Relationship of 3D biomechanical analysis with outcomes after ACL reconstruction

Abstract

Introduction
Despite the large number of anterior cruciate ligament reconstructions (ACLR) annually and the volume of research in the area, there are still mixed outcomes after ACLR relating to restoration of normal function, return to play (RTP) and second ACL injury. It is unknown what threshold of clinical and biomechanical measures need to be achieved after ACLR to ensure restoration of normal movement to facilitate a pain free RTP and minimise second ACL injury. The aim of this thesis was to examine the use of 3D biomechanical analysis specific to these outcomes.
Methods
Male multidirectional field athletes (age 18-35) who were diagnosed with an ACL rupture and were scheduled for ACLR were recruited into the study along with matched controls. Statistical parametric mapping was used to examine 3D biomechanical kinetic and kinematic measures throughout the kinetic chain during a series of jump and change of direction (CoD) tests in combination with isokinetic strength testing of the quadriceps and hamstrings and patient reported outcomes at 6 and 9 months post-surgery. Subjects were then followed up at annual review to identify ongoing progress and identify those that had suffered second ACL injury.
Results
Biomechanical differences were found across tests and throughout the kinetic chain between limbs and in comparison of symmetry with healthy subjects. In addition biomechanical differences were identified between those that made a pain free RTP and those that did not and between those that suffered second ACL injury after ACLR, in the latter case in the absence of any difference in commonly used clinical measures.
Conclusion
The findings of this thesis demonstrate the utility of 3D biomechanical analysis of jump and CoD tests after ACLR when assessing rehabilitation status specific to the restoration of normal movement, RTP status and second ACL injury outcomes.

Date of Award	2 Apr 2019
Original language	English
Awarding Institution	University of Roehampton
Supervisor	Chris Richter (Supervisor) & Ross Wadey (Supervisor)