Landing biomechanics deficits in anterior cruciate ligament reconstruction patients can be assessed in a non‐laboratory setting

Abstract

Landing biomechanics provide important information pertaining to second anterior cruciate ligament (ACL) injury risk in patients following ACL reconstruction (ACLR). While traditional motion analysis technologies are often impractical for use in non-laboratory settings, methods to assess landing biomechanics which are inexpensive, portable, and user-friendly have recently been developed and validated. The purpose of this study was to compare landing kinematics and kinetics between ACLR patients and uninjured controls in a non-laboratory setting. Sixteen ACLR patients (7 male/9 female, 6-12 months post-ACLR) and 16 gender-matched controls completed seven bilateral drop vertical jumps and seven unilateral drop landings on each limb. Plantar force was measured bilaterally using force sensing insoles and frontal and sagittal-plane knee kinematics were measured using two tablets, six reflective markers, and automated point tracking software. Plantar force impulse normalized symmetry index (NSI) and knee frontal plane projection angle (FPPA) range of motion were computed during bilateral landing, and knee flexion range of motion NSI was computed during unilateral landing and compared between groups using independent samples t tests. ACLR patients had larger NSIs (reflecting less symmetry) for plantar force impulse during bilateral landing (p < 0.001) and knee flexion range of motion during unilateral landing (p = 0.004). No between-group differences were observed for knee FPPA range of motion (p = 0.111). This study is an important step towards assessing landing biomechanics in non-research settings with the goal of providing quantitative injury risk metrics in a clinical setting that can be used for return to sport decision making.

Asymmetries in Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-of-Concept Study

“…As evidence has shown that deficits in frontal plane hip mechanics and postural stability may contribute to second ACL injury risk [ 34 ], the inclusion of hip joint kinematics may be a better predictor of ACL rupture risk than analysis of knee joint kinematics alone. A recent study by Peebles et al [ 35 ] found reduced symmetry in individuals with ACLR compared to controls, but found no between-group difference in knee FPPA in a bilateral landing. However, their work revealed a significant difference in knee kinematics during unilateral landing [ 35 ].…”

“…A recent study by Peebles et al [ 35 ] found reduced symmetry in individuals with ACLR compared to controls, but found no between-group difference in knee FPPA in a bilateral landing. However, their work revealed a significant difference in knee kinematics during unilateral landing [ 35 ]. Based on our data and current literature, it is suggested that unilateral landing tasks may be more proficient at detecting asymmetries and that there may be a need to assess both the hip and the knee for asymmetries between limbs of individuals with ACLR.…”

Continuous similarity analysis in patient populations

“…Data collection was completed for ACLR patients in a local rehabilitation facility, while data collection for landing controls was completed in a university athletic center (Peebles et al, 2021). All participants wore standardized neutral cushioning running shoes (Air Pegasus, Nike Inc., Beaverton, Oregon).…”

“…All participants wore standardized neutral cushioning running shoes (Air Pegasus, Nike Inc., Beaverton, Oregon). Participants completed seven bilateral drop vertical jumps, with a forward distance of half the participant's body height, and seven unilateral drop landings on each limb, during which participants dropped off of a 31 cm high box, landed on a single limb and held the unilateral landing for two seconds (Peebles et al, 2021).…”

ACL special issue, editors

“…They assessed movements patterns (landing biomechanics) in a nonresearch setting, demonstrating equivalence to laboratory measures. This study is an important step toward providing quantitative injury risk metrics in a clinical setting that can be used for return to sport decision‐making 33 …”