title: Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.
abstract: BACKGROUND
  Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury.
  
  
  METHODS
  Sixty-one female athletes who were cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify differences.
  
  
  RESULTS
  A main effect of group (P = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (P = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], P = 0.03.
  
  
  CONCLUSIONS
  Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at risk.
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH USA. Electronic address: mark.paterno@cchmc.org.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Paterno
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH USA; Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH USA.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Kiefer
authors.affiliation: Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Bonnette
authors.affiliation: Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Riley
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Schmitt
authors.affiliation: Department of Physical Therapy, School of Health Sciences, High Point University, High Point, NC USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ford
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH USA; Sports Health and Performance Institute, Division of Sports Medicine, The Ohio State University, Columbus, OH USA; The Micheli Center for Sports injury Prevention, Waltham, MA, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shockley
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH USA; Sports Health and Performance Institute, Division of Sports Medicine, The Ohio State University, Columbus, OH USA; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH USA; Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH USA; Department of Physiology and Cell Biology, Ohio State University, Columbus, OH, USA; Department of Orthopaedic Surgery, Ohio State University, Columbus, OH, USA; Department of Family Medicine, Ohio State University, Columbus, OH, USA; Department of Biomedical Engineering, College of Medicine, Ohio State University, Columbus, OH USA; Department of School of Health, College of Medicine, Ohio State University, Columbus, OH USA; Department of Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH USA; PhD Consultant, Orthopedic Surgery Director, Biomechanics, Sports Medicine Research Professor of Orthopedic Surgery, Physical Medicine & Rehabilitation Physiology & Biomedical Engineering Mayo Clinic.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000502:physiology*; D000843:Ankle Joint / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D056352:Athletes; D003657:Decision Making; D005260:Female; D006615:Hip / Q000502:physiology*; D006801:Humans; D007717:Knee / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D009068:Movement; D000068958:Return to Sport; D013177:Sports; D013639:Tarsal Bones / Q000601:surgery
keywords: ACL reconstruction; Postural coordination; Second injury