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Ye H, Li ZQ, Yang JM, Long Y, Zhong YB, Wu Y, Wang MY. A network pharmacology-based study to investigate the mechanism of curcumin-regulated regenerative repair of quadriceps femoris muscle in KOA rats. Eur J Pharmacol 2024; 982:176910. [PMID: 39154821 DOI: 10.1016/j.ejphar.2024.176910] [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: 05/05/2024] [Revised: 07/29/2024] [Accepted: 08/15/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a very common musculoskeletal disorder, and patients with KOA often exhibit significant quadriceps femoris muscle atrophy. It is well established that curcumin (CUR) exerts protective effects on skeletal muscle. However, the efficacy of CUR in treating KOA-induced quadriceps femoris muscle atrophy and its underlying mechanisms remain uncertain. In this study, we employed network pharmacology to investigate the mechanism by which CUR promotes regenerative repair of the quadriceps femoris muscle in rats with KOA. METHODS The potential targets of CUR were obtained from Swiss Target Prediction. The targets of skeletal muscle regeneration were identified from GeneCard and OMIM. A Venn diagram was generated to visualize the intersection of CUR targets and skeletal muscle regeneration targets, and the core targets were identified using STRING. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted using DAVID. Finally, the network pharmacology results were further validated by establishing a KOA rat model using the Hulth method. RESULTS Network pharmacology analysis and molecular docking results revealed that CUR affects skeletal muscle regeneration through multiple targets and pathways. In vivo experimental results were validated by demonstrating that KOA causes atrophy and induces apoptosis in the quadriceps femoris muscle. Furthermore, CUR was shown to inhibit apoptosis in the quadriceps femoris muscle by regulating STAT3 and FOS, as well as the PI3K/AKT signaling pathway. CONCLUSIONS Our study revealed the apoptosis-inhibiting effects of CUR and its underlying mechanisms. Consequently, CUR has the potential to improve quadriceps femoris muscle atrophy caused by KOA.
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Affiliation(s)
- Hua Ye
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China; Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Ze-Qin Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China; Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Jia-Ming Yang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Yi Long
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China; Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China; Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi, China
| | - Yi Wu
- Gannan Medical University, Ganzhou City, Jiangxi, China; Jiangxi Provincal Key Laboratory of Tissue Engineering (2024SSY06291), School of Pharmacy, Gannan Medical University, Gouzhou, Jiangxi, China.
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China; Ganzhou Key Laboratory of Rehabilitation Medicine, GanZhou City, Jiangxi, China.
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Lloyd D. The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries. Sports Biomech 2024; 23:1284-1312. [PMID: 34496728 DOI: 10.1080/14763141.2021.1959947] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.
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Affiliation(s)
- David Lloyd
- School of Health Sciences and Social Work, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), in the Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Griffith University, Australia
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Rodriguez KM, Krishnan C, Palmieri-Smith RM. Number of conditioning trials, but not stimulus intensity, influences operant conditioning of brain responses after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39324365 DOI: 10.1002/ksa.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/07/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE The primary purpose of this randomized, cross-sectional study was to determine whether operant conditioning of motor evoked torque (MEPTORQUE) in individuals with total knee arthroplasty (TKA) increases quadriceps MEPTORQUE responses within a single session and induces acute corticospinal adaptations by producing sustained increases in MEPTORQUE after training. A secondary purpose was to determine if these changes were affected by the stimulus intensity and number of training trials. METHODS Thirty participants were block-randomized into one of three groups based on the participant's active motor threshold (100%, 120%, and 140%) to evaluate the effect of stimulus intensity. Participants received three blocks of conditioning trials (COND), where they trained to increase their MEPTORQUE. Control (CTRL) transcranial magnetic stimulation pulses were provided before and after each COND block to establish baseline corticospinal excitability and to evaluate the effect of the number of training trials. Two MEPTORQUE recruitment curves were collected to evaluate the effect of up-conditioning on acute corticospinal adaptations. RESULTS TKA participants were able to successfully increase their MEPTORQUE in a single session (F3,81 = 10.719, p < 0.001) and induce acute corticospinal adaptations (F1,27 = 20.029, p < 0.001), indicating sustained increases in quadriceps corticospinal excitability due to operant conditioning. While the stimulus intensity used during training did not affect the ability to increase MEPTORQUE (F2,26 = 0.021, n.s.) or its associated acute adaptations (F2,27 = 0.935, n.s.), the number of training trials significantly influenced these outcomes (F3,81 = 10.719, p < 0.001; F3,81 = 4.379, p = 0.007, respectively). CONCLUSION Operant conditioning is a feasible approach for improving quadriceps corticospinal excitability following TKA. While any of the three stimulus intensities evaluated in this study may be used in future operant conditioning interventions, using a low or moderate stimulus intensity and 150 training trials are recommended to improve treatment efficiency and patient adherence. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kazandra M Rodriguez
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, Michigan, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Therapy, College of Health Sciences, University of Michigan-Flint, Flint, Michigan, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Schoepp C, Dickschas J, Schmeling A, Perwanger F, Izadpanah K, Praetorius A. Treatment of Arthrogenic-Muscle-Inhibition in patients after knee-surgery with Motion-Activated-Neuromuscular stimulation - a case-series. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024. [PMID: 39231494 DOI: 10.1055/a-2365-9612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Arthrogenic muscle inhibition (AMI) presents a persistent challenge in postoperative knee rehabilitation and is often resistant to standard care. This case series examines the efficacy of Motion-Activated Neuromuscular Electrical Stimulation (mNMES) in addressing AMI refractory to rehabilitation after ACL (revision) surgery, patellar dislocation, trochleoplasty, or conservative treatment of the patellofemoral pain syndrome. Eight patients who had undergone extensive unsuccessful rehabilitation received six weeks of a novel mNMES treatment regimen. Outcome assessments included patient-reported outcome measures (PROMs) and AMI classification. Results revealed significant improvements in pain reduction, knee function, and AMI reduction. Despite study limitations, mNMES demonstrated promising outcomes and could be used as an adjunct to standard rehabilitation, offering potential for enhancing postoperative outcomes in patients refractory to conventional therapy. Further research is required to validate these findings and optimise treatment protocols.
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Affiliation(s)
- Christian Schoepp
- Klinik für Arthroskopische Chrirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
| | - Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, GERMANY
| | | | | | - Kaywan Izadpanah
- Universitätsklinikum Freiburg Chirurgische Universitatsklinik: Universitatsklinikum Freiburg Department Chirurgie, Freiburg, GERMANY
| | - Arthur Praetorius
- Klinik für Arthroskopische Chirurgie, Sportraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
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Kim S, Park J, Boling MC, Glaviano NR. Lower Extremity Muscle Volume in Unilateral and Bilateral Patellofemoral Pain: A Cross-Sectional Exploratory Study Including Superficial and Deep Muscles. J Athl Train 2024; 59:915-924. [PMID: 38015817 PMCID: PMC11440819 DOI: 10.4085/1062-6050-0330.23] [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] [Indexed: 11/30/2023]
Abstract
CONTEXT Existing patellofemoral pain (PFP) literature has primarily been focused on quadriceps muscle volume, with limited attention given to the deep and superficial muscle volume of the lower limbs in individuals with unilateral and bilateral PFP. In this paper, we aim to fill this gap. OBJECTIVE To explore superficial and deep lower extremity muscle volume in women with unilateral or bilateral PFP compared with a normative database of pain-free women. DESIGN Cross-sectional study. SETTING University imaging research center. PATIENTS OR OTHER PARTICIPANTS Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women from a normative database. MAIN OUTCOME MEASURE(S) We quantified lower extremity muscle volume via 3.0-T magnetic resonance imaging. Two separate 1-way analyses of variance were performed: (1) unilateral PFP (painful versus nonpainful limb) versus pain-free control groups and (2) bilateral PFP (more painful versus less painful limb) versus pain-free control groups. RESULTS We observed no differences in age and body mass index across groups (P > .05). Compared with the pain-free group, the unilateral and bilateral PFP groups had bilaterally smaller volumes of the anterior (iliacus: P ≤ .0004; d range, 2.12-2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤ .02; d range, 1.25-2.48), posterior (obturator externus, obturator internus, and quadratus femoris: P < .05; d range, 1.17-4.82), and lateral (gluteus minimus: P ≤ .03; d range, 1.16-2.09) hip muscles and knee extensors (rectus femoris: P ≤ .003; d range, 1.67-2.16) and flexors (long and short head of the biceps femoris: P ≤ .01, d range, 1.56-1.93). CONCLUSIONS Women with unilateral and those with bilateral PFP displayed less volume of multiple superficial and deep muscles of the bilateral hips and knees than pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to increase choices for intervention.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs
- Institute for Sports Medicine, University of Connecticut, Storrs
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs
- Institute for Sports Medicine, University of Connecticut, Storrs
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Dos Anjos T, Guillot A, Daligault S, Chamoun DM, De Sousa T, Di Rienzo F. Low-frequency sounds combined with motor imagery elicits a transient disruption of force performance: A path to neuromotor reprogramming? Neuroimage 2024; 297:120746. [PMID: 39033789 DOI: 10.1016/j.neuroimage.2024.120746] [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: 02/08/2024] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 07/23/2024] Open
Abstract
The effectiveness of motor imagery (MI) training on sports performance is now well-documented. Recently, it has been proposed that a single session of MI combined with low frequency sound (LFS) might enhance muscle activation. However, the neural mechanisms underlying this effect remain unknown. We set up a test-retest intervention over the course of 2 consecutive days to evaluate the effect of (i) MI training (MI, n = 20), (ii) MI combined with LFS (MI + LFS, n = 20), and (iii) a control condition (CTRL, n = 20) on force torque produced across repeated maximal voluntary contractions of the quadriceps before (Pretest), after (Posttest) and at +12 h (Retention) post-intervention. We collected the integrated electromyograms of the quadriceps muscles, as well as brain electrical potentials during each experimental intervention. In the CTRL group, total force torque decreased from Pretest to Retention and from Posttest to Retention. By contrast, there was an increase between Posttest and Retention in both MI + LFS and MI groups (both ηP2 = 0.03, p < 0.05). Regression analyses further revealed a negative relationship between force performance and EEG activity in the MI + LFS group only. The data support a transient interference of LFS on cortical activity underlying the priming effects of MI practice on force performance. Findings are discussed in relation to the potential for motor reprogramming through MI combined with LFS.
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Affiliation(s)
- Typhanie Dos Anjos
- Universite Lyon 1, UCB-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-UR 7424, F-69622, Villeurbanne Cedex, France; Allyane®, 84 quai Joseph Gillet, 69004 Lyon, France
| | - Aymeric Guillot
- Universite Lyon 1, UCB-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-UR 7424, F-69622, Villeurbanne Cedex, France
| | - Sebastien Daligault
- Centre de Recherche Multimodal et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Department of Magnetoencephalography, F-69500 Bron, France
| | - Donna-Maria Chamoun
- Universite Lyon 1, UCB-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-UR 7424, F-69622, Villeurbanne Cedex, France
| | - Thomas De Sousa
- Universite Lyon 1, UCB-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-UR 7424, F-69622, Villeurbanne Cedex, France
| | - Franck Di Rienzo
- Universite Lyon 1, UCB-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-UR 7424, F-69622, Villeurbanne Cedex, France.
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Praetorius A. [Blood flow restriction training (BFRT) in patients before and after total knee arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024:10.1007/s00132-024-04543-1. [PMID: 39120683 DOI: 10.1007/s00132-024-04543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND In healthy individuals, blood flow restriction training (BFRT) has shown positive effects on muscle mass, strength, fatigue resistance, as well as tendon and bone metabolism. BFRT reduces blood flow in the extremities using inflatable cuffs, creating local muscular hypoxia, which produces an anabolic metabolic environment. This promotes significant muscular and cardiovascular adaptations even at low mechanical training loads. KNEE ENDOPROSTHESES BFRT also shows promising initial results in pre- and postoperative applications for knee endoprostheses (KTEP). Both preoperative and postoperative BFRT can improve muscle strength and joint function, accelerate recovery, and alleviate pain. Although the method is generally safe, potential risks such as discomfort and rare side effects must be considered. Clear application protocols are still lacking, necessitating further research and individualized programs to achieve optimal training effects. BFRT thus offers an innovative way to effectively rehabilitate patients despite their low load tolerance.
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Affiliation(s)
- Arthur Praetorius
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, Motoriklabor Athletikum Rhein Ruhr, BG Klinikum Duisburg, Großenbaumer Allee 250, 47259, Duisburg, Deutschland.
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Kim M, Gu M, Kim HY, Kim J, Lee JH, Lee HY. Assessment of arthrogenic quadriceps muscle inhibition by physical examination in the supine position during isometric contraction is feasible as demonstrated by electromyography: a cross-sectional study. J Orthop Surg Res 2024; 19:458. [PMID: 39095797 PMCID: PMC11297743 DOI: 10.1186/s13018-024-04949-9] [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] [Received: 05/31/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Preventing severe arthrogenic muscle inhibition (AMI) after knee injury is critical for better prognosis. The novel Sonnery-Cottet classification of AMI enables the evaluation of AMI severity but requires validation. This study aimed to investigate the electromyography (EMG) patterns of leg muscles in the examination position from the classification during isometric contraction to confirm its validity. We hypothesised that the AMI pattern, which is characterised by quadriceps inhibition and hamstring hypercontraction, would be detectable in the supine position during isometric contraction. METHODS Patients with meniscal or knee ligament injuries were enrolled between August 2023 and May 2024. Surface EMG was assessed during submaximal voluntary isometric contractions (sMVIC) at 0° extension in the supine position for the vastus medialis (VM) and vastus lateralis (VL) muscles and at 20° flexion in the prone position for the semitendinosus (ST) and biceps femoris (BF) muscles. Reference values for normalisation were obtained from the EMG activity during the gait of the uninjured leg. The Kruskal-Wallis test was used to compare the activation patterns of the muscle groups within the same leg, and the post-hoc tests were conducted using the Mann-Whitney U test and Bonferroni correction. RESULTS Electromyographic data of 40 patients with knee injuries were analyzed. During sMVIC, the extensor and flexor muscles of the injured leg showed distinct behaviours (P < 0.001), whereas the uninjured side did not (P = 0.144). In the injured leg, the VM differed significantly from the ST (P = 0.018), and the VL differed significantly from the ST and BF (P = 0.001 and P = 0.026, respectively). However, there were no statistically significant differences within the extensor muscle groups (VM and VL, P = 0.487) or flexor muscle groups (ST and BF, P = 0.377). CONCLUSION AMI was detectable in the examination position suggested by the Sonnery-Cottet classification. The flexor and extensor muscles of the injured leg exhibited distinct activation behaviours, with inhibition predominantly occurring in the quadriceps muscles, whereas the hamstrings showed excitation.
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Affiliation(s)
- Minhee Kim
- Department of Physical Therapy, College of Health Science, Eulji University, Seongnam, Republic of Korea
| | - Minseo Gu
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Jinee Kim
- Physical Therapy and Rehabilitation Centre, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Jeong-Hoon Lee
- Physical Therapy and Rehabilitation Centre, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea.
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Republic of Korea.
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Yoshii R, Konishi Y, Ochiai S, Hagino T, Takeshita D, Yamagata Z. Abnormality in re-programing of preparatory muscle activity for landing following unpredictable events in patients with anterior cruciate ligament injury. Knee 2024; 49:8-16. [PMID: 38824769 DOI: 10.1016/j.knee.2024.05.004] [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: 10/15/2023] [Revised: 03/17/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Anterior cruciate ligament deficiency (ACL-D) causes dysfunction in the quadriceps femoris muscle, and this dysfunction hampers a safe return to sports. However, how the dysfunctional quadriceps femoris muscle affects instantaneous re-programming of motor command in response to unpredictable events remains unknown. This study aimed to examine the effects of ACL-D on re-programming of preparatory muscle activity during an unpredictable landing task. METHODS Eighteen patients with ACL-D and 20 healthy participants (controls) performed normal landing and surprise landing tasks. In the surprise landing task, a false floor, designed to dislodge easily under load, was positioned in the middle of the descent path. This setup causes participants to unpredictably fall through the false floor onto the actual landing surface. Electromyography data collected during the period after passing through the false floor until landing was segmented into two equal halves. The average electromyography amplitude for each muscle in each period was compared between patients and controls. RESULTS In the vastus medialis and rectus femoris during the surprise landing task, the average electromyography amplitude during only the second half period in patients with ACL-D was significantly smaller than that in controls (p = 0.011 and 0.004, respectively). CONCLUSIONS Abnormalities were detected in the re-programming of preparatory muscle activation during an unpredictable landing task in the vastus medialis and rectus femoris of patients with ACL-D. The surprise landing task used in the present study has the potential to become a diagnostic tool to evaluate readiness for safely returning to sports.
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Affiliation(s)
- Ryo Yoshii
- Department of Rehabilitation, National Hospital Organization, Kofu National Hospital, 11-35 Tenjincho, Kofu City, Yamanashi 400-8533, Japan; Department of Health Sciences, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi 409-3898, Japan
| | - Yu Konishi
- Department of Physical Education, National Defense Academy of Japan, 1-10-20 Hashirimizu, Yokosuka City, Kanagawa 239-8686, Japan
| | - Satoshi Ochiai
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjincho, Kofu City, Yamanashi 400-8533, Japan
| | - Tetsuo Hagino
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjincho, Kofu City, Yamanashi 400-8533, Japan
| | - Daisuke Takeshita
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan.
| | - Zentaro Yamagata
- Department of Health Sciences, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi 409-3898, Japan
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Tarantino D, Forte AM, Picone A, Sirico F, Ruosi C. The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study. J Pers Med 2024; 14:784. [PMID: 39201976 PMCID: PMC11355087 DOI: 10.3390/jpm14080784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 09/03/2024] Open
Abstract
Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | | | - Antonio Picone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
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Sartori F, Fagnani PLF, Monne-Guasch L, La Cagnina G, Picañol J, Puig-Diví A. Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial. Front Med (Lausanne) 2024; 11:1410495. [PMID: 39021827 PMCID: PMC11251890 DOI: 10.3389/fmed.2024.1410495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited. Objectives This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS. Methods Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations. Results Peripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group. Conclusion This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.
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Affiliation(s)
- Francesco Sartori
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | | | - Laia Monne-Guasch
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | | | - Javier Picañol
- Department of Health Sciences, Tecnocampus, Pompeu Fabra University, Mataró, Spain
| | - Albert Puig-Diví
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
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Correia Bulhões LC, Alves Gomes SR, da Silva VD, de Azevedo Rodolfo JI, Macedo LDB, Brasileiro JS. Effects of a mat Pilates-based exercise program for low back pain in helicopter pilots of the Brazilian Air Force: Randomized controlled trial. J Bodyw Mov Ther 2024; 39:544-549. [PMID: 38876683 DOI: 10.1016/j.jbmt.2024.03.052] [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: 11/07/2022] [Revised: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Helicopter pilots may present chronic low back pain due to vibration exposure and asymmetric posture during flight. OBJECTIVES To analyze the effects of a Pilates-based exercise program on low back pain of helicopter pilots of the Brazilian Air Force. METHODS This is a randomized controlled trial with fifteen helicopter pilots of the Brazilian Air Force, who were assessed for pain intensity (Numerical Pain Rating Scale), disability associated with low back pain, and spine muscle endurance in three positions: trunk extension (Ito test) and left and right lateral bridge. Individuals were randomly distributed into the regular exercises group (REG) (n = 7), oriented to maintain their exercise routine, and Pilates group (PG) (n = 8), which performed an exercise program based on Pilates method twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Data were analyzed on SPSS 20.0 software using a significance level of 5%. RESULTS PG showed a significant reduction in low back pain after 12 weeks of training compared with REG (mean difference of 3.5 points, p < 0.0001). We also observed increased endurance of trunk extensors (p = 0.002) and right (p = 0.001) and left lateral muscles (p = 0.001) in the PG compared with REG. However, the indexes of disability did not change between groups. CONCLUSION Pain intensity was significantly reduced while spine muscle endurance increased in PG compared with REG after intervention; thus, Pilates-based exercises should be considered in physical conditioning programs for helicopter pilots.
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Cruz-Montecinos C, Moena-León M, Durán-Ovalle A, Lizama-Jofré A, Soto V, Oyarzún A, Tapia C, Freitas SR, Pinto RS, Núñez-Cortés R, Daffunchio C. 30-sit-to-stand power is a better tool than isometric knee extensor strength to detect motor impairment in people with haemophilic arthropathy. Haemophilia 2024; 30:1010-1017. [PMID: 38712982 DOI: 10.1111/hae.15021] [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: 01/17/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Regular assessment of motor impairments is crucial in people with haemophilic arthropathy (PwHA). This study aimed to determine if there are differences in 30-seconds sit-to-stand (30-STS) power and maximal voluntary isometric contraction (MVIC) of the knee extensors between PwHA and healthy control group (CG). The secondary aims were to investigate the correlation between 30-STS power and MVIC of knee extensors with clinical characteristics and to assess their effectiveness in identifying motor impairment in PwHA. METHODS A cross-sectional study was conducted by collecting data from PwHA (n = 17) and a sedentary CG (n = 15). MVIC (torque) and 30-STS power were normalised to body mass. Correlation analysis and simple linear regression adjusted for age were used to assess the association between tests and clinical variables. Using z-scores derived from the mean and standard deviation of the CG, we compared the MVIC and the 30-STS power in PwHA. RESULTS PwHA showed lower MVIC and 30-STS power compared to CG (p < .001; large effect size d > .8). Lower 30-STS power was associated with greater joint impairment and greater fear of movement, whereas MVIC showed no association with clinical variables. 30-STS power showed a lower z-score compared to MVIC (p < .001). In addition, 30-STS power detected 47% of PwHA with motor impairment compared to 0% for MVIC (p = .002). CONCLUSIONS Our results suggest that 30-STS power may be more effective than knee extensors MVIC in detecting motor impairment in PwHA. Consequently, lower limb skeletal muscle power, rather than maximum knee extensor strength, appears to be more affected in PwHA.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Research, Innovation, and Development Section in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - María Moena-León
- School of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Antonio Durán-Ovalle
- School of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Aracelli Lizama-Jofré
- School of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Soto
- Haemophilia Unit, Roberto del Río Hospital, Santiago, Chile
| | - Andrés Oyarzún
- Orthopaedic Surgery Unit, Hospital San Jose, Santiago, Chile, San José Hospital, Santiago, Chile
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandro R Freitas
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Lisboa, Portugal
| | - Ronei S Pinto
- Strength Training Research Group (GPTF), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carla Daffunchio
- Department of Traumatology, Juan A. Fernàndez Hospital, CABA, Buenos Aires, Argentina
- Haemophilia Foundation, CABA, Buenos Aires, Argentina
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Rodriguez KM, Moon J, Krishnan C, Palmieri-Smith RM. Conditioning of Motor Evoked Responses After Anterior Cruciate Ligament Reconstruction: Effects of Stimulus Intensity. Sports Health 2024:19417381241257258. [PMID: 38864306 DOI: 10.1177/19417381241257258] [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: 06/13/2024] Open
Abstract
BACKGROUND Operant conditioning of motor evoked torque (MEPTORQUE) can directly target the corticospinal pathway in patients with anterior cruciate ligament (ACL) reconstruction. However, it remains unclear whether operant conditioning can elicit short-term improvements in corticospinal excitability and whether these improvements are influenced by stimulus intensity. HYPOTHESIS Quadriceps MEPTORQUE responses can be upconditioned in a single session and will elicit short-term adaptations in corticospinal excitability, with higher stimulus intensities eliciting greater effects. STUDY DESIGN Randomized controlled laboratory study. LEVEL OF EVIDENCE Level 2. METHODS Thirty-six participants were assessed during a single session of an operant conditioning protocol. Participants were randomized into 1 of 3 groups for stimulus intensity used during operant conditioning based on the participant's active motor threshold (AMT: 100%, 120%, and 140%). Quadriceps MEPTORQUE amplitude was evaluated during a block of control transcranial magnetic stimulation trials (CTRL) to establish baseline corticospinal excitability, and 3 blocks of conditioning trials (COND) during which participants trained to upcondition their MEPTORQUE. MEPTORQUE recruitment curves were collected to evaluate the effect of operant conditioning on acute corticospinal adaptations. RESULTS Participants with ACL reconstruction could upcondition their MEPTORQUE in a single session (P < 0.01; CTRL, 17.27 ± 1.28; COND, 21.35 ± 1.28 [mean ± standard error [SE] in N·m]), but this ability was not influenced by the stimulus intensity used during training (P = 0.84). Furthermore, significant improvements in corticospinal excitability were observed (P = 0.05; PRE, 687.91 ± 50.15; POST, 761.08 ± 50.15 [mean ± SE in N·m %AMT]), but stimulus intensity did not influence corticospinal adaptations (P = 0.67). CONCLUSION Operant conditioning can elicit short-term neural adaptations in ACL-reconstructed patients. Future operant conditioning paradigms may effectively use any of the 3 stimulus intensities studied herein. CLINICAL RELEVANCE Operant conditioning may be a feasible approach to improve corticospinal excitability after ACL reconstruction.
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Affiliation(s)
| | - Jungsun Moon
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, Michigan
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
- Mechanical Engineering, University of Michigan
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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Tan M, Chen B, Li Q, Wang S, Chen D, Zhao M, Cao J. Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty: A Randomized Clinical Trial. Clin J Pain 2024; 40:373-382. [PMID: 38506437 PMCID: PMC11081475 DOI: 10.1097/ajp.0000000000001211] [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: 08/27/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these. METHODS Patients undergoing TKA were randomly assigned to 1 of 3 groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary end point was the Numeric Rating Scale (NRS) score at movement at 24 hours postsurgery. Secondary end points included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion, effective PCNA utilization, and opioid consumption at various postsurgery time points. RESULTS Of the 94 valid data sets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary end point (H=7.003, P =0.03). Post hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2 to 4]) compared with the ACB group (4 [3 to 5], Bonferroni-adjusted P =0.03). Regarding secondary end points, both the FNB and FTB groups had significantly lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other end points. DISCUSSION Continuous FTB provides postoperative analgesia comparable to FNB but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.
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Affiliation(s)
- Minghe Tan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Bozhou Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Qingshu Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Siqi Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Daiyu Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Maoji Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
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Johnston CD, Dewig DR, Pietrosimone B, Padua D, Ryan ED, Hart J, Spang J, Blackburn T. Longitudinal Changes in Quadriceps Morphology over the First 3 Months after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:933-941. [PMID: 38109204 DOI: 10.1249/mss.0000000000003359] [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: 12/20/2023]
Abstract
PURPOSE Neuromuscular deficits and atrophy after anterior cruciate ligament reconstruction (ACLR) may be accompanied by changes in muscle composition and poor quadriceps muscle quality (QMQ). Quadriceps atrophy occurs after ACLR but improves within the first three postoperative months, yet this hypertrophy could be attributable to increases in noncontractile tissue (i.e., poor QMQ). The purposes of this study were to evaluate changes in QMQ after ACLR and to determine if changes in QMQ and cross-sectional area (CSA) occur in parallel or independently. METHODS A longitudinal prospective cohort design was implemented to evaluate QMQ and CSA in 20 individuals with ACLR and 12 healthy controls. Participants completed three testing sessions (baseline/presurgery, 1 month, and 3 months) during which ultrasound images were obtained from the vastus lateralis (VL) and rectus femoris (RF). QMQ was calculated as the echo intensity (EI) of each image, with high EI representing poorer QMQ. Anatomical CSA was also obtained from each image. RESULTS RF and VL EI were greater at 1 and 3 months in the ACLR limb compared with baseline and the contralateral limb and did not change between 1 and 3 months. VL and RF CSA in the ACLR limb were smaller at 1 and 3 months compared with the contralateral limb and controls (VL only) but increased from 1 to 3 months. Changes in QMQ and CSA were not correlated. CONCLUSIONS QMQ declines within the first month after ACLR and does not improve by 3 months although hypertrophy occurs, suggesting that these morphological characteristics change independently after ACLR. Poorer QMQ represents greater concentration of noncontractile tissues within the muscle and potentially contributes to chronic quadriceps dysfunction observed after ACLR.
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Affiliation(s)
| | - Derek R Dewig
- Department of Health and Human Performance, Fairmont State University, Fairmont, WV
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darin Padua
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric D Ryan
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joe Hart
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Dos Anjos T, Gabriel F, Vieira TD, Hopper GP, Sonnery-Cottet B. Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery. Sports Health 2024; 16:383-389. [PMID: 37102673 PMCID: PMC11025506 DOI: 10.1177/19417381231169285] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries. HYPOTHESIS This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment. RESULTS A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% (P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment (P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment (P < 0.01). CONCLUSION Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery. CLINICAL RELEVANCE This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.
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Affiliation(s)
- Typhanie Dos Anjos
- Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, Villeurbanne Cedex, France
- ALLYANE, Lyon, France
| | | | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Graeme Philip Hopper
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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Dauty M, Le Mercier E, Menu P, Grondin J, Hirardot T, Daley P, Fouasson-Chailloux A. Prolonged Physiotherapy after Anterior Cruciate Ligament Reconstruction Does Not Improve Muscular Strength and Function. J Clin Med 2024; 13:2519. [PMID: 38731047 PMCID: PMC11084926 DOI: 10.3390/jcm13092519] [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: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: After the rupture of the anterior cruciate ligament (ACL), surgery is proposed in the case of knee instability or for athletes who want to return to a pivotal and/or contact sport. The current trend is to extend physiotherapy sessions until a patient's return to sport. We aimed to assess the interest in prolonging the physiotherapy sessions up to 4 postoperative months to restore muscle knee strength and function. Methods: From a historical cohort, 470 patients (24.3 ± 8.7 years) were included; 312 (66%) were males. They all had undergone a primary ACL reconstruction with a hamstring procedure. The number of physiotherapy sessions was established at 4 postoperative months. The main study parameters to assess the benefit of prolonged physiotherapy were the isokinetic limb symmetry index (LSI) for the quadriceps and the hamstrings as well as the Lysholm score. Results: At 4 postoperative months, 148 patients (31.4%) still had physiotherapy sessions. This group had performed 49 ± 14 physiotherapy sessions at the time of evaluation compared to 33 ± 9 sessions performed by the group that stopped physiotherapy at 3 months post-ACL reconstruction. The isokinetic knee LSI and the Lysholm score were not different between the two groups. Continued physiotherapy sessions were associated with female gender, previous high sport level, meniscal repair, lateral tenodesis and outpatient rehabilitation at the beginning of the rehabilitation management, while knee pain complications were not associated. Conclusions: No significant correlation was found between the number of physiotherapy sessions and the knee strength LSI or the Lysholm score. Prolonging patient physiotherapy sessions after 3 months post-ACL reconstruction seems ineffective in improving knee strength recovery and function.
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Affiliation(s)
- Marc Dauty
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Emmanuel Le Mercier
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
| | - Pierre Menu
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Jérôme Grondin
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Thomas Hirardot
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Pauline Daley
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Alban Fouasson-Chailloux
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
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Chan WWY, Fu SN, Chong TF, Singh G, Tsai DSJ, Wong MCY, Zheng YP, Parent EC, Cheung JPY, Wong AYL. Associations between paraspinal muscle characteristics and spinal curvature in conservatively treated adolescent idiopathic scoliosis: a systematic review. Spine J 2024; 24:692-720. [PMID: 38008187 DOI: 10.1016/j.spinee.2023.11.008] [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: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND CONTEXT Children with adolescent idiopathic scoliosis (AIS) may show asymmetrical paraspinal muscle characteristics. PURPOSE To summarize the evidence regarding: (1) the associations between various paraspinal muscle characteristics and spinal curvature; (2) whether paraspinal muscle properties significantly differed between children with and without AIS; and (3) whether baseline paraspinal muscle characteristics predicted curve progression. STUDY DESIGN/SETTING Systematic literature review. METHODS Five databases (CINAHL, Academic Search Premier, MEDLINE, Scopus, and PubMed) were searched from inception to May 2022. This protocol was registered in the PROSPERO database of systematic reviews CRD 42020171263. The Critical appraisal skills program, the Appraisal Tool for Cross-Sectional Studies and Quality In Prognosis Studies tool were used to evaluate the risk of bias of the included studies. The strength of evidence of each identified association was determined by the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). RESULTS Of 1,530 identified citations, four cohort, 17 cross-sectional, and 23 case-control studies including 31 with low, nine with moderate and four with high risk of bias were included. Low to very low-strength evidence supported that the convex side of the curve had more type I muscle fibers, higher muscle volume and paraspinal muscle activity, while the concavity had more intramuscular fatty infiltration. Very low-strength evidence substantiated greater side-to-side surface electromyography signals during left trunk bending in prone lying, standing, and standing with perturbation between people with and without AIS. Also, low to very low-strength evidence supported that a larger side-to-side surface electromyography ratio at the lower end vertebra predicted curve progression. CONCLUSIONS Our review highlights that paraspinal muscles on the concavity of the curve demonstrate consistent changes (ie, altered muscle-related gene expression, muscle atrophy, increased fatty infiltration, reduced type I fibers, and reduced muscle activity), which may be the cause or consequence.
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Affiliation(s)
- Winnie W Y Chan
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Tsz-Fung Chong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Gurjiven Singh
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Desmond S J Tsai
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Mathew C Y Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 St NW, Edmonton, Alberta T6G 2G4, Canada
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China.
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Ataş A, Abit Kocaman A, Karaca ŞB, Kasikci Çavdar M. Acute Effect of Kinesiology Taping on Muscle Activation, Functionality and Proprioception in Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Percept Mot Skills 2024; 131:446-468. [PMID: 38134448 DOI: 10.1177/00315125231222816] [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] [Indexed: 12/24/2023]
Abstract
Data on the mechanism of kinesiology taping (KT) for providing mechanical support, facilitating or inhibiting muscles, and increasing functionality in the treatment of knee osteoarthritis (OA) have been contradictory, with no study evaluating acute muscle activation. Our aim in this study was to determine the acute effect of KT applied to the rectus femoris muscle on this muscle's activation, functionality and proprioception in patients with knee osteoarthritis. We divided 40 individuals diagnosed with knee osteoarthritis into two groups: (a) KT group (taping with tension facilitation) and (b) a placebo group (taping with no tension facilitation). We applied taping to the participants' left and right side rectus femoris muscles for 30 minutes, but with muscle facilitation in the KT group and without tension in the placebo group. We assessed participants for muscle activation with surface electromyography (sEMG), for functionality with the Timed Up and Go Test (TUG), and for proprioception/joint sense with the Five Times Sit-to-Stand Test (5TSTS) before and after taping. Demographic and clinical characteristics of the groups before these interventions were similar (p > .05). Muscle activation did not change significantly in either group compared to before taping (p > .05), but there were improvements in both knees for proprioception/joint sense (p < .05). Both groups were similar in terms of functionality (5TSTS, TUG) results (p > .05). We concluded that KT applied bilaterally to the rectus femoris did not affect rectus femoris muscle activation and functionality in patients with knee OA, but it did improve proprioception.
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Affiliation(s)
- Aylin Ataş
- Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Ayşe Abit Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Şahika Burcu Karaca
- Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Merve Kasikci Çavdar
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Labanca L, Tedeschi R, Mosca M, Benedetti MG. Individuals With Chronic Ankle Instability Show Abnormalities in Maximal and Submaximal Isometric Strength of the Knee Extensor and Flexor Muscles. Am J Sports Med 2024; 52:1328-1335. [PMID: 38459686 PMCID: PMC10986150 DOI: 10.1177/03635465241232090] [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: 07/18/2023] [Accepted: 12/15/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND It has been shown that chronic ankle instability (CAI) leads to abnormalities in neuromuscular control of more proximal joints than the ankle. Although strength of the hip and the ankle muscles has been largely investigated providing concordant results, limited evidence with contrasting results has been reported regarding knee extensor and flexor muscles. PURPOSE To investigate maximal and submaximal isometric muscle strength in individuals with CAI. STUDY DESIGN Controlled laboratory study. METHODS Fifteen participants with unilateral CAI and 15 healthy matched controls were recruited. To quantify maximal strength, peak forces were recorded during a maximal isometric voluntary contraction of knee extensor and flexor muscles at 30° and 90° of knee flexion and normalized by the body weight of each participant. At both angles, submaximal isometric contractions at 20%, 50%, and 80% of the maximal voluntary isometric contraction were performed to analyze strength steadiness, in terms of coefficient of variation, and strength accuracy, in terms of absolute error. During all the assessments, knee extensor and flexor muscle activation was recorded by means of surface electromyography. RESULTS Knee flexor maximal isometric strength was significantly lower in the injured limb of individuals with CAI in comparison with healthy controls at both 30° (0.15 ± 0.05 vs 0.20 ± 0.05; P < .05) and 90° (0.14 ± 0.04 vs 0.18 ± 0.05; P < .05). Knee extensor and flexor steadiness was significantly lower (higher coefficient of variation) in both the injured and the noninjured limbs of individuals with CAI in comparison with healthy individuals at 90° and at 30° for knee flexor steadiness of the injured limb. Knee extensor and flexor accuracy was lower (higher absolute error) in both the injured and noninjured limbs of individuals with CAI in comparison with healthy individuals, mainly at 30°, while at 90° it was lower only in the injured limb. No differences between the 2 groups were found for maximal isometric strength of knee extensor muscles, as well as for muscle activations. CONCLUSION Individuals with CAI show abnormalities in maximal and submaximal isometric strength of knee flexor muscles, and submaximal strength of the knee extensor muscles. Further studies should deeply investigate mechanisms leading to these abnormalities. CLINICAL RELEVANCE Rehabilitation interventions should consider abnormalities of neuromuscular control affecting joints more proximal than the ankle in individuals with CAI. REGISTRATION NCT05273177 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Churchill L, John Bade M, Koonce RC, Stevens-Lapsley JE, Bandholm T. The past and future of peri-operative interventions to reduce arthrogenic quadriceps muscle inhibition after total knee arthroplasty: A narrative review. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100429. [PMID: 38304413 PMCID: PMC10832271 DOI: 10.1016/j.ocarto.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024] Open
Abstract
Total knee arthroplasty (TKA) improves patient-reported function by alleviating joint pain, however the surgical trauma exacerbates already impaired muscle function, which leads to further muscle weakness and disability after surgery. This early postoperative strength loss indicates a massive neural inhibition and is primarily driven by a deficit in quadriceps muscle activation, a process known as arthrogenic muscle inhibition (AMI). To enhance acute recovery of quadriceps muscle function and long-term rehabilitation of individuals after TKA, AMI must be significantly reduced in the early post-operative period. The aim of this narrative review is to review and discuss previous efforts to mitigate AMI after TKA and to suggest new approaches and interventions for future efficacy evaluation. Several strategies have been explored to reduce the degree of post-operative quadriceps AMI and improve strength recovery after TKA by targeting post-operative swelling and inflammation or changing neural discharge. A challenge of this work is the ability to directly measure AMI and relevant contributing factors. For this review we focused on interventions that aimed to reduce post-operative swelling or improve knee extension strength or quadriceps muscle activation measured by twitch interpolation. For individuals undergoing TKA, the use of anti-inflammatory medications, tranexamic acid, cryotherapy, intra-articular drains, torniquets, and minimally invasive surgical techniques for TKA have limited benefit in attenuating quadriceps AMI early after surgery. However, interventions such as inelastic compression garments, voluntary muscle contractions, and neuro-muscular electrical stimulation show promise in mitigating or circumventing AMI and should continue to be refined and explored.
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Affiliation(s)
- Laura Churchill
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael John Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Ryan C. Koonce
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Highlands Ranch, CO, USA
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
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Chen P, Wang L, Zhou W, Wang L. Efficacy on knee function of Kinesio taping among individuals with anterior cruciate ligament reconstruction: A systematic review. PLoS One 2024; 19:e0299008. [PMID: 38421970 PMCID: PMC10903864 DOI: 10.1371/journal.pone.0299008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/04/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study aims to evaluate systematically the efficacy of Kinesio taping (KT) on the knee function of individuals who undergo anterior cruciate ligament reconstruction (ACLR). METHODS This study was registered in PROSPERO (registration number CRD42023399885) on February 26, 2023. Randomized controlled trials (RCTs) about the effects on the knee function of KT among individuals after ACLR were electronically searched from PubMed, Web of Science, Embase, The Cochrane Library, and EBSCO from inception to July 02, 2023. The outcome measures included six continuous variables: quadriceps strength, hamstring strength, knee swelling, knee flexion angle, Lysholm knee function score, and Visual Analog Scale (VAS) pain scores. The Cochrane Risk Bias Assessment Tool was used to evaluate the quality of the included literature. RESULTS Seven RCTs including 278 patients who underwent ACLR were included in the systematic review. One of three (33%) studies found a remarkable increase in quadricep strength associated with the use of KT compared with the control group. Two of two (100%) studies found substantial increases in hamstring strength associated with KT. Two of four (50%) studies reported KT reduced knee swelling. Two of five (40%) studies reported considerable improvements in knee flexion angle in the groups that used KT. All three (100%) studies found KT did not improve Lysholm knee function scores. Three of four (75%) studies noted a significant reduction in VAS pain scores associated with KT. CONCLUSION KT may help improve hamstring strength and reduce knee swelling and pain in patients after ACLR. Further studies are needed to determine the effects of KT on quadricep strength and knee flexion angle.
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Affiliation(s)
- Peng Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Ling Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Wenxing Zhou
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lin Wang
- Sports Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
- Shanghai Shangti Orthopaedic Hospital, Shanghai, China
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Maeda T, Sasaki E, Kasai T, Igarashi S, Wakai Y, Sasaki T, Tsuda E, Ishibashi Y. Therapeutic effect of knee extension exercise with single-joint hybrid assistive limb following total knee arthroplasty: a prospective, randomized controlled trial. Sci Rep 2024; 14:3889. [PMID: 38365932 PMCID: PMC10873320 DOI: 10.1038/s41598-024-53891-7] [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: 08/27/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
The single-joint hybrid assistive limb (HAL-SJ), an exoskeletal robotic suit, offers functional improvement. In this prospective randomized controlled trial, we investigated the therapeutic effects of knee extension exercises using the HAL-SJ after total knee arthroplasty (TKA). Seventy-six patients with knee osteoarthritis were randomly assigned to HAL-SJ or conventional physical therapy (CPT) groups. The HAL-SJ group underwent exercise using the HAL-SJ for 10 days postoperatively, in addition to CPT; the CPT group underwent only CPT. Pain intensity and active and passive knee extension angles were evaluated preoperatively and on postoperative days 1-10 and weeks 2 and 4. Performance tests and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated preoperatively and at postoperative weeks 2 and 4. Statistical analysis showed that the HAL-SJ group significantly improved active and passive knee extension angles compared with the CPT group. The HAL-SJ group showed immediate improvement in active knee extension angle through day 5. There were no significant differences in results between the performance tests and KOOS. Knee extension exercises with the HAL-SJ improved knee pain and the angle of extension in the acute phase after TKA.
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Affiliation(s)
- Takaya Maeda
- Department of Rehabilitation, Hirosaki Memorial Hospital, 59-1, Sakaizekinishida, Hirosaki, Aomori, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Shigesato Igarashi
- Department of Rehabilitation, Hirosaki Memorial Hospital, 59-1, Sakaizekinishida, Hirosaki, Aomori, Japan
| | - Yuji Wakai
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Tomoyuki Sasaki
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Sonnery-Cottet B, Ripoll T, Cavaignac E. Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI). Orthop Traumatol Surg Res 2024; 110:103784. [PMID: 38056774 DOI: 10.1016/j.otsr.2023.103784] [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: 10/24/2022] [Accepted: 06/06/2023] [Indexed: 12/08/2023]
Abstract
The knee is a joint that is often injured in sport, with a large and increasing number of ligament tears and repairs; postoperative complications can lead to poor outcome, such as stiffness. Beyond the well-known and well-described intra- and extra-articular causes of postoperative stiffness, the present study introduces the concept of a central reflex motor inhibition mechanism called arthrogenic muscle inhibition (AMI). AMI occurs after trauma and can be defined as active knee extension deficit due to central impairment of Vastus Medialis Obliquus (VMO) contraction, often associated with spinal reflex hamstring contracture. This explains the post-traumatic flexion contracture that is so common after knee sprain. The clinical presentation of AMI is easy to detect in consultation, in 4 grades from simple VMO inhibition to fixed flexion contracture by posterior capsule retraction in chronic cases. After recent anterior cruciate ligament (ACL) tear, more than 55% of patients show AMI, reducible in 80% of cases by simple targeted exercises initiated in consultation. Practically, in patients who have sustained knee sprain, it is essential to screen for this reflex mechanism and assess reducibility, as AMI greatly aggravates the risk of postoperative stiffness. In case of hemarthrosis, we recommend joint aspiration, which provides immediate benefit in terms of pain and motor inhibition. In case of persistent AMI, classical electrostimulation and "cushion crush", as used by all physiotherapists, are ineffective. To reduce the risk of postoperative stiffness, no surgery should be considered until AMI has resolved. LEVEL OF EVIDENCE: expert opinion.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Groupe Ramsay-Santé, centre orthopédique Santy, FIFA Medical Center of Excellence, hôpital privé Jean-Mermoz, Lyon, France.
| | - Thomas Ripoll
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
| | - Etienne Cavaignac
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
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Drigny J, Reboursière E, Praz C, Guermont H, Hulet C, Gauthier A. Changes in passive hamstring stiffness after primary anterior cruciate ligament reconstruction: A prospective study with comparison of healthy controls. Clin Biomech (Bristol, Avon) 2024; 112:106168. [PMID: 38219455 DOI: 10.1016/j.clinbiomech.2023.106168] [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: 07/25/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The mechanical properties of knee flexors muscles contribute to reducing anterior cruciate ligament loading. This case-control study evaluated the passive knee flexors stiffness after primary anterior cruciate ligament reconstruction with comparison of healthy controls. METHODS After anterior cruciate ligament reconstruction, 88 participants (24.5 [8.6] years, 56,8% males) had two isokinetic tests at 4 and 8 postoperative months with measurement of the passive resistive torque of knee flexors and extensors/flexors strength. In the control group, 44 participants (24.5 [4.3] years, 56,8% males) had one visit with the same procedures. Passive knee flexors stiffness was calculated as the slope of the passive torque-angle curve on the last 10° of knee extension (Nm/°). We investigated the impact of timing and type of surgery (autograft and combined meniscus repair) and persistent knee extension deficits on knee flexors stiffness. FINDINGS At 4 and 8 postoperative months, passive knee flexors stiffness was lower on the operated limb than on the non-operated limb (P < 0.001) but both limbs had significant lower values than controls (P < 0.001). Stiffness was positively correlated with knee flexors strength (P < 0.010), and knee flexors stiffness at 4 months was lower in individuals who underwent surgery <6 months from injury (P = 0.040). Knee extension deficit or the type of surgery did not have a significant influence on knee flexors stiffness. INTERPRETATION Similarly to neuromuscular factors that are traditionally altered after anterior cruciate ligament reconstruction, evaluating passive knee flexors stiffness changes over time could provide supplementary insights into postoperative muscle recovery.
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Affiliation(s)
- Joffrey Drigny
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France.
| | | | - Cesar Praz
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Henri Guermont
- Service de Médecine du Sport, CHU de Caen Normandie, 14000 Caen, France
| | - Christophe Hulet
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
| | - Antoine Gauthier
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Bilateral neuromuscular control in patients one year after unilateral ACL rupture or reconstruction. A cross-sectional study. Heliyon 2024; 10:e24364. [PMID: 38268828 PMCID: PMC10803901 DOI: 10.1016/j.heliyon.2024.e24364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Objectives To compare bilateral neuromuscular control in patients one year after anterior cruciate ligament reconstruction (ACL-R) or conservative treatment (ACL-C) to healthy controls (ACL-I). Design Cross-sectional study. Setting Electromyography of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded during stair descent and anterior tibial translation. Each step of stair descent was divided into pre-activity, weight-acceptance and push-off phase. Pre-activation, short, medium (MLR) and long latency responses (LLR) were defined for reflex activity. Participants N = 38 patients one year after ACL reconstruction (ACL-R), N = 26 participants with conservative treatment one year after ACL rupture (ACL-C), N = 38 healthy controls with an intact ACL (ACL-I). Main outcome measures Normalized root mean squares per muscle and phase (α = 0.05). Results During stair descent, within-group leg differences were found for the quadriceps in ACL-R during all phases and for the BF in ACL-C during weight-acceptance. Between-group leg differences were found for BF in both patient groups compared to ACL-I during push-off.Between-group differences in pre-activation for VM between ACL-R and ACL-C, and between ACL-C and ACL-I were found, and as LLR between patients and ACL-R versus ACL-I. Pre-activation of BF and MLR of ST differed for each patient group compared to ACL-I. Conclusions Bilateral neuromuscular alterations are still present one year after ACL rupture or reconstruction.
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Aglaja Busch
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopedics, 14469, Potsdam, Germany
| | - Philipp Henle
- Lindenhof Group AG, Sonnenhof Orthopaedic Center, 3006, Bern, Switzerland
- University of Bern, Bern University Hospital, Inselspital, Department of Orthopaedic Surgery and Traumatology, 3010, Bern, Switzerland
| | - Sven Bruhn
- University of Rostock, Institute of Sports Science, 18051, Rostock, Germany
| | - Dirk Vissers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
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Collimore AN, Alvarez JT, Sherman DA, Gerez LF, Barrow N, Choe DK, Binder-Macleod S, Walsh CJ, Awad LN. A Portable, Neurostimulation-Integrated, Force Measurement Platform for the Clinical Assessment of Plantarflexor Central Drive. Bioengineering (Basel) 2024; 11:137. [PMID: 38391623 PMCID: PMC10885982 DOI: 10.3390/bioengineering11020137] [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: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Plantarflexor central drive is a promising biomarker of neuromotor impairment; however, routine clinical assessment is hindered by the unavailability of force measurement systems with integrated neurostimulation capabilities. In this study, we evaluate the accuracy of a portable, neurostimulation-integrated, plantarflexor force measurement system we developed to facilitate the assessment of plantarflexor neuromotor function in clinical settings. Two experiments were conducted with the Central Drive System (CEDRS). To evaluate accuracy, experiment #1 included 16 neurotypical adults and used intra-class correlation (ICC2,1) to test agreement of plantarflexor strength capacity measured with CEDRS versus a stationary dynamometer. To evaluate validity, experiment #2 added 26 individuals with post-stroke hemiparesis and used one-way ANOVAs to test for between-limb differences in CEDRS' measurements of plantarflexor neuromotor function, comparing neurotypical, non-paretic, and paretic limb measurements. The association between paretic plantarflexor neuromotor function and walking function outcomes derived from the six-minute walk test (6MWT) were also evaluated. CEDRS' measurements of plantarflexor neuromotor function showed high agreement with measurements made by the stationary dynamometer (ICC = 0.83, p < 0.001). CEDRS' measurements also showed the expected between-limb differences (p's < 0.001) in maximum voluntary strength (Neurotypical: 76.21 ± 13.84 ft-lbs., Non-paretic: 56.93 ± 17.75 ft-lbs., and Paretic: 31.51 ± 14.08 ft-lbs.), strength capacity (Neurotypical: 76.47 ± 13.59 ft-lbs., Non-paretic: 64.08 ± 14.50 ft-lbs., and Paretic: 44.55 ± 14.23 ft-lbs.), and central drive (Neurotypical: 88.73 ± 1.71%, Non-paretic: 73.66% ± 17.74%, and Paretic: 52.04% ± 20.22%). CEDRS-measured plantarflexor central drive was moderately correlated with 6MWT total distance (r = 0.69, p < 0.001) and distance-induced changes in speed (r = 0.61, p = 0.002). CEDRS is a clinician-operated, portable, neurostimulation-integrated force measurement platform that produces accurate measurements of plantarflexor neuromotor function that are associated with post-stroke walking ability.
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Affiliation(s)
- Ashley N Collimore
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Jonathan T Alvarez
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - David A Sherman
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Section of Rheumatology, Boston University, Boston, MA 02215, USA
| | - Lucas F Gerez
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Noah Barrow
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Dabin K Choe
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | | | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Louis N Awad
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
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Coppack RJ, Ladlow P, Cassidy RP, Egginton N, Barker-Davies R, Houston A, Lunt KM, O'Sullivan O, Bennett AN. Academic Department of Military Rehabilitation (ADMR): avoiding the pitfalls of ' the Walker Dip'. BMJ Mil Health 2024; 170:4-8. [PMID: 37495378 DOI: 10.1136/military-2023-002469] [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: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
A key research theme identified during the 2021 Strategic Delivery Plan (SDP) for Defence Medical Services (DMS) Research was preventing and treating musculoskeletal injury (MSKI). MSKI is a significant burden to military populations globally, reducing both operational strength and force readiness. It is therefore essential that research is conducted to gain a greater understanding of the epidemiology, aetiology and risk factors associated with MSKI to develop targeted prevention strategies and rehabilitation interventions. The Academic Department of Military Rehabilitation (ADMR) and the recently established MSKI research-theme working group must use a combination of balance and flexibility when coordinating research priorities to ensure they align and reflect both higher level DMS and UK Defence Rehabilitation practitioner-driven priorities. This article describes the response ADMR have taken to meet and align with the requirements of the 2021 SDP.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - N Egginton
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - K M Lunt
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Konishi Y, Yoshii R, Takeshita D. Tactile stimulation restores inhibited stretch reflex attributable to attenuation of Ia afferents during surprise landing. Scand J Med Sci Sports 2024; 34:e14568. [PMID: 38268071 DOI: 10.1111/sms.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Arthrogenic muscle inhibition (AMI) is induced by pathological knee conditions. The present study aimed to investigate the effect of tactile stimulation on reflex changes induced by simulated AMI during unpredictable landing performances. Twenty participants performed six unilateral landing tasks: 15 cm normal landing (15NL), 30 cm normal landing (30NL), surprise landing (SL), 30 cm normal landing following vibration (30NLV), SL following vibration (SLV), and SL following vibration with Kinesiology tape (SLK). For SL, the solid landing platform (15 cm) was removed and replaced by a false floor. Since the false floor dislodged easily under load, participants unpredictably fell through the platform to the actual landing surface 15 cm below. After completing 15NL, 30NL, and SL, vibration was applied to participants' knees to induce neurological changes similar to AMI. After vibration, participants performed 30NLV, SLV, and SLK in a random order. EMG signals in the post-landing short latency (31-60 ms) and medium latency (61-90 ms) periods were examined. EMG signals from the vastus lateralis (VL), vastus medialis (VM), and biceps femoris (BF) were recorded and compared between tasks. EMG signals of all muscles in SL were significantly enhanced in the medium latency period as compared with 30NL. Enhanced EMG signals in SL were suppressed by vibration stimulation in the VL, but the suppressed EMG signals were restored after cutaneous stimulation with Kinesiology tape (p < 0.01). Our findings suggest that AMI could alter motor control patterns during unpredictable landing and that tactile stimulation could restore the altered motor control to a normal state.
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Affiliation(s)
- Yu Konishi
- Department of Physical Education, National Defense Academy of Japan, Kanagawa, Japan
| | - Ryo Yoshii
- Division of Medicine, Department of Health Sciences, Interdisciplinary Graduate School, University of Yamanashi, Yamanashi, Japan
- Department of Rehabilitation, National Hospital Organization, Kofu National Hospital, Yamanashi, Japan
| | - Daisuke Takeshita
- Department of Life Sciences (Sports Sciences), University of Tokyo, Tokyo, Japan
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Qiu J, Choi CY, Man GCW, He X, Yu M, Cao M, Wang Q, Ng JP, Yung PSH, Ong MTY. Serum vitamin D insufficiency is correlated with quadriceps neuromuscular functions in patients with anterior cruciate ligament injury: A preliminary study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:76-80. [PMID: 38292822 PMCID: PMC10827444 DOI: 10.1016/j.asmart.2023.11.001] [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: 08/07/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
Background This study aimed to investigate the correlations of serum vitamin D insufficiency with quadriceps neuromuscular function in patients with anterior cruciate ligament (ACL) injury. Methods A cross-sectional study was conducted. Eighteen patients with a primary, unilateral ACL injury who had insufficient serum vitamin D concentrations (<30 ng/ml) were recruited for the study. Bilateral quadriceps neuromuscular function, including maximal strength, the speed of rapid contraction, and inhibition, were measured on an isokinetic dynamometer with the hip and the knee joint flexion at 90° and 45°, respectively. Quadriceps strength was measured by maximal voluntary isometric contractions (MVIC); the speed of rapid contraction was quantified by the rate of torque development (RTD), which was divided into the early (RTD0-50) and the late phase (RTD100-200); quadriceps inhibition was quantified by the central activation ratio (CAR). Serum vitamin D concentration was quantitatively determined by serum 25(OH)D concentration measured by the 25(OH)D ELISA kit. The Spearman rank correlation analysis was used to examine the correlation between the vitamin D concentration and bilateral quadriceps MVIC, RTD0-50, RTD100-200, and CAR, respectively. Results The results of Spearman rank correlation analyses showed that the serum 25(OH)D concentration was significantly correlated with bilateral quadriceps MVIC (injured: r = 0.574, p = 0.013; uninjured: r = 0.650, p = 0.003) and RTD0-50 (r = 0.651, p = 0.003), and CAR (r = 0.662, p = 0.003) on the uninjured limb. However, no significant correlations were found between the serum 25(OH)D concentration and the other outcomes. Conclusions The serum vitamin D concentration correlates with quadriceps neuromuscular function in patients with ACL injury who had vitamin D insufficiency.
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Affiliation(s)
- Jihong Qiu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Chi-Yin Choi
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Gene Chi-Wai Man
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Xin He
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Mingqian Yu
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Mingde Cao
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Qianwen Wang
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jonathan Patrick Ng
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Michael Tim-Yun Ong
- Department of Orthopaedices and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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Kim JS, Hwang UJ, Chung KS, Yi CH, Choi WJ, Kwon OY. Influence of strength and balance ability on functional performance in the involved and uninvolved sides after anterior cruciate ligament reconstruction. J Back Musculoskelet Rehabil 2024; 37:407-417. [PMID: 37899053 DOI: 10.3233/bmr-230121] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND The restoration and management of the uninvolved side have been emphasized to prevent a second anterior cruciate ligament (ACL) injury and to ensure that athletes return to sports after ACL reconstruction. OBJECTIVE To determine the factors influencing the single leg hop test (SLHT) and single leg vertical jump test (SLVJT) at 1 year postoperatively after ACL reconstruction in both the involved and uninvolved sides. METHODS Ninety-four patients who underwent ACL reconstruction were assessed at 1 year postoperatively. Multiple regression models included eight independent variables with two dependent variables (SLHT and SLVJT.), each on the involved and uninvolved side. RESULTS On the involved side, the Y balance test (YBT), extensor peak torque per body weight (PT/BW), Biodex balance system anteroposterior index (BBS-API), and sex accounted for 53.9% of the variance in SLHT (P= 0.002), and extensor PT/BW and YBT accounted for 26.3% of the variance in SLVJT (P= 0.027). On the uninvolved side, YBT, sex, age, BBS-API, and flexor PT/BW accounted for 47.0% of the variance in SLHT (P= 0.046), and flexor PT/BW, YBT, and age accounted for 44.9% of the variance in SLVJT (P= 0.002). CONCLUSION Knee extensor strength on the involved side and flexor strength on the uninvolved side influence the two functional performance tests. The YBT was an important factor in the two functional performance tests in both sides. Anteroposterior stability was the only factor that influenced the SLHT bilaterally.
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Affiliation(s)
- Jin Seong Kim
- Department of Physical Therapy, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Ui Jae Hwang
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Chung Hwi Yi
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Korea
| | - Woochol Joseph Choi
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Korea
| | - Oh Yun Kwon
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Korea
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Kim KM, Needle AR, Kim JS, An YW, Cruz-Díaz D, Taube W. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:241-256. [PMID: 36650898 DOI: 10.1080/09638288.2022.2161643] [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: 04/04/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). MATERIALS AND METHODS Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. RESULTS Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior). CONCLUSIONS FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
| | - Joo-Sung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
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Sonnery-Cottet B, Hopper GP, Gousopoulos L, Pioger C, Vieira TD, Thaunat M, Fayard JM, Freychet B, Cavaignac E, Saithna A. Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group. Am J Sports Med 2024; 52:60-68. [PMID: 38164669 DOI: 10.1177/03635465231209987] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. PURPOSE To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification. RESULTS A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI (P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99). CONCLUSION AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of "red flags" should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Charles Pioger
- Department of Orthopedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Paris, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Etienne Cavaignac
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
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Kii S, Sonohata M, Nakashima T, Hashimoto A, Ueno M, Mawatari M. Comparison of the clinical outcomes following total knee arthroplasty in osseous ankylosed and non-ankylosed knees using propensity-score matching. Mod Rheumatol 2023; 34:226-237. [PMID: 36508296 DOI: 10.1093/mr/roac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Few studies have compared the clinical outcomes and complications of total knee arthroplasty (TKA) in patients with and without osseous ankylosed knees. Thus, we investigated the clinical outcomes and complications of TKA in patients with osseous ankylosed knees using a propensity-score matching method. METHODS Thirteen knees in the osseous ankylosed-knees group and 13 knees in the non-ankylosed-knees group were included after excluding those with less than 2 years of follow-up or a lack of data and after propensity-score matching. The American Knee Society Score-knee (AKSS-knee), AKSS-function, knee-flexion angle, knee-extension angle, knee range of motion (ROM) before and after TKA, and the number of knees with postoperative complications were evaluated as primary outcomes. RESULTS The AKSS-knee, AKSS-function, knee-flexion angle, and knee ROM in the osseous ankylosed-knees group after TKA were significantly lower than those in the non-ankylosed-knees group. The knee-extension angle after TKA and number of knees with postoperative complications within 2 years were not significantly different between the two groups. CONCLUSIONS The clinical results of TKA in patients with osseous ankylosed knees were inferior to those in patients with non-ankylosed knees.
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Affiliation(s)
- Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takema Nakashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Qiu J, Zhou T, Jin H, Pan Y, Qian T, Xue C, Xia W, Shi H, An B. Effect of adding hip exercises to general rehabilitation treatment of knee osteoarthritis on patients' physical functions: a randomized clinical trial. BMC Sports Sci Med Rehabil 2023; 15:158. [PMID: 37996958 PMCID: PMC10668394 DOI: 10.1186/s13102-023-00772-7] [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: 04/01/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Hip adductor and abductor strength were both reduced in KOA patients. But to date, most of the researches have only focused on quadriceps combined with hip abductor strengthening versus quadriceps strengthening. OBJECTIVE The aim of the study is to evaluate the effect of adding hip abductor and adductor strengthening to quadriceps strengthening on lower limb strength, knee pain and physical function in patients with medial compartmental knee osteoarthritis. METHODS In this study, 42 participants, were randomly divided into two groups: the general treatment group (GT group) and the added-hip-exercise group (AH group). All participants were given a general rehabilitation treatment. The AH group performed hip abductor and adductor strengthening in addition to the general rehabilitation treatment. Knee and hip muscle strength, Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go Test (TUGT), Numerical Rating Scale (NRS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline and 6 weeks. A two-sided 2-sample unpaired t test was performed to compare the difference in mean change scores between AH and GT groups. RESULTS Finally, 36 participants completed the study: both groups consist of 18 participants. In the per-protocol analysis, the AH group had a greater improvement in knee extension strength (mean changes, 7.84 versus 36.48; P < 0.001) and hip abduction strength (mean changes, 5.05 versus 26.62; P = 0.001) than the control group. Similarly, the AH group had a greater improvement in the FTSST time (mean changes, 0.40 s versus 3.57 s; P < 0.001) and the TUFT time (mean changes, 0.18 s versus 1.67 s; P = 0.002) than the GH group. No statistical difference was found in the change of WOMAC pain scores and NRS between the 2 groups. CONCLUSIONS Older adults with knee OA in the AH group had superior muscle strength, symptoms and daily activity performance at the 6th week than those in the GT group. And adding hip exercises could expedite improvement of pain at the 2th week, but not at the 6th week. TRIAL REGISTRATION Clinical trial registration numbers and date of registration: ChiCTR-IOR-16009124, Registered 30 August 2016.
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Affiliation(s)
- Jie Qiu
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Tiantian Zhou
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Huihong Jin
- Qibao Community Health Service Center, Minhang District, Shanghai, China
| | - Yujian Pan
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Tingting Qian
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chuan Xue
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wen Xia
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Haitao Shi
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Bingchen An
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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Flórez Fonnegra JP, Pino Prestan AC, López LL, Yepes JC, Pérez VZ. Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality. SENSORS (BASEL, SWITZERLAND) 2023; 23:9114. [PMID: 38005502 PMCID: PMC10674760 DOI: 10.3390/s23229114] [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: 09/12/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023]
Abstract
Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.
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Affiliation(s)
- Juan Pablo Flórez Fonnegra
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.P.F.F.); (J.C.Y.)
- Grupo de Investigaciones en Bioingeniería, Universidad Pontificia Bolivariana, Medellín 055031, Colombia;
| | | | - Lucelly López López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 055031, Colombia;
| | - Juan C. Yepes
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.P.F.F.); (J.C.Y.)
- Grupo de Automática y Diseño A+D, Universidad Pontificia Bolivariana, Medellín 055031, Colombia
| | - Vera Z. Pérez
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.P.F.F.); (J.C.Y.)
- Grupo de Investigaciones en Bioingeniería, Universidad Pontificia Bolivariana, Medellín 055031, Colombia;
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Martini D, Sconza C, Di Matteo B, Superchi F, Leonardi G, Kon E, Respizzi S, Morenghi E, D'Agostino MC. Early application of extracorporeal shock wave therapy improves pain control and functional scores in patients undergoing total knee arthroplasty: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2023; 47:2757-2765. [PMID: 37566226 DOI: 10.1007/s00264-023-05906-7] [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: 09/05/2022] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The use of biophysical stimuli produced by extracorporeal shock wave therapy (ESWT) can improve the rehabilitation treatment of patients undergoing total knee arthroplasty (TKA). The aim of our study is to evaluate the short-term efficacy of early postoperative ESWT in combination with physiotherapy in terms of pain reduction and motor function recovery of patients undergoing TKA and compare it with conventional physiotherapy treatment. METHODS Fifty-six patients undergoing TKA were enrolled in the study from January 2019 to February 2020. Patients received two sessions of physiotherapy daily, with (experimental group) or without (control group) four sessions of ESWT within seven days after surgery. Patients were prospectively evaluated at baseline and at post-operative day two and seven. Assessment included active knee range of motion (aROM), timed up and go (TUG) test, visual analogue scale (VAS) for pain, and Borg scale. RESULTS Fifty patients completed the study. Both treatments proved to be effective in reducing pain and improving the knee range of motion and functional scores at seven days after surgery: the aROM in the ESWT group was 36.8 ± 11.0 grades (p < 0.001), while in control group was 19.8 ± 7.8 grades (p < 0.001). TUG, VAS, and BORG scores showed a similar trend. Comparative analysis revealed superior clinical results for the experimental group in all the outcomes, in particular aROM (96.0 ± 5.40 vs. 81.20 ± 11.01, p < 0.001) and TUG test (17.4 ± 5.61 vs. 21.24 ± 5.88, p < 0.001), at day seven after surgery. CONCLUSION Early application of ESWT in addition to physiotherapy can positively influence the rehabilitation process after TKA. The treatment proved to be well tolerated and safe. Preliminary results demonstrated better pain control and functional scores compared to physiotherapy alone.
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Affiliation(s)
| | - Cristiano Sconza
- IRCCS Humanitas Research Center, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Berardo Di Matteo
- IRCCS Humanitas Research Center, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Francesco Superchi
- Physical Medicine and Rehabilitation School, University of Milan, Milan, Italy
| | - Giulia Leonardi
- U.O.C. of Physical and Rehabilitation Medicine and Sports Medicine, Policlinico Universitario "G. Martino,", Messina, Italy
| | - Elizaveta Kon
- IRCCS Humanitas Research Center, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | | | - Emanuela Morenghi
- IRCCS Humanitas Research Center, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Willems M, Gilson L, Verschueren S, Vanrenterghem J, Staes F, Vandenneucker H, Claes S, Smeets A. Fatigue-induced Landing Alterations in ACL Reconstructed Athletes after Return-to-Sport. Int J Sports Med 2023; 44:830-838. [PMID: 37490929 DOI: 10.1055/a-2108-5219] [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: 07/27/2023]
Abstract
At the time of return-to-sport, anterior cruciate ligament reconstructed athletes still show altered neuromechanics in their injured leg during single leg hopping tasks. Part of these alterations can be magnified when these athletes are fatigued. So far, little is known whether fatigue-induced landing alterations persist after return-to-sport. Therefore, the aim of this study was to evaluate whether these alterations persist in the six months following return-to-sport. Sixteen anterior cruciate ligament reconstructed athletes performed five unilateral hop tasks before and after a fatigue protocol. The hop tasks were executed at three different time points (return-to-sport, 3 and 6 months post-return-to-sport). A 2-by-3 repeated measures ANOVA was performed to evaluate whether fatigue-induced landing alterations persisted 3 and 6 months following return-to-sport. At 6 months following return-to-sport, fatigue still induces a reduction in hamstring medialis activation and an increase in the knee abduction moment during a vertical hop with 90-degree inward rotation. Most fatigue-induced landing alterations present at the time of return-to-sport normalize after resumption of sports activities. However, a larger knee abduction moment in the injured leg after resumption of sports activities can still be observed.
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Affiliation(s)
- Miel Willems
- Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Laurens Gilson
- Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Vandenneucker
- Department of Orthopedics, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals, Herentals, Belgium
| | - Annemie Smeets
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Physical Medicine & Rehabilitation, KU Leuven University Hospitals Leuven Pellenberg Campus, Leuven, Belgium
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Di Giminiani R, Marinelli S, La Greca S, Di Blasio A, Angelozzi M, Cacchio A. Neuromuscular Characteristics of Unilateral and Bilateral Maximal Voluntary Isometric Contractions following ACL Reconstruction. BIOLOGY 2023; 12:1173. [PMID: 37759573 PMCID: PMC10525486 DOI: 10.3390/biology12091173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m2), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m2). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant (p > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally (p < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally (p < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally (p < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
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Affiliation(s)
- Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano Marinelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano La Greca
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. D’Annunzio’ University of Chieti-Pescara, 66013 Chieti, Italy;
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
| | - Angelo Cacchio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
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41
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Chauhan R, Boissonnault W, Gormack N, White S. Early triage of a patient with metastatic melanoma presenting as mechanical knee pain - a case report. J Man Manip Ther 2023; 31:297-303. [PMID: 36867066 PMCID: PMC10324426 DOI: 10.1080/10669817.2023.2183338] [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: 08/01/2022] [Accepted: 12/02/2022] [Indexed: 03/04/2023] Open
Abstract
Physical therapists (PTs) working in primary care settings commonly encounter mechanical causes of knee pain. Non-mechanical causes of knee pain, such as bone tumors, are rare, and therefore, PTs often have a low index of suspicion regarding sinister pathology. The purpose of this case report is to describe the physical therapist's clinical reasoning process for a 33-year-old female presenting with medial knee pain and a subsequent history of metastatic melanoma. Initially, subjective and objective testing pointed to a mechanical internal derangement of the knee. However, symptom progression and poor treatment responses between physical therapy visits 2 and 3 raised suspicions as to the cause of the knee pain. This prompted an orthopedic referral and medical imaging, revealing a large bone tumor invading the medial femoral condyle, which was further characterized as metastatic melanoma by a specialty oncology team. Further imaging revealed several metastatic subcutaneous, intramuscular and cerebral lesions. This case highlights the importance of the ongoing medical screening process, including the monitoring of symptoms and treatment responses.
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Affiliation(s)
- Rohil Chauhan
- Musculoskeletal Physiotherapy, Refine Health Ltd, Auckland, New Zealand
| | - William Boissonnault
- Musculoskeletal Physiotherapy, University of Wisconsin- Madison, Madison, WI, USA
| | | | - Steven White
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Zunzarren G, Garet B, Vinciguerra B, Murgier J. Persistence of neuromuscular activation deficit in the lower limb at 3-years of follow-up after ACL reconstruction surgery. Knee 2023; 43:97-105. [PMID: 37385113 DOI: 10.1016/j.knee.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Almost all patients experience neuromuscular disorders of the quadriceps after knee trauma or surgery such as anterior cruciate ligament (ACL) reconstruction. This phenomenon is described in literature as arthrogenic muscle inhibition (AMI). It can be detrimental to patients and cause complications. However, few studies have evaluated the long-term persistence of deficits arising from this, following ACL reconstruction. PURPOSE By comparing neuromuscular activation in the lower limb after ACL reconstruction with the unaffected lower limb, after more than 3-years of follow-up, this study aimed to evaluate the possible persistence of long-term deficits after surgery. METHODS Fifty-one patients who underwent ACL reconstruction in 2018 were included in the study, with a minimum follow-up of 3 years. The neuromuscular activation deficit was assessed using the Biarritz Activation Score-Knee (BAS-K), whose intra- and inter-observer reproducibility was also evaluated. The ACL-RSI, KOOS, SANE Leg, Tegner and IKDC scores were also evaluated. RESULTS The mean BAS-K score of the knee that underwent surgery was 21.8/50 versus 37.9/50 in the healthy knee (p < 0.05). The SANE leg score was 76.8/100 versus 97.6/100 (p < 0.05). The mean IKDC was 84.17 (±12.7). The mean KOOS was 86.2 (±9.2). The mean ACL-RSI was 70 (±7.9) and the Tegner score was 6.3 (±1.2). Intra- and inter-observer reproducibility was satisfactory for the BAS-K score. CONCLUSION We found that the neuromuscular activation deficit was high (roughly 42%) at more than 3-years of follow-up after ACL reconstruction. The deficit is not limited to the quadriceps and affects the whole limb. Our findings highlight the need for appropriate rehabilitation after ACL surgery, targeting the corticospinal level in particular. LEVEL OF EVIDENCE III prognostic retrospective case-control study.
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Affiliation(s)
- G Zunzarren
- Cabinet de Médecine du Sport, 64200 Biarritz, France
| | - B Garet
- Cabinet de Rééducation Neuro Musculaire, 64200 Biarritz, France
| | - B Vinciguerra
- Clinique Aguiléra, 21 rue de l'Estagnas, Service de Chirurgie Orthopédique, 64200 Biarritz, France
| | - J Murgier
- Clinique Aguiléra, 21 rue de l'Estagnas, Service de Chirurgie Orthopédique, 64200 Biarritz, France
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43
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Lepley LK, Stoneback L, Macpherson PC, Butterfield TA. Eccentric Exercise as a Potent Prescription for Muscle Weakness After Joint Injury. Exerc Sport Sci Rev 2023; 51:109-116. [PMID: 37093645 PMCID: PMC10330137 DOI: 10.1249/jes.0000000000000319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Lengthening contractions (i.e., eccentric contractions) are capable of uniquely triggering the nervous system and signaling pathways to promote tissue health/growth. This mode of exercise may be particularly potent for patients suffering from muscle weakness after joint injury. Here we provide a novel framework for eccentric exercise as a safe, effective mode of exercise prescription for muscle recovery.
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Affiliation(s)
| | - Luke Stoneback
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Peter C.D. Macpherson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy A. Butterfield
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
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44
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Young BL, Hammond KE. Editorial Commentary: Limited Preoperative Range of Motion Is Associated With Range of Motion Deficits After Anterior Cruciate Ligament Reconstruction: "If the Knee Is Not Straight, Wait". Arthroscopy 2023; 39:1690-1691. [PMID: 37286287 DOI: 10.1016/j.arthro.2023.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 06/09/2023]
Abstract
Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains under debate. Prolonging time between injury and ACLR risks damaging the meniscus and chondral surface, as well as delays return to play. Early ACLR may be associated with postoperative stiffness or arthrofibrosis. We emphasize that optimal timing for ACLR depends on criterion-based return of knee range of motion and quadriceps strength, not a quantitative temporal period. The length of time is far less important that the quality of prereconstruction care provided. Prereconstruction care includes "prehabilitation," including prone hangs focusing on optimizing knee range of motion, postinjury effusion resolution, and mentally preparing the patient for postoperative expectations. Defining preoperative criteria for proceeding with surgery is crucial to decrease the risk of arthrofibrosis. Some patients meet these criteria within 2 weeks, whereas others linger to 10 weeks. Reduction in arthrofibrosis requiring surgical intervention is multifactorial and not solely dependent on the length of time between injury and intervention.
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45
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Solie BS, Eggleston GG, Schwery NA, Doney CP, Kiely MT, Larson CM. Clinic and Home-Based Exercise with Blood Flow Restriction Resolves Thigh Muscle Atrophy after Anterior Cruciate Ligament Reconstruction with the Bone-Patellar Tendon-Bone Autograft: A Case Report. Healthcare (Basel) 2023; 11:1885. [PMID: 37444719 DOI: 10.3390/healthcare11131885] [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: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) results in thigh muscle atrophy. Of the various interventions proposed to mitigate thigh muscle atrophy, exercise with blood flow restriction (BFR) appears safe and effective. Some literature suggests daily exposure to exercise with BFR may be indicated during the early phase of ACLR rehabilitation; this case report outlines the methodology utilized to prescribe clinic- and home-based BFR within an outpatient rehabilitation program. A 15-year-old male soccer player suffered a left knee injury involving the anterior cruciate ligament and both menisci. He underwent ACLR and completed exercise with BFR as part of his clinic- and home-based rehabilitation program, which included practical blood flow restriction during home-based rehabilitation. After 16 weeks of rehabilitation, surgical limb thigh girth values were objectively larger than the non-surgical limb (surgical, 52.25 cm; non-surgical 50 cm), as well as the multi-frequency bioelectrical impedance analysis of his lower-extremity lean body mass (surgical limb, 10.37 kg; non-surgical limb, 10.02 kg). The findings of this case report suggest that the inclusion of clinic- and home-based BFR within an outpatient rehabilitation program may be indicated to resolve thigh muscle atrophy early after ACLR.
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Affiliation(s)
- Braidy S Solie
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Nicole A Schwery
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Michael T Kiely
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
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46
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Singleton S, Scofield H, Davis B, Waller A, Garrison C, Goto S, Hannon J. Altered Knee Loading Following Primary ACL Repair versus ACL Reconstruction. Int J Sports Phys Ther 2023; V18:596-605. [PMID: 37415672 PMCID: PMC10321778 DOI: 10.26603/001c.77362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
Background ACL repair (ACL-r) has recently gained renewed clinical interest for treatment of ACL tears. ACL-r has several potential benefits over ACL reconstruction (ACL-R) including maintaining the native ACL innervation and blood supply, no graft site morbidity, and possible improved knee biomechanics and decrease in osteoarthritis. The purpose of this study was to assess for differences in metrics of knee joint loading during a single limb squat task between individuals following a primary ACL-r versus those who underwent a standard ACL-R with a patella bone-tendon-bone autograft. Study type Case Control Study. Methods The ACL-r group [n: 15, age(yrs): 38.8±13.9] sustained a proximal ACL disruption that was amenable to repair, while the ACL-R group [n: 15, age(yrs): 25.60±1.7] underwent primary reconstruction with patella bone-tendon-bone autograft. At 12-weeks post-operation, both groups completed the IKDC questionnaire and biomechanical testing during performance of the single limb squat. Bilateral peak knee extension moment and total knee joint power as a measure of eccentric loading (contraction) during the descent phase of the squat were calculated on the surgical and non-surgical limb and averaged across the middle three of five trials. Participants also completed quadriceps strength testing on both limbs three months after surgery on an isokinetic dynamometer at 60°/sec. LSI (Limb Strength Index) was calculated for all variables. Separate ANCOVAs were performed on each biomechanical variable to examine differences between groups. Results The ACL-r had a significantly greater peak knee extension moment LSI (ACL-r: 78.46±5.79%; ACL-R: 56.86±5.79%; p=0.019, ηp2=.186) and total knee joint power LSI (ACL-r: 72.47±7.39%; ACL-R: 39.70±7.39%, p=0.006, ηp2=.245) than the ACL-R group. The ACL-r also had a significantly greater quadriceps LSI than the ACL-R group (ACL-r: 66.318±4.61%, ACL-R: 48.03±4.61%, p=0.013, ηp2=.206). Conclusions Individuals following ACL-r demonstrate increased knee joint loading symmetry during a single leg squat task and greater quadriceps strength symmetry at 12 weeks post-surgery compared to those who underwent ACL-R. Level of Evidence 3.
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47
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Dudoniene V, Adomaitytė A, Žlibinaitė L. Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement. J Back Musculoskelet Rehabil 2023:BMR220340. [PMID: 37248880 DOI: 10.3233/bmr-220340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.
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48
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Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
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Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
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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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50
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. The temporal and spatial effects of reconstructive surgery on the atrophy of hindlimb muscles in anterior cruciate ligament transected rats. Physiol Res 2023; 72:99-109. [PMID: 36545871 PMCID: PMC10069818 DOI: 10.33549/physiolres.934909] [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: 03/24/2023] Open
Abstract
After anterior cruciate ligament (ACL) injury, a decrease in muscle strength associated with muscle atrophy is frequently observed. The temporal and spatial effects of reconstructive surgery on muscle atrophy have not been examined in detail. This study aimed to 1) reveal the short and mid-term effects of reconstructive surgery on muscle atrophy, and 2) investigate the differences in the degree of atrophy after ACL reconstruction in the hindlimb muscles. ACL transection with or without reconstructive surgery was performed unilaterally on the knees of rats. Untreated rats were used as controls. At one or four weeks post-surgery, the relative muscle wet weights (wet weight/body weight) of the hindlimb muscles were calculated to assess atrophy. At one week post-surgery, muscle atrophy was induced by ACL transection and further aggravated by reconstructive surgery. Reconstructive surgery facilitated recovery from muscle atrophy in some muscles compared with those without reconstructive surgery (ACL transection alone) at four weeks post-surgery. Muscle atrophy after ACL reconstruction was greater in the rectus femoris and plantar flexors than in the semitendinosus and plantar extensors at one week post-surgery. These results indicate that reconstructive surgery exacerbates muscle atrophy in the first week post-surgery, while facilitating recovery between the first and fourth week post-surgery. After reconstructive surgery, muscle atrophy was observed not only in the quadriceps and hamstrings, but also in the lower leg muscles, suggesting the need for muscle strengthening interventions for the lower leg muscles as well as the quadriceps and hamstrings.
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Affiliation(s)
- A Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.
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