Einfluss einer muskulären Ermüdung auf den Limb Symmetry Index nach VKB-Rekonstruktion

Zusammenfassung

Auch wenn Athlet*innen die Return to Sport (RTS) Kriterien nach einer vorderen Kreuzbandrekonstruktion (VKBR) erfüllen, erleiden sie dennoch häufig eine erneute Verletzung des vorderen Kreuzbandes (VKB). Ein Grund für das erhöhte Risiko könnte darin bestehen, dass die Kriterien nicht unter ermüdeten Bedingungen getestet werden, obwohl eine muskuläre Ermüdung ein Risiko für Verletzungen darstellt. Das Ziel dieser Studie war es, den Einfluss einer muskulären Ermüdung auf den Limb Symmetry Index (LSI) bei Athlet*innen nach einer VKBR und gesunden Proband*innen zu untersuchen.

Neun Proband*innen nach einer unilateralen VKBR und 17 Gesunde (28,1 ± 5,2 LJ.) absolvierten eine Serie von 3 Sprungtests – Side Hop Test (SH), Single Leg Vertical Jump (SLVJ), Single Leg Hop for Distance (SLHD) – in einem nicht ermüdeten und einem muskulär ermüdeten Zustand. Mittels einer 2 × 3 ANOVA mit Messwiederholung wurden die LSI-Werte vor und nach der muskulären Ermüdung miteinander verglichen.

Die VKBR-Gruppe erreichte im Gesamt-LSI 91,3 ± 12,3 %, die Kontrollgruppe 100,1 ± 11,9 %. Innerhalb der Gruppen bestand kein signifikanter Unterschied zwischen dem ermüdeten und nicht ermüdeten Zustand. Es konnten keine signifikanten Interaktionseffekte (p > 0,05) oder Zeiteffekte (p > 0,05) des LSI hinsichtlich der Ermüdung festgestellt werden, jedoch zeigten der LSI des SLVJ und der Gesamt-LSI hoch signifikante Gruppeneffekte (p = 0,003, p = 0,001). Patient*innen nach einer VKBR wiesen niedrigere LSI-Werte als die gesunde Kontrollgruppe auf. Der geringere LSI der VKBR-Gruppe kann einen möglichen Risikofaktor für eine Wiederverletzung darstellen.

Eine muskuläre Ermüdung hatte keinen signifikanten Einfluss auf den LSI. Ein LSI unter ermüdeten Bedingungen scheint somit als RTS-Kriterium ungeeignet zu sein. Der bisherige Cut-off-Wert des LSI von 90 % sollte in Frage gestellt und eine Erhöhung dieses Grenzwertes in Betracht gezogen werden.

Abstract

Even when athletes meet the criteria for a Return to Sports (RTS) after a reconstruction of the anterior cruciate ligament (ACLR), they often suffer renewed injuries of the anterior cruciate ligament (ACL). One of the reasons for the increased risk could be that the criteria are not tested under fatigue conditions, although muscular fatigue is a known injury risk. It was the aim of this study to investigate the effects of muscular fatigue on the Limb Symmetry Index (LSI) in athletes after ACLR and healthy subjects.

Nine subjects after unilateral ACLR and 17 healthy subjects (28.1 ± 5.2 YO) performed a series of 3 jump tests – Side Hop Test (SH), Single Leg Vertical Jump (SLVJ), Single Leg Hop for Distance (SLHD) – in a non-fatigued and a muscularly fatigued state. LSI values before and after muscular fatigue were compared using 2 × 3 ANOVA with repeat measurements.

The ACLR group achieved overall LSI values of 91.3 ± 12.3 %, compared to 100.1 ± 11.9 % for the control group. Within the groups, there were no significant differences between the fatigued and the non-fatigued state. No significant interaction (p > 0.05) or time effects (p > 0.05) of the LSI showed with regard to fatigue, but highly significant group effects were observed for both the LSI of the SLVJ (p = 0.003) and the overall LSI (p = 0.001). Patients after ACLR demonstrated lower LSI values than healthy subjects. Lower LSI values of the ACLR group may constitute a potential risk factor for renewed injuries.

Muscular fatigue had no significant effect on the LSI. Consequently, the LSI under fatigue conditions seems unsuitable as a criterion for RTS. The previous LSI cut-off value of 90 % should be called into question and an increase of this limit considered.

Schlüsselwörter

Vorderes Kreuzband - Return to Sport - Limb Symmetry Index - Ermüdung

Key words

anterior cruciate ligament - Return to Sport - Limb Symmetry Index - fatigue

Publication History

Received: 12 July 2021

Accepted: 08 August 2021

Article published online:
18 May 2022

• Literatur

• 1 Grindem H, Snyder-Mackler L, Moksnes H. et al. Simple decision rules can reduce reinjury risk by 84 % after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808 DOI: 10.1136/bjsports-2016-096031.
• 2 Paterno MV, Rauh MJ, Schmitt LC. et al. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. Am J Sports Med 2014; 42: 1567-1573 DOI: 10.1177/0363546514530088.
• 3 Dingenen B, Gokeler A. Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward. Sports med 2017; 47: 1487-1500 DOI: 10.1007/s40279-017-0674-6.
• 4 Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27: 1697-1705 DOI: 10.1016/j.arthro.2011.09.009.
• 5 Grindem H, Engebretsen L, Axe M. et al. Activity and functional readiness, not age, are the critical factors for second anterior cruciate ligament injury – the Delaware-Oslo ACL cohort study. Br J Sports Med 2020; 54: 1099-1102 DOI: 10.1136/bjsports-2019-100623.
• 6 Gustavsson A, Neeter C, Thomee P. et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Athrosc 2006; 14: 778-788 DOI: 10.1007/s00167-006-0045-6.
• 7 Steidl-Müller L, Hildebrandt C, Müller E. et al. Limb symmetry index in competitive alpine ski racers: Reference values and injury risk identification according to age-related performance levels. J Sport Health Sci 2018; 7: 405-415 DOI: 10.1016/j.jshs.2018.09.002.
• 8 Welling W, Benjaminse A, Lemmink K. et al. Passing return to sports tests after ACL reconstruction is associated with greater likelihood for return to sport but fail to identify second injury risk. Knee 2020; 27: 949-957 DOI: 10.1016/j.knee.2020.03.007.
• 9 McGrath TM, Waddington G, Scarvell JM. et al. The effect of limb dominance on lower limb functional performance--a systematic review. J Sports Sci 2016; 34: 289-302 DOI: 10.1080/02640414.2015.1050601.
• 10 van Melick N, van Rijn L, Nijhuis-van der Sanden MWG. et al. Fatigue affects quality of movement more in ACL-reconstructed soccer players than in healthy soccer players. Knee Surg Sports Traumatol Arthrosc 2019; 27: 549-555 DOI: 10.1007/s00167-018-5149-2.
• 11 Thomeé R, Kaplan Y, Kvist J. et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Traumatol Arthrosc 2011; 19: 1798-1805 DOI: 10.1007/s00167-011-1669-8.
• 12 Gokeler A, Welling W, Benjaminse A. et al. A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study. Orthop Traumatol Surg Res 2017; 103: 947-951 DOI: 10.1016/j.otsr.2017.02.015.
• 13 Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther 2017; 47: 334-338 DOI: 10.2519/jospt.2017.7285.
• 14 Gans I, Retzky JS, Jones LC. et al. Epidemiology of Recurrent Anterior Cruciate Ligament Injuries in National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2004–2014. Orthop J Sports Med 2018; 6: 2325967118777823 DOI: 10.1177/2325967118777823.
• 15 Capin JJ, Snyder-Mackler L, Risberg MA. et al. Keep calm and carry on testing: a substantive reanalysis and critique of ‘what is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? A sys tematic review and meta-analysis’. Br J Sports Med 2019; 53: 1444-1446 DOI: 10.1136/bjsports-2019-100906.
• 16 Hawkins RD, Hulse MA, Wilkinson C. et al. The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 2001; 35: 43-47 DOI: 10.1136/bjsm.35.1.43.
• 17 Harris JD, Erickson BJ, Bach Jr BR. et al. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Sports Health 2013; 5: 562-568 DOI: 10.1177/1941738113495788.
• 18 Brooks JH, Fuller CW, Kemp SPT. et al. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006; 34: 1297-1306 DOI: 10.1177/0363546505286022.
• 19 Roberts D, Ageberg E, Andersson G. et al. Effects of short-term cycling on knee joint proprioception in healthy young persons. Am J Sports Med 2003; 31: 990-994 DOI: 10.1177/03635465030310064001.
• 20 Santamaria LJ, Webster KE. The effect of fatigue on lower-limb biomechanics during single-limb landings: a systematic review. J Orthop Sports Phys Ther 2010; 40: 464-473 DOI: 10.2519/jospt.2010.3295.
• 21 Barber-Westin SD, Noyes FR. Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review. Am J Sports Med 2017; 45: 3388-3396 DOI: 10.1177/0363546517693846.
• 22 Gokeler A, Eppinga P, Dijkstra PU. et al. Effect of fatigue on landing performance assessed with the landing error scoring system (less) in patients after ACL reconstruction. A pilot study. Int J Sports Phys Ther 2014; 9: 302-311
• 23 McLean SG, Fellin RE, Suedekum N. et al. Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc 2007; 39: 502-514 DOI: 10.1249/mss.0b013e3180d47f0.
• 24 Okoroha KR, Marfo K, Meta F. et al. Amount of Minutes Played Does Not Contribute to Anterior Cruciate Ligament Injury in National Basketball Association Athletes. Orthopedics 2017; 40: e658-e662 DOI: 10.3928/01477447-20170503-04.
• 25 Leister I, Mattiassich G, Kindermann H. et al. Reference values for fatigued versus non-fatigued limb symmetry index measured by a newly designed single-leg hop test battery in healthy subjects: a pilot study. Sport Sci Health 2018; 14: 105-113 DOI: 10.1007/s11332-017-0410-5.
• 26 Augustsson J, Thomee R, Karlsson J. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2004; 12: 350-356 DOI: 10.1007/s00167-004-0518-4.
• 27 van Melick N, Meddeler BM, Hoogeboom TJ. et al. How to determine leg dominance: The agreement between self-reported and observed performance in healthy adults. PloS One 2017; 12: e0189876 DOI: 10.1371/journal.pone.0189876.
• 28 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; 43-49
• 29 Swanenburg J, Koch PP, Meier N. et al. Function and activity in patients with knee arthroplasty: validity and reliability of a German version of the Lysholm Score and the Tegner Activity Scale. Swiss Med Wkly 2014; 144: w13976 DOI: 10.4414/smw.2014.13976.
• 30 Wirth B, Meier N, Koch PP. et al. [Development and evaluation of a German version of the Tegner activity scale for measuring outcome after anterior cruciate ligament injury]. Sportverletz Sportschaden 2013; 27: 21-27 DOI: 10.1055/s-0032-1330752.
• 31 Davies WT, Myer GD, Read PJ. Is It Time We Better Understood the Tests We are Using for Return to Sport Decision Making Following ACL Reconstruction? A Critical Review of the Hop Tests. Sports Med 2020; 50: 485-495 DOI: 10.1007/s40279-019-01221-7.
• 32 Kockum B, Heijne AI. Hop performance and leg muscle power in athletes: Reliability of a test battery. Phys Ther Sport 2015; 16: 222-227 DOI: 10.1016/j.ptsp.2014.09.002.
• 33 Manske RC, Smith B, Wyatt F. Test–Retest Reliability of Lower Extremity Functional Tests after a Closed Kinetic Chain Isokinetic Testing Bout. Journal of Sport Rehabilitation 2003; 12: 119-132 DOI: 10.1123/jsr.12.2.119.
• 34 Cruvinel-Cabral RM, Oliveira-Silva I, Medeiros AR. et al. The validity and reliability of the “My Jump App” for measuring jump height of the elderly. PeerJ 2018; 6: e5804 DOI: 10.7717/peerj.5804.
• 35 Pueo B, Lipinska P, Jimenez-Olmedo JM. et al. Accuracy of Jump-Mat Systems for Measuring Jump Height. International journal of sports physiology and performance 2017; 12: 959-963 DOI: 10.1123/ijspp.2016-0511.
• 36 Pires FO, Hammond J. Manipulation effects of prior exercise intensity feedback by the Borg scale during open-loop cycling. Br J Sports Med 2012; 46: 18-22 DOI: 10.1136/bjsm.2010.079053.
• 37 Mizrahi J, Verbitsky O, Isakov E. et al. Effect of fatigue on leg kinematics and impact acceleration in long distance running. Human Movement Science 2000; 19: 139-151 DOI: 10.1016/S0167-9457(00)00013-0.
• 38 Holsgaard-Larsen A, Jensen C, Mortensen NHM. et al. Concurrent assessments of lower limb loading patterns, mechanical muscle strength and functional performance in ACL-patients--a cross-sectional study. Knee 2014; 21: 66-73 DOI: 10.1016/j.knee.2013.06.002.
• 39 Thomeé R, Neeter C, Gustavsson A. et al. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1143-1151 DOI: 10.1007/s00167-012-1912-y.
• 40 Ardern CL, Taylor NF, Feller JA. et al. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41: 1549-1558 DOI: 10.1177/0363546513489284.
• 41 Ardern CL. Anterior Cruciate Ligament Reconstruction-Not Exactly a One-Way Ticket Back to the Preinjury Level: A Review of Contextual Factors Affecting Return to Sport After Surgery. Sports Health 2015; 7: 224-230 DOI: 10.1177/1941738115578131.