Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

by Raymond Che Tin Li. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 149-168.

Despite the well-researched impact of ACL injuries, both acutely and longitudinally, and even though adolescent females have the highest risk of sustaining an ACL injury, there is surprisingly very little biomechanical research conducted on adolescent populations after an ACL rupture has taken place. The increasing rates of ACL injuries and re-injury among adolescents demonstrates a need for improved rehabilitation and return-to-activity (RTA) guidelines that are age/maturity- and sex-appropriate. To accomplish this, the first step is to describe this population alongside a non-injured activity-, maturity- and sex-matched population. Therefore, the overall purpose of this Doctoral thesis was to provide evidence to support the creation of return-to-activity guidelines for adolescent patients with ACL injuries. The findings of this thesis, briefly outlined below, can directly contribute to improving clinical and rehabilitation management of ACL injuries among adolescent males and females. First, a systematic review was performed to synthesize sex differences in muscle activation patterns in movements associated with ACL injuries in both adult and adolescent populations. Ultimately, 30 articles were included in the review with a wide range of inconsistent findings. In brief, females demonstrated higher pre- and post-landing activation of the quadriceps and lower activation of the hamstrings in 15 of 27 studies. Females also had higher quadriceps-to-hamstring co-contraction ratios during pre- and post-landing phases compared to their male counterparts in 4 of 9 studies. What's more concerning was the identification of only five research articles that evaluated muscle activations in adolescent or younger cohorts, further emphasising the importance of addressing this gap in literature. The second article of this thesis explored metrics used to evaluate knee joint function that are often a part of rehabilitation guidelines, such as limb symmetry indices (LSI) during single limb hopping and strength tasks. To date, no evidence exists to support or refute the use of these measures in an adolescent population. Therefore, we sought to investigate LSIs and knee joint function among adolescent males and females with and without ACL-injuries during single-limb assessments. A total of 141 participants were recruited and evaluated during a series of maximum voluntary tasks; isometric knee extension and flexion, and single-limb hopping tasks (anterior-hops, lateral-hops, 6m timed-hops, cross-hops, and triple-hops). In brief, females and males with ACL injuries had lower performance metrics compared to their matched controls, however, the differences were not the same within each sex. Females displayed deficits in all tasks, whereas males with and without ACL injuries were only different in the anterior-hop, triple-hop, and knee extension tasks. The final two articles of this thesis are complimentary as they both explored knee stabilisation strategies during countermovement jumps (CMJs) and side-cutting tasks. However, Article 3 included only adolescent males and females without ACL injuries to identify the influence of sex and limb-dominance on knee stabilisation strategies, whereas Article 4 included the same uninjured cohorts but compared with matched groups of males and females with ACL injuries. In both studies, surface electromyography and full-body kinematics were captured during CMJs and side-cutting. Knee stabilisation strategies were evaluated using co-activation indices (CIs), full muscle waveforms, knee joint flexion stiffness (KJFS) and knee joint sagittal and frontal excursions (KJSE and KJFE, respectively). In Article 3, sex differences were observed in CIs, with females having higher medial CIs in the non-dominant limb in both CMJs and side-cuts, and higher total CIs in the non-dominant limb during side-cuts. Between-limb differences were present in both sexes. Females had higher total CI in their non-dominant limb in CMJs and higher frontal KJE in their non-dominant limb during the stance phase of side-cuts. Males had higher medial CIs in their dominant limb in CMJs and higher sagittal KJE in their non-dominant limb during the preparatory and landing phases of CMJs. No significant sex or limb differences were identified in individual muscle activations or KJFS. Based on these findings, males and females were treated statistically independent when evaluating the effect of ACL-injury in Article 4. Interestingly, when comparing groups, only one significant effect of injury was observed in knee stability metrics; males with ACL injuries had significantly higher vastus medialis activity during the preparatory phase of the CMJ compared to their uninjured counterparts. There were no other significant differences in either task. Despite the importance of ACL injury prevention in adolescents, the evidence on sex difference in muscle activation patterns in this population is still scarce. The results of this Doctoral thesis indicate that males and females in adolescent populations have differences in knee stabilisation strategies and overall knee joint function. These findings further support the need for additional research considering risk factors such as, age/maturity-, sex-, and limb-dominance. This research will contribute to the tailoring of rehabilitation programs, thus providing an opportunity to improve the success rate of rehabilitation following ACL-injury among adolescents.

Li Chi Kei. / Thesis (M.Phil.)--Chinese University of Hong Kong,1995. / Includes bibliogrpahical references (leaves 54-68). / Abstract --- p.1 / Acknowledgments --- p.4 / Lists of Figures --- p.5 / List of Tables --- p.8 / Chapter Chapter 1 --- Introduction --- p.9 / Chapter 1.1 --- Ligamental Injury --- p.9 / Chapter 1.2 --- ACL Injury --- p.10 / Chapter 1.3 --- Patellar Tendon and Anterior Cruciate Ligament --- p.11 / Chapter 1.4 --- Patellar Tendon Bone Graft --- p.13 / Chapter 1.41 --- Strength of the Patellar Tendon Bone Graft --- p.13 / Chapter 1.42 --- Use of the Patellar Tendon Bone Graft --- p.14 / Chapter 1.5 --- Patellar Tendon Bone Graft in Anterior Cruciate Ligament Reconstruction --- p.14 / Chapter 1.6 --- Complications of Anterior Cruciate Ligament Reconstruction after the Use of Patellar Tendon Bone Graft --- p.16 / Chapter 1.7 --- Healing of the Patellar Tendon Donor Site --- p.17 / Chapter 1.8 --- Objective of the Study --- p.22 / Chapter 1.9 --- Significance of the Study --- p.22 / Chapter Chapter 2 --- Material & Method --- p.24 / Chapter 2.1 --- Animal Model --- p.24 / Chapter 2.2 --- Grouping --- p.24 / Chapter 2.3 --- Operative Procedure --- p.24 / Chapter 2.4 --- Method of Assessment --- p.26 / Chapter 2.41 --- Gross Morphology --- p.26 / Chapter 2.42 --- Biomechanical Testing --- p.27 / Chapter 2.43 --- Biochemical Assay --- p.28 / Chapter 2.43.1 --- Water Content --- p.29 / Chapter 2.43.2 --- Collagen Content --- p.29 / Chapter 2.44 --- Histology --- p.30 / Chapter 2.45 --- Immunohistochemistry --- p.31 / Chapter 2.5 --- Statistics --- p.32 / Chapter Chapter 3 --- Results --- p.33 / Chapter 3.1 --- Operation Complications --- p.33 / Chapter 3.2 --- Gross Morphology --- p.33 / Chapter 3.21 --- Dimension of the Patellar Tendon --- p.33 / Chapter 3.22 --- Dimension of the Patellar Tendon Bone Graft --- p.33 / Chapter 3.23 --- Dimension of the Remain Patellar Tendon --- p.34 / Chapter 3.24 --- Gross Appearance of the Patellar Tendon Donor Site --- p.35 / Chapter 3.3 --- Biomechanical Testing --- p.36 / Chapter 3.31 --- Failure Load --- p.36 / Chapter 3.32 --- Ultimate Stress --- p.37 / Chapter 3.33 --- Stiffness --- p.37 / Chapter 3.34 --- Energy Absorbed before Failure --- p.38 / Chapter 3.4 --- Biochemical Assay --- p.38 / Chapter 3.41 --- Water Content --- p.38 / Chapter 3.42 --- Collagen Content --- p.39 / Chapter 3 .5 --- Histology & Immunohistochemistry --- p.39 / Chapter 3.51 --- Morphology of Control Tendon --- p.40 / Chapter 3.52 --- Morphology of Experimental Tendon with 'Open' Procedure --- p.40 / Chapter 3.53 --- Morphology of Experimental Tendon with 'Close' Procedure --- p.41 / Chapter 3.54 --- Healing at the Patellar and Tibial Insertion Site --- p.41 / Chapter 3.55 --- Morphology of the Cartilage Surface --- p.42 / Chapter Chapter 4 --- Discussion & Conclusion --- p.43 / Chapter 4.1 --- Gross Morphology --- p.43 / Chapter 4.2 --- Biomechanical Testing --- p.45 / Chapter 4.3 --- Biochemical Assay --- p.47 / Chapter 4.4 --- Histology & Immunohistochemistry --- p.49 / Chapter 4.5 --- Conclusion --- p.51 / References --- p.54 / Figures / Tables / Appendix

Recorded by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / This is a Systematic Review Presentation titled - "Neuromuscular Training & ACL Injury Prevention: A Systematic Review", created by Master of Physical Therapy Graduating Students, University of British Columbia - 2006, Presented on September 14-15, 2006 , Vancouver, BC, Canada

ACL injuries are severe injuries and also the most common diagnosis among alpine skiers. The purpose of this study was to evaluate alpine skiers isokinetic strength and the risk of ACL injury. 31 alpine skiers were included in this study, 17 men and 14 women, who had conducted physiological assessments between 1999 and 2007 during their active careers. The participants were sent an online questionnaire in 2018 regarding ACL injuries during their active alpine careers. The risk of injury was then evaluated by comparing injured athletes concentric isokinetic strength, hamstring to quadriceps ratio and limb symmetry index with non-injured athletes. Results showed a significant likelihood of injury for having a lower hamstring to quadriceps ratio in the left limb but not in the right limb. There was no significant likelihood of injury and having a greater limb asymmetry. Because of the small number of participants and few ACL injured there is difficult to draw any conclusions. However, there seems to be a relationship of having a lower H/Q ratio on the left limb and the risk of ACL injury. Further research is recommended.

Physical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participated in the study. Post-surveys indicated most learners: (1) prefer to use standardized patients (SPs) and soft-embalmed cadavers in their physical examination courses, (2) increased their confidence in performing the Lachman exam on real patients, and (3) enhanced their Lachman technique. SPs ultimately cannot volitionally reproduce the physical exam findings of ACL deficiency. Consequently, learners cannot accurately identify positive versus negative examination findings. Thiel-embalmed cadavers are a valuable resource for physical examination education. (Journal of Surgical Orthopaedic Advances 30(2):112-115, 2021).

Bakgrund: Främre korsbandsskador är en av de vanligaste idrottsskadorna, speciellt bland idrottande kvinnor. Uppkomstmekanismerna bakom främre korsbandsskador är många och skadan inträffar oftast i samband med snabba riktningsförändringar, inbromsningar eller landningar. Efter en främre korsbandsskada ökar risken för återfall samt utveckling av artros. Att förebygga denna skada är av vikt då det ofta innebär negativa konsekvenser för individen och dess idrottskarriär.  Syfte: Att genom en systematisk litteraturstudie granska studier som använt neuromuskulär träning (NMT) som preventionsåtgärd för främre korsbandsskador hos idrottande kvinnor samt utvärdera ifall någon kombination av NMT visats ha bättre effekt än annan.  Metod: Litteratursökningen genomfördes i databaserna Pubmed samt Web of Science. Randomiserade kontrollerade studier (RCT) granskades enskilt samt gemensamt av författarna enligt PEDro-skalan. Tillförlitligheten av resultatet bedömdes enskilt med hjälp av GRADEstud innan gemensam bedömning genomfördes.  Resultat: Litteratursökningen resulterade i 524 träffar, dessa granskades i relation till PICO vilket resulterade i åtta inkluderade artiklar. Samtliga artiklar bedömdes ha hög kvalitet. Gällande incidensen av främre korsbandsskador presenterade endast två studier en signifikant mellangruppsskillnad. Samtliga studier redovisade en generellt minskad incidens av främre korsbandsskador, förutom en studie. Tillförlitligheten av det sammanvägda resultatet bedömdes som begränsad (++) på grund av bristande samstämmighet samt precision. Konklusion: Denna litteraturstudie bidrar inte med ett vetenskapligt underlag som tyder på att NMT bör rekommenderas för kvinnliga idrottare för att förebygga främre korsbandsskador. Ingen slutsats kan dras gällande vilken kombination av neuromuskulära övningar som kan anses mer effektiva än andra. / Background: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries among female athletes. There are multiple risk factors and the injury normally occurs with quick change of direction, decelerations or landings. The risk of reinjury and developing arthritis increases considerably after a first injury. Preventing this injury is important considering the negative effects an injured athlete and their sports career will experience.  Objective: Through a systematic review, determine the effectiveness of neuromuscular training (NMT) in preventing anterior cruciate ligament injuries among athletic females. Also, explore if any specific combination of NMT exercises does have a superior outcome. Method: A literature search was made in the databases Pubmed and Web of Science. Randomised controlled studies (RCT) were reviewed separately and then jointly by the authors according to PEDro, and for assessment of reliability, with GRADEstud.  Results: The literature search resulted in 524 articles and they all were assessed by PICO. A final number of eight articles were included and were assessed to be of good quality and the level of evidence was considered limited (++). Solely two studies presented a significant result. All studies except one, presented a reduced incidence of ACL injury.  Conclusion: This systematic review does not provide a result which implies that NMT is an effective preventative measure for the incidence of ACL injuries among female athletes. No conclusion could be drawn if any combination of NMT exercises was more effective.

Studiedesign: Deskriptiv laborativ studie Introduktion: En främre korsbandsskada är en vanlig men allvarlig skada inom idrotten. Trots en läkt skada kan individen uppvisa förändringar i form av fysiska faktorer såsom förändrat rörelsemönster, eller psykologiska faktorer såsom ökad rädsla för återskada. Personer som drabbats av en främre korsbandskada har setts uppvisa en asymmetri mellan det skadade och det friska benet genom en ökad avlastning i det skadade benet. Den traditionella rehabilitering avser en individ som återställd när denne klarar en uppsättning standardiserade fysiska tester för knät. Studier har dock visat på att även psykologiska faktorer har en betydande roll vid förändrat rörelsemönster och återgång till sport. Syfte: Undersöka psykologiska faktorers relation till avlastning i knäleden under idrottslika hopptest med och utan sekundära kognitiva uppgifter för personer med en främre korsbandsskada. Ett sekundärt syfte var att undersöka skillnader i avlastning mellan de två hopptesterna. Metod: Tio kvinnliga idrottsaktiva idrottare som tidigare opererats för en främre korsbandsskada utförde drop-jump test med och utan sekundära kognitiva uppgifter. Avlastning i knäleden mättes genom asymmetri i maximalt knäflexionsmoment under de första 100 ms av landningen mellan respektive ben. Testerna utfördes i ett rörelseanalyslaboratorium där åtta rörelsekameror och två kraftplattor användes. Enkäten Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) användes för att kartlägga psykologiska faktorer såsom känslor, förtroende och riskbedömning. Pearson’s korrelationskoeficcient användes för att analysera samband mellan ACL-RSI och asymmetri i knäflexionsmoment och presenterades i spridningsdiagram. Parat T-test tillämpades vid jämförelse av avlastning i knäleden mellan de båda hopptesterna. Resultat: Inga signifikanta samband påvisades mellan asymmetri i knäflexionsmoment och ACL-RSI varken i hopptest utan eller i hopptest med tillägg av kognitiv uppgift (Pearson’s R=-0.210-0.502, p=0.168-0.652). Inga tydliga skillnader observerades i knäflexionsmoment mellan benen vid hopptest utan kognitiv uppgift (p=0.103). Däremot visades ett lägre knäflexionsmoment i skadat ben relativt oskadat ben vid hopptest med tillägg av kognitiv uppgift (p=0.024). Inga tydliga skillnader observerades i asymmetri i knäflexionsmoment mellan hopp utan o ch hopp med tillägg av kognitiv uppgift (p=0.176). Konklusion: Studiens resultat indikerar på ett minskat knäflexionsmoment i det skadade benet jämfört med det oskadade. Detta gäller främst i hopptestet med sekundära kognitiva uppgifter. Ingen slutsats om psykologiska faktorers påverkan på avlastning i knäleden kan dras på grund av låg signifikans. Den låga deltagarantalet gör att detta arbete kan ses som en pilotstudie, varpå den kan bidra till hypotesgenerering vid framtida forskning. Framtida studier bör även inkludera ett större antal deltagare samt även de individer som ej återgått till sport.

A lesão do ligamento cruzado anterior (LCA) é incapacitante para vários esportes pela instabilidade e deficiência funcional. O tratamento indicado é a reconstrução cirúrgica do ligamento, no entanto, nem sempre a recuperação funcional após a operação é suficiente para o retorno ao esporte. O objetivo deste estudo foi avaliar o controle postural dinâmico, a força muscular e o parâmetro funcional medido pelo Hop Test de atletas com e sem lesão do LCA. Métodos: Foram incluídos 74 atletas, 60 homens e 14 mulheres, com idades entre 16 e 45 anos, divididos em dois grupos: Grupo-Lesão LCA (GL) com 34 atletas (25,05 anos ± 6,82) e Grupo-Controle (GC) com 40 atletas sem lesão de LCA (27,7 anos ± 8,16). Todos os voluntários realizaram posturografia, dinamometria isocinética e o Hop Test. O GL foi avaliado antes e 12 meses após a reconstrução. O Grupocontrole (GC) foi avaliado num único momento. Resultados: Nas comparações pré e pós-operatórias do GL: a posturografia mostrou maior área de deslocamento no pré-operatório; na dinamometria isocinética, o pico de torque e trabalho total foram maiores no pós-operatório, mas a relação entre músculos flexores e extensores foi menor que a preconizada em ambas as avaliações (pré e pós-operatório); no Hop Test, a distância saltada e a simetria entre os membros foram maiores no pós-operatório. Na comparação com o GC, a posturografia mostrou maior oscilação anteroposterior e menor oscilação mediolateral no GL pré-operatório; na dinamometria isocinética, o pico de torque e trabalho total foram maiores no pré-operatório. No pós-operatório, GL mostrou maior relação entre flexores e extensores que GC. Conclusão: Os atletas submetidos à reconstrução do LCA apresentaram melhor desempenho funcional na avaliação pós-operatória quando comparados com o pré-operatório e com GC. Porém, os parâmetros isocinéticos apresentaram recuperação incompleta / The injury of the anterior cruciate ligament (ACL) is crippling for various sports by instability and functional impairment. The recommended treatment is surgical ligament reconstruction, however, sometimes that functional recovery after operation is not enough to return to the sport. The objective of this study was to evaluate the dynamic postural control, muscle strength, and functional parameter measured by Hop Test of athletes with and without ACL injury. Method: We included 74 athletes, 60 men and 14 women, who are between 16 and 45 years old, divided into two groups: Injury Group (GL) with 34 athletes (25.05 years ± 6.82) and Group Control (GC) with 40 athletes without ACL injury (27.7 years ± 8.16). All volunteers held posturography, isokinetic dynamometry and the Hop Test. The GL was assessed before and 12 months after the reconstruction. The Control Group was evaluated in a single moment. Results: Pre and postoperative comparison of GL: posturography showed greater area of displacement; in isokinetic dynamometry, peak torque and total work were higher in the postoperative period, but the relationship between flexors and extensors muscles was lower than recommended in both evaluation (pre and postoperative); in Hop Test, the distance hopped and the symmetry between the limbs was greater in the postoperative period. In comparison to the GC, posturography showed greater anteroposterior oscillation and lower mediolateral oscillation in preoperative GL; in isokinetic dynamometry, peak torque and total work were higher in GL preoperative. In postoperative period GL showed higher relationship between flexors and extensors than GC. Conclusion: The athletes submitted to ACL reconstruction showed better functional performance in postoperative assessment when surgery was compared to the preoperative period, and to GC. However, isokinetic parameters showed incomplete recovery