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Greater knee flexion excursion/moment in hopping is associated with better knee function following anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Individuals with impaired knee function after anterior cruciate ligament reconstruction (ACLR) may be at greater risk of developing knee osteoarthritis related to abnormal knee joint movement and loading. The aim of this study was to assess the association between knee biomechanics and knee laxity during hopping and clinically assessed knee function (i.e., patient-reported knee function and hop tests) following ACLR.

Methods

Sixty-six participants (23 women, mean age 28 ± 6 years, mean 18 ± 3 months following ACLR) completed a standardized single-leg hopping task. Three-dimensional movement analysis was used to assess knee flexion excursion and body weight/height normalized knee flexion moments during landing for the involved limb. Anterior–posterior knee laxity was assessed with a KT-1000 knee arthrometer. Participants then completed a patient-reported knee function questionnaire and three separate hop tests (% of uninvolved limb) and were divided into poor and satisfactory knee function groups (satisfactory: ≥85% patient-reported knee function and ≥ 85% hop test symmetry). Associations between knee function and hop biomechanics/knee laxity were assessed using logistic regression and interquartile range scaled odds ratios (ORIQR).

Results

Greater knee flexion excursion (ORIQR 2.9, 95%CI 1.1–7.8), greater knee flexion moment (ORIQR 4.9, 95%CI 1.6–14.3) and lesser knee laxity (ORIQR 4.7, 95%CI 1.5–14.9) were significantly associated with greater odds of having satisfactory knee function (≥ 85% patient-reported knee function and ≥ 85% hop test symmetry).

Conclusion

Greater knee flexion excursion/moment during hop-landing and lesser knee laxity is associated with better patient-reported knee function and single-leg hop test performance following ACLR. Patients with lower levels of knee function following ACLR demonstrated hop-landing biomechanics previously associated with early patellofemoral osteoarthritis. Therefore, interventions aimed at improving hop landing biomechanics in people with poor knee function are likely required.

Level of evidence

III, Cross-sectional study.

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Acknowledgements

We gratefully acknowledge the assistance of Ms. Stacey Telianidis and Ms. Karine Fortin who assisted with data collection.

Funding

Luke Perraton was a recipient of a National Health and Medical Research Council (NHMRC) postgraduate scholarship (APP1038378). Adam Bryant and Ross Clark are recipients of NHMRC Career Development Fellowships (R.D.Wright Biomedical, No. 1053521 and 1090415). AC was supported by postdoctoral funding from a European Union Seventh Framework Program (FP7-PEOPLE-2013-ITN; 607510) and is a recipient of an NHMRC Early Career Fellowship (Neil Hamilton Fairley, No. 1121173). The authors have no professional or financial affiliations that may be perceived to have biased the presentation.

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Authors and Affiliations

  1. Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Building B, McMahons Road, Peninsula campus, Frankston, VIC, 3199, Australia

    Luke G. Perraton

  2. School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Australia

    Ross A. Clark

  3. School of Allied Health, La Trobe University, Bundoora, Australia

    Kay M. Crossley & Adam G. Culvenor

  4. Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore

    Yong-Hao Pua

  5. Orthosport Victoria, Epworth Hospital, Melbourne, Australia

    Tim S. Whitehead

  6. The Park Clinic, Melbourne, Australia

    Hayden G. Morris

  7. Paracelsus Medical University, Institute of Anatomy Salzburg and Nuremburg, Salzburg, Austria

    Adam G. Culvenor

  8. Melbourne School of Physiotherapy, The University of Melbourne, Melbourne, Australia

    Adam L. Bryant

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  1. Luke G. Perraton
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Correspondence to Luke G. Perraton.

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Ethical approval was provided by the University of Melbourne Human Research Ethics committee (ID 1136167).

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Perraton, L.G., Clark, R.A., Crossley, K.M. et al. Greater knee flexion excursion/moment in hopping is associated with better knee function following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 596–603 (2019). https://doi.org/10.1007/s00167-018-5197-7

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