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(9) ACL INJURIES INCREASE BALANCE AND JUMP-LANDING ASYMMETRIES IN COLLEGIATE ATHLETES: A LONGITUDINAL STUDY WITH PRE-INJURY ASSESSMENTS


Authors:

Nicole M. Bordelon, MS, CSCS – Doctoral Student, Auburn University

JACOB LAYER – Doctoral Student, University of Wyoming

Sydne LaCroix – Graduate Assistant, University of Wyoming

Megan Critchley – Doctoral Student, University of Calgary

Boyi Dai

Abstract:

Introduction: Anterior cruciate ligament (ACL) tears are one of the most severe lower extremity injuries amongst collegiate athletes. Following an ACL injury, individuals typically decrease strength and balance performance and increase lower extremity asymmetry. ACL re-injury rates are very high despite surgical reconstruction and rehabilitation, so it is imperative to understand the injury mechanism and develop prevention strategies.
Purpose:
To quantify the effect of ACL injuries and reconstruction on performance and bilateral asymmetries in a lower extremity reaching test and a counter-movement jump-landing (CMVJ) test in collegiate athletes. Methodology: The current study was a continuation of a previous study, where approximately 500 collegiate athletes from a National Collegiate Athletic Association Division I university performed baseline assessments. In the follow-up, 8 athletes (5 men’s American Football, 1 women’s soccer, 1 women’s basketball, and 1 women’s volleyball; age: 19.4 ± 1.2y; height: 1.83 ± 0.10m; weight: 85.2 ± 16.5kg) sustained an ACL injury and were included in the study. All participants were treated with a standard rehabilitation program under team physicians and athletic trainers. Athletes performed baseline lower extremity reaching and CMVJ tests prior to their injury. They also performed a lower extremity reaching test 3 and 6 month post-ACL reconstruction surgeries and a CMVJ test 6 months after their surgeries. Lower extremity anterior reaching distances were recorded using a Y-balance apparatus. 3 practice trials per leg were performed prior to recording 3 official trials. The greatest reaching distance was used and normalized to leg length for analysis. 1 practice and 3 successful CMVJ trials were also performed using two force platforms. Participants stood shoulder-width apart with each foot on a force platform. They were instructed to lower the body and jump vertically as high as possible with an arm swing. Peak forces for each leg during jumping and landing phases were extracted and normalized to body weight. Bilateral asymmetry index was calculated as: (non-injured side – injured side) / (larger value of the two sides). For the reaching test, dependent variables were compared among the three time points (pre-injury, 3-month post-surgery, and 6-month post-surgery) using a RM·ANOVA, followed by paired t-tests (a = 0.05). For the CMVJ test, dependent variables were compared between pre-injury and 6-month post-surgery using paired t-tests.
Results:
Participants demonstrated decreased reaching distances for the injured leg and increased reaching distance asymmetries at 3-month and 6-month post-surgery compared pre-injury (p < 0.02). Participants also increased jumping and landing force asymmetries at 3-months and 6-months post-surgery compared to pre-injury (p < 0.03).
Conclusion:
The results show ACL injuries increase balance and CMVJ asymmetries. Increased asymmetries were likely attributed to decreased performance in the injured leg since participants showed limited asymmetry during baseline testing. Practical Application: The decreased performance of the injured leg and compensatory loading in the non-injured leg might contribute to high ACL re-injury rates to both legs. Baseline assessments prior to potential ACL injuries should be considered for establishing an individual’s pre-injury data. Normalized asymmetries of < 10% should be encouraged in post-surgery rehabilitation.

 

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