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Du C, Jiao J, Zhou J, Chow BC, Shi Q, Zhang X, Liu S, Yang J. Three-month functional training programme improves knee joint function in athletes post-ACL reconstruction surgery. J Rehabil Med 2024; 56:jrm18701. [PMID: 39291912 PMCID: PMC11418274 DOI: 10.2340/jrm.v56.18701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 07/18/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Rehabilitation and recovery duration following anterior cruciate ligament reconstructive surgery play a pivotal role in restoring optimal knee functionality in athletes. This study aimed to explore the impact of a 3-month functional training programme aligned with enhanced recovery after surgery on recuperation subsequent to anterior cruciate ligament reconstructive surgery. DESIGN A quasi-experimental study. SUBJECTS A cohort of 34 patients aged 14 to 24, who underwent anterior cruciate ligament reconstructive surgery and adhered to enhanced recovery after surgery protocols during the perioperative period, were allocated to an experimental group and a control group according to their eligibility, capacity, and willingness to engage in the functional training programme. METHODS The participants in the experimental group underwent a 3-month regimen of functional training following anterior cruciate ligament reconstructive surgery, whereas the control group followed a conventional recovery approach. Evaluations were conducted both prior to and following the 3-month recovery interval, utilizing the Y-Balance Test, Functional Movement Screening, and Isokinetic Knee Test. RESULTS Assessment outcomes of the Y-Balance Test, Isokinetic Knee Test, and Functional Movement Screening exhibited significant enhancement (p < 0.05) within the experimental group, as opposed to the control group. These findings underscore that those athletes who undertook the 3-month functional training regimen within the experimental group exhibited heightened dynamic balance capabilities, increased knee joint mobility, and enhanced stability compared with their counterparts in the control group. CONCLUSION Consequently, this underscores the efficacy of the 3-month functional training protocol aligned with enhanced recovery after surgery, as a means to effectively facilitate recuperation subsequent to anterior cruciate ligament reconstructive surgery.
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Affiliation(s)
- Chuanjia Du
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China; Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
| | - Jihe Zhou
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China.
| | - Bik Chu Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China; Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
| | - Qiuqiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaopei Zhang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Siyu Liu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Jianchao Yang
- Business School of Hohai University, Nanjing, Jiangsu, China
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Kamiue M, Tsubahara A, Ito T, Koike Y. Measurement of Knee Extensor Torque During Repetitive Peripheral Magnetic Stimulation: Comparison of the Forces Induced by Different Stimulators. Ann Rehabil Med 2024; 48:203-210. [PMID: 38714208 PMCID: PMC11217762 DOI: 10.5535/arm.230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/09/2024] [Accepted: 04/11/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVE To investigate the factors that induce strong contractions during repetitive peripheral magnetic stimulation (rPMS) and compare the muscle torque induced by two stimulators (Stim A and Stim B) with different coil properties. METHODS rPMS was applied to the right vastus lateralis of 30 healthy young adults. Stim A contained a 10.1 cm2 rectangular iron core coil, while Stim B contained a 191 cm2 round coil. The knee extensor torque (KET) induced by rPMS at 30 Hz was measured isometrically and divided by the maximum voluntary contraction (MVC) to obtain a relative value of MVC (%MVC). KET at 100% intensity of Stim A (A100%, 1.08 T) was compared to those at 100% or 70% intensity of Stim B (B100%, 1.47 T vs. B70%, 1.07 T). Additionally, we conducted a comprehensive literature search for studies that measured the KET during rPMS. RESULTS Both the mean values of %MVC using B100% and B70% were significantly greater than that using A100%. Furthermore, the KET induced by Stim B was found to be larger than that described in previous reports, unless booster units were used to directly stimulate the main trunk of the femoral nerve. CONCLUSION Stim B induced a stronger muscle contraction force than Stim A did. This may be because the larger the coil area, the wider the area that can be stimulated. Additionally, a circular coil allows for deeper stimulation.
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Affiliation(s)
- Masanori Kamiue
- Doctoral Program in Rehabilitation, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Akio Tsubahara
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tomotaka Ito
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Yasuhiro Koike
- Department of Occupational Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
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Harput G, Demirci S, Soylu AR, Bayrakci Tunay V. Association between quadriceps muscle thickness and knee function in anterior cruciate ligament reconstructed athletes: a cross-sectional study. Physiother Theory Pract 2023; 39:2171-2179. [PMID: 35442153 DOI: 10.1080/09593985.2022.2068096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between vastus medialis obliquus (VMO), rectus femoris (RF), and vastus lateralis (VL) muscle thickness and quadriceps isokinetic strength, single-leg hop performance, and self-reported knee function in male athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS Forty-two male athletes [mean ± standard deviation, age: 21.4 ± 3.4 years], who had undergone ACLR and had cleared to return to activity, were included in this study. Real-time ultrasound images of VMO, RF, and VL thicknesses were obtained from both reconstructed and contralateral limbs. Concentric quadriceps peak torque at 60°/s and 180°/s, single-leg hop for Distance (SLHD), and self-reported knee function scores were also assessed. Linear regression analysis and student t tests were used for statistical analysis. RESULTS In reconstructed limb, greater VMO, RF, and VL thicknesses were associated with greater quadriceps peak torque at 60°/s (p = .008, r2 = 0.46) and at 180°/s (p = .006, r2 = 0.47). Greater quadriceps thickness was related to greater SLHD score in reconstructed limb (p = .002, r2 = 0.21). Self-reported knee function scores were not related to quadriceps thickness. VMO, RF, and VL thicknesses were smaller in reconstructed limb compared to contralateral limb (p < .001, p = .01, and p = .002, respectively). CONCLUSION Quadriceps thickness by using ultrasound was associated with concentric quadriceps strength and single-leg hop distance in individuals who had undergone ACLR. However, quadriceps thickness was not related to self-reported knee function. The ultrasonography may be included in the evaluation of the knee function after ACLR, and it may be a useful and easy method in the follow-up of the quadriceps strength recovery following ACLR.
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Affiliation(s)
- Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Serdar Demirci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Balıkesir University, Bigadic, Turkey
| | - Abdullah Ruhi Soylu
- Faculty of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Schilaty ND, McPherson AL, Nagai T, Bates NA. Arthrogenic muscle inhibition manifests in thigh musculature motor unit characteristics after anterior cruciate ligament injury. Eur J Sport Sci 2023; 23:840-850. [PMID: 35306977 PMCID: PMC9626399 DOI: 10.1080/17461391.2022.2056520] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Joint trauma induces a presynaptic reflex inhibition termed arthrogenic muscle inhibition (AMI) that prevents complete activation of muscles. Reduced motor unit (MU) output is a hypothesised mechanism for persistent strength deficits. The objective of this study was to determine MU characteristics of thigh musculature and determine how they change with anterior cruciate ligament (ACL) injury compared to healthy controls. A randomised protocol of knee flexion/extension isometric contractions (10-50% maximal voluntary isometric contraction) was performed for each leg with surface EMG 5-pin array electrodes placed on the vastus medialis, vastus lateralis, semitendinosus and biceps femoris. Longitudinal assessments for average rate coding, recruitment thresholds and MU action potentials were acquired at 6-month intervals. With exception of the vastus medialis, all thigh musculature of ACL-injured demonstrated smaller MU action potential peak-to-peak amplitude. For average rate coding, ACL-injured demonstrated lower coding rates than Controls for the quadriceps (p < .05) and higher rates than Controls for the hamstrings (p < .05). These MU characteristics were different from Controls after ACL reconstruction up to 12 months post-surgery, yet maximal strength increased during this time frame. As thigh MU characteristics are known across phases of ACL rehabilitation, future studies can assess these patterns of motor control and their potential to determine risk of re-injury. Further, future rehabilitation can target specific intervention programmes to restore motor control.HighlightsMotor unit strategies of arthrogenic muscle inhibition are characterised for the first time via decomposed EMG.Motor unit deficits of thigh musculature persist throughout all phases of ACL rehabilitation, even after return-to-sport.After ACL injury, motor unit sizes at similar recruitment thresholds were smaller than those of healthy controls.
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Affiliation(s)
- Nathan D. Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA
- Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - April L. McPherson
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
- United States Olympic & Paralympic Committee, Colorado Springs, CO, USA
| | - Takashi Nagai
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
- United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Nathaniel A. Bates
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
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Kaneguchi A, Takahashi A, Shimoe A, Hayakawa M, Yamaoka K, Ozawa J. The combined effects of treadmill exercise and steroid administration on anterior cruciate ligament reconstruction-induced joint contracture and muscle atrophy in rats. Steroids 2023; 192:109183. [PMID: 36690288 DOI: 10.1016/j.steroids.2023.109183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Rehabilitation protocols to treat joint contracture and muscle atrophy following anterior cruciate ligament (ACL) reconstruction have not been established. In this study, we examined the combined effects of exercise therapy and steroid administration on joint contracture and muscle atrophy following ACL reconstruction. Rats received ACL transection and reconstructive surgery in one knee. After surgery, they were divided into four groups: no intervention, treadmill exercise (started from day three post-surgery, 12 m/min, 60 min/d, 6 d/week), treatment with the steroidal drug dexamethasone (250 μg/kg on days 0-5, 7, and 9 post-surgery), and dexamethasone treatment plus treadmill exercise. Age-matched untreated rats were used as controls. At day 10 or 30 post-surgery, we assessed ACL-reconstruction-induced joint contracture, joint capsule fibrosis, osteophyte formation, and muscle atrophy of the rectus femoris and gastrocnemius. Treadmill exercise after ACL reconstruction improved several indicators of muscle atrophy in both muscles, but it did not have positive effects on joint contracture. Dexamethasone treatment after ACL reconstruction improved joint contracture and joint capsule fibrosis at both timepoints and partially attenuated osteophyte formation at day 10 post-surgery, but delayed recovery from atrophy of the rectus femoris at day 30 post-surgery. The two treatments combined improved both joint contracture and atrophy of the rectus femoris and gastrocnemius. Exercise therapy combined with steroid administration may therefore be a novel therapeutic strategy for joint contracture and muscle atrophy following ACL reconstruction.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan.
| | - Akira Takahashi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Atsuhiro Shimoe
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Momoka Hayakawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
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Wenning M, Mauch M, Heitner AH, Heinrich S, Sofack GN, Behrens M, Ritzmann R. General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:487-494. [PMID: 35908113 PMCID: PMC9898431 DOI: 10.1007/s00167-022-07052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function. METHODS In this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion. RESULTS Using one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.). CONCLUSIONS The findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M. Wenning
- Rennbahnklinik, Muttenz, Basel, Switzerland ,Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79104 Freiburg, Germany
| | - M. Mauch
- Department of Biomechanics, Rennbahnklinik, Kriegackerstrasse 100, Muttenz, CH-4132, Basel, Switzerland
| | | | - S. Heinrich
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - G. N. Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M. Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R. Ritzmann
- Rennbahnklinik, Muttenz, Basel, Switzerland ,Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
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Straub RK, Mandelbaum B, Powers CM. Predictors of Quadriceps Strength Asymmetry after Anterior Cruciate Ligament Reconstruction: A Chi-Squared Automatic Interaction Detection Decision Tree Analysis. Med Sci Sports Exerc 2022; 54:2005-2010. [PMID: 35797489 DOI: 10.1249/mss.0000000000002995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The influence of graft type on the restoration of quadriceps strength symmetry after ACL reconstruction (ACLR) has been widely studied. However, an important consideration when evaluating quadriceps symmetry is the fact that this measure can be influenced by numerous factors beyond graft type. This study sought to determine if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration potentially influential factors (i.e., age, sex, body mass index, time post-ACLR). METHODS We retrospectively reviewed quadriceps strength data from 434 patients (303 female patients and 131 male patients) who had previously undergone ACLR with an autograft (hamstring tendon, quadriceps tendon [QT], patellar tendon [PT]) or allograft. Chi-Squared Automatic Interaction Detection decision tree analysis was used to evaluate if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration age, sex, body mass index, and time post-ACLR. RESULTS The best predictor of quadriceps strength asymmetry was graft type. Specifically, three graft categories were identified: 1) allograft and hamstring tendon autograft, 2) PT autograft, and 3) QT autograft. The average quadriceps strength asymmetry for each of the three identified categories was 0.91, 0.87, and 0.81, respectively, and differed statistically from each other ( P < 0.001). The second-best predictor of quadriceps strength asymmetry was sex, albeit only in the PT and QT groups (with female patients having increased asymmetry). Female patients post-ACLR with a QT autograft were at highest risk for quadriceps strength asymmetry. CONCLUSIONS Graft type and sex are important predictors of quadriceps strength asymmetry after ACLR. Clinicians should take these factors into consideration when designing rehabilitation protocols to restore quadriceps strength symmetry during the postoperative period.
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Affiliation(s)
- Rachel K Straub
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
| | | | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
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Beynnon BD, Pius AK, Tourville TW, Endres NK, Failla MJ, Choquette RH, DeSarno M, Toth MJ. The Duration of Thigh Tourniquet Use Associated With Anterior Cruciate Ligament Reconstruction Does Not Produce Cellular-Level Contractile Dysfunction of the Quadriceps Muscle at 3 Weeks After Surgery. Am J Sports Med 2022; 50:2925-2934. [PMID: 35980007 DOI: 10.1177/03635465221115823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) trauma and ACL reconstruction (ACLR) are associated with the loss of strength and function of the muscles that span the knee joint. The underlying mechanism associated with this is not completely understood. PURPOSE To determine whether the duration of tourniquet use during ACLR has an effect on knee extensor muscle contractile function and size at the cellular (ie, fiber) level 3 weeks after surgery and at the whole-muscle level at 6 months after surgery. STUDY DESIGN Descriptive laboratory study and case series; Level of evidence, 4. METHODS Study participants sustained an acute, first-time ACL injury. All participants underwent ACLR with the use of a tourniquet placed in a standardized location on the thigh; the tourniquet was inflated (pressure range, 250-275 mm Hg), and the time of tourniquet use during surgery was documented. Participants were evaluated 1 week before surgery (to measure patient function, strength, and subjective outcome with the Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] score), at 3 weeks after ACLR surgery (to obtain muscle biopsy specimens of the vastus lateralis and assess muscle fiber cross-sectional area, contractile function, and mitochondrial content and morphometry), and at 6 months after ACLR (to evaluate patient function, strength, and subjective outcomes via KOOS and IKDC scores). Data were acquired on both the injured/surgical limb and the contralateral, normal side to facilitate the use of a within-subjects study design. Results are based on additional analysis of data acquired from previous research that had common entry criteria, treatments, and follow-up protocols. RESULTS At 3 weeks after ACLR, the duration of tourniquet use at the time of surgery did not explain the variation in single-muscle fiber contractile function or cross-sectional area (myosin heavy chain [MHC] I and II fibers) or subsarcolemmal and intermyofibrillar mitochondrial content or morphometry. At 6 months after ACLR, the duration of tourniquet use was not associated with the peak isometric and isokinetic torque measurements, patient function, or patient-reported outcomes. CONCLUSION The duration of tourniquet use at the time of ACLR surgery did not explain variation in muscle fiber size, contractile function, or mitochondrial content at 3 weeks after surgery or strength of the quadriceps musculature or patient-reported function or quality of life at 6-month follow-up.
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Affiliation(s)
- Bruce D Beynnon
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Alexa K Pius
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W Tourville
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Nathan K Endres
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mathew J Failla
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Rebecca H Choquette
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike DeSarno
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Michael J Toth
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Molecular Physiology and Biophysics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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Koc BB, Truyens A, Heymans MJLF, Jansen EJP, Schotanus MGM. Effect of Low-Load Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Int J Sports Phys Ther 2022; 17:334-346. [PMID: 35391871 PMCID: PMC8975583 DOI: 10.26603/001c.33151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Quadriceps strength and mass deficits are common after anterior cruciate ligament (ACL) reconstruction. Postoperatively, heavy load resistance training can have detrimental effects on knee joint pain and ACL graft laxity. Therefore, low-load blood flow restriction (LL-BFR) training has been suggested as an alternative to traditional strength rehabilitation. Purpose The present systematic review aimed to investigate the effect of LL-BFR training on quadriceps strength, quadriceps mass, knee joint pain, and ACL graft laxity after ACL reconstruction compared to non-BFR training. Study design Systematic review. Methods A systematic literature search of PubMed, EMBASE.com, Cochrane Library/Wiley, CINAHL/Ebsco and Web of Science/Clarivate Analytics was performed on 19 February 2021. Studies were included if they compared LL-BFR and non-BFR training after ACL reconstruction with pre- and post-intervention quadriceps strength, quadriceps mass, knee joint pain or ACL graft laxity measurement. Systematic reviews, editorials, case reports and studies not published in a scientific peer reviewed journal were excluded. The risk of bias of randomized studies was assessed with the use of the Cochrane Risk of Bias Tool. Results A total of six randomized controlled trials were included. Random sequence generation and allocation concealment was defined as high risk in two of the six studies. In all studies blinding of participants and personnel was unclear or could not be performed. The included studies used different LL-BFR and non-BFR protocols with heterogeneous outcome measurements. Therefore, a qualitative analysis was performed. Two of the six studies assessed quadriceps strength and demonstrated significant greater quadriceps strength after LL-BFR compared to non-BFR training. Quadriceps mass was evaluated in four studies. Two studies observed significant greater quadriceps mass after LL-BFR compared to non-BFR training, while two studies observed no significant difference in quadriceps mass. Knee joint pain was assessed in three studies with significantly less knee joint pain after LL-BFR compared to non-BFR training. Two studies evaluated ACL graft laxity and observed no significant difference in ACL graft laxity between LL-BFR and non-BFR training. Conclusion The results of this systematic review indicate that LL-BFR training after ACL reconstruction may be beneficial on quadriceps strength, quadriceps mass, and knee joint pain compared to non-BFR training with non-detrimental effects on ACL graft laxity. However, more randomized controlled trials with standardized intervention protocols and outcome measurements are needed to add evidence on the clinical value of LL-BFR training. Level of evidence 2a.
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Affiliation(s)
- Baris B Koc
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | - Alexander Truyens
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | | | - Edwin J P Jansen
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | - Martijn G M Schotanus
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Centre; School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Centre
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Bilateral muscle atrophy after anterior cruciate ligament reconstruction in rats: Protective effects of anti-inflammatory drug celecoxib. Knee 2022; 35:201-212. [PMID: 35381572 DOI: 10.1016/j.knee.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle atrophy after anterior cruciate ligament (ACL) reconstruction occurs bilaterally and contributes to a decrease in muscle strength. However, effective treatment strategies for ACL reconstruction-induced muscle atrophy have not been established. We examined the effects of anti-inflammatory drug on muscle atrophy after ACL reconstruction. MATERIALS AND METHODS Rats were divided into groups according to treatment received: untreated control (n = 4), arthrotomy (n = 6), ACL transection (n = 7), ACL reconstruction (n = 8), and ACL reconstruction plus anti-inflammatory drug celecoxib (CBX; 50 mg/kg/day) administration (n = 8). At one-week post-surgery, the muscle fiber cross-sectional area (CSA) in the rectus femoris (RF) and semitendinosus (ST) was measured to assess muscle atrophy. In addition, we examined joint swelling and serum C‑reactive protein (CRP) levels to assess local and systemic inflammation, respectively. RESULTS Each additional procedure (i.e., arthrotomy, ACL transection, and ACL reconstruction) gradually decreased the muscle fiber CSAs in the RF and ST on both operated and contralateral sides. The degree of muscle fiber atrophy on the operated side was larger than that detected on the contralateral side. Moreover, ACL reconstruction induced joint swelling on the operated side and tended to increase serum CRP levels. CBX lessened the RF atrophy on both sides and was associated with less joint swelling and a smaller increase CRP level; however, it did not affect ST atrophy on either side. CONCLUSIONS Anti-inflammatory treatments after ACL reconstruction may be effective in lessening muscle atrophy in the quadriceps, but not in the hamstrings.
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Tourville TW, Voigt TB, Choquette RH, Failla MJ, Endres NK, Slauterbeck JR, Beynnon BD, Toth MJ. Skeletal muscle cellular contractile dysfunction after anterior cruciate ligament reconstruction contributes to quadriceps weakness at 6-month follow-up. J Orthop Res 2022; 40:727-737. [PMID: 33969521 PMCID: PMC8578585 DOI: 10.1002/jor.25065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Muscle dysfunction following anterior cruciate ligament reconstruction (ACLR) may evolve from alterations in muscle contractility at the myofilament protein level. Using a prospective, within-subject case-control design, we evaluated cellular-level contractility, cross-sectional area (CSA), and myosin heavy chain (MHC) isoform expression on single muscle fibers 3 weeks post ACLR, and evaluated their relationship to whole muscle strength and patient-oriented outcomes 6 months post operation. Biopsies of the vastus lateralis were performed 3 weeks post ACLR in 11 subjects (5 females, mean age ± SD = 24.7 ± 6.5 years, height = 172.7 ± 8.2 cm, mass = 75.7 ± 12.5 kg) following first-time ACL rupture and whole muscle strength and self-reported pain, function, and quality of life assessed 6 months post ACLR. At 3 weeks post ACLR, force production was reduced (p < 0.01) in MHC I (-36%) and IIA (-48%) fibers compared with the non-injured leg. When force production was expressed relative to CSA to account for fiber atrophy, reductions remained in MHC IIA fibers (-40%; p < 0.001), but MHC I fibers showed only a trend toward being lower (-13%; p = 0.09). Finally, skeletal muscle fiber functional deficits at 3 weeks post ACLR were associated with whole muscle weakness and less favorable patient-reported outcomes at 6-month follow-up. Thus, ACLR promotes early cellular contractile dysfunction that may contribute to decreased whole muscle strength and patient function, and increased patient-reported symptoms, at 6-month follow-up.
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Affiliation(s)
- Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Michael J. Toth
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
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12
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Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31:694-706. [PMID: 35168201 DOI: 10.1123/jsr.2021-0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1) neural pathways involved in the AMI pathogenesis following ACL injury; (2) consequence of AMI on muscle function, joint biomechanics, and patient function; and (3) development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.
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13
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Arumugam A, Björklund M, Mikko S, Häger CK. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open 2021; 11:e049226. [PMID: 34006560 PMCID: PMC8130739 DOI: 10.1136/bmjopen-2021-049226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury. DESIGN Systematic Review. DATA SOURCES PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. RESULTS Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low. CONCLUSIONS The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking. PROSPERO REGISTRATION NUMBER CRD42018107349.
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Affiliation(s)
- Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Sanna Mikko
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
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14
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Dauty M, Menu P, Mesland O, Fouasson-Chailloux A. Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery. Eur J Sport Sci 2021; 22:627-635. [PMID: 33487103 DOI: 10.1080/17461391.2021.1881620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Arthrofibrosis is a devastating complication after Anterior Cruciate Ligament reconstruction (ACLr) characterized by a muscle weakness secondary to an arthrogenic muscle inhibition process. The loss of knee isokinetic strength due to arthrogenic muscle inhibition may be more important after arthrofibrosis, compared to an ACLr population with no complication. The isokinetic strength deficit [Limb Symmetry Index (LSI) at 60 and 180°/s of angular speed] was measured at 4, 7 and 12 post-operative months. Knee function, return to running and return to sport were evaluated. A comparison of the Quadriceps and the Hamstring LSI between patients with arthrofibrosis and those without post-operative complication was performed according to time and taking into consideration the type of surgical procedure. 539 primary ACLr patients were assessed. The arthrofibrosis group presented at 4, 7 and 12 post-operative months a Quadriceps LSI significantly lower compared to the control group, without influence of the graft procedure (LSI: 38, 53, 68% vs 63, 73, 85% at 60°/s, respectively). The Hamstring LSI was significantly lower at 4 and 7 post-operative months, but comparable at 12 months with an influence of the Hamstring procedure. Knee function was significantly lower at 4 and 7 post-operative months. Few arthrofibrosis ACLr patients returned to running at 7 post-operative months (6.8% vs 69.9%; p < .0001). An important and durable Quadriceps muscle weakness occurred after arthrofibrosis, whatever the type of graft procedure. This is explained by an Arthrogenic muscle inhibition which compromised the return to sport at the same level until 12 post-operative months. HighlightsAn important and durable quadriceps muscle weakness occurred after arthrofibrosis.The arthrogenic muscle inhibition was significant on the operated side independently of the type of the graft procedure.Arthrogenic muscle inhibition compromised the return to sport at the same level until 12 post-operative months.
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Affiliation(s)
- Marc Dauty
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Pierre Menu
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Olivier Mesland
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
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15
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Rodrigues R, Souza da Rocha E, Klein KD, Sonda FC, Pompeo KD, Frasson VB, Vaz MA. Proximal and distal muscle thickness is different in women with patellofemoral pain but is not associated with knee frontal plane projection angle. J Bodyw Mov Ther 2020; 25:205-211. [PMID: 33714497 DOI: 10.1016/j.jbmt.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to compare proximal and distal muscle thickness between patellofemoral pain (PFP) and asymptomatic women (CG) and to verify the possible association between morphology and lower limb alignment during single leg-squat. METHODS Thirty women (PFP, n = 15 and CG, n = 15) performed the following evaluations: (i) muscle thickness of external oblique (EO), gluteus medius (GMed), tensor fascia latae (TFL), peroneus (PER) and tibialis anterior (TA); (ii) knee frontal plane projection angle (FPPA) during single-leg squat. RESULTS Compared with the CG, PFP showed: (1) smaller GMed (-10.02%; p = 0.04; effect size = 0.82), greater TFL (+18.44%; p = 0.02; effect size = 0.92) and PER (+14.23%; p = 0.02; effect size = 0.87) muscle thickness and greater knee FPPA during single-leg squat (+31.8%; p = 0.04; effect size = 1.12). No differences were observed in EO (+7.17%; p = 0.37; effect size = 0.34) and TA (-1.35%; p = 0.81; effect size = 0.12) muscle thickness. Additionally, we failed to observe significant associations between muscle morphology and knee FPPA in both groups. CONCLUSION PFP patients showed alterations in proximal and distal muscle thickness, despite the lack of association with poor lower limb alignment. Prospective studies are necessary to determine if differences in muscle morphology are the cause or the consequence of PFP and to confirm the absence of relationship with lower limb alignment.
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Affiliation(s)
- Rodrigo Rodrigues
- Exercise Physiology and Physical Assessment Laboratory, Serra Gaucha University Center, Caxias do Sul, RS, Brazil; Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Emmanuel Souza da Rocha
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kelli Daiana Klein
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Francesca Chaida Sonda
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Klauber Dalcero Pompeo
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marco Aurélio Vaz
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Physique Physiotherapy Centre, Porto Alegre, RS, Brazil
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16
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Bilateral Comparisons of Quadriceps Thickness after Anterior Cruciate Ligament Reconstruction. ACTA ACUST UNITED AC 2020; 56:medicina56070335. [PMID: 32635259 PMCID: PMC7404692 DOI: 10.3390/medicina56070335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Anterior cruciate ligament reconstruction (ACLR) often results in quadricep atrophy. The purpose of this study was to compare the bilateral thickness of each quadricep component before and after ACLR. Materials and Methods: Cross-sectional study design. In 14 patients who underwent ACLR, bilateral quadricep muscle thicknesses were measured using a portable ultrasound device, 1 h before and 48–72 h after ACLR. Two-way analysis of variance (ANOVA) was used to compare muscle thickness pre- and post-ACLR between the limbs. Results: The primary finding was that the vastus intermedius (VI) muscle was significantly smaller in the reconstructed limb after ACLR compared to that in the healthy limb (Reconstructed limb; RCL = Pre-operated (PRE): 19.89 ± 6.91 mm, Post-operated(POST): 16.04 ± 6.13 mm, Healthy limb; HL = PRE: 22.88 ± 6.07, POST: 20.90 ± 5.78 mm, F = 9.325, p = 0.009, η2p = 0.418). Conclusions: The results represent a selective surgical influence on the quadricep muscle thickness. These findings highlight the need of advanced strengthening exercises in order to restore VI thickness after ACLR.
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17
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Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing. Knee Surg Sports Traumatol Arthrosc 2020; 28:645-652. [PMID: 31776624 DOI: 10.1007/s00167-019-05795-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 11/07/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender-matched healthy control group, subjects who were post-ACL reconstruction would display impaired active joint position sense, knee extensor and flexor strength symmetry and knee function at 1 year post-surgery. A secondary hypothesis was that differences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups. METHODS Sixty-seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee flexion. International Knee Documentation Committee (IKDC) subjective score and one-leg hop test were used to assess the functional status of the patients. RESULTS The JPS detection was different at the 15° target angle between groups (F3.86 = 24.56, p < 0.001). A significantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p < 0.0001). The quadriceps index was lower in patients compared to healthy individuals (p < 0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.). CONCLUSION Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over-estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group. LEVEL OF EVIDENCE III.
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18
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Nelson CM, Marchese V, Rock K, Henshaw RM, Addison O. Alterations in Muscle Architecture: A Review of the Relevance to Individuals After Limb Salvage Surgery for Bone Sarcoma. Front Pediatr 2020; 8:292. [PMID: 32612962 PMCID: PMC7308581 DOI: 10.3389/fped.2020.00292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Osteosarcoma and Ewing's sarcoma are the most common primary bone malignancies affecting children and adolescents. Optimal treatment requires a combination of chemotherapy and/or radiation along with surgical removal when feasible. Advances in multiple aspects of surgical management have allowed limb salvage surgery (LSS) to supplant amputation as the most common procedure for these tumors. However, individuals may experience significant impairment after LSS, including deficits in range of motion and strength that limit function and impact participation in work, school, and the community, ultimately affecting quality of life. Muscle force and speed of contraction are important contributors to normal function during activities such as gait, stairs, and other functional tasks. Muscle architecture is the primary contributor to muscle function and adapts to various stimuli, including periods of immobilization-protected weightbearing after surgery. The impacts of LSS on muscle architecture and how adaptations may impact deficits within the rehabilitation period and into long-term survivorship is not well-studied. The purpose of this paper is to [1] provide relevant background on bone sarcomas and LSS, [2] highlight the importance of muscle architecture, its measurement, and alterations as seen in other relevant populations and [3] discuss the clinical relevance of muscle architectural changes and the impact on muscle dysfunction in this population. Understanding the changes that occur in muscle architecture and its impact on long-term impairments in bone sarcoma survivors is important in developing new rehabilitation treatments that optimize functional outcomes.
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Affiliation(s)
- Christa M Nelson
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robert M Henshaw
- Department of Orthopedic Oncology, MedStar Georgetown Orthopedic Institute, Washington, DC, United States.,Department of Orthopedic Oncology, Children's National Medical Center, Washington, DC, United States
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States.,Baltimore VA GRECC, Baltimore, MD, United States
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19
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Liu H, Lu W, Liang D, Geng H, Zhu W, Ouyang K, Li H, Peng L, Feng W, Zhong M, Chen K, Li Y, Deng Z, Wang D. [Effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1088-1094. [PMID: 31512448 PMCID: PMC8355844 DOI: 10.7507/1002-1892.201902059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/10/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic. METHODS Between August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group ( n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining. RESULTS The invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups ( P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups ( P<0.05). But there was no significant difference between the two groups ( t=0.868, P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups ( P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group ( P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant ( P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy ( P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group ( P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups ( P>0.05), and the histological score of the isokinetic group was superior to the control group ( P<0.05). CONCLUSION On the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.
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Affiliation(s)
- Haifeng Liu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Wei Lu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000,
| | - Daqiang Liang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Hongli Geng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Weimin Zhu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Kan Ouyang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Hao Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Liangquan Peng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Wenzhe Feng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Mingjin Zhong
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Kang Chen
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Ying Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Zhenhan Deng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China
| | - Daping Wang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangzhou, 518000, P.R.China;Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000,
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