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Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction

Miles, Joshua, McGuigan, Polly, King, Enda and Daniels, Katherine ORCID logoORCID: https://orcid.org/0000-0001-8134-6764 (2022) Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction. Scandinavian Journal of Medicine and Science in Sports. ISSN 0905-7188

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File will be available on: 14 April 2023.

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Abstract

Nine months after anterior cruciate ligament (ACL) reconstruction, athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft demonstrate higher loading asymmetries during vertical jumping than those with a hamstring tendon (HT) autograft. These asymmetries may transfer into sporting movements with a greater ACL injury risk. The aim of this study was to compare between-limb asymmetries in knee mechanics and task performance during an unplanned 90° change-of-direction (CoD) task in male field sport athletes reconstructed with BPTB or HT autografts. Seventy-eight male multidirectional field sport athletes with either a BPTB (n=39) or HT (n=39) autograft completed maximal unplanned CoD trials in a three-dimensional motion capture laboratory at approximately nine months post-surgery. A mixed model 2x2 ANOVA (autograft type x limb) was used to compare variables related to ACL injury risk (e.g. internal knee moments) and performance (e.g. completion time) between autografts and limbs. Statistical parametric mapping was used for a waveform comparison throughout stance, supplemented with a discrete point analyses of peak knee moments and performance variables. Interaction effects were found at the knee joint, with BPTB demonstrating greater asymmetries than HT in knee extension moment (p<0.001); resultant ground reaction force (p<0.001); peak knee external rotation moment (p=0.04); and knee adduction (p=0.05), medial rotation (p<0.001) and flexion (p<0.001) angles. No differences were found between autografts for any performance variable. BPTB demonstrated greater lower-limb biomechanical asymmetries than HT during CoD, which may influence knee loading and longer-term outcomes and should thus be targeted during rehabilitation prior to return to play.

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