Uso de testes clínicos para avaliar variáveis biomecânicas relacionadas com o risco de lesão do LCA

Abstract

Non-contact anterior cruciate ligament (ACL) injury affects thousands of individuals annually. The ACL injured individuals have a lower physical activity level and increased risk of developing degenerative disease and submit to arthroplasty surgery. The assessment of risk factors plays a crucial role in ACL injury prevention. However, screening risk factors often requires a highly instrumented laboratory, frequently less accessible and expensive. To provide the best choices for the assessment of ACL injury risk, scientists and sports medicine professionals make daily use of clinical tests. However, it remains unclear how clinical tests correspond to biomechanical outcomes of jump landing tasks in which ACL is often injured. This dissertation explores how clinical tests can be used to assess risk factors of ACL injury. We developed a cross-sectional study with male recreational athletes submitted to a battery of clinical tests followed by biomechanical assessment. The associations between clinical tests and biomechanics outcomes were investigated. Our main findings support important biomechanical variables during jump landing tasks being predicted by specific combinations of clinical tests. We also found that lateral step down (LSD) test can identify two groups of participants according to proximal and distal deviations. The groups' stratification differenced participants concerning hip kinematics and impact absorption, with worse performance in participants showing both proximal and distal deviations. Considering isometric strength asymmetries, we found only a poor association of hip strength asymmetry with clinical and biomechanical asymmetries, while hip adductor strength asymmetry predicted asymmetry in the triple hop test. In addition, asymmetry in the hop tests did not correspond to asymmetry in biomechanical outcomes related to quadriceps dominance theory. Asymmetry outcomes seems also to vary according to kinetics and kinematics variables. If using the “10% symmetry criteria”, asymmetry in single and crossover hop tests identified asymmetries in kinetics but not in kinematics of unilateral landings. We conclude that clinical tests can better predict biomechanical outcomes related to a risk of ACL injury in jump landing tasks when combined. We suggest that clinical test selection should consider the main risk factors, proximal or distal deviations, and individually assess preferred and non-preferred legs. Although this reveals an already expected complex scenario, it provides important directions for clinical assessment and can potentially help clinical decision-making.