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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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Dos Santos MA, Lemos AL, Machado MS, Lazaro LDOC, Paz MM, de Andrade AGP, Carpes FP. Effects of triceps surae exercise-induced delayed onset muscle soreness on control of body stability in different postures. J Electromyogr Kinesiol 2024; 76:102882. [PMID: 38599050 DOI: 10.1016/j.jelekin.2024.102882] [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: 11/13/2023] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
This research aimed to determine whether triceps surae delayed onset muscle soreness (DOMS) affects stability while performing different postural control tasks requiring upright and landing stabilization. Twenty-four participants who self-reported as healthy were recruited. Pre and 48 h after a protocol to induce DOMS in the triceps surae, participants were evaluated for DOMS perception, pressure pain threshold, and postural control (assessed by the center of pressure, CoP) during different standing and landing stabilization tasks. We found higher DOMS perception and lower pressure pain threshold 48 h after the exercise. Mediolateral CoP displacement was more sensitive to DOMS across different postural tasks, but no effects were found for bilateral standing. The landing time to stabilization elicited high individual variability in the presence of DOMS. Effects of DOMS in the performance of less challenging tasks, such as bipedal standing, were not found. We conclude that DOMS in the triceps surae impairs mediolateral postural control during challenging tasks such as unilateral standing and body forward lean. It highlights the need for caution and individualized approaches when incorporating movements requiring frontal plane control in training and rehabilitation sessions under the presence of DOMS.
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Affiliation(s)
- Milena A Dos Santos
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Andressa L Lemos
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Mathias S Machado
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Laura de O C Lazaro
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Marieli M Paz
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
| | | | - Felipe P Carpes
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil.
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Dauty M, Combes P, Gernigon M, Menu P, Crenn V, Daley P, Fouasson-Chailloux A. Difference of Knee Strength Recovery Between Revision and Primary ACL Reconstruction. Int J Sports Med 2024; 45:390-398. [PMID: 38267006 DOI: 10.1055/a-2253-0103] [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: 01/26/2024]
Abstract
Different grafting procedures are available to restore knee stability after revision anterior cruciate ligament (ACL) reconstruction. We compared knee strength recovery between ACL revision surgery and primary reconstruction. One hundred and ten patients with ACL revision surgery were matched with 110 patients with primary reconstruction based on the graft procedure. The isokinetic knee strength had been assessed for the first 9 months post-surgery. Knee laxity, function, and activity score were also evaluated. Limb symmetry index for knee extensor and flexor strength was not different at 4-, 6- and 9-months post-surgery between revision surgery and primary reconstruction. These results depended on ipsilateral or contralateral graft choice. Ipsilateral hamstring tendon (HT) and contralateral bone-patellar-tendon-bone (BPTB) graft procedures were similar for a revision of a BPTB graft failure. Contralateral HT procedure was better than ipsilateral BPTB procedure for a revision of a HT graft failure. The early recovery of isokinetic knee strength after ACL revision surgery regardless of the HT or BPTB procedures, was similar to the recovery after primary ACL reconstruction with the same graft technique. These results apparently depended on a temporary quadriceps arthrogenic muscle inhibition and on a persistent donor site morbidity, concerning the new and the previous grafts, respectively.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
- Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
| | - Philippe Combes
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
| | - Marie Gernigon
- CIAMS, Université Paris-Saclay, Gif-sur-Yvette, France
- CIAMS, Université d'Orléans, Orleans, France
| | - Pierre Menu
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
- Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
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Servant G, Bothorel H, Pernoud A, Fourchet F, Christofilopoulos P. Hip Arthroscopy Followed by 6-Month Rehabilitation Leads to Improved Periarticular Muscle Strength, Except for Abductors and External Rotators. Arthrosc Sports Med Rehabil 2024; 6:100900. [PMID: 38379599 PMCID: PMC10878845 DOI: 10.1016/j.asmr.2024.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI). Methods A retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of 8 hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after 6 months of rehabilitation in terms of relative strength changes between time points. Results A total of 29 patients (aged 26.9 ± 7.1 years, 86% of women) were included. Except for the abductors, which remained of comparable strength than before surgery, a statistically significant (P < .05) increase in hip muscle strength on the operated side could be noted at 6 postoperative months for hamstrings (9% ± 17%, P = .041), quadriceps (11% ± 27%, P = .045), extensors (17% ± 32%, P = .006), flexors (17% ± 29%, P = .003), adductors (18% ± 23%, P < .001), and internal rotators (32% ± 36%, P < .001). The proportion of patients who reached a strength level above their preoperative status ranged from 62% (quadriceps) to 86% (adductors and flexors), depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13% ± 26%, P = .002) and nonoperated (-17% ± 25%, P < .001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48%, respectively). Conclusions Arthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators, which remained comparable and weakened, respectively. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Guillaume Servant
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | | | - François Fourchet
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
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Lowe T, Dong XN, Griffin L. Hamstrings vibration reduces tibiofemoral compressive force following anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:788-797. [PMID: 37975273 DOI: 10.1002/jor.25736] [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: 03/24/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Individuals who have undergone anterior cruciate ligament reconstruction (ACLR) are at greater risk of developing knee osteoarthritis (OA). This elevated risk of knee OA is associated with high tibiofemoral (TF) compressive force, due to a combination of low knee flexion angles and increased co-contraction of the hamstrings and quadriceps during limb loading. Prolonged vibration of the hamstrings fatigues the intrafusal muscle fibers, which reduces autonomic reflexive excitation of the hamstrings and alleviates reciprocal inhibition to the quadriceps. The aim of this study was to examine the effect of prolonged hamstrings vibration on TF compressive force in individuals who have undergone ACL reconstruction. Fourteen participants with unilateral ACLR and 14 participants without knee injury performed a single-leg drop-land task before and after prolonged (20 min) vibration of the hamstrings. Peak TF compressive force, knee flexion angle, and hamstrings/quadriceps co-contraction were calculated during the deceleration phase of the drop-land task before and after vibration. The ACLR group experienced an 18% decrease in TF compressive force, a 32% increase in knee flexion angle, and a 38% decrease in hamstrings/quadriceps co-contraction after hamstrings vibration. There was no difference in any of the parameters in the noninjured group after vibration. These data suggest that acute prolonged hamstrings vibration has the potential to mitigate TF compressive force, which may protect the knee joint in the long term. Clinical significance: The results of this research are expected to lead to improved clinical care for ACLR patients because it holds promise for mitigating altered joint mechanics and perhaps slowing down the onset of posttraumatic knee osteoarthritis.
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Affiliation(s)
- Timothy Lowe
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Xuanliang Neil Dong
- Department of Health and Kinesiology, The University of Texas at Tyler, Tyler, Texas, USA
| | - Lisa Griffin
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
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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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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Pereira CS, Klauznicer J, Maree D, McAuliffe S, Farooq A, Whiteley R, Finni T. Quadriceps strength, patellar tendon quality, relative load exposure, and knee symptoms in male athletes before the anterior cruciate ligament reconstruction. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1283635. [PMID: 37928751 PMCID: PMC10624220 DOI: 10.3389/fresc.2023.1283635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Introduction Anterior cruciate ligament (ACL) injuries cause knee instability, knee pain, weight-bearing adjustments, and functional deficits but their association to patellar tendon quality is unknown. Our purpose was to investigate quadriceps strength, patellar tendon quality, relative load exposure, perceived knee stability, knee pain, extension angle, and time from ACL injury; in addition to examining their relative associations. Methods Injured and uninjured legs of 81 male athletes of different sports with a unilateral ACL injury (18-45 years) were examined. Participants reported location and intensity of knee pain and their perceived stability using a numerical rating scale (NRS 0-10). Strength was tested with an isokinetic device. Tendon quality was measured using ultrasound tissue characterization. Means ± standard deviation (SD) of perceived knee stability, knee extension angle, knee pain, isokinetic quadriceps strength in relation to body mass, proportion of echo-types (I-IV), tendon volume, and number of days from ACL injury to assessment are reported. Values of effect sizes (ES) and correlations (rs) were calculated. Results ACL injured leg demonstrated reduced reported knee stability (6.3 ± 2.5), decreased knee extension angle (-0.7 ± 3.1° vs. -2.7 ± 2.2°; ES = 0.7; P < 0.001), greater knee pain (NRS 3.1 ± 2.2 vs. 0.0 ± 0.1; ES = 2.0; P < 0.001), and 22% lower quadriceps strength (228.0 ± 65.0 vs. 291.2 ± 52.9 Nm/kg: ES = 1.2; P < 0.001) as compared to the uninjured leg. However, patellar tendons in both legs displayed similar quality. Quadriceps strength was associated with stability (rs = -0.54; P < 0.001), pain (rs = -0.47; P < 0.001), extension angle (rs = -0.39; P < 0.001), and relative load exposure (rs = -0.34; P < 0.004). Echo-types distribution was beneficially associated with time from ACL injury (rs range: -0.20/ -0.32; P < 0.05). Discussion ACL injured athletes displayed knee pain, extension deficit, and weaker quadriceps in the injured leg. While there were no differences in patellar tendon quality between legs, longer time from ACL injury showed better tendon quality.
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Affiliation(s)
- Carla S. Pereira
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jasenko Klauznicer
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Sean McAuliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Abdulaziz Farooq
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Rod Whiteley
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Taija Finni
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Pilanthananond M, Tharawadeepimuk K, Saengsirisuwan V, Limroongreungrat W. Muscle Activation and Ground Reaction Force between Single-Leg Drop Landing and Jump Landing among Young Females during Weight-Acceptance Phase. Sports (Basel) 2023; 11:185. [PMID: 37755862 PMCID: PMC10536380 DOI: 10.3390/sports11090185] [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: 08/06/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Single-leg drop landing (SLDL) and jump landing (SLJL) are frequently used as assessment tools for identifying potential high-risk movement patterns; thus, understanding differences in neuromuscular responses between these types of landings is essential. This study aimed to compare lower extremity neuromuscular responses between the SLDL and SLJL. Thirteen female participants performed an SLDL and SLJL from a 30-cm box height. Vertical ground reaction force (vGRF), time to peak vGRF, and surface electromyography (sEMG) data were collected. Continuous neuromuscular responses, peak vGRF, and time to peak vGRF were compared between the tasks. Statistical parametric mapping (SPM) analysis demonstrated that the SLJL had a significantly higher sEMG activity in the rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM) within the first 10% of the landing phase compared with SLDL. At 20-30% of the landing phase, sEMGs in the RF and VL during the SLDL were significantly higher compared with SLJL (p < 0.05). A higher peak vGRF and shorter time to peak vGRF was observed during SLJL (p < 0.05). In conclusion, our findings highlight that SLJL exhibited greater RF, VL, and VM activities than SLDL at initial impact (10% landing), coinciding with a higher peak vGRF and shorter time to attain peak vGRF. Our findings support the role of the quadriceps as the primary energy dissipator during the SLJL.
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Affiliation(s)
- Metaneeya Pilanthananond
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (M.P.); (V.S.)
| | | | - Vitoon Saengsirisuwan
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (M.P.); (V.S.)
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Patel HH, Berlinberg EJ, Nwachukwu B, Williams RJ, Mandelbaum B, Sonkin K, Forsythe B. Quadriceps Weakness is Associated with Neuroplastic Changes Within Specific Corticospinal Pathways and Brain Areas After Anterior Cruciate Ligament Reconstruction: Theoretical Utility of Motor Imagery-Based Brain-Computer Interface Technology for Rehabilitation. Arthrosc Sports Med Rehabil 2022; 5:e207-e216. [PMID: 36866306 PMCID: PMC9971910 DOI: 10.1016/j.asmr.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/09/2022] [Indexed: 12/29/2022] Open
Abstract
Persistent quadriceps weakness is a problematic sequela of anterior cruciate ligament reconstruction (ACLR). The purposes of this review are to summarize neuroplastic changes after ACL reconstruction; provide an overview of a promising interventions, motor imagery (MI), and its utility in muscle activation; and propose a framework using a brain-computer interface (BCI) to augment quadriceps activation. A literature review of neuroplastic changes, MI training, and BCI-MI technology in postoperative neuromuscular rehabilitation was conducted in PubMed, Embase, and Scopus. Combinations of the following search terms were used to identify articles: "quadriceps muscle," "neurofeedback," "biofeedback," "muscle activation," "motor learning," "anterior cruciate ligament," and "cortical plasticity." We found that ACLR disrupts sensory input from the quadriceps, which results in reduced sensitivity to electrochemical neuronal signals, an increase in central inhibition of neurons regulating quadriceps control and dampening of reflexive motor activity. MI training consists of visualizing an action, without physically engaging in muscle activity. Imagined motor output during MI training increases the sensitivity and conductivity of corticospinal tracts emerging from the primary motor cortex, which helps "exercise" the connections between the brain and target muscle tissues. Motor rehabilitation studies using BCI-MI technology have demonstrated increased excitability of the motor cortex, corticospinal tract, spinal motor neurons, and disinhibition of inhibitory interneurons. This technology has been validated and successfully applied in the recovery of atrophied neuromuscular pathways in stroke patients but has yet to be investigated in peripheral neuromuscular insults, such as ACL injury and reconstruction. Well-designed clinical studies may assess the impact of BCI on clinical outcomes and recovery time. Quadriceps weakness is associated with neuroplastic changes within specific corticospinal pathways and brain areas. BCI-MI shows strong potential for facilitating recovery of atrophied neuromuscular pathways after ACLR and may offer an innovative, multidisciplinary approach to orthopaedic care. Level of Evidence V, expert opinion.
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Affiliation(s)
- Harsh H. Patel
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Elyse J. Berlinberg
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Riley J. Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Bert Mandelbaum
- Department of Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, U.S.A
| | | | - Brian Forsythe
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois,Address correspondence to Brian Forsythe, M.D., 1611 W. Harrison St, Suite 360, Chicago, IL 60621
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Pinto RF, Birmingham TB, Philpott HT, Primeau CA, Leitch KM, Arsenault DA, Appleton CT. Changes and Associations Between Gait Biomechanics and Knee Inflammation After Aspiration and Glucocorticoid Injection for Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022. [PMID: 36478406 DOI: 10.1002/acr.25064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although knee inflammation is thought to adversely affect joint function in patients with knee osteoarthritis (OA), the effects of reducing knee inflammation on gait biomechanics and strength are unknown. Our objectives were to compare ultrasound (US) measures of knee inflammation, gait biomechanics, knee extension and flexion strength, and pain before and after knee aspiration and glucocorticoid injection, and to explore associations among changes. METHODS Forty-nine patients (69 knees) with symptomatic knee OA and synovitis were tested before and 3-4 weeks after US-guided knee aspiration and glucocorticoid injection. At each visit, participants completed US assessments for inflammatory features of knee OA, 3D gait analysis, isokinetic knee extension and flexion strength tests, and Knee Osteoarthritis Outcome Score (KOOS) pain subscales. Linear and polynomial mixed-effects regression models were used to investigate changes and their associations. RESULTS Changes were observed for the synovitis score (unstandardized β [post-injection minus pre-injection] -0.55/9 [95% confidence interval (95% CI) -0.97, -0.12]), effusion depth (-1.05 mm [95% CI -1.07, -0.39]), KOOS pain (unstandardized β 5.91/100 [95% CI 1.86, 9.97]), peak external knee flexion and extension moments (KFM; 3.33 Nm [95% CI 0.45, 6.22]), KEM (-2.99 Nm [95% CI -5.93, -0.05]), and knee extension strength (4.70 Nm [95% CI 0.39, 9.00]) and flexion strength (3.91 Nm [95% CI 1.50, 6.81]). The external KFM increased during 13-38% and 76-89% of stance post-injection. When controlled for time, greater synovitis was associated with lower knee extension strength, while lower pain was associated with increased knee extension and flexion strength. CONCLUSION In patients with knee OA and synovitis, reduced inflammation and pain after aspiration and glucocorticoid injection are associated with changes in knee gait biomechanics and strength.
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Affiliation(s)
- Ryan F Pinto
- University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Trevor B Birmingham
- University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Holly T Philpott
- University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Codie A Primeau
- University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Kristyn M Leitch
- University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | | | - C Thomas Appleton
- St. Joseph's Health Care London and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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12
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Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31:694-706. [PMID: 35168201 DOI: 10.1123/jsr.2021-0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1) neural pathways involved in the AMI pathogenesis following ACL injury; (2) consequence of AMI on muscle function, joint biomechanics, and patient function; and (3) development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.
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Relationship between individual forces of each quadriceps head during low-load knee extension and cartilage thickness and knee pain in women with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2022; 91:105546. [PMID: 34920238 DOI: 10.1016/j.clinbiomech.2021.105546] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to clarify the individual forces of each quadriceps head during low-load contractions and to determine the associations between individual muscle force and cartilage thickness and symptoms in female knee osteoarthritis patients. METHODS Twenty-two women with painful knee osteoarthritis and 15 asymptomatic age-matched women (control group) participated in this cross-sectional study. Maximal knee extension strength and the cross-sectional area of each quadriceps muscle were measured. Shear modulus was calculated for each muscle during 20-Nm torque production by shear-wave elastography. Muscle force index was defined as the product of the cross-sectional area and shear modulus. Medial femur cartilage thickness was measured using an ultrasound B-mode image. Knee pain during gait was evaluated using a Numerical Rating Scale. Muscle force index, cross-sectional area, and maximal knee extension strength, which were defined as muscle functions, were compared between groups using the unpaired t-test. Correlation coefficients were calculated using muscle function, cartilage thickness, or pain. FINDINGS Maximal strength and vastus lateralis force index were smaller in the knee osteoarthritis group than in the control group (p < 0.001 and p = 0.005, respectively). In the knee osteoarthritis group, vastus medialis and vastus lateralis force indexes were positively correlated with cartilage thickness (r = 0.57 and r = 0.45, respectively), whereas the rectus femoris force index was negatively correlated with cartilage thickness (r = -0.45). The vastus lateralis force index was negatively correlated with knee pain (ρ = -0.56). INTERPRETATION Vasti force indices were positively associated with cartilage thickness; however, rectus femoris index was negatively associated in female patients with knee osteoarthritis.
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Yang JH, Hwang KT, Lee MK, Jo S, Cho E, Lee JK. Comparison of a Cryopneumatic Compression Device and Ice Packs for Cryotherapy Following Anterior Cruciate Ligament Reconstruction. Clin Orthop Surg 2022; 15:234-240. [PMID: 37008961 PMCID: PMC10060780 DOI: 10.4055/cios21246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of the current study was to evaluate and compare the effectiveness of a cryopneumatic compression device with that of standard ice packs following arthroscopic anterior cruciate ligament (ACL) reconstruction, with a primary focus on early postoperative pain. Methods Participants were divided into two groups: cryopneumatic compression device group (CC group) and standard ice pack group (IP group). Patients in the CC Group (28 patients) received a cryopneumatic compression device (CTC-7, Daesung Maref) treatment, while patients in the IP group (28 patients) received standard ice pack cryotherapy postoperatively. All cryotherapy was applied three times (every 8 hours) per day for 20 minutes until discharge (postoperative day 7). Pain scores were assessed preoperatively and at 4, 7, and 14 days after surgery, and the primary outcome for analysis was pain at postoperative day 4 assessed using a visual analog scale (VAS). Other variables were opioid and rescue medication use, knee and thigh circumferences, postoperative drainage, and joint effusion quantified by a three-dimensional magnetic resonance imaging (MRI) reconstruction model. Results The mean pain VAS score and difference in VAS relative to the preoperative measurements for postoperative day 4 were significantly lower in the CC group than in the IP group (p = 0.001 and p = 0.007, respectively). The sum of postoperative drainage and effusion quantified by MRI showed a significant reduction of postoperative effusion in the CC group compared to the IP group (p = 0.015). The average total rescue medication consumption was comparable between the two groups. Circumferential measurements at days 7 and 14 postoperatively relative to those at day 4 (index day) demonstrated no significant differences between the groups. Conclusions Compared to standard ice packs, application of cryopneumatic compression was associated with a significant reduction in VAS pain scores and joint effusion during the early postoperative period following ACL reconstruction.
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Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Kyu-Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Myoung Keun Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Sungsin Jo
- Hanyang University Institute for Rheumatology Research, Hanyang University, Seoul, Korea
| | | | - Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
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15
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Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2021; 31:717-735. [PMID: 34883466 DOI: 10.1123/jsr.2021-0139] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. OBJECTIVES To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. EVIDENCE ACQUISITION PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. EVIDENCE SYNTHESIS 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. CONCLUSION AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.
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Early postoperative practices following anterior cruciate ligament reconstruction in France. Orthop Traumatol Surg Res 2021; 107:103065. [PMID: 34537390 DOI: 10.1016/j.otsr.2021.103065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The early postoperative period after anterior cruciate ligament reconstruction (ACL) is critical for optimal functional recovery. Despite an abundance of literature, there is no consensus regarding good practices. This period is often under-considered by orthopedic surgeons. The aim of this study was to identify early postoperative practices after ACL reconstruction in France. HYPOTHESIS The hypothesis was that there was a discrepancy between validated data in the literature and the current practices of orthopedic surgeons in France. MATERIAL AND METHODS In 2019, a questionnaire was sent to all the members of the French Arthroscopy Society to investigate their postoperative practices after ACL reconstruction. Two hundred sixty-nine members responded. Surgeons were divided into two groups of experienced (n=137) and less experienced (n=132) surgeons, according to the number of ACL reconstructions performed per year (<or≥50/year). Outpatient management, effusion prevention measures, and rehabilitation instructions and goals were collected. Overall responses were analyzed after multiple linear logistic regression and the responses of the two groups were compared. RESULTS ACL reconstruction was performed as an outpatient procedure in 72.9% of cases. This rate increased with surgical experience (p=0.009×10-3). Among measures to prevent effusion, cryotherapy was recommended in 97.8% of cases. The experienced group more often used compressive cryotherapy devices (p=0.004). Rehabilitation was started immediately in 75.5% of cases, with as main objective recovery of full extension (89.6%). Weight-bearing was allowed in 98.5% of cases and a brace was prescribed in 69.9% of cases. In the experienced group, braces were less frequent (p=0.02) and self-rehabilitation was preferred (p=0.0006). CONCLUSION Early postoperative practices after ACL reconstruction in France are related to surgical experience. The greater the surgical experience, the greater the role of joint effusion prevention and self-rehabilitation. Despite recommendations in the literature, a quarter of the French orthopedic surgeons who responded to this survey did not perform this procedure on an outpatient basis and more than two-thirds prescribed braces. LEVEL OF EVIDENCE IV.
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Seeley MK, Denning WM, Park J, Croft K, Horton WZ, Hopkins JT. Anterior knee pain independently alters landing and jumping biomechanics. Clin Biomech (Bristol, Avon) 2021; 89:105458. [PMID: 34455339 DOI: 10.1016/j.clinbiomech.2021.105458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
Background Biomechanical effects of anterior knee pain are difficult to distinguish from effects of other factors also related to knee injury (e.g., joint effusion). The purpose of this study was to evaluate independent effects of anterior knee pain on landing and jumping biomechanics. Methods Thirteen healthy participants performed a land and jump movement task, under three experimental conditions (pre-pain, pain, and post-pain), during one data collection session. One 1-ml injection of hypertonic saline into the infrapatellar fat pad was used to induce experimental anterior knee pain during the pain condition. Participant-perceived anterior knee pain was measured every 2 min throughout data collection. Landing and jumping biomechanics were measured and compared between the experimental conditions using a functional statistical approach. Findings The aforementioned injection increased mean participant-perceived anterior knee pain, from zero during the pre-pain condition to 2.6 ± 0.71 cm during the pain condition. Vertical ground reaction force, knee flexion angle, and internal knee extension moment decreased by approximately 0.100 body weights, 3°, and 0.010 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Conversely, hip flexion angle and internal hip extension moment increased by approximately 3° and 0.006 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Several biomechanical changes persisted after anterior knee pain abatement (the post-pain condition). Interpretation Anterior knee pain alters landing and jumping biomechanics, independent of other injury-related factors. These altered biomechanics likely change knee joint loading patterns and might increase risk for chronic knee joint injury and/or pathology.
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Affiliation(s)
- Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA.
| | - W Matt Denning
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin 17104, Korea
| | - Kaitland Croft
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - W Zachary Horton
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
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Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil 2021; 31:707-716. [PMID: 34470911 DOI: 10.1123/jsr.2020-0479] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) continues to be a limiting factor in joint rehabilitation as the inability to volitionally activate muscle significantly dampens recovery. New evidence acquired at higher brain centers and in clinical populations continues to reshape our perspective of what AMI is and how to treat it. This review aims to stimulate discussion about the far-reaching effects of AMI by exploring the interconnected pathways by which it evolves. OBJECTIVES To discuss how reflexive inhibition can lead to adaptations in brain activity, to illustrate how changes in descending motor pathways limit our ability to contract muscle following injury, and to summarize the emerging literature on the wide-reaching effects of AMI on other interconnected systems. DATA SOURCES The databases PubMed, SPORTDiscus, and Web of Science were searched for articles pertaining to AMI. Reference lists from appropriate articles were cross-referenced. CONCLUSION AMI is a sequential and cumulative neurological process that leads to complex clinical impairments. Originating with altered afferent information arising from an injured joint, patients experience changes in afferent information, reflexive muscle inhibition, deficiencies in somatosensation, neuroplastic compensations in higher brain centers, and ultimately decreased motor output to the muscle surrounding the joint. Other aspects of clinical function, like muscle structure and psychological responses to injury, are also impaired and influenced by AMI. Removing, or reducing, AMI should continue to be a focus of rehabilitation programs to assist in the optimization of health after joint injury.
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Pfeiffer SJ, Spang JT, Nissman D, Lalush D, Wallace K, Harkey MS, Pietrosimone LS, Padua D, Blackburn T, Pietrosimone B. Association of Jump-Landing Biomechanics With Tibiofemoral Articular Cartilage Composition 12 Months After ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211016424. [PMID: 34368382 PMCID: PMC8299897 DOI: 10.1177/23259671211016424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Excessively high joint loading during dynamic movements may negatively influence articular cartilage health and contribute to the development of posttraumatic osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Little is known regarding the link between aberrant jump-landing biomechanics and articular cartilage health after ACLR. PURPOSE/HYPOTHESIS The purpose of this study was to determine the associations between jump-landing biomechanics and tibiofemoral articular cartilage composition measured using T1ρ magnetic resonance imaging (MRI) relaxation times 12 months postoperatively. We hypothesized that individuals who demonstrate alterations in jump-landing biomechanics, commonly observed after ACLR, would have longer T1ρ MRI relaxation times (longer T1ρ relaxation times associated with less proteoglycan density). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 27 individuals with unilateral ACLR participated in this cross-sectional study. Jump-landing biomechanics (peak vertical ground-reaction force [vGRF], peak internal knee extension moment [KEM], peak internal knee adduction moment [KAM]) and T1ρ MRI were collected 12 months postoperatively. Mean T1ρ relaxation times for the entire weightbearing medial femoral condyle, lateral femoral condyle (global LFC), medial tibial condyle, and lateral tibial condyle (global LTC) were calculated bilaterally. Global regions of interest were further subsectioned into posterior, central, and anterior regions of interest. All T1ρ relaxation times in the ACLR limb were normalized to the uninjured contralateral limb. Linear regressions were used to determine associations between T1ρ relaxation times and biomechanics after accounting for meniscal/chondral injury. RESULTS Lower ACLR limb KEM was associated with longer T1ρ relaxation times for the global LTC (ΔR 2 = 0.24; P = .02), posterior LTC (ΔR 2 = 0.21; P = .03), and anterior LTC (ΔR 2 = 0.18; P = .04). Greater ACLR limb peak vGRF was associated with longer T1ρ relaxation times for the global LFC (ΔR 2 = 0.20; P = .02) and central LFC (ΔR 2 = 0.15; P = .05). Peak KAM was not associated with T1ρ outcomes. CONCLUSION At 12 months postoperatively, lower peak KEM and greater peak vGRF during jump landing were related to longer T1ρ relaxation times, suggesting worse articular cartilage composition.
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Affiliation(s)
- Steven J. Pfeiffer
- Ohio Musculoskeletal & Neurological Institute, Athens, Ohio, USA
- Division of Exercise Physiology, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Athens, Ohio, USA
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Kyle Wallace
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew S. Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Laura S. Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Darin Padua
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Criss CR, Melton MS, Ulloa SA, Simon JE, Clark BC, France CR, Grooms DR. Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury. Knee 2021; 30:78-89. [PMID: 33873089 DOI: 10.1016/j.knee.2021.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked. OBJECTIVE This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation) RESULTS: Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation. CONCLUSION Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.
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Affiliation(s)
- Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.
| | - M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Sergio A Ulloa
- OhioHealth Physician Group Heritage College: Orthopedic and Sports Medicine, OhioHealth O'Bleness Memorial Hospital, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 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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Ercan N, Akmese R, Ulusoy B. Single-tunnel and double-tunnel medial patellofemoral ligament reconstructions have similar clinical, radiological and functional results. Knee Surg Sports Traumatol Arthrosc 2021; 29:1904-1912. [PMID: 32889556 DOI: 10.1007/s00167-020-06260-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the clinical, radiological and functional results of patients underwent single-tunnel (ST) and double-tunnel (DT) medial patellofemoral ligament(MPFL) reconstructions with hamstring autograft following recurrent patella dislocation prospectively in a single institution. METHODS From 2013 to 2017, 80 patients with symptomatic recurrent patellar dislocation or instability were randomly divided into 2 groups for MPFL reconstruction with ST technique or DT technique and evaluated prospectively. In the ST group, there were 20 male and 20 female with a median follow-up of 46.5 months (range 24-74). The median age was 15 years (range 10-28). In the DT group, there were 18 male and 22 female with a median follow-up of 40 months (range 24-74). The median age was 19 years (range 14-29). Clinical scores (Kujala score, Lysholm score, Tegner score and IKDC score) and radiological measurements (congruence angle and patellar tilt angle) of the patients were evaluated preoperatively and at postoperative 24th month. Isokinetic dynamometric tests were performed at postoperative 24th month and the difference between the operated leg and the non-operated leg was found as a percentage deficit. RESULTS There were no postoperative complications, redislocation or subluxation in any patient. Kujala, Lysholm, Tegner and IKDC scores were better and statistically significant postoperatively in both groups (p < 0.05). However, there was no statistically significant difference between the groups (n.s.). The congruence angle and patellar tilt angle were found to be returned to normal values postoperatively, but there was no statistically significant difference between the groups (n.s.). There was no statistically significant difference between the two groups in isokinetic dynamometric tests performed as 60° flexion, 60° extension, 180° flexion and 180° extension (n.s.). CONCLUSION The present study is the first that compared the clinical, radiological and functional results of the ST and DT techniques to date. Regardless of the number of the tunnels, similar results were obtained in ST and DT reconstruction using transpatellar tunnel technique. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Niyazi Ercan
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Ramazan Akmese
- Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Ulusoy
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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22
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Jeon W, Whitall J, Griffin L, Westlake KP. Trunk kinematics and muscle activation patterns during stand-to-sit movement and the relationship with postural stability in aging. Gait Posture 2021; 86:292-298. [PMID: 33838526 DOI: 10.1016/j.gaitpost.2021.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stand-to-sit (StandTS) movement is an important functional activity that can be challenging for older adults due to age-related changes in neuromotor control. Although trunk flexion, eccentric contraction of the rectus femoris (RF), and coordination of RF and biceps femoris (BF) muscles are important to the StandTS task, the effects of aging on these and related outcomes are not well studied. RESEARCH QUESTION What are the age-related differences in trunk flexion, lower extremity muscle activation patterns, and postural stability during a StandTS task and what is the relationship between these variables? METHODS Ten younger and ten older healthy adults performed three StandTS trials at self-selected speeds. Outcomes included peak amplitude, peak timing, burst duration, and onset latency of electromyography (EMG) activity of the RF and BF muscles, trunk flexion angle and angular velocity, whole body center of mass (CoM) displacement, center of pressure (CoP) velocity, and ground reaction force (GRF). RESULTS There were no age-related differences in weight-bearing symmetry, StandTS and trunk flexion angular velocity, or BF activity. In both groups, EMG peak timing of RF was preceded by BF. Compared to younger adults, older adults demonstrated shorter RF EMG burst duration, reduced trunk flexion, and reduced stability as indicated by the longer duration in which CoM was maintained beyond the posterior limit of base of support (BoS), greater mean anterior-posterior CoP velocity and larger standard deviation of CoM vertical acceleration during StandTS with smaller vertical GRF immediately prior to StandTS termination. Trunk flexion angle and RF EMG burst duration correlated with stability as measured by the duration in which the CoM stayed within the BoS. SIGNIFICANCE Decreased trunk flexion and impaired eccentric control of the RF are associated with StandTS instability in aging and suggest the importance of including StandTS training as a part of a comprehensive balance intervention.
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Affiliation(s)
- Woohyoung Jeon
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States; University of Maryland School of Medicine, Department of Physical Therapy & Rehabilitation Science, Baltimore, MD, United States.
| | - Jill Whitall
- University of Maryland School of Medicine, Department of Physical Therapy & Rehabilitation Science, Baltimore, MD, United States.
| | - Lisa Griffin
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States.
| | - Kelly P Westlake
- University of Maryland School of Medicine, Department of Physical Therapy & Rehabilitation Science, Baltimore, MD, 21201, United States.
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23
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Buckthorpe M. Recommendations for Movement Re-training After ACL Reconstruction. Sports Med 2021; 51:1601-1618. [PMID: 33840081 DOI: 10.1007/s40279-021-01454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Marys University, Twickenham, London, TW1 4SX, UK.
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24
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Abstract
Outcomes following anterior cruciate ligament (ACL) reconstruction need improving, with poor return-to-sport rates and high risk of secondary re-injury. There is a need to improve rehabilitation strategies after ACL reconstruction, if we can support enhanced patient outcomes. This paper discusses how to optimise the mid-stage rehabilitation process after ACL reconstruction. Mid-stage is a difficult and vitally important stage of the functional recovery process and provides the foundation on which to commence late-stage rehabilitation training. Often many aspects of mid-stage rehabilitation (e.g. knee extensors isolated muscle strength) are not actually restored prior to return-to-sport. In addition, if we are to allow time for optimal late-stage rehabilitation and return-to-sport training, we need to optimise the mid-stage rehabilitation approach and complete it in a timely manner. This paper forms a key part of a strategy to optimise the ACL rehabilitation approach and considers factors more specific to mid-stage rehabilitation characterised in 3 areas: (1) muscle strength: muscle and joint specific, in particular at the knee level, with the knee extensors and flexors and distally with the triceps surae and proximally with the lumbo-pelvic-hip complex, as well as closed kinetic chain strength; (2) altered basic motor patterning (movement quality) and (3) fitness re-conditioning. In addition, the paper provides recommendations on how to implement these into practice, discussing training planning and programming and suggests specific screening to monitor work and when the athlete is able to progress to the next stage (e.g. late-stage rehabilitation criteria).
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25
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Palmieri-Smith RM, Curran MT, Garcia SA, Krishnan C. Factors That Predict Sagittal Plane Knee Biomechanical Symmetry After Anterior Cruciate Ligament Reconstruction: A Decision Tree Analysis. Sports Health 2021; 14:167-175. [PMID: 33764229 DOI: 10.1177/19417381211004932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Biomechanical knee asymmetry is commonly present after anterior cruciate ligament (ACL) reconstruction. Factors that could assist in identification of asymmetrical biomechanics after ACL reconstruction could help clinicians in making return-to-play decisions. The purpose of this study is to determine factors that may contribute to knee biomechanical asymmetry present after ACL reconstruction. HYPOTHESIS We hypothesized that quadriceps strength and activation and patient-reported function would allow for identification of patients with symmetrical knee biomechanics. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Thirty-one subjects (18 women; time since ACL reconstruction = 284.4 ± 53.6 days) who underwent ACL reconstruction and were to return to activity were recruited. Participants completed bilateral assessments of isokinetic quadriceps strength, quadriceps activation using the superimposed burst technique, and biomechanical function testing during a single-leg forward hop. The International Knee Documentation Committee (IKDC) subjective knee form was also completed. Symmetry values were calculated for each variable. Decision trees were utilized to determine which input factors (quadriceps strength symmetry, quadriceps activation symmetry, IKDC score, age, sex, height, mass, graft type) were able to identify participants who had symmetrical knee flexion angles (KFAs) and extension moments. Angles and moments were considered symmetrical if symmetry values were ≥90%. RESULTS Quadriceps strength and activation symmetry were able to predict whether a patient landed with symmetrical or asymmetrical KFAs, with thresholds of 77.2% strength symmetry and 91.3% activation symmetry being established. Patient-reported function and quadriceps strength were factors that allowed for classification of participants with symmetrical/asymmetrical knee extension moments, with thresholds of 89.1 for the IKDC and 80.0% for quadriceps strength symmetry. CONCLUSIONS Quadriceps strength contributed to both models and appears to be a critical factor for achieving symmetrical knee biomechanics. High patient-reported function and quadriceps activation are also important for restoring knee biomechanical symmetry after ACL reconstruction. CLINICAL RELEVANCE Quadriceps strength and activation and patient-reported function may be able to assist clinicians in identifying ACL patients with symmetrical/asymmetrical knee biomechanics.
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Affiliation(s)
- Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan.,Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Michael T Curran
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.,Robotics Institute, University of Michigan, Ann Arbor, Michigan.,Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, Michigan
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26
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Diermeier T, Rothrauff BB, Engebretsen L, Lynch AD, Svantesson E, Hamrin Senorski E, Rauer T, Meredith SJ, Ayeni OR, Paterno MV, Xerogeanes JW, Fu FH, Karlsson J, Musahl V. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. J ISAKOS 2021; 6:129-137. [PMID: 34006576 DOI: 10.1136/jisakos-2020-000493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 01/25/2023]
Abstract
Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence on operative versus non-operative treatment for ACL injury.The purpose of this study was to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative veresus non-operative treatment of ACL injury reached consensus during the symposium. Nine statements achieved unanimous support; two reached strong consensus; one did not achieve consensus; and one was removed due to redundancy in the information provided.In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical anterior cruciate ligament reconstruction (ACLR) is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability or when episodes of giving way occur, anatomical ACLR is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury.Level of evidence: V.
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Affiliation(s)
- Theresa Diermeier
- Department of Sportorthopedic, Technical University of Munich, Munchen, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lars Engebretsen
- Department of Orthopedics, Institute of Clinical Sciences, University of Gothenburg, Mölndal, Sweden
| | | | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, University of Gothenburg, Mölndal, Sweden
| | | | | | - Sean J Meredith
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Olufemi R Ayeni
- Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John W Xerogeanes
- Department of Orthopaedics, Emory University Orthopaedic and Spine Hospital, Atlanta, Georgia, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jón Karlsson
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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27
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Obese Youth Demonstrate Altered Landing Knee Mechanics Unrelated to Lower-Extremity Peak Torque When Compared With Healthy Weight Youth. J Appl Biomech 2021; 37:109-117. [PMID: 33450728 DOI: 10.1123/jab.2020-0013] [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: 01/17/2020] [Revised: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022]
Abstract
Obese (OB) youth demonstrate altered knee mechanics and worse lower-extremity performance compared with healthy weight (HW) youth. Our objectives were to compare sagittal plane knee landing mechanics between OB and HW youth and to examine the associations of knee and hip extension peak torque with landing mechanics in OB youth. Twenty-four OB and 24 age- and sex-matched HW youth participated. Peak torque was measured and normalized to leg lean mass. Peak knee flexion angle and peak internal knee extension moment were measured during a single-leg hop landing. Paired t tests, Pearson correlation coefficients, and Bonferroni corrections were used. OB youth demonstrated worse performance and lower knee extension (OB: 12.76 [1.38], HW: 14.03 [2.08], P = .03) and hip extension (OB: 8.59 [3.13], HW: 11.10 [2.89], P = .005) peak torque. Furthermore, OB youth demonstrated lower peak knee flexion angles (OB: 48.89 [45.41 to 52.37], HW: 56.07 [52.59 to 59.55], P = .02) and knee extension moments (OB: -1.73 [-1.89 to -1.57], HW: -2.21 [-2.37 to -2.05], P = .0001) during landing compared with HW youth. Peak torque measures were not correlated with peak knee flexion angle nor internal knee extension moment during landing in either group (P > .01). OB youth demonstrated altered landing mechanics compared with HW youth. However, no associations among peak torque measurements and knee landing mechanics were present.
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28
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Karaborklu Argut S, Celik D, Yasacı Z. Effectiveness of therapeutic electromyographic biofeedback after orthopedic knee surgeries: a systematic review. Disabil Rehabil 2021; 44:3364-3372. [PMID: 33417500 DOI: 10.1080/09638288.2020.1867904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To present an evidence-based overview of the current utilization and the effectiveness of therapeutic Electromyographic Biofeedback (EMG-BF) in rehabilitation after orthopedic knee surgeries. MATERIALS AND METHODS This systematic review was conducted according to the PRISMA statement. MEDLINE (PubMed), PEDro, The Cochrane Library, and Web of Science databases were searched from their inception to June 20, 2020. RESULTS Eight RCTs investigating effectiveness of the EMG-BF in rehabilitation after orthopedic knee surgeries were identified. The quality scores for included studies ranged from 6 to 8 on PEDro Scale. Most of the included studies reported that EMG-BF was more effective compared to home exercises, standard rehabilitation program or electrical stimulation for improving quadriceps strength or activation. Besides, EMG-BF was revealed positive results in functional assessments except gait velocity and IKDC. Only two studies reported knee ROMs were significantly improved in favour of EMG-BF. CONCLUSIONS This systematic review shows that EMG-BF seems to control pain and improve quadriceps femoris strength and functionality. However, the results are inconclusive regarding knee ROMs. Although available high-quality evidence is limited, EMG-BF might be a part of the rehabilitation after knee surgeries.Implications for rehabilitationThis paper reviews the effectiveness of the therapeutic EMG-BF as a potential option in rehabilitation after orthopedic knee surgeries.It is recommended EMG-BF can be used to control pain and to improve quadriceps strength and function.There is insufficient evidence to support EMG-BF to improve the range of motion.
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Affiliation(s)
- Sezen Karaborklu Argut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Derya Celik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynal Yasacı
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Harran University, Sanliurfa, Turkey
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29
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Jeong J, Choi DH, Shin CS. Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:183-192. [PMID: 33381989 DOI: 10.1177/0363546520972990] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Core stability is influential in the incidence of lower extremity injuries, including anterior cruciate ligament (ACL) injuries, but the effects of core strength training on the risk for ACL injury remain unclear. HYPOTHESIS Core muscle strength training increases the knee flexion angle, hamstring to quadriceps (H:Q) coactivation ratio, and vastus medialis to vastus lateralis (VM:VL) muscle activation ratio, as well as decreases the hip adduction, knee valgus, and tibial internal rotation angles. STUDY DESIGN Controlled laboratory study. METHODS A total of 48 male participants were recruited and randomly assigned to either the intervention group (n = 32) or the control group (n = 16). Three-dimensional trunk, hip, knee, and ankle kinematic data and muscle activations of selected trunk and lower extremity muscles were obtained while the participants performed side-step cutting. The core endurance scores were measured before and after training. Two-way analyses of variance were conducted for each dependent variable to determine the effects of 10 weeks of core strength training. RESULTS The trunk endurance scores in the intervention group significantly increased after training (P < .05 for all comparisons). The intervention group showed decreased knee valgus (P = .038) and hip adduction angles (P = .032) but increased trunk flexion angle (P = .018), rectus abdominis to erector spinae coactivation ratio (P = .047), H:Q coactivation ratio (P = .021), and VM:VL activation ratio (P = .016). In addition, the knee valgus angle at initial contact was negatively correlated with the VM:VL activation ratio in the precontact phase (R2 = 0.188; P < .001) but was positively correlated with the hip adduction angle (R2 = 0.120; P < .005). No statistically significant differences were observed in the trunk endurance scores, kinematics, and muscle activations for the control group. CONCLUSION Core strength training altered the motor control strategies and joint kinematics for the trunk and the lower extremity by increasing the trunk flexion angle, VM:VL activation ratio, and H:Q activation ratio and reducing the knee valgus and hip adduction angles. CLINICAL RELEVANCE Training core muscles can modify the biomechanics associated with ACL injuries in a side-step cutting task; thus, core strength training might be considered in ACL injury prevention programs to alter the lower extremity alignment in the frontal plane and muscle activations during sports-related tasks.
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Affiliation(s)
- Jiyoung Jeong
- Department of Mechanical Engineering, Sogang University, Mapo-gu, Seoul, Republic of Korea
| | - Dai-Hyuk Choi
- Department of Physical Education, Graduate School of Education, Sogang University, Mapo-gu, Seoul, Republic of Korea
| | - Choongsoo S Shin
- Department of Mechanical Engineering, Sogang University, Mapo-gu, Seoul, Republic of Korea
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30
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Thermal and non-thermal effects of capacitive-resistive electric transfer application on different structures of the knee: a cadaveric study. Sci Rep 2020; 10:22290. [PMID: 33339869 PMCID: PMC7749154 DOI: 10.1038/s41598-020-78612-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
Capacitive-resistive electric transfer therapy is used in physical rehabilitation and sports medicine to treat muscle, bone, ligament and tendon injuries. The purpose is to analyze the temperature change and transmission of electric current in superficial and deep knee tissues when applying different protocols of capacitive-resistive electric transfer therapy. Five fresh frozen cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 min by a physiotherapist with experience. Dynamic movements were performed to the posterior region of the knee. Capsular, intra-articular and superficial temperature were recorded at 1-min intervals and 5 min after the treatment, using thermocouples placed with ultrasound guidance. The low-power protocols had only slight capsular and intra-capsular thermal effects, but electric current flow was observed. The high-power protocols achieved a greater increase in capsular and intra-articular temperature and a greater current flow than the low-power protocols. The information obtained in this in vitro study could serve as basic science data to hypothesize capsular and intra-articular knee recovery in living subjects. The current flow without increasing the temperature in inflammatory processes and increasing the temperature of the tissues in chronic processes with capacitive-resistive electric transfer therapy could be useful for real patients.
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31
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Diermeier TA, Rothrauff BB, Engebretsen L, Lynch A, Svantesson E, Hamrin Senorski EA, Meredith SJ, Rauer T, Ayeni OR, Paterno M, Xerogeanes JW, Fu FH, Karlsson J, Musahl V. Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group. Br J Sports Med 2020; 55:14-22. [DOI: 10.1136/bjsports-2020-102200] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Abstract
Treatment strategies for ACL injuries continue to evolve. Evidence supporting best practice guidelines to manage ACL injury is largely based on studies with low-level evidence. An international consensus group of experts was convened determine consensus regarding best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus non-operative treatment of ACL injury reached consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomical ACL reconstruction is indicated. The consensus statements derived from international leaders in the field may assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury. Level of evidence: Level V
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32
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Diermeier T, Rothrauff BB, Engebretsen L, Lynch AD, Ayeni OR, Paterno MV, Xerogeanes JW, Fu FH, Karlsson J, Musahl V, Brown CH, Chmielewski TL, Clatworthy M, Villa SD, Ernlund L, Fink C, Getgood A, Hewett TE, Ishibashi Y, Johnson DL, Macalena JA, Marx RG, Menetrey J, Meredith SJ, Onishi K, Rauer T, Rothrauff BB, Schmitt LC, Seil R, Senorski EH, Siebold R, Snyder-Mackler L, Spalding T, Svantesson E, Wilk KE. Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group. Orthop J Sports Med 2020; 8:2325967120931097. [PMID: 32637434 PMCID: PMC7315684 DOI: 10.1177/2325967120931097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022] Open
Abstract
Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight-plane activities, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.
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Affiliation(s)
- Theresa Diermeier
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lars Engebretsen
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew D Lynch
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi R Ayeni
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark V Paterno
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John W Xerogeanes
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Charles H Brown
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Terese L Chmielewski
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark Clatworthy
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lucio Ernlund
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christian Fink
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan Getgood
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy E Hewett
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yasuyuki Ishibashi
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darren L Johnson
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey A Macalena
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert G Marx
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacques Menetrey
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kentaro Onishi
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laura C Schmitt
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Romain Seil
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric H Senorski
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rainer Siebold
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lynn Snyder-Mackler
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tim Spalding
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleonore Svantesson
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin E Wilk
- Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Armitano‐Lago CN, Morrison S, Hoch JM, Bennett HJ, Russell DM. Anterior cruciate ligament reconstructed individuals demonstrate slower reactions during a dynamic postural task. Scand J Med Sci Sports 2020; 30:1518-1528. [DOI: 10.1111/sms.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Cortney N. Armitano‐Lago
- Department of Exercise and Sport Science University of North Carolina Chapel Hill North CarolinaUSA
| | - Steven Morrison
- School of Rehabilitation Sciences Old Dominion University Norfolk VirginiaUSA
| | - Johanna M. Hoch
- Department of Athletic Training & Clinical Nutrition University of Kentucky Lexington KentuckyUSA
| | - Hunter J. Bennett
- Department of Human Movement Sciences Old Dominion University Norfolk VirginiaUSA
| | - Daniel M. Russell
- School of Rehabilitation Sciences Old Dominion University Norfolk VirginiaUSA
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Knee effusion evaluated by ultrasonography warns knee osteoarthritis patients to develop their muscle atrophy: a three-year cohort study. Sci Rep 2020; 10:8444. [PMID: 32439881 PMCID: PMC7242413 DOI: 10.1038/s41598-020-65368-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/29/2020] [Indexed: 11/08/2022] Open
Abstract
This study aimed to elucidate the relationship between the quantitative value of suprapatellar effusion and the longitudinal changes in lower-extremity muscle mass (MM) in a cohort with knee osteoarthritis (KOA). Fifty-three subjects (106 legs) with bilateral radiographic KOA at baseline (BL) were enrolled. MM was calculated by bioimpedance analysis three times at BL, and at the one-year (1Y) and three-year (3Y) follow-ups. The longitudinal change in the lower-extremity MM was calculated by subtracting MMBL from MM1Y, and MM1Y from MM3Y. Subjects with ≥1.0 z-score loss were defined as having severe MM loss (SMML). Effusion was evaluated as the sagittal area of suprapatellar pouch (mm2) by ultrasonography. The ROC curve was drawn to determine the cut-off of effusion area. General estimating equations (GEEs) were conducted with the prevalence of SMML as the dependent variable and with the cut-off of effusion area as the independent variable. Sixteen legs (15.1%) demonstrated SMMLBL-1Y and another sixteen legs demonstrated SMML1Y-3Y. GEEs revealed that individuals with ≥90 mm2 effusion had significantly higher odds of SMMLBL-1Y prevalence (Odds ratio: 21.561; P-value: 0.003). Individuals with leachate knee effusion at BL had a significant risk of losing MM through the first year of the initial knee effusion assessment.
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Cannon J, Weber AE, Park S, Mayer EN, Powers CM. Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice. Phys Ther 2020; 100:788-797. [PMID: 31899497 DOI: 10.1093/ptj/pzz189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/16/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.
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Affiliation(s)
- Jordan Cannon
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Seol Park
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erik N Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Christopher M Powers
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar St, CHP-155, Los Angeles, CA (USA)
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Olson MW. Static loading of the knee joint results in modified single leg landing biomechanics. PLoS One 2020; 15:e0219648. [PMID: 32084138 PMCID: PMC7034804 DOI: 10.1371/journal.pone.0219648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background External loading of the ligamentous tissues induces mechanical creep, which modifies neuromuscular response to perturbations. It is not well understood how ligamentous creep affects athletic performance and contributes to modifications of knee biomechanics during functional tasks. Hypothesis/purpose The purpose of this study was to examine the mechanical and neuromuscular responses to single leg drop landing perturbations before and after passive loading of the knee joint. Methods Descriptive laboratory study. Male (n = 7) and female (n = 14) participants’ (21.3 ± 2.1 yrs., 1.69 ± 0.09 m, 69.3 ± 13.0 kg) right hip, knee, and ankle kinematics were assessed during drop landings performed from a 30 cm height onto a force platform before and after a 10 min creep protocol. Electromyography (EMG) signals were recorded from rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), semimembranosus (SM), and biceps femoris (BF) muscles. The creep protocol involved fixing the knee joint at 35° during static loading with perpendicular loads of either 200 N (males) or 150 N (females). Maximum, minimum, range of motion (ROM), and angular velocities were assessed for the hip, knee, and ankle joints, while normalized EMG (NEMG), vertical ground reaction forces (VGRF), and rate of force development (RFD) were assessed at landing using ANOVAs. Alpha was set at 0.05. Results Maximum hip flexion velocity decreased (p < 0.01). Minimum knee flexion velocity increased (p < 0.02). Minimum knee ad/abduction velocity decreased (p < 0.001). Ankle ROM decreased (p < 0.001). aVGRF decreased (p < 0.02). RFD had a non-significant trend (p = 0.076). NAEMG was significant between muscle groups (p < 0.02). Conclusion Distinct changes in velocity parameters are attributed to the altered mechanical behavior of the knee joint tissues and may contribute to changes in the loading of the leg during landing.
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Affiliation(s)
- Michael W. Olson
- Department of Kinesiology, Southern Illinois University Carbondale, Carbondale, IL, United States of America
- Department of Athletic Training and Exercise Physiology, Midwestern State University, Wichita Falls, TX, United States of America
- * E-mail:
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Moudy SC, Tillin NA, Sibley AR, Strike S. Mechanisms to Attenuate Load in the Intact Limb of Transtibial Amputees When Performing a Unilateral Drop Landing. J Appl Biomech 2020; 36:4-12. [PMID: 31775122 DOI: 10.1123/jab.2019-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/22/2019] [Accepted: 09/25/2019] [Indexed: 11/18/2022]
Abstract
Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.
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Affiliation(s)
- Sarah C Moudy
- University of Roehampton
- University of North Texas Health Science Center
| | | | - Amy R Sibley
- University of Roehampton
- London South Bank University
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Diermeier T, Rothrauff BB, Engebretsen L, Lynch AD, Ayeni OR, Paterno MV, Xerogeanes JW, Fu FH, Karlsson J, Musahl V, Svantesson E, Hamrin Senorski E, Rauer T, Meredith SJ. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2390-2402. [PMID: 32388664 PMCID: PMC7524809 DOI: 10.1007/s00167-020-06012-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative vs. non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative vs. non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organizing Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided the initial agreement and comments on the statement via an online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty percent agreement was defined a-priori as consensus. A total of 11 of 13 statements on operative v. non-operative treatment of ACL injury reached the consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatments with patients after an ACL injury.Level of evidence V.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA ,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Benjamin B. Rothrauff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Lars Engebretsen
- Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andrew D. Lynch
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Mark V. Paterno
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | | | - Freddie H. Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Rauer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA ,Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sean J. Meredith
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 USA ,Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
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Jennings JM, Loyd BJ, Miner TM, Yang CC, Stevens-Lapsley J, Dennis DA. A prospective randomized trial examining the use of a closed suction drain shows no influence on strength or function in primary total knee arthroplasty. Bone Joint J 2019; 101-B:84-90. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1420.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. Patients and Methods A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction (‘sham drain’). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student’s t-tests or Wilcoxon’s signed-rank tests. Results No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. Conclusion The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84–90
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Affiliation(s)
- J. M. Jennings
- Colorado Joint Replacement, Denver, Colorado, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
| | - B. J. Loyd
- Physical Therapy Department, University of Utah, Salt Lake City, Utah, USA
| | - T. M. Miner
- Colorado Joint Replacement, Denver, Colorado, USA
| | - C. C. Yang
- Colorado Joint Replacement, Denver, Colorado, USA
| | - J. Stevens-Lapsley
- University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
| | - D. A. Dennis
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
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40
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Wilkinson BG, Donnenwerth JJ, Peterson AR. Use of Blood Flow Restriction Training for Postoperative Rehabilitation. Curr Sports Med Rep 2019; 18:224-228. [DOI: 10.1249/jsr.0000000000000604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Loyd BJ, Burrows K, Forster JE, Stackhouse SK, Hogan C, Stevens-Lapsley JE. Reliability and precision of single frequency bioelectrical impedance assessment of lower extremity swelling following total knee arthroplasty. Physiother Theory Pract 2019; 37:197-203. [PMID: 31140887 DOI: 10.1080/09593985.2019.1619886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Total knee arthroplasty (TKA) is the most common elective orthopedic surgery performed in the United States. Following surgery patients experience significant lower extremity swelling that is related to poor satisfaction with surgery and is hypothesized to contribute to functional decline. However, in practice, precise and reliable methods for measuring lower extremity swelling do not exist. The purpose of this study was to provide reliability and precision parameters of an innovative approach, single frequency bioelectrical impedance assessment (SF-BIA), for measuring post-TKA lower extremity swelling. Swelling in 56 patients (64.3 ± 9.3 years; 29 males) was measured before and after TKA using SF-BIA and circumferential measures (CM). Reliability of the measures was calculated using Intraclass Correlation Coefficients (ICC). Precision of the measures was provided using standard error of the measurement and minimal detectable change (MDC90). Change values between time points for SF-BIA and CM are provided. SF-BIA was found to have greater reliability following surgery compared to CM (ICC = 0.99 vs 0.68). SF-BIA was found to have an MDC90 = 2% following surgery, indicating improved ability to detect minute fluctuations in swelling compared to CM (MDC90 = 6%) following surgery. These results indicate that SF-BIA improves the precision and reliability of swelling measurement compared to CM.
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Affiliation(s)
- Brian J Loyd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus , Aurora, CO, USA
| | - Kristine Burrows
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus , Aurora, CO, USA
| | - Jeri E Forster
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus , Aurora, CO, USA
| | - Scott K Stackhouse
- Department of Physical Therapy, University of New England , Portland, ME, USA
| | - Craig Hogan
- Department of Orthopedic Surgery, University of Colorado Hospital , Aurora, 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 Geriatric Research Education and Clinical Center , Aurora, CO, USA
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A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial. Pain Res Manag 2019; 2019:8514808. [PMID: 31191790 PMCID: PMC6525802 DOI: 10.1155/2019/8514808] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
Abstract
Objective In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis. Methods Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week. Results We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups (p < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (p=0.028). Conclusions According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.
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Shaker A, Alshehri MSM, Alshehri FS, Alshahrani MM, Alshahrani MS, Alamri OM. Knowledge and awareness toward anterior cruciate ligament (ACL) injury among population of Aseer region, Saudi Arabia. J Family Med Prim Care 2019; 8:812-817. [PMID: 31041206 PMCID: PMC6482765 DOI: 10.4103/jfmpc.jfmpc_27_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this article is to determine the knowledge and awareness of population toward anterior cruciate ligament (ACL) injury in Aseer region, and to determine the extent of knowledge about what does a person with ACL injury suffer from, and thus investigate the main sources of information that public obtained their medical information about sport injury from. Materials and Methods: This is a cross-sectional study based on a questionnaire distributed to the participants either in malls, campuses, or campaigns and filled by them in Aseer region. A sample of 576 participants was successfully interviewed. Convenience sampling method was used. Results: Nearly all of the participants considered this injury as a multi-factorial incident resulting from a combination of any of the following risk factors: sports, high body weight, heavy housework, and car accidents. Regarding mechanisms responsible about occurrence of ACL injuries during playing sports, the majority (60.8%) proposed a combination of two or more incorrect technical movements: lack of self-protection awareness, insufficient preparation, and overload of exercise. Regarding the participant's information about methods that could decrease pain of ACL injury, about three quarters of all participants (72.2%) stated that resting could alleviate pain. Moreover, most of individuals with previous ACL injury confirmed this. In addition, those with pervious ACL injury supported the role of ice significantly more than the remainder (53.6% vs. 48.1%). Prescription pain medications were selected by 47.3% of all participants. In all, 53.8% of all participants considered Internet as a main source of information about ACL injury. Conclusion: Findings indicated reasonable awareness of the general population in Aseer region about the seriousness of ACL injury, but there was a lack of information about risk factors other than sports, that is, dangerous actions that increase incidence of ACL injuries and their characteristic symptoms.
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Affiliation(s)
- Alsheri Shaker
- Department of Surgery, King Khalid University, College of Medicine, Abha, Saudi Arabia
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Lepley AS, Grooms DR, Burland JP, Davi SM, Kinsella-Shaw JM, Lepley LK. Quadriceps muscle function following anterior cruciate ligament reconstruction: systemic differences in neural and morphological characteristics. Exp Brain Res 2019; 237:1267-1278. [DOI: 10.1007/s00221-019-05499-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
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Loyd BJ, Stackhouse S, Dayton M, Hogan C, Bade M, Stevens-Lapsley J. The relationship between lower extremity swelling, quadriceps strength, and functional performance following total knee arthroplasty. Knee 2019; 26:382-391. [PMID: 30772186 PMCID: PMC6486428 DOI: 10.1016/j.knee.2019.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/15/2018] [Accepted: 01/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationships between swelling after total knee arthroplasty (TKA) and quadriceps strength and functional performance are poorly understood. Therefore, the aim of this study was to examine the relationships between lower extremity swelling, measured using bioelectrical impedance assessment (SF-BIA), and quadriceps strength and timed up and go (TUG) times following TKA. METHODS 53 participants (64 ± 9.5 y/o, 43% male) undergoing primary unilateral TKA were recruited for the longitudinal observational study with repeated measures. Quantities of swelling were examined for contribution to two and six-week outcomes of strength and TUG time using hierarchical regression controlling for age, sex, and the baseline value of the dependent variable. Swelling was assessed using bioelectrical impedance assessment and quantified as the peak level of swelling and cumulative swelling (integral) over the post-TKA time window. Maximum isometric quadriceps strength (MVIC) was measured using a electromechanical dynamometer and participant functional performance measured using the TUG. RESULTS Neither peak swelling nor cumulative swelling significantly contributed to the variance of two-week quadriceps strength. At six weeks, peak swelling significantly improved the variance in maximal quadriceps strength by an additional four percent (p = 0.05), while cumulative swelling did not significantly contribute. Peak swelling significantly contributed to the variance in two-week (16%) and six-week (five percent) TUG times (p < 0.05), but the cumulative swelling did not. CONCLUSIONS Peak swelling represents a value of post-TKA swelling that is associated with strength and function. Reducing the peak level of swelling, occurring early after surgery, may improve patient functional recovery. LEVEL OF EVIDENCE Level II - Prospective observational study.
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Affiliation(s)
- Brian J Loyd
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America.
| | | | - Michael Dayton
- The University of Colorado Denver AMC, Department of Orthopedics, United States of America
| | - Craig Hogan
- The University of Colorado Denver AMC, Department of Orthopedics, United States of America
| | - Michael Bade
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America
| | - Jennifer Stevens-Lapsley
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America; Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO, United States of America
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Loyd BJ, Kittelson AJ, Forster J, Stackhouse S, Stevens-Lapsley J. Development of a reference chart to monitor postoperative swelling following total knee arthroplasty. Disabil Rehabil 2019; 42:1767-1774. [PMID: 30668214 DOI: 10.1080/09638288.2018.1534005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Title: Development of a reference chart to monitor postoperative swelling following total knee arthroplasty.Purpose: Lower extremity swelling is a feature of total knee arthroplasty. Until recently, clinicians lacked tools to accurately measure swelling in clinical settings, but bioelectrical impedance assessment has shown promise in this regard. The purpose of this study was to develop a reference chart of lower extremity swelling following total knee arthroplasty.Method: Fifty-six participants (54% male, mean age = 64 years) were followed for the first 7 weeks following total knee arthroplasty, during which frequent lower extremity bioelectrical impedance assessments were performed. Using Generalized Additive Models for Location Scale and Shape, a reference chart for swelling was developed with bioelectrical impedance assessment data from the first 40 patients enrolled in the study (223 observations) and preliminarily tested for performance in the remaining 16 patients' data (96 observations).Results: The reference chart illustrates approximately 10% per day increase for the first 3 days following surgery. Peak swelling occurs 6-8 days following surgery; the 10th percentile demonstrates a peak of 25%, whereas the 90th percentile peaks at 47%. In the test data, this reference chart demonstrated accurate coverage at each estimated centile.Conclusion: The reference chart provides a novel framework for monitoring swelling following total knee arthroplasty and may augment clinical decisions to improve postoperative swelling management.Implications for rehabilitationThe use of bioelectrical impedance assessment provides an accurate and easily implemented approach for rehabilitation professionals to measure swelling.The reference chart provided allows for monitoring of patient recovery of swelling following total knee arthroplasty.Precise depictions of where a patient's swelling is in reference to others will improve clinical decision making at the individual level.
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Affiliation(s)
- Brian J Loyd
- Department of Physical Medicine and Rehabilitation, The University of Colorado Denver AMC, Denver, CO, USA
| | - Andrew J Kittelson
- Department of Physical Medicine and Rehabilitation, The University of Colorado Denver AMC, Denver, CO, USA
| | - Jeri Forster
- Department of Physical Medicine and Rehabilitation, The University of Colorado Denver AMC, Denver, CO, USA
| | - Scott Stackhouse
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, The University of Colorado Denver AMC, Denver, CO, USA.,Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO, USA
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Ward SH, Blackburn JT, Padua DA, Stanley LE, Harkey MS, Luc-Harkey BA, Pietrosimone B. Quadriceps Neuromuscular Function and Jump-Landing Sagittal-Plane Knee Biomechanics After Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53:135-143. [PMID: 29350554 DOI: 10.4085/1062-6050-306-16] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
CONTEXT Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the development of aberrant biomechanics. OBJECTIVE To determine the association between quadriceps neuromuscular function (strength, voluntary activation, and spinal-reflex and corticomotor excitability) and sagittal-plane knee biomechanics during jump landings in individuals with ACLR. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight individuals with unilateral ACLR (7 men, 21 women; age = 22.4 ± 3.7 years, height = 1.69 ± 0.10 m, mass = 69.4 ± 10.1 kg, time postsurgery = 52 ± 42 months). MAIN OUTCOME MEASURE(S) We quantified quadriceps spinal-reflex excitability via the Hoffmann reflex normalized to maximal muscle response (H : M ratio), corticomotor excitability via active motor threshold, strength as knee-extension maximal voluntary isometric contraction (MVIC), and voluntary activation using the central activation ratio (CAR). In a separate session, sagittal-plane kinetics (peak vertical ground reaction force [vGRF] and peak internal knee-extension moment) and kinematics (knee-flexion angle at initial contact, peak knee-flexion angle, and knee-flexion excursion) were collected during the loading phase of a jump-landing task. Separate bivariate associations were performed between the neuromuscular and biomechanical variables. RESULTS In the ACLR limb, greater MVIC was associated with greater peak knee-flexion angle ( r = 0.38, P = .045) and less peak vGRF ( r = -0.41, P = .03). Greater CAR was associated with greater peak internal knee-extension moment (ρ = -0.38, P = .045), and greater H : M ratios were associated with greater peak vGRF ( r = 0.45, P = .02). CONCLUSIONS Greater quadriceps MVIC and CAR may provide better energy attenuation during a jump-landing task. Individuals with greater peak vGRF in the ACLR limb possibly require greater spinal-reflex excitability to attenuate greater loading during dynamic movements.
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Affiliation(s)
- Sarah H Ward
- Department of Physiotherapy, Centre for Health Exercise and Sports Medicine, University of Melbourne, Australia
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Laura E Stanley
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Matthew S Harkey
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brittney A Luc-Harkey
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Bade M, Struessel T, Paxton R, Winters J, Baym C, Stevens-Lapsley J. Performance on a Clinical Quadriceps Activation Battery Is Related to a Laboratory Measure of Activation and Recovery After Total Knee Arthroplasty. Arch Phys Med Rehabil 2017; 99:99-106. [PMID: 28864244 DOI: 10.1016/j.apmr.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/12/2017] [Accepted: 07/20/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the relation between performance on a clinical quadriceps activation battery with (1) activation measured by doublet interpolation and (2) recovery of quadriceps strength and functional performance after total knee arthroplasty (TKA). DESIGN Planned secondary analysis of a randomized controlled trial. SETTING University research laboratory. PARTICIPANTS Patients (N=162; mean age, 63±7y; 89 women) undergoing TKA. MAIN OUTCOME MEASURES Patients were classified as high (quadriceps activation battery ≥4/6) or low (quadriceps activation battery ≤3/6) based on performance on the quadriceps activation battery measured 4 days after TKA. Differences between groups in activation and recovery at 1, 2, 3, 6, and 12 months after TKA were compared using a repeated-measures maximum likelihood model. RESULTS The low quadriceps activation battery group demonstrated poorer quadriceps activation via doublet interpolation (P=.01), greater quadriceps strength loss (P=.01), and greater functional performance decline (all P<.001) at 1 month after TKA compared with the high quadriceps activation battery group. Differences between low and high quadriceps activation battery groups on all measures did not persist at 3 and 12 months (all P>.05). CONCLUSIONS Poor performance on the quadriceps activation battery early after TKA is related to poor quadriceps activation and poor recovery in the early postoperative period. Patients in the low quadriceps activation battery group took 3 months to recover to the same level as the high quadriceps activation battery group. The quadriceps activation battery may be useful in identifying individuals who need specific interventions to target activation deficits or different care pathways in the early postoperative period to speed recovery after TKA.
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Affiliation(s)
- Michael Bade
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Tamara Struessel
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Roger Paxton
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joshua Winters
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY
| | - Carol Baym
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
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Jacksteit R, Mau-Moeller A, Behrens M, Bader R, Mittelmeier W, Skripitz R, Stöckel T. The mental representation of the human gait in patients with severe knee osteoarthrosis: a clinical study to aid understanding of impairment and disability. Clin Rehabil 2017; 32:103-115. [PMID: 28719981 DOI: 10.1177/0269215517719312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objectives were (1) to explore differences in gait-specific long-term memory structures and gait performance between knee osteoarthrosis patients and healthy subjects and (2) to identify the extent to which the gait-specific mental representation is associated with gait performance. DESIGN Cross-sectional study. SUBJECTS In total, 18 knee osteoarthrosis patients and 18 control subjects. METHODS Spatio-temporal (gait speed, step length) and temporophasic (stance time, swing time, single support time, total double support time) gait parameters and gait variability were measured with an electronic walkway (OptoGait). The mental representation was assessed using the structural dimensional analysis of mental representations (SDA-M). RESULTS (1) Patients showed significantly longer stance times ( P < 0.002) and total double support times, shorter swing times and single support times, a decreased gait speed ( P-values < 0.001) and structural differences in the gait-specific mental representation as compared with the healthy controls. (2) Correlation analyses revealed the mental representation of the human gait to be associated with actual gait performance in osteoarthrosis patients. Double support times were positively associated with the structural quality of the mental representation and step length variability was positively associated with the number of sequencing errors in the representation. CONCLUSION The gait-specific mental representation and actual gait performance differ between patients with severe knee osteoarthrosis and healthy controls, and both are linked to one another. This finding suggests that musculoskeletal disorders can lead to changes in the mental representation of the gait, and as such the SDA-M could provide useful information to improve the rehabilitation following osteoarthrosis.
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Affiliation(s)
- Robert Jacksteit
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Anett Mau-Moeller
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Martin Behrens
- 2 Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Rainer Bader
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | | | - Ralf Skripitz
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Tino Stöckel
- 2 Institute of Sport Science, University of Rostock, Rostock, Germany
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Tanaka Y, Oka H, Nakayama S, Ueno T, Matsudaira K, Miura T, Tanaka K, Tanaka S. Improvement of walking ability during postoperative rehabilitation with the hybrid assistive limb after total knee arthroplasty: A randomized controlled study. SAGE Open Med 2017. [PMID: 28634540 PMCID: PMC5467967 DOI: 10.1177/2050312117712888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: We aimed to compare the efficacies of rehabilitation with the hybrid assistive limb and conventional rehabilitation after total knee arthroplasty. Materials and methods: A total of 37 consecutive patients who underwent primary total knee arthroplasty for knee osteoarthritis were enrolled. Seven patients withdrew from the study after randomization, and 30 patients (hybrid assistive limb group: n = 16; conventional group: n = 14) completed the randomized controlled trial. Patients in the hybrid assistive limb group underwent ten 20-min rehabilitation sessions with the hybrid assistive limb as well as 20-min conventional sessions over the course of 2 weeks, whereas patients in the conventional group received ten 40-min conventional sessions during the same period. The primary outcome measure was walking speed, whereas the secondary outcome measures included quadriceps strength and knee pain assessed using a numerical rating scale. The outcome measures were evaluated prior to surgery and on postoperative weeks 1, 2, and 3. Results: In the early postoperative period, rehabilitation after total knee arthroplasty with the hybrid assistive limb resulted in a significantly greater improvement in walking speed (weeks 1 and 2: p = 0.045), quadriceps strength (weeks 1 and 2; weeks 1 and 3: p < 0.0001), and numerical rating scale scores (week 1: p = 0.03) than conventional rehabilitation. Conclusion: Rehabilitation with the hybrid assistive limb after total knee arthroplasty led to greater improvements in walking speed, quadriceps strength, and pain scores than conventional rehabilitation.
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Affiliation(s)
- Yohei Tanaka
- Department of Rehabilitation, JR Tokyo General Hospital, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuichi Nakayama
- Department of Orthopaedic Surgery, JR Tokyo General Hospital, Tokyo, Japan
| | - Takaaki Ueno
- Department of Rehabilitation, JR Tokyo General Hospital, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiki Miura
- Department of Orthopaedic Surgery, JR Tokyo General Hospital, Tokyo, Japan
| | - Kiyokazu Tanaka
- Department of Rehabilitation, JR Tokyo General Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
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