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University of Massachusetts - Amherst

ScholarWorks@UMass Amherst

Masters Theses May 2014 - current Dissertations and Theses

Inter-Segment Coordination Variability Post

Anterior Cruciate Ligament Reconstruction

Devin K. Kelly

University of Massachusetts - Amherst, dkkelly@kin.umass.edu

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Part of the Biomechanics Commons, Laboratory and Basic Science Research Commons, and the Motor Control Commons Recommended Citation Kelly, Devin K., "Inter-Segment Coordination Variability Post Anterior Cruciate Ligament Reconstruction" (2015). Masters Theses May 2014 - current. Paper 278.

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INTER-SEGMENT COORDINATION VARIABILITY POST ANTERIOR CRUCIATE

LIGAMENT RECONSTRUCTION

A Thesis Presented by DEVIN K. KELLY Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE

September 2015 Department of Kinesiology

INTER-SEGMENT COORDINATION VARIABILITY POST ANTERIOR CRUCIATE

LIGAMENT RECONSTRUCTION

A Thesis Presented by DEVIN K. KELLY

Approved as to style and content by:

Joseph Hamill, Chair Katherine Boyer, Member Richard Van Emmerik, Member Patty S. Freedson, Department Chair Department of Kinesiology

ACKNOWLEDGEMENTS

I would like to thank my advisor, Joseph Hamill for his invaluable guidance during both my undergraduate and graduate careers at UMass Amherst. I would also like to extend thanks to the members of my committee, Katherine Boyer and Richard Van Emmerik, for contributing their expertise and constructive suggestions during all stages of this project, as well as Susan Sigward for her insight and collaboration. I want to express my appreciation to Julia Freedman Silvernail for her additional mentorship over the past several years.

Finally, I want to thank my family, friends, and fellow graduate students who have given me endless support and encouragement.

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There is an increased risk for ipsilateral graft rupture and contralateral ACL rupture following ACL reconstruction surgery (ACLR) despite return to sport clearance. The reason for this increased risk is not well understood. Previous literature has shown that decreased coordination variability is indicative of an injured system regardless of the absence of pain. PURPOSE: To quantify inter-segment coordination variability during

three portions of the stance phase of gait in athletes at three progressive time points postsurgery compared to the contralateral limb (NI) and healthy controls. METHODS:

Three-dimensional kinematic and kinetic data were collected for 10 ACLR and 10 healthy athletes matched for age, gender, and activity level. The ACLR group was measured at 4 weeks, 12 weeks, and when cleared to run post-surgery. Kinematic data were used in a modified vector coding technique to determine inter-segment coordination variability of lower extremity couples of interest. Statistical significance was determined using two factor multivariate ANOVAs (limb x visit) for early (1-33%), mid (34-66%), and late (67-100%) stance with alpha level set at.05. Tukey post-hoc tests were

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coordination variability of the involved lower extremity during the late stance phase of gait compared to both the contralateral limb and healthy controls at 4 weeks post-surgery.

By 12 weeks post-surgery there were improvements in joint function as exemplified by inter-segment coordination variability of the ACLR involved limb becoming similar to the healthy control limb. CONCLUSION: Inter-segment coordination variability during late stance in the present study is not an indication for the increased risk for ipsilateral graft rupture and contralateral ACL rupture in ACLR athletes.

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ACKNOWLEDGEMENTS………………………………………………………………iii ABSTRACT...……………………………………………………………………………iv LIST OF TABLES...………………………………………………………………………x LIST OF FIGURES...……………………………………………………………………xii CHAPTER 1: INTRODUCTION……………………………………………………………………...1

1.1 Background……….…………………………………………………………...1

1.2 Statement of the Problem…….………………………………………………..7

1.3 Purpose of the Study…………………………………………………………..7

1.4 Significance of the Study……………………………………………………...9

1.5 Summary………………………………………………………………………9

1.6 References……………………………………………………………………12 2: REVIEW OF THE LITERATURE…………...………………………………………16

2.1 Introduction...………………………………………………………………..16

2.2 ACL Reconstruction…………………………………………………………17 2.2.1 ACL Injury Following Reconstruction…………………………….17 2.2.2 ACL Reconstruction Alters Gait- Traditional Measures…………..18

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Summary……………………………………………………….....21

2.3 Dynamical Systems Approach to Coordination and Coordination Variability…..………………………………………………………….....22 2.3.1 End-Point Variability versus Coordination Variability…………….22 2.3.2 Coordination Variability and Loss of Complexity Hypothesis………………………………………………………..23 2.3.3 Dynamical Systems Approach Summary…………………………..26

2.4 Techniques for Quantifying Coordination and Coordination Variability…....27

2.5 Joint Coordination and Coordination Variability Post ACL Reconstruction.…..……………………………………………….............28

2.6 Chapter Summary…………………………………………………………….29

2.7 References…………………………………………………………………....31 3: METHODS………...………………………………………………………………….39

3.1 Introduction………………………………………………………………….39

3.2 Participants…………………………………………………………………..39

3.3 Experimental Set-up…………………………………………………………40

3.4 Experimental Protocol……………………………………………………….41

3.5 Data Analysis………………………………………………………………...42

3.6 Statistical Analysis.…………………………………………………………..45

3.7 Summary.......………………………………………………………………...45

3.8 Reference…………………………………………………………………….47

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CRUCIATE LIGAMENT RECONSTRUCTION……………………………………48

4.1 Introduction…………………………………………………………...……...48

4.2 Methods………………………………………………………………………51 4.2.1 Participants…………………………………………………………51 4.2.2 Experimental Setup………………………………………………...52 4.2.3 Experimental Protocol……………………………………………..52 4.2.4 Data Analysis………………………………………………………53 4.2.5 Statistical Analysis…………………………………………………55

4.3 Results………………………………………………………………………..55 4.3.1 Participant Characteristics…………………………………………55 4.3.2 Walking Velocity…………………...……………………………..56 4.3.3 Results-Hypothesis 1………………………………………………56 4.3.4 Results-Hypothesis 2...…………………………..………………..59 4.3.5 Results-Hypothesis 3………………………………………………62 4.3.6 Results-Hypothesis 4...………………….………………………...64 4.3.7 Results-Coordination Variability Figures by Couple……………...67 4.3.7.1 Pelvis-Thigh Flexion/Extension……………..…………...67 4.3.7.2 Pelvis-Thigh Rotation……………………………………70 4.3.7.3 Thigh-Leg Flexion/Extension……………………………72 4.3.7.4 Thigh Flexion-Leg Internal Rotation…………………….75 4.3.7.5 Thigh-Leg Rotation………………………………………77 4.3.7.6 Leg-Foot Flexion/Extension……………………………..80

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4.4 Discussion……………………………………………………………………85

4.5 Conclusions…………………………………………………………………..91

4.6 References……………………………………………………………………92 5: SUMMARY OF RESULTS AND FUTURE STUDIES……………………………...96

5.1 Introduction………………………………………………………………….96

5.2 Summary of Results………………………………………………………….96

5.3 Conclusions…………………………………………………………………102

5.4 Future Studies………………………………………………………………103

5.5 References…………………………………………………………………..106 BIBLIOGRAPHY………………………………………………………………………107

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4.3.1 Participant characteristics of the ACLR involved group (ACLR), ACLR noninvolved group (NI), and control group (CTRL) at 4 weeks (V1), 12 weeks (V2), and when cleared to run post-surgery (V3).…..……………………55 Group mean walking velocities and standard deviations at each visit……..…….56 4.3.2 4.3.3.1 Coordination variability of the ACLR involved limb compared to the healthy control limb during early stance at each visit …………………………...57 4.3.3.2 Coordination variability of the ACLR involved limb compared to the healthy control limb during mid-stance at each visit ……………………………58 4.3.3.3 Coordination variability of the ACLR involved limb compared to the healthy control limb during late stance at each visit ………………………...…..58 4.3.4.1 Coordination variability of the ACLR involved limb progressively over time during early stance………………………………………………..…...……60 4.3.4.2 Coordination variability of the ACLR involved limb progressively over time during mid-stance ……………………………………………………….....60 4.3.4.3 Coordination variability of the ACLR involved limb progressively over time during late stance ……………………………………………………...…...61

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ACLR contralateral limb during early stance at each visit…………………...….62 4.3.5.2 Coordination variability of the ACLR involved limb compared to the ACLR contralateral limb during mid-stance at each visit ………………………63 4.3.5.3 Coordination variability of the ACLR involved limb compared to the ACLR contralateral limb during late stance at each visit……………………..…64 4.3.6.1 Coordination variability of the ACLR contralateral limb compared to the healthy control limb during early stance at each visit…………………………....65 4.3.6.2 Coordination variability of the ACLR contralateral limb compared to the healthy control limb during early stance at each visit ………………………......66 4.3.6.3 Coordination variability of the ACLR contralateral limb compared to the healthy control limb during early stance at each visit ………………………......66

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3.1 Example of phase angle plot for rearfoot-forefoot coordination in the sagittal plane

3.2 Polar plot providing reference for coordination patterns….……………...….......44 4.3.7.1 Coordination variability of the pelvis-thigh flexion/extension couple during early, mid, and late stance……..…………………………………………67 4.3.7.2 Coordination variability of the pelvis-thigh rotation couple during early, mid, and late stance…………………………………….………….….……........70 4.3.7.3 Coordination variability of the thigh-leg flexion/extension couple during early, mid, and late stance………..………………………………………..…......72 4.3.7.4 Coordination variability of the thigh flexion-leg internal rotation couple during early, mid, and late stance…………………….…………….….………...75 4.3.7.5 Coordination variability of the thigh-leg rotation couple during early, mid, and late stance……………………………………………………...………..…..77 4.3.7.6 Coordination variability of the leg-foot flexion/extension couple during early, mid, and late stance……………………….…………

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