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Purpose
The purpose of this study was to investigate the impact of sex on knee function, activity and quality of life following meniscus surgery using data from the German Arthroscopy Registry.
Methods
This is a retrospective cohort study with data collected between 2017 and 2022. Patient-reported outcome measures (PROMs), namely Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol Visual Analogue Scale (EQ Scale), and Marx Activity Rating Scale (MARS), were collected preoperatively and at 6, 12 and 24 months postoperatively. Data were analysed to examine differences between male and female patients regarding PROMs, pre-existing conditions, meniscus lesion types and surgical treatments.
Results
A total of 1106 female (36.6%) and 1945 male patients (63.7%) were included. Males were significantly younger than females and had a higher body mass index. Overall, there were four times more medial meniscus lesions (MMLs) (77.5%) than lateral meniscus lesions (LMLs) (27.9%). Degenerative LMLs were more frequent in females, while traumatic LMLs were more common in males. Frequencies of traumatic and degenerative MMLs were similar among males and females. Males had higher absolute KOOS irrespective of treatment or meniscus lesion type. Meniscus repair resulted in similar improvements in ΔKOOS for both sexes, while meniscus resection exhibited higher absolute KOOS for males at each time point. Males generally had higher EQ Scale and MARS than females.
Conclusion
Greater improvements in knee function, activity and quality of life were observed in males. While MMLs appear to be comparable among sexes, the nature of LML differed significantly. These results may help surgeons to refine patient selection for specific treatments to improve overall clinical outcomes.
Level of Evidence
Level III.
Background
Sidestep cutting technique is highly individual and has been shown to influence knee joint loading. However, studies assessing whether individualized technique feedback improves technique and ACL injury-relevant knee joint loads instantly in a sport-specific task are lacking.
Purpose
To determine the instant effects of individualized augmented technique feedback and instructions on technique and the peak external knee abduction moment (pKAM) in a handball-specific sidestep cut. Additionally, to determine the effects of technique modifications on the resultant ground reaction force and its frontal plane moment arm to the knee joint center.
Study Design
Controlled laboratory cohort study
Methods
Three-dimensional biomechanics of 48 adolescent female handball players were recorded during a handball-specific sidestep cut. Following baseline cuts to each side, leg-specific visual and verbal technique feedback on foot strike angle, knee valgus motion, or vertical impact velocity using a hierarchically organized structure accounting for the variables’ association with performance was provided. Subsequently, sidestep cuts were performed again while verbal instructions were provided to guide technique modifications. Combined effects of feedback and instructions on technique and pKAM as well as on the resultant ground reaction force and its frontal plane moment arm to the knee joint center were assessed.
Results
On average, each targeted technique variable improved following feedback and instructions, leading to instant reductions in pKAM of 13.4% to 17.1%. High inter-individual differences in response to feedback-instruction combinations were observed. These differences were evident in both the adherence to instructions and the impact on pKAM and its components.
Conclusion
Most players were able to instantly adapt their technique and decrease ACL injury-relevant knee joint loads through individualized augmented technique feedback, thereby potentially reducing the risk of injury. More research is needed to assess the retention of these adaptations and move towards on-field technique assessments using low-cost equipment.
Level of Evidence:
Level 3
OBJECTIVE: To compare knee abduction moment (KAM) magnitudes between a generic 180° pivot turn (modified 505 change-of-direction test; m505) and a handball-specific sidestep cut, and to assess ranking consistency. Additionally, to examine the resultant ground reaction force (GRF) and its frontal plane moment arm to the knee to comprehend their contributions to KAM.
STUDY DESIGN: Observational laboratory study.
METHODS: High-level female handball players (n = 45) performed the m505 and handball-specific sidestep cut. Resultant GRF, its frontal plane moment arm to the knee, and KAM were obtained and subsequently compared between the tasks. Rank correlation coefficients were employed to assess if variables of both tasks are related.
RESULTS: Peak KAM was similar for the m505 and the sidestep cut (1.79 (0.95 – 3.53) Nm/kg vs. 1.64 (0.34 – 3.60) Nm/kg; rB = .25; p = .14). The ranking of the players' peak KAM differed substantially (rS = 0.26, p = .084), suggesting that different tasks could classify the same player with different injury risk. The m505 generated lower resultant GRF (24 ± 4 N/kg, 95% CI [23, 24] vs. 33 ± 9 N/kg, 95% CI [31, 35]; d = 1.30; p < .001) but longer frontal plane moment arms (7.8 ± 1.8 cm, 95% CI [7.3, 8.4] vs. 5.4 ± 1.5 cm, 95% CI: [5.0, 5.8]; d = 1.36; p < .001) than the sidestep cut.
CONCLUSION: A difference in individual ACL injury risk assessment depending on movement type was revealed. While KAM magnitudes were similar across direction-change tasks, player rankings differed. The contributions of resultant GRF and frontal plane moment arms to peak KAM varied between tasks, underscoring the importance of task-specific and individualized injury prevention.
Managing lower extremity loading in distance running by altering sagittal plane trunk leaning
(2024)
Background
Trunk lean angle is an underrepresented biomechanical variable for modulating and redistributing lower extremity joint loading and potentially reducing the risk of running-related overuse injuries. The purpose of this study was to systematically alter the trunk lean angle in distance running using an auditory real-time feedback approach and to derive dose–response relationships between sagittal plane trunk lean angle and lower extremity (cumulative) joint loading to guide overuse load management in clinical practice.
Methods
Thirty recreational runners (15 males and 15 females) ran at a constant speed of 2.5 m/s at 5 systematically varied trunk lean conditions on a force-instrumented treadmill while kinematic and kinetic data were captured.
Results
A change in trunk lean angle from –2° (extension) to 28° (flexion) resulted in a systematic increase in stance phase angular impulse, cumulative impulse, and peak moment at the hip joint in the sagittal and transversal plane. In contrast, a systematic decrease in these parameters at the knee joint in the sagittal plane and the hip joint in the frontal plane was found (p < 0.001). Linear fitting revealed that with every degree of anterior trunk leaning, the cumulative hip joint extension loading increases by 3.26 Nm·s/kg/1000 m, while simultaneously decreasing knee joint extension loading by 1.08 Nm·s/kg/1000 m.
Conclusion
Trunk leaning can reduce knee joint loading and hip joint abduction loading, at the cost of hip joint loading in the sagittal and transversal planes during distance running. Modulating lower extremity joint loading by altering trunk lean angle is an effective strategy to redistribute joint load between/within the knee and hip joints. When implementing anterior trunk leaning in clinical practice, the increased demands on the hip musculature, dynamic stability, and the potential trade-off with running economy should be considered.
Tibial stress injuries are problematic among runners. The loading magnitude is the most important mechanical contributor to bone damage accumulation, but loading quantity is also important, and faster runners require fewer loading cycles to complete a given distance than slower runners. This study estimated tibial loading and damage accumulation throughout a demanding 10-km run in recreational (RR) and competitive runners (CR). Male runners reporting a 10-km season-best run slower than 47:30 min (RR) or faster than 37:30 min (CR) completed a 10-km treadmill running protocol at 105% of their season's best time. Tibial loading was estimated from bending moments at the distal 1/3rd of the tibia by ensuring static equilibrium at each 1% of stance. Peak loading was obtained, and cumulative damage per kilometer was estimated using a tissue-dependent weighting factor. Peak tibial loading and damage accumulation per kilometer significantly decreased throughout the run, by 5% and 4%, respectively. Peak loading was significantly higher (31%) in CR than RR, and there was an indication (p = 0.058 and large effect size) of a greater rate of damage accumulation in CR than RR. Tibial loading per step and the rate of accumulation per kilometer decreased throughout a demanding 10-km run suggesting that changes in running mechanics as a result of prolonged running may not be a primary mechanism for stress injury development. Competitive runners experience greater peak tibial loading and possibly greater cumulative tibial damage when they complete 10 km faster than recreational runners.
Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.
Background: Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology.
Objective: To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to
suggest future research directions.
Design: Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832).
Data Sources: PubMed. Connected Papers. The search was performed in February 2021.
Eligibility Criteria: English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running.
Results: Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs.
Conclusion: This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
Running shoes were categorized either as motion control, cushioned, or minimal footwear in the past. Today, these categories blur and are not as clearly defined. Moreover, with the advances in manufacturing processes, it is possible to create individualized running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualize footwear to reduce individual injury risk are poorly understood. Therefore, the purpose of this scoping review was to provide an overview of (1) footwear design features that have the potential for individualization; (2) human biomechanical variability as a theoretical foundation for individualization; (3) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing running-related risk factors for overuse injuries. We included studies in the English language on adults that analyzed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, gender) for running-related biomechanical risk factors or injury incidences; (2) footwear perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analyzed male runners. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualization. However, the overall body of literature addressing individualized footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualization.
The purpose of this study was to 1) compare knee joint kinematics and kinetics of fake-and-cut tasks of varying complexity in 51 female handball players and 2) present a case study of one athlete who ruptured her ACL three weeks post data collection. External knee joint moments and knee joint angles in all planes at the instance of the peak external knee abduction moment (KAM) as well as moment and angle time curves were analyzed. Peak KAMs and knee internal rotation moments were substantially higher than published values obtained during simple change-of-direction tasks and, along with flexion angles, differed significantly between the tasks. Introducing a ball reception and a static defender increased joint loads while they partially decreased again when anticipation was lacking. Our results suggest to use game-specific assessments of injury risk while complexity levels do not directly increase knee loading. Extreme values of several risk factors for a post-test injured athlete highlight the need and usefulness of appropriate screenings.