Author: Dr. Luca Molteni
Introduction to the clinical problem
Anterior cruciate ligament lesion is one of the most common injuries involving the knee. As reported by the estimates of the Italian Society of Orthopedics and Traumatology, in Italy there are about 150,000 cases per year. This condition is observed above all in athletes and young sports: the causes are represented for 90% by jumps, twists and frequent changes of direction [1].
The risk of damaging the anterior cruciate ligament, moreover, increases tenfold during competitive matches compared to moments of athletic preparation [2] because the sense of competition and emotional involvement lead to greater physical effort.
What happens after the injury? Let's see some data that can help understanding the extent of the phenomenon:
• only 44% of non-professional athletes return to competitive play
• about 90% of professional footballers return to their previous sports performance levels on average in 12 months (the fastest players play their first match even after 7-9 months)
• if all the criteria for returning to sport are met, the risk of relapse fluctuates between 7 and 10%. Otherwise it increases dramatically up to 30% [3]
Importance of evaluation in clinical problems
After an injury, the real challenge for rehabilitation professionals is the success of the athlete's return to sport without incurring relapses. For a gradual and lasting recovery, in addition to a successful surgery, it is necessary a functional rehabilitation program based on several parameters: joint mobility of the knee, the ability to maintain monopodalic balance and the performance of strength and power of the lower limbs during the execution of the vertical jump. To monitor the progress of therapy, tests should be performed in monopodal support to compare the injured limb with the healthy one. This allows you to understand whether the patient is progressing towards full recovery.
Importance of objective technological assessment
Evaluating the athlete's performance in an objective and repeatable way is essential for a safe return to sport. Inertial-type systems are wearable technologies that are easy to use to conduct a quantitative analysis of the range of motion in a quick and versatile way.
In the case of anterior cruciate ligament injury, these tools facilitate the assessment of various aspects:
- joint mobility of the knee, providing accurate and repeatable measurements
- maintaining balance, providing important information at the level of proprioception of the lower limb
- strength and power of the lower limbs, through the execution of the jump test
Conclusion
The use of inertial sensors makes possible to evaluate the overall situation of the athlete's performance. Based on the information obtained, the expert can verify the real progress of the rehabilitation by identifying the right time to return to sport, guaranteeing the athlete good performance on the field and minimizing the risk of relapses.
References
[1] Della Villa, F., Buckthorpe, M., Grassi, A., Nabiuzzi, A., Tosarelli, F., Zaffagnini, S., & Della Villa, S. (2020). Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. British journal of sports medicine, 54(23), 1423-1432
[2] Montalvo, A. M., Schneider, D. K., Webster, K. E., Yut, L., Galloway, M. T., Heidt Jr, R. S., ... & Myer, G. D. (2019). Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. Journal of athletic training, 54(5), 472-482
[3] Wright, R. W., Dunn, W. R., Amendola, A., Andrish, J. T., Bergfeld, J., Kaeding, C. C., ... & Spindler, K. P. (2007). Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. The American journal of sports medicine, 35(7), 1131-1134