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Viswanathan VK, Vaishya R, Iyengar KP, Jain VK, Vaish A. Strategies for preventing anterior cruciate ligament injuries in athletes: Insights from a scoping review. J Orthop 2025; 67:101-110. [PMID: 39911228 PMCID: PMC11791312 DOI: 10.1016/j.jor.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 12/29/2024] [Accepted: 01/01/2025] [Indexed: 02/07/2025] Open
Abstract
Background and aims Anterior cruciate ligament (ACL) injuries significantly impact young athletes, leading to long-term physical, psychological, and socioeconomic consequences. There is an urgent need to develop effective preventive strategies. This scoping review aims to evaluate modifiable and non-modifiable risk factors for ACL injuries and assess existing preventive strategies. Methods A comprehensive literature search was performed on November 20, 2024, across databases including Embase, PubMed, Web of Science, Google Scholar, and Cochrane Library. Articles published between 2000 and 2024 focusing on ACL injury prevention were included, while editorial content, non-clinical studies, and non-English publications were excluded. Results The search yielded 322 articles, narrowing down to 94 after deduplication. After title screening, 46 studies progressed to full review, ultimately leading to the inclusion of 14 relevant manuscripts. Key findings indicate that ACL injuries result from various factors, with female athletes being 2.2 times more susceptible. Genetic predispositions linked to collagen-related SNPs and biomechanical patterns, such as landing techniques and knee positioning, were identified as significant contributors. Effective preventive programs integrated strength training, neuromuscular training, and advanced technology, including wearable devices and video analysis. Conclusion The study reinforces the importance of a personalized, multifaceted approach to ACL injury prevention, focusing on risk stratification and optimizing training strategies alongside technological advancements. Implementing these strategies can significantly mitigate the risk of ACL injuries in high-risk populations.
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Affiliation(s)
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
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Bartsch A, Sherman SL, Tramer J, Vel MS, Fredericson M. Preserving Knee Health and Delivering Specialized Care for Active Older Athletes. Sports Health 2025:19417381251326527. [PMID: 40145656 PMCID: PMC11951129 DOI: 10.1177/19417381251326527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2025] Open
Abstract
CONTEXT Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population. EVIDENCE ACQUISITION Nonsystematic review with critical appraisal of existing literature. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy. CONCLUSION With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.
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Affiliation(s)
- Anna Bartsch
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
- Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Redwood City, California
- Department of Orthopedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Seth Lawrence Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Joseph Tramer
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Garfield Heights, Ohio
| | - Monica Sri Vel
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
- Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Redwood City, California
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Mercurio M, Cerciello S, Corona K, Guerra G, Simonetta R, Familiari F, Galasso O, Gasparini G. Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players. Orthop J Sports Med 2024; 12:23259671241275663. [PMID: 39430117 PMCID: PMC11490974 DOI: 10.1177/23259671241275663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 10/22/2024] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR. Purpose To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR. Study Design Cohort study; Level of evidence, 3. Methods A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale. Results After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score (P = .013), IKDC (P = .003), total KOOS (P < .001), KOOS Symptoms (P = .004), KOOS Pain (P = .029), KOOS Activities of Daily Living (ADL) (P = .044), KOOS Sport and Recreation (Sport/Rec) (P = .001), KOOS Quality of Life (QoL) (P < .001), and Lysholm score (P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores (P = .003), total KOOS (P = .001), and KOOS Sport/Rec (P = .011). Playing only on artificial turf was associated with lower Lysholm score (P = .018) and total KOOS (P = .014). The contact mechanism was associated with higher IKDC (P = .044) and KOOS QoL (P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores (P = .012). Playing at a nonprofessional level was associated with lower total KOOS (P = .028), KOOS Symptoms (P = .002), KOOS ADL (P = .033), and KOOS Sport/Rec (P = .016). Conclusion Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Simone Cerciello
- Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences “Vincenzo Tiberio,” University of Molise, Campobasso, Italy
- Regional Sports School of Italian National Olympic Committee (CONI), Molise, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences “Vincenzo Tiberio,” University of Molise, Campobasso, Italy
| | - Roberto Simonetta
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Clinica Ortopedica Department, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Sa), Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
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Shibata S, Kodai S, Takemura M. The effect of a basketball game on balance ability: A study using a dual task paradigm. J Bodyw Mov Ther 2023; 36:343-348. [PMID: 37949582 DOI: 10.1016/j.jbmt.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sports activity can affect balance ability, increasing injury risk. Single session of acute exercise can also alter cognitive function, potentially linked to balance ability. In this study, we examined the changes in cognitive function and static and dynamic balance abilities before and after the basketball game, and a dual-task was used to evaluate static balance ability. METHOD We measured the rating of perceived exertion (RPE), static and dynamic balance ability, and cognitive function in 12 male university basketball players before and after basketball game. We compared the differences in each measurement before and after the game using a t-test and examined the correlation between RPE, cognitive function, and balance ability. RESULTS We found RPE and cognitive function increased after the game. However, static balance ability in the dual-task and dynamic balance ability did not change before and after the game. Positive correlation found pre-RPE with SC-total and DO-locus length, and SEBT-ANT. Negative correlation found post-RPE with SEBT-PL, and positive correlation found ΔRPE with DO-peripheral area. DISCUSSION To enhance post-game balance ability, it is crucial to assess pre-game RPE for each player. Also, the understanding game-induced load is imperative as high post-game RPE negatively affects static and dynamic balance ability. Therefore, game load management strategies must be employed to ensure optimal balance ability. CONCLUSION Because RPE before and after a basketball game is related to balance ability after the game, it is important to understand the amount of load on the players.
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Affiliation(s)
- Satoshi Shibata
- Ibaraki Prefectural University of Health Sciences, Department of Physical Therapy, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan.
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Dalvandpour N, Zareei M, Abbasi H, Abdoli B, Mohammadian MA, Rommers N, Rössler R. Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial. J Strength Cond Res 2023; 37:337-342. [PMID: 36696258 DOI: 10.1519/jsc.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.
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Affiliation(s)
- Nazanin Dalvandpour
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mostafa Zareei
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Hamed Abbasi
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Sciences in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | | | - Nikki Rommers
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland; and
| | - Roland Rössler
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Romanchuk NJ, Livock H, Lukas KJ, Del Bel MJ, Benoit DL, Carsen S. Protocol for the systematic review of return-to-activity criteria in adolescent patients following an anterior cruciate ligament reconstruction. Syst Rev 2022; 11:93. [PMID: 35568927 PMCID: PMC9107732 DOI: 10.1186/s13643-022-01965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a debilitating knee injury associated with sequela such as joint instability and progressive degeneration. Unfortunately, following surgical ACL reconstruction in adolescents, the rates of ACL graft failure range from 17 to 19%. A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return-to-activities (RTA) postoperatively. Several systematic reviews have already sought to develop a consensus on what criteria should be utilized for releasing patients to unrestricted sports activities; however, these reviews have focused on adult populations, a group at much lower risk for reinjury. Our objective is to systematically examine the literature and identify the criteria used when determining unrestricted RTA following an ACL reconstruction in an adolescent population. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search will be performed of the MEDLINE/PubMed, Cochrane, Embase, CINAHL, and SPORTDiscus electronic databases. Searches will be conducted from January 1, 2000, until submission of the final review. Studies will be identified that include adolescent patients (10-18 years old) undergoing a primary ACL reconstruction and which have specified the criteria used to determine RTA. Each article will be independently screened by two reviewers. To supplement the electronic database search, citations within all included studies will be manually reviewed. Reviewers will record the RTA assessment utilized and the rates of ACL reinjury through a standardized data extraction sheet. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the most commonly used types of RTA criteria. DISCUSSION This systematic review will determine the most commonly used RTA criteria in adolescent patients post-ACL reconstruction. This will help future interventions build more effective adolescent-specific RTA assessments through the validation of current RTA criteria as well as the implementation of new criteria according to the identified literature gaps.
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Affiliation(s)
- Nicholas J. Romanchuk
- Ottawa Carleton Institute for Biomedical Engineering, University of Ottawa, 800 King Edward Ave., Ottawa, ON K1N 6N5 Canada
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, K1H 8L1 Canada
| | - Kenneth J. Lukas
- Trinity College, University of Dublin, College Green, Dublin 2, Dublin, Ireland
| | - Michael J. Del Bel
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Daniel L. Benoit
- Ottawa Carleton Institute for Biomedical Engineering, University of Ottawa, 800 King Edward Ave., Ottawa, ON K1N 6N5 Canada
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- School of Human Kinetics, University of Ottawa, 125 University, Ottawa, ON K1N 6N5 Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, K1H 8L1 Canada
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Chen J. CARDIOVASCULAR RESPONSE OF ATHLETES UNDER DIFFERENT TRAINING CONDITIONS. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228012021_0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Improving cardiovascular function is one of the main training goals of many sports. Objective: To understand the characteristics of the cardiovascular response of athletes under different training conditions. Methods: Thirty male basketball students were enrolled. The subjects were divided into A and B groups according to their years of training, with 15 students in each group. Exercise fatigue tests were performed, starting at a low intensity and gradually increasing the load to a relatively high degree of fatigue. Results: The RMSSD value was 42.82±31.41ms in group A and 46.48±35.26ms in group B undera low fatigue state. The LF/HF value of the athletes in group A was 2.86±1.47 and the LF/HF value of the athletes in group B was 2.94±1.68. The RMSSD value was 40.78±31.17ms and 32.37±36.42ms for groups A and B, respectively, undera high fatigue state. Conclusions: Athletes with more years of training can mobilize more cardiac reserves to meet the increase in exercise load in a fatigue state and have better autonomic nervous regulation in the process of reaching a higher degree of fatigue state. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Nishizawa K, Hashimoto T, Hakukawa S, Nagura T, Otani T, Harato K. Effects of foot progression angle on kinematics and kinetics of a cutting movement. J Exp Orthop 2022; 9:11. [PMID: 35041099 PMCID: PMC8766617 DOI: 10.1186/s40634-022-00447-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Foot progression angle is a key factor for biomechanical knee load, which is associated with noncontact anterior cruciate ligament (ACL) injury during sports-specific tasks. The purpose of the present study was to assess the biomechanics of trunk, pelvis, and lower extremities during a cutting maneuver under different foot progression angles. Methods Nineteen male collegiate athletes (ages 18–24) participated in the present study. Cutting motion was analyzed using eight infrared cameras (250 Hz), two force plates (1250 Hz), and 44 reflective markers. Subjects performed 45-degree side cutting maneuvers under three foot progression angles, including 20 degrees (toe-out: TO), 0 degrees (neutral: TN), and − 20 degrees (toe-in: TI). Peak values of each biomechanical parameters in trunk, pelvis, hip, and knee within a first 40% stance phase and each parameter at the timing of the peak vertical ground reaction force were assessed. A statistical analysis was performed to compare data among the three-foot progression angles using the Friedman test. Results Peak angles of knee abduction, tibial internal rotation, hip internal rotation, and hip adduction were significantly greater for TI position than for TO position (p < 0.01). Peak moments of knee abduction and tibial internal rotation under TI position were also significantly larger than TO position (p < 0.01). Moreover, greater peak pelvis-trunk rotation was found for TI position than for TN and TO positions (p < 0.01). Conclusion From the present study, TI position could lead to an increased risk of ACL injury during a pre-planned cut maneuver, compared to TO position.
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Affiliation(s)
- Kohei Nishizawa
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa, Kanagawa, 252-0883, Japan.
| | - Takeshi Hashimoto
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa, Kanagawa, 252-0883, Japan.,Sports Medicine Research Center, Keio University, Yokohama, Kanagawa, Japan
| | - Satoshi Hakukawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Toshiro Otani
- International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Giesche F, Vieluf S, Wilke J, Engeroff T, Niederer D, Banzer W. Cortical Motor Planning and Biomechanical Stability During Unplanned Jump-Landings in Males With ACL-Reconstruction. J Athl Train 2021; 57:547-556. [PMID: 35969662 PMCID: PMC9387379 DOI: 10.4085/1062-6050-0544.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletes with anterior cruciate ligament (ACL) reconstruction exhibit increased cortical motor planning during simple sensorimotor tasks compared to healthy controls. This may interfere with proper decision-making during time-constrained movements elevating the re-injury risk. OBJECTIVE To compare cortical motor planning and biomechanical stability during jump-landings between participants with ACL-reconstruction and healthy individuals. DESIGN Cross-sectional exploratory study. SETTING Laboratory patients or other participants: Ten males with ACL-reconstruction (28±4 yrs., 63±35 months post-surgery) and 17 healthy males (28±4 yrs.) completed pre-planned (landing leg shown before take-off; n=43±4) and unplanned (visual cue during flight; n=51±5) countermovement-jumps with single-leg-landings. MAIN OUTCOME MEASURES Movement-related cortical potentials (MRCP) and frontal theta frequency power before the jump were analyzed using electroencephalography. MRCP were subdivided into three successive 0.5 sec epochs (readiness potential 1 and 2; RP and negative slope; NS) relative to movement onset (higher values indicative of more motor planning). Theta power was calculated for the last 0.5 sec prior to movement onset (higher values indicative of more focused attention). Biomechanical landing stability was measured via vertical peak ground reaction force, time to stabilization, and center of pressure. RESULTS Both conditions evoked MRCP at all epochs in both groups. During the unplanned condition, the ACL-reconstructed group exhibited slightly, but not significantly higher MRCP (RP-1:p=0.651, d=0.44, RP-2:p=0.451, d=0.48; NS:p=0.482, d=0.41). The ACL-reconstructed group also showed slightly higher theta power values during the pre-planned (p=0.175, d=0.5) and unplanned condition (p=0.422, d=0.3) reaching small to moderate effect sizes. In none of the biomechanical outcomes, both groups differed significantly (p>0.05). No significant condition and group interactions occurred (p>0.05). CONCLUSIONS Our jump-landing task evoked MRCP. Although not significant between groups, the observed effect sizes provide first indication that males with ACL-reconstruction may persistently rely on more cortical motor planning associated with unplanned jump-landings. Confirmatory studies with larger sample sizes are warranted. TRIAL REGISTRY clinicalTrials.gov (NCT03336060).
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Affiliation(s)
| | | | - Jan Wilke
- *Goethe University, Frankfurt am Main, Germany
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Orejel Bustos A, Belluscio V, Camomilla V, Lucangeli L, Rizzo F, Sciarra T, Martelli F, Giacomozzi C. Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques. SENSORS (BASEL, SWITZERLAND) 2021; 21:2438. [PMID: 33916269 PMCID: PMC8037357 DOI: 10.3390/s21072438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.
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Affiliation(s)
- Amaranta Orejel Bustos
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Valeria Belluscio
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Valentina Camomilla
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Leandro Lucangeli
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Francesco Rizzo
- Joint Veterans Defence Center, Army Medical Center, 00184 Rome, Italy; (F.R.); (T.S.)
| | - Tommaso Sciarra
- Joint Veterans Defence Center, Army Medical Center, 00184 Rome, Italy; (F.R.); (T.S.)
| | - Francesco Martelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00161 Rome, Italy;
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00161 Rome, Italy;
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Bisciotti GN, Eirale C, Corsini A, Baudot C, Saillant G, Chalabi H. Return to football training and competition after lockdown caused by the COVID-19 pandemic: medical recommendations. Biol Sport 2020; 37:313-319. [PMID: 32879554 PMCID: PMC7433324 DOI: 10.5114/biolsport.2020.96652] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023] Open
Abstract
The lockdown caused by the COVID-19 pandemic represents a great unknown regarding the physiological changes induced in elite football players. Although it will differ from country to country, the return to sport for professional football players will follow a forced lockdown never experienced and longer than the normal annual season break. Moreover, in addition to an obvious decrease in performance, the lockdown will possibly lead to an increase of the injury risk. In fact, preseason is always a period with a specific football injury epidemiology, with an increase in the incidence and prevalence of overuse injuries. Therefore, it seems appropriate to recommend that specific training and injury prevention programmes be developed, with careful load monitoring. Training sessions should include specific aerobic, resistance, speed and flexibility training programmes. The aerobic, resistance and speed training should respect some specific phases based on the progressiveness of the training load and the consequent physiological adaptation response. These different phases, based on the current evidence found in the literature, are described in their practical details. Moreover, injury prevention exercises should be incorporated, especially focusing on overuse injuries such as tendon and muscle lesions. The aim of this paper is to provide practical recommendations for the preparation of training sessions for professional footballers returning to sport after the lockdown.
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Affiliation(s)
| | - Cristiano Eirale
- Paris Saint Germain FC, France
- Aspetar Sports and Orthopedics Hospital, Doha, Qatar
| | | | | | | | - Hakim Chalabi
- Paris Saint Germain FC, France
- Aspetar Sports and Orthopedics Hospital, Doha, Qatar
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12
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Jamaludin NI, Sahabuddin FNA, Raja Ahmad Najib RKM, Shamshul Bahari MLH, Shaharudin S. Bottom-Up Kinetic Chain in Drop Landing among University Athletes with Normal Dynamic Knee Valgus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124418. [PMID: 32575511 PMCID: PMC7344677 DOI: 10.3390/ijerph17124418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023]
Abstract
The study investigated the influence of ankle strength and its range of motion (ROM) on knee kinematics during drop landing. Fifteen male and fifteen female university athletes with a normal range of dynamic knee valgus (DKV) (knee frontal plane projection angle: men = 3° to 8°, females = 7° to 13°) were recruited. They performed drop landing at height 30 cm and 45 cm with three-dimensional motion capture and analysis. Knee angles were compared at specific landing phases. Isokinetic ankle strength was tested at 60°/s angular velocity while the weight-bearing lunge test was conducted to evaluate ankle ROM. For males, strength for both plantarflexors and dorsiflexors were associated with knee kinematics at both heights (30 cm: r = −0.50, p = 0.03; 45 cm: r = −0.45, p = 0.05) during maximum vertical ground reaction force (MVGRF) phase. For females, ankle invertor strength and knee kinematics were associated at both 30cm (r = 0.53; p = 0.02,) and 45 cm landing heights (r = 0.49, p = 0.03), while plantarflexor strength and knee kinematics showed a significant association during initial contact (r = 0.70, p < 0.01) and MVGRF (r = 0.55, p = 0.02) phases at height 30 cm only. Male and female athletes with normal range of DKV showed a significant relationship between ankle strength and knee kinematics at specific landing phases. These relationships varied with increased landing height.
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Affiliation(s)
- Nazatul Izzati Jamaludin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (N.I.J.); (F.N.A.S.); (R.K.M.R.A.N.); (M.L.H.S.B.)
| | - Farhah Nadhirah Aiman Sahabuddin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (N.I.J.); (F.N.A.S.); (R.K.M.R.A.N.); (M.L.H.S.B.)
| | - Raja Khairul Mustaqim Raja Ahmad Najib
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (N.I.J.); (F.N.A.S.); (R.K.M.R.A.N.); (M.L.H.S.B.)
- Department of Mathematics and Science Education, Faculty of Education, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Muhamad Lutfi Hanif Shamshul Bahari
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (N.I.J.); (F.N.A.S.); (R.K.M.R.A.N.); (M.L.H.S.B.)
| | - Shazlin Shaharudin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (N.I.J.); (F.N.A.S.); (R.K.M.R.A.N.); (M.L.H.S.B.)
- Correspondence:
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13
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Niederer D, Giesche F, Janko M, Niemeyer P, Wilke J, Engeroff T, Stein T, Frank J, Banzer W, Vogt L. Unanticipated jump-landing quality in patients with anterior cruciate ligament reconstruction: How long after the surgery and return to sport does the re-injury risk factor persist? Clin Biomech (Bristol, Avon) 2020; 72:195-201. [PMID: 31901699 DOI: 10.1016/j.clinbiomech.2019.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inadequate reactions to unforeseen external stimuli are regarded as a major cause for non-contact anterior cruciate ligament (ACL) injuries. We aimed to delineate a potential deficit in the ability to perform unanticipated jump-landing manoeuvres, its sustainability and potential as a new outcome measure after ACL-reconstruction. METHODS Physically active adults (n = 27, 13 females, 14 males, 29.7 standard deviation 3.1 years) with a history of unilateral ACL rupture and subsequent reconstruction (6 months to 7 years ago), cleared for return to sports, were included. All participants performed counter-movement jumps with unanticipated single leg landings. Visual information shown after jump take-off indicated the required landing leg. Jump time [s] and successfulness [yes/no], vertical peak ground reaction forces at landing [N], as well as time to stabilisation after landing [s] and path length of the centre of pressure (CoP, [mm]) were calculated. Limb symmetry ratios were determined and analysed for their association with the time since surgery. FINDINGS Time since ACL reconstruction was logarithmically (basis 10) associated with side symmetry improvements in peak ground reaction force (R2 = 0.23, p < .01) and time to stabilisation (R2 = 0.18, p < .01) during and after landing in unanticipated/unpredictable single-leg jump landing tasks. The asymmetry found persists up to 18-26 months post-surgery. INTERPRETATION A deficit in unanticipated jump-landing ability seems to persist far beyond surgical restoration of mechanical stability and resumption of initial physical activities levels. The assessment of the ability to suddenly adapt movements to unanticipated visual stimuli may be a relevant complementary component within current functional testing canon in monitoring therapy success and return to sport testing.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany.
| | - Florian Giesche
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Maren Janko
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Philipp Niemeyer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Tobias Engeroff
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sport Traumatology-, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
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14
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Niemeyer P, Niederer D, Giesche F, Janko M, Frank J, Vogt L, Banzer W. Unanticipated jump-landing after anterior cruciate ligament reconstruction: Does unanticipated jump-landing testing deliver additional return to sport information to traditional jump performance tests? Clin Biomech (Bristol, Avon) 2019; 70:72-79. [PMID: 31408765 DOI: 10.1016/j.clinbiomech.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to delineate if unanticipated jump-landing assessments delivers complementary information to those of commonly used hop and jump tests after anterior cruciate ligament reconstruction. METHODS Eleven participants (5 males) performed a series of unanticipated jump-landings and traditional hop and jump performance tests (single leg hops for distance, triple crossover hops for distance and drop jumps). The number of mistrials, time to stabilization and peak ground reaction force (pGRF) at landing and jump/hop distance were measured. Pearson correlations to find potential associations between the unanticipated jump-landing-values and the traditional jump/hop performance tests were calculated twice: once for the affected and once for the unaffected legs. t-Tests for dependent samples were used to detect differences between affected and unaffected leg within each test condition. FINDINGS The pGRF at unanticipated landing significantly correlated to the pGRF at drop jump landing (r = 0.68) and the hopping distance after the triple crossover hops (r = 0.71, each p < .05). No other significant correlation occurred (p > .05). Hopping distance after single leg hops (mean: 110.2 cm vs. 95.5 cm) and triple crossover hops for distance (mean: 315.3 cm vs. 294.2 cm) showed significant differences between the unaffected and the reconstructed leg (p < .05). Other parameters showed no significant between-legs differences (p > .05). INTERPRETATION Both, the reconstructed and the contralateral leg seems to be affected. Unanticipated jump landing tasks deliver information beyond those of commonly used jump and hop tests, the thereby assessed abilities may thus be a complementary aspect of dynamic knee function than those assessed with classic tests.
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Affiliation(s)
- Philipp Niemeyer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany.
| | - Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany; Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Florian Giesche
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Maren Janko
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
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15
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Limroongreungrat W, Boonkerd C. Immediate effect of ACL kinesio taping technique on knee joint biomechanics during a drop vertical jump: a randomized crossover controlled trial. BMC Sports Sci Med Rehabil 2019; 11:32. [PMID: 31737276 PMCID: PMC6844057 DOI: 10.1186/s13102-019-0144-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
Background The purpose of this study was to investigate the effect of an ACL Kinesio Taping technique (ACL-KT) on knee joint biomechanics during a drop vertical jump (DVJ). Methods Twenty healthy male participants (age 21.1±0.3 years; mass 64.2±4.3 kg; height 174.2±5.5 cm) participated in this study. The participants performed a DVJ and landed onto 2 adjacent force platforms under both ACL-KT and placebo (PT) conditions. All data were collected with 3-D motion analysis and comparison peak knee joint angles and moments, and knee joint angle at initial contact (IC) between conditions analyzed using a paired sample t-test. Statistical parametric mapping (SPM) was selected to assess difference between groups for the entire three-component knee trajectory during the contact phase. Results ACL-KT had a significant effect on decreasing knee abduction angle at IC (1.43±2.12 deg.) compared with the PT (-1.24±2.42 deg.) (p=0.04). A significant difference in knee abduction angle between the taping conditions was found between 100 ms before IC, at IC and 100 ms after IC (p<0.05). There were no significant differences (p>0.05) found between conditions in any of the other variables. Conclusion This result confirmed that the application of ACL-KT is useful to reduce knee abduction angle at IC during a DVJ in healthy participants. Therefore, ACL-KT may be an acceptable intervention to reduce ACL injury risk. Trial registration Retrospective registered on 25 September 2018. Trial number: TCTR20180926005.
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Affiliation(s)
- Weerawat Limroongreungrat
- 1College of Sports Science and Technology, Mahidol University, Puthamonthon 4 Road, Nakhon Pathom, 73170 Thailand
| | - Chuanpis Boonkerd
- 2Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
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16
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Boonkerd C, Limroongreungrat W. ACL kinesio taping on knee joint biomechanics during a drop vertical jump in healthy young adults. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Niederer D, Willberg C, Kruse A, Exler N, Giesche F, Vogt L, Banzer W. Acute effects of preventive warm-up exercises on modifiable risk factors for anterior cruciate ligament injuries: a three-arm randomized-controlled crossover trial. J Sports Med Phys Fitness 2019; 60:92-101. [PMID: 31663311 DOI: 10.23736/s0022-4707.19.09949-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to compare the potential acute effects of single bouts of a classic prevention and a risk factor-focus training aiming to target modifiable anterior cruciate ligament (ACL) rupture risk factors and the impact of neuromuscular fatigue on relevant ACL rupture risk factors. METHODS Two preventive warm-up (standard and ACL rupture risk factor training) and one inactive arm were compared; each of these were followed by a standardized neuromuscular fatigue protocol. The assessments included two Trail making tests (TMT-A; TMT-B, time to complete), drop jump landings (knee separation distance, normalized at hip width), as well as unanticipated counter movement jump landings (time to stabilization and peak ground reaction force). RESULTS We included 18 participants (25±2years). No differences were found between times and conditions for TMT (P>0.05). A significant time effect occurred in time to stabilization (F=2.6; P<0.05) and a significant time*baseline-value*jumping time interaction was seen in peak ground reaction force (F=3.1; P<0.05). No time effect was found for any knee separation distance (F=.1-2.4; P>0.05); but a significant time*baseline-value*jumping time interaction was seen at initial ground contact (F=2.8; P<0.05), and lowest point (F=4.2; P<0.01). CONCLUSIONS Risk factor-focus and classic warm-up may not differ in their acute effects on modifiable functional ACL (re-)injury risks factors.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University, Frankfurt, Germany -
| | - Christina Willberg
- Department of Sports Medicine, Goethe University, Frankfurt, Germany.,Department of Movement and Training Science, Goethe University, Frankfurt, Germany
| | - Adele Kruse
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Nicola Exler
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Florian Giesche
- Department of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Winfried Banzer
- Department of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
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18
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Ireton MR, Till K, Weaving D, Jones B. Differences in the Movement Skills and Physical Qualities of Elite Senior and Academy Rugby League Players. J Strength Cond Res 2019; 33:1328-1338. [DOI: 10.1519/jsc.0000000000002016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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Brunner R, Friesenbichler B, Casartelli NC, Bizzini M, Maffiuletti NA, Niedermann K. Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review. Br J Sports Med 2019; 53:282-288. [PMID: 30201793 DOI: 10.1136/bjsports-2017-098944] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes. DESIGN Umbrella review. DATA SOURCES A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review. STUDY ELIGIBILITY CRITERIA Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes. RESULTS Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries. SUMMARY/CONCLUSION Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.
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Affiliation(s)
- Romana Brunner
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | | | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
- Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | | | - Karin Niedermann
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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20
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Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. A Review of Field-Based Assessments of Neuromuscular Control and Their Utility in Male Youth Soccer Players. J Strength Cond Res 2019; 33:283-299. [PMID: 28658071 DOI: 10.1519/jsc.0000000000002069] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Read, PJ, Oliver, JL, Croix, MS, Myer, GD, and Lloyd, RS. A review of field-based assessments of neuromuscular control and their utility in male youth soccer players. J Strength Cond Res 33(1): 283-299, 2019-Lower-extremity injuries in male youth soccer are common and equate to a substantial time loss from training and competitions during the course of a season. Extended periods of absence will impact player involvement in skill and physical development activities, as well as participation in competitive match play. Neuromuscular risk factors for lower-extremity injury in male youth soccer players can be categorized into quadriceps dominance, leg dominance, ligament dominance, trunk dominance, and reduced dynamic stability. Valid screening methods to identify risk factors that are practically viable are needed for youth athletes who may be at a greater risk of injury in soccer. Although field-based tests of neuromuscular control provide a reliable option for the assessment of injury risk in adults and females, less data are available in male youth soccer players, and further research is required to examine their ability to predict injury risk. This article provides a review of the current literature pertaining to field-based screening tests and critically appraises their suitability for use with male youth soccer players. Currently, the only method that has been validated in male youth soccer players is the landing error scoring system. Asymmetrical anterior reach measured during the Y-Balance test may also be considered because of its strong predictive ability in male youth basketball players; however, further research is required to fully support its use with soccer players.
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Affiliation(s)
- Paul J Read
- School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom.,Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jon L Oliver
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, United Kingdom.,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | | | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,The Micheli Center for Sports Injury Prevention, Boston, Massachusetts.,Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhodri S Lloyd
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, United Kingdom.,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand.,Center for Sport Science and Human Performance, Waikato Institute of Technology, New Zealand
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21
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Meehan WP, Weisskopf MG, Krishnan S, McCracken C, Zafonte R, Taylor HA, Baggish A, Pascual-Leone A, Nadler LM, Speizer FE. Relation of Anterior Cruciate Ligament Tears to Potential Chronic Cardiovascular diseases. Am J Cardiol 2018; 122:1879-1884. [PMID: 30282598 DOI: 10.1016/j.amjcard.2018.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 02/04/2023]
Abstract
We have enrolled a cohort of former National Football League players (n = 3,506) who played since 1960 to assess potential long term health consequences associated with participating in the sport. Each participant has completed a self-administered questionnaire including reporting of physician-diagnosed health conditions. One of the early assessments was to evaluate whether anterior cruciate ligament (ACL) tears were associated with later life co-morbidities, including cardiovascular effects. We used Cox proportional hazards to estimate hazard ratios (HR) for joint replacement surgeries, myocardial infarction, sleep apnea, arthritis, dementia, and stroke by history of ACL tear during their professional career. For additional outcomes without date of occurrence reported we used logistic regression to estimate odds ratios adjusted for potential confounding variables in all models. After adjusting for covariates, former National Football League players who tore their ACL had approximately a twofold increase in muscular skeletal co-morbidities, including knee joint replacement and arthritis, compared with those without ACL tears. In addition, those with a history of ACL tears also had more than a 50% increased risk of myocardial infarction (HR 1.52; 95% confidence interval 0.97 to 2.38) and a slight increase in sleep apnea (HR 1.15; 95% confidence interval 0.96 to 1.38). ACL tears sustained by athletes may increase the risk of co-morbidities beyond the musculoskeletal system. As there are more than 100,000 ACL reconstructions annually in the United States, our findings could have widespread public health importance if these findings generalize to a population beyond professional football players. In conclusion, enhanced screening for other risk factors for these conditions in patients who have torn their ACL might identify those who could most benefit from prevention strategies.
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Affiliation(s)
- William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Supriya Krishnan
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Caitlin McCracken
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts; Cardiovascular Research Institute, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Berenson-Allen Center and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Dana Farber Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Environmental Health and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts.
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22
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Xu J, Zhou X, Guo X, Wang G, Fu S, Zhang L. Effects of Unilateral Electroacupuncture on Bilateral Proprioception in a Unilateral Anterior Cruciate Ligament Injury Model. Med Sci Monit 2018; 24:5473-5479. [PMID: 30082677 PMCID: PMC6094982 DOI: 10.12659/msm.909508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury can cause knee proprioception degeneration, on which the electroacupuncture (EA) treatment has a definite effect. However, it is still not clear whether conducting EA intervention on the injured side can promote bilateral proprioception recovery. MATERIAL AND METHODS We randomly selected 6 of 9 normal cynomolgus monkeys to develop unilateral ACL injury models via arthroscopy. All knees were divided into 5 groups: the normal control (NC) group, injured side of blank model (ISBM) group, contralateral side of blank model (CSBM) group, injured side of EA (ISE) group, and contralateral side of EA (CSE) group. Ten days after modeling, the monkeys in the EA group were treated with EA daily for 6 weeks at the acupoints. At 6 weeks, the 5 groups were examined by electrophysiology (SEPs and MCV). The ACL was separated to conduct the gold chloride staining for morphology observation and count the number of total and variant proprioceptors. RESULTS At 6 weeks, the latent period of the SEPs and MCV and the number of variant proprioceptors in the blank model group and the EA group were increased compared with the NC group, while the amplitude and the number of total proprioceptors were decreased. The changes in the ISBM and CSBM group were more remarkable than in the ISE and CSE group. All differences were statistically significant (P<0.05). CONCLUSIONS Unilateral ACL injury leads to bilateral proprioception degeneration, and the unilateral knee EA intervention can aid bilateral proprioception recovery.
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Affiliation(s)
- Jie Xu
- School of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xiaoguang Guo
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guoyou Wang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shijie Fu
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
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23
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Exercise-based injury prevention in football. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dello Iacono A, Ayalon M, Wang W. The influence of single-leg landing direction on lower limbs biomechanics. J Sports Med Phys Fitness 2018; 59:195-203. [PMID: 29619806 DOI: 10.23736/s0022-4707.18.08358-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The purpose of this study was to investigate whether different directions of single-leg landing tasks would influence lower limbs joints biomechanics. METHODS Using a controlled and experimental design, thirty physically active male subjects (age: 26.4±4.4 years; height: 180.5±3.7 cm; weight: 79.8:±4.4 kg), by dropping down from the top of a wooden box of 31 cm height, performed three one-leg landing tasks featured by different landing directions: frontward (FL), lateral (LL), and rotational (RL). The trunk and lower limbs` joints biomechanical responses were assessed through a laboratory setup consisting in a 6-camera motion capture system synchronized with force plates. A repeated measures one-way Analysis of Variance (ANOVA) was used to investigate the main effects of the landing directions on the lower limbs joints biomechanics during the main phases of interest of the landing tasks. RESULTS The results indicated two major findings: 1) FL resulted in an advantageous active whole-body configuration; 2) the lower limbs' joints adopted different and specific energy absorption strategies between the landing tasks. CONCLUSIONS This study indicates that the different landing tasks likely generate meaningful changes in in whole body biomechanics and specific lower limbs joints kinetic and kinematic responses. Such outcomes might be used by clinicians towards a practical approach in selecting either assessment modalities or exercise interventions.
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Affiliation(s)
| | - Moshe Ayalon
- Department of Life Science, The Academic College at Wingate, Tel Aviv, Israel
| | - Weijie Wang
- Institute of Motion Analysis and Research (IMAR), TORT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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25
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Alsalaheen B, Bean R, Almeida A, Eckner J, Lorincz M. Characterization of cervical neuromuscular response to head-neck perturbation in active young adults. J Electromyogr Kinesiol 2018; 39:70-76. [DOI: 10.1016/j.jelekin.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 01/17/2023] Open
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Mechanism of Activating the Proprioceptive NT-3/TrkC Signalling Pathway by Reverse Intervention for the Anterior Cruciate Ligament-Hamstring Reflex Arc with Electroacupuncture. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6348764. [PMID: 29581981 PMCID: PMC5822800 DOI: 10.1155/2018/6348764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/02/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022]
Abstract
The anterior cruciate ligament (ACL) is an important structure maintaining stability of the knee joints. Deficits in physical stability and the proprioceptive capabilities of the knee joints are observed, when the ACL is damaged. Additionally, a unilateral ACL injury can affect bilateral knee proprioception; therefore, proprioception of the ACL may play a key role in stability. Electroacupuncture therapy has a definite effect nerve regeneration. In this study, cynomolgus monkeys were randomly divided into 4 groups: the model control group, intervention of the injured knee with electroacupuncture (IIKE) group, intervention of the bilateral knees with electroacupuncture (IBKE) group, and the blank control group. The unilateral ACL injury model was developed in IIKE and IBKE groups; acupuncture points around the knees underwent intervention similarly in the IIKE and IBKE groups. Then, mRNA and protein expressions of NT-3 and TrkC in the dorsal root ganglion and of growth-associated protein-43 in the ACL increased according to reverse-transcription quantitative polymerase chain reaction and Western blotting results. Decreased incubations and increased amplitudes were found for somatosensory-evoked potentials and motor nerve conduction velocity. The finding indicates that electroacupuncture may play an important role in the recovery of proprioception in the ACL by activating the NT-3/TrkC signalling pathway.
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Trojian T, Driban J, Nuti R, Distefano L, Root H, Nistler C, LaBella C. Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs. World J Orthop 2017; 8:726-734. [PMID: 28979857 PMCID: PMC5605359 DOI: 10.5312/wjo.v8.i9.726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/04/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify best practice features of an anterior cruciate ligament (ACL) and lower limb injury prevention programs (IPPs) to reduce osteoarthritis (OA).
METHODS This 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.
RESULTS The 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.
CONCLUSION Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.
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Affiliation(s)
- Thomas Trojian
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Jeffrey Driban
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Rathna Nuti
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Lindsay Distefano
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Hayley Root
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cristina Nistler
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cynthia LaBella
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
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Herzberg SD, Motu'apuaka ML, Lambert W, Fu R, Brady J, Guise JM. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthop J Sports Med 2017; 5:2325967117718781. [PMID: 28795075 PMCID: PMC5524267 DOI: 10.1177/2325967117718781] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men. PURPOSE To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Searches were conducted using MEDLINE (1946-August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included athletic injuries, knee injuries, ligaments, joint instability, menstrual cycle, ovulation, hormones, and contraceptives. Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. RESULTS Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase. CONCLUSION The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.
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Affiliation(s)
- Simone D Herzberg
- Seattle Pacific University, Seattle, Washington, USA.,Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Makalapua L Motu'apuaka
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA
| | - William Lambert
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacqueline Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Leppänen M, Pasanen K, Kujala UM, Vasankari T, Kannus P, Äyrämö S, Krosshaug T, Bahr R, Avela J, Perttunen J, Parkkari J. Stiff Landings Are Associated With Increased ACL Injury Risk in Young Female Basketball and Floorball Players. Am J Sports Med 2017; 45:386-393. [PMID: 27637264 DOI: 10.1177/0363546516665810] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few prospective studies have investigated the biomechanical risk factors of anterior cruciate ligament (ACL) injury. PURPOSE To investigate the relationship between biomechanical characteristics of vertical drop jump (VDJ) performance and the risk of ACL injury in young female basketball and floorball players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At baseline, a total of 171 female basketball and floorball players (age range, 12-21 years) participated in a VDJ test using 3-dimensional motion analysis. The following biomechanical variables were analyzed: (1) knee valgus angle at initial contact (IC), (2) peak knee abduction moment, (3) knee flexion angle at IC, (4) peak knee flexion angle, (5) peak vertical ground-reaction force (vGRF), and (6) medial knee displacement. All new ACL injuries, as well as match and training exposure, were then recorded for 1 to 3 years. Cox regression models were used to calculate hazard ratios (HRs) and 95% CIs. RESULTS Fifteen new ACL injuries occurred during the study period (0.2 injuries/1000 player-hours). Of the 6 factors considered, lower peak knee flexion angle (HR for each 10° increase in knee flexion angle, 0.55; 95% CI, 0.34-0.88) and higher peak vGRF (HR for each 100-N increase in vGRF, 1.26; 95% CI, 1.09-1.45) were the only factors associated with increased risk of ACL injury. A receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.6 for peak knee flexion and 0.7 for vGRF, indicating a failed-to-fair combined sensitivity and specificity of the test. CONCLUSIONS Stiff landings, with less knee flexion and greater vGRF, in a VDJ test were associated with increased risk of ACL injury among young female basketball and floorball players. However, although 2 factors (decreased peak knee flexion and increased vGRF) had significant associations with ACL injury risk, the ROC curve analyses revealed that these variables cannot be used for screening of athletes.
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Affiliation(s)
- Mari Leppänen
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
| | - Kati Pasanen
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
| | - Urho M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Pekka Kannus
- Injury and Osteoporosis Research Center, UKK Institute, Tampere, Finland.,Medical School, University of Tampere, and Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Sami Äyrämö
- Department of Mathematical Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Janne Avela
- Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä, Finland
| | | | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
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30
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Read PJ, Oliver JL, de Ste Croix MBA, Myer GD, Lloyd RS. Reliability of the Tuck Jump Injury Risk Screening Assessment in Elite Male Youth Soccer Players. J Strength Cond Res 2016; 30:1510-6. [PMID: 26562715 DOI: 10.1519/jsc.0000000000001260] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Read, PJ, Oliver, JL, de Ste Croix, MBA, Myer, GD, and Lloyd, RS. Reliability of the tuck jump injury risk screening assessment in elite male youth soccer players. J Strength Cond Res 30(6): 1510-1516, 2016-Altered neuromuscular control has been suggested as a mechanism for injury in soccer players. Ligamentous injuries most often occur during dynamic movements, such as decelerations from jump-landing maneuvers where high-risk movement patterns are present. The assessment of kinematic variables during jump-landing tasks as part of a preparticipation screen is useful in the identification of injury risk. An example of a field-based screening tool is the repeated tuck jump assessment. The purpose of this study was to analyze the within-subject variation of the tuck jump screening assessment in elite male youth soccer players. Twenty-five pre-peak height velocity (PHV) and 25 post-PHV elite male youth soccer players from the academy of a professional English soccer club completed the assessment. A test-retest design was used to explore the within-subject intersession reliability. Technique was graded retrospectively against the 10-point criteria set out in the screening protocol using two-dimensional video cameras. The typical error range reported for tuck jump total score (0.90-1.01 in pre-PHV and post-PHV players respectively) was considered acceptable. When each criteria was analyzed individually, kappa coefficient determined that knee valgus was the only criterion to reach substantial agreement across the two test sessions for both groups. The results of this study suggest that although tuck jump total score may be reliably assessed in elite male youth soccer players, caution should be applied in solely interpreting the composite score due to the high within-subject variation in a number of the individual criteria. Knee valgus may be reliably used to screen elite youth male soccer players for this plyometric technique error and for test-retest comparison.
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Affiliation(s)
- Paul J Read
- 1School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom; 2Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 3Exercise and Sport Research Centre, School of Sport and Exercise, University of Gloucestershire, Gloucester United Kingdom; 4Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 5Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; 6The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 7Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; and 8Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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Read PJ, Oliver JL, Croix MBDS, Myer GD, Lloyd RS. Consistency of Field-Based Measures of Neuromuscular Control Using Force-Plate Diagnostics in Elite Male Youth Soccer Players. J Strength Cond Res 2016; 30:3304-3311. [PMID: 27075641 PMCID: PMC5053830 DOI: 10.1519/jsc.0000000000001438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Read, P, Oliver, JL, Croix, MD, Myer, GD, and Lloyd, RS. Consistency of field-based measures of neuromuscular control using force-plate diagnostics in elite male youth soccer players. J Strength Cond Res 30(12): 3304-3311, 2016-Deficits in neuromuscular control during movement patterns such as landing are suggested pathomechanics that underlie sport-related injury. A common mode of assessment is measurement of landing forces during jumping tasks; however, these measures have been used less frequently in male youth soccer players, and reliability data are sparse. The aim of this study was to examine the reliability of a field-based neuromuscular control screening battery using force-plate diagnostics in this cohort. Twenty-six pre-peak height velocity (PHV) and 25 post-PHV elite male youth soccer players completed a drop vertical jump (DVJ), single-leg 75% horizontal hop and stick (75%HOP), and single-leg countermovement jump (SLCMJ). Measures of peak landing vertical ground reaction force (pVGRF), time to stabilization, time to pVGRF, and pVGRF asymmetry were recorded. A test-retest design was used, and reliability statistics included change in mean, intraclass correlation coefficient, and coefficient of variation (CV). No significant differences in mean score were reported for any of the assessed variables between test sessions. In both groups, pVGRF and asymmetry during the 75%HOP and SLCMJ demonstrated largely acceptable reliability (CV ≤ 10%). Greater variability was evident in DVJ pVGRF and all other assessed variables, across the 3 protocols (CV range = 13.8-49.7%). Intraclass correlation coefficient values ranged from small to large and were generally higher in the post-PHV players. The results of this study suggest that pVGRF and asymmetry can be reliably assessed using a 75%HOP and SLCMJ in this cohort. These measures could be used to support a screening battery for elite male youth soccer players and for test-retest comparison.
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Affiliation(s)
- Paul J Read
- 1School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom; 2Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 3School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom; 4Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio; 5Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; 6The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 7Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; and 8Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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Lundblad M, Waldén M, Hägglund M, Ekstrand J, Thomeé C, Karlsson J. No Association Between Return to Play After Injury and Increased Rate of Anterior Cruciate Ligament Injury in Men's Professional Soccer. Orthop J Sports Med 2016; 4:2325967116669708. [PMID: 27830159 PMCID: PMC5089321 DOI: 10.1177/2325967116669708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Studies have shown that previous injury, not necessarily anatomically related, is an important injury risk factor. However, it is not known whether a player runs an increased risk of anterior cruciate ligament (ACL) injury after returning to play from other injury types. PURPOSE To analyze whether professional soccer players are more susceptible to ACL injury after returning to play from any previous injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 101 elite male soccer players suffering a first-time complete ACL injury between 2001 and 2014 were included and matched according to team, age, and playing position with control players who did not have a current injury (1:1 match). For each injured player, the 90-day period prior to the ACL injury was analyzed for injuries and compared with that of control players by using odds ratios (ORs) and 95% CIs. RESULTS The odds of a player with an ACL injury sustaining a previous injury in the 90-day period did not differ significantly from that of controls (OR, 1.20; 95% CI, 0.66-2.17; P = .65). Testing the frequency of absence periods due to injury between the groups revealed that the odds of a player with an ACL injury having a previous period of absence due to injury did not differ compared with controls (OR, 1.14; 95% CI, 0.64-2.01; P = .77). CONCLUSION Players with ACL injury did not have a greater occurrence of absence due to injury in the 3 months preceding their ACL injury compared with matched controls. This indicates that previous injury of any type does not increase the risk of suffering an ACL injury.
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Affiliation(s)
- Matilda Lundblad
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.; Football Research Group, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping University, Linköping, Sweden.; Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Football Research Group, Linköping University, Linköping, Sweden.; Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Ekstrand
- Football Research Group, Linköping University, Linköping, Sweden.; Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.; Football Research Group, Linköping University, Linköping, Sweden
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Hrysomallis C. Neck Muscular Strength, Training, Performance and Sport Injury Risk: A Review. Sports Med 2016; 46:1111-24. [DOI: 10.1007/s40279-016-0490-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Kay J, de Sa D, Karlsson J, Musahl V, Ayeni OR. Anterior Cruciate Ligament Rupture: A Family Affair. Orthop J Sports Med 2016; 3:2325967115616783. [PMID: 26740954 PMCID: PMC4687833 DOI: 10.1177/2325967115616783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jeffrey Kay
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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35
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Stuelcken MC, Mellifont DB, Gorman AD, Sayers MGL. Mechanisms of anterior cruciate ligament injuries in elite women's netball: a systematic video analysis. J Sports Sci 2015; 34:1516-22. [PMID: 26644060 DOI: 10.1080/02640414.2015.1121285] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player's behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as "indirect contact" and eight as "non-contact". Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player's landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.
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Affiliation(s)
- Max C Stuelcken
- a School of Health and Sport Sciences , University of the Sunshine Coast , Maroochydore , Australia
| | - Daniel B Mellifont
- a School of Health and Sport Sciences , University of the Sunshine Coast , Maroochydore , Australia
| | - Adam D Gorman
- a School of Health and Sport Sciences , University of the Sunshine Coast , Maroochydore , Australia
| | - Mark G L Sayers
- a School of Health and Sport Sciences , University of the Sunshine Coast , Maroochydore , Australia
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Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research Retreat VII: An Update on Anterior Cruciate Ligament Injury Risk Factor Identification, Screening, and Prevention. J Athl Train 2015; 50:1076-93. [PMID: 26340613 PMCID: PMC4641546 DOI: 10.4085/1062-6050-50.10.06] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Anne Benjaminse
- The Department of Human Movement Sciences, University of Groningen, and The School of Sports Studies, Hanze University, Groningen, The Netherlands
| | - Malcolm Collins
- Department of Human Biology, University of Cape Town, South Africa
| | - Kevin Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Anthony S. Kulas
- Department of Health Education and Promotion, Eastern Carolina University, Greenville, NC
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