- Email: [email protected]
Risk management during cutting maneuvers: How movement strategies predetermine the risk of an ACL injury
ABSTRACTS - GOTS-KONGRESS Sports Orthop. Traumatol. 33, 166–218 (2017)
International Knee Documentation Committee Subjective Form (IKDC). Differences between the operated and non-operated leg as well as between the legs of both groups were analysed with the FDA approach. Additionally, the means of the maximum torque, work per repetition, average power, and time as well as angle at the maximum torque were analysed with the T-test for paired and unpaired samples. Result: Within both groups, the maximum torque during knee extension was lower in the operated compared to the non-operated leg (High IKDC OP vs. nOP: 2.06 0.56, 2.19 0.54 Nm/kg, p=0.007; low IKDC OP vs. nOP: 1.80 0.53, 1.98 0.62 Nm/kg; p=0.044). Moreover, in the non-operated leg, the maximum torque occurred earlier during knee flexion in the low IKDC-group (0.34 0.07%) than in the HighIKDC-group (0.41 0.10%, p=0.028). In the FDA, the mean curves of the torques exhibit higher asymmetries in the low IKDC-group during knee extension and flexion as well as lower values in the low IKDCgroups overall. However, no significant differences during the extension and flexion were present in the FDA. Both FDA and CDA revealed only few significant isokinetic torque differences within and between patients of different subjective knee function during knee extension and flexion. The within differences in the maximum torque during knee extension were characteristically in patients with a patella tendon graft. Overall, the FDA derived mean torque curves may be helpful to identify long-term muscle adaptations, especially in patients with low subjective knee function. However, in both approaches individually torque characteristics of the patients (e.g. trial-to-trial differences) get lost.
196
Keywords: Asymmetry, rehabilitation, strength http://dx.doi.org/10.1016/j. orthtr.2017.03.046
HT02-51 Risk management during cutting maneuvers: How movement strategies predetermine the risk of an ACL injury S. David1, I. Komnik1, M. Peters1, W. Potthast1, W. Potthast2 1
Deutsche Sporthochschule Ko¨ln, Institut fu¨r Biomechanik und Orthopa¨die, Ko¨ln, Germany 2
ARCUS Kliniken, Pforzheim, Germany
Pforzheim,
E-Mail: [email protected] Objectives: Approximately 70% of anterior cruciate ligament (ACL) injuries occur in non-contact situations during cutting and landing maneuvers. Parameters such as footstrike patterns and trunk orientation were found to govern ACL relevant knee loading. However, the relationship between the whole body movement and injury risk is debated. Risk factors are defined to be an increased knee valgus moment in combination of increased knee internal rotation moments at a knee flexion angle between 08 and 308. Additionally, increased muscle forces of the quadriceps muscle lead to a further increase of ACL relevant knee joint loading. This study identifies whole body movement strategies that increase injury risk and provides training recommendations to reduce this risk or enable a save return to sports after injury. Methods: Three-dimensional movement analysis was used to investigate 50 participants performing 908
cutting maneuvers. A detailed AnyBody Model was used to calculate the kinematics and kinetics in an inverse dynamics approach. To identify and characterize movement strategies, footstrike pattern, knee valgus moment, knee internal rotation moment, the muscle force of mus. vastus lateralis and medialis, the anterior-posterior angle of attack, and the position of the shoulder and pelvis axis were calculated and subsequently analyzed using statistical parametric mapping. Result: Three different movement strategies were identified. One strategy included rearfoot (RF) striking in combination with a relatively upright body position which generated higher knee joint loads than the second strategy, forefoot (FF) striking in combination with more backwards leaning and preorientation of the trunk. A third strategy combined forefoot striking with less preorientation (FF_straight) which increased the ACL relevant knee joint load compared to the second strategy. Additionally, the RF and the FF_straight group exhibit a faster increase in the muscle forces of the quadriceps muscles which is suspected to further increase the load on the ACL. The identified movement strategies clearly pre-determine the injury risk during non-contact situations. The third strategy is identified to be the most unfavorable strategy as it generates high loads on the ACL and at the same time, forefoot striking is suspected to increase the risk for ankle joint injuries. Compared to focusing on isolated parameters, the analysis of the whole body movement allowed for detailed separation of more risky from less risky cutting strategies. These results give practical recommendations for the prevention of ACL injury. Moreover, in inexperienced athletes
ABSTRACTS - GOTS-KONGRESS Sports Orthop. Traumatol. 33, 166–218 (2017)
or those returning after an injury, the safer strategies should be aimed. Keywords: ACL injury, Movement Strategy, Knee joint load, Return to play http://dx.doi.org/10.1016/j. orthtr.2017.03.047
HT02-10 Pra¨ventives hochreaktives Training bei jugendlichen Fußballspielern mit dem SpeedCourtSystem G. Fieseler1, T. Bartels2, S. Proeger2, K. Brehme2, M. Pyschik2, S. Schulze3, K.-S. Delank4, R. Schwesig3 1
Sektion fu¨r Schulterchirurgie & Sportorthopa¨die, Helios Klinikum Warburg, Warburg/Westfalen, Germany 2
Sportsclinic Germany
Halle,
Halle/Saale,
3
Labor fu¨r Experimentelle Orthopa¨die und Sportmedizin, Dep.fu¨r Orthopa¨die, Unfall- und Wiederherstellungschirurgie, Halle/Saale, Germany
4
Dep.fu¨r Orthopa¨die, Unfall- und Wiederherstellungschirurgie, Halle/ Saale, Germany E-Mail: [email protected] Fragestellung: Trotz bestehender multipler Pra¨ventionsprogramme stellen Knie- und Sprunggelenksverletzungen im Fußball weiterhin ein ernstes Problem dar. Mit einer Trainingsstudie sollte bei jugendlichen Fußballern stichprobenartig ein neuer Interventionsansatz mittels hochreaktivem Training durch das SpeedCourt System hinsichtlich seiner Wirksamkeit u¨berpru¨ft werden.
Methodik: 24 ma¨nnliche Fußballer (A-Jugend, Alter: 18,00,7 Jahre) einer Regionalligamannschaft fu¨hrten wa¨hrend der Spielsaison u¨ber einen Zeitraum von 7 Wochen sieben Trainingseinheiten (TE) mit dem SpeedCourt (Erwa¨rmung 15 min, hochreaktives Training 30 min) durch. Vor und nach dem Trainingsprogramm erfolgte die sportmotorische Testung der Spieler (Counter Movement Jump [CMJ], Shuttle run, Tapping, 10-Sekunden-Lauf). Ergebnisse und Schlussfolgerung: Ergebnisse: In allen Testparametern wurden in der einfaktoriellen, univariaten Varianzanalyse signifikante Verbesserungen festgestellt (2 >0,10, range 2=0,106 [Bodenkontaktzeit rechts] und 2=0,730 [Reaktionszeit rechts]). Es fanden sich keine relevanten Korrelationen (r2>0,5) zwischen den Tests und Parametern. Die Anzahl verletzungsinduzierender Unfa¨lle reduzierte sich im definerten Zeitraum um ca. 50%. Schlussfolgerung: Hochreaktives Training mit dem SpeedCourt System verbessert deutlich die Schnelligkeits- und Schnellkraftleistungen jugendlicher Fußballer. Dies ist insbesondere vor dem Hintergrund der sehr geringen Reizdichte (1 TE/Woche) bemerkenswert. Schlu¨sselwo¨rter: Verletzungspra¨vention, Fußball, SpeedCourt http://dx.doi.org/10.1016/j. orthtr.2017.03.048
HT02-71 A Critical Analysis of Limb Symmetry Indices of Hop Tests in Athletes After Anterior Cruciate Ligament Reconstruction A. Gokeler1, W. Welling2, A. Benjaminse3, K. Lemmink1, R. Seil4, S. Zaffagnini5
1
Center for Human Movement Sciences. University of Groningen, Groningen, Netherlands 2
Center for Human Movement Sciences. University of Groningen, Medisch Centrum Zuid, Groningen, Groningen, Netherlands 3
Center for Human Movement Sciences. University of Groningen, Hanze University Applied Science, Groningen, Netherlands Departement de l’Appareil Locomoteur, Centre Hospitalier, Sports Medicine Research Laboratory, Luxemburg, Luxembourg
4
5
Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy E-Mail: [email protected] Objectives: Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). It is common use to calculate a limb symmetry index (LSI) defined as hop test performance of the involved limb/hop test performance of the uninvolved limb x 100%. Given that bilateral deficits are present after ACLR, this may result in a falsely high LSI, since LSI is calculated as a ratio between the values of the limbs. The purpose of the current study was therefore to compare the results of 3 different hop tests in patients after ACLR to normative data of healthy athletes. Methods: Fifty-two patients who had undergone an ACLR participated in this study. There were 38 male patients (mean age 23.9 3.5 yrs) and 14 female patients (mean age 21.73.5 years). Patients performed the single hop for distance (SLH), triple leg hop for distance (TLH) and side hop (SH) at mean
197
International Knee Documentation Committee Subjective Form (IKDC). Differences between the operated and non-operated leg as well as between the legs of both groups were analysed with the FDA approach. Additionally, the means of the maximum torque, work per repetition, average power, and time as well as angle at the maximum torque were analysed with the T-test for paired and unpaired samples. Result: Within both groups, the maximum torque during knee extension was lower in the operated compared to the non-operated leg (High IKDC OP vs. nOP: 2.06 0.56, 2.19 0.54 Nm/kg, p=0.007; low IKDC OP vs. nOP: 1.80 0.53, 1.98 0.62 Nm/kg; p=0.044). Moreover, in the non-operated leg, the maximum torque occurred earlier during knee flexion in the low IKDC-group (0.34 0.07%) than in the HighIKDC-group (0.41 0.10%, p=0.028). In the FDA, the mean curves of the torques exhibit higher asymmetries in the low IKDC-group during knee extension and flexion as well as lower values in the low IKDCgroups overall. However, no significant differences during the extension and flexion were present in the FDA. Both FDA and CDA revealed only few significant isokinetic torque differences within and between patients of different subjective knee function during knee extension and flexion. The within differences in the maximum torque during knee extension were characteristically in patients with a patella tendon graft. Overall, the FDA derived mean torque curves may be helpful to identify long-term muscle adaptations, especially in patients with low subjective knee function. However, in both approaches individually torque characteristics of the patients (e.g. trial-to-trial differences) get lost.
196
Keywords: Asymmetry, rehabilitation, strength http://dx.doi.org/10.1016/j. orthtr.2017.03.046
HT02-51 Risk management during cutting maneuvers: How movement strategies predetermine the risk of an ACL injury S. David1, I. Komnik1, M. Peters1, W. Potthast1, W. Potthast2 1
Deutsche Sporthochschule Ko¨ln, Institut fu¨r Biomechanik und Orthopa¨die, Ko¨ln, Germany 2
ARCUS Kliniken, Pforzheim, Germany
Pforzheim,
E-Mail: [email protected] Objectives: Approximately 70% of anterior cruciate ligament (ACL) injuries occur in non-contact situations during cutting and landing maneuvers. Parameters such as footstrike patterns and trunk orientation were found to govern ACL relevant knee loading. However, the relationship between the whole body movement and injury risk is debated. Risk factors are defined to be an increased knee valgus moment in combination of increased knee internal rotation moments at a knee flexion angle between 08 and 308. Additionally, increased muscle forces of the quadriceps muscle lead to a further increase of ACL relevant knee joint loading. This study identifies whole body movement strategies that increase injury risk and provides training recommendations to reduce this risk or enable a save return to sports after injury. Methods: Three-dimensional movement analysis was used to investigate 50 participants performing 908
cutting maneuvers. A detailed AnyBody Model was used to calculate the kinematics and kinetics in an inverse dynamics approach. To identify and characterize movement strategies, footstrike pattern, knee valgus moment, knee internal rotation moment, the muscle force of mus. vastus lateralis and medialis, the anterior-posterior angle of attack, and the position of the shoulder and pelvis axis were calculated and subsequently analyzed using statistical parametric mapping. Result: Three different movement strategies were identified. One strategy included rearfoot (RF) striking in combination with a relatively upright body position which generated higher knee joint loads than the second strategy, forefoot (FF) striking in combination with more backwards leaning and preorientation of the trunk. A third strategy combined forefoot striking with less preorientation (FF_straight) which increased the ACL relevant knee joint load compared to the second strategy. Additionally, the RF and the FF_straight group exhibit a faster increase in the muscle forces of the quadriceps muscles which is suspected to further increase the load on the ACL. The identified movement strategies clearly pre-determine the injury risk during non-contact situations. The third strategy is identified to be the most unfavorable strategy as it generates high loads on the ACL and at the same time, forefoot striking is suspected to increase the risk for ankle joint injuries. Compared to focusing on isolated parameters, the analysis of the whole body movement allowed for detailed separation of more risky from less risky cutting strategies. These results give practical recommendations for the prevention of ACL injury. Moreover, in inexperienced athletes
ABSTRACTS - GOTS-KONGRESS Sports Orthop. Traumatol. 33, 166–218 (2017)
or those returning after an injury, the safer strategies should be aimed. Keywords: ACL injury, Movement Strategy, Knee joint load, Return to play http://dx.doi.org/10.1016/j. orthtr.2017.03.047
HT02-10 Pra¨ventives hochreaktives Training bei jugendlichen Fußballspielern mit dem SpeedCourtSystem G. Fieseler1, T. Bartels2, S. Proeger2, K. Brehme2, M. Pyschik2, S. Schulze3, K.-S. Delank4, R. Schwesig3 1
Sektion fu¨r Schulterchirurgie & Sportorthopa¨die, Helios Klinikum Warburg, Warburg/Westfalen, Germany 2
Sportsclinic Germany
Halle,
Halle/Saale,
3
Labor fu¨r Experimentelle Orthopa¨die und Sportmedizin, Dep.fu¨r Orthopa¨die, Unfall- und Wiederherstellungschirurgie, Halle/Saale, Germany
4
Dep.fu¨r Orthopa¨die, Unfall- und Wiederherstellungschirurgie, Halle/ Saale, Germany E-Mail: [email protected] Fragestellung: Trotz bestehender multipler Pra¨ventionsprogramme stellen Knie- und Sprunggelenksverletzungen im Fußball weiterhin ein ernstes Problem dar. Mit einer Trainingsstudie sollte bei jugendlichen Fußballern stichprobenartig ein neuer Interventionsansatz mittels hochreaktivem Training durch das SpeedCourt System hinsichtlich seiner Wirksamkeit u¨berpru¨ft werden.
Methodik: 24 ma¨nnliche Fußballer (A-Jugend, Alter: 18,00,7 Jahre) einer Regionalligamannschaft fu¨hrten wa¨hrend der Spielsaison u¨ber einen Zeitraum von 7 Wochen sieben Trainingseinheiten (TE) mit dem SpeedCourt (Erwa¨rmung 15 min, hochreaktives Training 30 min) durch. Vor und nach dem Trainingsprogramm erfolgte die sportmotorische Testung der Spieler (Counter Movement Jump [CMJ], Shuttle run, Tapping, 10-Sekunden-Lauf). Ergebnisse und Schlussfolgerung: Ergebnisse: In allen Testparametern wurden in der einfaktoriellen, univariaten Varianzanalyse signifikante Verbesserungen festgestellt (2 >0,10, range 2=0,106 [Bodenkontaktzeit rechts] und 2=0,730 [Reaktionszeit rechts]). Es fanden sich keine relevanten Korrelationen (r2>0,5) zwischen den Tests und Parametern. Die Anzahl verletzungsinduzierender Unfa¨lle reduzierte sich im definerten Zeitraum um ca. 50%. Schlussfolgerung: Hochreaktives Training mit dem SpeedCourt System verbessert deutlich die Schnelligkeits- und Schnellkraftleistungen jugendlicher Fußballer. Dies ist insbesondere vor dem Hintergrund der sehr geringen Reizdichte (1 TE/Woche) bemerkenswert. Schlu¨sselwo¨rter: Verletzungspra¨vention, Fußball, SpeedCourt http://dx.doi.org/10.1016/j. orthtr.2017.03.048
HT02-71 A Critical Analysis of Limb Symmetry Indices of Hop Tests in Athletes After Anterior Cruciate Ligament Reconstruction A. Gokeler1, W. Welling2, A. Benjaminse3, K. Lemmink1, R. Seil4, S. Zaffagnini5
1
Center for Human Movement Sciences. University of Groningen, Groningen, Netherlands 2
Center for Human Movement Sciences. University of Groningen, Medisch Centrum Zuid, Groningen, Groningen, Netherlands 3
Center for Human Movement Sciences. University of Groningen, Hanze University Applied Science, Groningen, Netherlands Departement de l’Appareil Locomoteur, Centre Hospitalier, Sports Medicine Research Laboratory, Luxemburg, Luxembourg
4
5
Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy E-Mail: [email protected] Objectives: Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). It is common use to calculate a limb symmetry index (LSI) defined as hop test performance of the involved limb/hop test performance of the uninvolved limb x 100%. Given that bilateral deficits are present after ACLR, this may result in a falsely high LSI, since LSI is calculated as a ratio between the values of the limbs. The purpose of the current study was therefore to compare the results of 3 different hop tests in patients after ACLR to normative data of healthy athletes. Methods: Fifty-two patients who had undergone an ACLR participated in this study. There were 38 male patients (mean age 23.9 3.5 yrs) and 14 female patients (mean age 21.73.5 years). Patients performed the single hop for distance (SLH), triple leg hop for distance (TLH) and side hop (SH) at mean
197