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White MS, Ogier AC, Chenevert TL, Zucker E, Stoneback L, Michel CP, Palmieri-Smith RM, Lepley LK. Beyond weakness: Exploring intramuscular fat and quadriceps atrophy in ACLR recovery. J Orthop Res 2024. [PMID: 38824275 DOI: 10.1002/jor.25910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/19/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024]
Abstract
Muscle weakness following anterior cruciate ligament reconstruction (ACLR) increases the risk of posttraumatic osteoarthritis (OA). However, focusing solely on muscle weakness overlooks other aspects like muscle composition, which could hinder strength recovery. Intramuscular fat is a non-contractile element linked to joint degeneration in idiopathic OA, but its role post-ACLR has not been thoroughly investigated. To bridge this gap, we aimed to characterize quadriceps volume and intramuscular fat in participants with ACLR (male/female = 15/9, age = 22.8 ± 3.6 years, body mass index [BMI] = 23.2 ± 1.9, time since surgery = 3.3 ± 0.9 years) and in controls (male/female = 14/10, age = 22.0 ± 3.1 years, BMI = 23.3 ± 2.6) while also exploring the associations between intramuscular fat and muscle volume with isometric strength. Linear mixed effects models assessed (I) muscle volume, (II) intramuscular fat, and (III) strength between limbs (ACLR vs. contralateral vs. control). Regression analyses were run to determine if intramuscular fat or volume were associated with quadriceps strength. The ACLR limb was 8%-11% smaller than the contralateral limb (p < 0.05). No between-limb differences in intramuscular fat were observed (p 0.091-0.997). Muscle volume but not intramuscular fat was associated with strength in the ACLR and control limbs (p < 0.001-0.002). We demonstrate that intramuscular fat does not appear to be an additional source of quadriceps dysfunction following ACLR and that muscle size only explains some of the variance in muscle strength.
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Affiliation(s)
- McKenzie S White
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Augustin C Ogier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Zucker
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Luke Stoneback
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Lindsey K Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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Buck AN, Lisee C, Bjornsen E, Büttner C, Birchmeier T, Nilius A, Favoreto N, Spang J, Blackburn T, Pietrosimone B. Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:464-475. [PMID: 38051127 PMCID: PMC10922289 DOI: 10.1249/mss.0000000000003330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared with their habitual speed and uninjured matched-controls. METHODS Gait biomechanics were collected on 30 ACLR individuals (20 females; age, 22.0 ± 4.2 yr; body mass index, 24.0 ± 3.0 kg·m -2 ) at their habitual speed and at 1.3 m·s -1 , a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, body mass index: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s -1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s -1 vs controls. RESULTS In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s -1 ) and 1.3 m·s -1 (1.29 ± 0.05 m·s -1 ). Compared with controls (habitual speed: 1.34 ± 0.12 m·s -1 ), the ACLR group while walking at 1.3 m·s -1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13-28, 78-90% stance phase), greater midstance vGRF (47-61%), smaller early-to-midstance knee flexion angle (KFA; 1-44%), greater mid-to-late stance KFA (68-73, 96-101%), greater internal knee abduction moment (69-101%), and smaller internal knee extension moment (4-51, 88-96%). CONCLUSIONS Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls.
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Affiliation(s)
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Thomas Birchmeier
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Natalia Favoreto
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Latham CM, Balawender PJ, Thomas NT, Keeble AR, Brightwell CR, Ismaeel A, Wen Y, Fry JL, Sullivan PG, Johnson DL, Noehren B, Owen AM, Fry CS. Overexpression of manganese superoxide dismutase mitigates ACL injury-induced muscle atrophy, weakness and oxidative damage. Free Radic Biol Med 2024; 212:191-198. [PMID: 38154571 PMCID: PMC10842887 DOI: 10.1016/j.freeradbiomed.2023.12.037] [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: 09/29/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
Oxidative stress has been implicated in the etiology of skeletal muscle weakness following joint injury. We investigated longitudinal patient muscle samples following knee injury (anterior cruciate ligament tear). Following injury, transcriptomic analysis revealed downregulation of mitochondrial metabolism-related gene networks, which were supported by reduced mitochondrial respiratory flux rates. Additionally, enrichment of reactive oxygen species (ROS)-related pathways were upregulated in muscle following knee injury, and further investigation unveiled marked oxidative damage in a progressive manner following injury and surgical reconstruction. We then investigated whether antioxidant protection is effective in preventing muscle atrophy and weakness after knee injury in mice that overexpress Mn-superoxide dismutase (MnSOD+/-). MnSOD+/- mice showed attenuated oxidative damage, atrophy, and muscle weakness compared to wild type littermate controls following ACL transection surgery. Taken together, our results indicate that ROS-related damage is a causative mechanism of muscle dysfunction after knee injury, and that mitochondrial antioxidant protection may hold promise as a therapeutic target to prevent weakness and development of disability.
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Affiliation(s)
- Christine M Latham
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | | | - Nicholas T Thomas
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Alexander R Keeble
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Camille R Brightwell
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Ahmed Ismaeel
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Yuan Wen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jean L Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Patrick G Sullivan
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Darren L Johnson
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Brian Noehren
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Allison M Owen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
| | - Christopher S Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
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Giampetruzzi N, Weaver AP, Roman DP, Cleland JA, Ness BM. Which Tests Predict 6-Month Isokinetic Quadriceps Strength After ACL Reconstruction? An Examination of Isometric Quadriceps Strength and Functional Tests at 3 Months. Int J Sports Phys Ther 2023; 18:1261-1270. [PMID: 38050543 PMCID: PMC10693486 DOI: 10.26603/001c.89263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
Background Restoration of quadriceps strength after anterior ligament reconstruction (ACLR) is a persistent challenge for patients and clinicians. Inadequate recovery of quadriceps strength has been linked to increase risk of re-injury. Developing methods of early identification of strength deficits is essential to allow clinicians to provide more individualized interventions early in the rehabilitation process. Purpose To determine whether 3-month isometric quadriceps strength, the Y-Balance Test (YBT), and the anterior step-down test are predictive of isokinetic quadriceps strength at six months in adolescents after ACLR. Design Retrospective cohort. Methods Thirty-six adolescent patients with primary ACLR (58% female, 36% with concomitant meniscal repair, age: 15.7 ± 1.6 years). At three months post-operative, isometric quadriceps strength via isokinetic dynamometer, YBT-Lower Quarter, and anterior step-down tests were completed. At six months post-operative, an isokinetic knee strength assessment was completed. Regression analysis was used to evaluate the predictive relationship between 3-month isometric tests and 6-month isokinetic knee extension tests. Results Three-month post operative isometric quadriceps peak torque predicted isokinetic quadriceps peak torque at 6 months, F(1,34) = 19.61, p <0.001. Three-month isometric quadriceps peak torque accounted for 36.6% of the variance in normalized isokinetic quadriceps peak torque at 6 months with adjusted R2 = 34.7%. Including YBT anterior reach (β = 0.157, p = 0.318) in regression added 1.9% of variance when predicting 6-month isokinetic quadriceps peak torque, F (2,33) = 10.32, p <0.001, R2 = 0.385, ΔR2 = 0.019. Conclusion At three months post-ACLR, isometric strength testing appears more optimal than other functional tests in predicting isokinetic quadriceps peak torque in later stages of rehabilitation for adolescents. Clinicians should use tests at three months that measure quadriceps strength if aiming to predict isokinetic quadriceps peak torque at six months post-ACLR, rather than using functional tests such as the YBT-LQ or anterior step-down. Level of Evidence Level 3.
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Affiliation(s)
| | - Adam P Weaver
- Sports Physical Therapy Connecticut Children's Medical Center
| | - Dylan P Roman
- Sports Physical Therapy Connecticut Children's Medical Center
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Ong MTY, Chi-Wai Man G, He X, Yu M, Lau LCM, Qiu J, Wang Q, Ho-Pak Liu J, Chi-Yin Choi B, Ng JP, Shu-Hang Yung P. Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:510. [PMID: 37349732 PMCID: PMC10286400 DOI: 10.1186/s12891-023-06639-9] [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: 03/14/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Persistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR. METHODS Patients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers. RESULTS A total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05). CONCLUSION In this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China.
- Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Mingqian Yu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jihong Qiu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Qianwen Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Jeremy Ho-Pak Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Ben Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
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Ishida T, Samukawa M, Koshino Y, Ino T, Kasahara S, Tohyama H. Interlimb Asymmetry in Knee Extension Moment During Double-Leg Squatting Is Associated With Persistent Quadriceps Weakness After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231182105. [PMID: 37441507 PMCID: PMC10334007 DOI: 10.1177/23259671231182105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/15/2023] Open
Abstract
Background Although double-leg squatting is less dynamic and places less demand on the quadriceps compared with landing tasks, the relationship between double-leg squatting biomechanics and persistent quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is unknown. Purpose To clarify the relationships between asymmetries in quadriceps strength and lower limb biomechanics during double-leg squatting >1 year after ACLR. Study Design Controlled laboratory study. Methods A total of 26 participants (5.5 ± 3.8 years after ACLR) were enrolled. The limb symmetry index (LSI) of isokinetic quadriceps strength was used to divide participants into the high-quadriceps (HQ) group (LSI ≥90%; n = 18) and the low-quadriceps (LQ) group (LSI <90%; n = 8). The knee, hip, and ankle extension moment (relative to body weight and support moment [sum of knee, hip, and ankle moments]) and vertical ground-reaction force during double-leg squatting were analyzed using 3-dimensional motion analysis. The association of quadriceps strength and biomechanical variables was tested using 2-way analysis of variance and univariate regression analysis. Results A significant group-by-limb interaction was found for the peak knee extension moment and the ratios of knee and hip extension moment to support moment (P < .001, P = .015 and P < .001, respectively). The LQ group showed a significantly smaller peak knee extension moment and knee to support moment ratio but a larger hip to support moment ratio in the involved limb than in the uninvolved limb (95% CIs: knee extension moment, -0.273 to -0.088 N·m/kg; knee to support moment ratio, -10.7% to -2.2%; hip to support moment ratio, 3.2% to 8.5%). No interlimb difference was found for the HQ group. The LSI of quadriceps strength was significantly associated with the LSI of peak knee extension moment (R2 = 0.183), knee to support moment ratio (R2 = 0.256), and hip to support moment ratio (R2 = 0.233). The mean maximum isokinetic quadriceps strength and peak knee extension moment during squatting on the involved limb of the LQ group were 2.40 ± 0.39 and 0.90 ± 0.16 N·m/kg, respectively. Conclusion Asymmetrical biomechanics during double-leg squatting was associated with persistent quadriceps weakness after ACLR. The LQ group had reduced knee extensor moment on the involved side during squatting despite loading at approximately half the maximum strength. Clinical Relevance Quadriceps strengthening exercises, together with interventions to improve neuromuscular control, may reduce asymmetrical biomechanics during double-leg squatting.
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Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido
University of Science, Sapporo, Japan
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Gaj S, Eck BL, Xie D, Lartey R, Lo C, Zaylor W, Yang M, Nakamura K, Winalski CS, Spindler KP, Li X. Deep learning-based automatic pipeline for quantitative assessment of thigh muscle morphology and fatty infiltration. Magn Reson Med 2023; 89:2441-2455. [PMID: 36744695 PMCID: PMC10050107 DOI: 10.1002/mrm.29599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Fast and accurate thigh muscle segmentation from MRI is important for quantitative assessment of thigh muscle morphology and composition. A novel deep learning (DL) based thigh muscle and surrounding tissues segmentation model was developed for fully automatic and reproducible cross-sectional area (CSA) and fat fraction (FF) quantification and tested in patients at 10 years after anterior cruciate ligament reconstructions. METHODS A DL model combining UNet and DenseNet was trained and tested using manually segmented thighs from 16 patients (32 legs). Segmentation accuracy was evaluated using Dice similarity coefficients (DSC) and average symmetric surface distance (ASSD). A UNet model was trained for comparison. These segmentations were used to obtain CSA and FF quantification. Reproducibility of CSA and FF quantification was tested with scan and rescan of six healthy subjects. RESULTS The proposed UNet and DenseNet had high agreement with manual segmentation (DSC >0.97, ASSD < 0.24) and improved performance compared with UNet. For hamstrings of the operated knee, the automated pipeline had largest absolute difference of 6.01% for CSA and 0.47% for FF as compared to manual segmentation. In reproducibility analysis, the average difference (absolute) in CSA quantification between scan and rescan was better for the automatic method as compared with manual segmentation (2.27% vs. 3.34%), whereas the average difference (absolute) in FF quantification were similar. CONCLUSIONS The proposed method exhibits excellent accuracy and reproducibility in CSA and FF quantification compared with manual segmentation and can be used in large-scale patient studies.
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Affiliation(s)
- Sibaji Gaj
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Brendan L. Eck
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dongxing Xie
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Richard Lartey
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Charlotte Lo
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - William Zaylor
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Kunio Nakamura
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Carl S. Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt P. Spindler
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Orthopaedics, Cleveland Clinic Florida Region, Weston, Florida, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
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Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
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Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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Zhou L, Xu Y, Wang S, Wang S, Xu W. Quadriceps strength and psychological readiness are associated with multiplanar knee kinematics after anterior cruciate ligament reconstruction. Gait Posture 2023; 101:101-105. [PMID: 36773479 DOI: 10.1016/j.gaitpost.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Gait asymmetry, negative psychological factors and quadriceps strength deficits are common after anterior cruciate ligament reconstruction (ACLR). Whether quadriceps strength and psychological factors have impacts on multiplanar knee kinematics remains unclear. RESEARCH QUESTION What are the relationships of multiplanar knee kinematics during the gait cycle and psychological readiness to quadriceps strength after ACLR? METHOD In total, 45 patients were enrolled in this study at 8.3 ± 1.5 months after ACLR. All patients underwent gait analysis and isokinetic testing. Interlimb differences in the range of motion (ROM) and maximum and initial contact (IC) angles in abduction-adduction, flexion-extension, and internal-external rotation were calculated. The limb symmetry index (LSI) for quadriceps strength was calculated. Psychological readiness was measured using the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. The paired t test analyzed the differences between contralateral and affected limbs in quadriceps and hamstrings strength. Pearson or Spearman correlation was used to assess relationships between the variables of interest. RESULTS Significant differences between contralateral and affected limbs were observed in isokinetic knee quadriceps strength (P < 0.001) and hamstring strength (P = 0.009). The ACL-RSI score correlated negatively with interlimb differences in the knee flexion angle at IC (r = -0.35, P = 0.02) and ROM in the transverse plane (r = -0.41, P = 0.003). The LSI for quadriceps strength correlated negatively with the peak knee flexion angle (r = -0.37, P = 0.02) and positively with the ACL-RSI score (r = 0.3, P = 0.05). SIGNIFICANCE Greater psychological readiness and quadriceps strength are associated with more symmetrical multiplanar knee kinematics. The improvement of these parameters may aid the recovery of knee kinematics after ACLR, and reduce the rate of reinjury and incidence of posttraumatic osteoarthritis.
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Affiliation(s)
- Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yihong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Siya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China.
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China.
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11
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Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2023; 32:76-84. [PMID: 35926847 DOI: 10.1123/jsr.2021-0336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6 months after anterior cruciate ligament reconstruction. DESIGN Retrospective study. METHODS Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3 months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6 months postoperatively as the dependent variable and the LSI of IKE at 3 months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6 months postoperatively as the dependent variable; LSI of IKE at 3 months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. RESULTS The correlation analysis revealed that the LSIs of IKE at 3 and 6 months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3 months postoperatively was significantly associated with that at 6 months postoperatively, even when other variables were included as covariates (R2 = .349, P = .004). CONCLUSION Asymmetry of knee extension strength at 3 months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6 months postoperatively.
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Straub RK, Mandelbaum B, Powers CM. Predictors of Quadriceps Strength Asymmetry after Anterior Cruciate Ligament Reconstruction: A Chi-Squared Automatic Interaction Detection Decision Tree Analysis. Med Sci Sports Exerc 2022; 54:2005-2010. [PMID: 35797489 DOI: 10.1249/mss.0000000000002995] [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: 11/21/2022]
Abstract
INTRODUCTION The influence of graft type on the restoration of quadriceps strength symmetry after ACL reconstruction (ACLR) has been widely studied. However, an important consideration when evaluating quadriceps symmetry is the fact that this measure can be influenced by numerous factors beyond graft type. This study sought to determine if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration potentially influential factors (i.e., age, sex, body mass index, time post-ACLR). METHODS We retrospectively reviewed quadriceps strength data from 434 patients (303 female patients and 131 male patients) who had previously undergone ACLR with an autograft (hamstring tendon, quadriceps tendon [QT], patellar tendon [PT]) or allograft. Chi-Squared Automatic Interaction Detection decision tree analysis was used to evaluate if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration age, sex, body mass index, and time post-ACLR. RESULTS The best predictor of quadriceps strength asymmetry was graft type. Specifically, three graft categories were identified: 1) allograft and hamstring tendon autograft, 2) PT autograft, and 3) QT autograft. The average quadriceps strength asymmetry for each of the three identified categories was 0.91, 0.87, and 0.81, respectively, and differed statistically from each other ( P < 0.001). The second-best predictor of quadriceps strength asymmetry was sex, albeit only in the PT and QT groups (with female patients having increased asymmetry). Female patients post-ACLR with a QT autograft were at highest risk for quadriceps strength asymmetry. CONCLUSIONS Graft type and sex are important predictors of quadriceps strength asymmetry after ACLR. Clinicians should take these factors into consideration when designing rehabilitation protocols to restore quadriceps strength symmetry during the postoperative period.
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Affiliation(s)
- Rachel K Straub
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
| | | | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
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Tomihara T, Hashimoto Y, Nishino K, Taniuchi M, Takigami J, Tsumoto S, Katsuda H. Bone-patellar tendon-bone autograft and female sex are associated with the presence of cyclops lesions and syndrome after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07219-5. [PMID: 36352241 DOI: 10.1007/s00167-022-07219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Associated risk factors for the development of cyclops lesions have been little. Investigated, because most previous studies have limited their research to cases with symptomatic cyclops lesions (cyclops syndrome). The purpose of this study was to evaluate the presence of cyclops lesions using magnetic resonance image (MRI) at 6 and 12 months after anterior cruciate ligament reconstruction (ACL-R), and to investigate the associated risk factors of cyclops lesions and syndrome. METHODS A retrospective analysis of patients who underwent ACL-R using bone-patellar tendon-bone (BTPB) or hamstring tendon autograft from 2008 to 2017 was conducted. Predictor variables (age, sex, body mass index [BMI], time from injury to ACL-R, preinjury Tegner activity score, graft, meniscal and cartilage injury, and notch width index on MRI for the presence of cyclops lesions and syndrome were analyzed with multivariate logistic regression. RESULTS Four hundred and fifty-five patients (225 males and 230 females) were enrolled. One hundred and four patients (22.9%) had cyclops lesions, and all cyclops lesions were detected on MRI at 6 months post-operatively. In addition, 20 patients (4.4%) had cyclops syndrome which means that these were symptomatic cases. The risk factors for presence of cyclops lesions were BPTB autograft (OR = 2.85; 95% CI 1.75-4.63; P < 0.001) and female sex (OR = 2.03; 95% CI 1.27-3.25; P = 0.003). The presence of cyclops syndrome increased with graft (BPTB) (OR = 18.0; 95% CI 3.67-88.3; Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation P < 0.001), female sex (OR = 3.27; 95% CI 1.07-10.0; P = 0.038), and increased BMI (OR = 1.21; 95% CI 1.05-1.39; P = 0.008). CONCLUSIONS All cyclops lesions were detected 6 months after ACL-R, and the majority of them were asymptomatic. BPTB autograft and female sex were the significant risk factors for the presence of cyclops lesions and syndrome. In addition, increased BMI was associated with a higher risk of developing cyclops syndrome. When BPTB autograft is used for a female patient, full active knee extension should be encouraged in the early period after ACL-R to prevent cyclops lesion formation. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1‑4‑3 Asahi‑machi, Abeno‑ku, Osaka, 545-8585, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1‑4‑3 Asahi‑machi, Abeno‑ku, Osaka, 545-8585, Japan
| | - Masatoshi Taniuchi
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
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14
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Ivarsson A, Cronström A. Agreement Between Isokinetic Dynamometer and Hand-held Isometric Dynamometer as Measures to Detect Lower Limb Asymmetry in Muscle Torque After Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2022; 17:1307-1317. [PMID: 36518830 PMCID: PMC9718723 DOI: 10.26603/001c.39798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Two commonly used instruments to assess muscle strength after anterior cruciate ligament reconstruction are the isokinetic dynamometer, which measures isokinetic torque and the hand-held dynamometer, which measures isometric torque. Isokinetic dynamometers are considered superior to other instruments but may not be commonly used in clinical settings. Hand-held dynamometers are small, portable, and more clinically applicable devices. Purpose The purpose of this study was to assess agreement between a hand-held dynamometer and an isokinetic dynamometer, used to assess lower limb symmetry in knee muscle torque one year after anterior cruciate ligament (ACL) reconstruction. Study design Cross-sectional measurement study. Methods Seventy-two participants who had undergone ACL reconstruction (35 men, 37 women; age= 25.8 ± 5.4 years) were included. Isokinetic muscle torque in knee flexion and extension was measured with an isokinetic dynamometer. Isometric flexion and extension knee muscle torque was measured with a hand-held dynamometer. Bland & Altman plots and Cohen's Kappa coefficient were used to assess agreement between measurements obtained from the instruments. Result Bland & Altman plots showed wide limits of agreement between the instruments for both flexion and extension limb symmetry index. Cohen´s Kappa coefficient revealed a poor to slight agreement between the extension limb symmetry index values (0.136) and a fair agreement for flexion limb symmetry index values (0.236). Cross-tabulations showed that the hand-held dynamometer detected a significantly larger number of participants with abnormal flexion torque limb symmetry index compared to the isokinetic dynamometer. Conclusion The wide limits of agreements and Cohen's Kappa coefficients values revealed insufficient agreement between the measurements taken with the two instruments, indicating that the instruments should not be used interchangeably. The hand-held dynamometer was more sensitive in detecting abnormal limb symmetry index in flexion torque, which promotes the option of use of hand-held dynamometers to detect differences between the injured and uninjured leg after ACL reconstruction. Level of evidence 3b.
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Affiliation(s)
| | - Anna Cronström
- Department of Health Sciences Lund University
- Department of Community Medicine and Rehabilitation Umeå University, Umeå, Sweden
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15
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Palmieri-Smith RM, Brown SR, Wojtys EM, Krishnan C. Functional Resistance Training Improves Thigh Muscle Strength after ACL Reconstruction: A Randomized Clinical Trial. Med Sci Sports Exerc 2022; 54:1729-1737. [PMID: 35551165 PMCID: PMC9481660 DOI: 10.1249/mss.0000000000002958] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction, resulting in prolonged disability and increased risk for reinjury and osteoarthritis. Functional resistance training (FRT) combines resistance training with task-specific training and may prove beneficial in restoring quadriceps strength. The primary purpose of this study was to determine if a walking-specific FRT program (e.g., resisted walking) improves knee strength in individuals after ACL reconstruction. METHODS Thirty participants were randomized into one of three groups: 1) FRT with a customized knee BRACE applied to the ACL leg, 2) FRT with elastic BAND tethered to the ankle of the ACL leg, or 3) a TARGET MATCH condition where no resistance was externally applied. Participants in all groups received training while walking on a treadmill 2-3 times per week for 8 wk. Isometric knee extension and flexion strength were measured before the start of the intervention, after the intervention (POST), and 8 wk after intervention completion (POST-2). RESULTS The BRACE group had greater knee extensor strength compared with the TARGET MATCH group at POST and POST-2 ( P < 0.05). The BRACE group had greater knee flexor strength than the TARGET MATCH group at POST and POST-2 ( P < 0.05) and the BAND group at POST ( P < 0.05). CONCLUSIONS FRT applied via a customized knee brace results in improvements in knee extensor and flexor strength after ACL reconstruction. FRT is a beneficial adjuvant to ACL rehabilitation and leads to better strength compared with standard of care.
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Affiliation(s)
- Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan; Ann Arbor, MI
- Orthopedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, MI
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Scott R. Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan; Ann Arbor, MI
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan; Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan; Ann Arbor, MI
- Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan; Ann Arbor, MI
- Robotics Institute, University of Michigan, Ann Arbor, MI
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16
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Suzuki M, Ishida T, Samukawa M, Matsumoto H, Ito Y, Aoki Y, Tohyama H. Rate of Torque Development in the Quadriceps after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autografts in Young Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11761. [PMID: 36142034 PMCID: PMC9517280 DOI: 10.3390/ijerph191811761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
This study aims to compare the limb symmetry index (LSI) of the rate of torque development (RTD) of the quadriceps with that of the peak torque after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STG) autografts and to investigate the associations of the LSI of torque parameters with patient-reported knee function. The participants included 23 female athletes after ACLR with STG grafts. Isometric quadriceps tests were performed using an isokinetic dynamometer. The peak torque, RTD100 (0 to 100 ms) and RTD200 (100 to 200 ms) were determined using torque-time curves. Comparisons of the LSI of torque parameters was performed by ANOVA. Univariate regression analysis was used to examine the relationship between the LSI of torque parameters and the patient-reported knee function. The LSIs of the peak torque and RTD200 were significantly lower than that of the RTD100 (p = 0.049, p = 0.039, respectively). Regression analysis showed that the LSI of the peak torque was associated with the patient-reported knee function (R2 = 0.40, p = 0.001). It would be useful to evaluate the peak torque in young female athletes under the age of 18 and at 8-10 months after ACLR with STG grafts.
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Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Yu Ito
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
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17
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Beynnon BD, Pius AK, Tourville TW, Endres NK, Failla MJ, Choquette RH, DeSarno M, Toth MJ. The Duration of Thigh Tourniquet Use Associated With Anterior Cruciate Ligament Reconstruction Does Not Produce Cellular-Level Contractile Dysfunction of the Quadriceps Muscle at 3 Weeks After Surgery. Am J Sports Med 2022; 50:2925-2934. [PMID: 35980007 DOI: 10.1177/03635465221115823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) trauma and ACL reconstruction (ACLR) are associated with the loss of strength and function of the muscles that span the knee joint. The underlying mechanism associated with this is not completely understood. PURPOSE To determine whether the duration of tourniquet use during ACLR has an effect on knee extensor muscle contractile function and size at the cellular (ie, fiber) level 3 weeks after surgery and at the whole-muscle level at 6 months after surgery. STUDY DESIGN Descriptive laboratory study and case series; Level of evidence, 4. METHODS Study participants sustained an acute, first-time ACL injury. All participants underwent ACLR with the use of a tourniquet placed in a standardized location on the thigh; the tourniquet was inflated (pressure range, 250-275 mm Hg), and the time of tourniquet use during surgery was documented. Participants were evaluated 1 week before surgery (to measure patient function, strength, and subjective outcome with the Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] score), at 3 weeks after ACLR surgery (to obtain muscle biopsy specimens of the vastus lateralis and assess muscle fiber cross-sectional area, contractile function, and mitochondrial content and morphometry), and at 6 months after ACLR (to evaluate patient function, strength, and subjective outcomes via KOOS and IKDC scores). Data were acquired on both the injured/surgical limb and the contralateral, normal side to facilitate the use of a within-subjects study design. Results are based on additional analysis of data acquired from previous research that had common entry criteria, treatments, and follow-up protocols. RESULTS At 3 weeks after ACLR, the duration of tourniquet use at the time of surgery did not explain the variation in single-muscle fiber contractile function or cross-sectional area (myosin heavy chain [MHC] I and II fibers) or subsarcolemmal and intermyofibrillar mitochondrial content or morphometry. At 6 months after ACLR, the duration of tourniquet use was not associated with the peak isometric and isokinetic torque measurements, patient function, or patient-reported outcomes. CONCLUSION The duration of tourniquet use at the time of ACLR surgery did not explain variation in muscle fiber size, contractile function, or mitochondrial content at 3 weeks after surgery or strength of the quadriceps musculature or patient-reported function or quality of life at 6-month follow-up.
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Affiliation(s)
- Bruce D Beynnon
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Alexa K Pius
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W Tourville
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Nathan K Endres
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mathew J Failla
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Rebecca H Choquette
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike DeSarno
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Michael J Toth
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Molecular Physiology and Biophysics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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18
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Washabaugh EP, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training Differentially Alters Gait Kinetics After Anterior Cruciate Ligament Reconstruction: A Pilot Study. Sports Health 2022; 15:372-381. [PMID: 35766451 PMCID: PMC10170229 DOI: 10.1177/19417381221104042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)-acutely alter gait kinetics in this population. HYPOTHESIS The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band. STUDY DESIGN Crossover study. LEVEL OF EVIDENCE Level 2. METHODS A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping. RESULTS Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie, push-off), while resistance applied via elastic band acutely increased gait kinetics during initial contact/loading (ie, braking). Both braces behaved similarly, but the unidirectional brace was less effective for increasing push-off GRFs. CONCLUSION FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown. CLINICAL RELEVANCE FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.
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Affiliation(s)
- Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Kinesiology, Aquinas College, Grand Rapids, Michigan
| | - Riann M Palmieri-Smith
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
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19
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Li D, Zhang Q, Liu X, Chen C, Lu J, Ye D, Li Y, Wang W, Shen M. Effect of water-based walking exercise on rehabilitation of patients following ACL reconstruction: a prospective, randomised, single-blind clinical trial. Physiotherapy 2022; 115:18-26. [DOI: 10.1016/j.physio.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/23/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
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20
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Hipsley A, Hall M, Saxby DJ, Bennell KL, Wang X, Bryant AL. Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:1949-1957. [PMID: 34997247 DOI: 10.1007/s00167-021-06853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. METHODS The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. RESULTS In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. CONCLUSION Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony Hipsley
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.
| | - Michelle Hall
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Gold Coast, Australia.,Gold Coast Orthopaedic Research and Education Alliance, Gold Coast, Australia
| | - Kim L Bennell
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Xinyang Wang
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Beijing Chao-Yang Hospital, Beijing, China
| | - Adam L Bryant
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
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21
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Tourville TW, Voigt TB, Choquette RH, Failla MJ, Endres NK, Slauterbeck JR, Beynnon BD, Toth MJ. Skeletal muscle cellular contractile dysfunction after anterior cruciate ligament reconstruction contributes to quadriceps weakness at 6-month follow-up. J Orthop Res 2022; 40:727-737. [PMID: 33969521 PMCID: PMC8578585 DOI: 10.1002/jor.25065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Muscle dysfunction following anterior cruciate ligament reconstruction (ACLR) may evolve from alterations in muscle contractility at the myofilament protein level. Using a prospective, within-subject case-control design, we evaluated cellular-level contractility, cross-sectional area (CSA), and myosin heavy chain (MHC) isoform expression on single muscle fibers 3 weeks post ACLR, and evaluated their relationship to whole muscle strength and patient-oriented outcomes 6 months post operation. Biopsies of the vastus lateralis were performed 3 weeks post ACLR in 11 subjects (5 females, mean age ± SD = 24.7 ± 6.5 years, height = 172.7 ± 8.2 cm, mass = 75.7 ± 12.5 kg) following first-time ACL rupture and whole muscle strength and self-reported pain, function, and quality of life assessed 6 months post ACLR. At 3 weeks post ACLR, force production was reduced (p < 0.01) in MHC I (-36%) and IIA (-48%) fibers compared with the non-injured leg. When force production was expressed relative to CSA to account for fiber atrophy, reductions remained in MHC IIA fibers (-40%; p < 0.001), but MHC I fibers showed only a trend toward being lower (-13%; p = 0.09). Finally, skeletal muscle fiber functional deficits at 3 weeks post ACLR were associated with whole muscle weakness and less favorable patient-reported outcomes at 6-month follow-up. Thus, ACLR promotes early cellular contractile dysfunction that may contribute to decreased whole muscle strength and patient function, and increased patient-reported symptoms, at 6-month follow-up.
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Affiliation(s)
- Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Michael J. Toth
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
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22
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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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23
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Read PJ, Trama R, Racinais S, McAuliffe S, Klauznicer J, Alhammoud M. Angle specific analysis of hamstrings and quadriceps isokinetic torque identify residual deficits in soccer players following ACL reconstruction: a longitudinal investigation. J Sports Sci 2022; 40:871-877. [PMID: 34983321 DOI: 10.1080/02640414.2021.2022275] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Analysing the isokinetic curve is important following ACL reconstruction as there may be deficits in torque production at specific points throughout the range of motion. We examined isokinetic (60°.s-1) torque-angle characteristics in 27 male soccer players (24.5 ± 3.9 years) at 3 time-points (17 ± 5; 25 ± 6; and 34 ± 7 weeks post-surgery). Extracted data included knee flexor and extensor peak torque, conventional hamstrings: quadriceps (H/Q) ratio, and angle-specific torque using Statistical Parametric Mapping (SPM). There were significant involved limb increases in extension peak torque at each assessment (p<0.001); however, asymmetry favouring the un-involved limb was observed (p<0.01). Flexion peak torque was greater on the un-involved limb at assessments 1 and 2 only (p<0.05). The angle of peak torque was not significantly different at individual time-points or within-limbs across the 3 assessments. SPM revealed involved limb angle-specific reductions in extension torque across the full range of motion at time-points 1 and 2 (p<0.001) but only in angles [51-80°] at assessment 3 (p<0.05). Between limb H/Q angle differences [33-45°] were shown at assessments 2 and 3. The ratio ranged from 1.60-0.74 depending on the angle tested. Angle-specific moment curves are useful for monitoring patterns of strength development during rehabilitation.
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Affiliation(s)
- Paul J Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Institute of Sport Exercise and Health, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Robin Trama
- Univ Lyon, Ucb Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, Villeurbanne, France
| | | | - Sean McAuliffe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Health Research Board, Dublin, Ireland.,College of Health Sciences, Qatar University, Doha, Qatar
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24
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Pius AK, Beynnon BD, Fiorentino N, Gardner-Morse M, Vacek PM, DeSarno M, Failla M, Slauterbeck JR, Sturnick DR, Argentieri EC, Tourville TW. Articular cartilage thickness changes differ between males and females 4 years following anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:65-73. [PMID: 34288090 DOI: 10.1002/jor.25142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament injury and reconstruction (ACLR) affects articular cartilage thickness profiles about the tibial, femoral, and patellar surfaces; however, it's unclear whether the magnitudes of change in cartilage thickness, as well as the locations and areas over which these changes occur, differ between males and females. This is important to consider as differences exist between the sexes with regard to knee biomechanics, patellofemoral pain, and anatomic alignment, which influence risk of an index and repeated injury. Subjects underwent ACLR with a bone-patella tendon-bone autograft. At 4-year follow-up, they had asymptomatic knees; however, significant ACL injured-to-contralateral normal knee differences in articular cartilage thickness values were observed. Both thickening and thinning of cartilage occurred about the tibiofemoral and patellofemoral joints, relative to matched control subjects with normal knees. Further, the location of the areas and magnitudes of thickening and thinning were different between females and males. Thickening (swelling) of articular cartilage is an early finding associated with the onset of posttraumatic osteoarthritis (PTOA). Therefore, the increases in cartilage thickness that were observed in this cohort may represent early signs of the onset of PTOA that occur prior to the patient developing symptoms and radiographic evidence of this disease. The different locations of areas that underwent a change in cartilage thicknesses between males and females suggest that each sex responds differently to knee ligament trauma, reconstruction, rehabilitation, and return to activity, and indicates that sex-specific analysis should be utilized in studies of PTOA.
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Affiliation(s)
- Alexa K Pius
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA.,Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Niccolo Fiorentino
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA.,Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Mack Gardner-Morse
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M Vacek
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike DeSarno
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mat Failla
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - James R Slauterbeck
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Daniel R Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, USA
| | - Erin C Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, USA
| | - Timothy W Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
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25
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Brunst C, Ithurburn M, Zbojniewicz A, Paterno MV, Schmitt LC. Return-to-sport quadriceps strength symmetry impacts 5-year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis. J Orthop Res 2022; 40:285-294. [PMID: 33834527 PMCID: PMC8724934 DOI: 10.1002/jor.25029] [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: 11/30/2020] [Revised: 02/12/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Quadriceps femoris strength asymmetry at the time of return to sports participation after anterior cruciate ligament (ACL) reconstruction contributes to worse function and asymmetric landing patterns, but the impact on longitudinal outcomes is not known. This study determined if young athletes after ACL reconstruction with quadriceps femoris strength asymmetry at a return to sports clearance would demonstrate markers of knee cartilage degeneration 5 years later compared to those with symmetric quadriceps femoris strength at return to sports. Participants (n = 27) were enrolled at the time of medical clearance for sports participation (baseline testing) and followed for 5 years. At baseline, quadriceps femoris strength was measured bilaterally and a limb symmetry index was used to divide the cohort into two groups: return to sport clearance with high quadriceps femoris strength (RTS-HQ; limb symmetry index ≥ 90%) and return to sport clearance with low quadriceps femoris strength (RTS-LQ; limb symmetry index < 85%). At 5 years post-baseline, quantitative magnetic resonance imaging (T2 relaxation times (ms): involved knee medial/lateral femoral condyle and tibial plateau) data were collected. Group differences were evaluated with independent samples t tests. At 5 years post-return to sports, the RTS-LQ strength group (n = 14) demonstrated elevated T2 relaxation times at the anterior region of the lateral femoral condyle compared to the RTS-HQ strength group (n = 13). Clinical Significance: Just over 50% of this cohort was cleared for sports participation with involved limb quadriceps femoris strength deficits that may contribute to early markers of knee cartilage degeneration within the subsequent 5 years.
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Affiliation(s)
- Caroline Brunst
- OSU Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, OH
| | - Matthew Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Mark V. Paterno
- Division of Sports Medicine and Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Laura C. Schmitt
- OSU Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH
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26
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Weaver A, Ness BM, Roman DP, Giampetruzzi N, Cleland JA, Pace JL, Crepeau AE. Short-term isokinetic and isometric strength outcomes after anterior cruciate ligament reconstruction in adolescents. Phys Ther Sport 2021; 53:75-83. [PMID: 34875528 DOI: 10.1016/j.ptsp.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine differences in knee strength outcomes after ACL reconstruction according to quadriceps tendon (QT) or hamstring tendon (HT) autograft in adolescents. DESIGN Retrospective cohort. METHODS Surgical and clinical outcome data were collected. Analyses were conducted separately for female and male cohorts and grouped by graft type (HT or QT). A Mann-Whitney U test of independent samples was used to examine group differences according to graft type. RESULTS 107 females (age = 15.6 ± 1.5 years) and 94 males (age = 15.7 ± 1.5 years) were included. Mean time since surgery ranged from 7.2 to 7.9 months. Those with a QT autograft had decreased normalized isokinetic quadriceps peak torque on the involved limb compared to the HT group (p < 0.01, ES = 0.71-0.89). Normalized isometric hamstring peak torque was decreased for those with HT autograft in the female cohort (p = 0.02, ES = 0.57). CONCLUSION Normalized isokinetic quadriceps peak torque was reduced by 18-20% on the involved limb in those with a QT autograft. Normalized isometric hamstring peak torque was decreased by 13% for those with HT autograft in the female cohort. Method of strength testing may be an important consideration to fully appreciate strength deficits after ACL reconstruction according to graft type.
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Affiliation(s)
- Adam Weaver
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, USA
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
| | - Dylan P Roman
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, USA.
| | | | - Joshua A Cleland
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
| | - J Lee Pace
- Elite Sports Medicine at Connecticut Children's, Hartford, CT, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, CT, USA
| | - Allison E Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, CT, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, CT, USA
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27
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Coulondre C, Souron R, Rambaud A, Dalmais É, Espeit L, Neri T, Pinaroli A, Estour G, Millet GY, Rupp T, Feasson L, Edouard P, Lapole T. Local vibration training improves the recovery of quadriceps strength in early rehabilitation after anterior cruciate ligament reconstruction: A feasibility randomised controlled trial. Ann Phys Rehabil Med 2021; 65:101441. [PMID: 33059096 DOI: 10.1016/j.rehab.2020.08.005] [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] [Received: 03/27/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), quadriceps strength must be maximised as early as possible. OBJECTIVES We tested whether local vibration training (LVT) during the early post-ACLR period (i.e., ∼10 weeks) could improve strength recovery. METHODS This was a multicentric, open, parallel-group, randomised controlled trial. Thirty individuals attending ACLR were randomised by use of a dedicated Web application to 2 groups: vibration (standardised rehabilitation plus LVT, n=16) or control (standardised rehabilitation alone, n=14). Experimenters, physiotherapists and participants were not blinded. Both groups received 24 sessions of standardised rehabilitation over ∼10 weeks. In addition, the vibration group received 1 hour of vibration applied to the relaxed quadriceps of the injured leg at the end of each rehabilitation session. The primary outcome - maximal isometric strength of both injured and non-injured legs (i.e., allowing for limb asymmetry measurement) - was evaluated before ACLR (PRE) and after the 10-week rehabilitation (POST). RESULTS Seven participants were lost to follow-up, so data for 23 participants were used in the complete-case analysis. For the injured leg, the mean (SD) decrease in maximal strength from PRE to POST was significantly lower for the vibration than control group (n=11, -16% [10] vs. n=12, -30% [11]; P=0.0045, Cohen's d effect size=1.33). Mean PRE-POST change in limb symmetry was lower for the vibration than control group (-19% [11] vs. -29% [13]) but not significantly (P=0.051, Cohen's d effect size=0.85). CONCLUSION LVT improved strength recovery after ACLR. This feasibility study suggests that LVT applied to relaxed muscles is a promising modality of vibration therapy that could be implemented early in ACLR. TRIAL REGISTRATION ClinicalTrials.gov: NCT02929004.
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Affiliation(s)
- Claire Coulondre
- Inter-university laboratory of human movement biology (LIBM), University of Savoie-Mont Blanc, EA 7424, 73000 Chambéry, France; Centre d'évaluation et de prévention articulaire (CEPART), 73490 Challes-les-Eaux, France; Centre d'orthopédie et de traumatologie du sport, 73000 Bassens, France
| | - Robin Souron
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France; Laboratory of impact of physical activity on health (IAPS), UR n(o)201723207F, University of Toulon, Toulon, France
| | - Alexandre Rambaud
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France
| | - Étienne Dalmais
- Inter-university laboratory of human movement biology (LIBM), University of Savoie-Mont Blanc, EA 7424, 73000 Chambéry, France; Centre d'évaluation et de prévention articulaire (CEPART), 73490 Challes-les-Eaux, France; Centre d'orthopédie et de traumatologie du sport, 73000 Bassens, France
| | - Loïc Espeit
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France
| | - Thomas Neri
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France; Department of orthopaedic surgery, university hospital of Saint Étienne, Faculty of medicine, Saint-Étienne, France
| | | | | | - Guillaume Y Millet
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France; Institut universitaire de France (IUF), France
| | - Thomas Rupp
- Inter-university laboratory of human movement biology (LIBM), University of Savoie-Mont Blanc, EA 7424, 73000 Chambéry, France
| | - Léonard Feasson
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France; Department of clinical and exercise physiology, sports medicine and myology units, regional institute of medicine and sports engineering (IRMIS), University hospital of Saint-Étienne, Faculty of medicine, Saint-Étienne, France
| | - Pascal Edouard
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France; Department of clinical and exercise physiology, sports medicine and myology units, regional institute of medicine and sports engineering (IRMIS), University hospital of Saint-Étienne, Faculty of medicine, Saint-Étienne, France
| | - Thomas Lapole
- Université de Lyon, UJM-Saint-Étienne, Inter-university laboratory of human movement biology, EA 7424, 42023 Saint-Étienne, France.
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28
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Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial. Eur J Appl Physiol 2021; 121:3551-3559. [PMID: 34542671 DOI: 10.1007/s00421-021-04812-3] [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] [Received: 04/26/2021] [Accepted: 09/11/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of cross-education (CE) exercise on strength and performance at 10 and 24 weeks post anterior cruciate ligament (ACL) surgery. METHODS Design: randomised controlled trial. N = 44 ACL-reconstruction patients, randomly-allocated into: CE: strength training of the non-operative limb, or CON: sham exercise of upper limb stretching. Each patient underwent standardised ACL rehabilitation, plus 8 weeks of thrice weekly CE or CON, commencing at 2 weeks post surgery. The primary outcome was quadriceps peak force (QPF) of the ACL-reconstructed limb at 10 weeks post surgery. Secondary measures were hamstrings peak force (HPF), rate of force development (RFD) and International Knee Documentation Committee score (IKDC) at 10 and 24 weeks; QPF and hop for distance (HOP) at 24 weeks post surgery. RESULTS CE significantly attenuated the decline in QPF of the ACL-reconstructed limb at 10 weeks compared to CON (16.6% decrease vs. 32.0%, respectively); that advantage was not retained at 24 weeks. A training effect was observed in the trained limb for HPF and QPF, which was retained at 24 weeks. No significant differences were observed for IKDC, HOP, RFD, or HPF of the reconstructed limb. Inter-limb symmetry (ILS) ranged from 0.78 to 0.89 and was not significantly different between groups. CONCLUSION High-intensity CE strength training attenuated the post-operative decline in QPF and should be considered in early-phase ACL rehabilitation. ILS data showed good symmetry, but it masked significantly inferior performance between groups and should be used with caution. TRIAL REGISTRATION NUMBER NCT02722876.
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Noyes FR, Barber-Westin SD, Sipes L. Blood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstrings Muscles. Arthroscopy 2021; 37:2860-2869. [PMID: 33812031 DOI: 10.1016/j.arthro.2021.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report a prospective study of patients who underwent blood flow restriction training (BFRT) for marked quadriceps or hamstring muscle deficits after failure to respond to traditional rehabilitation after knee surgery. METHODS The BFRT protocol consisted of 4 low resistance exercises (30% of 1 repetition maximum): leg press, knee extension, mini-squats, and hamstring curls with 60% to 80% limb arterial occlusion pressure. Knee peak isometric muscle torque (60° flexion) was measured on an isokinetic dynamometer. RESULTS Twenty-seven patients (18 females, 9 males; mean age, 40.1 years) with severe quadriceps and/or hamstrings deficits were enrolled from April 2017 to January 2020. They had undergone a mean of 5.3 ± 3.5 months of outpatient therapy and 22 ± 10 supervised therapy visits and did not respond to traditional rehabilitation. Prior surgery included anterior cruciate ligament reconstruction, partial or total knee replacements, meniscus repairs, and others. All patients completed 9 BFRT sessions, and 14 patients completed 18 sessions. The mean quadriceps and hamstrings torque deficits before BFRT were 43% ± 16% and 38% ± 14%, respectively. After 9 BFRT sessions, statistically significant improvements were found in muscle peak torque deficits for the quadriceps (P = .003) and hamstring (P = .02), with continued improvements after 18 sessions (P = .004 and P = .002, respectively). After 18 BFRT sessions, the peak quadriceps and hamstring peak torques increased > 20% in 86% and 76% of the patients, respectively. The failure rate of achieving this improvement in peak quadriceps and hamstring torque after 18 BFRT sessions was 14% and 24%, respectively. CONCLUSIONS BFRT produced statistically significant improvements in peak quadriceps and hamstring torque measurements after 9 and 18 sessions in a majority of patients with severe quadriceps and hamstring strength deficits that had failed to respond to many months of standard and monitored postoperative rehabilitation. LEVEL OF EVIDENCE Level IV therapeutic case series.
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Affiliation(s)
- Frank R Noyes
- Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A.; Mercy Health, Cincinnati, Ohio, U.S.A.; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A.; Noyes Knee Institute, Cincinnati, Ohio, U.S.A
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Unverzagt C, Andreyo E, Tompkins J. ACL Return to Sport Testing: It's Time to Step up Our Game. Int J Sports Phys Ther 2021; 16:1169-1177. [PMID: 34386294 PMCID: PMC8329322 DOI: 10.26603/001c.25463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
Patients and physicians have long looked to physical therapists to help determine an athlete's readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). This is a complex decision that must take into account biological healing, joint stability, functional performance, and psychological readiness. Considering that the vast majority of medical professionals use time as the sole determinant of an athlete's readiness, and few are using performance-based criteria, it appears as though our profession is failing to capture the necessary information to make this weighty recommendation. The time is now to take a hard look at current practice patterns with RTS testing and push the envelope forward. The purpose of this clinical commentary is challenge our failing status quo by disseminating a robust model for RTS testing that incorporates temporal and criterion-based factors, as well as intrinsic and extrinsic data. LEVEL OF EVIDENCE 5.
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Horteur C, Rubens Duval B, Merlin A, Cognault J, Ollivier M, Pailhe R. Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:857-865. [PMID: 34152474 DOI: 10.1007/s00590-021-03062-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim was to assess the consequences of quadriceps tendon (QT) harvest on knee extensor strength after anterior cruciate ligament reconstruction (ACL-R) compared to hamstring tendon (HT) autograft. Secondary objectives were to evaluate flexor strength recovery and search for correlation between strength status and functional outcome. METHODS This a retrospective cohort of 44 patients who underwent ACL-R using either QT (25) or HT (19). Median age was 31.1 years. We assessed thigh muscle strength thanks to concentric iso kinetic evaluation (peak torque) at 60°.s-1, 180°.s-1, 240°.s-1 and eccentric at 30°.s-1, 7 months on average after surgery. Muscle strength values were compared to the uninjured leg in order to calculate a percentage of deficit as well as unilateral hamstring/quadriceps (H/Q) ratios. KOOS score was obtained at a mean follow-up of 18 months. RESULTS Extensor strength deficit (concentric 60°.s-1) was one average 33.1% in the QT group and 28.2% in the HT group (p = 0.42). Difference of flexor strength deficit (concentric 60°.s-1) was close to be significant with 5% and 12% of deficit in the QT and HT group, respectively (p = 0.1), and statistically significant for high angular velocity (14% versus 3% at 240°.s-1, p = 0.04). H/Q ratios were comparable in both groups ranging from 0.62 to 0.78. Quadriceps muscle strength deficit was negatively correlated with the KOOS score (Pearson coefficient = -0.4; p = 0.005). CONCLUSION QT autograft harvest does not yield significant quadriceps muscle weakness after ACL-R, which appear to be a pejorative factor for functional outcome. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- C Horteur
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France.
| | - B Rubens Duval
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - A Merlin
- Sport Lab Kine - 9 bis Rue Conrad Killian, 38950, Saint-Martin-le-Vinoux, France
| | - J Cognault
- Clinique du Parc, Boulevard de Stalingrad, 69006, Lyon, France
| | - M Ollivier
- Department of Orthopedics and Traumatology, Institute for Locomotion, ISM, Aix Marseille Univ, APHM, CNRS, Sainte-Marguerite Hospital, Marseille, France
| | - R Pailhe
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
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Blackburn T, Padua DA, Pietrosimone B, Schwartz TA, Spang JT, Goodwin JS, Dewig DR, Johnston CD. Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury. J Orthop Res 2021; 39:1113-1122. [PMID: 32757272 DOI: 10.1002/jor.24821] [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: 01/07/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of posttraumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was to evaluate the effects of whole-body vibration (WBV) and local muscle vibration (LMV) on gait biomechanics in individuals with ACLR. Seventy-five volunteers (time since ACLR 27 ± 16 months) were randomized to WBV, LMV, or Control interventions. Walking biomechanics were assessed prior to and following a single exposure to the interventions. Outcomes included pre-post change scores in the ACLR limb for the peak vertical ground reaction force (vGRF) and its loading rate, peak internal knee extension (KEM) and abduction moments, and peak knee flexion and varus angles. LMV produced a significant decrease in the vGRF loading rate (-3.6 BW/s) that was greater than the changes in the WBV (-0.3 BW/s) and Control (0.5 BW/s) groups. Additionally, WBV produced an increase in the peak KEM (0.27% BW × Ht) that was greater than the change in the Control group (-0.17% BW × Ht) but not the LMV group (0.01% BW × Ht). Lower KEM and greater loading rates have been linked to declines in joint health following ACLR. WBV acutely increased the peak KEM and LMV decreased loading rates. These data suggest that vibration has the potential to mitigate aberrant gait biomechanics, and may represent an effective approach for reducing PTOA risk following ACLR.
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Affiliation(s)
- Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Todd A Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Derek R Dewig
- Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris D Johnston
- Department of Athletic Training, High Point University, North Carolina
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Read PJ, Auliffe SM, Thomson A. Commonly used clinical criteria following ACL reconstruction including time from surgery and isokinetic limb symmetry thresholds are not associated with between-limb loading deficits during running. Phys Ther Sport 2021; 49:236-242. [PMID: 33812124 DOI: 10.1016/j.ptsp.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We included objective measures of gait and functional assessments to examine their associations in athletes who had recently commenced running after ACL reconstruction. DESIGN Cross-sectional. SETTING Sports medicine. PARTICIPANTS 65 male athletes with a history of ACL reconstruction. MAIN OUTCOME MEASURES Time from surgery, isokinetic knee extension/flexion strength (60°/s), and peak vertical ground reaction force (pVGRF) measured during running using an instrumented treadmill. We also investigated if a range of recommended isokinetic thresholds (e.g. > 70% quadriceps limb symmetry index) affected the magnitude of pVGRF asymmetry during running. RESULTS There were significant relationships between quadriceps (r = 0.50) and hamstrings (r = 0.46) peak torque and pVGRF. Quadriceps peak torque explained a quarter of the variance in pVGRF (R2 = 0.24; p < 0.001). There was no association was between running pVGRF and time from surgery. Between-group differences in running pVGRF LSI% were trivial (d < 0.20) for all quadriceps and hamstring peak torque LSI thresholds. CONCLUSIONS Current clinical criteria including time from surgery and isokinetic strength limb symmetry thresholds were not associated with lower pVGRF asymmetry measured during running. Quadriceps strength is important, but 'minimum symmetry thresholds' should be used with caution.
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Affiliation(s)
- Paul J Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports, Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, London, UK; Division of Surgery & Interventional Science, University College London, UK; School of Sport and Exercise Sciences, University of Gloucestershire, UK
| | - Sean Mc Auliffe
- Qatar University, Physiotherapy Program, Qatar University, Doha, Qatar
| | - Athol Thomson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports, Medicine Hospital, Doha, Qatar; La Trobe University, Discipline of Podiatry, College of Science, Health and Engineering, La Trobe Sport and Exercise Medicine Research Centre, Victoria, Australia.
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Grooms DR, Criss CR, Simon JE, Haggerty AL, Wohl TR. Neural Correlates of Knee Extension and Flexion Force Control: A Kinetically-Instrumented Neuroimaging Study. Front Hum Neurosci 2021; 14:622637. [PMID: 33613205 PMCID: PMC7890238 DOI: 10.3389/fnhum.2020.622637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The regulation of muscle force is a vital aspect of sensorimotor control, requiring intricate neural processes. While neural activity associated with upper extremity force control has been documented, extrapolation to lower extremity force control is limited. Knowledge of how the brain regulates force control for knee extension and flexion may provide insights as to how pathology or intervention impacts central control of movement. Objectives: To develop and implement a neuroimaging-compatible force control paradigm for knee extension and flexion. Methods: A magnetic resonance imaging (MRI) safe load cell was used in a customized apparatus to quantify force (N) during neuroimaging (Philips Achieva 3T). Visual biofeedback and a target sinusoidal wave that fluctuated between 0 and 5 N was provided via an MRI-safe virtual reality display. Fifteen right leg dominant female participants (age = 20.3 ± 1.2 years, height = 1.6 ± 0.10 m, weight = 64.8 ± 6.4 kg) completed a knee extension and flexion force matching paradigm during neuroimaging. The force-matching error was calculated based on the difference between the visual target and actual performance. Brain activation patterns were calculated and associated with force-matching error and the difference between quadriceps and hamstring force-matching tasks were evaluated with a mixed-effects model (z > 3.1, p < 0.05, cluster corrected). Results: Knee extension and flexion force-matching tasks increased BOLD signal among cerebellar, sensorimotor, and visual-processing regions. Increased knee extension force-matching error was associated with greater right frontal cortex and left parietal cortex activity and reduced left lingual gyrus activity. Increased knee flexion force-matching error was associated with reduced left frontal and right parietal region activity. Knee flexion force control increased bilateral premotor, secondary somatosensory, and right anterior temporal activity relative to knee extension. The force-matching error was not statistically different between tasks. Conclusion: Lower extremity force control results in unique activation strategies depending on if engaging knee extension or flexion, with knee flexion requiring increased neural activity (BOLD signal) for the same level of force and no difference in relative error. These fMRI compatible force control paradigms allow precise behavioral quantification of motor performance concurrent with brain activity for lower extremity sensorimotor function and may serve as a method for future research to investigate how pathologies affect lower extremity neuromuscular function.
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Affiliation(s)
- Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Translational Biomedical Sciences Program, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Adam L Haggerty
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Timothy R Wohl
- Honors Tutorial College, Ohio University, Athens, OH, United States.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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Pietrosimone B, Davis-Wilson HC, Seeley MK, Johnston C, Spang JT, Creighton RA, Kamath GM, Blackburn JT. Gait Biomechanics in Individuals Meeting Sufficient Quadriceps Strength Cutoffs Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:960-966. [PMID: 33481020 DOI: 10.4085/425-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Quadriceps weakness is associated with disability and aberrant gait biomechanics following anterior cruciate ligament reconstruction (ACLR). Strength sufficiency cutoff scores, that normalize quadriceps strength to the mass of an individual, are capable of predicting individuals who will report better function following ACLR. Yet, it remains unknown if gait biomechanics differ between individuals who meet a strength sufficiency cutoff (strong) compared to those who do not (weak). OBJECTIVE Determine if vertical ground reaction force (vGRF), knee flexion angle (KFA) and internal knee extension moment (KEM) differ between strong and weak individuals with an ACLR throughout stance phase of walking. DESIGN Comparison-control. SETTING Laboratory Participants: Individuals who received unilateral ACLR ≥12 months prior to testing were dichotomized into strong (n=31) and weak groups (n=116). MAIN OUTCOME MEASURES Maximal isometric quadriceps strength was collected at 90° of knee flexion using an isokinetic dynamometer and normalized to body mass. Individuals demonstrating ≥3.0Nm/kg were considered strong. Three-dimensional gait biomechanics were collected at a self-selected walking speed. Biomechanical data were time-normalized to 100% of stance phase. vGRF were normalized to body weight (BW), and KEM was normalized to BW*height. Pairwise comparison functions were calculated for each outcome to identify between-group differences for each percentile of stance. RESULTS vGRF was significantly greater in weak participants for the first 22% of stance (average difference of 6.2% BW) and lesser in weak participants between 36-43% of stance (1.4% BW). KFA was significantly greater (i.e., more flexion) in strong participants between 6-62% of stance (2.3°) and lesser (i.e., less flexion) between 68-79% of stance (1.0°). KEM was significantly greater in strong participants between 7-62% of stance (0.007 BW*height). CONCLUSIONS ACLR individuals able to generate knee extension torque ≥3.0Nm/kg exhibit different biomechanical gait profiles compared to weak individuals, which may allow for better energy attenuation following ACLR.
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Affiliation(s)
- Brian Pietrosimone
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Hope C Davis-Wilson
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Matthew K Seeley
- 4Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States
| | - Christopher Johnston
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Jeffrey T Spang
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - R Alexander Creighton
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ganesh M Kamath
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - J Troy Blackburn
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
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Troy Blackburn J, Dewig DR, Johnston CD. Time course of the effects of vibration on quadriceps function in individuals with anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2020; 56:102508. [PMID: 33302006 DOI: 10.1016/j.jelekin.2020.102508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Quadriceps dysfunction is a common, chronic complication following anterior cruciate ligament reconstruction (ACLR) that contributes to aberrant gait biomechanics and poor joint health. Vibration enhances quadriceps function in individuals with ACLR, but the duration of these effects is unknown. This study evaluated the time course of the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function. Twenty-four volunteers with ACLR completed 3 testing sessions during which quadriceps isometric peak torque, rate of torque development, and EMG amplitude were assessed prior to and immediately, 10, 20, 30, 45, and 60 min following a WBV, LMV, or control intervention. WBV and LMV (30 Hz, 2g) were applied during six one-minute bouts. WBV increased peak torque 5-11% relative to baseline and control at all post-intervention time points. LMV increased peak torque 6% relative to baseline at 10 min post-intervention and 4-6% relative to control immediately, 10 min, and 20 min post-intervention. The interventions did not influence EMG amplitudes or rate of torque development. The sustained improvements in quadriceps following vibration, especially WBV, suggest that it could be applied at the beginning of rehabilitation sessions to "prime" the central nervous system, potentially improving the efficacy of ACLR rehabilitative exercise.
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Affiliation(s)
- J Troy Blackburn
- Department of Exercise and Sport Science, High Point University, USA; Program in Human Movement Science, High Point University, USA.
| | - Derek R Dewig
- Program in Human Movement Science, High Point University, USA
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The Immediate Effects of Transcranial Direct Current Stimulation on Quadriceps Muscle Function in Individuals With a History of Anterior Cruciate Ligament Reconstruction: A Preliminary Investigation. J Sport Rehabil 2020; 29:1121-1130. [PMID: 32221043 DOI: 10.1123/jsr.2019-0179] [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: 05/02/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered quadriceps activation is common following anterior cruciate ligament reconstruction (ACLR), and can persist for years after surgery. These neural deficits are due, in part, to chronic central nervous system alterations. Transcranial direct current stimulation (tDCS) is a noninvasive modality, that is, believed to immediately increase motor neuron activity by stimulating the primary motor cortex, making it a promising modality to use improve outcomes in the ACLR population. OBJECTIVE To determine if a single treatment of tDCS would result in increased quadriceps activity and decreased levels of self-reported pain and dysfunction during exercise. DESIGN Randomized crossover design. SETTING Controlled laboratory. PATIENTS Ten participants with a history of ACLR (5 males/5 females, 22.9 [4.23] y, 176.57 [12.01] cm, 80.87 [16.86] kg, 68.1 [39.37] mo since ACLR). INTERVENTIONS Active tDCS and Sham tDCS. MAIN OUTCOME MEASURES Percentage of maximum electromyographic data of vastus medialis and lateralis, voluntary isometric strength, percentage of voluntary activation, and self-reported pain and symptom scores were measured. The 2 × 2 repeated-measures analysis of variance by limb were performed to explain the differences between time points (pre and post) and condition (tDCS and sham). RESULTS There was a significant time main effect for quadriceps percentage of maximum electromyographic of vastus medialis (F9,1 = 11.931, P = .01) and vastus lateralis (F9,1 = 9.132, P = .01), isometric strength (F9,1 = 5.343, P = .046), and subjective scores for pain (F9,1 = 15.499, P = .04) and symptoms (F9,1 = 15.499, P = .04). Quadriceps percentage of maximum electromyographic, isometric strength, and voluntary activation showed an immediate decline from pre to post regardless of tDCS condition. Subjective scores improved slightly after each condition. CONCLUSIONS One session of active tDCS did not have an immediate effect on quadriceps activity and subjective scores of pain and symptoms. To determine if tDCS is a valid modality for this patient population, a larger scale investigation with multiple treatments of active tDCS is warranted.
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Examination of Corticospinal and Spinal Reflexive Excitability During the Course of Postoperative Rehabilitation After Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 2020; 50:516-522. [PMID: 32741329 PMCID: PMC9361008 DOI: 10.2519/jospt.2020.9329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate corticospinal and spinal reflexive excitability and quadriceps strength in healthy athletes and athletes after anterior cruciate ligament reconstruction (ACLR) over the course of rehabilitation. DESIGN Prospective cohort study. METHODS Eighteen athletes with ACLR and 18 healthy athletes, matched by sex, age, and activity, were tested at (1) 2 weeks after surgery, (2) the "quiet knee" time point, defined as full range of motion and minimal effusion, and (3) return to running, defined as achieving a quadriceps index of 80% or greater. We measured (1) corticospinal excitability, using resting motor threshold (RMT) and motor-evoked potential amplitude at a stimulator intensity of 120% of RMT (MEP120) to the vastus medialis, (2) spinal reflexive excitability, calculating the ratio of the maximal Hoffmann reflex to the maximal M-wave to the vastus medialis, and (3) isometric quadriceps strength. RESULTS The ACLR group had higher RMTs in the nonsurgical limb and higher MEP120 in the surgical limb at all time points. The healthy-athlete group did not have interlimb differences. The RMT was positively associated with quadriceps strength 2 weeks after surgery; MEP120 was associated with quadriceps strength at all time points. CONCLUSION Compared to healthy athletes, athletes after ACLR had altered corticospinal excitability that did not change from 2 weeks after surgery to the time of return to running. J Orthop Sports Phys Ther 2020;50(9):516-522. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9329.
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Lepley LK, Davi SM, Burland JP, Lepley AS. Muscle Atrophy After ACL Injury: Implications for Clinical Practice. Sports Health 2020; 12:579-586. [PMID: 32866081 DOI: 10.1177/1941738120944256] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Distinct from the muscle atrophy that develops from inactivity or disuse, atrophy that occurs after traumatic joint injury continues despite the patient being actively engaged in exercise. Recognizing the multitude of factors and cascade of events that are present and negatively influence the regulation of muscle mass after traumatic joint injury will likely enable clinicians to design more effective treatment strategies. To provide sports medicine practitioners with the best strategies to optimize muscle mass, the purpose of this clinical review is to discuss the predominant mechanisms that control muscle atrophy for disuse and posttraumatic scenarios, and to highlight how they differ. EVIDENCE ACQUISITION Articles that reported on disuse atrophy and muscle atrophy after traumatic joint injury were collected from peer-reviewed sources available on PubMed (2000 through December 2019). Search terms included the following: disuse muscle atrophy OR disuse muscle mass OR anterior cruciate ligament OR ACL AND mechanism OR muscle loss OR atrophy OR neurological disruption OR rehabilitation OR exercise. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS We highlight that (1) muscle atrophy after traumatic joint injury is due to a broad range of atrophy-inducing factors that are resistant to standard resistance exercises and need to be effectively targeted with treatments and (2) neurological disruptions after traumatic joint injury uncouple the nervous system from muscle tissue, contributing to a more complex manifestation of muscle loss as well as degraded tissue quality. CONCLUSION Atrophy occurring after traumatic joint injury is distinctly different from the muscle atrophy that develops from disuse and is likely due to the broad range of atrophy-inducing factors that are present after injury. Clinicians must challenge the standard prescriptive approach to combating muscle atrophy from simply prescribing physical activity to targeting the neurophysiological origins of muscle atrophy after traumatic joint injury.
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Affiliation(s)
- Lindsey K Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven M Davi
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Julie P Burland
- Spaulding National Running Center, Harvard Medical School, Boston, Massachusetts
| | - Adam S Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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Garcia SA, Rodriguez KM, Krishnan C, Palmieri-Smith RM. Type of measurement used influences central and peripheral contributions to quadriceps weakness after anterior cruciate ligament (ACL) reconstruction. Phys Ther Sport 2020; 46:14-22. [PMID: 32846386 DOI: 10.1016/j.ptsp.2020.08.001] [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: 05/25/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The relative contribution of muscle size and voluntary activation (VA) on quadriceps strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Here, we aimed to determine the contributions of muscle size and VA on quadriceps strength in ACL-reconstructed patients and determine if contributions were similar if unilateral outcomes (i.e. ACL-reconstructed limb) or the LSI was used. DESIGN A cross-sectional study. SETTING A university research laboratory. PARTICIPANTS Sixteen individuals 6-12 months after ACL reconstruction (Age: 22.3 ± 6.0yr, Height: 1.7 ± 0.1 m, Mass: 68.7 ± 11.5 kg) were recruited. MAIN OUTCOME MEASURES Quadriceps isometric strength and VA, via the interpolated triplet technique, were assessed bilaterally. Ultrasound images were acquired of the vastus lateralis to calculate cross-sectional area (CSA) in both legs. LSI's were computed for all variables by expressing values of the reconstructed leg as a percent of the non-reconstructed leg. Separate stepwise linear regressions were performed to examine the contribution of VA and CSA on quadriceps strength. Model 1 used LSI for all outcomes and model 2 used outcomes from the reconstructed leg. RESULTS We observed between limb deficits of 27.78% in quadriceps strength, 13.61% in vastus lateralis CSA, and 13.18% in VA (P < 0.05). Strength LSI was significantly predicted by VA LSI (R2 = 0.45, P < 0.01), but not by CSA LSI (R2 = 0.01, P =0.87). Reconstructed leg strength was significantly predicted by VL CSA (R2 = 0.50, P < 0.01) but not quadriceps VA (R2 = 0.08, P =0.11). CONCLUSIONS The contributions of VA and CSA on quadriceps PT differed greatly if LSI or reconstructed leg outcomes were used. Evaluation of VA and CSA in unison may be provide a more holistic understanding of the sources of muscle weakness after ACL reconstruction.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI, USA; Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, MI, USA.
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Toth MJ, Tourville TW, Voigt TB, Choquette RH, Anair BM, Falcone MJ, Failla MJ, Stevens-Lapslaey JE, Endres NK, Slauterbeck JR, Beynnon BD. Utility of Neuromuscular Electrical Stimulation to Preserve Quadriceps Muscle Fiber Size and Contractility After Anterior Cruciate Ligament Injuries and Reconstruction: A Randomized, Sham-Controlled, Blinded Trial. Am J Sports Med 2020; 48:2429-2437. [PMID: 32631074 PMCID: PMC7775613 DOI: 10.1177/0363546520933622] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries and reconstruction (ACLR) promote quadriceps muscle atrophy and weakness that can persist for years, suggesting the need for more effective rehabilitation programs. Whether neuromuscular electrical stimulation (NMES) can be used to prevent maladaptations in skeletal muscle size and function is unclear. PURPOSE To examine whether early NMES use, started soon after an injury and maintained through 3 weeks after surgery, can preserve quadriceps muscle size and contractile function at the cellular (ie, fiber) level in the injured versus noninjured leg of patients undergoing ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients (n = 25; 12 men/13 women) with an acute, first-time ACL rupture were randomized to NMES (5 d/wk) or sham (simulated microcurrent electrical nerve stimulation; 5 d/wk) treatment to the quadriceps muscles of their injured leg. Bilateral biopsies of the vastus lateralis were performed 3 weeks after surgery to measure skeletal muscle fiber size and contractility. Quadriceps muscle size and strength were assessed 6 months after surgery. RESULTS A total of 21 patients (9 men/12 women) completed the trial. ACLR reduced single muscle fiber size and contractility across all fiber types (P < .01 to P < .001) in the injured compared with noninjured leg 3 weeks after surgery. NMES reduced muscle fiber atrophy (P < .01) through effects on fast-twitch myosin heavy chain (MHC) II fibers (P < .01 to P < .001). NMES preserved contractility in slow-twitch MHC I fibers (P < .01 to P < .001), increasing maximal contractile velocity (P < .01) and preserving power output (P < .01), but not in MHC II fibers. Differences in whole muscle strength between groups were not discerned 6 months after surgery. CONCLUSION Early NMES use reduced skeletal muscle fiber atrophy in MHC II fibers and preserved contractility in MHC I fibers. These results provide seminal, cellular-level data demonstrating the utility of the early use of NMES to beneficially modify skeletal muscle maladaptations to ACLR. CLINICAL RELEVANCE Our results provide the first comprehensive, cellular-level evidence to show that the early use of NMES mitigates early skeletal muscle maladaptations to ACLR. REGISTRATION NCT02945553 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael J. Toth
- Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bradley M. Anair
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael J. Falcone
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | | | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
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Stevens T, McGinnis RS, Hewgill B, Choquette RH, Tourville TW, Harvey J, Lachapelle R, Beynnon BD, Toth MJ, Skalka C. A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile-Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation. JMIR Hum Factors 2020; 7:e16605. [PMID: 32384052 PMCID: PMC7248795 DOI: 10.2196/16605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. OBJECTIVE This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. METHODS The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System-based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. RESULTS Compared with the NMES device software-tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. CONCLUSIONS RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing.
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Affiliation(s)
- Timothy Stevens
- Department of Computer Science, University of Vermont, Burlington, VT, United States
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Blake Hewgill
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Rebecca H Choquette
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States
| | - Timothy W Tourville
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States.,Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington, VT, United States
| | - Jean Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States
| | - Richard Lachapelle
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, United States
| | - Bruce D Beynnon
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States
| | - Michael J Toth
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, United States.,Department of Medicine, University of Vermont, Burlington, VT, United States
| | - Christian Skalka
- Department of Computer Science, University of Vermont, Burlington, VT, United States
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Baroni BM, Ruas CV, Ribeiro-Alvares JB, Pinto RS. Hamstring-to-Quadriceps Torque Ratios of Professional Male Soccer Players: A Systematic Review. J Strength Cond Res 2020; 34:281-293. [PMID: 29794893 DOI: 10.1519/jsc.0000000000002609] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Baroni, BM, Ruas, CV, Ribeiro-Alvares, JB, and Pinto, RS. Hamstring-to-quadriceps torque ratios of professional male soccer players: A systematic review. J Strength Cond Res 34(1): 281-293, 2020-The goal of this review was to determine the isokinetic hamstring-to-quadriceps (H/Q) torque ratios of professional male soccer players. Systematic searches were independently carried out by 2 researchers in 7 electronic databases. Only studies with teams from the first or second national leagues were included. From these studies, we extracted the players' H/Q conventional (concentric/concentric) and/or functional (eccentric/concentric) ratios. The initial search resulted in 2,128 articles that were filtered to 30 articles (1,727 players) meeting the inclusion criteria. The H/Q conventional ratio was assessed in 27 studies (1,274 players), whereas the H/Q functional ratio was assessed in 15 studies (1,082 players). The H/Q conventional ratio mean scores of professional male soccer players were close to 60% when tested at low to intermediate angular velocities (12°·s = 52 ± 7%; 30°·s = 52 ± 8%; 60°·s = 65 ± 12%; 90°·s = 57 ± 6%; 120°·s = 65 ± 16%; 180°·s = 67 ± 17%) and around 70-80% at fast angular velocities (240°·s = 80 ± 40%; 300°·s = 70 ± 15%; 360°·s = 80 ± 13%). The H/Q functional ratio mean scores of professional male soccer players were close to 80% at 60°·s (79 ± 19%), around 100-130% at intermediate to fast angular velocities (120°·s = 127 ± 42%; 180°·s = 96 ± 19%; 240°·s = 109 ± 22%; 300°·s = 123 ± 18%), and near or above 130% when angular testing velocities were mixed (eccentric hamstring < concentric quadriceps; 30/240°·s = 132 ± 26%; 60/180°·s = 129 ± 20%; 60/240°·s = 153 ± 30%). In conclusion, considering the tested isokinetic angular velocity, professional male soccer players do not meet the traditional reference landmarks used to assess the strength balance between quadriceps and hamstring muscles (i.e., 60 and 100% for H/Q conventional and functional ratios, respectively), which supports a need for specific reference values according to the angular velocity selected for testing H/Q torque ratios.
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Affiliation(s)
- Bruno Manfredini Baroni
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cassio Victora Ruas
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Edith Cowan University, Joondalup, Australia
| | | | - Ronei Silveira Pinto
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Curran MT, Bedi A, Mendias CL, Wojtys EM, Kujawa MV, Palmieri-Smith RM. Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Am J Sports Med 2020; 48:825-837. [PMID: 32167837 DOI: 10.1177/0363546520904008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A major goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is restoring quadriceps muscle strength. Unfortunately, current rehabilitation paradigms fall short of this goal, such that substantial quadriceps muscle strength deficits can limit return to play and increase the risk of recurrent injuries. Blood flow restriction training (BFRT) involves the obstruction of venous return to working muscles during exercise and may lead to better recovery of quadriceps muscle strength after ACLR. PURPOSE To examine the efficacy of BFRT with high-intensity exercise on the recovery of quadriceps muscle function in patients undergoing ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 34 patients (19 female, 15 male; mean age, 16.5 ± 2.7 years; mean height, 169.0 ± 19.7 cm; mean weight, 73.2 ± 17.7 kg) scheduled to undergo ACLR were randomly assigned to 1 of 4 groups: concentric (n = 8), eccentric (n = 8), concentric with BFRT (n = 9), and eccentric with BFRT (n = 9). The exercise component of the intervention consisted of patients performing a single-leg isokinetic leg press, at an intensity of 70% of the patients' 1-repetition maximum during either the concentric or eccentric action, for 4 sets of 10 repetitions 2 times per week for 8 weeks beginning at 10 weeks postoperatively. Patients randomized to the BFRT groups performed the leg-press exercise with a cuff applied to the thigh, set to a limb occlusion pressure of 80%. Isometric and isokinetic (60 deg/s) quadriceps peak torque, quadriceps muscle activation, and rectus femoris muscle volume were assessed before ACLR, after BFRT, and at the time that patients returned to activity and were converted to the change in values from baseline for analysis. Also, 1-way analyses of covariance were used to compare the change in values for each dependent variable between groups after BFRT and at return to activity (P ≤ .05). RESULTS No significant differences were found between groups for any outcome measures at either time point (P > .05). CONCLUSION An 8-week BFRT plus high-intensity exercise intervention did not significantly improve quadriceps muscle strength, activation, or volume. On the basis of our findings, the use of BFRT in conjunction with high-intensity resistance exercise in patients undergoing ACLR to improve quadriceps muscle function may not be warranted. REGISTRATION NCT03141801 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael T Curran
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher L Mendias
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Hospital for Special Surgery, New York, New York, USA.,Department of Physiology and Biophysics, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Edward M Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan V Kujawa
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Smeets A, Verheul J, Vanrenterghem J, Staes F, Vandenneucker H, Claes S, Verschueren S. Single-Joint and Whole-Body Movement Changes in Anterior Cruciate Ligament Athletes Returning to Sport. Med Sci Sports Exerc 2020; 52:1658-1667. [PMID: 32079913 DOI: 10.1249/mss.0000000000002308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Athletes returning to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate prolonged changes in landing kinematics, kinetics, and muscle activation, predisposing them for reinjury, knee osteoarthritis, and/or knee instability. So far, researchers have been focusing on how kinematics and kinetics change in every joint separately. However, as the human body operates within a kinetic chain, we will assess whether single-joint changes are associated with whole-body changes. METHODS Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks, whereas lower limb kinematics, kinetics, and muscle activations of vastus medialis, vastus lateralis, biceps femoris, semitendinosus, semimembranosus, gastrocnemius, and gluteus medius were recorded. Single-joint landing kinematics, kinetics, and muscle activations of the ACL-injured leg were compared with the uninjured leg and compared with the control group. Whole-body changes were assessed by decomposing movements into fundamental components using marker-based principal component analysis (PCA). RESULTS We found several single-joint changes in landing kinematics, kinetics, and muscle activations in the athletes with ACLR that were seen across all tasks and therefore of major interest as they are likely to occur during sports as well. Hamstrings activation increased and external knee flexion moments decreased in the ACL-injured leg compared with their uninjured leg. Furthermore, hip adduction moments and knee abduction angles decreased compared with the control group. The PCA could detect changes in whole-body movement, which were task-specific. CONCLUSIONS Athletes with ACLR still show protective task-independent single-joint kinematic, kinetic, and muscle activation changes during single-leg landings at the time of return to sport. These single-joint changes were not consistently accompanied by changes in whole-body movements (revealed by marker-based PCA). Whole-body expressions of the single-joint compensations are likely to be affected by the demands of the task.
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Affiliation(s)
- Annemie Smeets
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jasper Verheul
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UNITED KINGDOM
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | | | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, BELGIUM
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
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Silva ACF, Prada LM, Gava NF, Engel EE. Results of muscle strength and range of motion after total open knee synovectomy. INTERNATIONAL ORTHOPAEDICS 2020; 44:863-868. [PMID: 32043197 DOI: 10.1007/s00264-020-04495-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
AIM OF THE STUDY Scar tissue formation after synovectomy limits range of motion and causes muscle atrophy. The functional results for patients who underwent total open knee synovectomy often included questionnaires, and assessment of muscle strength was lacking in the literature. Therefore, we aimed to identify the strength and range of motion outcomes for patients who underwent total open synovectomy and to compare the results with the contralateral limb and healthy individuals. METHOD Knee range of motion and muscle strength were assessed in fourteen patients that underwent total (anterior and posterior) open knee synovectomy and were compared with the contralateral limb and with 14 healthy individuals matched by sex, age, height, and weight. RESULTS The range of motion of flexion decreased 8.4% compared with the contralateral limb (95% CI - 18.9 to - 4.7, p = 0.002) and 9.9% compared with the control group (95% CI 3.9-14.9, p < 0.01). Knee extension strength decreased by 35% compared with the contralateral limb (95% CI 11.1-77.2, p = 0.01) and 37% compared with the control group (95% CI - 112.4-12.1, p = 0.01). CONCLUSION Despite the aggressiveness of the surgical procedure, the patients achieved satisfactory functional results.
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Affiliation(s)
| | - Lídia Maria Prada
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Nelson Fabrício Gava
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Edgard Eduard Engel
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, SP, Brazil. .,Department of Orthopedics and Anesthesiology, Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes, No. 3900, 11th Floor, Ribeirao Preto, SP, Brazil.
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Hunnicutt JL, McLeod MM, Slone HS, Gregory CM. Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:238-245. [PMID: 31995392 DOI: 10.4085/1062-6050-516-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Persistent neuromuscular deficits in the surgical limb after anterior cruciate ligament reconstruction (ACLR) have been repeatedly described in the literature, yet little is known regarding their association with physical performance and patient-reported function. OBJECTIVE To describe (1) interlimb differences in neuromuscular and functional outcomes and (2) the associations of neuromuscular outcomes with measures of physical and knee-related patient-reported function. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty individuals after primary, unilateral ACLR (19 males; age = 21.5 years [range, 14-41 years]; 8 months [range = 6-23 months] postsurgery). MAIN OUTCOME MEASURE(S) Knee-extensor isometric and isokinetic peak torque was measured with an isokinetic dynamometer. Cross-sectional area (CSA) was measured bilaterally for each of the quadriceps muscles via magnetic resonance imaging. We measured quadriceps central activation bilaterally via the superimposed-burst technique. Physical performance (single-legged hop tests, step length via spatiotemporal gait analysis) and patient-reported outcomes (International Knee Documentation Committee questionnaire and Knee Injury and Osteoarthritis Outcome Score Sport and Recreation subscale) were also recorded. We conducted Wilcoxon signed rank tests to identify interlimb differences. Spearman ρ correlation analyses revealed associations between limb symmetry and neuromuscular and functional outcomes, as well as with patient-reported function. RESULTS Deficits in the surgical limb as compared with the nonsurgical limb were present for all outcomes (P values < .05). Greater single-legged hop-test symmetry (83%) was significantly correlated with greater symmetry in knee-extensor isometric (63%; rs = 0.567, P = .002) and isokinetic (68%; rs = 0.540, P = .003) strength, as well as greater cross-sectional area of the vastus medialis (78%; rs = 0.519, P = .006) and vastus lateralis (82%; rs = 0.752, P < .001). A higher International Knee Documentation Committee questionnaire score (82.2) was significantly correlated with greater symmetry in knee-extensor isokinetic strength (rs = 0.379, P = .039). CONCLUSIONS Although deficits were observed in the surgical limb for all neuromuscular measures, greater symmetry in the size and strength of the quadriceps, rather than activation, was more strongly associated with physical performance after ACLR. Greater symmetry in strength was also more strongly associated with patient-reported function.
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Affiliation(s)
| | | | - Harris S Slone
- Department of Orthopaedics, College of Medicine, and Department of Health Science & Research, Medical University of South Carolina, Charleston
| | - Chris M Gregory
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston
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Garcia SA, Moffit TJ, Vakula MN, Holmes SC, Montgomery MM, Pamukoff DN. Quadriceps Muscle Size, Quality, and Strength and Self-Reported Function in Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:246-254. [PMID: 31951147 DOI: 10.4085/1062-6050-38-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Ultrasound imaging provides a cost-effective method of measuring quadriceps morphology, which may be related to self-reported function after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To compare quadriceps morphology and strength between limbs in individuals with ACLR and matched control limbs and determine their associations with self-reported function. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-two individuals with ACLR (females = 66%; age = 21.8 ± 2.6 years; time since ACLR = 50.5 ± 29.4 months) and 37 controls (females = 73%; age = 21.7 ± 1.2 years). MAIN OUTCOME MEASURE(S) Quadriceps peak torque (PT) and rate of torque development were assessed bilaterally. Ultrasonography was used to measure the cross-sectional area (CSA) and echo intensity (EI) of the rectus femoris, vastus lateralis (VL), and vastus medialis. Self-reported function was assessed via the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Paired-samples t tests were calculated to compare involved and uninvolved limbs. Independent t tests were conducted to compare groups (α = .05). Linear regression was performed to analyze associations between quadriceps function and self-reported function after accounting for time since ACLR, activity level, and sex, and models for EI added subcutaneous fat as a covariate. RESULTS Isometric PT did not differ between limbs or groups. Involved limbs had a lower rate of torque development compared with the control (P = .01) but not the uninvolved limbs (P = .08). Vastus lateralis CSA was smaller in the involved than in the uninvolved (P < .01) but not the control limbs (P = .10). Larger VL CSA (ΔR2 = 0.103) and lower VL EI (ΔR2 = 0.076) were associated with a higher IKDC score (P < .05). Larger VL CSA was associated with greater KOOS Symptoms (ΔR2 = 0.09, P = .043) and Sport and Recreation (ΔR2 = 0.125, P = .014) scores. Lower VL EI was associated with higher KOOS Symptoms (ΔR2 = 0.104, P = .03) and Quality of Life (ΔR2 = 0.113, P = .01) scores. Quadriceps PT and rate of torque development were not associated with IKDC or KOOS subscale scores. CONCLUSIONS Quadriceps morphology was associated with self-reported function in individuals with ACLR and may provide unique assessments of quadriceps function.
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Affiliation(s)
| | - Tyler J Moffit
- Department of Kinesiology, California State University, Bakersfield
| | - Mike N Vakula
- Department of Kinesiology and Health Science, Utah State University, Logan
| | - Skylar C Holmes
- Department of Kinesiology, California State University, Fullerton
| | | | - Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton
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Clark NC, Reilly LJ, Davies SC. Intra-rater reliability, measurement precision, and inter-test correlations of 1RM single-leg leg-press, knee-flexion, and knee-extension in uninjured adult agility-sport athletes: Considerations for right and left unilateral measurements in knee injury control. Phys Ther Sport 2019; 40:128-136. [DOI: 10.1016/j.ptsp.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022]
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