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Ahn T, Loflin BE, Nguyen NB, Miller CK, Colglazier KA, Wojtys EM, Schlecht SH. Acute Bone Loss and Infrapatellar Fat Pad Fibrosis in the Knee After an In Vivo ACL Injury in Adolescent Mice. Am J Sports Med 2023; 51:2342-2356. [PMID: 37366163 PMCID: PMC10529334 DOI: 10.1177/03635465231180616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Young patients are 6 times more likely than adults to have a primary anterior cruciate ligament (ACL) graft failure. Biological factors (ie, tunnel osteolysis) may account for up to a third of these failures. Previous evaluations of patient ACL explants indicated significant bone loss within the entheseal regions. However, it remains unknown if the degree of bone loss within the ACL insertion regions, wherein ACL grafts are fixated, exceeds that of the femoral and tibial condylar bone. HYPOTHESIS Bone loss in the mineralized matrices of the femoral and tibial ACL entheses is distinct from that clinically reported across the whole knee after injury. STUDY DESIGN Controlled laboratory study. METHODS We developed a clinically relevant in vivo mouse ACL injury model to cross-sectionally track the morphological and physiological postinjury changes within the ACL, femoral and tibial entheses, synovial joint space, and load-bearing epiphyseal cortical and trabecular bone components of the knee joint. Right ACLs of 10-week-old C57BL/6J female mice (N = 75) were injured in vivo with the contralateral ACLs serving as controls. Mice were euthanized at 1, 3, 7, 14, or 28 days after injury (n = 12/cohort). Downstream analyses included volumetric cortical and trabecular bone analyses and histopathologic assessments of the knee joint after injury. Gait analyses across all time points were also performed (n = 15 mice). RESULTS The majority of the ACL injuries in mice were partial tears. The femoral and tibial cortical bone volumes were 39% and 32% lower, respectively, at 28 days after injury than those of the uninjured contralateral knees (P < .01). Trabecular bone measures demonstrated little difference between injured and control knees after injury. Across all bone measures, bone loss was similar between the injured knee condyles and ACL entheses. There was also significant inflammatory activity within the knee after injury. By 7 days after injury, synovitis and fibrosis were sigificantly elevated in the injured knee compared with the controls (P < .01), which corresponded with significantly higher osteoclast activity in bone at this time point compared with the controls. This inflammatory response signficantly persisted throughout the duration of the study (P < .01). The hindlimb gait after injury deviated from normal, but mice habitually loaded their injured knee throughout the study. CONCLUSION Bone loss was acute and persisted for 4 weeks after injury in mice. However, the authors' hypothesis was not confirmed, as bone quality was not significantly lower in the entheses compared with the condylar bone regions after injury. With relatively normal hindlimb loading but a significant physiological response after injury, bone loss in this model may be driven by inflammation. CLINICAL RELEVANCE There is persistent bone resorption and fibrotic tissue development after injury that is not resolved. Inflammatory and catabolic activity may have a significant role in the postinjury decline of bone quality in the knee.
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Affiliation(s)
- Taeyong Ahn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Benjamin E. Loflin
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Ciena K. Miller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kaitlyn A. Colglazier
- Department of Biomedical Engineering, Indiana University Purdue University–Indianapolis, Indianapolis, Indiana, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen H. Schlecht
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biomedical Engineering, Indiana University Purdue University–Indianapolis, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA Investigation performed at Indiana University School of Medicine, Indianapolis, Indiana, USA
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular Control During Stair Descent and Artificial Tibial Translation After Acute ACL Rupture. Orthop J Sports Med 2022; 10:23259671221123299. [PMID: 36263309 PMCID: PMC9575465 DOI: 10.1177/23259671221123299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) rupture has direct effect on passive and
active knee stability and, specifically, stretch-reflex excitability. Purpose/Hypothesis: The purpose of this study was to investigate neuromuscular activity in
patients with an acute ACL deficit (ACL-D group) compared with a matched
control group with an intact ACL (ACL-I group) during stair descent and
artificially induced anterior tibial translation. It was hypothesized that
neuromuscular control would be impaired in the ACL-D group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Surface electromyographic (EMG) activity of the vastus medialis (VM), vastus
lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles was
recorded bilaterally in 15 patients with ACL-D (mean, 13.8 days [range, 7-21
days] since injury) and 15 controls with ACL-I during stair descent and
artificially induced anterior tibial translation. The movements of stair
descent were divided into preactivity, weight acceptance, and push-off
phases. Reflex activity during anterior tibial translation was split into
preactivity and short, medium, and late latency responses. Walking on a
treadmill was used for submaximal EMG normalization. Kruskal-Wallis test and
post hoc analyses with Dunn-Bonferroni correction were used to compare
normalized root mean square values for each muscle, limb, movement, and
reflex phase between the ACL-D and ACL-I groups. Results: During the preactivity phase of stair descent, the hamstrings of the involved
leg of the ACL-D group showed 33% to 51% less activity compared with the
matched leg and contralateral leg of the ACL-I group (P
< .05). During the weight acceptance and push-off phases, the VL revealed
a significant reduction (approximately 40%) in the involved leg of the ACL-D
group compared with the ACL-I group. At short latency, the BF and ST of the
involved leg of the ACL-D group showed a significant increase in EMG
activity compared with the uninvolved leg of the ACL-I group, by a factor of
2.2 to 4.6. Conclusion: In the acute phase after an ACL rupture, neuromuscular alterations were found
mainly in the hamstrings of both limbs during stair descent and reflex
activity. The potential role of prehabilitation needs to be further
studied.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Angela Blasimann, MSc, Department of Health Professions, Bern
University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland
()
| | - Aglaja Busch
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,University Outpatient Clinic, Sports Medicine & Sports
Orthopedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern,
Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock,
Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland
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Li C, Lin Y, Kernkamp WA, Xia H, Lin Z. Effect of Time After Injury on Tibiofemoral Joint Kinematics in Anterior Cruciate Ligament-Deficient Knees During Gait. Orthop J Sports Med 2022; 10:23259671221110160. [PMID: 35898201 PMCID: PMC9310238 DOI: 10.1177/23259671221110160] [Citation(s) in RCA: 1] [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: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury can lead to changes in tibiofemoral kinematics during gait, but the detailed short-term kinematic changes after ACL injury are still unknown. Purpose: To measure tibiofemoral kinematics during gait in ACL-deficient (ACLD) knees over time after ACL injury. Study Design: Controlled laboratory study. Methods: The authors categorized 76 patients with unilateral ACLD knees into 4 groups based on the time from injury: <3 months (group 1), 3 to 6 months (group 2), >6 to 12 months (group 3), and >12 months (group 4). The controls were 20 participants with ACL-intact knees. Changes in the knee kinematics and range of motion during gait were compared among ACLD groups and those with ACL-intact knees. Results: Compared with controls, the range of motion of flexion in group 1 was significantly lower (6°; P = .033), and the mean knee flexion was significantly increased (0.7°-3.4°) in groups 1 to 4 (all P ≤ .004). There was more internal tibial rotation (2.9°-4.3°) in group 1 and 2, and more anterior tibial translation (4.3 mm) in group 1 during the stance or swing phases than in controls (P ≤ .049 for all). The mean internal tibial rotation and anterior tibial translation significantly decreased from group 1 to group 4 (P < .001 for both). Compared with controls, the mean medial tibial translation was significantly greater (1.2-2.5 mm) in all groups, and more medial tibial translations (2.4-3.7 mm) were observed during the stance phase in groups 1, 3, and 4 (P ≤ .047 for all). Conclusion: ACLD knees displayed a motion impairment walking strategy within 3 months, and a higher-flexion walking strategy increased with time after injury. Excessive anterior translation and internal rotation of the tibia tended to return to normal, while excessive medial translation of the tibia increased in ACLD knees after 6 months postinjury. These results may provide new insight into the compensatory mechanisms and risk factors for premature osteoarthritis in ACLD knees.
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Affiliation(s)
- Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China.,Southern Medical University, Guangzhou, China
| | - Yulin Lin
- Department of Orthopedics, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Willem A Kernkamp
- Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hong Xia
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zefeng Lin
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
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Yokoyama S, Fukuda W, Ikeno Y, Kataoka Y, Horan SA. Lower limb kinematics of single-leg squat performance in patients with anterior cruciate ligament deficiency. J Phys Ther Sci 2021; 33:429-433. [PMID: 34083883 PMCID: PMC8165361 DOI: 10.1589/jpts.33.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the parameters that characterize the knee, hip, and pelvic kinematics during a single-leg squat in preoperative anterior cruciate ligament rupture injury. [Participants and Methods] Overall, 15 patients with unilateral anterior cruciate ligament deficiency were enrolled in this study. For each single-leg squat, data from two-dimensional video cameras and three-dimensional motion analysis were collected. Measurement indices included the articular angles of the knee, hip, and trunk. The anterior cruciate ligament-injured leg was compared with the uninjured leg. [Results] The maximum knee valgus and flexion angles during a single-leg squat were smaller in the injured leg than in the uninjured leg. During the single-leg squat, the effect of "compensatory mechanisms" appeared as knee valgus and flexion movements. In particular, the knee valgus angle decreased in the anterior cruciate ligament-injured leg compared to that in the uninjured leg. [Conclusion] This phenomenon suggests that it is possible to utilize recurrence prevention training for anterior cruciate ligament injury.
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Affiliation(s)
- Shigeki Yokoyama
- Kyoto Tachibana University: 34 Yamada-cho, Oyake, Yamashina-ku, Kyoto 607-8175, Japan
| | - Wataru Fukuda
- Department of Physical Therapy, Center of Joint Surgery, Kaisei General Hospital, Japan
| | - Yutaro Ikeno
- Department of Physical Therapy, Center of Joint Surgery, Kaisei General Hospital, Japan
| | - Yusuke Kataoka
- Department of Physical Therapy, Center of Joint Surgery, Kaisei General Hospital, Japan
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Australia
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Sharifi M, Shirazi-Adl A. Changes in gastrocnemii activation at mid-to-late stance markedly affects the intact and anterior cruciate ligament deficient knee biomechanics and stability in gait. Knee 2021; 29:530-540. [PMID: 33756263 DOI: 10.1016/j.knee.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/26/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We aimed to quantify the sensitivity in biomechanical response and stability of the intact and anterior cruciate ligament deficient (ACL-D) joints at mid-to-late stance periods of gait to the alterations in activation of gastrocnemii (Gas) muscles. METHODS A validated kinematics-driven musculoskeletal finite-element model of the lower extremity is used to compute knee joint response and stability under reported kinetics-kinematics of healthy subjects. Activation in Gas is altered under prescribed gait data at the mid-to-late stance of gait and associated changes in remaining muscle forces/contact forces/areas/ACL force and joint stability are computed in both intact and ACL-D joints. RESULTS In the intact joint, the anterior-tibial-translation (ATT) as well as ACL and joint contact forces follow variations in Gas forces. Both the stability and ATT of an ACL-D joint are restored to the near-intact levels when the activity in Gas is reduced. Knee joint instability, excessive ATT as well as larger peak articular contact stresses with a posterior shift in contact areas are estimated under greater Gas forces. CONCLUSIONS ACL-D joint is unstable with ATT > 10 mm under larger activities in Gas. Gas is an ACL-antagonist while hamstrings and soleus are ACL-agonists. The near-intact joint stability and ATT of an ACL-D joint can be restored at a lower activation in Gas; or in other words, when activation in ACL-antagonist muscles drops compared with that in ACL-agonist muscles. Results could help analyze the gait of ACL-D copers and non-copers and provide better understanding towards improved preventive, diagnostic, and treatment approaches.
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Affiliation(s)
- M Sharifi
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique, Montréal, Québec, Canada.
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique, Montréal, Québec, Canada
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Agostinone P, Di Paolo S, Grassi A, Pinelli E, Bontempi M, Bragonzoni L, Zaffagnini S. ACL deficiency influences medio-lateral tibial alignment and knee varus-valgus during in vivo activities. Knee Surg Sports Traumatol Arthrosc 2021; 29:389-397. [PMID: 32253481 DOI: 10.1007/s00167-020-05979-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The role of the anterior cruciate ligament (ACL) in knee biomechanics in vivo and under weight-bearing is still unclear. The purpose of this study was to compare the tibiofemoral kinematics of ACL-deficient knees to healthy contralateral ones during the execution of weight-bearing activities. METHODS Eight patients with isolated ACL injury and healthy contralateral knees were included in the study. Patients were asked to perform a single step forward and a single leg squat first with the injured knee and then with the contralateral one. Knee motion was determined using a validated model-based tracking process that matched subject-specific MRI bone models to dynamic biplane radiographic images, under the principles of Roentgen stereophotogrammetric analysis (RSA). Data processing was performed in a specific software developed in Matlab. RESULTS Statistically significant differences (p < 0.05) were found for single leg squat along the frontal plane: ACL-deficient knees showed a more varus angle, especially at the highest knee flexion angles (40°-50° on average), compared to the contralateral knees. Furthermore, ACL-deficient knees showed tibial medialization along the entire task, while contralateral knees were always laterally aligned. This difference became statistically relevant (p < 0.05) for knee flexion angles included between 0° and about 30°. CONCLUSION ACL-deficient knees showed an abnormal tibial medialization and increased varus angle during single leg squat when compared to the contralateral knees. These biomechanical anomalies could cause a different force distribution on tibial plateau, explaining the higher risk of early osteoarthritis in ACL deficiency. The clinical relevance of this study is that also safe activities used in ACL rehabilitation protocols are significantly altered in ACL deficiency. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erika Pinelli
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - Marco Bontempi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Bragonzoni
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
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Sharifi M, Shirazi-Adl A. Knee flexion angle and muscle activations control the stability of an anterior cruciate ligament deficient joint in gait. J Biomech 2021; 117:110258. [PMID: 33493713 DOI: 10.1016/j.jbiomech.2021.110258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 01/14/2023]
Abstract
Anterior cruciate ligament (ACL) is a primary structure and a commonly injured ligament of the knee joint. Some patients with ACL deficiency (ACLD) experience joint instability and require a reconstructive surgery to return to daily routines, some can adapt by limiting their activities while others, called copers, can return to high-level activities with no instability. We investigated the effects of alterations in the knee flexion angle (KFA) and muscle force activations on the stability and biomechanics of ACLD joints at 25, 50, and 75% periods of gait stance. ACLD joint stability is controlled by variations in both KFA and knee muscle forces. For the latter, a parameter called activity index is defined as the ratio of forces in ACL antagonists (quadriceps and gastrocnemii) to those in ACL agonists (hamstrings). Under a greater KFA (2-6° beyond the mean of reported values in healthy subjects), an ACLD joint regains its pre-injury stability levels. The ACLD joint stability also markedly improves at smaller quadriceps and larger hamstrings forces (activity indices of 2.0-3.6 at 25%) at the first half of stance and smaller gastrocnemii and larger hamstrings forces (activity indices of 0.1-1.1 at 50% and 0.1-1.2 at 75%) at the second half of stance. Activity index and KFA are both crucial when assessing the dynamic stability of an ACLD joint. These results are helpful in our understanding of the biomechanics and stability of ACLD joints towards improved prevention and treatment strategies.
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Affiliation(s)
- M Sharifi
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Québec, Canada
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Québec, Canada.
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Sharifi M, Shirazi-Adl A, Marouane H. Sensitivity of the knee joint response, muscle forces and stability to variations in gait kinematics-kinetics. J Biomech 2020; 99:109472. [DOI: 10.1016/j.jbiomech.2019.109472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
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Muscular Force Patterns during Level Walking in ACL-Deficient Patients with a Concomitant Medial Meniscus Tear. Appl Bionics Biomech 2019; 2019:7921785. [PMID: 31191712 PMCID: PMC6525939 DOI: 10.1155/2019/7921785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background The abnormal knee joint motion patterns caused by anterior cruciate ligament (ACL) deficiency are thought to be associated with articular cartilage degeneration. High rates of meniscus tear combined with ACL rupture are observed, and these knees suffer a higher risk of early cartilage degeneration. Research Question This study investigated lower limb muscular force patterns of ACL-deficient knees with a concomitant medial meniscus tear. Methods 12 volunteers and 22 patients were recruited, including 12 patients with isolated ACL deficiency (ACLD) and 10 ACL-deficient patients with a concomitant medial meniscus tear (ACLDM). Level walking data at a self-selected speed were collected before surgery. Then, a musculoskeletal dynamic analysis system, AnyBody, was applied to simulate tibiofemoral flexion moments and muscle forces. Results Our results indicate that the tibiofemoral peak flexion and extension moments in ACLDM patients are significantly lower than in controls. The rectus femoris force in ACLDM patients was significantly lower than in isolated ACL-deficient patients and the controls during mid and terminal stance phase, while no significant difference was found in hamstring and vastus force. Additionally, the gastrocnemius force in ACL-deficient patients both with and without a medial meniscus tear was lower than in controls during mid-stance phase. Significance The ACLDM patients had lower peak tibiofemoral flexion moment, lower gastrocnemius force in mid-stance phase, and lower rectus femoris force during the mid and terminal stance phase. These results may help clinicians to better understand the muscle function and gait pattern in ACL-deficient patients with a concomitant medial meniscus tear.
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Smale KB, Flaxman TE, Alkjaer T, Simonsen EB, Krogsgaard MR, Benoit DL. Anterior cruciate ligament reconstruction improves subjective ability but not neuromuscular biomechanics during dynamic tasks. Knee Surg Sports Traumatol Arthrosc 2019; 27:636-645. [PMID: 30306241 DOI: 10.1007/s00167-018-5189-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 10/01/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to identify high-functioning anterior cruciate ligament-deficient patients and assess the effects of reconstruction on their self-reported functionality, muscle activations and biomechanical properties. METHODS Twenty young and active patients participated pre- (11.5 ± 14.3 months post-injury) and again 10.5 ± 1.7 months post-reconstruction and were individually matched to 20 healthy controls. Participants completed hop and side cut movements while patient-related outcome measures, lower limb electromyography, kinetic, and whole body kinematic data were collected. One-dimensional statistical parametric mapping was used to test for group differences (healthy vs deficient; deficient vs reconstructed; reconstructed vs healthy). RESULTS When comparing healthy to anterior cruciate ligament-deficient participants, all questionnaires indicated significant lower subjective function while the only substantial biomechanical difference between these participants was a decreased knee extensor moment in both the hop (peak difference: 0.63 Nm/kg, p < 0.001) and side cut (peak difference: 0.76 Nm/kg, p < 0.001). When comparing patients' pre- and post-reconstruction, no biomechanical differences were observed whereas only half of the questionnaires (Tegner, Lysholm, KNEES-ADL, KNEES-Slackness, KNEES-Looseness, KNEES-Sport Behaviour, IKDC, and KOOS-QoL) indicated higher function in the reconstructed state. When comparing the reconstructed patients to the healthy participants, all questionnaires were still significantly higher in the healthy controls. The reconstructed group also had a smaller flexion angle (peak difference: 14.5°, p = 0.007) and knee extensor moment (peak difference: 0.62 Nm/kg, p < 0.001) during the hop and a smaller knee extensor moment (peak difference: 0.90 Nm/kg, p < 0.001) during the side-cut task. CONCLUSION At 10-months post-reconstruction, the current results indicate that in high-functioning anterior cruciate ligament-deficient patients, reconstruction had little impact on objective measures of functional ability during dynamic tasks although self-reported function was improved. LEVEL OF EVIDENCE Therapeutic prospective cohort study, Level II.
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Affiliation(s)
- Kenneth B Smale
- School of Human Kinetics, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada
| | - Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada
| | - Tine Alkjaer
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51 (a part of IOC Sports Medicine Copenhagen), Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Daniel L Benoit
- School of Human Kinetics, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada. .,School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada.
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Çınar-Medeni Ö, Harput G, Baltaci G. Angle-specific knee muscle torques of ACL-reconstructed subjects and determinants of functional tests after reconstruction. J Sports Sci 2018; 37:671-676. [PMID: 30317916 DOI: 10.1080/02640414.2018.1522701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purposes of this study were to analyse (a) if "angle-specific" (AS) flexor and extensor torques were different between ACL-reconstructed and uninvolved limbs, (b) the difference in peak torque occurrence angles for concentric and eccentric knee flexor and extensor torques between involved and uninvolved limbs and (c) if AS concentric and eccentric knee flexor and extensor torques are determinants of performance in the "single-leg hop test" (SLHT) and "vertical jump and reach test" (VJRT) in ACL-reconstructed legs. Twenty-seven male ACL-reconstructed volunteers were included in the study. Isokinetic knee muscle strength, SLHT and VJRT were performed 6 months after ACL reconstruction. No difference was found in extremity and knee joint angle interaction for concentric and eccentric flexor and extensor torques (p > 0.05). Peak torque occurrence angles were not different between involved and uninvolved limbs (p > 0.05). In involved extremities, concentric knee extensor strength at 90° was a determinant of SLHT performance (R2 = 0.403, p < 0.05), and concentric knee extensor strength at 60° was a determinant of VJRT (R2 = 0.224, p < 0.05). Assessment of AS concentric knee extensor strength at 60° and 90° might be important, because these were determinants of functional test performance.
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Affiliation(s)
- Özge Çınar-Medeni
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Cankiri Karatekin University , Cankiri , Turkey
| | - Gulcan Harput
- b Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Gul Baltaci
- c Private Ankara Guven Hospital , Ankara , Turkey
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Computation of the role of kinetics, kinematics, posterior tibial slope and muscle cocontraction on the stability of ACL-deficient knee joint at heel strike – Towards identification of copers from non-copers. J Biomech 2018; 77:171-182. [DOI: 10.1016/j.jbiomech.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/21/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
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