Benjaminse A, Holden S, Myer GD. ACL rupture is a single leg injury but a double leg problem: too much focus on ’symmetry’ alone and that’s not enough!. Br J Sports Med 2018: British Journal of Sports Medicine (BJSM) -2017-098502
Additional perspectives on ‘ACL rupture is a single leg injury but a double leg problem…’ Anna Trulsson, april 2018 British Journal of Sports Medicine (BJSM) as a clinical commentary on the first article.
- No consensus exists on how to decide when to return to sports.
- Often, strength and hop tests are used, calculating an LSI (the ratio of injured/non-injured sides), and LSI >90% is frequently suggested as a cut-off criteria.
- impaired capacity on both sides after ACL injury is well known, underestimating deficits measured as LSI. Therefore, measurements of preinjury capacity or normative data of non-injured controls have been suggested.
- several authors conclude that one important sensorimotor risk factor is altered movement patterns (in specific increased frontal plane knee motion, poor trunk positioning or landing techniques). Therefore, quantification of altered movement patterns should be included in test batteries: This is an observation test measuring predefined, unfavourable movements/alignment in ankle–knee–hip and trunk regions and can be used before, during and after rehabilitation. It should be kept in mind that when measuring movement patterns, considerable interindividual variations exist, and the individual has to be his or her own control.
- Use versatile test batteries reflecting also sensorimotor deficits.
a complex integration of neural and muscular mechanisms coordinated by the central nervous system, CNS, and takes into account soft tissue restraints, articular mechanics and joint loads to create appropriate movements and stabilisation.
maintain and modify posture during movements, the CNS coordinates visual, vestibular and proprioceptive information into automatic, continuous muscular activation in muscular synergies. Feed-forward control (anticipatory actions) and feedback control (corrective response to tasks/perturbation, also involved in motor learning) the continuous corrections in functional/ dynamic joint stabilisation (the ability to remain stable in single joints and in kinematic chains).
- This implicates the use of more versatile test batteries to measure sensorimotor deficits that include strength- , hop- and movement-quality tests and measurements of, for example, muscle activation, joint stabilisation and motor learning aspects.