Normalized Hip and Knee Strength in Two Age Groups of Adolescent Female Soccer Players.

ABSTRACT: Hannon, JP, Wang-Price, S, Garrison, JC, Goto, S, Bothwell, JM, and Bush, CA. Normalized hip and knee strength in two age groups of adolescent female soccer players. J Strength Cond Res 36(1): 207-211, 2022-Limb symmetry strength measures are used for clinical decision-making considering when an athlete is ready to return to sport after anterior cruciate ligament (ACL) injuries. However, changes in bilateral muscle strength occur after ACL injury resulting in potentially altered limb symmetry calculations. Adolescent female soccer players are at increased risk of sustaining ACL injuries. Published age and sex-matched strength values in this population may be of benefit to clinicians to improve clinical decision-making. The purpose of this study was to establish normative hip and knee strength data of both the dominant and nondominant limbs in adolescent female soccer players. Sixty-four female soccer players (ages 10-18) were enrolled in this study. Subjects were divided by age into 2 groups (group 1: 10-14 years; group 2: 15-18 years). Subjects underwent Biodex isokinetic strength testing at 60°·s-1 and 180°·s-1 to assess quadriceps and hamstring strength. Isometric hip strength (abduction and external rotation) was measured using a hand-held dynamometer. No significant differences were found between groups on either limb in regards to quadriceps or hamstring strength. No significant differences were found between groups on either limb for hip external rotation strength. Significant differences in hip abduction strength were found between groups on the dominant (group 1: 0.21 ± 0.04; group 2: 0.18 ± 0.04; p = 0.014) and nondominant (group 1: 0.21 ± 0.05; group 2: 0.18 ± 0.05; p = 0.019) limbs. The results of this study shed light on normative strength values for a high-risk injury population.

Twelve-Week Quadriceps Strength as A Predictor of Quadriceps Strength At Time Of Return To Sport Testing Following Bone-Patellar Tendon-Bone Autograft Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Restoration of quadriceps strength following anterior cruciate ligament reconstruction (ACL-R) continues to challenge both patients and clinicians. Failure to adequately restore quadriceps strength has been linked to decreased patients' self-reported outcomes and an increased risk for re-injury. Early identification of quadriceps strength deficits may assist in tailoring early interventions to better address impairments. PURPOSE: The purpose of this study was to assess the relationship between early (12 weeks following ACL-R) isokinetic peak torque and isokinetic peak torque at time of return to sport (RTS) testing. STUDY DESIGN: Cohort Study. METHODS: A total of 120 participants (males = 55; females =65) were enrolled in the study (age = 16.1±1.4 yrs; height = 1.72±10.5 m; mass = 70.7±16.3 kg). All participants were level 1 or 2 cutting and pivoting sport athletes who underwent a primary bone-patellar tendon-bone autograft ACL-R. Participants were tested at two time points: 12 weeks following surgery and again at time of RTS testing. A linear regression model was carried out to investigate the relationship between age, sex, and isokinetic peak torque at 12 weeks following ACL-R and isokinetic peak torque at time of RTS testing. RESULTS: When 12-week isokinetic peak torque was entered first for the hierarchy regression analysis, this factor was predictive of the peak torque at the time of RTS testing, F(1, 118) = 105.6, p < 0.001, R 2 = 0.472, indicating that the 12-week quadriceps strength accounted for 47% of the variance in the quadriceps strength at the time of RTS testing. When age and sex were added in the regression analysis, both factors only added 0.8% of variance for the quadriceps strength at the time of RTS testing. CONCLUSION: Isokinetic peak torque at 12 weeks following surgery was shown to be a significantly strong predictor (47%) for isokinetic quadriceps strength recovery at time of RTS. This finding underscores the importance of early restoration of quadriceps strength and that while non-modifiable factors such as sex and age are important, early restoration of quadriceps strength most strongly influences late stage quadriceps strength. LEVEL OF EVIDENCE: 3.

Female Adolescent Soccer Players Utilize Different Neuromuscular Strategies Between Limbs During the Propulsion Phase of a Lateral Vertical Jump.

BACKGROUND: Multiplanar dynamic stability is an important unilateral function in soccer performance but has been scarcely examined in female soccer players. The lateral vertical jump task assesses unilateral functional performance, and energy generation contribution examines how each joint (hip, knee, ankle) contributes to the vertical component of the vertical jump phase to measure inter- and intra-limb differences. PURPOSE: To examine dominant versus non-dominant limb performance using energy generation contribution of the hip, knee, and ankle during the vertical jump component of the lateral vertical jump. STUDY DESIGN: Cross-sectional observational study. METHODS: Seventeen healthy, adolescent female soccer players (age 13.4±1.7 years; height 160.6±6.0 cm; mass 53.1±8.2 kg) participated. Quadriceps strength was measured via isokinetic dynamometry. Energy generation contribution (measured from maximal knee flexion to toe off) and vertical jump height were measured during the vertical component of the lateral vertical jump. RESULTS: There was no significant difference between limbs for quadriceps strength (p=0.64), jump height (p=0.59), or ankle energy generation contribution (p=0.38). Energy generation contribution was significantly greater in the dominant hip (dominant 29.7±8.6%, non-dominant 18.4±6.3%, p<0.001) and non-dominant knee (dominant 22.8±6.8%, non-dominant 36.2±8.5%, p<0.001). CONCLUSION: High demand on coordination and motor control during the lateral vertical jump and inherent limb dominance may explain different intra-limb strategies for task performance despite jump height symmetry. Non-dominant affinity for stability and dominant compensatory performance may neutralize potential asymmetries. Implications for symmetry in observable outcomes such as jump height must consider underlying internal asymmetries. LEVELS OF EVIDENCE: 3B. CLINICAL RELEVANCE: Symmetrical findings on functional tasks have underlying internal asymmetries observed here in female adolescent soccer players. The lateral vertical jump may highlight these internal asymmetries (hip- versus knee-dominant movement strategies) due to the high coordinative demand to perform the task. Clinicians should be cognizant of underlying, potentially inherent, asymmetries even when observing functional symmetry in a task. WHAT IS KNOWN ABOUT THE SUBJECT: Female adolescent soccer players are a high-risk cohort for sustaining anterior cruciate ligament injuries. Limb dominance may play a role in the performance of functional tasks, and limb dominance in soccer players is quite specialized: the dominant limb is the preferred kicking limb, while the non-dominant limb is the preferred stabilizing limb (plant leg). Functional performance in female soccer players has been studied in kicking, dribbling, sprinting, change of direction, and jumping - however, these tasks were measured independent of limb dominance. It remains to be seen how unilateral functional tasks may be affected by limb dominance in female adolescent soccer players. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: This study provides data on functional performance relative to limb dominance in female adolescent soccer players, and captures the lateral vertical jump task in both inter- and intra-limb measures. This highlights that intra-limb strategies to perform a coordinated motor task may be different between limbs, herein attributed to limb dominance. Even if gross motor outputs between limbs are symmetrical (i.e. jump height), the underlying movement strategies to achieve that output may be different (hip- versus knee-dominant movement strategies). These findings are important to research on functional performance measures related to attaining between-limb symmetry, as measures of energy generation contribution open the door for a more thorough understanding of joint-by-joint intra-limb contributions during a functional task.

U.S. Montmorency Tart Cherry Juice Decreases Bone Resorption in Women Aged 65-80 Years.

Pre-clinical studies have demonstrated that tart cherries, rich in hydroxycinnamic acids and anthocyanins, protect against age-related and inflammation-induced bone loss. This study examined how daily consumption of Montmorency tart cherry juice (TC) alters biomarkers of bone metabolism in older women. Healthy women, aged 65-80 years (n = 27), were randomly assigned to consume ~240 mL (8 fl. oz.) of juice once (TC1X) or twice (TC2X) per day for 90 d. Dual-energy x-ray absorptiometry (DXA) scans were performed to determine bone density at baseline, and pre- and post-treatment serum biomarkers of bone formation and resorption, vitamin D, inflammation, and oxidative stress were assessed. Irrespective of osteoporosis risk, the bone resorption marker, tartrate resistant acid phosphatase type 5b, was significantly reduced with the TC2X dose compared to baseline, but not with the TC1X dose. In terms of indicators of bone formation and turnover, neither serum bone-specific alkaline phosphatase nor osteocalcin were altered. No changes in thiobarbituric acid reactive substances or high sensitivity C-reactive protein were observed in response to either TC1X or TC2X. We conclude that short-term supplementation with the higher dose of tart cherry juice decreased bone resorption from baseline without altering bone formation and turnover biomarkers in this cohort.

ß-carotene oxygenase 2 deficiency-triggered mitochondrial oxidative stress promotes low-grade inflammation and metabolic dysfunction.

Low-grade inflammation is a critical pathological factor contributing to the development of metabolic disorders. ß-carotene oxygenase 2 (BCO2) was initially identified as an enzyme catalyzing carotenoids in the inner mitochondrial membrane. Mutations in BCO2 are associated with inflammation and metabolic disorders in humans, yet the underlying mechanisms remain unknown. Here, we used loss-of-function approaches in mice and cell culture models to investigate the role of BCO2 in inflammation and metabolic dysfunction. We demonstrated decreases in BCO2 mRNA and protein levels and suppression of mitochondrial respiratory complex I proteins and mitochondrial superoxide dismutase levels in the liver of type 2 diabetic human subjects. Deficiency of BCO2 caused disruption of assembly of the mitochondrial respiratory supercomplexes, such as supercomplex III2+IV in mice, and overproduction of superoxide radicals in primary mouse embryonic fibroblasts. Further, deficiency of BCO2 increased protein carbonylation and populations of natural killer cells and M1 macrophages, and decreased populations of T cells, including CD4+ and/or CD8+ in the bone marrow and white adipose tissues. Elevation of plasma inflammatory cytokines and adipose tissue hypertrophy and inflammation were also characterized in BCO2 deficient mice. Moreover, BCO2 deficient mice were more susceptible to high-fat diet-induced obesity and hyperglycemia. Double knockout of BCO2 and leptin receptor genes caused a significantly greater elevation of the fasting blood glucose level in mice at 4 weeks of age, compared to the age- and sex-matched leptin receptor knockout. Finally, administration of Mito-TEMPO, a mitochondrial specific antioxidant attenuated systemic low-grade inflammation induced by BCO2 deficiency. Collectively, these findings suggest that BCO2 is essential for mitochondrial respiration and metabolic homeostasis in mammals. Loss or decreased expression of BCO2 leads to mitochondrial oxidative stress, low-grade inflammation, and the subsequent development of metabolic disorders.

Effects of anterior cruciate ligament reconstruction on patellofemoral joint stress and lower extremity biomechanics at 12 weeks post-surgery and at time of return to sport in adolescent females.

BACKGROUND: The purpose of this study was to examine kinematic and kinetic differences associated with patellofemoral pain after anterior cruciate ligament reconstruction between limbs at 12-week post-surgery and at time of return to sport. METHOD: Twenty-four adolescent females completed 5 consecutive single leg squats on each limb at 12-weeks post-surgery and again during their RTS assessment. Peak knee extension moment, peak hip adduction angle, and patellofemoral joint stress at 45 degrees of knee flexion were calculated. Separate two by two repeated measures ANOVA were performed. FINDINGS: There was a significant interaction (limb × time) for knee extension moment (p < 0.001). Surgical limb knee extension moment was significantly less than the non-surgical limb at return to sport (p < 0.001). At 12-weeks the surgical limb was significantly less than non-surgical limb (p < 0.001), additionally the surgical limb was significantly greater at time of return to sport than at 12 weeks (p < 0.001). There was a significant main effect of limb for hip adduction angle (p = 0.002). Surgical limb was significantly greater than non-surgical limb (Surgical = 9.84 (SE 1.53) degree, non-surgical = 4.79 (SE 1.01) degree). There was also a main effect of time and limb for patellofemoral joint stress. Return to sport was significantly greater than 12 weeks and the surgical limb was significantly less than non-surgical limb (Surgical = 4.93 (SE 0325) MPa, Nonsurgical = 5.29 (SE 0.30) MPa). INTERPRETATION: The surgical limb of participants following ACL-R demonstrated variables that have been associated with the development of patellofemoral pain.

Quadriceps strength changes across the continuum of care in adolescent male and female athletes with anterior cruciate ligament injury and reconstruction.

OBJECTIVES: To examine the quadriceps strength (QUADS) on the surgical (SURG) and non-surgical (Non-SURG) limbs in adolescent male and female athletes at pre-operative (PRE), 12 weeks post-operative (12WK), and return to sport (RTS) time points following ACL injury and reconstruction. DESIGN: Prospective cohort study design. SETTING: Clinical Research Laboratory. PARTICIPANTS: 66 adolescent athletes. MAIN OUTCOME MEASURES: Isokinetic QUADS of the SURG and Non-SURG limbs at the PRE, 12WK, and RTS time points were assessed and compared between each time point. RESULTS: Both male and female participants had significantly lower 12 WK QUADS in the SURG limb than the PRE QUADS, but the RTS QUADS was significantly greater than the 12WK QUAD (p < 0.05). However, only female participants had greater RTS QUADS as compared to the PRE QUADS (p < 0.001). For the Non-SURG limb, only male participants had a significant improvement over time (PRE vs RTS; p < 0.001). CONCLUSION: Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.

Thigh-Muscle and Patient-Reported Function Early After Anterior Cruciate Ligament Reconstruction: Clinical Cutoffs Unique to Graft Type and Age.

CONTEXT: Patient-reported function is an important outcome in anterior cruciate ligament rehabilitation. Identifying which metrics of thigh-muscle function are indicators of normal patient-reported function can help guide treatment. OBJECTIVE: To identify which metrics of thigh-muscle function discriminate between patients who meet and patients who fail to meet age- and sex-matched normative values for patient-reported knee function in the first 9 months after anterior cruciate ligament reconstruction (ACLR) and establish cutoffs for these metrics by covariate subgroups. DESIGN: Cross-sectional retrospective study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 256 patients (129 females, 128 males; age = 17.1 ± 3.0 years, height = 1.7 ± 0.1 m, mass = 74.1 ± 17.9 kg, months since surgery = 6.4 ± 1.4), 3 to 9 months after primary unilateral ACLR. MAIN OUTCOME MEASURE(S): We stratified the sample into dichotomous groups by the International Knee Documentation Committee (IKDC) score (IKDCMET, IKDCNOT MET) using sex- and age-matched normative values. We measured quadriceps and hamstrings isokinetic (60°/s) torque and power bilaterally. Normalized quadriceps and hamstrings peak torque (Nm/kg) and power (W/kg), limb symmetry indices (LSI, %), and hamstrings : quadriceps ratios were calculated. Logistic regression indicated which of these metrics could predict IKDC classification while controlling for age, graft type, and sex. Receiver operating characteristic curves established cutoffs for explanatory variables for both total cohort and covariate subgroups. Odds ratios (OR) determined the utility of each cutoff to discriminate IKDC status. RESULTS: Quadriceps torque LSI (≥69.4%, OR = 3.6), hamstrings torque (≥1.11 Nm/kg, OR = 2.1), and quadriceps power LSI (≥71.4%, OR = 2.0) discriminated between IKDC classification in the total cohort. Quadriceps torque LSI discriminated between IKDC classification in the patellar-tendon graft (≥61.6%, OR = 5.3), hamstrings-tendon graft (≥71.8%, OR = 10.5), and age <18 years (≥74.3%, OR = 5.2) subgroups. Hamstrings torque discriminated between IKDC classifications in the age <18 years (≥1.10 Nm/kg, OR = 2.6) subgroup. CONCLUSIONS: Quadriceps torque LSI, hamstrings torque, and quadriceps power LSI were the most useful metrics for predicting normal patient-reported knee function early after ACLR. Further, cutoff values that best predicted normal patient-reported function differed by graft type and age.

Effect of Meniscal Repair on Joint Loading in Athletes With Anterior Cruciate Ligament Reconstruction at 3 Months Following Surgery.

CONTEXT: Joint loading following anterior cruciate ligament reconstruction (ACL-R) is thought to influence long-term outcomes. However, our understanding of the role of meniscus repair at the time of ACL-R on early joint loading is limited. OBJECTIVE: To assess if differences in total energy absorption and energy absorption contribution of the hip, knee, and ankle exist in the early stages of rehabilitation between patients who received an isolated ACL-R and those with concomitant meniscal repairs. DESIGN: Cross-sectional. SETTING: Clinical laboratory. PATIENTS: Fifty-nine human subjects, including 27 who underwent ACL-R and 32 who underwent ACL-R with concomitant meniscal repairs. MAIN OUTCOME MEASURE: The total energy absorption and the energy absorption contribution of each joint of both the involved and uninvolved limbs during a double-limb squat task. RESULTS: There were significant differences in energy absorption contribution between groups at the knee joint (P = .01) and the hip joint (P = .04), but not at the ankle joint (P = .48) of the involved limb. Post hoc analysis indicates that preoperative hip and knee loading differences exist and when you control for preoperative loading (analysis of covariance), the postsurgery difference was not significant. CONCLUSIONS: The results of the study suggest that the additional surgical procedure of MR may not have had negative effects on joint loading during squatting at 12 weeks.

Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care.

BACKGROUND: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). PURPOSE: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05. RESULTS: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (-2.68° ± 3.19° vs -0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical (P < .0003) and nonsurgical (P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P = .0201) of surgical limb knee EAC, explaining 12.92% of the variance. CONCLUSION: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.

The validity and reliability of the Vail Sport Test™ as a measure of performance following anterior cruciate ligament reconstruction.

OBJECTIVES: To determine the validity and inter-session reliability of the Vail Sport Test™. DESIGN: Cohort study-exploratory methodological research design. SETTING: Clinical Research Laboratory. PARTICIPANTS: Forty-eight participants who underwent ACL-R. MAIN OUTCOME MEASURE: Participants performance on the Vail Sport Test™ was graded by an experienced rater in real-time, and simultaneously recorded by a three-dimensional (3D) motion capture system. Construct validity was assessed using the reference standards of the camera system and the IKDC short form. To determine the between-day reliability, a subset of participants returned to repeat the test. RESULTS: There were no significant difference between the scores collected in real-time and from the kinematic data on the involved limb (p = 0.222). There was a significant difference for the uninvolved limb (p = 0.015). There was no significant difference between the scores collected in real time and those of the IKDC (p = 0.885). Good inter-session reliability (ICC = 0.787) was found for the involved limb. CONCLUSION: The results of this study showed good reliability and partially support the validity of the Vail Sport Test as a measure of readiness to return to play.

Joint-Level Analyses of the Back Squat With and Without Intraset Rest.

Purpose: To provide a joint-level analysis of traditional (TS) and cluster (CS) set structure during the back-squat exercise. Methods: Eight men (24 [3] y, 177.3 [7.9] cm, 82.7 [11.0] kg, 11.9 [3.5] % body fat, and 150.3 [23.0] kg 1-repetition maximum [1RM]) performed the back-squat exercise (80%1RM) using TS (4 × 6, 2-min interset rest) and CS (4 × [2 × 3], 30-s intraset rest, 90-s interset rest), randomly. Lower-limb kinematics were collected by motion capture, as well as kinetic data by bilateral force platforms. Results: CS attenuated the loss in mean power (TS -21.6% [3.9%]; CS -12.4% [7.5%]; P = .042), although no differences in gross movement pattern (sagittal-plane joint angles) within and between conditions were observed (P ≥ .05). However, joint power produced at the hip increased from repetition (REP) 1 through REP 6 during TS, while a decrease was noted at the knee. A similar pattern was observed in the CS condition but was limited to the hip. Joint power produced at the hip increased from REP 1 through REP 3 but returned to REP 1 values before a similar increase through REP 6, resulting in differences between conditions (REP 4, P = .018; REP 5, P = .022). Conclusions: Sagittal-plane joint angles did not change in either condition, although CS elicited greater power. Differing joint power contributions (hip and knee) suggest potential central mechanism that may contribute to enhanced power output during CS and warrant further study. Practitioners should consider incorporating CS into training to promote greater power adaptations and to mitigate fatigue.

Validity and Reliability of a Commercially-Available Velocity and Power Testing Device.

Given the relationship between explosive-type training and power adaptation, tracking movement velocity has become popular. However, unlike previous variables, tracking velocity necessitates the use of a valid and reliable tool to monitor adaptation over time. Therefore, the primary purpose of this research was to assess the validity and reliability of a commercially-available linear position transducer (LPT). Nine resistance-trained men completed four sessions consisting of a single set of barbell back squat to volitional failure at 75% or 90% one-repetition maximum. Kinetic and kinematic data were captured for each repetition by the LPT and a 3-dimensional motion capture system and bipedal force platforms. In total, 357 instances of data from both systems were analyzed using intraclass correlations (ICC), effect size estimates, and standard error of measurement. Overall, the LPT yielded excellent ICCs (all ≥0.94) and small/trivial differences (d < 0.60). When categorized by median values, ICCs remained high (all ≥0.89) and differences remained small or trivial with the exception of high peak velocities (d = -1.46). Together, these data indicate that the commercially-available LPT is a valid and reliable measure for kinetic and kinematic variables of interest with the exception of high peak velocities.

Participants at three months post-operative anterior cruciate ligament reconstruction (ACL-R) demonstrate differences in lower extremity energy absorption contribution and quadriceps strength compared to healthy controls.

BACKGROUND: The purpose of this study was to compare hip and knee energy absorption contribution (EAC) during a double limb squat (DLS) and quadriceps strength in patients three months post-operative ACL-R versus matched healthy controls. METHODS: Twenty-four ACL-R participants (Age = 15.5 ±â€¯1.3 yrs; Ht = 1.66 ±â€¯.07 m; Mass = 66.3 ±â€¯15.5 kg) were compared to 24 age, sex, limb, and activity-matched healthy controls (Age = 15.5 ±â€¯1.2 yrs; Ht = 1.65 ±â€¯.08 m; Mass = 59.0 ±â€¯9.8 kg). Lower extremity biomechanical data was collected at three months post-operative ACL-R during five consecutive DLS. EAC was calculated during DLS descent. Isokinetic quadriceps strength was collected at 60°/s. Normalized quadriceps peak torque (QUADS) was averaged across five trials. Independent t-tests examined differences in group hip and knee EAC during each task. Separate Pearson product-moment correlations examined the relationship between QUADS and hip and knee EAC during the DLS. RESULTS: ACL-R demonstrated greater injured limb hip EAC (46.4 ±â€¯16.0) than Healthy (31.7 ±â€¯11.0) during a DLS (p = 0.001). ACL-R demonstrated less injured limb knee EAC (42.7 ±â€¯14.6) than Healthy (60.6 ±â€¯8.9) during DLS (p < 0.001). No differences were seen between uninjured limb hip (ACL-R = 0.0 ±â€¯14.2; Healthy = 33.4 ±â€¯9.1, p = 0.629) or knee (ACL-R = 56.9 ±â€¯15.6; Healthy = 59.1 ±â€¯9.8, p = 0.561) EAC and matched limbs. ACL-R injured limb QUADS was decreased compared to Healthy (ACL-R = 1.1 ±â€¯0.5; Healthy = 2.0 ±â€¯0.5, p < 0.001). No differences were seen in QUADS on the uninjured and matched limbs (ACL-R = 2.0 ±â€¯0.6; Healthy = 1.9 ±â€¯0.5, p = 0.894). There was a weak, negative correlation between injured limb QUADS and hip EAC (r = -0.471, p = 0.001) and moderate, positive correlation between injured limb QUADS and knee EAC (r = 0.615, p < 0.001). CONCLUSIONS: ACL-R participants demonstrate different eccentric loading strategies during a DLS at three months postoperative compared to matched healthy controls.

Energy Absorption Contribution and Strength in Female Athletes at Return to Sport After Anterior Cruciate Ligament Reconstruction: Comparison With Healthy Controls.

BACKGROUND: Female patients are more likely to suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) compared with healthy female controls. Few studies have examined the energy absorption contribution (EAC) that could lead to this subsequent injury. HYPOTHESIS: The ACLR group would demonstrate an altered EAC between joints (hip, knee, and ankle) but no difference in quadriceps, hip abduction, or hip external rotation (ER) strength at the time of RTS. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 34 female participants (ACLR: n = 17; control: n = 17) were enrolled in the study and matched for age and activity level. Jump landing performance for the initial 50 milliseconds of landing of a lateral-vertical jump was assessed using a 10-camera 3-dimensional motion capture system and 2 force plates. Isokinetic quadriceps strength was measured using a Biodex machine, and hip abduction and ER isometric strength were measured using a handheld dynamometer. All values were normalized to the participant's height and weight. A 1-way multivariate analysis of variance was used to assess between-group differences in the EAC at the hip, knee, and ankle. Two 1-way analyses of variance were used to independently examine quadriceps, hip abduction, and hip ER strength between the groups. RESULTS: Significant differences in the EAC were found between the groups for the involved hip (P = .002), uninvolved hip (P = .005), and involved ankle (P = .023). There were no between-group differences in the EAC for the involved or uninvolved knee or the uninvolved ankle. Patients who underwent ACLR demonstrated significantly decreased quadriceps strength on the involved limb (P = .02) and decreased hip ER strength on both the involved (P = .005) and uninvolved limbs (P = .002). No significant strength differences were found between the groups for the uninvolved quadriceps or for involved or uninvolved hip abduction. CONCLUSION: At RTS, patients who underwent ACLR utilized a greater hip EAC bilaterally and a decreased involved ankle EAC during a lateral-vertical jump. Furthermore, quadriceps strength on the involved limb and hip ER strength of bilateral lower extremities remained decreased. This could place greater stress on the ACL graft and ultimately lead to an increased injury risk.

THE RELATIONSHIP BETWEEN PRE-OPERATIVE AND TWELVE-WEEK POST-OPERATIVE Y-BALANCE AND QUADRICEPS STRENGTH IN ATHLETES WITH AN ANTERIOR CRUCIATE LIGAMENT TEAR.

BACKGROUND: Pre-operative quadriceps strength may have a positive influence on post-operative function and outcomes at time of return to sport. Little consideration has been given to quadriceps strength during the early post-operative timeframes. Twelve-week post-operative anterior cruciate ligament reconstruction (ACL-R) is considered a critical time point for progression in the rehabilitation process. There is currently limited research looking at the relationship between clinical measurements pre-operatively and at 12-weeks following ACL-R. PURPOSE/HYPOTHESIS: The primary purpose of this study was to examine the differences between Y-Balance Test Lower Quarter (YBT-LQ) and isokinetic quadriceps strength tested pre-operatively and post-operatively following ACL-R (12-weeks). STUDY DESIGN: Within subject, repeated measures. METHODS: Thirty-nine participants (15.6 ± 1.5 y/o) were diagnosed with an ACL tear and were undergoing rehabilitation to return to a sport requiring cutting and pivoting were included. YBT-LQ and isokinetic quadriceps strength were assessed pre-operatively and at 12-weeks after ACL-R. YBT-LQ composite scores were calculated bilaterally and isokinetic quadriceps strength was tested using the Biodex Multi-Joint Testing and Rehabilitation System. Paired T-tests were used to determine mean group differences between YBT-LQ and isokinetic quadriceps strength scores pre-operatively and at 12-weeks post-operative. A Pearson Correlation was performed to determine relationships between variables at both time points. RESULTS: There was a significant improvement in YBT-LQ composite scores from pre-operative to 12-weeks post-operative on both the involved (Pre-operative: 89.0 ± 7.7; 12-weeks: 94.1 ± 7.1, p<0.001) and uninvolved (Pre-operative: 92.6 ± 6.2; 12-weeks: 97.6 ± 6.8, p<0.001) limbs. Quadriceps strength decreased significantly from pre-operative to 12-weeks on the involved limb (Pre-operative: 82.3 ftlbs ± 38.6; 12-weeks: 67.9 ftlbs±27.4, p<0.01), but no differences were found on the uninvolved limb (Pre-operative: 117.3ftlbs ± 42.0; 12-weeks: 121.7ftlbs ± 41.5, p = 0.226). CONCLUSIONS: Involved limb quadriceps strength decreases from time of pre-operative to 12-weeks following ACL-R. LEVEL OF EVIDENCE: 3.

Do Muscle Strength Deficits of the Uninvolved Hip and Knee Exist in Young Athletes Before Anterior Cruciate Ligament Reconstruction?

BACKGROUND: Muscle strength of the involved limb is known to be decreased after injury. Comparison with the uninvolved limb has become standard of practice to measure progress and for calculation of limb symmetry indices (LSIs) to determine readiness to return to sport. However, some literature suggests strength changes in the uninvolved limb also are present after lower extremity injury. PURPOSE: To examine the uninvolved limb strength in a population of adolescent athletes after an anterior cruciate ligament (ACL) injury and compare strength values with those of the dominant limb in a healthy control group. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 64 athletes were enrolled in this study, including 31with injured ACLs (mean age, 15.6 ± 1.4 years) and 33 healthy controls (mean age, 14.9 ± 1.9 years). The median time from injury to testing was 23 days for the ACL-injured group. Participants underwent Biodex isokinetic strength testing at 60 deg/s to assess quadriceps and hamstring strength. Isometric hip strength (abduction, extension, external rotation) was measured using a handheld dynamometer. The muscle strength of the uninvolved limb of the ACL-injured group was compared with that of the dominant limb of the healthy control group. RESULTS: The results showed a significant difference in quadriceps muscle strength between the 2 study groups (P < .001). Isokinetic quadriceps strength of the uninvolved limb in the ACL group was significantly decreased by 25.5% (P < .001) when compared with the dominant limb of the control group. CONCLUSION: The results of this study demonstrate a decreased isokinetic strength of the quadriceps muscle in the uninvolved limb after ACL injury as compared with healthy controls. Consideration should be taken when using the uninvolved limb for comparison when assessing quadriceps strength in a population with an ACL injury.

Knee Extension Range of Motion at 4 Weeks Is Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The anterior cruciate ligament (ACL) is commonly torn, and surgical reconstruction is often required to allow a patient to return to their prior level of activity. Avoiding range of motion (ROM) loss is a common goal, but little research has been done to identify when ROM loss becomes detrimental to a patient's future function. PURPOSE: To determine whether there is a relationship between early knee side-to-side extension difference after ACL reconstruction and knee side-to-side extension difference at 12 weeks. The hypothesis was that early (within the first 8 weeks) knee side-to-side extension difference will be predictive of knee side-to-side extension difference seen at 12 weeks. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Knee side-to-side extension difference measures were taken on 74 patients undergoing ACL reconstruction rehabilitation at the initial visit and 4, 8, and 12 weeks postoperatively. Visual analog scores (VAS) and International Knee Documentation Committee (IKDC) scores were also recorded at these time frames. RESULTS: There was a strong relationship between knee extension ROM at 4 and 12 weeks (r = 0.639, P < .001) and 8 and 12 weeks (r = 0.742, P < .001). When the variables of knee extension ROM at initial visit and 4 and 8 weeks were entered into a regression analysis, the predictor variable explained 61% (R (2) = 0.611) of variance for knee extension ROM at 12 weeks, with 4 weeks (R (2) = 0.259) explaining the majority of this variance. CONCLUSION: This study found that a patient's knee extension at 4 weeks was strongly correlated with knee extension at 12 weeks. CLINICAL RELEVANCE: This information may be useful for clinicians treating athletic patients who are anxious for return to sport by providing them an initial goal to work toward in hopes of ensuring successful rehabilitation of their knee.

Y BALANCE TEST™ ANTERIOR REACH SYMMETRY AT THREE MONTHS IS RELATED TO SINGLE LEG FUNCTIONAL PERFORMANCE AT TIME OF RETURN TO SPORTS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

BACKGROUND: Restoration of symmetrical strength, balance, and power following anterior cruciate ligament reconstruction (ACL-R) are thought to be important factors for successful return to sports. Little information is available regarding early rehabilitation outcomes and achieving suggested limb indices of 90% on functional performance measures at the time of return to sports (RTS). HYPOTHESIS/PURPOSE: To examine the relationship between symmetry of the anterior reach of the Y Balance Test™ at 12 weeks and functional performance measures at time of return to sports after anterior cruciate ligament (ACL) reconstruction. STUDY DESIGN: Retrospective Cohort. METHODS: Forty subjects (mean ± SD age, 17.2 ± 3.8 years) who were in the process of rehabilitation following ACL reconstruction. Each subject volunteered and was enrolled in the study during physical therapy following ACL-R. Participants averaged two visits per week in physical therapy until the time of testing for RTS. The Y Balance Test™ was assessed at 12 weeks. Participants completed a battery of tests at RTS (6.4 ± 1.1 months) including triple hop distance (THD), single hop distance (SHD), isometric knee extension strength (KE), and the Vail Sport Test™. Side to side difference was calculated for the Y Balance Test™ anterior reach and limb symmetry indices (LSI) were computed for THD, SHD, and KE. Multiple regression models were used to study the relationship between variables at 12 weeks and RTS while controlling for age, gender, type of graft, and pain score. In addition, subjects were dichotomized based on a side-to-side Y Balance anterior reach difference into high risk (>4 cm) or low risk (≤4 cm) categories. A receiver operating characteristic (ROC) curve was used to identify individuals at 12 weeks who do not achieve 90% limb symmetry indices at time of RTS testing. . RESULTS: A statistically significant association was seen between Y Balance ANT at 12 weeks and SHD at RTS (ß = -1.46, p = 0.0005, R(2) = 0.395), THD at RTS (ß = -1.08, p = 0.0011, R(2) = 0.354) and KE at RTS (ß = -1.00, p = 0.0025, R(2) = 0.279) after adjusting for age, gender, type of graft and pain score at week 12. There was no significant association between Y Balance ANT at 12 weeks and Vail Sport Test at RTS (p = 0.273). ROC curves indicated that the Y Balance ANT at 12 weeks identified participants who did not achieve 90% LSI for the SHD (AUC = 0.82 p = 0.02) and THD (AUC=0.85, p = 0.01) at RTS with a sensitivity of 0.96 (SHD) and 0.92 (THD) respectively. CONCLUSIONS: Participants following ACL-R who demonstrated > 4 cm Y Balance ANT deficits at 12 weeks on their involved limb did not tend to achieve 90% LSI for the SHD and THD at time of return to sports. The Y Balance ANT at 12 weeks and Vail Sport Test™ appear to measure different constructs following ACL-R. LEVELS OF EVIDENCE: Level 3.