Lack of Proprioceptive Strategy Modulation Leads to At-Risk Biomechanics for Anterior Cruciate Ligament in Healthy Athletes

Abstract

ABSTRACT Introduction Anterior cruciate ligament (ACL) injuries are frequent in handball, and altered sensory integration may contribute to increased injury risk. Recent evidence showed that proprioceptive postural control strategies differ among athletes. The aim of this study was to evaluate the relationship between proprioceptive strategy and biomechanics during side-cutting maneuvers. Methods A total of 47 handball players performed anticipated and unanticipated cutting tasks. Their postural proprioceptive strategy was then characterized according to the perturbation of the center of pressure displacement generated by the muscle vibration on a firm and foam surface. Individuals able to reweight proprioception from ankle to lumbar signals according to the stability of the support were defined as flexible. Conversely, athletes maintaining an ankle-steered strategy on foam surface were characterized as rigid. Statistical parametric mapping analysis was used to compare pelvic and lower limb side-cutting kinematics, kinetics, and EMG activity from seven muscles 200 ms before and after initial contact (IC) using a two-way ANOVA (group–condition). Results Twenty athletes (11 females and 9 males, 18.5 yr) were characterized as flexible and 20 athletes (12 females and 8 males, 18.9 yr) as rigid. No interaction between condition and proprioceptive profile was observed. More ipsilateral pelvic tilt before IC and lower vastus lateralis (VL) activity immediately after IC was observed during CUTant. When comparing proprioceptive strategy, rigid individuals exhibited less preactivity of the semitendinosus (P < 0.001) and higher VL activity (P = 0.032). Conversely, rigid showed higher gluteus medius preactivity (P < 0.05) and higher VL activity 100 ms after IC (P < 0.001). Ankle was also more internally rotated before and during the stance phase (P < 0.05) among rigid athletes. Conclusions Rigid handball players exhibited at-risk determinants for anterior cruciate ligament injuries during side-cutting maneuvers.