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

dc.contributor.authorKing, Endaen
dc.contributor.authorRichter, Chrisen
dc.contributor.authorDaniels, Katherine A. J.en
dc.contributor.authorFranklyn-Miller, Andyen
dc.contributor.authorFalvey, Éannaen
dc.contributor.authorMyer, Gregory D.en
dc.contributor.authorJackson, Marken
dc.contributor.authorMoran, Rayen
dc.contributor.authorStrike, Siobhanen
dc.date.accessioned2023-04-19T11:00:29Z
dc.date.available2023-04-19T10:06:14Zen
dc.date.available2023-04-19T11:00:29Z
dc.date.issued2021-02-09
dc.date.updated2023-04-19T09:06:17Z
dc.description.abstractBackground: 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.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationKing, 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
dc.identifier.doi10.1177/0363546520985283en
dc.identifier.eissn1552-3365
dc.identifier.endpage619
dc.identifier.issn0363-5465
dc.identifier.issued3
dc.identifier.journaltitleAmerican Journal of Sports Medicine
dc.identifier.startpage609
dc.identifier.urihttps://hdl.handle.net/10468/14390
dc.identifier.volume49
dc.language.isoenen
dc.publisherSAGE Publishing
dc.rights© 2021, the Authors. Reprinted by permission of SAGE Publications. This is a post-peer-review, pre-copyedit version of the following article: 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. The final authenticated version is available online at: https://doi.org/10.1177/0363546520985283
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectAnterior cruciate ligament
dc.subjectReconstruction
dc.subjectContralateral knee
dc.subjectReturn to play
dc.subjectRe-injury
dc.subjectBiomechanics
dc.titleCan biomechanical testing after anterior cruciate ligament reconstruction identify athletes at risk forsubsequent ACL injury to the contralateral uninjured limb?
dc.typeArticle (peer-reviewed)
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