Change of Direction Assessment Following Anterior Cruciate Ligament Reconstruction: A Review of Current Practice and Considerations to Enhance Practical Application

Abstract

Change of direction (CoD) has been indicated as a key mechanism in the occurrence of anterior cruciate ligament (ACL) injury during invasion sports. Despite these associations, assessments of knee function in athletic populations at the time of return to sport following ACL reconstruction (ACLr) have often focused on strength and single-leg hop tests, with a paucity of evidence to describe the CoD characteristics. Therefore, the aim of this narrative review was to describe the movement strategies exhibited following ACLr during CoD tasks and to critically analyze the range of tests that have been used. Specifically, we examined their ability to identify between-limb deficits and individuals who display a heightened risk of secondary injury and/or reductions in their level of pre-injury performance. MEDLINE, PubMed and SPORT Discuss databases were used and 13 articles were identified that met the inclusion criteria. Examination of the available literature indicates that current field-based practices are not representative of relevant sport demands and are unable to effectively assess knee function following ACLr. Laboratory-based studies have identified residual deficits and altered movement strategies at the time of return to sport, and this in part may be related to risk of re-injury. However, these assessments exhibit inherent limitations and are not practically viable for monitoring progress during rehabilitation. Consequently, alternative solutions that are more-aligned with the multitude of factors occurring during CoD maneuvers in chaotic sports environments are warranted to allow practitioners to 'bridge the gap' between the laboratory and the sports field/court. This approach may facilitate a more informed decision-making process with the end goal being, a heightened 'return to performance' and a lower risk of re-injury.

Can Countermovement Jump Neuromuscular Performance Qualities Differentiate Maximal Horizontal Deceleration Ability in Team Sport Athletes?

“…These findings, accordingly, have important implications for coaches and sport science professionals tasked with preparing team sport athletes for competition demands. Given the significance of maximal horizontal deceleration ability to team sport performance [ 2 ], injury risk [ 6 ] and the effectiveness of return-to-play protocols [ 56 ], future research should (a) investigate the NMP determinants of horizontal deceleration ability across different sports and performance levels, and (b) seek to determine the efficacy of training interventions specifically focused on improving maximal horizontal deceleration ability.…”

Whole-Body Reactive Agility Metrics to Identify Football Players With a Core and Lower Extremity Injury Risk

“…Movement happens with some degree of cognitive processing in order for the proper response to occur. Research has demonstrated those with a history of concussion or anterior cruciate ligament reconstruction have slowed dual-task performance (Marques et al, 2020 ; Ness et al, 2020 ). This slowing of dual-task neural processing may lead to differences in performance capabilities which may also lead to an elevated risk for musculoskeletal injury (Wilkerson et al, 2017 , 2020 ).…”

The use of inertial measurement units for analyzing change of direction movement in sports: A scoping review

“…Motion capture systems are recognized as the gold standard for movement analysis and are used to measure joint moments, ground reaction forces, contact times, velocities, joint angles and speed of COD movement. [19][20][21][22][23] However, motion capture systems are not easily transported to field settings. 19,24,25 Global positioning systems (GPS) are a potential feasible on-field monitoring system, but there are limitations with GPS in recognizing highspeed direction changes.…”

“…There are previous reviews presenting the challenges on the use of IMUs for measuring ground reaction forces 40 and the use of regression techniques for continuous biomechanical monitoring. 41 In addition, the review by Marques et al 23 underlines the need for viable solutions for onpitch/court measurements to 'bridge the gap' between laboratory based measures and real-life situations.…”