title: Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.
abstract: BACKGROUND
  Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes.
  
  
  OBJECTIVE
  Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.
  
  
  METHODS
  Cohort study (prognosis); Level of evidence, 2.
  
  
  METHODS
  Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury.
  
  
  RESULTS
  Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81).
  
  
  CONCLUSIONS
  Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. mark.paterno@cchmc.org
authors: Mark V
authors: MV
authors: Paterno
authors: Laura C
authors: LC
authors: Schmitt
authors: Kevin R
authors: KR
authors: Ford
authors: Mitchell J
authors: MJ
authors: Rauh
authors: Gregory D
authors: GD
authors: Myer
authors: Bin
authors: B
authors: Huang
authors: Timothy E
authors: TE
authors: Hewett
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D056352:Athletes; D001696:Biomechanical Phenomena / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D009068:Movement / Q000502:physiology*; D019637:Orthopedic Procedures; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D055815:Young Adult