Mapping current research trends on neuromuscular risk factors of non-contact ACL injury

Rafeeuddin, Radin; Sharir, Raihana; Staes, Filip; Dingenen, Bart; George, Keith; Robinson, Mark A.; Vanrenterghem, Jos

doi:10.1016/j.ptsp.2016.06.004

Cited by 12 publications

(10 citation statements)

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“…In fact, in the current and in all the previous laboratory studies, fatigue was never enough to induce a non-contact ACL injury: an inciting event must occur to trigger the causal pathway leading to ligamentous rupture ( Hewett et al, 2016 ). This could originate from external factors as an opponent’s feint or a cognitive perturbations, combined with weather and playing surface conditions ( Rafeeuddin et al, 2016 ; Bourne et al, 2019 ; Monfort et al, 2019 ; Della Villa et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention

Zago

David

Bertozzi

et al. 2021

Front. Bioeng. Biotechnol.

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BackgroundThe etiology of Anterior Cruciate Ligament (ACL) injury in women football results from the interaction of several extrinsic and intrinsic risk factors. Extrinsic factors change dynamically, also due to fatigue. However, existing biomechanical findings concerning the impact of fatigue on the risk of ACL injuries remains inconsistent. We hypothesized that fatigue induced by acute workload in short and intense game periods, might in either of two ways: by pushing lower limbs mechanics toward a pattern close to injury mechanism, or alternatively by inducing opposed protective compensatory adjustments.AimIn this study, we aimed at assessing the extent to which fatigue impact on joints kinematics and kinetics while performing repeated changes of direction (CoDs) in the light of the ACL risk factors.MethodsThis was an observational, cross-sectional associative study. Twenty female players (age: 20–31 years, 1st–2nd Italian division) performed a continuous shuttle run test (5-m) involving repeated 180°-CoDs until exhaustion. During the whole test, 3D kinematics and ground reaction forces were used to compute lower limb joints angles and internal moments. Measures of exercise internal load were: peak post-exercise blood lactate concentration, heart rate (HR) and perceived exertion. Continuous linear correlations between kinematics/kinetics waveforms (during the ground contact phase of the pivoting limb) and the number of consecutive CoD were computed during the exercise using a Statistical Parametric Mapping (SPM) approach.ResultsThe test lasted 153 ± 72 s, with a rate of 14 ± 2 CoDs/min. Participants reached 95% of maximum HR and a peak lactate concentration of 11.2 ± 2.8 mmol/L. Exercise duration was inversely related to lactate concentration (r = −0.517, p < 0.01), while neither%HRmax nor [La–]b nor RPE were correlated with test duration before exhaustion (p > 0.05). Alterations in lower limb kinematics were found in 100%, and in lower limb kinetics in 85% of the players. The most common kinematic pattern was a concurrent progressive reduction in hip and knee flexion angle at initial contact (10 players); 5 of them also showed a significantly more adducted hip. Knee extension moment decreased in 8, knee valgus moment increased in 5 players. A subset of participants showed a drift of pivoting limb kinematics that matches the known ACL injury mechanism; other players displayed less definite or even opposed behaviors.DiscussionPlayers exhibited different strategies to cope with repeated CoDs, ranging from protective to potentially dangerous behaviors. While the latter was not a univocal effect, it reinforces the importance of individual biomechanical assessment when coping with fatigue.

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Section: Discussionmentioning

confidence: 99%

Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention

Zago

David

Bertozzi

et al. 2021

Front. Bioeng. Biotechnol.

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“…To establish the risk factors for a specific injury, prospective studies with injury as primary outcome are needed. So far, many studies assessed neuromuscular and/or biomechanical changes after ACL injury or after intervention programs but very few prospective studies assessed ACL injury risk with ACL injury as primary outcome [6,7]. To date, only 4 prospective studies assessed neuromuscular risk factors for ACL injuries [8][9][10][11], and only 4 prospective studies assessed biomechanical risk factors [12][13][14][15], delivering contradictory outcomes.…”

Section: Introductionmentioning

confidence: 99%

Is knee neuromuscular activity related to anterior cruciate ligament injury risk? A pilot study

et al. 2019

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Background: Limited evidence exists on neuromuscular risk factors for anterior cruciate ligament injuries, with most work mainly focussing on the strength of hamstrings and quadriceps muscles. In this prospective pilot study, we explored if neuromuscular activation patterns of the quadriceps and hamstrings during a drop vertical jump influence anterior cruciate ligament injury risk.Methods: Forty-six female athletes performed a drop vertical jump at baseline. Injuries were monitored throughout a one year follow-up. Neuromuscular activation patterns of the vastus medialis, vastus lateralis, hamstrings medialis and hamstrings lateralis, and selected landing kinematic and kinetic profiles (knee flexion, knee abduction and hip flexion angles, and knee abduction moments), were compared between athletes who sustained a non-contact anterior cruciate ligament injury and those who remained injury-free. EMG vector fields were created to represent neuromuscular activation patterns of muscle pairs around the knee joint rather than only considering individual muscle activations, and compared using Statistical Parametric Mapping.Results: Four athletes sustained an anterior cruciate ligament injury. Significantly greater {hamstrings medialis, hamstrings lateralis}, {vastus lateralis, hamstrings lateralis} and {hamstrings lateralis, vastus medialis} activations, mainly due to greater hamstrings lateralis activation, were found in the injured group around peak loading and just before take off (P < 0.001). No group differences were found in knee flexion, knee abduction and hip flexion angles, or knee abduction moments.Conclusions: This pilot study revealed initial evidence that athletes already showed altered neuromuscular activation patterns prior to sustaining an anterior cruciate ligament injury, namely increased lateral and posterior muscle activations.

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Section: Resultsmentioning

confidence: 99%

“…We note that hamstring/quadriceps ratio is a noted risk factor for ACL injuries[ 32 ]. Hence, these muscle group are considered to be an important risk factors for an ACL injury[ 16 , 21 , 25 , 32 - 34 ]. Eccentric hamstring exercises such as Russian/Nordic exercises should be incorporated as it has been proven to increase hamstring/quadriceps strength ratio and improve eccentric hamstring torque and isometric strength[ 18 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs

Trojian¹,

Driban²,

Nuti³

et al. 2017

WJO

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AIMTo identify best practice features of an anterior cruciate ligament (ACL) and lower limb injury prevention programs (IPPs) to reduce osteoarthritis (OA).METHODSThis consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubMed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading (MeSH) and keywords for terms: (1) ACL OR “knee injury” OR “anterior cruciate ligament”; (2) “prevention and control” OR “risk reduction” OR “injury prevention” OR “neuromuscular training”; and (3) meta-analysis OR “systematic review” OR “cohort study” OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.RESULTSThe best practice features of an IPP have the following six components: (1) lower extremity and core strengthening; (2) plyometrics; (3) continual feedback to athletes regarding proper technique; (4) sufficient dosage; (5) minimal-to-no additional equipment; and (6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement. Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.CONCLUSIONBest practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.

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Mapping current research trends on neuromuscular risk factors of non-contact ACL injury

Abstract: Mapping current research trends on neuromuscular risk factors of noncontact ACL injury.http://researchonline.ljmu.ac.uk/4214/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively.

Cited by 12 publications

References 59 publications

Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention

Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention

Is knee neuromuscular activity related to anterior cruciate ligament injury risk? A pilot study

Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs

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