hamstring and quadriceps strength, before (Tinitial), during and 3 min after (Tfinal) an isokinetic fatigue protocol (25 repetitions of knee flexion / extension at 180°.s−1). Laxity values (slope of the displacement-load curve and anterior tibial translation) were measured using a GNRB-Rotab® arthrometer; torque values were measured at specific joint angles and peak muscle torque using an isokinetic dynamometer. Nineteen women (20.9±2.4 years, 62.0±4.9 kg, 166±5 cm) were included. Normalized peak torque decreased significantly between the first three and last three repetitions of the fatigue protocol (p<0.0001, ES=3.2 and 3.2). Slope of the displacement-load curve and anterior tibial translation, functional and conventional ratios did not change significantly between Tinitial and Tfinal. Active and passive markers of knee stability were not altered by a fatigue protocol in female handball players, suggesting these players have a large capacity for recovery. These results suggest that muscle strengthening to prevent ACL injury in female handball players may be inappropriate.Level of evidence: Level 2b, Prospective Cohort.

Clinical Observations of Anterior Cruciate Ligament (ACL) Lesions in Patients with Chronic Fatigue

“…Some research has pointed that fatigue could cause acute ACL lesion [12][13][14][15][16][17][18][19][20][21][22][23] , but the de nition of ACL fatigue lesion has not been revealed completely from academic eld. Until 2013, Ashton-Miller 's biomechanical study based on knee model through donated human corpses has demonstrated that repetitive pressure-applying jump is likely to cause ACL fatigue damage, but Miller 's research is only limited in biomechanical eld, not involved with clinical research [24][25] .…”

Mobile Applications in Evaluations of Knee Joint Kinematics: A Pilot Study

“…This study’s salience lies in the fact that maintaining a proper trajectory is a pre-condition for the correct function of the knee joint in many life and sports activities [53]. Furthermore, all deviations from the correct knee joint trajectory signal possible joint instability [53,54] or dissynergy of muscle activities that affect the joint [55], which could be caused by fatigue [56]. Because precise motor control and being able to feel and indicate a joint’s position are crucial elements determining proper knee function, we decided to assess patients’ ability to return to flexion of 60° degrees, the speed used when re-establishing this angle, and we tested patients for any deviations from proper flexion path.…”

Risk factors of young males with physically demanding occupations having accumulated damage of anterior cruciate ligament

“…Some research has pointed out that fatigue could cause acute ACL lesion, [14][15][16][17][18][19][20][21][22] but the definition of ACL accumulated damage has not been revealed entirely from the academic field. Not until 2013 did Ashton-Miller's biomechanical study based on a knee model demonstrate through human cadavers that repetitive pressure jumping could lead to cruciate ligament non-contact injury.…”