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Recent Advances in the Prevention and Rehabilitation of ACL Injuries

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Biomedical Engineering".

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 20871

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Dr. Dimitris G. Mandalidis

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Department of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
Interests: anatomical and functional asymmetries of the musculoskeletal system; postural control assessment, ; gait analysis; rehabilitation of musculoskeletal dysfunctions; prevention of sports injuries
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Special Issue Information

Dear Colleagues,

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee in the athletic population. The treatment of this injury very often requires the implementation of appropriate surgical interventions and long-term physical rehabilitation programs, which are necessary to safely return to the pre-injury level of activity. However, despite improvements in the management of ACL injuries, many athletes worldwide are still injured each year, making it more imperative than ever to prevent the onset of the injury and minimize—if not eliminate—the adverse effects of re-injury.

The anatomy of the athlete’s musculoskeletal system related to lower-limb joint alignment, skeletal asymmetries or deviations, non-fatigued or fatigue-induced functional imbalances, postural control, and fitness deficits are only some of the intrinsic factors which in recent years have been under continuous research.

Research related to the biomechanical analysis of injury is also ongoing, being undertaken by many investigators in an attempt to identify the sports-related factors that contribute to its provocation during the execution of athletic movements such as cuts, jumps, and landings.

Establishing effective and balanced rehabilitation programs with strength training and neuromuscular exercises that will increase athletes’ compliance continues to be pursued by clinical therapists, while simultaneously seeking methods and tests that will optimally assess athletes’ readiness before returning to sports activities.

Furthermore, wearable technology, the use of fMRI to identify brain mechanisms underlying ACL injury risk and sports-related movements, and the application of virtual reality (VR) as well as augmented reality (AR) to identify deficits and enhance neuromuscular training, consistently gain ground in individualized ACL injury prevention and rehabilitation.

This Special Issue is addressed to all those working in these areas, and welcomes original papers, review articles, and meta-analyses that provide insight into "Recent Advances in the Prevention and Rehabilitation of ACL Injuries". We are looking forward to your contributions.

Dr. Dimitris G. Mandalidis
Guest Editor

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Keywords

anatomic variations
musculoskeletal assessment
skeletal asymmetries
tibial torsion
valgus knee
medial knee displacement
foot overpronation
lower limb joints alignment/misalignment
postural control
fatigue-induced functional imbalances
injury-related biomechanics
cutting movements
jumping and landing
strength exercises/training
unsupervised/supervised preventive/rehabilitative programs
adherence/compliance with intervention programs
post-rehabilitation assessment
neuromuscular training
wearable technology
inertial sensors
injury-related brain function
virtual and/or augmented reality
augmented neuromuscular training
personalized rehabilitation

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Recent Advances in the Prevention and Rehabilitation of ACL Injuries—2nd Edition in Applied Sciences (1 article)

Published Papers (8 papers)

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Research

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15 pages, 824 KiB

Open AccessArticle

Examination of the Validity and Reliability of the Greek Version of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire

by Dimitrios Krokos, Andreas Kandanoleon, Eleftherios Paraskevopoulos, Maria Tsekoura, Eleni Kapreli and Anna Christakou

Appl. Sci. 2024, 14(24), 11655; https://doi.org/10.3390/app142411655 - 13 Dec 2024

Viewed by 470

Abstract

The psychological readiness of athletes and its connection to their functional status in returning to sport after a musculoskeletal injury has been previously studied. The “Psychological Readiness of Injured Athlete to Return to Sport” (PRIA-RS) questionnaire is a widely used tool designed to assess an athlete’s psychological readiness to return to sport. The purpose of the present study is to investigate the validity and reliability of the PRIA-RS questionnaire in Greek football athletes. The questionnaire was administered to 113 football athletes, and its face validity, content validity, concurrent validity, construct validity, test–retest reliability, and internal consistency were assessed. The face and content validity of the PRIA-RS were supported, and an exploratory factor analysis confirmed the instrument’s original two-factor structure. Its concurrent validity was demonstrated by examining correlations between the PRIA-RS and three other measures: the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire for Rehabilitated Athletes Returning to Competition, and the Attention Questionnaire for Rehabilitated Athletes Returning to Competition. The PRIA-RS exhibited a good internal consistency (Cronbach’s α = 0.82). The intraclass correlation coefficients (ICCs) for the test–retest reliability of each factor were excellent (ICC = 0.97−0.99). Overall, the PRIA-RS appears to be a valid and reliable tool that rehabilitation professionals can utilize in both clinical practice and research by realizing the athletes’ psychological needs and helping them to return safer with no future musculoskeletal injuries. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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23 pages, 1858 KiB

Open AccessArticle

The Complex Interrelationships of the Risk Factors Leading to Hamstring Injury and Implications for Injury Prevention: A Group Model Building Approach

by Nikolaos I. Liveris, Charis Tsarbou, George Papageorgiou, Elias Tsepis, Konstantinos Fousekis, Joanna Kvist and Sofia A. Xergia

Appl. Sci. 2024, 14(14), 6316; https://doi.org/10.3390/app14146316 - 19 Jul 2024

Cited by 2 | Viewed by 1407

Abstract

There is a gap in the literature regarding the complex interrelationships among hamstring injury (HI) risk factors. System dynamics (SD) modeling is considered an appropriate approach for understanding the complex etiology of HI for effective injury prevention. This study adopted the SD method and developed a causal loop model (CLD) to elucidate the intricate relationships among HI risk factors. This is performed by combining literature evidence and insights from expert stakeholders through a group model building (GMB) approach. The GMB methodology facilitated the identification of sixty-five critical factors influencing the HI risk, revealing the dynamic interplay between factors. Stakeholder engagement underscored the importance of previous injury characteristics (level of influence of previous injury, severity of previous injury, quality and size of scar tissue) and the quality of rehabilitation. HI-CLD revealed that many factors had indirect effects on HI risk. The HI-causal loop model establishes a foundation for a future stock and flow quantitative SD model aiming to advance HI prevention strategies through an interdisciplinary collaborative effort. These findings underscore the complexity of HI prevention, necessitating a holistic approach that integrates the views of diverse professional expertise. Appropriate inter-professional collaboration and continuous athlete screening are important for effective injury prevention strategies. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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12 pages, 1110 KiB

Open AccessArticle

A Single-Leg Vertical Hop Test Is an Effective Tool to Measure Functional Performance after Anterior Cruciate Ligament (ACL) Reconstruction

by Jürgen Höher, Isabella Ostner, Anne Schraplau, Nina Sprenger, Ulrike Allers, Helen Sulprizio, Arndt Düsing, Markus Fink, Caroline Schmidt-Lucke and Oliver Tenfelde

Appl. Sci. 2024, 14(8), 3143; https://doi.org/10.3390/app14083143 - 9 Apr 2024

Viewed by 1613

Abstract

This study evaluated the single-leg vertical hop test (SLVHT), using digital sensor technology, for the functional assessment of rehabilitation progress in patients after ACL reconstruction (ACL-R). Between January 2019 and June 2022, 143 patients (26.6 (8.9) years, m/f 66/34%) completed return-to-sport testing at 3 and 6 months after ACL-R. The jump height during SLVHT was quantified with a digital motion sensor, containing a three-axis acceleration gyroscope sensor, and the limb symmetry index (LSI) (injured/non-injured leg ratio) was calculated. Three months postoperatively, the jump height of the injured leg was 59.6% (13.5 (5.5) cm) that of the non-injured leg (22.9 (6.2) cm; p < 0.01). After 6 months, the jump height of the injured leg (18.4 (6.9) cm) improved by 44.1% compared to that at the 3-month follow-up but was still lower than the non-injured leg jump height (23.2 (7.0) cm, p < 0.001; LSI = 79.6%). Men jumped higher than women, but their LSI was not different at 3 (59.6 vs. 59.5%) and 6 months (80.6 vs. 77.8%). Regression analysis identified the non-injured leg jump height as the primary independent predictor of the jump height of the injured leg (β = 0.776, T = 51.506, p < 0.001). SLVHT, using digital sensor technology, is a simple and cost-effective functional test to assess rehabilitation progress after ACL-R, with the potential for multi-centre data analysis. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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11 pages, 548 KiB

Open AccessArticle

Pre-Season ACL Risk Classification of Professional and Semi-Professional Football Players, via a Proof-of-Concept Test Battery

by Charis Tsarbou, Nikolaos I. Liveris, Sofia A. Xergia, Maria Tsekoura, Konstantinos Fousekis and Elias Tsepis

Appl. Sci. 2023, 13(13), 7780; https://doi.org/10.3390/app13137780 - 30 Jun 2023

Cited by 4 | Viewed by 2162

Abstract

This study aimed to identify football players at high risk (HR) for anterior cruciate ligament (ACL) injury via a four-test battery and assess possible factors affecting classification. Ninety-one professional and semi-professional male athletes participated in a field-based pre-season screening. The cut-off points of the test battery were 10% acknowledged inter-limb asymmetry limit for quadriceps and hamstring isometric strength and single-leg triple hop for distance, in addition to the upper limit of 6 errors in the landing error scoring system (LESS). Additional assessment of hip adductors and core stability completed the global functional profile of the players. Sixty-one players were identified as HR and thirty as low-risk (LR) for ACL injury. Discriminant analysis showed that the proposed test battery classified accurately 78.0% of them, with 91.8 sensitivity and 61.9% specificity. Only four misclassified players in the LR group were at risk of inadequate treatment. All participants were considered healthy, and history of a previously rehabilitated injury did not interfere with the results. LESS seems to be the best predictor for injury-risk grouping. Prone bridge time was also a whole-body variable discriminating between groups. The proposed test battery provides a promising option for field-based pre-season ACL risk assessment of football players and needs to be studied prospectively. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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15 pages, 1751 KiB

Open AccessArticle

M-Mode Ultrasound Behavior of Rectus Femoris and Vastus Intermedius during Contraction with Anthropometric Correlations: Cross-Sectional Study

by Fermin Naranjo-Cinto, Daniel Pecos-Martín, Juan Nicolás Cuenca-Zaldivar, Alexander Achalandabaso-Ochoa, Jessica Quintero-Pérez, Pilar Bierge-Sanclemente, María García-Escudero and Samuel Fernández-Carnero

Appl. Sci. 2023, 13(4), 2589; https://doi.org/10.3390/app13042589 - 17 Feb 2023

Cited by 1 | Viewed by 3283

Abstract

The quadriceps femoris muscle (QF) is of clinical importance since it has been correlated with pathologies at knee level, such as anterior cruciate ligament (ACL) injury, pain processes and complex clinical conditions. Among the variables that have been related to these clinical conditions are anthropometric measurements, architecture and muscular behavior of the QF. The aim of this study was to determine the relationship between the rectus femoris (RF) and vastus intermedius (VIM) muscles’ behavior measured by rehabilitative ultrasound imaging (RUSI) M-mode under maximal voluntary isometric contraction (MVIC) and anthropometric measurements. This was a cross-sectional, observational study. Sixty-two asymptomatic volunteers were included (20.42 ± 4.97 years, most women 59.7%). RUSI measurements were muscle contraction/rest thickness and contraction/relaxation velocity. Anthropometric measurements were, lower limb length, RF length, QF tendon length, distance between spines, proximal, middle and distal thigh perimeter. Statistically significant correlations (p < 0.05) were found between VIM thickness at rest and contraction with thigh perimetry, RF length and dominant lower limb length. For the RF, a correlation was found between the thickness at rest and the length of this muscle (p = 0.003). There is a correlation between anthropometric variables and muscular behavior measured by RUSI M-mode. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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Review

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20 pages, 389 KiB

Open AccessReview

Effective Prevention and Rehabilitation Strategies to Mitigate Non-Contact Anterior Cruciate Ligament Injuries: A Narrative Review

by Domenico Franco, Luca Ambrosio, Pierangelo Za, Girolamo Maltese, Fabrizio Russo, Gianluca Vadalà, Rocco Papalia and Vincenzo Denaro

Appl. Sci. 2024, 14(20), 9330; https://doi.org/10.3390/app14209330 - 13 Oct 2024

Cited by 1 | Viewed by 5073

Abstract

Non-contact anterior cruciate ligament injuries (NC-ACLs) represent a significant concern in sports medicine, particularly among athletes and physically active individuals. These injuries not only result in immediate functional impairment but also predispose individuals to long-term issues such as recurrent instability and early-onset osteoarthritis. This narrative review examines the biomechanical, neuromuscular, and environmental factors that contribute to the high incidence of NC-ACLs and evaluates the effectiveness of current prevention and rehabilitation strategies. The review identifies key risk factors, including improper landing mechanics, deficits in neuromuscular control, and muscle imbalances, which are pivotal in the etiology of NC-ACLs. Prevention programs that incorporate plyometric exercises, strength training, and neuromuscular education have shown efficacy in reducing injury rates. Rehabilitation protocols that emphasize a gradual return to sport, focusing on pain management, restoration of range of motion, and progressive strengthening, are critical for successful recovery and prevention of re-injury. The evidence suggests that an integrated approach, combining prevention and rehabilitation strategies tailored to the individual, is essential for minimizing NC-ACL risk and improving outcomes in affected populations. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

23 pages, 3558 KiB

Open AccessReview

Classification, Structure and Construction of Functional Orthopaedic Compression Knits for Medical Application: A Review

by Daiva Mikucioniene, Liudmyla Halavska, Liudmyla Melnyk, Rimvydas Milašius, Ginta Laureckiene and Svitlana Arabuli

Appl. Sci. 2024, 14(11), 4486; https://doi.org/10.3390/app14114486 - 24 May 2024

Cited by 3 | Viewed by 1248

Abstract

Analysis of functional products for medical textiles indicates that there are plenty of different classifications of this group. Requirements for compression generated by compression garments differ depending on the application area, and even more, sometimes are contradictory and can be fulfilled in very different ways. The effectiveness of such products depends on mechanical and physical properties as well as psychological barriers. Currently, there is no uniform classification of compression classes, furthermore, there is no uniform standard, test method or technic for evaluation of the product’ compression. Knitted compression fabrics are made by knitting together at least two types of yarns: a ground yarn which ensures stiffness and thickness and an elastomeric yarn which generates compression. Knitted compression products can be produced on both flat and circular knitting machines, though parameters and usage of production are different. Additional elements used in the structure of the compression product can significantly change the generated compression. Purposes and number of additional details depend on the application and functionality of the compression support, nevertheless, all rigid elements must be taken into account at the designing stage. Additional functionality like antimicrobial activity or thermal therapy can also be provided for compression knits. It is highly important to ensure the longevity of all functional properties. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

Other

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15 pages, 1032 KiB

Open AccessPerspective

The Utilization of Lean Six Sigma Methodologies in Enhancing Surgical Pathways and Surgical Rehabilitation

by Seán Paul Teeling, Michelle McGuirk, Martin McNamara, Marie McGroarty and Aileen Igoe

Appl. Sci. 2023, 13(12), 6920; https://doi.org/10.3390/app13126920 - 8 Jun 2023

Cited by 5 | Viewed by 4260

Abstract

The authors offer their perspective on the application of Lean Six Sigma methodology to surgical pathways, from referral to post-operative rehabilitation, and how it has resulted in sustainable improvements in patient outcomes, and patient and staff satisfaction. The origin of Lean Six Sigma is described before considering its application to improving scheduled surgical care. The concept of ‘flow’, and its relevance to pre-, intra-, and post-operative care, is discussed as well as the role of Lean Six Sigma in supporting innovation and in promoting an organizational culture that promotes openness to new ideas. The elements of the methodology that render it especially suitable for the redesign of surgical pathways include eliciting the customer voice, co-design, enabling system awareness and inculcating a continuous improvement mindset. The necessary conditions for the successful implementation of Lean Six Sigma initiatives include managerial support, high-quality education and training, and alignment with organizational strategy. Future directions for practice and research are discussed before presenting a key finding from the literature and from the authors’ collective experience: Lean Six Sigma initiatives will not lead to sustainable improvements where the key elements of the methodology are not recognized and enacted, and where the necessary conditions are absent. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention and Rehabilitation of ACL Injuries)

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