ACL Rehab

Mentoring Minutes: ACL Rehab and Single Leg Hopping

REFERENCE LINKS AND NOTES

2013 Jan;41(1):216-24. doi: 10.1177/0363546512459638. Epub 2012 Oct 5.
Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction.

Hewett TE1, Di Stasi SL, Myer GD.

ACL Tears/Re-tears:

  • Related most to:

    • Hip rotation control (IR), frontal plane knee motion during landing (adduction), sagittal plane knee moment asymmetries at initial contact (hamstring/quad contractions), postural stability deficits on surgical leg (trunk side bend, poor control);

  • Treatments:

    • Quadriceps strength- need to make sure > 90% compared to opposite side; emphasis on proper activation if needed (NMES)

    • Gait mechanics- need to make sure get back proper shock absorption at loading (moving from extension into flexion)

    • Loading: look at Drop jumps and SL jumping (tend to still land more on non surgical leg at 2 years out)

      • Need to train single leg

    • Large % of patients do not go back to same level of sports due to fear (kinesiophobia): use sport specifics when able

 

Orthop J Sports Med. 2017 Nov 14;5(11):. eCollection 2017 Nov.

SingleLeg Hop Test Performance and Isokinetic Knee Strength  After Anterior Cruciate Ligament Reconstruction in Athletes.

Sueyoshi T1, Nakahata A2, Emoto G2, Yuasa T2.

 

  • Looked at single-leg hop and isokinetic knee strength testing in athletes who underwent anterior cruciate ligament reconstruction (ACLR) upon returning to sport participation

  • The strongest correlation between the hop tests and knee strength was found between the total distance of the hop tests and flexion total work/body weight and between the timed 6-m hop test and flexion peak torque/body weight.

J Athl Train. 2016 Sep;51(9):669-681. Epub 2016 Oct 10.

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia.

Shimokochi Y1, Ambegaonkar JP2, Meyer EG3.

  • Looked at ground reaction force and tibiofemoral force vectors with changing single leg jump landing, using 3D kinetics and kinematics

  • Patients performed single leg landing using 1) self selected, 2) leaning forward on toes, and 3) body upright foot flat.

  • The upright foot flat landing: less time to peak tibial axis forces, smaller knee flexion angles, greater magnitude and anteriorly directed ground reaction force vector= greater peak tibial axial and anterior shear forces

  • The leaning forward and landing on toes: resulted in longer time to peak tibial axial forces, greater knee flexion angles, and reduced magnitude and a more posterior incline ground reaction force vector to the tibia = lowest peak tibial axial and largest posterior shear forces.

 

 

J Athl Train. 2017 Nov 20. doi: 10.4085/1062-6050-52.11.25. [Epub ahead of print]

Landing Kinematics and Kinetics at the Knee During Different Landing Tasks.

Heebner NR1, Rafferty DM2, Wohleber MF3, Simonson AJ3, Lovalekar M3, Reinert A4, Sell TC5.

 

  • Kinematic and kinetic analysis Comparing lower extremity biomechanics across 5 commonly used landing tasks: (double- and single-legged drop landing, double- and single-legged stop jump, and forward jump to single-legged landing)

  • Single-legged landings generated higher vertical GRF and lower peak knee-flexion values except for forward jump to single-legged landing, which had the lowest peak knee-flexion value and the second highest peak vertical GRF. The single-legged drop landing generated the highest vertical and posterior GRFs. Peak knee-valgus moment was higher during the double-legged drop landing

 

 

 

Extra Tests:

-       Star excursion balance test (Y test)

o   Risk for injury: Ant direction < 4cm, and total composite score < 94%

-       Landing Error Scoring System (LESS) (side and front views jumping off step)

o   Excellent 0-3, Score > 7 is poor

-       Noyes Hop tests

o   Single, Triple, cross over, 6 meter timed –need to stick landing for 2 seconds; > 90% compared to opposite side