1
|
Paredes R, Crasto C, Mesquita Montes A, Arias-Buría JL. Changes in co-contraction magnitude during functional tasks following anterior cruciate ligament reconstruction: A systematic review. Knee 2024; 48:243-256. [PMID: 38781829 DOI: 10.1016/j.knee.2024.05.005] [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: 10/10/2023] [Revised: 03/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic surgery procedure whose incidence has increased over the past few decades. Nevertheless, it is believed that neuromuscular control remains altered from the early stages after ACLR to later years. Therefore, the aim of this study was to systematically evaluate the magnitude of co-contraction during functional tasks in subjects with unilateral ACLR. METHODS A systematic review design was followed. The search strategy was conducted in PubMed, Scopus, EBSCO, PEDro, Cochrane Library, and Web of Science databases from inception to March 2024. The inclusion criteria involved studies using electromyography (EMG) data to calculate muscle pair activation via the co-contraction index (CCI) in ACLR individuals during functional tasks. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and study quality was evaluated using National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS The search strategy found a total of 792 studies, of which 15 were included in this systematic review after reviewing the eligibility criteria. The magnitude of co-contraction was assessed in a total of 433 ACLR individuals and 206 controls during functional tasks such as hop, drop-land, step-up/step-down, and gait. Overall, approximately 79.6% of individuals who had undergone ACLR exhibited increased levels of co-contraction magnitude in the ACLR limb, while 8.5% showed low co-contraction levels. CONCLUSIONS The findings of the review suggest that, during functional tasks, most individuals who have undergone ACLR exhibit changes of co-contraction magnitude in the involved limb.
Collapse
Affiliation(s)
- Ricardo Paredes
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Carlos Crasto
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - António Mesquita Montes
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| |
Collapse
|
2
|
Bruce Leicht AS, Thompson XD, Kaur M, Hopper HM, Stolzenfeld RL, Wahl AJ, Sroufe MD, Werner BC, Diduch DR, Gwathmey FW, Brockmeier SF, Miller MD, Hart JM. Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231169196. [PMID: 37435425 PMCID: PMC10331192 DOI: 10.1177/23259671231169196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
Background Return-to-play (RTP) assessment after anterior cruciate ligament reconstruction (ACLR) rarely includes hip strength. Hypothesis It was hypothesized that (1) patients after ACLR will have weaker hip abduction (AB) and adduction (AD) strength compared with the contralateral limb, with larger deficits in women, (2) there will be a correlation between hip and thigh strength ratios and patient-reported outcomes (PROs), and (3) hip AB and AD strength will improve over time. Study Design Descriptive laboratory study. Methods Included were 140 patients (74 male, 66 female; mean age, 24.16 ± 10.82 years) who underwent RTP assessment at 6.1 ± 1.6 months after ACLR; 86 patients underwent a second assessment at 8.2 ± 2.2 months. Hip AB/AD and knee extension/flexion isometric strength were measured and normalized to body mass, and PRO scores were collected. Strength ratios (hip vs thigh), limb differences (injured vs uninjured), sex-based differences, and relationships between strength ratios and PROs were determined. Results Hip AB strength was weaker on the ACLR limb (ACLR vs contralateral: 1.85 ± 0.49 vs 1.89 ± 0.48 N·m/kg; P < .001) and hip AD torque was stronger (ACLR vs contralateral: 1.80 ± 0.51 vs 1.76 ± 0.52 N·m/kg; P = .004), with no sex-by-limb interaction found. Lower hip-to-thigh strength ratios of the ACLR limb were correlated with higher PRO scores (r = -0.17 to -0.25). Over time, hip AB strength increased in the ACLR limb more than in the contralateral limb (P = .01); however, the ACLR limb remained weaker in hip AB at visit 2 (ACLR vs contralateral: 1.88 ± 0.46 vs 1.91 ± 0.45 N·m/kg; P = .04). In both limbs, hip AD strength was greater at visit 2 than visit 1 (ACLR: 1.82 ± 0.48 vs 1.70 ± 0.48 N·m/kg; contralateral: 1.76 ± 0.47 vs 1.67 ± 0.47 N·m/kg; P < .01 for both). Conclusion The ACLR limb had weaker hip AB and stronger AD compared with the contralateral limb at initial assessment. Hip muscle strength recovery was not influenced by sex. Hip strength and symmetry improved over the course of rehabilitation. Although strength differences across limbs were minor, the clinical importance of these differences is still unknown. Clinical Relevance The evidence provided highlights the need to integrate hip strength into RTP assessments to identify hip strength deficits that may increase reinjury or lead to poor long-term outcomes.
Collapse
Affiliation(s)
| | - Xavier D. Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Mandeep Kaur
- Department of Physical Therapy, Northern Arizona University, Phoenix, Arizona, USA
| | - Haleigh M. Hopper
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Alexander J. Wahl
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Madison D. Sroufe
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F. Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joe M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Georgoulis JD, Melissaridou D, Patras K, Megaloikonomos PD, Trikoupis I, Savvidou OD, Papagelopoulos PJ. Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies. J Exp Orthop 2023; 10:43. [PMID: 37058177 PMCID: PMC10105000 DOI: 10.1186/s40634-023-00603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear. METHODS A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed. RESULTS Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients. CONCLUSION This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jim D Georgoulis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece.
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Patras
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Trikoupis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
4
|
Jiang Y. INJURIES IN AEROBIC EXERCISE: CAUSES AND PREVENTIONS. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228052022_0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Professional aerobic exercises require high performance from exercisers. Injuries are common during their execution. Understanding the causal reasons is essential for prevention methods to reduce athletes’ injuries. Objective: Investigate the influential factors of ligament injuries caused by aerobic exercise. Methods: This paper analyzes the injuries caused by aerobic exercise through mathematical statistics. Time, course, degree of injury, location of the injury, cause, early treatment time, primary approach, treatment methods, recovery conditions, and speed in recovery time of sports injuries were investigated. Results: Injuries are mainly concentrated at the hip, knee, and ankle joint level; sprains are the first injuries, followed by muscle strains, lower back muscle contractures, kneecap deformities, and joint ligament injuries. The leading causes of injuries were poor warm-up, excessive load, technical errors, and fatigue. Conclusion: Various physiotherapy methods can improve the recovery rate from ligament injuries. This method can also improve sports ligament injuries’ prevention and treatment effects. Evidence Level II; Therapeutic Studies - Investigating the result.
Collapse
|
5
|
Rinaldi VG, Prill R, Jahnke S, Zaffagnini S, Becker R. The influence of gluteal muscle strength deficits on dynamic knee valgus: a scoping review. J Exp Orthop 2022; 9:81. [PMID: 35976534 PMCID: PMC9385941 DOI: 10.1186/s40634-022-00513-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries are caused by both contact and non-contact injuries. However, it can be claimed that non-contact ones account approximately for 70% of all cases. Thus, several authors have emphasized the role of reduction of muscle strength as a modifiable risk factor referred to non-contact ACL injury, with the latter being targeted by specific training interventions.The present paper wants to review the available literature specifically on the relationship between dynamic knee valgus, gluteal muscles (GM) strength, apart from the potential correlation regarding ACL injury.After a research based on MEDLINE via PubMed, Google scholar, and Web of Science, a total of 29 articles were collected and thus included.Additionally, this review highlights the crucial role of gluteal muscles in maintaining a correct knee position in the coronal plane during different exercises, namely walking, running, jumping and landing.
Collapse
Affiliation(s)
- Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg, Germany
| | - Sonja Jahnke
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.,DIBINEM, University of Bologna, Bologna, Italy
| | - Roland Becker
- Medical School Theodor Fontane, 14770, Brandenburg, Germany.,Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg, Germany
| |
Collapse
|
6
|
Collings TJ, Diamond LE, Barrett RS, Timmins RG, Hickey JT, DU Moulin WS, Williams MD, Beerworth KA, Bourne MN. Strength and Biomechanical Risk Factors for Noncontact ACL Injury in Elite Female Footballers: A Prospective Study. Med Sci Sports Exerc 2022; 54:1242-1251. [PMID: 35320148 DOI: 10.1249/mss.0000000000002908] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine if a preseason field-based test battery was prospectively associated with noncontact anterior cruciate ligament (ACL) injury in elite female footballers. METHODS In total, 322 elite senior and junior female Australian Rules Football and soccer players had their isometric hip adductor and abductor strength, eccentric knee flexor strength, countermovement jump (CMJ) kinetics, and single-leg hop kinematics assessed during the 2019 preseason. Demographic and injury history details were also collected. Footballers were subsequently followed for 18 months for ACL injury. RESULTS Fifteen noncontact ACL injuries occurred during the follow-up period. Prior ACL injury (odds ratio [OR], 9.68; 95% confidence interval (95% CI), 2.67-31.46), a lower isometric hip adductor to abductor strength ratio (OR, 1.98; 95% CI, 1.09-3.61), greater CMJ peak take-off force (OR, 1.74; 95% CI, 1.09-3.61), and greater single-leg triple vertical hop average dynamic knee valgus (OR, 1.97; 95% CI, 1.06-3.63) and ipsilateral trunk flexion (OR, 1.60; 95% CI, 1.01-2.55) were independently associated with an increased risk of subsequent ACL injury. A multivariable prediction model consisting of CMJ peak take-off force, dynamic knee valgus, and ACL injury history that was internally validated classified ACL injured from uninjured footballers with 78% total accuracy. Between-leg asymmetry in lower limb strength and CMJ kinetics were not associated with subsequent ACL injury risk. CONCLUSIONS Preseason field-based measures of lower limb muscle strength and biomechanics were associated with future noncontact ACL injury in elite female footballers. These risk factors can be used to guide ACL injury screening practices and inform the design of targeted injury prevention training in elite female footballers.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Wales, UNITED KINGDOM
| | | | | |
Collapse
|
7
|
Saki F, Tahayori B, Bakhtiari Khou S. Female athletes with ligament dominance exhibiting altered hip and ankle muscle co-contraction patterns compared to healthy individuals during single-leg landing. Gait Posture 2022; 93:225-229. [PMID: 35183840 DOI: 10.1016/j.gaitpost.2022.02.011] [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: 03/26/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is one of the most serious knee injuries and occurs frequently during exercise. Altered hip and ankle muscle co-contraction patterns may contribute to dynamic knee valgus and ACL injury mechanisms. Lack of dynamic control of ground reaction force (GRF) is known to be contributing factor for ACL injury by placing excessive force on passive structures. Muscle co-contraction is a dynamic mechanism for GRF absorption. Therefore, any alterations in co-contraction might be a risk factor for ACL injury. Ligament dominance is a term to define individuals who rely more on ACL ligament for GRF control. RESEARCH QUESTION This study aimed to compare the muscle co-contraction patterns of distal and proximal knee muscles during single leg landing in female athletes with and without ligament dominance. METHODS This is a cross-sectional study. A total of 54 female athletes were assigned to the healthy (n = 27) and ligament dominance (n = 27) group based on their Tuck Jump test scores. The electromyography activity of the gluteus medius, adductor longus, tibialis anterior, peroneus longus, medial and lateral gastrocnemius was measured by an electromyography in drop down a 30-cm-high stair. A Multivariate Analysis of Variance (MANOVA) was used for statistical analysis (p ≤ 0.05). RESULTS The two groups demonstrated an overall significantly different muscle co-contraction patterns (P < 0.05). There was a decreased in co-contraction of proximal group and an increased co-contraction in the distal muscles in ligament dominant group. SIGNIFICANCE The findings have provided evidence to support the notion of neuromuscular imbalances in ligament dominance deficit. These findings can be useful for the coaches and experts to design preventive exercises and modify the current programs for the people affected by ligament dominance.
Collapse
Affiliation(s)
- Farzaneh Saki
- Department of Sport Injuries and Corrective Exercise, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.
| | - Behdad Tahayori
- Department of Physical Therapy, University of Saint Augustine for Health Sciences, Miami, FL, USA
| | - Shima Bakhtiari Khou
- Department of Sport Injuries and Corrective Exercise, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| |
Collapse
|
8
|
Blasimann A, Koenig I, Baert I, Baur H, Vissers D. Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review. BMC Sports Sci Med Rehabil 2021; 13:142. [PMID: 34749813 PMCID: PMC8577028 DOI: 10.1186/s13102-021-00370-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. METHODS This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. RESULTS From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. CONCLUSIONS Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.
Collapse
Affiliation(s)
- Angela Blasimann
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. .,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Irene Koenig
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
| |
Collapse
|
9
|
Lower limb kinematics differ at the time of foot contact between successful and unsuccessful single limb landings following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 51:17-21. [PMID: 34174529 DOI: 10.1016/j.ptsp.2021.06.004] [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: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate differences in lower extremity kinematics at initial ground contact between successful and unsuccessful single limb landings following anterior cruciate ligament (ACL) reconstruction. DESIGN Observational study. SETTING Controlled laboratory environment. PARTICIPANTS 22 male participants (aged 17-40 years) who had undergone unilateral ACL reconstruction attended a single test session. MAIN OUTCOME MEASURES Within-subjects comparisons was performed for pelvis, hip, knee and ankle kinematics using paired t-tests. RESULTS When unsuccessful at landing on the ACL reconstructed limb, participants had significantly increased knee flexion (P = 0.04) and reduced ankle plantarflexion (P = 0.03) compared to their successful landings. In contrast, when unsuccessful at landing on the unaffected limb, participants had significantly increased pelvic contralateral hitch (P < 0.01) and increased hip abduction (P < 0.01) compared to successful landings. CONCLUSION Body position at the time of initial contact was different for landings that were successful compared to landings that were unsuccessful. These differences were limb-specific: altered position in sagittal plane preceded unsuccessful landings on the reconstructed limb whereas altered position in the coronal plane body position that preceded unsuccessful landings on the unaffected limb. These findings suggest that limb specific landing strategies may be required to improve athletes' performance following ACL reconstruction. LEVEL OF EVIDENCE IV.
Collapse
|
10
|
Altered Neuromuscular Activity of the Lower-Extremities During Landing Tasks in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review of Electromyographic Studies. J Sport Rehabil 2020; 29:1194-1203. [PMID: 32357316 DOI: 10.1123/jsr.2019-0393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. OBJECTIVE To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. EVIDENCE ACQUISITION Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. EVIDENCE SYNTHESIS Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. CONCLUSIONS Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
Collapse
|