BackgroundAthletes 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.HypothesesProspective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.Study DesignCohort study (prognosis); Level of evidence, 2.MethodsFifty-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 regressi...

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined.Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations.Study Design: Case series; Level of evidence, 4.Methods: Six international experts performed visual inspection analyses of 39 videos (17 male and 22 female players) of anterior cruciate ligament injury situations from high school, college, and professional basketball games. Two predefined time points were analyzed: initial ground contact and 50 milliseconds later. The analysts were asked to assess the playing situation, player behavior, and joint kinematics.Results: There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group...

Mechanisms of Anterior Cruciate Ligament Injury in Basketball Video Analysis of 39 Cases

Background: Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability.Hypotheses: (1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury.Results...

Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk A Prospective Biomechanical-Epidemiologic Study

The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main aims of this narrative review are to describe the neuromuscular determinants of rate of force development and to discuss various methodological considerations inherent to its evaluation for research and clinical purposes. Rate of force development (1) seems to be mainly determined by the capacity to produce maximal voluntary activation in the early phase of an explosive contraction (first 50–75 ms), particularly as a result of increased motor unit discharge rate; (2) can be improved by both explosive-type and heavy-resistance strength training in different subject populations, mainly through an improvement in rapid muscle activation; (3) is quite difficult to evaluate in a valid and reliable way. Therefore, we provide evidence-based practical recommendations for rational quantification of rate of force development in both laboratory and clinical settings.

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Rate of force development: physiological and methodological considerations

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased “core” strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

Metabolic cost of submaximal running at constant speed is influenced by various factors including fatigue and kinematic characteristics. Metabolic costs typically drift upwards during extended running while stride characteristics often shift away from initial. When non-fatigued, experienced runners naturally optimize stride frequency in a manner that minimizes oxygen uptake. An initial objective was to determine whether runners demonstrate a similar self-optimizing capability when fatigued where stride characteristics have perhaps shifted away from the initial state. A secondary objective involved measurement of vertical and leg stiffness characteristics as a potential explanation for frequency changes with fatigue. We hypothesized that runners decrease stride frequency and stiffness with fatigue while optimizing these characteristics to minimize metabolic cost. Sixteen experienced runners completed a near maximal effort 1-h treadmill run at a constant speed. Preferred and optimal stride frequencies (PSF and OSF) were measured near the beginning and end of the hour run using frequencies ±4 and ±8% around PSF. From vertical force data recorded throughout the run, leg and vertical stiffness were determined. As expected, oxygen uptake significantly increased during the run from 45.9 to 47.4 ml kg−1 min−1 (P = 0.004). There was no difference between preferred and optimal stride frequencies at the beginning or the end of running (P = 0.978), however both PSF and OSF significantly decreased from 1.45 to 1.43 Hz (P = 0.026). All runners self-optimized stride frequency at the beginning and end of one-hour of running despite changes of optimal stride frequency. Stiffness and stride frequency changes were subject specific with some runners exhibiting little to no change. No clear relationship of frequency or stiffness changes to economy was found.

Preferred and optimal stride frequency, stiffness and economy: changes with fatigue during a 1-h high-intensity run.

DUTTO, D. J., and G. A. SMITH. Changes in spring-mass characteristics during treadmill running to exhaustion. Med. Sci. Sports Exerc., Vol. 34, No. 8, pp. 1324–1331, 2002.PurposeTo determine whether the stiffness characteristics of the leg change during a treadmill run to voluntary exhaustio

Changes in spring-mass characteristics during treadmill running to exhaustion.

Estimating 3D joint kinematics from video sequences of running and cutting maneuvers--assessing the accuracy of simple visual inspection.

In the golf instructional literature, the putting stroke is typically given higher priority than green reading and aiming. The main purpose of this study was to assess the importance of the putting stroke for direction consistency in golf putting. Kinematic stroke parameters were recorded from 71 elite golf players (mean handicap = 1.8, s = 4.2) on 1301 putts from about 4 m. Of the different factors deciding stroke direction consistency, face angle was found to be the most important (80%), followed by putter path (17%) and impact point (3%). This suggests that improvements in consistency of putter path and impact point will have very little effect on overall putting direction consistency and should not be prioritized in the training of elite players. In addition, mean stroke direction variability for an elite player (European Tour) was found to be 0.39 degrees, which is good enough to hole about 95% of all 4-m putts. In practice, however, top professionals in tournaments only hole about 17% of 4-m putts. We conclude that the putting stroke of elite golfers has a relatively minor influence on direction consistency.

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Gerald A. Smith

Papers

Mechanisms of Anterior Cruciate Ligament Injury in Basketball Video Analysis of 39 Cases

Preferred and optimal stride frequency, stiffness and economy: changes with fatigue during a 1-h high-intensity run.

Changes in spring-mass characteristics during treadmill running to exhaustion.

Estimating 3D joint kinematics from video sequences of running and cutting maneuvers--assessing the accuracy of simple visual inspection.

The stroke has only a minor influence on direction consistency in golf putting among elite players.