Skip to main content
SpringerLink
Log in

A Biomechanical Perspective on Rehabilitation of ACL Injuries in Basketball

  • Chapter
  • First Online:
Basketball Sports Medicine and Science

Abstract

The occurrence of an anterior cruciate ligament (ACL) injury in basketball is a serious clinical problem that should be tackled by different points of view. The incidence of noncontact ACL injuries in basketball is among the highest in team sports, and functional outcomes following ACL reconstruction (ACLR) are far from being considered optimal, particularly regarding low return to performance rates and a high second ACL injury risk in young athletes.

A biomechanical framework of activity should be considered following ACLR, with a strong focus on restoring the basketball player’s neuromuscular and movement function. It is important to balance the clinician’s attention on both return to play (RTP) and secondary injury prevention, which should be viewed equally as important. In this context, rehabilitation program should include an increasing attention on addressing faulty movement patterns, which may increase the athlete’s reinjury risk, prior to RTP.

Adopting a biomechanical perspective to basketball rehabilitation after ACLR begins with a thorough comprehension of the injury mechanisms and movement-specific factors which increase injury risk. Furthermore, it is essential to know how to correct these movement impairments as part of an RTP strategy. There are four well-known movement factors thought to influence ACL injury risk, including ligament dominance, quadriceps dominance, trunk dominance, and leg dominance. These four factors should be understood in detail, to maximize the application of secondary preventative measures. In addition, applying a targeted neuromuscular training program based on qualitative movement evaluation is also recommended to solve dynamic impairments that may present after surgery. The reduction of dynamic knee valgus loading is the typical but not sole example of this part of rehabilitation. Motor learning techniques should be used in order to change dangerous movement patterns and support better movement patterning upon RTP. This movement patterning needs to eventually be challenged under highly specific tasks (e.g., basketball-specific movement and techniques, on-parquet) to understand if a player is movement ready for RTP.

The aim of this chapter is to present a framework of activity based on biomechanical considerations, which may optimize the functional outcomes of basketball players following ACL injury and surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Andriolo L, Filardo G, Kon E, Ricci M, Della Villa F, Della Villa S, et al. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2825–45.

    PubMed  Google Scholar 

  2. Webster KE, Feller JA. Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(11):2827–32.

    PubMed  Google Scholar 

  3. Wiggins AJ, Granhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–76.

    PubMed  PubMed Central  Google Scholar 

  4. Cinque ME, Dornan GJ, Chahlia J, Moatshe G, LaPrade RF. High rates of osteoarthritis develop after anterior cruciate ligament surgery: an analysis of 4108 patients. Am J Sports Med. 2018;46(8):2011–9.

    PubMed  Google Scholar 

  5. Della Villa F, Andriolo L, Ricci M, Filardo G, Gamberini J, Caminati D. Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019; https://doi.org/10.1007/s00167-019-05649-2. [Epub ahead of print]

  6. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–8.

    PubMed  Google Scholar 

  7. Hewett TE, Ford KR, Hoogenboom B, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther. 2010;5(4):234–51.

    PubMed  PubMed Central  Google Scholar 

  8. Hewett TE, Myer GD, Ford KR, Heidt RS, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.

    PubMed  Google Scholar 

  9. Krosshaug T, Steffen K, Kristianslund E, Nilstad A, Mok KM, Mykelbust G, et al. The vertical drop jump is a poor screening test for ACL injuries in female elite soccer and handball players: a prospective cohort study of 710 athletes. Am J Sports Med. 2016;44(4):874–83.

    PubMed  Google Scholar 

  10. Leppänen M, Pasanen K, Kujala UM, Vasankari T, Kannus P, Äyrämö S, et al. Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players. Am J Sports Med. 2017;45(2):386–93.

    PubMed  Google Scholar 

  11. Paterno MV, Kiefer AW, Bonnette S, Riley MA, Schmitt LC, Ford KR, et al. Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Clin Biomech. 2015;30(10):1094–104.

    Google Scholar 

  12. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.

    PubMed  PubMed Central  Google Scholar 

  13. Arundale AJH, Capin JJ, Zarzycki R, Smith AH, Snyder-Mackler L. Two year ACL reinjury rate of 2.5%: outcomes report of the men in a secondary ACL injury prevention program (acl-sports). Int J Sports Phys Ther. 2018;13(3):422–31.

    PubMed  PubMed Central  Google Scholar 

  14. Taylor JB, Ford KR, Nguyen AD, Tarry LN, Hegedus EJ. Prevention of lower extremity injuries in basketball: a systematic review and meta-analysis. Sports Health. 2015;7(5):392–8.

    PubMed  PubMed Central  Google Scholar 

  15. Silvers-Granelli HJ, Bizzini M, Arundale A, Mandelbaum BR, Snyder-Mackler L. Does the FIFA 11+ Injury Prevention Program reduce the incidence of ACL injury in male soccer players? Clin Orthop Relat Res. 2017;475(10):2447–55.

    PubMed  PubMed Central  Google Scholar 

  16. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med. 2019;49(7):1043–58.

    PubMed  Google Scholar 

  17. Buckthorpe M, Della Villa F, Della Villa S, Roi GS. On-field rehabilitation part 1: 4 pillars of high-quality on-field rehabilitation are restoring movement quality, physical conditioning, restoring sport-specific skills, and progressively developing chronic training load. J Orthop Sports Phys Ther. 2019;49(8):565–9.

    PubMed  Google Scholar 

  18. Buckthorpe M, Frizziero A, Roi GS. Update on functional recovery process for the injured athlete: return to sport continuum redefined. Br J Sports Med. 2019;53(5):265–7.

    PubMed  Google Scholar 

  19. Grooms DR, Page SJ, Nichols-Larsen DS, Chaudhari AM, White SE, Onate JA. Neuroplasticity associated with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2017;47(3):180–9.

    PubMed  Google Scholar 

  20. Swanik CB. Brains and sprains: the brain’s role in noncontact anterior cruciate ligament injuries. J Athl Train. 2015;50(10):1100–2.

    PubMed  Google Scholar 

  21. Buckthorpe M, Della Villa F, Della Villa S, Roi GS. On-field rehabilitation Part 2: a 5-stage program for the soccer player focused on linear movements, multidirectional movements, soccer-specific skills, soccer-specific movements, and modified practice. J Orthop Sports Phys Ther. 2019;49(8):570–5.

    PubMed  Google Scholar 

  22. Almeida AM, Santos Silva PR, Pedrinelli A, Hernandez AJ. Aerobic fitness in professional soccer players after anterior cruciate ligament reconstruction. PLoS One. 2018;13(3):e0194432.

    PubMed  PubMed Central  Google Scholar 

  23. Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359–67.

    PubMed  Google Scholar 

  24. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100–10.

    Google Scholar 

  25. Dye S, Staubli H, Biedert R, Vaupel G. The mosaic of pathophysiology causing patellofemoral pain: therapeutic implications. Oper Tech Sports Med. 1999;7:46–54.

    Google Scholar 

  26. Della Villa S, Boldrini L, Ricci M, et al. Clinical outcomes and return-to-sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a sport-specific rehabilitation protocol. Sports Health. 2012;4(1):17–24.

    PubMed  PubMed Central  Google Scholar 

  27. Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg. 2014;134:1417–28.

    PubMed  Google Scholar 

  28. Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Multiplanar loading of the knee and its influence on anterior cruciate ligament and medial collateral ligament strain during simulated landings and noncontact tears. Am J Sports Med. 2019;47(8):1844–53.

    PubMed  PubMed Central  Google Scholar 

  29. Hewett TE, Myer GD. The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury. Exerc Sport Sci Rev. 2011;39(4):161–6.

    PubMed  PubMed Central  Google Scholar 

  30. Myer GD, Ford KR, Di Stasi SL, Foss KD, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? Br J Sports Med. 2015;49(2):118–22.

    PubMed  Google Scholar 

  31. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.

    PubMed  Google Scholar 

  32. Fox AS. Change-of-direction biomechanics: is what’s best for anterior cruciate ligament injury prevention also best for performance? Sports Med. 2018;48(8):1799–807.

    PubMed  Google Scholar 

  33. Sigward SM, Powers CM. Loading characteristics of females exhibiting excessive valgus moments during cutting. Clin Biomech. 2007;22(7):827–33.

    Google Scholar 

  34. Jones PA, Herrington LC, Graham-Smith P. Technique determinants of knee joint loads during cutting in female soccer players. Hum Mov Sci. 2015;42:203–11.

    PubMed  Google Scholar 

  35. Dempsy AR, Lloyd DG, Elliot BC, Steele JR, Munro BJ. Changing sidestep cutting technique reduces knee valgus loading. Am J Sports Med. 2009;37(11):2194–200.

    Google Scholar 

  36. Doyon J, Benali H. Reorganization and plasticity in the adult brain during learning of motor skills. Curr Opin Neurobiol. 2005;15(2):161–7.

    PubMed  CAS  Google Scholar 

  37. Vanrenterghem J, Venables E, Pataky T, Robinson MA. The effect of running speed on knee mechanical loading in females during side cutting. J Biomech. 2012;45(14):2444–9.

    PubMed  Google Scholar 

  38. Brophy RH, Stepan JG, Silvers HJ, et al. Defending puts the anterior cruciate ligament at risk during soccer: a gender-based analysis. Sports Health. 2015;7(3):244–9.

    PubMed  PubMed Central  Google Scholar 

  39. Grassi A, Smiley SP, Roberti di Sarsina T, et al. Mechanisms and situations of anterior cruciate ligament injuries in professional male soccer players: a YouTube-based video analysis. Eur J Orthop Surg Traumatol. 2017;27(7):967–81.

    PubMed  Google Scholar 

  40. Waldén M, Krosshaug T, Bjørneboe J, Andersen TE, Faul O, Hägglund M. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med. 2015;49(22):1452–60.

    PubMed  Google Scholar 

  41. Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc. 2001;33(7):1176–81.

    PubMed  CAS  Google Scholar 

  42. Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med. 2016;50:471–5.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy

    Francesco Della Villa, Stefano Della Villa & Matthew Buckthorpe

Authors
  1. Francesco Della Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Della Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Buckthorpe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Della Villa .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Sports Medicine Service, HYMC, Hadera, Israel

    Lior Laver

  2. Department of Orthopedics, Acibadem Mehmet Ali Aydinlar (MAA) University, Istanbul, Turkey

    Baris Kocaoglu

  3. Midwest Orthopedics at Rush, Chicago, IL, USA

    Brian Cole

  4. The Brooklyn Nets, Brooklyn, NY, USA

    Amelia J. H. Arundale

  5. Duke Sports Medicine, Duke University Medical Center, Durham, NC, USA

    Jeffrey Bytomski

  6. Duke Sports Medicine, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Annunziato Amendola

Rights and permissions

Reprints and permissions

Copyright information

© 2020 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Della Villa, F., Della Villa, S., Buckthorpe, M. (2020). A Biomechanical Perspective on Rehabilitation of ACL Injuries in Basketball. In: Laver, L., Kocaoglu, B., Cole, B., Arundale, A.J.H., Bytomski, J., Amendola, A. (eds) Basketball Sports Medicine and Science. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61070-1_57

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-61070-1_57

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-61069-5

  • Online ISBN: 978-3-662-61070-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation