Quality-of-movement patterns still present 6 months after ACL reconstruction

Symmetry and alignment were prevalent deviations in double- and single-leg movements, respectively.
Theresa Chiaia, PT, DPT
Theresa Chiaia

COLORADO SPRINGS, Colo. — Patients demonstrated quality of movement patterns associated with initial injury at 6 months after ACL reconstruction, according to results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“Movement patterns associated with initial and second ACL injury are consistently present at 6 months regardless of gender, limb, surgeon or physical therapist,” Theresa Chiaia, PT, DPT, physical therapist at Hospital for Special Surgery, said in her presentation.

Quality of movement

Polly de Mille, RN, MA, RCEP, CSCS, exercise physiologist at Hospital for Special Surgery, Chiaia and their quality-of-movement assessment team administered 10 quality-of-movement assessment tasks among 136 patients who underwent ACL reconstruction.

Polly de Mille, RN, MA, RCEP, CSCS
Polly de Mille

“Each task is assessed with the following criteria: movement strategy or where does the athlete move from first and foremost (do they move through their knees or preferably through their hips for a hip strategy); depth of movement; alignment; symmetry; control and pain,” de Mille said.

A physical therapist and performance specialist viewed all tasks from the frontal and sagittal planes and evaluated movements live for risk factors associated with ACL injury. Researchers also calculated the proportion of patients exhibiting risky movement patterns for each task.

Results showed all patients had risky movement patterns for at least one task and 60% of patients had risky movement patterns in five or more tasks.

Asymmetry was the most prevalent deviation noted in double-leg movements, while alignment was the most prevalent deviation in single-leg movements. The contralateral limb had just as many risky movement patterns as the injured limb with the exception of the forward step down on the involved limb.

“With regard to the forward step down of the involved limb, there was a higher proportion of faulty movement patterns, which is significant because this movement assesses the athlete’s ability to decelerate their body weight,” Chiaia said.

However, researchers found no differences in rates of risky movement patterns between men and women for all tasks.

Faulty movement patterns

Besides identifying risky movement patterns in patients, Chiaia noted they are also providing patients with recommendations that can help address their deficits in their faulty movement patterns with their physical therapy or in their training program.

“[We] do not just want to identify faulty movements, we want this return-to-play rate to go up and the risk of injury to go down,” Chiaia said. “We also want to see if there is any correlation between how [patients] look on this [quality of movement assessment] QMA and compare it to their psychological readiness. As they demonstrate less control, do they have more fear of re-injury? Fear of re-injury has been cited as one of the reasons that people do not go back to play. Does improved quality of movement lead to greater confidence?” – by Casey Tingle

Disclosures: de Mille and Chiaia report no relevant financial disclosures.

Theresa Chiaia, PT, DPT
Theresa Chiaia

COLORADO SPRINGS, Colo. — Patients demonstrated quality of movement patterns associated with initial injury at 6 months after ACL reconstruction, according to results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“Movement patterns associated with initial and second ACL injury are consistently present at 6 months regardless of gender, limb, surgeon or physical therapist,” Theresa Chiaia, PT, DPT, physical therapist at Hospital for Special Surgery, said in her presentation.

Quality of movement

Polly de Mille, RN, MA, RCEP, CSCS, exercise physiologist at Hospital for Special Surgery, Chiaia and their quality-of-movement assessment team administered 10 quality-of-movement assessment tasks among 136 patients who underwent ACL reconstruction.

Polly de Mille, RN, MA, RCEP, CSCS
Polly de Mille

“Each task is assessed with the following criteria: movement strategy or where does the athlete move from first and foremost (do they move through their knees or preferably through their hips for a hip strategy); depth of movement; alignment; symmetry; control and pain,” de Mille said.

A physical therapist and performance specialist viewed all tasks from the frontal and sagittal planes and evaluated movements live for risk factors associated with ACL injury. Researchers also calculated the proportion of patients exhibiting risky movement patterns for each task.

Results showed all patients had risky movement patterns for at least one task and 60% of patients had risky movement patterns in five or more tasks.

Asymmetry was the most prevalent deviation noted in double-leg movements, while alignment was the most prevalent deviation in single-leg movements. The contralateral limb had just as many risky movement patterns as the injured limb with the exception of the forward step down on the involved limb.

“With regard to the forward step down of the involved limb, there was a higher proportion of faulty movement patterns, which is significant because this movement assesses the athlete’s ability to decelerate their body weight,” Chiaia said.

However, researchers found no differences in rates of risky movement patterns between men and women for all tasks.

Faulty movement patterns

Besides identifying risky movement patterns in patients, Chiaia noted they are also providing patients with recommendations that can help address their deficits in their faulty movement patterns with their physical therapy or in their training program.

“[We] do not just want to identify faulty movements, we want this return-to-play rate to go up and the risk of injury to go down,” Chiaia said. “We also want to see if there is any correlation between how [patients] look on this [quality of movement assessment] QMA and compare it to their psychological readiness. As they demonstrate less control, do they have more fear of re-injury? Fear of re-injury has been cited as one of the reasons that people do not go back to play. Does improved quality of movement lead to greater confidence?” – by Casey Tingle

Disclosures: de Mille and Chiaia report no relevant financial disclosures.