Patients returning to sport after anterior cruciate ligament (ACL) reconstruction surgery currently have a high risk for sustaining a second ACL injury and having early signs of knee osteoarthritis. Assessing lower extremity kinetics and kinematics during landing can provide information about a patient's risk for sustaining a second ACL injury and having further joint trauma. However, currently accepted methods to assess kinetics and kinematics are not feasible to use in most non-research settings as they are expensive, time consuming, and take up a lot of space. The goal of this project was to identify methods to assess landing mechanics which are reliable and feasible to use in non-research settings. First, we found that the loadsol®, a wireless force sensing shoe insole, is valid relative to embedded force plates and repeatable between days for assessing kinetics and kinetic symmetry during bilateral and unilateral landing tasks. Second, we developed a new method to collect continuous kinematic data using a low-cost videocamera, disposable markers, and an automated point tracking program. This method was validated against a 3D motion capture system for measuring a fixed angle and for measuring sagittal plane running kinematics. Third, we found that the new video analysis method is valid relative to 3D motion capture and is repeatable between days for assessing frontal and sagittal plane knee kinematics during landing. Finally, we used the loadsol® and automated 2D video analysis to assess landing mechanics in both patients following ACL reconstruction and healthy uninjured control participants in a non-research setting. We found that, relative to controls, patients following ACL reconstruction had reduced kinetic symmetry during bilateral landing, where they offloaded their surgical limb and relied more heavily on their non-surgical limb. Additionally, patients following ACL reconstruction had reduced knee flexion range of motion symmetry during unilateral landing, where they had reduced knee flexion when landing on their surgical limb. Collectively, these projects developed methods to quantitatively assess landing mechanics that are feasible to use in non-research settings, documented the validity and between-day repeatability of these methods, and demonstrated that they could be used to identify kinetic and kinematic deficits in patients following ACL reconstruction. This project is an important step toward being able to assess landing mechanics in patients recovering from an ACL reconstruction. / Doctor of Philosophy / The anterior cruciate ligament (ACL) is a bundle of connective tissue that helps stabilize the knee joint. ACL injuries are common in sport, and ACL reconstruction surgery is the most widely used treatment strategy for patients who wish to return to playing sports. Unfortunately, even after ACL surgery and rehabilitation, many patients who return to sport wind up getting hurt again and developing severe joint pain down the road. Previous research has identified movement and loading patterns which are associated with this increased risk for further injury in patients following ACL reconstruction. For example, patients who have increased asymmetry when landing from a jump, where they shift weight away from their surgical limb and towards their non-surgical limb, have an increased likelihood of sustaining a second ACL injury to either their surgical or non-surgical leg. Assessing movement during rehabilitation could help identify patients who exhibit poor movement mechanics and improve movement to reduce their risk for second injuries. However, there are not currently methods available to reliably assess movement that are feasible for widespread use in non-research settings (i.e. physical therapy clinics). The purpose of this project was to identify and develop methods to assess movement which are accurate and feasible to use in a clinical setting. In this dissertation, we first determined the accuracy of using wireless force sensing shoe insoles to measure how hard and how symmetrically people contact the ground when they land from a jump. Second, we developed a new method to measure knee motion using videos collected with low-cost cameras (e.g. iPad), and determined the accuracy of this method compared to a three-dimensional motion capture system. For the last part of this dissertation we demonstrated that the aforementioned methods could be used to identify deficits in landing mechanics in patients following ACL reconstruction in a non-research setting. When comparing ACL reconstruction patients with uninjured controls, we found movement and loading asymmetries which were expected and which are associated with the risk for second ACL injuries and early onset knee osteoarthritis. This project is an important step towards being able to assess landing mechanics in patients recovering from an ACL reconstruction, which could improve our ability to prevent subsequent injuries in this clinical population.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/98810 |
| Date | 09 June 2020 |
| Creators | Peebles, Alexander Thomas |
| Contributors | Department of Biomedical Engineering and Mechanics, Queen, Robin M., Miller, Thomas K., Schmitt, Daniel, Ross, Shane D., Socha, John J. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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