Hip and Knee Kinematics and Kinetics During Landing Tasks After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Lepley, Adam S.; Kuenze, Christopher

doi:10.4085/1062-6050-334-16

Cited by 66 publications

(80 citation statements)

References 82 publications

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“…In the passed-RTS group, despite appropriate improvement in the muscle strength and functional performance (LSI ≥ 90%), lower hip abduction angle was found compared to the healthy group. This result is consistent with previous studies that reported a tendency toward hip adduction during walking and landing in individuals with ACLR who returned to play [25, 32]. Research suggest an association between ACL injury and excessive hip adduction and internal rotation during multiplanar movement, e.g., landing [8, 33].…”

Section: Discussionsupporting

confidence: 92%

“…Hip abduction (mean diff = 4.5°), hip external rotation (mean diff = 5.6°), and ankle inversion (mean diff = 7.8°) were significantly lower in the failed-RTS group compared to the healthy group. Previous studies also reported significant differences between the ACLR and healthy groups in peak hip flexion [17, 24], hip abduction/adduction [25] and frontal plane knee motion [44]. Decreased hip abduction, external rotation and ankle inversion may increase tendency toward dynamic valgus phenomena in the initial phase of landing which is an important risk factor to ACL re-injury [8].…”

Section: Discussionmentioning

confidence: 99%

“…A 7-camera (240 Hz) motion analysis system (Qualysis, Gothenburg, Sweden) was used to capture the 3D position of 36 reflective markers attached to the participants’ lower extremity while they performed a bilateral jump-landing task. The landing task adopted in this study (see below) is a common test to investigate biomechanical landing safety in ACLR athletes [25]. The markers placed bilaterally on the specific anatomic landmarks of the feet, ankles, shanks, knees, thighs, and pelvis to track segments’ motion during each trial.…”

Section: Methodsmentioning

confidence: 99%

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Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria

Norouzi

Esfandiarpour

Mehdizadeh

et al. 2019

BMC Musculoskelet Disord

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BackgroundReturn to sport (RTS) criteria are widely being used to identify anterior cruciate ligament reconstructed (ACLR) athletes ready to return to sportive activity and reduce risk of ACL re-injury. However, studies show a high rate of ACL re-injury in athletes who passed RTS criteria. This indicates that the current RTS criteria might not be sufficient to determine return to sport time in ACLR athletes. Previous studies have reported a close association between altered lower limb kinematics and ACL re-injury. However, it is not clear how lower extremity kinematics differs between ACLR athletes who passed the RTS-criteria and who failed. This study compared lower extremity kinematics in a jump-landing task between ACLR athletes who passed the RTS criteria (Limb symmetry in hop tests, quadriceps strength and questionnaires) to those who failed and to the healthy individuals.MethodsParticipants were 27 male football players with unilateral ACLR including 14 who passed -RTS criteria and 13 failed, and 15 healthy football players. A 3D motion capture system recorded participants’ lower extremity motion while performing 10 trials of a bilateral jump-landing task. Hip, knee and ankle angular motion were examined at initial contact. Two-way mixed analysis of variances (2 limbs × 3 groups) and Bonferroni post-hoc tests were performed to compare the joint angles between the limbs and groups.Resultslower hip abduction angle was found in the failed (involved limb 4.1 ° ± 4.2) and passed RTS (involved limb 6.8° ± 3.3) groups compared to the healthy group (non-dominant limb 10.7° ± 3.7). Ankle inversion in the failed RTS (0.4° ± 4.9) group was significantly lower than both passed RTS (4.8° ± 4.8, p = 0.05) and healthy (8.2° ± 8.1, p < 0.001) groups. There were no significant differences between the groups in knee kinematics.ConclusionsOur findings indicate reduced hip abduction during initial contact phase of landing in athletes returned to sport. Reduced hip abduction during the complex multiplanar movement of jump-landing is a risk factor for ACL re-injury. Current RTS criteria may not be sufficient to identify ACLR athletes at high risk of re-injury. The kinematic analysis in conjunction with current RTS criteria can provide additional insight into the return to sport decision making.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria

Norouzi

Esfandiarpour

Mehdizadeh

et al. 2019

BMC Musculoskelet Disord

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“…Despite this limitation, the study sample size was in accordance with previous investigations that reported hip and knee kinetics and kinematics after ACL reconstruction and referred to sample sizes of between 11 and 35 patients. 21…”

Section: The Orthopaedic Journal Of Sports Medicinementioning

confidence: 99%

“…These include relying primarily on (1) follow-up assessments of <2 years, which miss the time frame of long-term maintenance of activities, and (2) heterogeneous study populations of mixed graft sources, multiple age groups, or both sexes for a reported outcome. 8,15,21 Because knee function after ACL reconstruction is affected by patient age, 16,18 duration of follow-up, graft source, 32,33,37,41 and sex, 2,8,13,19,30,37,40 greater specificity of patient demographics and surgical procedure has been recommended, 21 and longer follow-up is required to evaluate function specifically during the maintenance phase after surgery. Furthermore, since ACL reconstruction is particularly justifiable in the young adult age group (ie, 18-35 years), 36 5-to 10-year follow-up could represent an optimal time frame for assessing maintenance of sports activities beyond the short-term recovery.…”

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confidence: 99%

Symmetries in Muscle Torque and Landing Kinematics Are Associated With Maintenance of Sports Participation at 5 to 10 Years After ACL Reconstruction in Young Men

Hetsroni

Wiener

Ben‐Sira

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Long-term maintenance of sports participation is important for young men undergoing anterior cruciate ligament (ACL) reconstruction. Identifying biomechanical characteristics in patients who achieve this goal can assist in elaborating rehabilitation programs and in identifying successful recovery, but this has rarely been investigated. Purpose: To test the association between maintenance of sports participation at 5 to 10 years after ACL reconstruction and measures of force production and landing biomechanics in men. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 30 men who underwent isolated ACL reconstruction were examined. At 5- to 10-year follow-up, associations were tested between reported outcomes of sports maintenance and objective biomechanical measures. The biomechanical tests included isokinetic knee torque and lower limb kinetics and kinematics during landing tasks. Measurements for each limb were conducted separately, and side-to-side symmetry indices (SI) were calculated. Subgroups included SI greater than +10% (ie, extreme positive), SI lower than –10% (ie, extreme negative), and SI between –10% and +10% (ie, symmetric). Results: At follow-up, concentric knee torque in the operated limb correlated with Tegner and Marx scores ( r = 0.42-0.47; P ≤ .05). Regarding the SI of knee torque, the highest Tegner, Marx, and KOOS (Knee injury and Osteoarthritis Outcome Score) results were associated with symmetry, as opposed to patients with extreme positive or extreme negative SIs ( P < .05). As for landing kinematics, Tegner score negatively correlated with knee range of motion (ROM) in the operated limb ( r = –0.38; P ≤ .05). With regard to SI, hip and knee ROM correlated with Tegner, IKDC, and KOOS scores ( r = 0.41-0.51; P ≤ .05). Specifically, the highest sports participation levels were associated with achieving symmetric hip and knee ROM but also with extreme positive SIs, as opposed to patients with extreme negative SIs ( P < .03), indicating substantially higher ROM in the uninjured limb as compared with the operated limb. Conclusion: At 5 to 10 years after ACL reconstruction, maintenance of sports participation was associated with symmetric side-to-side concentric knee torque and with producing greater attenuation of hip and knee ROM during the drop jump landing in the operated limb. Therefore, eccentric load programs that can improve attenuation-phase kinematics during landing tasks may be valuable in addition to concentric training and may facilitate enhanced long-term outcomes.

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Passing return‐to‐sport criteria and landing biomechanics in young athletes following anterior cruciate ligament reconstruction

Losciale

Ithurburn

Paterno

et al. 2021

Journal Orthopaedic Research

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We sought to evaluate the sagittal plane knee joint loading patterns during a double-leg landing task among young athletes who passed or failed return-tosport (RTS) criteria following anterior cruciate ligament reconstruction reconstruction (ACLR), and in uninjured athletes. Participants completed quadriceps strength testing, a hop test battery, and the International Knee Documentation Committee subjective form following medical RTS clearance.ACLR participants "passed" RTS criteria (RTS-PASS) if they met ≥90 limb symmetry (%) or score on all measures and were categorized as "failing" (RTS-FAIL) if not. All participants completed three-dimensional motion analysis testing. Sagittal plane kinematic and kinetic variables were calculated during a double-leg drop vertical jump task. Mean limb values and limb symmetry indices (LSI; %) were calculated and compared using a one-way analysis of variance (ANOVA) (for LSI) and mixed between-within ANOVA (for group × limb differences). A total of 205 participants were included, with 39 in the RTS-PASS group, 109 in the RTS-FAIL group, and 57 control groups (CTRLs). The RTS-FAIL group demonstrated lower symmetry values for peak vertical ground reaction force, peak internal knee extension moment, and peak knee flexion angle. Group × limb interactions were observed for peak vertical ground reaction force and peak internal knee extension moment. Involved limb values were reduced in the RTS-PASS and RTS-FAIL groups compared to CTRLs, while the RTS-PASS groups had lower uninvolved limb values compared to the RTS-FAIL and CTRLs.

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Hip and Knee Kinematics and Kinetics During Landing Tasks After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Cited by 66 publications

References 82 publications

Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria

Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria

Symmetries in Muscle Torque and Landing Kinematics Are Associated With Maintenance of Sports Participation at 5 to 10 Years After ACL Reconstruction in Young Men

Passing return‐to‐sport criteria and landing biomechanics in young athletes following anterior cruciate ligament reconstruction

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