Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction

Michèle N J Keizer; Egbert Otten; Chantal M I Beijersbergen; Reinoud W Brouwer; Juha M Hijmans

doi:10.1177/2325967121998061

Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction

Orthop J Sports Med. 2021 Apr 16;9(4):2325967121998061. doi: 10.1177/2325967121998061. eCollection 2021 Apr.

Authors

Michèle N J Keizer¹, Egbert Otten¹, Chantal M I Beijersbergen², Reinoud W Brouwer³, Juha M Hijmans²

Affiliations

¹ Center for Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands.
² Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands.
³ Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands.

Abstract

Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers.

Purpose/hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers.

Study design: Controlled laboratory study.

Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained.

Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing.

Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment.

Clinical relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.

Keywords: knee; knee laxity; motor control; muscle activity.