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Friday, 20 December 2019 09:31

Can anterior cruciate ligament injuries in football players be prevented? Kneemotion, a new tool from IBV for the functional assessment of the knee Featured

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José María Baydal Bertomeu; José Manuel Frias Bocanegra; Gonzalo Utrilla Redondo; Enrique Alcántara Alcover; Juan López Pascual; Laura Magraner Llavador.

Instituto de Biomecánica (IBV) Universitat Politècnica de València (Edificio 9C) Camino de Vera s/n (46022) Valencia (España).

 Injuries to the knee joint are very frequent among football players, especially women. One of the most common traumas is the anterior cruciate ligament (ACL) injury. This injury entails a high social, psychological and economic cost for football players and their teams. Unfortunately, many players never recover the level of physical activity they had before the injury, due to the loss of functional aspects such as the stability of the knee in rotational movements.

Currently there are no objective technological tools with which to assess the rotational stability of the knee in a dynamic way. For this reason, the IBV has developed Kneemotion, a biomechanical analysis tool that makes it possible to detect alterations in the motion of the knee during sports movements. The ultimate goal is to prevent the possible exposure to ACL injuries, among others. It could also be used to monitor the rehabilitation progress in a quantitative, objective and easily interpretable way.

INTRODUCTION 

A large part of the population that practices sport, whether in a recreational or in a professional way, suffers injuries to the knee joint. Epidemiological data show that football is one of the sports that present the higher risk of injury to that joint. This risk is up to nine times higher in women.

Among the most frequent traumas are injuries to the meniscus, or the most common of them all, anterior cruciate ligament (ACL) injury. The minimum recovery time for this injury is 6 months, and all too often players do not recover their previous performance level. Also, in the long term, this injury could lead to the onset of osteoarthritis, a degenerative disease that limits mobility and everyday life. Injuries to the knee joint entail a high social, psychological and economic cost for football players and their teams, a cost that could be avoided.

Rotational stability is one of the aspects in which the quality of movement usually deteriorates after an injury such as ACL injury. This movement is necessary for pivoting and jumping while changing direction, among others. If an athlete returns to playing sport before they should, they may leave themselves open to suffering the injury again. Therefore, an objective and precise measurement of the dynamic functionality of the knee would be very useful as an indicator of an athlete’s being in readiness for playing again.

Most sports teams incorporate subjective analysis methods, but there is increasing interest in the use of motion analysis systems for the functional assessment of sports gestures in order to apply prehabilitation and physical preparation protocols, if needed. In order to fill this gap, the Instituto de Biomecánica (IBV) has developed Kneemotion, a system designed for an objective and simple assessment of the rotational stability of the knee, by means of a gesture that subjects the joint to a load similar to that endured in the practice of sport.

DEVELOPMENT (METHODOLOGY USED) 

Clinical tests of painful knees and/or knees with an ACL injury

Traditionally, many clinical tests have been used to assess the rotational stability of this joint, such as the Losee Test and the Pivot-Shift Test. These tests are carried out without any measuring instruments and are based on the medical history of the patient, with a great deal of subjectivity on the part of the evaluating physician. Results can vary depending on the examiner’s abilities and experience. Therefore, these are tests whose sensitivity, reliability and objectivity can be improved.  

Current objective methodologies are, for the most part, invasive and static (X-Rays, CAT, MR, etc.). To date, no commercial device has been able to assess the “in vivo” dynamic rotational stability parameters of the knee, during the execution of complex sports moves. Kneemotion does just that. 

Figure 1: Pivot-Shift Test – This consists of the application of a force in valgus and an internal rotation, followed by a passive flexion of the knee.

The Kneemotion system 

Kneemotion uses a dynamometric platform to register forces and ground reactiontorques during the execution of a Single Foot Jump with a Turn consisting of:

♦ A jump taken in the direction of the counter-lateral side of the relevant limb to assess the external rotation of the tibia (reproducing the Clancy and Peterman tests), and in same direction of the relevant side, to assess the internal rotation of the tibia (reproducing the Losee Test).

♦ Five executions of the gesture are registered, starting from the single-foot support on the left foot. The process is then repeated with the right foot.

It is a user-friendly system that takes less than 15 minutes to assess an athlete, and it provides results automatically.

Figure 2 - Stages of the Single Foot Jump with a Turn. (1) Load phase in internal rotation + knee flexion + varus. (2) Pivot phase in external rotation + knee extension + valgus.

The system provides information that makes it possible to identify a possible alteration of the rotational stability of the knee, in order to:

  1. Prevent injuries.
  2. Determine the functional aspects of the knee that can be improved, in order to suggest a set of exercises required to enhance the improvement in the performance of the athlete.
  3. Establish the right time to start playing again after a knee injury. This makes it possible to direct the rehabilitation treatment of an injured patient in order to improve recovery times and to efficiently return to their level of activity prior to the injury, as well as recovering their quality of life.

Figure 3 - Reaction momentum and main variables calculated during the execution of a Single Foot Jump with a Turn test.

 

 [Figure 4 - Figure 4 - Simple interface that facilitates the use of the software and interpretation of the results.

Collaboration with Levante U.D. Football Club

In 2018, Levante U.D. incorporated the Kneemotion system into its assessment routines. Since then they have assessed the rotation stability of the players in their academy, their pool of young players, and the male and female teams. Currently, the IBV is collaborating with Levante U.D. providing advice and biomechanical support in the tasks of monitoring the evolution of football players in different categories, as well as studying a range of factors in the rotational stability of the knee, such as, for example, physical load or the phases of the menstrual cycle.

The IBV is establishing new lines of collaboration with football clubs at a national and international level, as well as with entities from other sports, such as basketball or rugby, in which the rotational stability of the knee plays an important role.

ACKNOWLEDGEMENTS 

We appreciate the collaboration of Levante U.D. and thank them for their support and participation in this research and development project.

Read 1332 times Last modified on Friday, 20 December 2019 11:07



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