Factors affecting knee abduction during weight-bearing activities in individuals with anterior cruciate ligament reconstruction

Objective To investigate if muscle strength and muscle activation patterns are associated with increased knee abduction during two functional tasks, commonly used in rehabilitation for individuals with anterior cruciate ligament reconstruction (ACLR). Design Cross-sectional study. Setting Laboratory. Participants 24 women and 29 men approximately 7 months after ACLR. Main outcome measures Isometric peak torque of the trunk and lower extremity muscles were determined during maximal voluntary contractions. Trunk and lower extremity average muscle activation amplitude and peak knee abduction were evaluated during the single-leg squat (SLS) and the single-leg hop for distance (SLHD) for the injured side. Separate backward regressions were performed for men and women. Results In women, lower knee flexion and extension strength were associated with greater peak knee abduction during the SLS (B = 4.63–18.26, p ≤ 0.036); lower knee flexion strength and iliocostalis activation on the non-injured side were associated with greater peak knee abduction during the SLHD (B = 0.60–20.48, p ≤ 0.043). No associations between muscle function and peak knee abduction were found in men. Conclusions Muscle function may contribute differently to knee abduction in men and women after ACLR. This should be considered when designing rehabilitation programs to reduce knee abduction in these patients

Is seeing just believing? Measurement properties of visual assessment of Postural Orientation Errors (POEs) in people with anterior cruciate ligament injury

Rupture of the anterior cruciate ligament (ACL) is a common knee injury among young physically active populations. The injury results in impaired physical functions, such as joint instability, limitations in daily activities and sport-specific activities, and worse movement quality, e.g., altered postural orientation. Postural orientation is defined as the ability to maintain alignment between body segments, and undesirable postural orientation is suggested to be a risk factor for subsequent injury. The “gold standard” for measuring postural orientation is with three-dimensional motion analysis. However, there is a need for a systematic feasible approach to evaluate postural orientation in the clinical setting, such as with visual assessment. Therefore, the primary aim of this thesis was to develop and evaluate clinically feasible measures of postural orientation in participants with or without lower extremity injury. Secondary aims were to evaluate sex differences in postural orientation and the association between postural orientation and other measures of physical function and self-reported outcomes, in men and women undergoing rehabilitation after ACL reconstruction.One systematic review with meta-analysis was conducted to summarize measurement properties of visual assessment of postural orientation in healthy populations, and populations with lower extremity injury (paper I). Evaluation of measurement properties (i.e., face validity, interpretability, internal consistency, inter-rater reliability, and measurement error) of a test battery for visual assessment of postural orientation errors (POEs) in patients with ACL injury were reported in two cross-sectional studies (papers II–III). Sex differences in POE scores (i.e., total POE score, POE subscales activity of daily living (ADL) and sport, and segment-specific POEs across tasks) were investigated in one cross-sectional study (paper IV). In the same paper, the association between POE scores and hop performance and Patient-Reported Outcome Measures (PROMs) were evaluated, in men and women with ACL reconstruction, separately.This thesis shows that visual assessment of the segment-specific POE knee medial-to-foot position (KMFP) is associated with two-dimensional and three-dimensional kinematic variables, and shows moderate to almost perfect reliability for the KMFP in healthy populations. For other segment-specific POEs or for patients with lower extremity injury there were not enough studies to permit any synthesis. The evaluation of measurement properties (face validity, interpretability, and internal consistency) of visual assessment of POEs during a variety of functional tasks in patients with ACL injury, resulted in the final test battery of 5 functional tasks (single-leg mini squat, stair descending, forward lunge, singe-leg hop for distance, and side-hop) and 6 segment-specific POEs (foot pronation, KMFP, femur medial to shank, femoral valgus, deviation of pelvis in any plane, and deviation of trunk in any plane). Women demonstrated worse POE scores compared with men and worse POE scores were associated with worse hop performance in women (especially the POE subscale ADL), but not in men.The results from this thesis indicate that visual assessment of the segment-specific POE KMFP is valid and reliable in healthy populations. However, there is limited evidence of measurement properties for visual assessment of other segment-specific POEs, and in patients with lower extremity injuries. The test battery for visual assessment of POEs showed no floor or ceiling effects, high internal consistency, and good inter-rater reliability in patients with ACL injury. This indicates that visual assessment of POEs can be used in patients with ACL injury, both in research and in clinical practice. Furthermore, the results suggest that postural orientation should be evaluated separately for men and women, and that the POE subscale ADL could be used to help clinicians to decide when it is time to progress to jumping exercises during rehabilitation of ACL injuries

Tester av rörelsekvalitet vid rehab av främre korsbandsskada

Rörelsekvalité är en faktor som anses vara viktig att utvärdera hos patienter med främre korsbandsskada. Däremot har det inte varit helt klarlagt hur rörelsekvaliteten ska utvärderas. Denna avhandling utvärderar postural orientering som ett kliniskt mått på rörelsekvalite

Association Between Hip Muscle Function And Hip-Specific Patient-Reported Outcomes In Patients With Longstanding Pre-Arthritic Hip And Groin Pain

Patients referred to orthopeadic care due to longstanding hip and groin pain often suffers from hip-related pain. Hip-related pain such as femoroacetabular impingement syndrome may lead to early onset of hip osteoarthritis. Previous research has shown that patients with longstanding hip and groin pain have poor patient-reported outcomes compared to healthy controls. Also, decreased hip muscle strength is a common functional limitation in this patient group. However, the association between hip muscle strength and hip-specific patient-reported function and quality of life is less known. Thus, this study aimed to assess the association between hip muscle strength and patient-reported function and quality of life in patients with longstanding hip and groin pain

Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury

Objectives: To investigate the association between sensorimotor function and visual assessment of postural orientation during execution of weight-bearing activities in patients with anterior cruciate ligament reconstruction (ACLR). Design: Cross-sectional study. Setting: Laboratory. Participants: Fifty-two individuals (23 women and 29 men, mean (SD) age 26.5 (6.4)) approximately 7 months after ACLR. Main outcome measures: Sensorimotor function (proprioception, ankle dorsiflexion range of motion, and isometric muscle strength of the hip, knee, and trunk) were recorded on the injured leg. Postural orientation errors (POEs) were visually scored from video-recordings of the injured leg during execution of 5 functional tasks, and POE subscales activities of daily living (ADL) and Sport, and Total POE score were used in the analysis. Results: Lower hip external rotation strength was associated with higher Total POE score (B = −24.4, p = 0.041) and higher POE subscale ADL score (B = −24.9, p = 0.03). No associations between sensorimotor function and POE subscale Sport were found. Conclusions: Decreased hip external rotation strength might contribute to higher scores on the POE subscale ADL and the Total POE score, in men and women following ACLR. Future studies will reveal if strengthening of hip external rotation strength improves postural orientation

Extended Version of a Test Battery for Visual Assessment of Postural Orientation Errors: Face Validity, Internal Consistency, and Reliability

Objective Undesirable postural orientation may be a risk factor for a second anterior cruciate ligament (ACL) injury. The purpose of this study was to evaluate face validity, internal consistency, and interrater reliability of an extended version of a previous test battery for visual assessment of postural orientation errors (POEs) in patients during the late phase of rehabilitation following ACL reconstruction (ACLR) (ie, when they have initiated jumping exercises). Methods This study used a cross-sectional design. Fifty-three patients (45% women) in the late phase of ACLR rehabilitation performed 5 functional tasks of varying difficulty. POEs of the lower extremity and trunk were visually assessed from video and scored on a scale from 0 (good) to 2 (poor). Results The side-hop and 2 new POEs (femur medial to shank, femoral valgus) were added to the test battery after expert focus group discussions. Internal consistency was calculated for all tasks (α = .712–.823). Interrater reliability showed fair to substantial agreement for femur medial to shank and femoral valgus during all tasks (K = 0.31–0.815) and almost perfect agreement for side-hop (intraclass correlation coefficient = 0.88). Conclusions The good internal consistency and reliability after adding side-hop, femur medial to shank, and femoral valgus suggests that this test battery is a suitable tool to quantify postural orientation throughout ACLR rehabilitation. Impact This test battery for visual assessment of POEs was evaluated in a heterogeneous group of patients in different phases of ACLR battery and can be used in clinical practice to measure POEs in patients with ACLR, including in the late phase of rehabilitation to return to sport. This study encourages research on more demanding tasks and additional POEs to cover the entire rehabilitation period after ACL injury or reconstruction