Prill R1, Michel S1, Schulz R1, Zirr M2, Seeber GH3
1Brandenburg University of Technology Cottbus - Senftenberg, Therapy Sciences II, Senftenberg, Germany, 2German Sports University, Cologne, Germany, 3University of Oldenburg, University Hospital for Orthopaedics and Trauma Surgery, Oldenburg, Germany
Background: Anterior cruciate ligament rupture is one of the most common serious knee injuries in judo. Even after anterior cruciate ligament reconstruction(ACLR) the risk for further injury and subsequent career ending in competitive and/or recreational athletes is increased. Nevertheless, it is often stated that there is no lack of strength and power in the previously injured leg after ACLR rehabilitation.
Purpose: With regard to highly divergent outcomes in currently available short-term follow-up studies it is of interest how athletes perform five years after ACLR compared to the non-injured leg. Therefore, this study aims to evaluate whether there are clinical relevant and significant deficits in important strength and power parameters in competitive judokas five years after ACLR. A secondary objective was to determine a new score for the evaluation of ACLR relevant strength Parameters.
Methods: In a multi-stage test design, a test battery was developed to assess lower limb peak forces and power. Test procedures were performed in two groups:
Group 1 comprised 17 Judokas 5.1±1.1 years after ACLR;
Group 2 involved 27 Judokas without injury serving as a control group.
The following outcome measures were used: an anamnestic questionnaire for evaluation of subjective performance perception, bio-impedance analysis, lower limb circumference measurement, single-leg countermovement jump on a force plate, and closed kinetic chain isokinetic and isometric test procedures.
Results: Judokas with ACLR showed a significantly lesser leg circumference (p .05), less maximum strength values in isokinetic and isometric tests (p .001 - .01), and a lower jump height in the single-leg countermovement jump (p 0.001) compared to the unaffected lower limb. Bio-impedance analysis and isokinetic endurance strength test showed no significant deficits (p>.05) in Group 1 subjects. No significant differences (p>.05) between both lower limbs were found within the control group in any of the used measures. A strength performance index containing isometric peak force, isokinetic concentric peak force at 0.6m/s, isokinetic concentric and eccentric peak forces at 0.2m/s, and single-leg countermovement jump, invented as a judo-specific strength testing index, identified serious deficits. In Group 2 athletes the stronger leg reached a higher index than the weaker one with a relative 95%CI of {1,04-1,08}. In Group 1 athletes the ACLR leg index was on average 18% lesser than that of the non-injured leg(95%CI{1,12-1,24}).
Conclusion(s): Judokas with ACLR show clinically relevant and significant long-term deficits of individual strength abilities germane for single-leg techniques and knee joint stability. With respect to ACLR, injured Judokas should focus on training of special techniques for both lower limbs, which should be further investigated in prospective studies. Moreover, athletes must be aware of higher risk for re-rupture when carrying on with Judo. Furthermore, it is obvious that regarding strength parameters five years after ACLR, there is no satisfying rehabilitation status reached.
Implications: During ACLR rehabilitation greater emphasis should be put on strength restoration status when bringing athletes back to sports and competition. When dealing with previously injured athletes one must be aware of continued strength deficits, which may not be compensated within the entire sporting career.
Keywords: return to sport, knee injuries, performance tests
Funding acknowledgements: none
Purpose: With regard to highly divergent outcomes in currently available short-term follow-up studies it is of interest how athletes perform five years after ACLR compared to the non-injured leg. Therefore, this study aims to evaluate whether there are clinical relevant and significant deficits in important strength and power parameters in competitive judokas five years after ACLR. A secondary objective was to determine a new score for the evaluation of ACLR relevant strength Parameters.
Methods: In a multi-stage test design, a test battery was developed to assess lower limb peak forces and power. Test procedures were performed in two groups:
Group 1 comprised 17 Judokas 5.1±1.1 years after ACLR;
Group 2 involved 27 Judokas without injury serving as a control group.
The following outcome measures were used: an anamnestic questionnaire for evaluation of subjective performance perception, bio-impedance analysis, lower limb circumference measurement, single-leg countermovement jump on a force plate, and closed kinetic chain isokinetic and isometric test procedures.
Results: Judokas with ACLR showed a significantly lesser leg circumference (p .05), less maximum strength values in isokinetic and isometric tests (p .001 - .01), and a lower jump height in the single-leg countermovement jump (p 0.001) compared to the unaffected lower limb. Bio-impedance analysis and isokinetic endurance strength test showed no significant deficits (p>.05) in Group 1 subjects. No significant differences (p>.05) between both lower limbs were found within the control group in any of the used measures. A strength performance index containing isometric peak force, isokinetic concentric peak force at 0.6m/s, isokinetic concentric and eccentric peak forces at 0.2m/s, and single-leg countermovement jump, invented as a judo-specific strength testing index, identified serious deficits. In Group 2 athletes the stronger leg reached a higher index than the weaker one with a relative 95%CI of {1,04-1,08}. In Group 1 athletes the ACLR leg index was on average 18% lesser than that of the non-injured leg(95%CI{1,12-1,24}).
Conclusion(s): Judokas with ACLR show clinically relevant and significant long-term deficits of individual strength abilities germane for single-leg techniques and knee joint stability. With respect to ACLR, injured Judokas should focus on training of special techniques for both lower limbs, which should be further investigated in prospective studies. Moreover, athletes must be aware of higher risk for re-rupture when carrying on with Judo. Furthermore, it is obvious that regarding strength parameters five years after ACLR, there is no satisfying rehabilitation status reached.
Implications: During ACLR rehabilitation greater emphasis should be put on strength restoration status when bringing athletes back to sports and competition. When dealing with previously injured athletes one must be aware of continued strength deficits, which may not be compensated within the entire sporting career.
Keywords: return to sport, knee injuries, performance tests
Funding acknowledgements: none
Topic: Sport & sports injuries; Musculoskeletal: lower limb; Musculoskeletal
Ethics approval required: Yes
Institution: Deutscher Verband für Physiotherapie Physio Deutschland
Ethics committee: Ethikkomssion des ZVK
Ethics number: ZVK 2016-05
All authors, affiliations and abstracts have been published as submitted.
