Biomechanical Measures During Landing and Postural

Stability Predict Second Anterior Cruciate Ligament

Injury After Anterior Cruciate Ligament Reconstruction

and Return to Sport

Mark V. Paterno, PT, MS, SCS, ATC*†‡§‖¶,
Laura C. Schmitt, PT, PhD†‡§#,
Kevin R. Ford, PhD, FACSM†‡‖,
Mitchell J. Rauh, PT, PhD, MPH, FACSM¶,
Gregory D. Myer, MS, CSCS†‡,a,
Bin Huang, PhD†,b and
Timothy E. Hewett, PhD, FACSM†‡‖,c

+Author Affiliations

^†Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
^‡Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio
^§Division of Occupational Therapy and Physical Therapy, Cincinnati, Ohio
^‖Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
^¶Graduate Program in Orthopaedic and Sports Sciences, Rocky Mountain University of Health Professions, Provo, Utah
^#Department of Physical Therapy, Ohio State University, Columbus, Ohio
^aGraduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah
^bDepartment of Epidemiology and Biostatistics, Cincinnati, Ohio
^cDepartments of Orthopaedic Surgery, College of Medicine and the Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio and The Ohio State University

*Mark V. Paterno, PT, MS, SCS, ATC, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229 (e-mail: mark.paterno@cchmc.org).

Abstract

Background: Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes.

Hypotheses: Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.

Study Design: Cohort study (prognosis); Level of evidence, 2.

Methods: Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury.

Results: Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81).

Conclusion: Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.

Saturday, November 13, 2010