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Prevention and management of ACL injuries: a New Zealand context

Research profile

Injuries of the anterior cruciate ligament (ACL) of the knee are common in many sports, such as rugby, football, hockey and netball, and may be treated with physiotherapy alone or with reconstructive surgery plus physiotherapy.

Despite this treatment, many individuals with these injuries do not return fully to the same level of sports and physical activity as prior to the injury, and may develop long term disability or symptoms that may be related to knee osteoarthritis. A more comprehensive rehabilitation approach may be needed to optimise function, improve quality of life and decrease fear of re-injury following ACL ruptures.

Projects include:

  • Exploring patients’ and whānau perspectives and experiences of the injury and recovery,
  • Post-reconstruction outcomes, assessing a range of sports- and function-related outcomes, including thigh muscle strength, jumping ability and knee movement patterns,
  • Prognostic value of 6-month assessments post ACL reconstruction for 12-month outcomes
  • Footwear variations for the management of ACL injuries.

Publications

Kaur M, Ribeiro D, Webster K, Sole G (2020). Knee biomechanics while navigating steps in participants with anterior cruciate ligament reconstruction 2 to 10 years post-surgery. Physical Therapy in Sport, 46:70-76.

Mahood C, Perry M, Gallagher P, Sole G (2020). Chaos and confusion with confidence: managing fear of re-injury following anterior cruciate ligament reconstruction. Physical Therapy in Sport, 45:145-154.

Kaur M, Ribeiro DC, Webster K, Theis JC, Sole G (2019). Individuals’ experiences of consequences of anterior cruciate ligament reconstruction surgery. New Zealand Journal of Physiotherapy, 48:76-93.

Scott SM, Perry M, Sole G (2018). “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. Disability and Rehabilitation. 40:2133-2317

Sole G, Pataky T, Tengman E, Häger C (2017). Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture – data revisited using Statistical Parametric Mapping. Journal of Electromyography and Kinesiology, 32:44-50

Kaur M, Ribeiro DC, Webster K, Theis JC, Sole G (2016). Movement patterns of the knee during gait following ACL reconstruction: a systematic review and meta-analysis. Sports Medicine, 46(12):1869-1895

Hajizadeh M, Oskouei AH, Ghalichi F, Ghomshe FT, Razi M, Sole G (2016). Knee kinematic and joint moments during stair negotiation in participants with anterior cruciate ligament deficiency and reconstruction: a systematic review. Physical Medicine & Rehabilitation, 8:563-579

Sole G, Tengman E, Grip H, Häger CK (2016). Knee kinematics during stair descent 20 years following anterior cruciate ligament rupture with and without reconstruction. Clinical Biomechanics 32:180-186

Von Aesch AV, Perry M, Sole G (2016). Physiotherapists’ experiences of the management of anterior cruciate ligament injuries. Physical Therapy in Sports, 19:14-22

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Conference presentations

Sole G, Kaur M (2020). Relationship between muscle strength, fear of re-injury and activity level following ACL reconstruction. Sports Medicine NZ conference, 31st October 2020, Christchurch, New Zealand.

Mahood C, Perry M, Gallagher P, Sole G (2020). Chaos and confusion with confidence: managing fear of re-injury after ACL reconstruction. Sports Medicine NZ conference, 31st October 2020, Christchurch, New Zealand.

Sole G, Brinckmann P, Sjöberg A, Sole CC, Kaur M (2019). Balance during jump landing following anterior cruciate ligament reconstruction and influence of footwear asymmetry. Sports Medicine NZ conference, 1-2 November 2019, Dunedin, New Zealand.

Sole G, Mahood C, Gallagher P, Perry M (2019). Overcoming fear of re-injury after anterior cruciate ligament reconstruction: a qualitative study. Asics Sports Medicine Australia conference, 23-26 October 2019, Sunshine Coast, Australia. Journal of Science and Medicine in Sports, 22:S110

Kaur M, Ribeiro DC, Webster KE, Sole G (2019). Joint loading asymmetry is associated with the asymmetry in muscle strength in people with anterior cruciate ligament reconstruction. Asics Sports Medicine Australia conference, 23-26 October 2019, Sunshine Coast, Australia. Journal of Science and Medicine in Sports, 22:S109

Kaur M, Ribeiro D, Theis JC, Webster K, Sole G. (2017) Difference in kinematics and kinetics during stair negotiation in partiicpants with anterior cruciate ligament reconstruction compared to control group. Podium presentation at the International Society of Biomechanics, Brisbane, Australia, 23-27 July 2017

Kaur M, Ribeiro D, Theis JC, Webster K, Sole G. (2016) Movement patterns of the knee during gain following ACL reconstruction: a systematic review and meta-analysis. Physiotherapy New Zealand, Auckland, 16-18 September 2016 (Abstract book p 78)

Scott SM, Perry M, Sole G. (2016) “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. 232rd Sientific Meeting of the Otago Medical School Research Society, Dunedin, 4th November 2015. Runner-up prize for best presentation. Also presented at Physiotherapy New Zealand, Auckland, 16-18 September 2016 (Abstract book p 118)

Von Aesch A, Perry M, Sole G. (2016) Physiotherapists’ perspectives of current management of anterior cruciate ligament injuries. Conference of the Australian Physiotherapy Association, Gold Coast, 2-5 October 2015 (Proceedings p 143), and conference of Physiotherapy New Zealand, Auckland, 16-18 September 2016 (Abstract book p 111)

Scott SM, Perry M, Sole G. (2016) “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. 232rd Scientific Meeting of the Otago Medical School Research Society, Dunedin, 4th November 2015. Sarah was awarded the runner-up prize for the Masters/Honours presentations.

Von Aesch A, Perry M, Sole G. (2015) Physiotherapists’ perspectives of current management of anterior cruciate ligament injuries. Conference of the Australian Physiotherapy Association, Gold Coast, 2-5 October 2015 (Proceedings p 143).

Sole G, Pataky T, Tengman E, Häger C. (2015) Analysing knee kinematics using Statistical Parametric Mapping during stair descent 20 years post-ACL rupture with and without reconstruction. Conference of the World Confederation of Physical Therapy, Singapore, 2-4 May 2015, Programme book p 89.

Sole G, Tengman E, Grip H, Selling J, Häger C. (2014) Knee kinematics during stair descent more than 20 years following anterior cruciate ligament injury. Conference of the NZ Rheumatology Association, Dunedin, 21-24 August 2014.

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Research funding

Sole G, Lamb P, Nevarre P (2020). Lower limb movement patterns following anterior cruciate ligament rupture and influence of footwear. University of Otago Research Grant,
$30,753

Ward S, Lamb P, Sole G (2019). Anterior cruciate ligament reconstruction outcomes in New Zealand. Jack Thomson Arthritis Grant, Otago Medical Research Society, $18,504

Ward, S (2019) Health Sciences Divisional Post Doctoral Award. 

Sole G, Hammer N, Lamb P, Pataky T, Gray A. (2018).Can wearing a knee sleeve influence recovery following anterior cruciate ligament reconstruction? Commercial funding, $100,000. 

Perry M, Sole G, Weatherall M, Kearney S (2015) Incidence of anterior cruciate ligament (ACL) injury in female netball players by age in New Zealand. Lottery Health, $18,712

Perry M, Sole G, Weatherall M, Kearney S, Barriers and facilitator to implementing and participating in an ACL injury prevention programme by non-elite netball coaches and players. Physiotherapy New Zealand Scholarship Trust Fund, $10,000

Kaur M, Sole G, Ribeiro D, Theis JC. Outcomes of anterior cruciate ligament reconstruction more than two years following surgery. Mark Steptoe Memorial Trust Grant-in-Aid, School of Physiotherapy, $2,000

Sole G, Ribeiro D, Sole CC, Mündermann A (2014) Do footwear variations influence the magnitude and direction of forces across the knee in people who have sustained a knee injury? Physiotherapy New Zealand Scholarship Trust Fund, $7,618

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Research students

PhD research

Mandeep Kaur (graduated): Outcome of anterior cruciate ligament injuries: an osteo-arthritis perspective.
Supervisors: Sole G, Ribeiro D, Theis JC

HRC Māori Summer student

Mark Alexander (2020)
Māori parent or primary caretaker’s perspectives of their child’s health care for anterior cruciate ligament ruptures

Masters by research

Sharon Kearney (2014): Anterior cruciate ligament injuries in Elite Netball in New Zealand: Knowledge on known Injury Prevention Strategies (IPS), Perceived Risk Factors (PRF) and Injury Prevention strategies implemented within Elite New Zealand Netball structures.
Supervisors: Sole G, Perry M

Honours research

Ciaran Mahood’s (2018): Overcoming fear and anxiety following ACL reconstruction to return to competitive sports.

Sarah Scott (2017): Patients’ perspectives of management of anterior cruciate ligament injuries. Supervisors: Sole G, Perry M.

Arlene von Aesch (2014): Physiotherapists’ perspectives of current management of anterior cruciate ligament injuries. Awarded the Sports Physiotherapy New Zealand prize (2014) for the best research project relating to sports physiotherapy.
Supervisors: Sole G, Perry M.

650 Research project

Hannah Fox (2018): Scoping review of potential use of virtual reality in ACL rehabilitation.

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Research contributors

Associate Professor Gisela Sole, School of Physiotherapy
Dr Peter Lamb, School of Physical Education, Sports and Exercise Sciences
Dr Sarah Ward, School of Physiotherapy
Dr Pierre Nevarre, Department of Orthopaedic Surgery, Southland Hospital / Department of Surgical Sciences, University of Otago

International Collaborators
Professor Charlotte Häger, Physiotherapy, University of Umeå, Sweden
Professor Dr. Annegret Mündermann, University Hospital Basel; Department of Biomedical Engineering; University of Basel, Switzerland

Further information

For more detailed information please email our Project leaders: Associate Professor Gisela Sole gisela.sole@otago.ac.nz 

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