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Högberg J, Piussi R, Lövgren J, Wernbom M, Simonsson R, Samuelsson K, Hamrin Senorski E. Restoring Knee Flexor Strength Symmetry Requires 2 Years After ACL Reconstruction, But Does It Matter for Second ACL Injuries? A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2024; 10:2. [PMID: 38180584 PMCID: PMC10769975 DOI: 10.1186/s40798-023-00666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND It is unknown whether knee flexor strength recovers after anterior cruciate ligament (ACL) reconstruction with a hamstring tendon (HT) autograft and whether persistent knee flexor strength asymmetry is associated to a second ACL injury. OBJECTIVE We aimed to systematically review (1) whether knee flexor strength recovers after ACL reconstruction with HT autografts, and (2) whether it influences the association with a second ACL injury. A third aim was to summarize the methodology used to assess knee flexor strength. DESIGN Systematic review and meta-analysis reported according to PRISMA. METHODS A systematic search was performed using the Cochrane Library, Embase, Medline, PEDRo, and AMED databases from inception to December 2021 and until completion in January 2023. Human clinical trials written in English and conducted as randomized controlled trials, longitudinal cohort, cross-sectional, and case-control studies on patients with index ACL reconstructions with HT autografts harvested from the ipsilateral side were considered. Knee flexor strength was measured isokinetically in both the reconstructed and uninjured limb to enable the calculation of the limb symmetry index (LSI). The Risk of Bias Assessment Tool for Non-Randomized Studies was used to assess risk of bias for non-randomized studies and the revised Cochrane Risk of Bias tool was used for randomized controlled trials. For the meta-analysis, the LSI (mean ± standard error) for concentric knee flexor strength at angular velocities of 60°/second (s) and 180°/s preoperatively and at 3 months, 6 months, 12 months, and 24 months were pooled as weighted means with standard errors. RESULTS The search yielded 64 studies with a total of 8378 patients, which were included for the assessment of recovery of knee flexor strength LSI, and a total of 610 patients from four studies that investigated the association between knee flexor strength and second ACL injuries. At 1 year after ACL reconstruction, the knee flexor strength LSI had recovered to 89.0% (95% CI 87.3; 90.7%) and 88.3% (95% CI 85.5; 91.1%) for the velocities of 60°/s and 180°/s, respectively. At 2 years, the LSI was 91.7% (95% CI 90.8; 92.6%) and 91.2% (95% CI 88.1; 94.2%), for velocities of 60°/s and 180°/s, respectively. For the association between knee flexor strength and second ACL injuries, there was insufficient and contradictory data. CONCLUSIONS There was low to very low certainty of evidence indicating that the recovery of knee flexor strength LSI, defined as ≥ 90% of the uninjured side, takes up to 2 years after ACL reconstruction with HT autografts. Whether knee flexor strength deficits influence the association of second ACL injuries is still uncertain. There was considerable heterogeneity in the methodology used for knee flexor strength assessment, which together with the low to very low certainty of evidence, warrants further caution in the interpretation of our results. REGISTRATION NUMBER CRD42022286773.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Johan Lövgren
- Active Physio Sports Medicine Clinic, Brogatan 23, 431 30, Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- The Rydberg Laboratory for Applied Sciences, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
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Alt T, Nolte K, Horn D, Modenbach D, Knicker AJ, Jaitner T. Analyses of Isokinetic Thigh Muscle Strength: Camera-Based Assessment Alters the Magnitude, but Not the Message. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:783-792. [PMID: 35426761 DOI: 10.1080/02701367.2022.2053648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Background: Thigh muscle strength capacities are major modifiable risk factors for knee and thigh muscle injuries. Therefore, their valid assessment is essential. Most isokinetic knee tests are conducted in a seated position and rely on dynamometer-based data. However, their accuracy is doubtful because axis alignment is erroneous. Purpose: This study investigated if hip angle (flexed vs. extended) and assessment method (dynamometer-based vs. camera-based) affect isokinetic outcome parameters. Methods: Sixteen healthy male participants (27 years, 184 cm, 80 kg) performed discrete isokinetic tests of the knee flexors and extensors (60°/s) while their kinematics were captured (100 fps). Results: Both assessment methods revealed very strong linear relationships (94% ≤ R2 ≤ 98%) although peak moments (d ≤ 0.87), contractional work (d ≤ 1.26), and functional knee flexor:extensor ratios (d ≤ 0.81) significantly differed. Seated knee flexor tests demonstrated the largest knee trajectory center's misalignment (x = 4.0 cm, z = -2.5 cm; 1.37 ≤ d ≤ 4.74). Conclusion: Hip-angle induced kinematic changes did not affect the relation between the lever arms, thus causing highly proportional deviations of kinetic parameters. The assessment method altered the magnitude, but not the message of isokinetic knee tests, which should be preferentially performed with extended hip joint to improve axis alignment. Knowledge of these kinetic and kinematic interactions assists practitioners and scientists with isokinetic tests and/or rehabilitation training to ensure reasonable interpretations of gathered isokinetic outcomes.
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Affiliation(s)
- Tobias Alt
- Olympic Training & Testing Centre Westphalia
| | | | | | | | - Axel J Knicker
- German Sport University
- Research Centre for Elite Sports 'momentum'
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Beaudoin A, Ogborn D, McRae S, Larose G, Brown H, McCormack R, MacDonald P. No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:3718-3725. [PMID: 35507037 DOI: 10.1007/s00167-022-06980-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Contralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long-term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow-up of a minimum 10 years post-reconstruction in the treatment of a complete ACL tear. METHODS Patients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL-QoL) and the Tegner activity scale. Participants completed four different single-leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer. RESULTS Of the original 100 patients, 50 patients (41.3 ± 9.5 years of age, 31 males, 19 females) reported on re-injury at 12.6 ± 1.4 years post-operative. Thirty-eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL-QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position. CONCLUSION Contralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long-term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alisha Beaudoin
- Max Rady College of Medicine, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada.
| | - Dan Ogborn
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada.,Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada.,Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Robert McCormack
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Peter MacDonald
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
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Comparison of the Agonist/Antagonist Tensional Balance of the Knee between Two Isokinetic Positions: A Pilot Study on a Sample of High-Level Competitive Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095397. [PMID: 35564792 PMCID: PMC9099487 DOI: 10.3390/ijerph19095397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
Isokinetic knee dynamometry evolves towards more precise techniques, such as the calculation of the functional ratio. This study evaluated the influence of an intermediate hip position called the unified reclined position (URP) compared to the classic sitting position, (CSP) on hamstring eccentric PT values (Hexc30) and conventional (Hcon60/Qcon60) and functional (Hexc30/Qcon60) ratios. Twenty Spanish high-level competitive soccer players (20.4 ± 4.44 years) were evaluated in CSP and in URP. The hip angle in URP (44°) was determined with a passive extensibility test (quadriceps and hamstrings), looking for an agonist/antagonist tension balance. The following were performed: three repetitions (60°/s) and five repetitions (240°/s) in concentric quadriceps and hamstrings mode; and three repetitions (30°/s) in concentric and eccentric for the hamstrings. At 30°/s, the CSP presents higher values of maximal eccentric hamstring strength than URP, (Dom + N-Dom leg (Nm): CSP = 148.3 ± 19.5 vs. URP 143.5 ± 23.2); p = 0.086 (n.s.). The conventional relationship did not show data justifying the preference for URP over CSP (p = 0.86 (n.s.)). However, although the functional index did not show significant values (p = 0.97 (n.s.), it did show a greater number of subjects with imbalances measured in URP (five in URP vs. two in CSP). An assessment angle of the hip closer to sports reality seems to favor the use of the URP as a complementary method to the CSP. These data stimulate new studies using URP together with the classic protocol.
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Persistent knee flexor strength deficits identified through the NordBord eccentric test compared with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft. Phys Ther Sport 2022; 55:119-124. [DOI: 10.1016/j.ptsp.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
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Weaver A, Ness BM, Roman DP, Giampetruzzi N, Cleland JA, Pace JL, Crepeau AE. Short-term isokinetic and isometric strength outcomes after anterior cruciate ligament reconstruction in adolescents. Phys Ther Sport 2021; 53:75-83. [PMID: 34875528 DOI: 10.1016/j.ptsp.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine differences in knee strength outcomes after ACL reconstruction according to quadriceps tendon (QT) or hamstring tendon (HT) autograft in adolescents. DESIGN Retrospective cohort. METHODS Surgical and clinical outcome data were collected. Analyses were conducted separately for female and male cohorts and grouped by graft type (HT or QT). A Mann-Whitney U test of independent samples was used to examine group differences according to graft type. RESULTS 107 females (age = 15.6 ± 1.5 years) and 94 males (age = 15.7 ± 1.5 years) were included. Mean time since surgery ranged from 7.2 to 7.9 months. Those with a QT autograft had decreased normalized isokinetic quadriceps peak torque on the involved limb compared to the HT group (p < 0.01, ES = 0.71-0.89). Normalized isometric hamstring peak torque was decreased for those with HT autograft in the female cohort (p = 0.02, ES = 0.57). CONCLUSION Normalized isokinetic quadriceps peak torque was reduced by 18-20% on the involved limb in those with a QT autograft. Normalized isometric hamstring peak torque was decreased by 13% for those with HT autograft in the female cohort. Method of strength testing may be an important consideration to fully appreciate strength deficits after ACL reconstruction according to graft type.
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Affiliation(s)
- Adam Weaver
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, USA
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
| | - Dylan P Roman
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, USA.
| | | | - Joshua A Cleland
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
| | - J Lee Pace
- Elite Sports Medicine at Connecticut Children's, Hartford, CT, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, CT, USA
| | - Allison E Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, CT, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, CT, USA
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Ogborn D, McRae S, Larose G, Leiter J, Brown H, MacDonald P. Knee flexor strength and symmetry vary by device, body position and angle of assessment following ACL reconstruction with hamstring grafts at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 31:1658-1664. [PMID: 34477895 DOI: 10.1007/s00167-021-06712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. METHODS Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. RESULTS Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p < 0.05), supine T60 against seated peak torque (82.7 ± 14.2%, p < 0.05), and the NordBord was lower than seated peak torque that was not statistically significant (83.9 ± 12.8%, n.s.). Knee extensor peak (r2 = 0.167 (F(1,27) = 5.3, p = 0.03) and Nordic curl eccentric torque (r2 = 0.267, F(2,26) = 4.736, p = 0.02) were predictors of ACL-QoL score, although a combined model did not improve over Nordic torque alone. CONCLUSION Limb symmetry cannot be assumed in clinical practice across differing assessment methods for knee flexor strength as deficits are greatest in the supine position with torque measured at 75° knee flexion. Isokinetic knee extensor and eccentric knee flexor torque during the Nordic hamstring curl were predictors of ACL-QoL scoring and should be considered alongside patient-reported outcomes for patients following ACL reconstruction with hamstring grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dan Ogborn
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada. .,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
| | - Sheila McRae
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Pete MacDonald
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
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Alt T, Breitenmoser T, Vonhoegen J, Horn D, Severin J, Nolte K, Knicker AJ, Jaitner T, Strüder HK. The dynamic control ratio masks bilateral asymmetries - A gender-specific analysis of 264 healthy and ACL-injured athletes. Res Sports Med 2021; 30:1-18. [PMID: 34187258 DOI: 10.1080/15438627.2021.1943389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Isokinetic strength tests are frequently applied to assess anterior cruciate ligament (ACL) rehabilitation processes. However, diverging methodologies cause misleading conclusions. This cross-sectional study evaluated the effects of gender (male vs. female), group (healthy vs. ACL-injured) and limb (dominant/healthy vs. non-dominant/ACL-injured) on thigh muscle balance of 138 female and 126 male athletes (50% ACL-injured, averagely 12.8 months after surgery). Balance was analysed between legs (bilateral asymmetry) and between concentric knee extensor (Qcon) and eccentric knee flexor strength (Hecc) (DCR = dynamic control ratio, DCRe = DCR at the equilibrium point). Females were generally 17-27% weaker than males. Independent of gender and time after surgery, ACL-injured athletes demonstrated bilateral asymmetries (7-20%) in peak (PMQcon, PMHecc) and DCRe moments (p ≤0.030; 0.018≤ηp2≤0.215). ACL-injured athletes' affected (24-28%) and unaffected (12-24%) hamstrings and quadriceps peak moments were significantly weaker compared to healthy athletes (p<0.001; 0.061≤ηp2≤0.362). The bilateral asymmetries of PMQcon significantly decreased from early to late self-reported rehabilitation phases (p<0.001; ηp2=0.158). Peak and DCRe moments detected bilateral asymmetries, whereas DCR revealed ~50% false negative attributions. This knowledge provides guidance for future design and interpretation of isokinetic tests.
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Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany.,Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Thomas Breitenmoser
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jan Vonhoegen
- Department of Orthopaedics and Sports Traumatology, Klinik am Ring, Cologne, Germany
| | - Dennis Horn
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jannik Severin
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Kevin Nolte
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Axel J Knicker
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
| | - Thomas Jaitner
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Heiko K Strüder
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
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Portela MA, Sánchez-Romero JI, Pérez VZ, Betancur MJ. Estimación de par basada en electromiografía de superficie: potencial herramienta para la rehabilitación de rodilla. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n3.75214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Múltiples estudios de procesamiento de señales han reportado la aplicación de las señales de electromiografía de superficie (sEMG) en robótica y en procesos de rehabilitación motora.Objetivo. Realizar una revisión de la literatura sobre el uso de señales de sEMG como alternativa para la estimación del par de rodilla con el fin de medir objetivamente el progreso de los pacientes en las diferentes etapas de rehabilitación de lesiones de rodilla.Materiales y métodos. Se realizó una revisión de la literatura publicada entre 1986 y 2018, sin límites geográficos, en las bases de datos Engineering Village, IEEE Xplore, ScienceDirect, Web of Science, Scopus y PubMed mediante la combinación de 8 términos de búsqueda.Resultados. Al finalizar la búsqueda inicial se obtuvieron 355 registros. Luego de realizar la remoción de duplicados esta cifra descendió a 308, los cuales fueron analizados para determinar si cumplían con los criterios de inclusión. Finalmente se incluyeron 18 estudios que describen de forma comparativa cómo estimar el par a partir de señales de sEMG.Conclusiones. El uso de señales de sEMG para calcular el par en una articulación es una herramienta alternativa que permite al terapeuta acceder a parámetros cuantitativos y, de esta forma, valorar el progreso de los pacientes durante el proceso de rehabilitación de rodilla.
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The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc 2019; 27:2608-2616. [PMID: 30421166 DOI: 10.1007/s00167-018-5283-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE While hamstring autograft is a popular option for the general population, BTB autograft is still significantly more popular among professional athletes due to concerns of altering knee kinematics with hamstring harvest. This study seeks to quantify the contribution of the medial hamstrings to knee stability. METHODS Valgus knee laxity, anterior tibial translation, and rotational motion were measured in eight fresh-frozen cadaveric knees after forces were applied on the tibia in each plane (coronal, sagittal, and axial). Four muscle loading conditions were tested: (1) physiologic fully loaded pes anserinus, (2) semitendinosus only loaded, (3) gracilis only loaded, and (4) unloaded pes anserinus. The protocol was then repeated with the ACL transected. RESULTS In the ACL intact knee, the neutral position of the tibia with an unloaded pes anserinus was significantly more externally rotated (p < 0.01) and anteriorly translated (p < 0.05) at all knee flexion angles than a tibia with a physiologic loaded pes anserinus. Applying an external rotation torque significantly increased external rotation for the fully unloaded (p < 0.001), gracilis only loaded (p < 0.001), and semitendinosus only loaded (p < 0.01) conditions at all flexion angles. Applying a valgus torque resulted in a significant increase in laxity for the fully unloaded condition only at 30° of flexion (p < 0.05). Applying an anterior tibial force resulted in significant increase in anterior translation for the fully unloaded condition at all flexion angles (p < 0.01), and for the gracilis only loaded condition in 30° and 60° of flexion (p < 0.05). Similar results were seen in the ACL deficient model. CONCLUSION The medial hamstrings are involved in rotational, translational, and varus/valgus control of the knee. Applying anterior, external rotation, and valgus forces on the hamstring deficient knee significantly increases motion in those planes. Harvesting the gracilis and semitendinosus tendons alters native knee kinematics and stability. This is clinically relevant and should be a consideration when choosing graft source for ACL reconstruction, especially in the elite athlete population.
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Alt T, Etzel JP, Knicker AJ, Strüder HK. The effects of fixation and contraction mode on prone isokinetic knee flexor tests. ISOKINET EXERC SCI 2019. [DOI: 10.3233/ies-192117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jakob P. Etzel
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Axel J. Knicker
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
- Research Centre for Elite Sports, MOMENTUM, Cologne, Germany
| | - Heiko K. Strüder
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
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Janssen RPA, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes. BMJ Open Sport Exerc Med 2018; 4:e000301. [PMID: 29682311 PMCID: PMC5905729 DOI: 10.1136/bmjsem-2017-000301] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 02/19/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction (ACLR) with accelerated, brace-free rehabilitation. DESIGN Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCES Embase, MEDLINE Ovid, Web of Science, Cochrane CENTRAL and Google scholar from 1 January 1974 to 31 January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Study designs reporting outcomes in adults after arthroscopic, primary ACLR with hamstring autograft and accelerated, brace-free rehabilitation. RESULTS Twenty-four studies were included in the review. The clinical outcomes after hamstring tendon autograft ACLR with accelerated brace-free rehabilitation were the following: (1) early start of open kinetic exercises at 4 weeks in a limited range of motion (ROM, 90°-45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes, (2) gender and age did not influence clinical outcomes, (3) anatomical reconstructions showed better results than non-anatomical reconstructions, (4) there was no difference between single-bundle and double-bundle reconstructions, (5) femoral and tibial tunnel widening occurred, (6) hamstring tendons regenerated after harvest and (7) biological knowledge did not support return to sports at 4-6 months. CONCLUSIONS After hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single-bundle and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited ROM (90°-45°) and progressive concentric and eccentric exercises from 12 weeks postsurgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as on validated, criterion-based assessments for safe return to sports. LEVEL OF EVIDENCE Level 2b; therapeutic outcome studies.
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Affiliation(s)
- Rob P A Janssen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
| | | | - Jan B A van Mourik
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
| | - Max Reijman
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lodewijk W van Rhijn
- Orthopaedic Surgery & Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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Pua YH, Ho JY, Chan SAS, Khoo SJ, Chong HC. Associations of isokinetic and isotonic knee strength with knee function and activity level after anterior cruciate ligament reconstruction: a prospective cohort study. Knee 2017; 24:1067-1074. [PMID: 28739425 DOI: 10.1016/j.knee.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/28/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although isokinetic dynamometry often serves as a reference to assess the concurrent validity of weight-machine isotonic strength testing, it is unknown whether isokinetic knee strength is associated with knee function and activity level more strongly than isotonic knee strength in patients with an anterior cruciate ligament reconstruction (ACLR). This study aimed to compare the associations of isokinetic and isotonic knee strength with knee function and work-and-sports activity levels in patients with ACLR. METHODS One-hundred and six patients with a unilateral ACLR participated. At three months post-ACLR, isokinetic quadriceps and hamstrings strength was measured using an isokinetic dynamometer whilst isotonic strength was measured using weight machines. At six months post-ACLR, patients performed the single-leg hop-for-distance test. Self reported knee function and work-and-sports activity levels were assessed by the Lysholm Knee Score and Tegner Activity Score, respectively. RESULTS In multivariable analyses, isotonic and isokinetic quadriceps strength limb symmetry indices (LSIs) were significantly associated with all outcomes (P≤0.03) and had comparable predictive performance. Isotonic and isokinetic hamstrings strength LSIs were significantly associated with Lysholm scores (P≤0.03) and isotonic hamstrings strength was additionally significantly associated with hop-for-distance LSI (P=0.01). CONCLUSIONS Weight machine-derived isotonic quadriceps strength was independently and consistently associated with knee function and work-and-sport activity level post-ACLR. Isokinetic knee strength was not more strongly associated than isotonic knee strength with the various outcomes. These findings have logistic and economic implications because the isokinetic dynamometer system is relatively expensive and its operation requires more logistic effort and technical skills.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Jia-Ying Ho
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | | | - Shin-Jiun Khoo
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Hwei-Chi Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore
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