Can biomechanical testing after anterior cruciate ligament reconstruction identify athletes at risk forsubsequent ACL injury to the contralateral uninjured limb?

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King, Enda
Richter, Chris
Daniels, Katherine A. J.
Franklyn-Miller, Andy
Falvey, Éanna
Myer, Gregory D.
Jackson, Mark
Moran, Ray
Strike, Siobhan
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SAGE Publishing
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Background: Athletes are twice as likely to rupture the anterior cruciate ligament (ACL) on their healthy contralateral knee than the reconstructed graft after ACL reconstruction (ACLR). Although physical testing is commonly used after ACLR to assess injury risk to the operated knee, strength, jump, and change-of-direction performance and biomechanical measures have not been examined in those who go on to experience a contralateral ACL injury, to identify factors that may be associated with injury risk. Purpose: To prospectively examine differences in biomechanical and clinical performance measures in male athletes 9 months after ACLR between those who ruptured their previously uninjured contralateral ACL and those who did not at 2-year follow-up and to examine the ability of these differences to predict contralateral ACL injury. Study Design: Case-control study; Level of evidence, 3.Methods:A cohort of male athletes returning to level 1 sports after ACLR (N = 1045) underwent isokinetic strength testing and 3-dimensional biomechanical analysis of jump and change-of-direction tests 9 months after surgery. Participants were followed up at 2 years regarding return to play or at second ACL injury. Between-group differences were analyzed in patient-reported outcomes, performance measures, and 3-dimensional biomechanics for the contralateral limb and asymmetry. Logistic regression was applied to determine the ability of identified differences to predict contralateral ACL injury. Results: Of the cohort, 993 had follow-up at 2 years (95%), with 67 experiencing a contralateral ACL injury and 38 an ipsilateral injury. Male athletes who had a contralateral ACL injury had lower quadriceps strength and biomechanical differences on the contralateral limb during double- and single-leg drop jump tests as compared with those who did not experience an injury. Differences were related primarily to deficits in sagittal plane mechanics and plyometric ability on the contralateral side. These variables could explain group membership with fair to good ability (area under the curve, 0.74-0.80). Patient-reported outcomes, limb symmetry of clinical performance measures, and biomechanical measures in change-of-direction tasks did not differentiate those at risk for contralateral injury. Conclusion: This study highlights the importance of sagittal plane control during drop jump tasks and the limited utility of limb symmetry in performance and biomechanical measures when assessing future contralateral ACL injury risk in male athletes. Targeting the identified differences in quadriceps strength and plyometric ability during late-stage rehabilitation and testing may reduce ACL injury risk in healthy limbs in male athletes playing level 1 sports.
Anterior cruciate ligament , Reconstruction , Contralateral knee , Return to play , Re-injury , Biomechanics
King, E., Richter, C., Daniels, K. A. J., Franklyn-Miller, A., Falvey, E., Myer, G. D., Jackson, M., Moran, R. and Strike, S. (2021) 'Can biomechanical testing after anterior cruciate ligament reconstruction identify athletes at risk for subsequent ACL injury to the contralateral uninjured limb?', American Journal of Sports Medicine, 49(3), pp. 609-619. doi: 10.1177/0363546520985283
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