Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury--the effects of twelve weeks of knee-specific training

Abstract

Background: Training of neuromuscular control has become increasingly important and plays a major role in rehabilitation of subjects with an injury to the anterior cruciate ligament (ACL). Little is known, however, of the influence of this training on knee stiffness during loading. Increased knee stiffness occurs as a loading strategy of ACL-injured subjects and is associated with increased joint contact forces. Increased or altered joint loads contribute to the development of osteoarthritis.The aim of the study was to determine if knee stiffness, defined by changes in knee kinetics and kinematics of gait, step activity and cross-over hop could be reduced through a knee-specific 12-week training programme.

Methods: A 3-dimensional motion analysis system (VICON) and a force plate (AMTI) were used to calculate knee kinetics and kinematics before and after 12 weeks of knee-specific training in 12 males recruited from a cohort with ACL injury 16 years earlier. Twelve uninjured males matched for age, sex, BMI and activity level served as a reference group. Self-reported patient-relevant data were obtained by the KOOS questionnaire.

Results: There were no significant changes in knee stiffness during gait and step activity after training. For the cross-over hop, increased peak knee flexion during landing (from 44 to 48 degrees, p = 0.031) and increased internal knee extensor moment (1.28 to 1.55 Nm/kg, p = 0.017) were seen after training, indicating reduced knee stiffness. The KOOS sport and recreation score improved from 70 to 77 (p = 0.005) and was significantly correlated with the changes in knee flexion during landing for the cross-over hop (r = 0.6, p = 0.039).

Conclusion: Knee-specific training improved lower extremity kinetics and kinematics, indicating reduced knee stiffness during demanding hop activity. Self-reported sport and recreational function correlated positively with the biomechanical changes supporting a clinical importance of the findings. Further studies are needed to confirm these results in women and in other ACL injured populations.

Figure 1

Balancing on one leg on a balance board.

Figure 2

Knee control of the weight bearing leg with rubber band resistance.

Figure 3

Stepping forward down from a step board with knee control on both the "supporting knee" and the "step down knee".

Figure 4

Jumping on one leg with knee control and knee elasticity during landing.

Figure 5

Rising up and sitting down on one leg.

Figure 6

Core control while lifting pelvis and lower back on single leg with simultaneous contraction of hip adductors and buttocks.

Figure 7

Mean (95% CI) KOOS scores for the reference group and the ACL group before and after the 12 week training programme.

Figure 8

Mean (95% CI) isokinetic thigh strength at 60 degrees/second for the reference group and the ACL group before and after the 12 week training programme.