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Syfte Syftet var att utvärdera om aktiv slutextension i knäleden kan påbörjas direkt postoperativt utan risk för ökad främre knälaxitet efter främre korsbandsrekonstruktion. Ett annat syfte var att ta reda på vilket sätt rörelseomfånget i knäleden påverkas av omedelbar aktiv slutextensionsträning efter främre korsbandsrekonstruktion. Metod Undersökningen är en prospektiv, randomiserad, kontrollerad studie baserad på data insamlade från 30 patienter (14 män och 16 kvinnor) som genomgått främre korsbandsrekonstruktion på Capio Artro Clinic. Deltagarna lottades till att utföra ett av två postoperativa hemträningsprogram, antingen gruppen med ”passiv slutextension” (kontrollgrupp) n=15, eller gruppen med ”aktiv slutextension” (interventionsgrupp) n=15. Materialet insamlades med början i mars 2013 och avslutades i december 2013. Utvärderingen genomfördes preoperativt, direkt postoperativt samt fyra månader postoperativt. Främre knäledslaxitet mättes med KT-1000 laxitetsmätare och knäledsrörligheten mättes med goniometer med lång skänkel. Resultat Ingen signifikant skillnad förelåg mellan grupperna vid mätning av främre knälaxitet preoperativt, direkt postoperativt samt 4 månader postoperativt. Ingen signifikant skillnad kunde uppmätas mellan grupperna avseende flexion och extension fyra månader postoperativt. Slutsats Aktiv knäextension i form av statiska quadricepskontraktioner och raka benlyft kan utföras direkt postoperativt efter främre korsbandsrekonstruktion med hamstringsgraft utan risk för ökad främre knälaxitet. Det krävs dock en större studie med fler patienter för att säkerställa power Nyckelord ACL-rekonstruktion, Anterior tibial translation, Knäextension, KT-1000 laxitetsmätare

Women are four to eight times more likely to injure their anterior cruciate ligament (ACL) compared to men. It is most commonly injured through a non-contact mechanism during game time situations. During landings, women display valgus collapse, where a less active gluteus medius muscle (GMed) may be unable to control the internal rotation of the thigh, causing an increase in knee joint abduction angle, augmenting the risk of ACL injury. This study’s purpose was to determine the difference between 12 male and 12 female athletes in muscle activity, specifically the GMed, and the 3D kinematics and kinetics of the lower-limb during drop jump landings from three heights; maximum vertical jump height, tibial length, and a commonly used height of 40cm. Results showed that females had greater hip adduction and knee abduction angles compared to men. The GMed activity showed no significant differences between sexes at each drop jump height.

It´s important to consider all the risks that the players are exposed to and have a holistic view on the matter. The conclusions from my sponsor and looking through research in the area I came to the conclusion that surface and shoes have minimal consequences and are not an area of interest for me in this project.

Anterior cruciate ligament (ACL) ruptures are one of the most common knee ligament injuries suffered by both male and female athletes. These injuries are severe in nature and also have long-term impacts on activities of daily living. Significant research has been conducted utilizing a drop landing task to attempt to better understand the mechanics behind the injury and to help identify at-risk athletes for targeted intervention. However, there have not been any published standards for the height of the drop landing activity, and previous researchers have also raised some concerns about the ability of a drop landing task to replicate the landing mechanics of a sport-specific task. To examine possible differences in performance based on specific landing tasks, the first study compared the landing mechanics of male and female high school athletes in three different landing conditions (drop landing, DL; adjusted height drop landing, AHDL; and a vertical jump task, VJL) (Chapter 3). Thirty-seven (37) athletes completed bilateral landings in the three conditions, and their kinetic and kinematic landing mechanics were compared across conditions. For the male participants, maximum knee flexion during landing was greater in AHDL condition as compared to the DL and VJL conditions. Both male and female participants demonstrated greater hip adduction at impact and overall maximum value in the VJL condition as compared to the two drop landings. As drop landing tasks have been used to identify at-risk athletes, it was important to examine the three different tasks’ ability to predict lower extremity ligamentous injuries, and whether those 3D motion analysis predictors were more precise than a quick clinical symmetry screening tool (Chapter 4). One-hundred-and-sixty-five (165) athletes completed the clinical symmetry screen, and a subgroup of thirty-seven (37) athletes completed the 3D motion analysis. All of these participants were surveyed for lower extremity ligamentous injuries over the course of a season. Due to a small number of reported injuries, none of the injury predictor models based on 3D motion analysis landing mechanics or the clinical symmetry screening tool were able to produce accurate predictor models of injury. Knee abduction moment has been shown to be one of the strongest predictors of ACL injuries, and due to the collection of bilateral kinetics for a previous study (Chapter 3), there was a need to examine differences in KAM between the three different landing tasks (Chapter 5). Ten (10) recreational athletes completed bilateral landings in the three conditions, with foot placement relative to force plates to enable KAM calculation. The participants did not demonstrate any difference in KAM between the three landing conditions; however, a test for constant variance showed that the AHDL resulted in significantly less variance in KAM than DL or VJL. The results of these studies suggest that while easy to standardize, a set height drop landing task does not produce identical landing mechanics to those from an adjusted height drop landing task or a vertical jump task. Further research is needed to create or justify standardized landing tasks for researchers to utilize that produce consistent results that best duplicate the landing mechanics athletes performed during sporting activities. While the landing mechanics demonstrated in the three tasks and the results from the clinical screening were not able to predict injuries, future studies should examine quick clinical screening tools to identify athletes at a high risk of injury.

Title: The Effect of Kinesiotaping on Postural Stabilization in Patients after ACL Reconstruction Aim: The main aim of the thesis was to evaluate, whether postural stabilization of patients after ACL reconstruction followed by kinesiotaping of the knee joint will be improved or decreased. Also the difference in postural stability of operated and un-operated lower extremity was evaluated. Methods: The thesis included 10 subjects. Each of them was from 4 to 6 weeks after ACL reconstruction, BTB technique. All subjects regularly attended group exercise in CLPA s.r.o. Every subject completed five measurements of postural somatooscilography, before exercise with kinesiotape and without, after exercise completed with kinesiotape, and after five days before and after exercise without kinesiotape. The values were saved by Microswing 6.0 and analyzed by Posturomed Commander. Then the values were evaluated by Microsoft Office Excel and statistic procedures were done by XLSTAT. Results: The measurement confirmed an effect of kinesiotaping on improvement of postural stabilization. Immediately after the application of the tape five out of seven parameters were improved. Participating in the exercise unit revealed an improving trend of postural stabilization, in comparison with the results before exercise. There...

O handebol é um esporte onde há mistura de velocidade, potência, resistência e, principalmente, de mudanças rápidas de direção, mudanças essas que são responsáveis por um número elevado de lesões. A ruptura do ligamento cruzado anterior (LCA) é frequente em atletas e pode ocorrer de duas maneiras: com ou sem contato direto. As lesões no LCA sem contato direto (LCASC) representam de 70 a 85% das lesões em atletas, normalmente em mudanças de direção denominadas \"sidestep\" (SID). Entender os fatores de risco e os mecanismos das lesões são algumas das etapas do processo de prevenção. O presente estudo tem como objetivo analisar as variáveis biomecânicas na articulação do joelho durante a mudança de direção seguida de um arremesso em atletas profissionais e universitárias de handebol com e sem informação visual. Participaram do estudo 14 atletas de nível profissional (GP = 21,5 ± 2.58) e 15 de nível universitário (GU = 22,4 ± 2,63), do sexo feminino. Foram posicionados 25 marcadores refletivos no tronco e membros inferiores da participante além de 10 eletrodos posicionados em: glúteo médio, bíceps femoral, reto femoral, gastrocnêmio e tibial anterior. Os valores angulares foram calculados pelos ângulos de Euler e a velocidade angular foi calculada pelos quatérnions. As participantes realizaram o sidestep cutting SID, sidestep cutting com bola (SIDB), sidestep cutting com luz (SIDluz) e sidestep cutting com bola e luz (SIDBluz). Foram encontrados maiores valores de flexão nos momentos CI e 40ms para GU em SID, SIBD e SIBluz. GP apresentou maiores valores de rotação em 100ms após o CI na maioria dos testes. GP apresentou maiores valores de velocidade angular (quatérnions) em 100ms em SID, SIDluz e SIDBluz. GP também apresentou maiores velocidade angulares na execução dos testes: SIDlu, SIDB e SIBluz. GU apresentou. GP apresentou melhor razão de co-contração (CC) quando comparado GU no SIDluz, e GU apresentou melhor CC em SID. GP apresentou maior tempo de contato (TC) SIDluz, SIDBluz e SID. Conclui-se que atletas universitários e profissionais apresentam padrões cinemáticos diferentes durante a execução de tarefas de mudanças de direção / Handball is a sport where there is mixture of speed, power, resistance, and especially the fast changes of direction. These changes are responsible for a high incidence of injuries in handball players. The rupture of the anterior cruciate ligament (ACL) is common in athletes and can occur in two different ways: with contact and non-contact. The ACL injuries non-contact (LCASC) represent 70 to 85% of injuries in athletes typically in the change of direction called \"sidestep\" (SID). Understand the risk factors and mechanisms of injury are some of the steps to prevent them. This study aims to analyze the biomechanical variables in the knee joint during the change of direction then a pitch in professional and college athletes of handball with and without visual information. All participants were female, 14 professional athletes (GP = 21.5 ± 2:58) and 15 the college athletes (GU = 22.4 ± 2.63). In total, 25 reflective markers were positioned on the trunk and lower limbs of the participant along with 10 electrodes placed on: gluteus medius, biceps femoris, rectus femoris, gastrocnemius and tibialis anterior. The angles were calculated by Euler angles and the angular velocity were calculated from the quaternions. The participants performed the SID, sidestep cutting Ball (SIDB), sidestep cutting with light (SIDluz) and sidestep cutting with ball and light (SIDBluz). We found greater flexion values in the CI and 40ms moments for GU in SID, SIDB and SIDBluz. GP has higher rotation values in 100ms after the IC in most tests. GP pointed high values of angular velocity (quaternions) in 100ms in SID, SIDluz and SIDBluz. GP also had higher angular speed in carrying out the tests: SIDluz, SIDB and SIDBluz. GU presented better rate of cocontraction (CC) compared GP in SIDluz, and GU pointed better CC in SID. GP presented greater contact time (TC) in SIDluz, SIDBluz and SID. Concludes that college and professional athletes have different kinematic patterns during the execution in changes of direction tasks

Typical rehabilitation strategies and performance tests after knee surgery are often based on peak lower extremity strength. However, people rarely generate maximal knee force in both daily and sports activities, which are characterized by brief periods of rapid muscle activation and relaxation. Thus, the ability to rapidly develop or modulate force may be more meaningful and more relevant to function. It is unclear how knee surgery influences the neuromuscular mechanisms controlling the ability to rapidly develop leg muscle force and produce power, or the functional relevance of these characterizations of muscle performance in relation to injury, surgery, and recovery. The primary purpose of this collection of studies was to assess rapid quadriceps muscle activation and lower extremity force production in people undergoing arthroscopic knee surgery for meniscal debridement and anterior cruciate ligament (ACL) reconstruction. People undergoing arthroscopic partial meniscectomy (APM) presented with significant deficits in knee extensor rate of torque development (RTD), leg press power, and rapid quadriceps muscle activation both prior to and in the initial month following surgery. Subjective knee function was significantly correlated with RTD variables but not with peak strength or quadriceps volume. Limitations in the ability to rapidly activate the involved quadriceps suggests that impaired centrally mediated neural function of the involved quadriceps may limit RTD and lower extremity power post-surgery. Next, the speed and intensity of quadriceps exercise performed in the early post-surgical period of patients post-APM and the relationships between training parameters, strength, quadriceps RTD, and subjective knee function were investigated. Subjects performed high intensity quadriceps contractions 2-3x/week in the first month following surgery. All subjects increased quadriceps strength, but people who trained with greater RTD following APM demonstrated greater improvements in RTD and had better patient-based outcomes scores than those who trained with a slower rate of torque rise. Finally, power and rate of force development (RFD) in people ≤ 1 year following ACL reconstruction were evaluated along with movement biomechanics, typical clinical measures of readiness to return to activity, and patient-based outcomes. Significant side-to-side asymmetries in quadriceps strength, RFD, leg press strength and power, and knee joint kinetics were noted. Deficits in voluntary quadriceps strength paralleled the deficits in early phase RFD, indicating that in this population RFD was limited by the intrinsic properties and force production capacity of the quadriceps, not the ability to rapidly activate the muscle. However, strong to very strong correlations were found between quadriceps RFD, movement biomechanics and subjective knee function, which were predominantly stronger than the correlations with peak quadriceps strength. Leg press strength, power, and acceleration were very strongly correlated with movement biomechanics and subjective knee function. In summary, this series of studies provides important insight into the neuromuscular mechanisms related to rapid lower extremity force development and muscle activation in the context of knee joint injury and recovery after arthroscopic knee surgery. Collectively, this work suggests that the inability to quickly develop or modulate quadriceps force may have significant functional consequences, and that rehabilitation efforts following arthroscopic knee surgery to incorporate both specific dosage of and earlier performance of rapid leg muscle contractions should be explored.

<p>Skador i de nedre extremiteterna, främst knäskador, är ett stort problem inom damfotbollen. Studier har visat att risken för unga fotbollspelande tjejer att drabbas av en främre korsbandsskada är 5-6 gånger så stor som för pojkar i samma ålder. De nedre extremiteterna är även de kroppsdelar där flest skador förekommer inom herrfotbollen, men män skadar oftare lår och ljumske än knä- och fotled. De är även i regel äldre när skadan inträffar än damspelarna är. Skillnaden i skadefrekvens mellan herr- och damspelare kan bero på flera olika faktorer, t ex anatomiska skillnader, hormonella skillnader och fysiska skillnader, såsom muskelstyrka och knästabilitet.</p><p>Syftet med det här projektet var att utforma ett träningsprogram med målet att stärka lårmuskulaturen, bålstyrka och att öka stabiliteten i knäleden. Vi ville att övningarna skulle vara så enkla och kräva så lite utrustning och utbildning att de skulle gå att genomföra en helt vanlig fotbollsträning.</p><p>Två flicklag födda 1993 ingick i projektet; ett som kontrollgrupp (n=10) och ett som träningsgrupp (n=13). Båda grupperna tränade fotboll 3h/v, samt deltog i seriespel, under hela säsongen. Träningsgruppen genomförd förutom den vanliga fotbollsträningen vårt skadeförebyggande träningsprogram 10-20 min/1gg/v under hela säsongen. </p><p>Grupperna testades med sit-to-stand-test vid projektets start och även efter 3, 6 och 12 månaders träning.</p><p>Vid projektstarten var kontrollgruppen snabbare vid första testet än träningsgruppen. Efter 6 månaders träning kom träningsgruppen ikapp kontrollgruppens tider och fortsatte sedan att förbättras genom hela projektet. Kontrollgruppen förändrade inte sina genomsnittstider på testerna under projektperioden. </p><p>När det gäller skador drabbades kontrollgruppen av fler och allvarligare skador än träningsgruppen. </p><p>Vårt resultat visar att de som genomfört vårt träningsprogram drabbades av färre och mindre allvarliga skador än de som inte gjorde det. Således kan långvariga träningsprogram med fokus på lårstyrka och knästabilitet förebygga skador i nedre extremiteterna hos unga fotbollsspelande flickor.</p>

Skador i de nedre extremiteterna, främst knäskador, är ett stort problem inom damfotbollen. Studier har visat att risken för unga fotbollspelande tjejer att drabbas av en främre korsbandsskada är 5-6 gånger så stor som för pojkar i samma ålder. De nedre extremiteterna är även de kroppsdelar där flest skador förekommer inom herrfotbollen, men män skadar oftare lår och ljumske än knä- och fotled. De är även i regel äldre när skadan inträffar än damspelarna är. Skillnaden i skadefrekvens mellan herr- och damspelare kan bero på flera olika faktorer, t ex anatomiska skillnader, hormonella skillnader och fysiska skillnader, såsom muskelstyrka och knästabilitet. Syftet med det här projektet var att utforma ett träningsprogram med målet att stärka lårmuskulaturen, bålstyrka och att öka stabiliteten i knäleden. Vi ville att övningarna skulle vara så enkla och kräva så lite utrustning och utbildning att de skulle gå att genomföra en helt vanlig fotbollsträning. Två flicklag födda 1993 ingick i projektet; ett som kontrollgrupp (n=10) och ett som träningsgrupp (n=13). Båda grupperna tränade fotboll 3h/v, samt deltog i seriespel, under hela säsongen. Träningsgruppen genomförd förutom den vanliga fotbollsträningen vårt skadeförebyggande träningsprogram 10-20 min/1gg/v under hela säsongen. Grupperna testades med sit-to-stand-test vid projektets start och även efter 3, 6 och 12 månaders träning. Vid projektstarten var kontrollgruppen snabbare vid första testet än träningsgruppen. Efter 6 månaders träning kom träningsgruppen ikapp kontrollgruppens tider och fortsatte sedan att förbättras genom hela projektet. Kontrollgruppen förändrade inte sina genomsnittstider på testerna under projektperioden. När det gäller skador drabbades kontrollgruppen av fler och allvarligare skador än träningsgruppen. Vårt resultat visar att de som genomfört vårt träningsprogram drabbades av färre och mindre allvarliga skador än de som inte gjorde det. Således kan långvariga träningsprogram med fokus på lårstyrka och knästabilitet förebygga skador i nedre extremiteterna hos unga fotbollsspelande flickor.