How safe are partial squats after the anterior cruciate ligament reconstruction? A finite element analysis

Котюк, В.В.; Kostrub, Oleksandr; Blonskyi, R.I.; Podik, V.; Sushchenko, L.

doi:10.1016/j.knee.2023.06.014

Cited by 3 publications

(7 citation statements)

References 48 publications

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“…Considering available data from other studies on the influence of PTS on ACL stress and the risk of ACL damage [35] and taking into account the data on the increase in ACL stress with increasing PTS in the standing and semi-squatting positions [12,13], some impact of PTS was expected on the ACL and ACL graft TA B L E 2 Stress in some knee joint elements while weight bearing in Smith machine and conventional horizontal squats depending on the load conditions, posterior tibial slope (PTS) and the state of the anterior cruciate ligament (ACL) (native double-bundle ACL or single-bundle ACL graft).…”

Section: Discussionmentioning

confidence: 99%

“…This finding is relevant for meniscus suture rehabilitation, favouring Smith machine squats. However, similarly to the ACL, even in the case of the Smith machine squat, the half-squat is the most dangerous position when the meniscal stress exceeds the highest values in the deeper horizontal squat by at least several times [13].…”

Section: Discussionmentioning

confidence: 99%

“…The most important finding of the present study was a relatively low stress on the ACL and ACL graft at the lowest point of conventional horizontal squats (less than in half squats). Nevertheless, reaching this point is only possible through the half squat position, which is risky for the ACL graft because of the stresses 2.3‐4.6 times higher than standing with the knees extended [13].…”

Section: Discussionmentioning

confidence: 99%

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Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Kotiuk,

Ziółek,

Kostrub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to evaluate the impact of squats after the anterior cruciate ligament (ACL) reconstruction on the ACL graft, considering new data on biomechanics, posterior tibial slope (PTS) and anterolateral ligament (ALL).MethodsUtilising finite element analysis on the new 14‐component knee joint model, we have evaluated stresses on the knee elements separately for the knee with a native double‐bundle ACL and with a single‐bundle ACL graft for the 5° and 14° PTS variants during both conventional and Smith machine horizontal squats.ResultsReplacing a native ACL with a single‐bundle graft causes an overstrain on the graft compared to the intact ACL under all conditions. Stresses on the ACL, ACL graft and ALL are much higher during the Smith machine squats compared to the conventional ones. The stress on the menisci is 3.6–4.9 times higher with conventional squats. PTS at the squats' lowest point minimally affects ACL stress but impacts menisci.ConclusionsThe single‐bundle ACL reconstruction (ACLR) does not reproduce the biomechanics of the native ACL and increases stresses in most knee joint elements, according to the current study. Conventional squats are relatively safe for the ACL graft at their lowest point. Passing the half‐squat position is the most dangerous point. Smith machine horizontal squats produce stress on the ACL graft several times higher than its estimated breaking load and dangerous stress levels on the ALL. During the rehabilitation following ACLR, it is advisable to prioritise the conventional squats over Smith machine squats until ligamentisation is complete.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Kotiuk,

Ziółek,

Kostrub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Реабілітація спортсменів включає у себе підготовку до повернення до певних видів спорту. Але якщо вплив силових вправ на ПХЗ та її трансплантат ще хоч якось досліджений [11], то вплив на ПХЗ різноманітних ударів в ігрових видах спорту та в бойових мистецтвах майже не описаний і є справжньою білою плямою. Це особливо дивно з огляду як на популярність футболу в світі, так і на частоту власне розривів ПХЗ у цьому виді спорту [12].…”

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“…(2018) [18,19,20]. Це змушує нас переглянути уніфікованість підходів до термінів початку навантажень після пластики ПХЗ та їх інтенсивність [11,25].…”

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Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction

Kotiuk,

Kostrub,

Zasadniuk

et al. 2023

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Summary. The following factors influence the choice of rehabilitation program after anterior cruciate ligament (ACL) reconstruction. Surgical factors: peculiarities of the tunnels drilling, method and quality of graft fixation, presence and type of additional distal fixation, as well as the presence or absence of additional reinforcement, graft diameter, graft material and quality, graft suturing method, type of ACL repair (single- or double-bundle), and other elements of the surgery. Patient factors: compliance, psychological readiness to move on to the next phase of rehabilitation, goals and objectives set by the patient; age, type, and level of activity and physical condition of the patient; motivation, expectations of the patient, the preoperative experience of the patient in performing rehabilitation exercises, weight and height of the patient, body proportions, in particular of the lower limb segments (different lever lengths), rotational and axial allignment of the lower limb bones, posterior tibial plateau slope, intercondylar notch width and notch roof slope, condition of the anterolateral ligament and other knee joint stabilizers, muscle tone and strength in general and at the time of surgery in particular, range of motion in the knee and adjacent joints. Given the need to consider at least the above factors, there should not be a single rehabilitation protocol for ACL reconstruction. Only close cooperation between the surgeon, rehabilitologist and physical therapist allows for the fastest and safest rehabilitation of such patients. The patient's subjective feelings and their ability to perform specific exercises are not the criteria for deciding to proceed to the next rehabilitation phase. There is a certain limit, determined by the speed of biological processes in the body, which we cannot yet overcome. It is a good practice for the surgeon to fill out a patient's rehabilitation card immediately after the surgery, indicating the exercises, the time they should start, and the allowed loads.

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Impact of the deep squat on articular knee joint structures, friend or enemy? A scoping review

Rojas-Jaramillo,

Cuervo-Arango,

Quintero

et al. 2024

Front. Sports Act. Living

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BackgroundThe squat exercise has been shown to improve athletic performance. However, the use of the deep squat has been questioned due to claims that it may cause knee joint injuries. Therefore, the purpose of this scoping review was to synthesize existing literature concerning the impact of deep squats on knee osteoarticular health in resistance-trained individuals.MethodsThis study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. The original protocol was prospectively registered in Figshare (https://doi.org/10.6084/m9.figshare.24945033.v1). A systematic and exhaustive search was conducted in different databases: PubMed, Scopus, Web of Science, and SPORTDiscus. Additional searches were performed in Google Scholar and PEDro. The main inclusion criteria were the following: (1) Articles of experimental, observational, or theoretical nature, including randomized controlled trials, longitudinal studies, case reports, integrative reviews, systematic reviews, and meta-analyses(Primary studies were required to have a minimum follow-up duration of 6 weeks, whereas secondary studies were expected to adhere to PRISMA or COCHRANE guidelines or be registered with PROSPERO; (2) Peer-reviewed articles published between 2000 and 2024; (3) Publications written in English, Spanish and Portuguese; (4) Studies reporting the effects of deep half, parallel or quarter squats on the knee or evaluating squats as a predictor of injury.ResultsThe keyword search resulted in 2,274 studies, out of which 15 met all inclusion criteria. These 15 studies comprised 5 cohort studies, 3 randomized controlled trials, 4 literature or narrative reviews, 1 case study, and 2 systematic reviews, one including a meta-analysis. Overall, the risk of bias (ROB) across these studies was generally low. It is worth noting that only one study, a case study, associated deep squats with an increased risk of injury, the remaining 14 studies showed no negative impact of deep squats on knee joint health.ConclusionThe deep squat appears to be a safe exercise for knee joint health and could be included in resistance training programs without risk, provided that proper technique is maintained.

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How safe are partial squats after the anterior cruciate ligament reconstruction? A finite element analysis

Cited by 3 publications

References 48 publications

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction

Impact of the deep squat on articular knee joint structures, friend or enemy? A scoping review

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