Changes in the sensorimotor system and semitendinosus muscle morphometry after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study with 1-year follow-up

Musculoskeletal ultrasound imaging of proximal and distal hamstrings cross sectional area in individuals with history of anterior cruciate ligament reconstruction

BACKGROUND

Ultrasound (US) imaging is used by physical therapists for diagnosis and assessment of musculoskeletal injury and follow-up.

PURPOSE

The aim was to identify long-term effects of graft harvesting on hamstrings muscle mass among athletes who had undergone anterior cruciate ligament reconstruction (ACLR).

METHODS

Twenty-eight participants (ages 18-55) were recruited: 18 with history of ACLR using semitendinosus (ST) autograft and 10 healthy controls. Images of the cross-sectional area (CSA) of ST and biceps femoris (BF) were captured at 30% and 70% of the distance from the ischial tuberosity to the popliteal crease. A mixed model ANOVA was used to identify inter-limb differences in the CSA of ST and BF at each location, for each group.

RESULTS

Inter-limb differences were found for the CSA of ST but not BF across both locations for the ACLR group, not controls (p < .001). Within the ACLR group, ST atrophy of the injured limb was relatively greater at the distal vs. proximal location (p < .001).

CONCLUSION

US imaging identified selective atrophy of ST on the injured side with no compensatory hypertrophy of BF. Specific rehabilitation may influence muscle mass of medial vs. lateral hamstrings muscle groups after ACLR using a ST graft, and monitored with US imaging.

High variability and lack of standardization in the evaluation of return to sport after ACL reconstruction: a systematic review

PURPOSE

Return to sport (RTS) after ACL reconstruction (ACLR) has been recognized as an important outcome, which is associated with success of the surgery. This study aimed to assess the methods used to determine return to sport after ACLR in the published literature, report on variability of methods and evaluate their strength in establishing accurate RTS data.

METHODS

Electronic databases (PubMed, Cochrane Library and Embase) were searched via a defined search strategy with no limits, to identify relevant studies from January 2008 to December 2020 for inclusion in the review. Defined eligibility criteria included studies specifically measuring and reporting on return to sport after ACLR with a clear methodology. Each included study was assessed for the definition of successful RTS, successful return to pre-injury level of sport and for methods used to determine RTS.

RESULTS

One hundred and seventy-one studies were included. Of the included studies, six studies (4%) were level of evidence 1 and seventy-two studies (42%) were level of evidence 4. Forty-one studies (24%) reported on return to a specific sport and 130 studies (76%) reported on return to multiple sports or general sport. Sixteen studies (9%) reported on RTS in the pediatric population, 36 (21%) in the adult population and 119 (70%) reported on a mixed-aged population. The most commonly used definition of successful RTS was return to the same sport (44 of 125 studies, 35%). The most common method used to determine RTS was a non-validated study-specific questionnaire (73 studies, 43%), which was administered in various ways to the patients. Time of RTS assessment was variable and ranged between 6 months and 27 years post-surgery.

CONCLUSION

This review demonstrates high variability in defining, evaluating and reporting RTS following ACLR. The findings of this study reveal low reliability and unproven validity of methods used to evaluate RTS and highlight the challenges in interpreting and using RTS data reported in literature.

LEVEL OF EVIDENCE

IV.

Kinetic measurement system use in individuals following anterior cruciate ligament reconstruction: a scoping review of methodological approaches

Purpose

Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs).

Methods

We followed the PRISMA extension for scoping reviews and Arksey and O’Malley’s 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included.

Results

In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs.

Conclusion

Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40634-021-00397-0.

Hamstrings Muscle Morphology After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

BACKGROUND

Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequelae.

OBJECTIVES

To effectively treat muscular impairments, an accurate understanding of differences in hamstrings morphology following ACLR is needed. A systematic review and meta-analysis were undertaken to describe the morphology of the hamstring muscle complex after ACLR.

METHODS

We searched five databases for studies evaluating the difference between hamstrings size and architecture in individuals with ACLR. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow fixed-effect size meta-analysis calculations for comparison of results.

RESULTS

Twenty-four studies were included for final review. Eight categories of morphological outcomes were identified, and studies were grouped accordingly: (1) volume, (2) cross-sectional area (CSA), (3) muscle length, (4) muscle thickness, (5) fascicle length, (6) pennation angle, (7) fiber area, and (8) fiber type. Meta-analysis demonstrated lower hamstrings volume in the ACLR-limb in both contralateral and control group comparisons, and lower CSA, length, and thickness in the ACLR-limb in contralateral comparisons. The semitendinosus and gracilis were most profoundly impacted. Limited moderate evidence demonstrated greater biceps femoris pennation angle in the ACLR-limb.

CONCLUSIONS

Individuals with ACLR demonstrated large deficits in semitendinosus and gracilis muscle CSA and volume in the ACLR-limb compared contralaterally, with no differences observed in the biceps femoris or semimembranosus. Clinical implications regarding assessment and treatment of individuals with ACLR are discussed.

Lower Limb Muscle Size after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis

BACKGROUND

Anterior cruciate ligament (ACL) injury is known to have a number of deleterious effects on lower limb muscle function. Alterations in muscle size are one such effect that have implications towards reductions in strength and functioning of the lower limbs. However, a comprehensive analysis of alterations in muscle size has yet to be undertaken.

OBJECTIVE

To systematically review the evidence investigating lower limb muscle size in ACL injured limbs.

DESIGN

Systematic review DATA SOURCES: Database searches of Medline, SPORTDiscus, Embase, Cinahl and Web of Science as well as citation tracking and manual reference list searching.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Individuals with ACL deficient or reconstructed limbs with an assessment of lower limb muscle size and control limb data (contralateral or uninjured control group) METHODS: Risk of bias assessment was completed on included studies. Data were extracted and where possible meta-analyses performed. Best evidence synthesis was also undertaken.

RESULTS

49 articles were included in this review, with 37 articles included in the meta-analyses. 66 separate meta-analyses were performed using various measures of lower limb muscle size. Across all measures, ACL deficient limbs showed lesser quadriceps femoris muscle size (d range = - 0.35 to - 0.40), whereas ACL reconstructed limbs showed lesser muscle size in the quadriceps femoris (d range = - 0.41 to - 0.69), vastus medialis (d = - 0.25), vastus lateralis (d = - 0.31), hamstrings (d = - 0.28), semitendinosus (d range = - 1.02 to - 1.14) and gracilis (d range = - 0.78 to - 0.99) when compared to uninjured limbs.

CONCLUSION

This review highlights the effect ACL injury has on lower limb muscle size. Regardless of whether an individual chooses a conservative or surgical approach, the quadriceps of the injured limb appear to have lesser muscle size compared to an uninjured limb. When undertaking reconstructive surgery with a semitendinosus/gracilis tendon graft, the harvested muscle shows lesser muscle size compared to the uninjured limb.

Pre-Planned and Non-Planned Agility in Patients Ongoing Rehabilitation after Knee Surgery: Design, Reliability and Validity of the Newly Developed Testing Protocols

Background: Due to its association with the risk of falling and consequent injury, the importance of agility is widely recognized, but no study so far has examined the different facets of agility in an untrained/clinical population. The aim of this study was to evaluate the reliability, validity, and correlates of newly developed tests of non-planned agility (NPA) and pre-planned agility (PPA) in an untrained/clinical sample. Methods: The sample comprised 38 participants older than 40 years (22 females, age: 56.1 ± 17.3 years, height: 170.4 ± 10.8 cm, mass: 82.54 ± 14.79 kg) who were involved in a rehabilitation program following total knee arthroplasty and knee arthroscopy. Variables included age, gender, type of surgery, history of fall, anthropometrics/body composition, and newly developed tests of NPA and PPA. Results: The results showed the high inter-testing- (ICC > 0.95, CV < 9%), and intra-testing-reliability (ICC > 0.96, CV < 9) of the newly developed tests. PPA and NPA were found to be valid in differentiation between age groups (>50 yrs. vs. <50 yrs.), and genders, with better performance in younger participants and males. Only NPA differentiated participants according to type of surgery, with better performance in those who had arthroscopic surgery, than those who had total knee arthroplasty. No differences in NPA and PPA were established between groups based on fall-history. In females, the body mass (Pearson’s r = 0.58 and 0.59, p < 0.001) and body fatness (Pearson’s r = 0.64 and 0.66, p < 0.001) were negatively correlated, while the lean body mass (Pearson’s r = 0.70 and 0.68, p < 0.001) was positively correlated with PPA and NPA. The NPA and PPA were highly correlated (Pearson’s r = 0.98, p < 0.001). Conclusions: We found that the proposed tests are reliable when evaluating agility characteristics in an untrained/clinical population after knee arthroplasty/arthroscopy. Further evaluation of the specific validity of the proposed tests in other specific subsamples is warranted.

The accuracy of MRI in the diagnosis of anterior cruciate ligament injury

Background

Anterior cruciate ligament (ACL) injury can cause damage to the meniscus and articular cartilage, and may even lead to osteoarthritis. This study aimed to analyze the accuracy and feasibility of magnetic resonance imaging (MRI) imaging signs in the diagnosis of knee joint ACL injury.

Methods

A total of 78 patients admitted to our hospital from June 2018 to October 2019 with highly suspected ACL injury were selected for this prospective study. We used MRI and arthroscopy to diagnose the ACL injuries, and the results of MRI and arthroscopy, as well as the value of MRI in diagnosing ACL injury, were compared.

Results

Among the 78 participants, 66 cases were diagnosed with ACL injury (28 with complete tear, 38 with partial tear), and 12 were normal according to arthroscopy. Among the 66 cases with ACL injury, 63 (95.45%) were confirmed by MRI detection. The sensitivity, specificity, and accuracy of MRI in the diagnosis of ACL injury were 95.45% (63/66), 91.67%, and 94.87%, respectively. The accuracy of MRI in the diagnosis of complete and partial tears were 92.86% and 94.74%, respectively. Among the four direct MRI signs of ACL injury, the differences in interruption of ACL continuity, thickening and edema, and abnormal walking were statistically significant (P<0.05). Among the 8 indirect MRI signs, all showed high specificity and low sensitivity, and which the specificity of posterior cruciate ligament index, Notch sign, meniscus exposure sign of posterior ankle, and lateral collateral ligament monolayer display showed higher specificity (P<0.05).

Conclusions

Examination with MRI offers high accuracy in the diagnosis of ACL injury, and has good consistency with arthroscopic diagnosis, which can provide reliable guidance for the selection and formulation of clinical surgery plans, and might be used as the first choice for the non-traumatic diagnosis of ACL injury.

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

This study investigates whether double-leg and single-leg vertical hops (VH) landing between-limb symmetry in males, an average of two years after anterior cruciate ligament (ACL) reconstruction (ACLR), is associated with postoperative physiotherapy supervision duration. Thirty-eight healthy controls and thirty-eight males after primary unilateral ACLR, with the use of ipsilateral semitendinosus and gracilis tendon autograft, on average two years before, underwent bilateral peak vertical ground reaction force (vGRF) measurements during double-leg and single-leg VH landing, using two force plates. The vGRF was normalized to the body mass (vGRF BM). The vGRF BM limb symmetry index (LSI) was calculated. Tests for dependent and independent samples and linear Pearson’s correlation coefficient (r) calculations were performed. There were significant between-leg differences in the double-leg (p < 0.001) vGRF BM values. The longer the postoperative physiotherapy supervision duration was, the higher the double-leg VH LSI values (r = 0.727; p < 0.001). There was also a significant but weak positive association between the single-leg VH landing LSI value and the physiotherapy supervision duration (r = 0.333; p = 0.041). Between-limb symmetry during double-leg VH landing in males, an average of two years after ACLR, was correlated with postoperative physiotherapy supervision duration. Fully supervised postoperative physiotherapy for a minimum of six months is more effective for improving VH landing limb symmetry in patients after ACLR.