Cross-Cultural Adaptation and Measurement Properties of the Indonesian Kujala Score for Anterior Cruciate Ligament Tear Patients

@#Introduction: There is an overwhelming need for worldwide applicable subjective grading systems for patients' anterior cruciate ligament (ACL) tear. The scoring system should be validated for their use in advance related measurements. For the Indonesian language speaking population, only the Kujala Patellofemoral Score (KPS) questionnaire has been translated and validated into the Indonesian language for diseases related to knee pain, but none for ACL tears. The present study aims at cross-cultural adaption to measure the validity and reliability of the Kujala patellofemoral score Indonesian version (KPS-I) specifically for ACL tear patients. Material and methods: The responses of 106 ACL tear patients on two questionnaires comprising the KPS-I and Short Form (SF)–36 were examined by determining the validity and reliability. We conducted the validity construct and content, so the reliability was evaluated by test-retest reliability, internal consistency and measurement error. In addition, the research utilised the Bland and Altman method to explore absolute agreement. Results: The construct and content validity were good, where all hypotheses were confirmed, and the floor or ceiling effect did not occur. The reliability proved excellent between test and retest (ICC=0.99). An internal consistency showed a good Cronbach α of 0.86. The standard error of measurement (SEM), minimal detectable change at the individual (MDCind), and minimal detectable change at the group (MDCgrp) were determined to be 2.1, 5.8, and 0.7, respectively. The application of the Bland and Altman plot method revealed no bias in this study. Conclusion: The validation procedure shows that the KPS-I is a good evaluation instrument for Indonesian patients with ACL tear. However, it is suggested that this score be used for follow-up of patients after ACL reconstruction procedure, especially with anterior knee pain related to the original objective of the Kujala score.

Kinematics and Comfortability Analysis of Orthosis for Patients Associated With Anterior Cruciate Ligament Injury: Hinge Versus Sleeve

@#Introduction: Every month, Sports National Institute (ISN) in Malaysia received around 3 to 4 cases associated with anterior cruciate ligament (ACL) injury involving athletes in hockey, kick volleyball and netball. Knee orthosis is one of treatment method and has been shown to support lower limb joint mechanics, which may protect the ACL injury for becoming worst. In this paper, an investigation was conducted to evaluate the performance of existing knee orthosis for treating ACL injury. Methods: Ten participants which have been grouped into two; six ACL patients (Group 1) and four healthy subjects (Group 2), where they took part in two bracing conditions; 1) with hinge (Brace 1) and 2) sleeve with bilateral hinges (Brace 2). A non-braced condition was included as a baseline measure. Three-dimensional kinematics data were used to calculate knee joint motions. Results: From the findings of ACL subjects, the knee flexion in non-braced condition (49.9°) has high value than others two braces, in which Brace 1 (40.9°) is less value than Brace 2 (44.6°). This shows the Brace 2 have higher degree of freedom than Brace 1. Other than that, the comfortability assessment found that Brace 2 is the most favourable options by participants in terms of less slippage and comfortless condition. Conclusion: In conclusion, the Brace 2 give best performance during dynamic balance activity in individuals who benefit from high degree of freedom and less slippage issue.

Effects of Gender and Maneuvers on ACL Injury Risk Factors for Volleyball Players / 医用生物力学

Objective To study the effect of gender and maneuvers on anterior cruciate ligament (ACL) injury risk factors for volleyball players. Methods Sports biomechanics data of volleyball players during stop-jump, drop landing and sidestep cutting were collected. The ACL injury rate and biomechanical parameters of simulated injured jumps were obtained with Monte Carlo simulation. The influence of gender and maneuvers on ACL injury risk factors was validated by 2×3 mixed designed two-way ANOVA. Results Sidestep cutting was the highest risk maneuver of ACL injury for both genders (P＜0.001). Compared with male players, female players had a greater risk of ACL injury during sidestep cutting and stop-jump (P＜0.001), while male players were more prone to have ACL injury than female players during drop landing (P＜0.001). The risk factors of ACL injury obtained by simulation were significantly influenced by gender and maneuvers (P＜0.001). Conclusions Male players were more likely to increase ACL load due to smaller knee flexion, forward leg tilt and heel landing than female players during sidestep cutting, while female players owned larger ground reaction force (GRF) and knee extension moment. Smaller knee flexion angle during stop jump was the major risk factor for both genders, however more characteristics contributed to the males. Female players with large GRF, knee valgus and extension moment, and heel-landing were likely to have ACL injury, while the small knee flexion angle was the key risk factor for male players. The results can provide evidences for evaluation of volleyball players’ ACL injury risk, individualized injury prevention protocols, and clinical treatment and rehabilitation directions.

Relationship between dynamic knee valgus and lateral trunk lean during single-leg squatting in two-dimensional image / 体力科学

Dynamic knee valgus is considered a risk factor for anterior cruciate ligament (ACL) injuries. This study identified how knee in distance (KID) and hip out distance (HOD) affect one’s lateral trunk lean (LTL). The results were also tested for reliability. Fifteen female basketball players (30 legs) from a university participated in this study. The participants performed single-leg squats by bending the knee of the supporting leg to 60°. The trials were recorded using a video camera. The KID, HOD, and LTL were measured with two-dimensional images using the Dartfish software, which measured the maximal knee valgus. The Pearson’s correlation coefficient was used to measure the correlation between dynamic knee valgus (KID and HOD) and LTL. Additionally, the Interclass Correlation Coefficient (ICC) was used to measure the reliability of the KID, HOD, and LTL data sets. The statistical significance was established at a level of p<0.05. Results showed that the KID and LTL had a significantly negative correlation, measured at r=-0.227, p<0.05. The ICC (2.1) values were: 0.83 for HOD, 0.99 for KID, and 0.96 for LTL; while the ICC (1.2) values were: 0.86 for HOD, 0.83 for KID, and 0.85 for LTL. The two-dimensional analysis technique revealed that the values were highly reliable. In sum, dynamic knee valgus had a negative correlation with LTL during single-leg squats. Therefore, it was suggested that the factors of dynamic knee valgus might be evaluated using LTL on two-dimensional screening test.

The effect of hip abductions muscle strength on knee alignment during a single-leg landing in female basketball players / 体力科学

<p>Non-contact anterior cruciate ligament (ACL) injury is one of the most severe knee problems for female athletes. Several studies have reported that the decreased lower limb control of women such as decrease of hip abductions muscle strength increase the risk of ACL injury. Also ACL Injury often occurs as a result of knee valgus collapse during single leg landing or pivoting in sports activities like basketball. Female basketball players often show an excessive knee valgus and hip adduction during the play. The purpose of this study was to analyze the effect of hip abductions muscle strength on knee alignment during a single leg landing. Thirty healthy female basketball players participated in this study. Mean age, height, body weight and plyer career were 17.3 years old±3.7, 162.7cm±17.2, 56.2kg±10.9, 8.9 years±3.8 respectively. All subjects were obtained written consent from after explanation of the procedure. Significant negative correlations showed that greater hip abductor peak torque (hip flexion 0 and 30degrees) exhibited less motion toward the knee valgus direction during single leg landing. And also, dynamic Trendelenburg test showed that all positive reactions cause knee valgus direction. These results suggest keeping proper knee position safety during single leg landing; female basketball player should improve the hip abductions muscle strength. Hip joint control will be a major issue for prevention of the non-contact ACL injury.</p>

Estudio del nivel de concordancia entre los diagnósticos prequirúrgico y artroscópico de lesiones meniscales asociadas a lesiones del ligamento cruzado anterior / Concordance between preoperatory diagnosis and arthroscopy findings of meniscal lesions associated to anterior cruciate ligament injury

Introducción: Las lesiones ligamentarias de la rodilla son comunes durante la segunda y tercera décadas de vida, su diagnóstico clínico es difícil ya que puede diferir con el diagnóstico definitivo. El objetivo es determinar la concordancia entre el diagnóstico preoperatorio-diagnóstico postoperatorio y entre la lesión meniscal sospechada-lesión meniscal encontrada, en pacientes con lesión del ligamento cruzado anterior. Material y métodos: Estudio transversal. En 29 pacientes con lesión del ligamento cruzado anterior a los cuales se realizó artroscopía. Las variables fueron edad, género, lado afectado, diagnóstico preoperatorio, diagnóstico postoperatorio, lesión meniscal sospechada, lesión meniscal encontrada. La estadística utilizada fue descriptiva, para la concordancia se usó índice de Kappa de Cohen. Resultados: Fueron 29 pacientes, 23 (79.3%) hombres y 6 (20.7%) mujeres, la edad promedio: 39.04 (15-50) ± 13.19 años, lado afectado derecho 69% e izquierdo 31%; el diagnóstico preoperatorio en 22 (75%) pacientes fue LLCA aislada, LLCA + menisco medial 6 (20.7%), LLCA + menisco lateral 1 (3.4%) y el diagnóstico artroscópico fue en 20 (68.96%) sin lesión meniscal, 7 (24.1%) lesión en menisco medial, 2 (6.9%) en menisco lateral, con una concordancia baja (Kappa 0.2), la concordancia diagnóstica preoperatoria intraobservador fue perfecta (Kappa 1.0); y la concordancia entre el diagnóstico de la lesión meniscal preoperatoria y de la lesión meniscal artroscópica fue baja (Kappa 0.2). Conclusiones: La concordancia entre el diagnóstico clínico-radiológico y el diagnóstico artroscópico en lesiones del LCA con asociación de lesión meniscal es baja, lo cual se tiene que tener en cuenta en la realización del diagnóstico inicial y en el tratamiento artroscópico de los pacientes.

Introduction: Ligament injuries of the knee joint are common during the second and third decades of life, clinical and radiological diagnosis presents difficulties since the surgical findings may differ significantly. The objective is to determine correlation between clinical-radiologic and arthroscopic diagnosis in patients with injury of the anterior cruciate ligament (ACL) and meniscal lesions. Material and methods: Cross-sectional study held in 29 patients with ACL injury associated to meniscal lesions treated arthroscopically. Variables were age, gender, affected side, preoperative and postoperative diagnosis, type and location of meniscal injury; descriptive statistics and Cohen Kappa for concordance were used. Results: There were 29 patients, 23 (79.3%) men and 6 (20.7%) women, mean age 39.04 (15-50) ± 13.19 years; right side was affected in 69% and left in 31%; 19% had not meniscal lesion, 17.2% had injury in anterior horn, 10.3% in posterior horn and 6.9% in the body. The concordance between preoperative and artroscopic diagnosis was: Kappa 0.2; intraboservador was Kappa 1.0; between suspected meniscal injury and arthroscopic findings was: Kappa 0.2. Conclusions: The concordance between the clinical-radiological and arthroscopic diagnosis in patients with ACL injuries and meniscal injury associated is low, which has to be considered in the initial review and the arthroscopic treatment of patients.

Cinemática fisiológica de rodilla en futbolistas amateur: análisis 3D / Physiological kinematics of the knee in amateur soccer players: a 3D analysis

La lesión del ligamento cruzado anterior (LCA) tiene un alta prevalencia en jugadores de fútbol. En esta disciplina, las carreras con cambios de dirección son frecuentes y pueden ser un factor de riesgo para el desarrollo de lesiones del LCA sin contacto. Objetivo: Describir en futbolistas jóvenes los rangos cinemáticos fisiológicos de rodilla sometida a tareas funcionales con cambios bruscos de dirección. Método: En una muestra de ocho futbolistas con rodillas clínicamente sanas, se evaluó, mediante un sistema de análisis de movimiento 3D, la cinemática de la rodilla de apoyo durante la ejecución de tres tareas funcionales, dos de estas implicaron cambios de dirección en 90° (CD90°) y 180° (CD180°), la tercera golpear un balón (GB). Los rangos fisiológicos de movimiento (ROM) fueron registrados y comparados en la misma rodilla en tres planos diferentes (T-Transversal; F-Frontal; S-Sagital). Resultados: Los rangos fisiológicos obtenidos fueron para las tareas funcionales CD90°: T 11°(13-8), F 5.6° (11-4) y S 22°(30-17); para CD180°: T 9°(12-8), F 6.3°(8-5) y S 17.6°(21-14); y para GB: T 9°(10-5), F 3.8°(10-2), y S 9.6°(15-6). El ROM fue significativamente mayor en el plano transversal para la tarea CD90°. El el plano sagital el ROM fue mayor para CD90° comparado con GB (p<.05), sin embargo no hubo diferencias respecto a la tarea CD180°. No existen diferencias del ROM en el plano frontal. Conclusión: Se logró describir los rangos cinemáticos fisiológicos de la rodilla durante la ejecución de tres tareas funcionales que implicaron cambios bruscos de dirección en futbolistas amateur. En la muestra evaluada, la prueba que produjo una mayor exigencia de los rangos articulares de rodilla en los planos transversal y sagital fue la prueba con cambio de dirección en 90°...

Anterior cruciate ligament (ACL) lesions are frequent among soccer players. In this sport cutting movements are usually made while running and may be a risk factor in developing non-contact ACL injuries. Purpose: To describe the physiological kinematics of the knee during sudden change of direction movements in amateur soccer players. Methods:Eight amateur soccer players without previous injuries were analysed. The kinematics of the support knee were evaluated using 3D motion analysis while executing 3 common manoeuvres: two of them involved a change of direction at 90° and 180° (CD90° and CD180°), and the third while kicking a ball (GB). Physiological articular ranges of motion (ROM) were recorded and compared for the same knee in three different planes (T-Transversal; F-Frontal; S-Sagittal). Results: The physiological ranges obtained were, for manouvre CD90°: T 11°(13-8), F 5.6° (11-4) and S 22°(30-17); for CD180°: T 9°(12-8), F 6.3°(8-5) and S 17.6°(21-14); and for GB: T 9°(10-5), F 3.8°(10-2), and S 9.6°(15-6). ROM was significantly greater in the transversal plane for the CD90° manoeuvre (P<.05). In the sagittal plane, ROM was greater for the CD90° when compared to the GB (P<.05), but no differences were seen when compared to the CD180° manoeuvre (P>.05). There were no differences in ROM in the frontal plane. Conclusion: A description of the physiological kinematic ranges of the knee during three sudden changes of direction manoeuvres in amateur soccer players was presented. According to our results, change of direction in 90° demands a higher range of motion in both the transversal and sagittal planes...

Differences in dynamic alignment and flexibility between junior high-school and high-school female basketball players / 体力科学

To identify athletes at a higher risk of anterior cruciate ligament (ACL) injury, we developed a video-based screening test focused on hip abductor and rearfoot function. However, age differences in hip or reafoot motion as a contributor to dynamic knee valgus remains unclear. The purpose of this study was to determine how age differences contribute to hip or reafoot motions. Eighty-three female basketball players (41 junior high-school and 42 high-school students) agreed to participate in this study. Participants were measured for hip rotation angle, tibial rotation angle, ankle dorsi-flexion angle, navicular drop and general joint laxity. Subjects also performed single-legged squatting and drop landing from a 30 cm box. Knee-in distance (KID) and Hip-out distance (HOD) were measured using 2-dimensional video images filmed at 30 Hz. Additionally, Dynamic Trendelenburg Test (DTT) and Heel-Floor Test (HFT) were performed. The prevalence of HFT-positive in junior high-school and high-school athletes were not statistically different. DTT-positive during landing was more prevalent in junior high-school athletes than in high-school athletes (P<0.05). Junior high-school athletes demonstrated greater HOD values in squatting than high-school athletes (P<0.05). The range of motion in high-school athletes was significantly greater than in junior high-school athletes in tibial external rotation, hip internal and external rotation (p<0.01). The navicular drop in junior high-school athletes was significantly greater than in high-school athletes (p<0.01), however the navicular height was greater in high-school athletes (p<0.01). Player's age is an important consideration in ACL injury preventative conditioning.

Influence of bending the trunk forward during drop landing on muscles around the knee joint / 体力科学

The aim of the present study was to investigate whether personal hamstring muscular activation increased by landing with the trunk bent forward. First, 14 healthy female university students were instructed to perform normal drop landing from a 40 cm-high box on both legs. Second, subjects were directed to perform drop landing with the trunk bent forward. Using images obtained from a high-speed video camera, the upper center of mass was calculated in the sagittal plane for determining the differences in these landings. For 0.1 second after toe contact, the muscular activation of quadriceps femoris and hamstring muscles was analyzed using an electromyogram (EMG), and these findings were compared between the 2 types of landings. There was no significant difference in the activation of quadriceps femoris, but the activation tended to decrease during landing with the trunk bent forward. However, the activation of hamstring muscles increased significantly during landing with the trunk bent forward compared with that during normal landing. During landing with the trunk bent forward, the activation of hamstring muscles increased, and the activation of quadriceps femoris tended to decrease. Because contraction of hamstring muscles decreases tension in the anterior cruciate ligament, the findings of this study may help in the prevention of anterior cruciate ligament (ACL) injury.

VALIDATION OF A TWO-DIMENSIONAL MOTION ANALYSIS TECHNIQUE FOR QUANTIFYING DYNAMIC KNEE VALGUS DURING A DROP LANDING BY COMPARISONS TO DATA FROM THREE-DIMENSIONAL ANALYSIS / 体力科学

Dynamic knee valgus is considered a risk factor of non-contact anterior cruciate ligament (ACL) injury. To identify athletes at a higher risk, we developed a two-dimensional (2D) video-based screening test that determines hip abductor function as well as dynamic hindfoot and knee valgus. The purpose of this study was to validate the accuracy of the indices for dynamic knee valgus derived knee-in distance (KID) and hip-out distance (HOD) from the 2D-video.Twenty healthy university students agreed to participate in this study. Subjects were asked to step off a 30-cm box and land on one leg. This procedure was recorded simultaneously using a 2D video camera in the frontal plane and the Vicon motion capture system. Pearson's correlations examined associations between KID, KID normalized by height (KID/H), HOD, as well as HOD normalized by height (HOD/H) and 3D-valgus (knee valgus) or 3D-IR (tibial internal rotation).Significant correlations were found between the KID and 3D-valgus (r=0.72, p<0.01) and KID/H and 3D-valgus (r=0.73, p<0.01). Associations were not significant between KID and 3D-IR (r=0.08) and between KID/H and 3D-IR (r=0.03). A positive moderate correlation between HOD and 3D-valgus (r=0.46, p<0.05) and HOD/H and 3D-valgus (r=0.50, p<0.05), as well as a negative moderate correlations between HOD and 3D-IR (r=-0.52, p<0.05) and between HOD/H and 3D-IR (r=-0.51, p<0.05) were also observed.We conclude that KID is a reliable alternative for the 3D-valgus and the HOD is for the 3D-valgus and tibial external rotation.

INFLUENCE OF FOOT POSITION ON KNEE VALGUS DURING FEINTING IN TEAM HANDBALL / 体力科学

Purpose: To determine whether performing a feint in team handball with a wide foot stance leads to a greater knee valgus angle and/or knee valgus moment.Methods: Eight women handball players performed a feint with 4 different foot stances (free and 30%, 40%, and 50% of their body height). Three-dimensional kinematics and ground reaction forces were measured during the feints. Hip abduction angle at first contact, peak vertical ground reaction force, peak knee valgus angle, and peak external knee valgus moment during the first 20% of the feint cycle were compared among the stances at 30%, 40%, and 50% of body height (ANOVA, P<0.05). In the free feint, we investigated intrasubject correlations among foot stance and hip abduction angle at first contact, peak knee valgus angle, and peak external knee valgus moment were then conducted (<i>P</i><0.05).Results: When performing a feint with foot stances at 40% and 50% of body height, the subjects had significantly greater peak external knee valgus moment. Hip abduction angle at first contact was significantly correlated to peak knee valgus angle and peak external knee valgus moment.Conclusion: Training athletes to avoid wide foot stance and large hip abduction angle may reduce the risk of sustaining noncontact anterior cruciate ligament injuries.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

Comparison between Primary repair and Reconstruction in Acute ACL Injury / 대한정형외과학회잡지

ACL plays an important role in stability of knee joint and its injury causes instability of joint which is known as the initiation of problem knee. Reconstruction of the anterior cruciate ligament would be preferred to the primary repair in treatment. And recently with the advance of arthroscopic technique and development of bone-patellar tendon-bone (BPB) graft material, the result of reconstruction is somewhat superior to that of primary repair. Authors compared the results of 20 primary repairs (Group I ) and 20 reconstructions (Group II) among 64 acute ACL injury treated Sung-Ae General Hospital from January 1989 to December 1994. The results were as follows: 1. Most common associated injuries were medial collateral ligament rupture and medial meniscal tear. 2. Group I showed postoperatively 13 negative anterior drawer test, 12 negative Lachmann test and 12 negative pivot shift test and group II showed postoperatively 17 negative anterior drawer test, 15 negative Lachmann test and 17 negative pivot shift test. (p<0.05) 3. In postoperative Lysholm knee scoring scale, group I showed 86 points and group II showed 93 points (p<0.05). 4. In postoperative KT-1000 arthrometer, 12 cases in Group I and 16 cases in Group II showed less than 2mm difference with sound side (p<0.05).

Primary Repair and Autogenous Tendon Augmentation for Acute ACL Injury

The purpose of this study is to evaluate the results of primary repair and autogenous tendon augrnentation for acute rupture of anterior cruciate ligament. We primarily repaired 13 cases of acute ACL injury with autogenous tendon augmentation between Jul. 1988 and Jan. 1996. Among 13 cases, there were 2 isolated ACL injuries and 11 cases were combined with MCL injuries. All 13 cases were followed up over 1 year. An average follow up period was 4.1 years (1.1 - 8). All patients had open primary rnultiple suture repair and semitendinosus tendon (11 cases) or iliotibial band (2 cases) augmentation at average 3.6 days after the injury. In 11 cases, medial collateral ligarnent injuries were noted and these ruptured ligaments were supplemented with staple or vicryl suture. We evaluated the results with Lysholm Knee Score, KT-1000 arthrometer, postoperative ROM of knee, thigh muscle atrophy, extension lag, Lachman and pivot shift test. The clinical results were as follows 1. Lysholm Knee Score was mean 87.2 points; over 90 points: 5 cases, 80-8$ points: 5 cases, 70-79 points: 3 cases 2. Using the KT-1000 arthrometer, the average side to side difference wm 1.8nun in 201b (89N) and the compliance index was average 1.7mm. 3. Postoperative ROM of knee was nearly normal and there was no extensioe lag in any cases. But, we performed arthroscopic adhesiolysis in one case for limited motion of knee joint a ( postoperative 8 months. Thigh circumference was measured 0.95 cm difference than the healthy side at 10cm above upper pole of patella. 4. Lachman test was positive in 2 cases. 5. Pivot shift test was positive in 2 cases. Even if not many cases, we obtained relatively satisfactory results. So the pirimary repair with autogenous tendon auynentation was recornmandable procedure for acute rupture of ACL, especially combined with MCL injury.