University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, Australia.
Research Laboratory of Exercise Science, CEFAN, Brazilian Navy, Rio de Janeiro, Brazil.
Am J Sports Med. 2018 May;46(6):1492-1499. doi: 10.1177/0363546517716930. Epub 2017 Jul 31.
Anterior cruciate ligament (ACL) tear is a common injury in sports and often occurs during landing from a jump.
To synthesize the evidence on the effects of injury prevention programs (IPPs) on landing biomechanics as they relate to the ligament, quadriceps, trunk, and leg dominance theories associated with ACL injury risk.
Meta-analysis.
Six electronic databases were searched for studies that investigated the effect of IPPs on landing task biomechanics. Prospective studies that reported landing biomechanics at baseline and post-IPP were included. Results from trunk, hip, and knee kinematics and kinetics related to the ACL injury theories were extracted, and meta-analyses were performed when possible.
The criteria were met by 28 studies with a total of 466 participants. Most studies evaluated young females, bilateral landing tasks, and recreational athletes, while most variables were related to the ligament and quadriceps dominance theories. An important predictor of ACL injury, peak knee abduction moment, decreased ( P = .01) after the IPPs while other variables related to the ligament dominance theory did not change. Regarding the quadriceps dominance theory, after the IPPs, angles of hip flexion at initial contact ( P = .009), peak hip flexion ( P = .002), and peak knee flexion ( P = .007) increased, while knee flexion at initial contact did not change ( P = .18). Moreover, peak knee flexion moment decreased ( P = .005) and peak vertical ground-reaction force did not change ( P = .10).
The exercises used in IPPs might have the potential to improve landing task biomechanics related to the quadriceps dominance theory, especially increasing peak knee and hip flexion angles. Importantly, peak knee abduction moment decreased, which indicates that IPPs influence a desired movement strategy to help athletes overcome dangerous ligament dominance loads arising from lack of frontal plane control during dynamic tasks. The lack of findings for some biomechanical variables suggests that future IPPs may be enhanced by targeting participants' baseline profile deficits, highlighting the need to deliver an individualized and task-specific IPP.
前交叉韧带（ACL）撕裂是运动中常见的损伤，通常发生在从跳跃中着陆时。
综合有关 ACL 损伤风险的韧带、四头肌、躯干和腿部优势理论的损伤预防计划（IPP）对着陆生物力学影响的证据。
荟萃分析。
检索了六个电子数据库，以研究调查 IPP 对着陆任务生物力学影响的研究。包括报告基线和 IPP 后着陆生物力学的前瞻性研究。提取与 ACL 损伤理论相关的躯干、臀部和膝关节运动学和动力学的结果，并在可能的情况下进行荟萃分析。
28 项研究符合标准，共有 466 名参与者。大多数研究评估了年轻女性、双侧着陆任务和娱乐运动员，而大多数变量与韧带和四头肌优势理论有关。ACL 损伤的一个重要预测指标，即峰值膝关节外展力矩，在 IPP 后降低（P=0.01），而与韧带优势理论相关的其他变量则没有变化。关于四头肌优势理论，IPP 后，初始接触时髋关节屈曲角度（P=0.009）、峰值髋关节屈曲（P=0.002）和峰值膝关节屈曲（P=0.007）增加，而初始接触时膝关节屈曲角度没有变化（P=0.18）。此外，峰值膝关节屈曲力矩降低（P=0.005），垂直地面反作用力峰值没有变化（P=0.10）。
IPP 中使用的练习可能有潜力改善与四头肌优势理论相关的着陆任务生物力学，特别是增加峰值膝关节和髋关节屈曲角度。重要的是，峰值膝关节外展力矩降低，这表明 IPP 影响了一种理想的运动策略，以帮助运动员克服在动态任务中缺乏额状面控制时出现的危险的韧带优势负荷。一些生物力学变量的研究结果缺乏表明，未来的 IPP 可能通过针对参与者的基线缺陷来增强，突出了提供个性化和特定于任务的 IPP 的必要性。
