Control of tibiofemoral movements in functional tasks after an ACL reconstruction

Annually around 0.2-4 percent of the athletes injure their anterior cruciate
ligament (ACL) (Moses, 2012). An ACL injury results in
increased tibiofemoral movements (anterior tibia translation (ATT) and internal
tibia rotation (ITR)), and alterations of muscle
activity and lower extremity kinematics (Abourezk et al., 2017; Alkjær et al.,
2012; Gardinier et al., 2012). Annually around 6000
ACL reconstructions (ACLR) are performed in the Netherlands. An ACLR aims to
reduce tibiofemoral movements, which results in
more knee stability. Despite functional improvements after an ACLR, one-third
of the patients do not manage to return to their preinjured
level of sports one year after surgery and only 44% of the patients return to
competitive sports (Ardern et al., 2011).
Extensive tibiofemoral movements are known to be a predictor of the inability
to return to sports. Tibiofemoral movements can be
determined by different factors (Keizer and Otten, 2018). Our previous studies
showed that muscle activation patterns can
influence dynamic ATT and that the correlation between dynamic ATT and muscle
activation patterns is different between copers
(patients who manage to return to sports) and noncopers (those who don*t manage
to return to sports) (Keizer et al., 2020c, 2021).
Moreover, we showed that the angle of the posterior tibia plateau relative to
the plane orthogonal to the longitudinal axis of the tibia
is an indicator of residual dynamic ATT (Keizer, 2020a). The studies described
in this METc-proposal will build further on our
previous findings (METc protocol 2017.658) using the same measurement technique
to explore additional factors that might be
related to dynamic tibiofemoral movements. We will investigate anatomical and
structural factors that might relate to dynamic tibiofemoral movements.

To investigate:

Study 1. the influence of graft choice (hamstring v.s. quadriceps v.s. patellar
tendon v.s. VKB repair) for ACLR on dynamic tibiofemoral
movements after an ACLR;

Study 2. the influence of the anatomy of the knee on dynamic tibiofemoral
movements after an ACLR;

Two observational studies will be conducted. Patients at least nine months
after an ACLR will be measured on one occasion.

For objective 1 patients who received an autograft (own) hamstring tendon,
autograft patellar tendon, autograft quadriceps
tendon or ACL repair will be included, evenly across the groups.

For objective 2. the same patients will be used.

The measurement will take about one to two hours. Subjects will perform dynamic
tests from the return to sports test battery protocol that is used to clear
patients after an ACLR to return to sports (based on Gokeler et al., 2017;
jump-landing task (LESS); the single leg hop for distance (SLH); the triple hop
for distance (TLH); side hop (SH); and walking). Dynamic anterior tibia
translation and internal tibia rotation will be measured
using VICON. During the dynamic measurements sEMG of the Lateral and medial
hamstrings, Lateral and medial gastrocnemius, Rectus femoris, Vastus medialis
and lateralis, Tibialis anterior will be recorded. In addition, multiple
aspects of the anatomy of the knee (angle of the tibia plateau, size of the
femoral condyles, size of the tibia plateau, size of the femoral notch) will be
determined using MRI scans that have been obtained before surgery as part of
the clinical routine(care as usual).

Forty patients will be tested in one session which will take about two hours
per session.
Minimal risk or discomforts, such as physical injury or harm, to the subjects
as a result of each procedure is involved in the studies.