Movement Performance 3D

Real-Time Dynamic Assessment For the Return to Sport in ACL Injury

DR KERITH AGINSKYPhD (Exercise Science)

Dr Maya Cale-Benzoor

FOOTBALL MEDICINE STRATEGIES RTP

April | 2016

The numbers behind the goals

Source: stack.com

Biomechanics modifiable risk factor

INTRODUCTION• ACL injury compromises:

• Neuromuscular control• Mobility• Strength• Stability

• Current RTP guidelines = No quality of movement assessment during dynamic tasks

• Faulty lower extremity biomechanics place athlete at risk of ACL injury & thus re-injury if not addressed prior to RTP

Myer et al (2006), Waters (2012), Bizzini (2012), Paterno et al (2010)

FOOTBALL SPECIFIC MOVEMENT ERRORS FOR RISK OF ACL INJURY & RE-INJURY

• ↑ dynamic knee valgus at initial contact• ↑ maximal knee valgus which ↑

anterior tibial translation. • ↓ maximal knee flexion angle at

initial contact• ↓ knee flexion displacement ↑ ACL

loading• Asymmetrical loading

Myer et al (2006), Waters (2012) Hewett et al (2005), Padua et al (2012), Hirth and Padua (2007), Dufek and Bates (1991), Fukuda et al (2003),Lloyd and Buchanan (2001), Markolf et al (1995)

IMPORTANT TO IDENTIFY: SPECIFIC CAUSE FOR FAULTY PATTERN

• Knee valgus may be due to:• ↓ ankle dorsiflexion ROM

• Assess also dorsiflexion lunge test• ↓ gluteal muscle activation

• ↓ joint displacement on LESS/single leg squat• ↑ hip-adductor activation

• Adductor squeeze test

LIMITATIONS FOR ASSESSMENT

• Lab-based 3D assessment• Specialised equipment, expensive and not available to

the clinician• 2D video analysis

• Human error, time-consuming, trained clinician• Inability to frequently retest • Cannot asses rotational patterns of movement

7

Introducing

A Real-Time cloud based technology that reliably scores athletes' risk of injury And functional performance. Leveraging evidence-based functional movement Tests, for training programs to address athletes'

personal condition. 

AIMS• Pilot study:

• Use of real-time marker-less 3D software to assess quality of movement assessment in football players.

• In progress:• Database development of normative kinematics in

football players per age group, level of participation and gender.

• Use normative data to establish guidelines for RTP following ACL injury in football players.

METHODS

• 25 Elite, male football players• 25,2 ± 4,8 years• No current ACL injuries• Drop Jump test assessed with LESS criteria (22

and 17 criteria)• Eg: Landing kinematics, symmetry, joint

displacement, neuromuscular control, mobility, dynamic stability

• Single leg squat • Dorsiflexion lunge, Unilateral vertical jump, Dynamic

knee stability

Validated Technology Prof. Darin Padua UNC Sports SciencesAND COLLEAGUES

VALIDATION STUDY (PH 1 — AUG 2014)1

LARGE-SCALE (PH 2 — AUG 2015)2

MICROSOFT KINECT vs VICON3

Padua et al (2015), Lee et al (2015), Gray et al (2014), Eltoukhy et al (2016), Yang et al (2015), Chen (2014)

RESULTS FOR LESS

CRITERIA DOMINANT NON-DOMINANTOverall Score LESS 22 6.6 ± 2.2Medial knee position at IC (o) -1.0 ± 4.4 -1.8 ± 4.4Medial knee displacement (o) 5.1 ± 12.2 3.6 ± 9.8Knee flexion at IC (o) 17.5 ± 13.8 18.5 ± 13.9Knee flexion displacement (o) 62.0 ± 26.1 61.4 ± 25.7Hip flexion at IC (o) 22.9 ± 15.7 24.4 ± 15.3Hip flexion displacement (o) 42.3 ± 27.7 41.9 ± 28.0Joint displacement 1 ± 1 1 ± 1

RESULTS FOR SINGLE LEG SQUAT

CRITERIA DOMINANT NON-DOMINANTOverall Score 4.9 ± 1.3 4.4 ± 1.0

Maximal knee valgus (o) 13.6 ± 14.9 14.8 ± 12.2

Maximal knee flexion (o) 81.5 ± 18.1 78.5 ± 16.3

Maximal hip Flexion (o) 75.7 ± 18.2 73.9 ± 18.1

Pelvic hike (o) 4.2 ± 4.6 1.5 ± 5.4

Lateral trunk flexion (o) -1.1 ± 4.3 1.8 ± 5.0

Dynamic knee stability (%) 17.4 ± 14.4 10.5 ± 14.7

PREVENTION + REHAB + RETURN TO SPORT

RIGHTReduced

knee flexion @ IC

Low knee flexion

displacement

Asymmetrical weight shift to

the RIGHT

RIGHTIncreased

knee valgus at IC and increases

with displaceme

nt

• Establish a quantitative orthopedic baseline for in-season monitoring or return-to-sport

• Enhanced rehabilitation, working their incorrect biomechanics

• Compare athletes to norms, pre-injury level and bilateral comparison

• Range of bilateral & unilateral dynamic tests LESS, Single leg squat, Dorsiflexion lunge, Single leg hop, Countermovement jump, SEBT

CONCLUSIONS

• Quality of movement criteria for RTP to avoid re-injury should include:• ↓ excessive knee valgus• ↓ medio-lateral displacement• Adequate, symmetrical knee flexion• Adequate dynamic knee instability• Full dorsiflexion ROM• No bilateral deficits in movement

quality• Adequate joint displacement

• Important need for objective, quality of movement assessment in RTP decision-making following non-contact ACL in football players

Juan Torrijo Navarro

“PhysiMax data takes our training to next level, Using latest scientific methods to objectively analyze & monitor players. Saving us time in our prevention workouts.”

Head Fitness Coach Maccabi Tel Aviv F.C

Fitness CoachValencia CF 1996-2012

REFERENCES• Hewett TE, Myer GD, Ford KR, Heidt RS, Jr., Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular

control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American journal of sports medicine. 2005;33(4):492-501.

• Padua DA, Marshall SW, Boling MC, Thigpen CA, Garrett WE, Jr., Beutler AI. The Landing Error Scoring System (LESS) Is a valid and reliable clinical assessment tool of jump-landing biomechanics: The JUMP-ACL study. The American journal of sports medicine. 2009;37(10):1996-2002.

• Padua DA, Bell DR, Clark MA. Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training. 2012;47(5):525-36.

• Hirth CJ, Padua DA. Clinical movement analysis to identify muscle imbalances and guide exercise. Athl Ther Today. 2007;12(4):10–14.

• Dufek JS, Bates BT. Biomechanical factors associated with injury during landing in jumping sports. Sports Med. 1991;12:326-337.

• Fukuda Y, Woo SL, Loh JC, et al. A quantitative analysis of valgus torque on the ACL: a human cadaveric study. J Orthop Res. 2003;21:1107-1112.

• Lloyd DG, Buchanan TS. Strategies of muscular support of varus and valgus isometric loads at the human knee. J Biomech. 2001;34:12571267. 28.Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. 1995;13:930-935

• Gustavsson A, Neeter C, Thomee P, et al. A test battery for evaluating hop performance 585 in patients with an ACL injury and patients who have undergone ACL reconstruction. 586 Knee Surg Sports Traumatol Arthrosc. 2006;14:778-788.

• Myklebust G, Holm I, Maehlum S, Engebretsen L, Bahr R. Clinical, functional, and 641 radiologic outcome in team handball players 6 to 11 years after anterior cruciate 642 ligament injury: a follow-up study. The American journal of sports medicine. 643 2003;31:981-989.

• Paterno MV, Schmitt LC, Ford KR, et al. Biomechanical measures during landing and 657 postural stability predict second anterior cruciate ligament injury after anterior cruciate 658 ligament reconstruction and return to sport. The American journal of sports medicine. 659 2010;38:1968-1978.

• Gray AD, Marks JM, Stone EE, Butler MC, Skubic M, Sherman SL. Validation of the Microsoft Kinect as a portable and inexpensive screening tool for identifying ACL injury risk. . The Orthopaedic Journal of Sports Medicine. 2014;2(7 (supp 2)).

• Eltoukhy M, Kelly A, Kim CY, Jun HP, Campbell R, Kuenze C. Validation of the Microsoft Kinect(R) camera system for measurement of lower extremity jump landing and squatting kinematics. Sports biomechanics / International Society of Biomechanics in Sports. 2016:1-14.

• Yang L, Zhang L, Haiwei D, Alelaiwi A, Saddik A. Evaluating and Improving the Depth Accuracy of Kinect for Windows v2. IEEE SENSOR JOURNAL. 2015:1-12.

• Chen C. Verification of specifications and aptitude for short-range applications of the Kinect v2 depth sensor. In: University C, editor. Lewis’ Educational and Research Collaborative Internship Project (LERCIP): NASA Glenn Research Center, Graphics & Visualization/Dr. Herb Schilling; 2014.

• Bizzini M, Hancock D, Impellizzeri F. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. The Journal of orthopaedic and sports physical therapy. 2012;42(4):304-12.

• Myer GD, Ford KR, McLean SG, Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. The American journal of sports medicine. 2006;34(3):445-55.

• Waters E. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball. The Journal of orthopaedic and sports physical therapy. 2012;42(4):326-36.

Thank you! • kerith@pmax.co

www.pmax.co