Effects of a Prophylactic Knee Sleeve on Anterior Cruciate Ligament Loading During Sport-Specific Movements

in Journal of Sport Rehabilitation
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Context: Prophylactic knee bracing is extensively utilized in athletic populations to reduce the high risk from knee injuries, but its role in the attenuation of anterior cruciate ligament (ACL) pathologies is not well understood. Objective: The aim of this investigation was to explore the effects of a prophylactic knee sleeve on ACL loading parameters linked to the etiology of injury in recreational athletes. Setting: Laboratory. Design: Repeated measures. Participants: Thirteen healthy male recreational athletes. Intervention: Participants performed run, cut, and single-leg hop movements under 2 conditions; prophylactic knee sleeve and no sleeve. Main Outcome Measures: Biomechanical data were captured using an 8-camera 3D motion capture system and a force platform. Peak ACL force, average ACL load rate, and instantaneous ACL load rate were quantified using a musculoskeletal modeling approach. Results: The results showed that both average and instantaneous ACL load rates were significantly reduced when wearing the knee sleeve in the hop (sleeve = 612.45/1286.39 N/kg/s and no sleeve = 743.91/1471.42 N/kg/s) and cut (sleeve = 222.55/1058.02 N/kg/s and no sleeve = 377.38/1183.01 N/kg/s) movements. Conclusions: Given the biomechanical association between ACL loading and the etiology of ACL injuries, it is proposed that athletes may be able to attenuate their risk from injury during cut and hop movements through utilization of a prophylactic knee sleeve.

Sinclair is with the Centre for Applied Sport and Exercise Sciences, School of Sport and Wellbeing, Faculty of Health and Wellbeing, University of Central Lancashire, Lancashire, United Kingdom. Taylor is with the School of Psychology, Faculty of Science and Technology, University of Central Lancashire, Lancashire, United Kingdom.

Sinclair (jksinclair@uclan.ac.uk) is corresponding author.
  • 1.

    Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65:411–419. PubMed ID: 25660917 doi:10.1016/j.jacc.2014.11.023.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48:871–877. PubMed ID: 24100287 doi:10.1136/bjsports-2013-092538

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury abnormalities in hip and ankle kinematics. Am J Sports Med. 2009;37:252–259. PubMed ID: 19182110 doi:10.1177/0363546508328107

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606. PubMed ID: 21398310 doi:10.1136/bjsm.2010.076364

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med. 2005;39:127–131. PubMed ID: 15728687 doi:10.1136/bjsm.2004.010900

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. 1995;3:261–267. PubMed ID: 8689461

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Carey JL, Huffman GR, Parekh SG, Sennett BJ. Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League. Am J Sports Med. 2006;34:1911–1917. PubMed ID: 16870822 doi:10.1177/0363546506290186

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury a systematic review. Am J Sports Med. 2009;37:1434–1443. PubMed ID: 19567666 doi:10.1177/0363546509338827

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42:2242–2252. PubMed ID: 24214929 doi:10.1177/0363546513508376

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Gottlob CA, Baker JL, Pellissier JM, Colvin L. Cost effectiveness of anterior cruciate ligament reconstruction in young adults. Clin Orthop Relat Res. 1999;367:272–282. PubMed ID: 10546625

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Smith HC, Vacek P, Johnson RJ, et al. Risk factors for anterior cruciate ligament injury: a review of the literature—part 1: neuromuscular and anatomic risk. Sports Health. 2012;4:69–78. PubMed ID: 23016072 doi:10.1177/1941738111428281

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. 2004;32:1002–1012. PubMed ID: 15150050 doi:10.1177/0363546503261724

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Sinclair J, Vincent H, Richards JD. Effects of prophylactic knee bracing on knee joint kinetics and kinematics during netball specific movements. Phys Ther Sport. 2017;23:93–98. PubMed ID: 27697389 doi:10.1016/j.ptsp.2016.08.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wu GKH, Ng GYF, Mak AFT. Effects of knee bracing on sensorimotor function of subjects with anterior cruciate ligament reconstruction. Am J Sports Med. 2001;29:641–645. PubMed ID: 11573924 doi:10.1177/03635465010290051801

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Ramsey DK, Wretenberg PF, Lamontagne M, et al. Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing. Clin Biomech. 2003;18:28–34. PubMed ID: 12527244

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Smith J, Malanga GA, Yu B. Effects of functional knee bracing on muscle firing patterns about the chronic anterior cruciate ligament-deficient knee. Arch Phys Med Rehabil. 2003;84:1680–1686. PubMed ID: 14639570

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    McDevitt ER, Taylor DC, Miller MD. Functional bracing after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:1887–1892. PubMed ID: 15572317

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Jackson RW, Reed SC, Dunbar F. An evaluation of knee injuries in a professional football team-risk factors, type of injuries, and the value of prophylactic knee bracing. Clin J Sport Med. 1991;1:1–7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Sitler M, Ryan CJ, Hopkinson LW, et al. The efficacy of a prophylactic knee brace to reduce knee injuries in football: a prospective, randomized study at West Point. Am J Sports Med. 1990;18:310–315. PubMed ID: 2372083 doi:10.1177/036354659001800315

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Erickson AR, Yasuda K, Beynnon BD, Johnson RJ, Pope MH. Dynamic elongation behavior in the medical collateral and anterior cruciate ligaments during lateral impact loading. J Orthop Res. 1993;11:190–198. PubMed ID: 8483032 doi:10.1002/jor.1100110206

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Raja K, Dewan N. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. Am J Phys Med Rehabil. 2011;90:247–262. PubMed ID: 21273902 doi:10.1097/PHM.0b013e318206386b

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Cappozzo A, Catani F, Leardini A, Benedeti MG, Della CU. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech. 1995;10:171–178. PubMed ID: 11415549

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Sinclair J, Hobbs SJ, Taylor PJ, Currigan G, Greenhalgh A. The influence of different force and pressure measuring transducers on lower extremity kinematics measured during running. J Appl Biomech. 2014;30:166–172. PubMed ID: 24676524 doi:10.1123/jab.2012-0238

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Dai B, Yu B. Estimating ACL force from lower extremity kinematics and kinetics. 36th annual meeting of the American Society of Biomechanics; 2012. Gainesville, FL:253–254.

    • Export Citation
  • 25.

    DeVita P, Hortobagyi T. Functional knee brace alters predicted knee muscle and joint forces in people with ACL reconstruction during walking. J Appl Biomech. 2001;17:297–311. doi:10.1123/jab.17.4.297

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Hohmann E, Bryant A, Reaburn P, Tetsworth K. Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries? Knee Surg Sports Traumatol Arthrosc. 2011;19:109–114. PubMed ID: 21607739 doi:10.1007/s00167-011-1547-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Lim BO, Lee YS, Kim JG, An KO, Yoo J, Kwon YH. Effects of sports injury prevention training on the biomechanical risk factors of anterior cruciate ligament injury in high school female basketball players. Am J Sports Med. 2009;37:1728–1734. PubMed ID: 19561174 doi:10.1177/0363546509334220

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Nunley RM, Wright D, Renner JB, Yu B, Garrett WE. Gender comparison of patellar tendon tibial shaft angle with weight bearing. Res Sports Med. 2003;11:173–185.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    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. PubMed ID: 8544031 doi:10.1002/jor.1100130618

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Sinclair J, Taylor PJ, Hobbs SJ. Alpha level adjustments for multiple dependent variable analyses and their applicability—a review. Int J Sports Sci Eng. 2013;7:17–20.

    • Search Google Scholar
    • Export Citation
  • 31.

    Fleming BC, Renstrom PA, Beynnon BD, et al. The influence of functional knee bracing on anterior cruciate ligament strain biomechanics in weight bearing and non-weight bearing knees. Am J Sports Med. 2000;28:815–824. PubMed ID: 11101104 doi:10.1177/03635465000280060901

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Liu SH, Daluiski A, Kabo M. The effects of thigh soft-tissue stiffness on the control of anterior tibial displacement by functional knee orthoses. J Rehabil Res Dev. 1995;32:135–140. PubMed ID: 7562653

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42:311–319. PubMed ID: 17710181

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Rishiraj N, Taunton JE, Lloyd-Smith R, Woollard R, Regan W, Clement DB. The potential role of prophylactic/functional knee bracing in preventing knee ligament injury. Sports Med. 2009;39:937–960. PubMed ID: 19827861 doi:10.2165/11317790-000000000-00000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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