Risk Factors Associated with Noncontact Injuries of the Anterior Cruciate Ligament (ACL) in male athletes

By:

D. Amraee: MS of Sport Injuries Dr. Alizadeh. M.H, PhD Dr. Razi . M, MD Dr .Yazdi. H.R, MD Dr. Minoonejhad. H, PhD
Tehran University of Medical Sciences &University of Tehran

Objective

The purpose of the present study was to compare the risk factors related to Noncontact ACL injury:

1. navicular drop
2. Q angle 3. internal tibial torsion 4. knee hyper extension 5. hip internal and external rotation ROM 6. hip anteversion ROM 7. ankle dorsiflexion ROM

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Statistical Populations

All the athletes had a complete tear of ACL (grade III) male athletes Noncontact ACL Injuries with minimum of 3 years experience
Athletes is injured during Competition or Practice

Subjects who have suffered over the past six months were excluded
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Statistical Samples
106

male athletes Group1: 53 subjects had a complete ACL injury. Group2: 53 subjects had no history of ACL injury that selected as controls.

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Measurement of Navicular drop (Brody Test)

Brody DM (1982)

Measurement of ankle dorsiflexion ROM

Standing position

Venturini C, et al. 2006

Sitting position
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Measurement of Q angle

Measurement of knee hyperextension

Livingston LA, et al. 1997

Nguyen AD, et al 2007

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Measurement of hip Internal rotation

Measurement of hip external rotation

Norkin CC, White DJ (2003) Measurement of joint motion. USA.Philadelphia 200-210

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Measurement of tibial torsion (Thigh foot angle)

Measurement of hip anteversion (Craig's Test)

Staheli LT (1977)

Ruwe PA, et al. 1992

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Statistical Analysis
The

data were analyzed by SPSS software version 16. The one-sample Kolmogorov-Smirnov test was used to distinguish the normal distribution of data. The Mann- Whitney U test & T-test was used to compare variables between the two groups.

The level of significance was established at (P<.05) .

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Intraclass correlation coefficients

Variables Navicular drop (mm) Tibial torsion () Q angle () Knee hyperextention() Hip anteversion () Hip internal rotation () Hip external rotation () Dorsiflexion ROM ()
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ICC
./92 ./99

SEM
./20 ./09

./94
./86 ./95

./35
./10 ./37

./97
./92 ./99

./61
./20 ./09
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Characteristics of the Study Sample

Characteristics
Age(yr)

Injured group (M SD)

24/984/83

uninjured group (M SD)

24/624/46

Weight(kg)
Height(cm) Sport history(yr)
Session(day per week)

79/0312/83
178/096/74 3/062/61

77/899/86
178/455/54 3/642/28

3/851/15

3/911/13

The average age of injured athletes 24/98 4/83 years

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Discussion
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1) Navicular drop : The difference was Significant (+)

Group
Injured uninjured

Mean

SD

P value

Result

6.79 6.30

1.52 0.95
1.98 0.05

Allen et al. (2000) + Loudon JK (2000), Beckett ME (1999) +

Daneshmandi et al (2009), Shambaugh JP(1991) +

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2) Q angle: The difference was not significant(-)

Group Injured uninjured Mean SD t P value Result

14.36 13.96

2.59 1.58
0.91 0.365 -

Shambaugh et al. (1991) , Puckree et al. (2007) (+)

A possible reason for above studies

lower limb injuries, whereas the present study ACLinjuries. more research from different genders in Iran.
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3) Hip anteversion: The difference was significant(+)

Group
Injured

Mean

SD

P value

Result

12.37

2.73

uninjured

10.90

1.10

3.62

0.001

Gulan G, et al.(2000) + Quatman CE, et al.(2009) + valgus collapse

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4) Hip external rotation: The difference was not significant(-) Group Injured uninjured Mean SD t P value Result

32.81 33.64

5.87 3.63
0.876 0.383

Daneshmandi and Sakis (2009) -

Little information is available on this topic

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5) Internal Tibia torsion: The difference was significant(+)

Group
Injured uninjured

Mean

SD

P value

Result

11.74 14.04

7.93

0.004
9.80

Daneshmandi et al. (2009)+ loudon JK, et al (1996)& Beckett ME, et al. (1992)+

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6) Knee hyper extension: The difference was not significant(-) Group Mean SD P value Result

Injured
uninjured

1.04 1.00

0.78 0.842 0.70

noncontact ACL injuries may be produced by knee hyperextension or loaded internal tibial rotation, abnormal postures that confirm these positions to occur may also increase stress to the ACL and made of lead to injury. (loudon JK, et al (1996)
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7) Hip Internal rotation: The difference was significant(+) Group Mean SD P value Result

Injured
uninjured

35.11

4.51

0.002 37.29 4.49

The reduce of hip internal rotation probably due to increased hip anteversion. hip adduction & knee valgus seemed to be the main mechanism for ACL injuries. ( Hideyuki koga, et al. 2010) There was a strong association between decreased hip range of motion and ACL ruptures in soccer players, not only but mainly because of internal rotation lessening (Gomes JL 2008)
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8) Dorsiflexion ROM: The difference was significant(+) Group Injured Mean SD P value Result

8.95

1.67 0.006

uninjured

9.69

1.44

ankle dorsiflexion ROM during landing knee flexion ROM & greater ground reaction forces, & knee valgus displacement. ACL injury. Chun-Man Fong , et al.(2011)

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Conclusion
According to the finding of the current research: decreased ROM : ankle dorsiflexion hip internal rotation as risk factors to noncontact ACL injury internal tibial torsion increased ROM: navicular drop hip anteversion
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Recommended
1. Since this research has investigated only LEA, It is suggested that Be investigated spinal column and hip position as core of the body. 2. Similar research done on the gender Differences in Anterior Cruciate Ligament Injury and What are the factors contributing to the differences in ACL injuries in male and female athletes? 3. in order to recognize athletes so susceptible to ACL injury, It is proposed to identify factors associated with implementation of ACL injury prevention strategies and A training protocol and corrective exercise designed to prevention the ACL injuries.
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Your welcome

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