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Petrucci A, Guglielmino D, Pecci J, Pareja-Galeano H. The effects of isokinetic training in athletes after knee surgery: a systematic review. PHYSICIAN SPORTSMED 2024; 52:309-316. [PMID: 38124233 DOI: 10.1080/00913847.2023.2297666] [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: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To review the effectiveness of isokinetic training as an alternative method to traditional isotonic resistance training. MATERIALS AND METHODS Researchers examined data from PubMed, CENTRAL, MEDLINE COMPLETE, and Web of Science until February 2023. A total of 365 entries were obtained from databases, including studies that analyzed the effects of isokinetic vs. isotonic-based rehabilitation in athletes (16-50 years) after a surgical knee intervention. Return to sport (RTS), strength of the flex/extensor compartment of the thigh, muscle mass of the thigh, and knee function were screened as main outcomes. Two reviewers independently screened the studies for eligibility and assessed the risk of bias of the included ones. RESULTS Six studies involving 181 athletes were included. Isokinetic training demonstrated significant benefits in peak torque for knee flexor-extensor muscles in four studies. Two studies favored isokinetic training over isotonic for strength. Muscle mass findings were mixed, with one study favoring isokinetic significantly and two showing no significant differences. In terms of returning to sport, the isotonic group displayed slightly better limb symmetry index values, but without significance. Isokinetic training outperformed isotonic in two functionality questionnaire studies, while two others showed no significant differences. CONCLUSIONS Isokinetic training appears equally, if not more effective than isotonic, for restoring strength balance between hamstrings and quadriceps. This could lead to more favorable muscle mass changes. Isokinetic training also parallels isotonic rehabilitation for functional outcomes and meeting return-to-sport criteria. Therefore, isokinetic training should be included as one of the main strength restoration strategies after knee surgery, especially in early and middle rehabilitation stages. REGISTRATION NUMBER The present systematic review was registered on PROSPERO (registration number: CRD42022370398).
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Affiliation(s)
- Angelo Petrucci
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Dario Guglielmino
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Javier Pecci
- Department of Physical Education, Sport and Human Movement. Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
- Department of Physical Education and Sport, Universidad de Sevilla, Sevilla, Spain
| | - Helios Pareja-Galeano
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Physical Education, Sport and Human Movement. Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
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Poretti K, Ghoddosi N, Martin J, Eddo O, Cortes N, Clark NC. The Nature of Rehabilitation Programs to Improve Musculoskeletal, Biomechanical, Functional, and Patient-Reported Outcomes in Athletes With ACL Reconstruction: A Scoping Review. Sports Health 2024; 16:390-395. [PMID: 36929850 PMCID: PMC11025522 DOI: 10.1177/19417381231158327] [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: 03/18/2023] Open
Abstract
CONTEXT After anterior cruciate ligament (ACL) reconstruction (ACLR), athletes commonly undergo prolonged rehabilitation (eg, 9-12 months), but few actually return to preinjury sports activities. The nature (composition, configuration) of an ACL rehabilitation program (ACL-RP) is an important factor in determining rehabilitation outcomes; however, details about the nature of ACL-RPs are reported inconsistently in research studies. To guide future research reporting to support clinical translation and implementation of ACL-RPs, it is necessary to describe the nature, reporting, and outcomes of ACL-RPs in the current literature. OBJECTIVE The purpose of this scoping review was to understand the nature and reporting of various ACL-RPs that address musculoskeletal, biomechanical, functional, or patient-reported outcome measures in adult and pediatric athletes with ACLR. DATA SOURCES Articles were selected from searches in 5 electronic databases (PubMed, EbscoHost [MEDLINE, SportDiscus, CINAHL Plus], PROQuest, Cochrane, and Embase). STUDY SELECTION Studies were included if they evaluated a post-ACL-RP that implemented strength, balance, plyometric, change of direction running, and/or agility running and included self-reported physical function, quality of life, or pain outcomes. STUDY DESIGN Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Data were extracted and synthesized to evaluate the reporting of acute program variables (APVs) and exercise descriptors (EDs); 17 studies were included in the final synthesis. RESULTS Studies reported between 0% and 67% of the APVs and EDs combined. Only 2 studies were considered to have adequate reporting of both APVs and EDs. CONCLUSION Inadequate reporting of APVs and EDs in past studies restricts the translation and implementation of existing research-based ACL-RPs to present-day clinical contexts.
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Affiliation(s)
- Kelly Poretti
- School of Kinesiology, George Mason University, Manassas, Virginia
| | - Navid Ghoddosi
- School of Kinesiology, George Mason University, Manassas, Virginia
| | - Joel Martin
- School of Kinesiology, George Mason University, Manassas, Virginia
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, George Mason University, Virginia
| | - Oladipo Eddo
- School of Kinesiology, George Mason University, Manassas, Virginia
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, George Mason University, Virginia
| | - Nelson Cortes
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, Essex, UK
- Department of Bioengineering, George Mason University, Fairfax, Virginia
| | - Nicholas C. Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, Essex, UK
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3
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Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
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Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
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4
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Stojanović MDM, Andrić N, Mikić M, Vukosav N, Vukosav B, Zolog-Șchiopea DN, Tăbăcar M, Melinte RM. Effects of Eccentric-Oriented Strength Training on Return to Sport Criteria in Late-Stage Anterior Cruciate Ligament (ACL)-Reconstructed Professional Team Sport Players. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1111. [PMID: 37374316 DOI: 10.3390/medicina59061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An effective post-injury training program is essential to regain performance and fulfill criteria for return to sport for team sport athletes following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the effects of 6 weeks of eccentric-oriented strength training vs. traditional strength training during the late-stage ACL-rehab phase on leg strength and vertical and horizontal jumping performance in professional team sport athletes. Materials and Methods: Twenty-two subjects (14 males, 8 females, age 19.9 ± 4.4 years, mass 77.4 ± 15.6 kg, height 182.4 ± 11.7 cm) (mean ± SD) with a unilateral reconstructed ACL (BTB graft) were included in the study. All participants enrolled in the same rehabilitation protocol prior to the training study. Players were randomly assigned to an experimental (ECC: n = 11, age 21.8 ± 4.6 years, mass 82.7 ± 16.6 kg, height 185.4 ± 12.2 cm), and a control group (CON: n = 11, age 19.1 ± 2.1 years, mass 76.6 ± 16.5 kg, height 182.5 ± 10.2 cm). Both groups underwent an equivolumed rehabilitation program, with the only difference being in strength training, which consisted of flywheel training vs. traditional strength training for the experimental and control groups, respectively. Testing was organized before and after the 6-week training programs and included isometric semi-squat tests (ISOSI-injured and ISOSU-uninjured legs), vertical jump tests (CMJ), single-leg vertical jump tests (SLJI-injured and SLJU-uninjured legs), single-leg hop tests (SLHI-injured and SLHU-uninjured legs), and triple hop tests (TLHI-injured and TLHU-uninjured legs). In addition, limb symmetry indexes were calculated for the isometric semi-squat (ISOSLSI) test, the single-leg vertical jump (SLJLSI), and the hop (SLHLSI) tests, as well as the triple-leg hop (THLLSI) test. Results: Main effects of time across training were observed for all dependent variables (posttest > pretest, p < 0.05). Significant group-by-time interactions were found for ISOSU (p < 0.05, ES = 2.51, very large), ISOSI (p < 0.05, ES = 1.78, large), CMJ (p < 0.05, ES = 2.23, very large), SLJI (p < 0.05, ES = 1.48, large), SLHI (p < 0.05, ES = 1.83, large), and TLHI (p < 0.05, ES = 1.83, large). Conclusions: This study suggests that eccentric-oriented strength training in late-stage ACL recovery, undertaken twice or three times weekly for 6 weeks, results in better outcomes than traditional strength training in leg strength, vertical jump ability, and single and triple hop tests with injured legs in professional team sport athletes. It seems that flywheel strength training can be recommended in late-stage ACL recovery for professional team sport athletes in order to regain recommended performance outcome levels faster.
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Affiliation(s)
- Marko D M Stojanović
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Andrić
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Mladen Mikić
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Vukosav
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Borko Vukosav
- Sports Medicine Department, Medical Clinic "ST Medicina", 21000 Novi Sad, Serbia
| | - Dan-Nicolae Zolog-Șchiopea
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Humanitas Hospital, 400001 Cluj Napoca, Romania
| | - Mircea Tăbăcar
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
| | - Răzvan Marian Melinte
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Humanitas Hospital, 400001 Cluj Napoca, Romania
- Fizionova Reahabilitation, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Dimitrie Cantemir University, 540136 Targu Mures, Romania
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5
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Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57:500-514. [PMID: 36731908 DOI: 10.1136/bjsports-2022-106158] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
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Affiliation(s)
- Roula Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vasileios Korakakis
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Olivia Barbosa
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Michail Pantouveris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Bjerregaard
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julius Luomajoki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan Wilhelmsen
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rodney Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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6
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Chantrelle M, Menu P, Crenn V, Grondin J, Daley P, Louguet B, Fouasson-Chailloux A, Dauty M. Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015-2020 cohort study. PLoS One 2023; 18:e0280146. [PMID: 36603016 PMCID: PMC9815630 DOI: 10.1371/journal.pone.0280146] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) graft aims to stabilise the knee, but it may bring some complications like anterior knee (AKP) pain that can have consequences on the functional aspect of this surgery. The aim of this study was to compare isokinetic knee strength and functional outcomes between patients with and without AKP following an ACLR using HT graft during the first-year post-surgery. Three hundred and thirty subjects operated by ACLR using hamstring tendon graft were included in our retrospective cohort and divided into two groups: a group with AKP (AKP+ group) and one without AKP (AKP-group). In our population, 14.8% of the patients had AKP. At 4 post-operative months, subjects with pain had lower isokinetic strength limb symmetry index (LSI) for knee flexors and extensors, and a lower Lysholm score than subjects without pain (p < 0.0001). These differences did not persist at 7 post-operative months, and there was no difference in the one-leg hop test. After multivariate analysis, we highlighted the impact of time on the evolution of these parameters. Yet, the exact definition of AKP after ACLR remains to be clearly defined since an imprecise diagnosis may lead to inappropriate management. Pre-operative information about this type of complication, which evolves favourably with time, could be useful for patients. Indeed, AKP can occur after ACLR, even if a HT graft has been used, compared to other surgical procedures using the knee extensor apparatus as patellar tendon graft (AKP is associated with the donor site morbidity). In case of AKP after ACLR, monitoring the muscle inhibition by isokinetic tests may enable clinicians to adapt the retraining and the return to sport.
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Affiliation(s)
- Marie Chantrelle
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatologique, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
| | - Bastien Louguet
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
- * E-mail:
| | - Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Johnson AK, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training After Anterior Cruciate Ligament Reconstruction Improves Knee Angle and Moment Symmetry During Gait: A Randomized Controlled Clinical Trial. Arthroscopy 2022; 38:3043-3055. [PMID: 35690253 DOI: 10.1016/j.arthro.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine 1) whether progressive functional resistance training (FRT) during walking would improve knee biomechanical symmetry after anterior cruciate ligament (ACL) reconstruction and 2) whether the mode of delivery of FRT would have a differential effect on symmetry. METHODS Thirty individuals who underwent primary ACL reconstruction at a single institution volunteered for this study. Participants were randomized into one of three groups: 1) BRACE, 2) BAND, or 3) CONTROL. The BRACE group received FRT with a novel robotic knee brace along with real-time kinematic feedback. The BAND group received FRT with a custom resistance band device along with real-time kinematic feedback. The CONTROL group received only real-time kinematic feedback. Participants in all groups received training (2-3/week for 8 weeks) while walking on a treadmill. Knee angle and moment symmetry were calculated immediately prior to beginning the intervention and within 1 week of completing the intervention. Statistical Parametric Mapping was used to assess differences in biomechanical symmetry between groups across time. RESULTS There was a significant interaction in knee moment symmetry from 21 and 24% of the stance phase (P = .046), in which the BAND group had greater improvements following training compared with both BRACE (P = .043) and CONTROL groups (P = .002). There was also a significant time effect in knee angle symmetry from 68 to 79% of the stance phase (P = .028) and from 97 to 100% of the swing phase (P = .050) in which only the BRACE group showed significant improvements after the intervention (stance: P = .020 and swing: P < .001). CONCLUSION The results of this randomized controlled clinical trial indicate that 8 weeks of progressive FRT during treadmill walking in individuals with ACL reconstruction improves knee angle and moment symmetry during gait. The findings suggest that FRT could serve as a potential therapeutic adjuvant to traditional rehabilitation after ACL reconstruction and can help restore knee joint biomechanical symmetry. LEVEL OF EVIDENCE Level II, randomized controlled trial.
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Affiliation(s)
- Alexa K Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Scott R Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, Michigan, U.S.A
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A; Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A; Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, U.S.A; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, U.S.A.
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8
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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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