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Hartshorne MT, Turner JA, Cameron KL, Padua DA. Strength of the Uninvolved Limb Following Return to Activity After ACL Injury: Implications for Symmetry as a Marker of Sufficient Strength. Int J Sports Phys Ther 2024; 19:657-669. [PMID: 38835985 PMCID: PMC11144673 DOI: 10.26603/001c.117547] [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: 01/04/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Muscular strength deficits are common after ACL injury. While the Limb Symmetry Index (LSI), using the uninvolved limb as a reference, is widely used, negative strength adaptations may affect both limbs post-injury. It is uncertain how the strength of the uninvolved limb in those with an ACL injury compares to uninjured individuals, making it unclear whether it is appropriate as a benchmark for determining sufficient strength. Purpose To compare the strength of key lower extremity muscles of the uninvolved limb in those with history of ACL injury (ACL-I) to the dominant limb in individuals with no history of ACL injury (control). Study Design Cross-sectional study. Methods: A total of 5,727 military cadets were examined, with 82 females and 126 males in the ACL-I group and 2,146 females and 3,373 males in the control group. Maximum isometric strength was assessed for six muscle groups measured with a hand-held dynamometer. Separate two-way ANOVAs with limb and sex were performed for each muscle group. Results Significant main effects for limb were observed with the uninvolved limb in the ACL-I group displaying greater strength compared to the dominant limb in the control group for the quadriceps, hamstrings, and gluteus medius, but effect sizes were small (Cohen's d <0.25). Significant main effects for sex were observed with greater male muscular strength in all six muscle groups with small to large effect sizes (Cohen's d 0.49-1.46). No limb-by-sex interactions were observed. Conclusions There was no evidence of reduced strength in the uninvolved limb in those with a history of ACL injury compared to the dominant limb in those with no prior ACL injury. This finding suggests that, after clearance to return to activities, the uninvolved limb can be used as a standard for comparison of sufficient strength, including when using the LSI. Level of Evidence: Level 3.
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Affiliation(s)
| | - Jeffrey A Turner
- Human Movement Science CurriculumUniversity of North Carolina at Chapel Hill
| | | | - Darin A Padua
- Department of Exercise and Sport ScienceUniversity of North Carolina at Chapel Hill
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Hammami N, Mechraoui A, Hattabi S, Forte P, Sampaio T, Sortwell A, Teixeira JE, Branquinho L, Ferraz R, Bouassida A. Concentric Isokinetic Strengthening Program's Impact on Knee Biomechanical Parameters, Physical Performance and Quality of Life in Overweight/Obese Women with Chronic Meniscal Lesions. Healthcare (Basel) 2023; 11:2079. [PMID: 37510520 PMCID: PMC10379594 DOI: 10.3390/healthcare11142079] [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: 06/04/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Meniscal injuries are one of the most common intra-articular knee injuries. Different treatments are presented depending on the symptoms and duration of meniscus tears, such as arthroscopic partial meniscectomy, physiotherapy, or even pharmacological treatment. The purpose was to investigate the effect of a concentric isokinetic knee muscle strengthening program on strength, joint range of motion, physical performance, quality of life and pain tolerance in overweight/obese women with chronic meniscal lesions. Twenty-four overweight/obese women were randomized into two groups. A control group (CG) performed a usual rehabilitation program plus isokinetic muscle strengthening (IMS) in the continuous passive motion mode and measured with an isokinetic dynamometer. An experimental group (EG) performed the same program in combination with IMS in the isokinetic active mode. The peak torque of the knee extensors (PTE) and flexors (PTF), sit-to-stand test, stair climb test, joint amplitude, heel-to-buttock distance, Thessaly test, KOOS questionnaire of pain and quality of life were measured pre- and post-protocol. After the intervention, the sit-stand number for both groups was significantly higher (p < 0.001) and the time to climb stairs was significantly reduced for the EG (p < 0.001). A significant improvement in joint range of motion, life quality (p < 0.001), relief in knee pain (p < 0.001) and in the post-program evaluation at the EG (p < 0.05) was noted. There was no significant difference in PTE and PTF between groups at 60°/s and 180°/s. The IMS in the active mode could be an effective therapeutic modality in managing middle-aged patients suffering from a degenerative meniscal tear.
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Affiliation(s)
- Nadhir Hammami
- Research Unit (UR22JS01) "Sport Sciences, Health and Movement", High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef 7100, Tunisia
| | - Amani Mechraoui
- Research Unit (UR22JS01) "Sport Sciences, Health and Movement", High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef 7100, Tunisia
| | - Soukaina Hattabi
- Research Unit (UR22JS01) "Sport Sciences, Health and Movement", High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef 7100, Tunisia
| | - Pedro Forte
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-547 Penafiel, Portugal
- CI-ISCE, Higher Institute of Educational Sciences of the Douro, 4560-547 Penafiel, Portugal
- Research Center in Sports, Health and Human Development, 6201-001 Covilhã, Portugal
- Department of Sports, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
| | - Tatiana Sampaio
- Research Center in Sports, Health and Human Development, 6201-001 Covilhã, Portugal
- Department of Sports, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
| | - Andrew Sortwell
- Research Center in Sports, Health and Human Development, 6201-001 Covilhã, Portugal
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - José E Teixeira
- Department of Sport Sciences, Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal
| | - Luís Branquinho
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-547 Penafiel, Portugal
- CI-ISCE, Higher Institute of Educational Sciences of the Douro, 4560-547 Penafiel, Portugal
- Research Center in Sports, Health and Human Development, 6201-001 Covilhã, Portugal
| | - Ricardo Ferraz
- Research Center in Sports, Health and Human Development, 6201-001 Covilhã, Portugal
- Department of Sports Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Anissa Bouassida
- Research Unit (UR22JS01) "Sport Sciences, Health and Movement", High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef 7100, Tunisia
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-547 Penafiel, Portugal
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Obara K, Silva P, Silva M, Mendes F, Santiago G, Oliveira I, Cardoso J. Isokinetic Training Program to Improve the Physical Function and Muscular Performance of an Individual with Partial Injury of the Medial Meniscus: A Case Report. Int J Sports Phys Ther 2023; 18:758-768. [PMID: 37636894 PMCID: PMC10449488 DOI: 10.26603/001c.74945] [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: 03/29/2022] [Accepted: 03/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background and Purpose One of the best alternatives for the treatment of meniscal injuries in relation to surgical procedures, is exercise. This case report aimed to describe the effects of isokinetic training and a neuromuscular/proprioceptive exercise program on muscle performance and physical function in an individual after a rupture of the posterior horn of the medial meniscus. Study Design Case report. Case Description A 40-year-old man injured his right knee during a soccer match, with a partial lesion of the medial meniscus confirmed by magnetic resonance imaging. He completed an isokinetic training program in addition to exercises that targeted proprioception (22 sessions, 11 weeks) to improve physical function and performance, which were assessed before and after treatment and at a six-month follow-up. An individual with similar anthropometric characteristics was chosen to be used as a control for understanding the patient's assessment values. Outcomes Muscular performance of the knee flexors and extensors was evaluated isokinetically using the Biodex System-4 in a concentric mode at angular velocities of 60, 120, and 300 °/s . The main results indicated that after 11 weeks, the peak torque normalized to body mass (PT/BM), at 60 °/s of the knee extensors remained unchanged (2.54 N.m/kg) (below the control value - 3.06 N.m/kg), and at the six-month follow-up, increased by approximately 20% (3.08 N.m/kg). For the hamstrings, at 60 °/s, an increase of 18 % occurred after intervention (1.98 N.m/kg) and by approximately 30 % at the six-month follow-up (2.12 N.m/kg) - values much higher than the control 1.55 N.m/kg). This increase in the PT/BM was also reflected in the Hamstrings:Quadriceps ratio (78 %) after treatment which improved at follow-up (68 %). Discussion The results showed that the isokinetic training and neuromuscular/proprioceptive exercises improved the muscle performance of the knee flexors and extensors, after eleven weeks of intervention, and remained (or continued to improve) at the six-month follow-up. Level of evidence 5, single case report.
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Affiliation(s)
- Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Pedro Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Mariana Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Fagner Mendes
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Gabriel Santiago
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Ihan Oliveira
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
| | - Jefferson Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group Universidade Estadual de Londrina
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Niederer D, Behringer M, Stein T. Functional outcomes after anterior cruciate ligament reconstruction: unravelling the role of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries. BMC Sports Sci Med Rehabil 2023; 15:49. [PMID: 37005699 PMCID: PMC10068137 DOI: 10.1186/s13102-023-00663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Numerous individual, temporal, injury- and surgery-specific factors impact the functional capacity during rehabilitation, return to sports (RTS), and re-injury prevention after an anterior cruciate ligament (ACL) reconstruction. PURPOSE This multicentre cohort study evaluated the isolated and interactive contributions of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries as to inertial sensor-assessed motor function after ACL reconstructions in multiple linear mixed model regressions. METHODS Anonymized data were retrieved from a nationwide German registry. In this cohort study, patients with an acute unilateral ACL rupture, with or without concomitant ipsilateral knee injuries, and having passed an arthroscopically assisted anatomic reconstruction were included. Potential predictors were age [years], gender/sex, time since reconstruction [days], time between injury and reconstruction [days], concomitant intra-articular injuries (isolated ACL tear, meniscal tear, lateral ligament, unhappy triad), graft type (hamstrings, patellar, or quadriceps tendon autograft), and pain during each measurement (visual analogue scale 0-10 cm). Repeated inertial motion unit-assessments of a comprehensive battery of classic functional RTS test were performed in the course of the rehabilitation and return to sports: Joint position sense/kinesthesia (Angle reproduction error [degrees]), Dynamic Balance Composite score [cm] of the Y-Balance test), drop jumps (Knee displacement [cm]), Vertical hop (Hopping height [mm]), Speedy jumps (Duration [seconds]), Side hops (Number of hops [n]), single leg hop for distance (hopping distance [cm]). Repeated measures multiple linear mixed models investigated the impact and nesting interaction of the potential predictors on the functional outcomes. RESULTS Data from 1441 persons (mean age 29.4, SD 11.8 years; 592 female, 849 male) were included. Most had an isolated ACL rupture: n = 938 (65.1%). Minor shares showed lateral ligament involvement: n = 70 (4.9%), meniscal tear: n = 414 (28.7%), or even unhappy triad: n = 15 (1%). Several predictors such as time between injury and reconstruction, time since reconstruction (estimates for ndays ranged from + .05 (i.e., an increase of the hopping distance of 0.05 cm per day since reconstruction occurs) for single leg hop for distance to + 0.17 for vertical hopping height; p < 0.001), age, gender, pain, graft type (patellar tendon graft: estimates between + 0.21 for Y-balance and + 0.48 for vertical hop performance; p < 0.001), and concomitant injuries contribute to the individual courses of functional abilities of the reconstructed side after ACL reconstruction. The unimpaired side was mostly influenced by sex, age, the time between injury and reconstruction (estimates between - 0.0033 (side hops) and + 0.10 (vertical hopping height), p < 0.001)), and time since reconstruction. CONCLUSIONS Time since reconstruction, time between injury and reconstruction, age, gender, pain, graft type, and concomitant injuries are not independent but nested interrelating predictors of functional outcomes after anterior cruciate ligament reconstruction. It might not be enough to assess them isolated; the knowledge on their interactive contribution to motor function is helpful for the management of the reconstruction (earlier reconstructions should be preferred) deficit-oriented function-based rehabilitation (time- and function based rehabilitation instead of solely a time- or function based approach) and individualized return to sports strategies.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany.
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany
| | - Thomas Stein
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany
- Sporthologicum Frankfurt - Center for Sport and Joint Injuries, Frankfurt, Germany
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5
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Simonson R, Piussi R, Högberg J, Senorski C, Thomeé R, Samuelsson K, Senorski EH. Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231157386. [PMID: 37152619 PMCID: PMC10155024 DOI: 10.1177/23259671231157386] [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: 11/15/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. Purpose To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. Results A total of 835 patients (46% women), with a mean age of 23.9 ± 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index ≥90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Conclusion Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.
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Affiliation(s)
- Rebecca Simonson
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
- Rebecca Simonsson, PT, MSc,
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of
Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden,
Sahlgrenska Sports Medicine Center. Box 455, SE-405 30, Gothenburg, Sweden
() (Twitter:
@BeccaSimonson2)
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Department of Orthopaedics, Institute
of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
- Department of Orthopaedics, Sahlgrenska
University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
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Niederer D, Mengis N, Wießmeier M, Keller M, Petersen W, Ellermann A, Drenck T, Schoepp C, Stöhr A, Fischer A, Achtnich A, Best R, Pinggera L, Krause M, Guenther D, Janko M, Kittl C, Efe T, Schüttler KF, Vogt L, Behringer M, Stein T. Contributors to self-report motor function after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:3073. [PMID: 36813953 PMCID: PMC9947165 DOI: 10.1038/s41598-023-30291-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Numerous functional factors may interactively contribute to the course of self-report functional abilities after anterior cruciate ligament (ACL)-reconstruction. This study purposes to identify these predictors using exploratory moderation-mediation models in a cohort study design. Adults with post unilateral ACL reconstruction (hamstring graft) status and who were aiming to return to their pre-injury type and level of sport were included. Our dependent variables were self-reported function, as assessed by the the KOOS subscales sport (SPORT), and activities of daily living (ADL). The independent variables assessed were the KOOS subscale pain and the time since reconstruction [days]. All other variables (sociodemographic, injury-, surgery-, rehabilitation-specific, kinesiophobia (Tampa Scale of Kinesiophobia), and the presence or absence of COVID-19-associated restrictions) were further considered as moderators, mediators, or co-variates. Data from 203 participants (mean 26 years, SD 5 years) were finally modelled. Total variance explanation was 59% (KOOS-SPORT) and 47% (KOOS-ADL). In the initial rehabilitation phase (< 2 weeks after reconstruction), pain was the strongest contributor to self-report function (KOOS-SPORT: coefficient: 0.89; 95%-confidence-interval: 0.51 to 1.2 / KOOS-ADL: 1.1; 0.95 to 1.3). In the early phase (2-6 weeks after reconstruction), time since reconstruction [days] was the major contributor (KOOS-SPORT: 1.1; 0.14 to 2.1 / KOOS-ADL: 1.2; 0.43 to 2.0). Starting with the mid-phases of the rehabilitation, self-report function was no longer explicitly impacted by one or more contributors. The amount of rehabilitation [minutes] is affected by COVID-19-associated restrictions (pre-versus-post: - 672; - 1264 to - 80 for SPORT / - 633; - 1222 to - 45 for ADL) and by the pre-injury activity scale (280; 103 to 455 / 264; 90 to 438). Other hypothesised contributors such as sex/gender or age were not found to mediate the time or pain, rehabilitation dose and self-report function triangle. When self-report function is rated after an ACL reconstruction, the rehabilitation phases (early, mid, late), the potentially COVID-19-associated rehabilitation limitations, and pain intensity should also be considered. As, for example, pain is the strongest contributor to function in the early rehabilitation phase, focussing on the value of the self-report function only may, consequently, not be sufficient to rate bias-free function.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany.
| | | | - Max Wießmeier
- grid.7839.50000 0004 1936 9721Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487 Frankfurt, Germany
| | | | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | | | | | - Christian Schoepp
- grid.491667.b0000 0004 0558 376XBerufsgenossenschaftliche Unfallklinik Duisburg, Duisburg, Germany
| | | | - Andreas Fischer
- grid.5252.00000 0004 1936 973XDepartment of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Andrea Achtnich
- grid.15474.330000 0004 0477 2438Department for Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Matthias Krause
- grid.13648.380000 0001 2180 3484Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Guenther
- grid.412581.b0000 0000 9024 6397Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Maren Janko
- grid.7839.50000 0004 1936 9721Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christoph Kittl
- grid.16149.3b0000 0004 0551 4246Universitätsklinikum Münster, Munster, Germany
| | - Turgay Efe
- Orthopaedicum Lich Giessen, Lich, Germany
| | | | - Lutz Vogt
- grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Behringer
- grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt - Center for Sport and Joint Injuries, Frankfurt, Germany ,grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
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7
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Çiftçi R. Evaluation of the effects of somatotype profiles on pain, proprioception, isokinetic muscle strength and kinesiophobia in patients with meniscopathy. J Back Musculoskelet Rehabil 2023; 36:1461-1468. [PMID: 37661871 DOI: 10.3233/bmr-230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Somatotype causes differentiation of physical, physiological and biochemical metabolisms in the body. To what extent meniscopathy (M) is affected by somatotype profiles has been an issue of concern. OBJECTIVE The aim of the study was to investigate whether somatotype profiles have an effect on kinesiophobia, pain, proprioception and isokinetic muscle strength in patients with an M diagnosis. METHODS 172 (85 female, 87 male) M patients between the ages of 18 and 65 were included in the study. The Heath-Carter method was used to determine somatotype components. Biodex Isokinetic system at 120∘/sec angular speed was used for muscle strength measurements, a digital inclinometer with goniometer was used for proprioception measurement, the Tampa Kinesiophobia Scale (TKS) was used for the assessment of kinesiophobia, the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale was used for the assessment of fatigue and pain, and the visual analogue scale (VAS) was used for pain assessment. RESULTS Five somatotype profiles were found. When the right-left knee proprioception values were compared according to the somatotype profiles of patients, a significant difference was found in favor of balanced ectomorph at 15∘ and 30∘. No significant difference was found when TKS, FACIT, VAS values were compared in terms of somatotype profiles; while no significant difference was found in TKS, FACIT, VAS (REST-NIGHT) in terms of gender, a significant difference was found in VAS MOVE. Endomorph somatotype was dominant in the M patients. CONCLUSIONS Individuals with M disease showed significant differences in terms of endomorph components. Obesity may also be one of the negative findings for M disease. Somatotype classification may represent a suitable tool for monitoring M.
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Mesnard G, Fournier G, Joseph L, Shatrov JG, Lustig S, Servien E. Does meniscal repair impact muscle strength following ACL reconstruction? SICOT J 2022; 8:16. [PMID: 35579438 PMCID: PMC9112909 DOI: 10.1051/sicotj/2022016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: Meniscal lesions are commonly associated with anterior cruciate ligament (ACL) rupture. Meniscal repair, when possible, is widely accepted as the standard of care. Despite advancements in surgical and rehabilitation techniques, meniscal repair may impact muscle recovery when performed in conjunction with ACL reconstruction. The objective of this study was to explore if meniscal repairs in the context of ACL reconstruction affected muscle recovery compared to isolated ACL reconstruction. Methods: Fifty-nine patients with isolated ACL reconstruction were compared to 35 patients with ACL reconstruction with an associated meniscal repair. All ACL reconstructions were performed using hamstring grafts with screw-interference graft fixation. Isokinetic muscle testing was performed between six and eight months of follow-up. Muscle recovery between both groups was compared. A further subgroup analysis was performed to compare muscle recovery function of gender and meniscal tear location. Tegner scores were assessed at six months’ follow-up. Results: No significant differences were found between the two groups regarding muscle recovery. No difference in muscle recovery was found concerning gender. Lesion of both menisci significantly increased the deficit of hamstrings muscular strength at 60°/s compared to a lesion of one meniscus (26.7% ± 15.2 vs. 18.1% ± 13.5, p = 0.018) and in eccentric test (32.4% ± 26.2 vs. 18.1% ± 13.5, p = 0.040). No significant differences were found concerning the Tegner score. Conclusion: Meniscal repairs performed during an ACL reconstruction do not impact muscle recovery at 6–8 months post-operatively compared to an isolated ACL reconstruction. However, reparations of both menisci appear to impact hamstring muscle recovery negatively. Level of evidence: III, Retrospective cohort study
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Affiliation(s)
- Guillaume Mesnard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
| | - Léopold Joseph
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
| | - Jobe Gennadi Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - The University of Notre Dame, Australia, School of Medicine, 6160 Sydney, Australia
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69100 Lyon, France
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9
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Tengman E, Schelin L, Häger CK. Angle-specific torque profiles of concentric and eccentric thigh muscle strength 20 years after anterior cruciate ligament injury. Sports Biomech 2022:1-17. [PMID: 35373714 DOI: 10.1080/14763141.2022.2054856] [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: 12/21/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Thigh muscle weakness prevails following anterior cruciate ligament (ACL) injury, as usually evaluated by peak concentric quadriceps strength. Assessment throughout the range of motion (ROM), and for antagonists may provide more comprehensive information. We evaluated angle-specific torque profiles and ratios of isokinetic thigh muscle strength in 70 individuals 23 ± 2 years post-ACL injury (44males, 46.9 ± 5.4 years); 33 treated with ACL-reconstruction (ACL-R), and 37 treated only with physiotherapy (ACL-PT), and 33 controls. Quadriceps and hamstrings torques for concentric/eccentric contractions (90°/s) and ratios between hamstrings/quadriceps strength (HQ) were compared between and within groups using inferential functional data methods. The injured ACL-R leg had lower concentric and eccentric quadriceps strength compared to non-injured leg throughout the ROM, and lower concentric (interval 70-79°) and eccentric (64-67°) quadriceps strength compared to controls. The injured ACL-PT leg showed lower eccentric quadriceps strength (53-77°) than non-injured leg and lower concentric (41-79°) and eccentric (52-81°) quadriceps and eccentric hamstrings (30-77°) strength than controls. There were no group differences for HQ-ratios. The injured ACL-R leg had higher HQ-ratio (34-37°) than non-injured leg. Angle-specific torque profiles revealed strength deficits, masked if using only peak values, and seem valuable for ACL-injury rehabilitation.
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Affiliation(s)
- E Tengman
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
| | - L Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - C K Häger
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
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10
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Esrafilian A, Stenroth L, Mononen ME, Vartiainen P, Tanska P, Karjalainen PA, Suomalainen JS, Arokoski JPA, Saxby DJ, Lloyd DG, Korhonen RK. Towards Tailored Rehabilitation by Implementation of a Novel Musculoskeletal Finite Element Analysis Pipeline. IEEE Trans Neural Syst Rehabil Eng 2022; 30:789-802. [PMID: 35286263 DOI: 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tissue-level mechanics (e.g., stress and strain) are important factors governing tissue remodeling and development of knee osteoarthritis (KOA), and hence, the success of physical rehabilitation. To date, no clinically feasible analysis toolbox has been introduced and used to inform clinical decision making with subject-specific in-depth joint mechanics of different activities. Herein, we utilized a rapid state-of-the-art electromyography-assisted musculoskeletal finite element analysis toolbox with fibril-reinforced poro(visco)elastic cartilages and menisci to investigate knee mechanics in different activities. Tissue mechanical responses, believed to govern collagen damage, cell death, and fixed charge density loss of proteoglycans, were characterized within 15 patients with KOA while various daily activities and rehabilitation exercises were performed. Results showed more inter-participant variation in joint mechanics during rehabilitation exercises compared to daily activities. Accordingly, the devised workflow may be used for designing subject-specific rehabilitation protocols. Further, results showed the potential to tailor rehabilitation exercises, or assess capacity for daily activity modifications, to optimally load knee tissue, especially when mechanically-induced cartilage degeneration and adaptation are of interest.
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11
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Dragičević-Cvjetković D, Erceg-Rukavina T, Jovičić Ž. Isokinetic exercises in quadriceps strength and endurance recovery after anterior cruciate ligament reconstruction. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-41859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background/Aim: Muscle strength and endurance recovery of the quadriceps after anterior cruciate ligament reconstruction is necessary for normal knee function. In addition to the use of the isokinetic dynamometer for diagnostic purposes, its possible therapeutic effect is also important, ie targeted correction of the measured muscle deficit. This work was aimed to examine the level of quadriceps strength and endurance recovery 6 months after the anterior cruciate ligament reconstruction in patients who performed isokinetic training and to determine whether it is a superior therapeutic intervention compared to isodynamic training. Methods: A total of 70 patients of both sexes were monitored in a prospective clinical study. Three months postoperatively, all patients had quadriceps torque measured to body weight on an isokinetic dynamometer at angular speeds of 60 and 180 °/s. Patients were divided into two groups according to the type of applied rehabilitation protocol. Group A patients (n = 35) underwent a rehabilitation program 5 times a week using an individual kinesitherapy program (isometric and isotonic exercises for quadriceps and hamstrings) and neuromuscular electrostimulation of the quadriceps. In addition patients from group B (n = 35) were included in targeted isokinetic exercises for the quadriceps. Control isokinetic testing was performed 6 months after surgery. The comparison of the effect of the applied therapeutic procedures in groups A and B was performed with the Student t-test (p < 0.05). Results: An average age of patients was 27.29 ± 5.94 years. In patients in group B, statistically significantly higher values of the peak torque to body weight were measured at angular velocities of 60 and 180 °/s for the quadriceps of the operated knee 6 months after reconstruction of the anterior cruciate ligament with hamstring tendons (p < 0.05). Conclusion: Isokinetic training achieved significantly better quadriceps strength and endurance in patients 6 months after anterior cruciate ligament reconstruction with hamstring tendons compared to dynamic exercises.
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12
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Berg B, Roos EM, Kise NJ, Engebretsen L, Holm I, Risberg MA. Muscle strength and osteoarthritis progression after surgery or exercise for degenerative meniscal tears: Secondary analyses of a randomized trial. Arthritis Care Res (Hoboken) 2021; 74:70-78. [PMID: 34151533 DOI: 10.1002/acr.24736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate muscle strength changes following partial meniscectomy or exercise therapy for degenerative meniscal tears and the relationship between baseline muscle strength and osteoarthritis progression. METHODS Secondary analysis of a randomized trial (n=140 participants). Isokinetic quadriceps and hamstrings strength (peak torque [N·m/kg] and total work [J/kg]) were assessed at baseline, three-, 12-month, and five-year follow-up. Between-group differences were analyzed using intention-to-treat linear mixed models. The relationship between baseline muscle strength and osteoarthritis progression (Kellgren and Lawrence, ≥1 grade increase) were assessed using logistic regression models. RESULTS We found statistically significant between-group differences favoring exercise therapy at three months (quadriceps: -0.30 N·m/kg, 95% CI -0.40, -0.20; hamstrings: -0.10 N·m/kg, 95% CI -0.15, -0.04) and 12 months (quadriceps: -0.13 N·m/kg, 95% CI -0.23, -0.03; hamstrings: -0.08 N·m/kg, 95% CI -0.14, -0.03). At five years, between-group differences were -0.10 N·m/kg (95% CI -0.21 to 0.01) for quadriceps and -0.07 N·m/kg (95% CI -0.13 to -0.01) for hamstrings. Quadriceps muscle weakness at baseline was associated with knee osteoarthritis progression over five years: adjusted odds ratio of 1.40 for every 0.2 N·m/kg decrease (95% CI 1.15 to 1.71). The adjusted odds ratio for hamstrings was 1.14 (95% CI 0.97-1.35) for every 0.1 N·m/kg decrease. CONCLUSION Exercise therapy was effective in improving muscle strength at three and 12-month follow-up compared to partial meniscectomy, but the effect was attenuated at five years. Quadriceps muscle weakness at baseline was associated with higher odds of osteoarthritis progression over five years.
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Affiliation(s)
- Bjørnar Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Nina Jullum Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway
| | - Lars Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Inger Holm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - May Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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13
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Recommendations to Increase Neuromuscular Electrical Stimulation Training Intensity During Quadriceps Treatments for Orthopedic Knee Conditions. Clin J Sport Med 2021; 31:330-334. [PMID: 30817324 DOI: 10.1097/jsm.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/21/2019] [Indexed: 02/02/2023]
Abstract
Neuromuscular electrical stimulation (NMES) is often used by clinicians as a therapeutic adjunct to improve quadriceps strength deficits following orthopedic knee conditions. The efficacy of NMES treatments is primarily dependent on the NMES training intensity, which is a direct result of NMES-induced torque production. The importance of NMES training intensity is well known, yet adequate NMES training intensities are often difficult to achieve due to a variety of limitations associated with NMES (eg, fatigue and patient discomfort). This article provides recommendations that a clinician can use to increase NMES training intensity when strengthening the quadriceps with NMES for orthopedic knee conditions. These recommendations should allow forceful contractions that can be sustained over a treatment with multiple repetitions without the rapid decline in force that is typically seen when NMES is used.
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14
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Hiranaka T, Furumatsu T, Okazaki Y, Yamawaki T, Okazaki Y, Kodama Y, Kamatsuki Y, Ozaki T. Steep medial tibial slope and prolonged delay to surgery are associated with bilateral medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 2021; 29:1052-1057. [PMID: 32488369 DOI: 10.1007/s00167-020-06079-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Contralateral medial meniscus posterior root tear (MMPRT) can sometimes occur after primary surgeries for MMPRT and lead to unsatisfactory outcomes. The incidence rate and risk factors for contralateral MMPRT have not been well investigated, despite their clinical importance. Therefore, the incidence and predictors of bilateral MMPRT were aimed to be evaluated. METHODS Fourteen patients with bilateral MMPRT (group B) and 169 patients with unilateral MMPRT (group U) were enrolled in this study. Sex, age, body mass index, time between injury and surgery, and medial tibial slope angle (MTSA) were compared between the groups. MTSA was measured using lateral radiographs. RESULTS The incidence rate of bilateral MMPRT was 6.2% among all patients with MMPRTs. Multivariate logistic regression analysis showed that a prolonged time between injury and surgery (odds ratio [OR], 1.0; 95% confidence interval [CI] 1.00-1.01; P < 0.05) and steeper MTSA (OR, 1.85; 95% CI 1.21-2.64; P < 0.01) were significantly associated with the development of bilateral MMPRT. Receiver operating characteristic curve analysis showed that MTSA > 10.0° was associated with bilateral MMPRT, with a sensitivity of 93% and specificity of 69%. CONCLUSION A longer time between injury and surgery and steeper MTSA were risk factors for the development of bilateral MMPRT. Surgeons need to pay close attention to the contralateral knee in addition to the primary injured knees when treating knees with steep MTSA. Besides, early meniscal repair of primary MMPRT would be important to prevent the events of contralateral MMPRT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, Okayama, 700-0985, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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de Andrade ALL, Castro A, Livani B, Belangero WD. Association between Lysholm score and muscular torque deficit after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong) 2021; 28:2309499020933485. [PMID: 32618222 DOI: 10.1177/2309499020933485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The asymmetry of muscular strength after anterior cruciate ligament reconstruction (ACLR) is associated with increase in the development of new lesions. This asymmetry is precisely assessed by isokinetic dynamometry which is a high-cost technique, limited to major centers and hospitals. Thus, the aim of this study was to test the accuracy of one of the most frequently used functional questionnaires, the Lysholm score, to diagnose the knee torque deficit. METHODS In total, 115 patients were evaluated after ACLR. Knee symptoms were evaluated using the Lysholm questionnaire and knee extensor and flexor peak torque during maximal isokinetic concentric contractions at 60° s-1 (5 repetitions) and 180° s-1 (15 repetitions). Patients with <20% peak torque deficit were considered symmetric (normal). RESULTS An increase in the Lysholm score was associated with a deficit reduction in the peak torque of knee extensors at 60° s-1 (r = -0.294) and 180° s-1 (r = -0.297) (p < 0.05 for both). Cutoff Lysholm scores of >90 points for 60° s-1 allowed the correct diagnosis of symmetry in 71% and of >89 points for 180º·s-1 allowed the correct diagnosis of symmetry in 73%, for knee extensors. Patients with a Lysholm score of >89 points presented an isokinetic deficit 36% lower than patients with a Lysholm score of ≤89 points (p < 0.05). CONCLUSION A Lysholm score of >89 points has predictive value for deficits in the peak torque of knee extension (<20%). However, replacement of the isokinetic evaluation by this instrument must be performed with caution because of its accuracy.
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Affiliation(s)
- André Luis Lugnani de Andrade
- Department of Orthopedics and Traumatology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Alex Castro
- Laboratory of Exercise Physiology, Faculty of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Bruno Livani
- Department of Orthopedics and Traumatology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - William Dias Belangero
- Department of Orthopedics and Traumatology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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16
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Kang CW, Wu LX, Pu XB, Tan G, Dong CC, Yan ZK, Liu L. Pseudotear Sign of the Anterior Horn of the Meniscus. Arthroscopy 2021; 37:588-597. [PMID: 32890637 DOI: 10.1016/j.arthro.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/19/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To observe the morphology of the transverse geniculate ligament of the knee (TGL) by magnetic resonance imaging (MRI) and to analyze the cause of the pseudotear sign of the anterior horn of the meniscus caused by the TGL. METHODS Patients who underwent MRI examination of the knee joint in the orthopaedics department of our hospital from July 2016 to August 2019 were identified. The occurrence rate, length, width, thickness, cross-sectional shape, pattern, appearance, and position relative to the anterior horn of the lateral and medial meniscus and anatomical variations were observed by multiplane and multisequence MRI. The frequency and cause of the pseudotear sign also were observed. RESULTS The data of 101 patients were analyzed. Among them, 60 were male, and 41 were female. The average age was 42.01 (18-75) years. The occurrence rate of the TGL was 67.3% (68/101), the average length was 38.75 ± 3.56 mm, the median coronal diameter was 1.79 ± 0.60 mm, the median sagittal diameter was 1.88 ± 0.35 mm, and the cross-sectional morphology was mostly oval and round. There were 5 types of TGL connection to the anterior horn of the medial meniscus: type 1, located at the front edge; type 2, located at the upper front edge; type 3, located at the upper edge; type 4, located at the back upper edge; and type 5, was located at the back edge of the anterior horn of the medial meniscus. There was only one type of TGL insertion into the anterior horn of the lateral meniscus, located at the anterior superior edge of the anterior horn of the lateral meniscus. There were 4 cases of the pseudotear sign in the anterior horn of the meniscus, 3 in the lateral meniscus and 1 in the medial meniscus. The pseudotear sign of the anterior horn of the meniscus caused by the TGL was observed at a rate of 5.88% (4/68). CONCLUSIONS In MRI examination of the knee, the anterior horn of the meniscus sometimes shows a pseudotear sign. According to the shape and route of the TGL on MRI and the direction and position of the pseudotear sign of the anterior horn of the meniscus, true and false tears of the anterior horn of the meniscus can be identified. LEVEL OF EVIDENCE Level III, diagnostic study (retrospective, noncomparative, observational case series without a consistently applied reference "gold" standard).
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Affiliation(s)
- Cheng-Wei Kang
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li-Xue Wu
- Department of Pathology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Bing Pu
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Gang Tan
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang-Chao Dong
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhao-Kui Yan
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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17
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Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:576-583. [PMID: 31598765 DOI: 10.1007/s00167-019-05739-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether articular cartilage damage noted at the time of primary anterior cruciate ligament reconstruction (ACLR) affects the likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery or risk of recurrent ACL injury. METHODS Five hundred and eight patients underwent primary ACLR and diagnostic arthroscopy. All identified cartilage lesions were graded using the Outerbridge system. All patients underwent isokinetic strength testing. The association between cartilage Outerbridge grade and a ≥ 90% Limb Symmetry Index (LSI) and recurrent ACL injury risk at mean 38.7 month follow-up (SD 31.8) was evaluated via multivariate regression analysis. RESULTS Grade 2 or higher damage was present in 394 (77.5%) of patients, grade 3 or higher in 143 (28.1%) and grade 4 in 83 (16.4%) at time of ACLR. Ipsilateral ACLR graft rupture occurred in 31 (6.1%) of patients. Contralateral ACL injury occurred in 19 (3.7%). Patients with grade 2 or higher damage were significantly less likely to meet an LSI goal of ≥ 90% for fast (300°/s) isokinetic extension. There was no association with slow isokinetic extension. Cartilage lesion severity at or beyond grade 2 had a similar effect on isokinetic testing results regardless of compartment involvement or performance of microfracture. Patients with grade 2-4 cartilage damage were less likely to sustain a second ipsilateral ACL injury or a contralateral native ACL injury. CONCLUSIONS Cartilage damage seen at time of ACL reconstruction is common and associated with lower likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery. However, lower recurrent ACL injury rates are seen in patients with concurrent cartilage damage. These data may inform future clinical decisions regarding operative managment of recurrent ACL injuries. LEVEL OF EVIDENCE III.
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19
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Becker R, Bernard M, Scheffler S, Kopf S. [Treatment of degenerative meniscal lesions : From eminence to evidence-based medicine]. DER ORTHOPADE 2019; 46:808-821. [PMID: 28875226 DOI: 10.1007/s00132-017-3465-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The treatment of degenerative meniscal lesions has received increased attention since the publication of several Level 1 studies over the last few years. The following review of literature including the consensus statement given by ESSKA reports on the management of patients with degenerative meniscal lesions. MATERIAL AND METHODS The analysis includes the literature of Level 1 to 4 studies and the statement of the consensus group of ESSKA concerning the surgical or conservative management of these patients. RESULTS Meniscal lesions cause progression in osteoarthritis. Patients presenting a combination of degenerative meniscal lesion and osteoarthritis show inferior clinical outcome. The average clinical outcome after surgical treatment was 70 points based on the Lysholm score. Level 1 studies show no difference in clinical outcome. However, over 30% of these patients require arthroscopy at the second stage after an interval of 3 to 6 months. Patients presenting a flap tear or complaining about mechanical symptoms show poor outcome after conservative treatment. DISCUSSION Level 1 studies have focused on very selected patients. These patients do not represent the daily practice of orthopaedic surgeons. The findings of the level 1 studies should, therefore, not be generalized. According to the consensus statement of ESSKA, the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier. Arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcome.
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Affiliation(s)
- R Becker
- Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland.
| | - M Bernard
- Klinik Sanssouci, Helene Lange Straße 13, 14469, Potsdam, Deutschland
| | - S Scheffler
- Sporthopaedicum Berlin, Bismarckstraße 45-47, 10627, Berlin, Deutschland
| | - S Kopf
- Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland
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20
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Somthavil S. Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.
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Affiliation(s)
- Sompiya Somthavil
- Lecturer Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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21
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Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines. J Orthop Sports Phys Ther 2018; 48:162-173. [PMID: 29308697 DOI: 10.2519/jospt.2018.7459] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background The inclusion of specific exercises in rehabilitation after knee injury is currently expert based, as a thorough description of the knee contact forces during different exercises is lacking. Objective To quantify knee loading during frequently used activities such as squats, lunges, single-leg hops, walking stairs, standing up, and gait, and to grade knee joint loading during these activities. Methods Three-dimensional motion-analysis data of 15 healthy adults were acquired during 9 standardized activities used in rehabilitation. Experimental motion data were processed using musculoskeletal modeling to calculate contact and shear forces on the different knee compartments (tibiofemoral and patellofemoral). Using repeated-measures analyses of variance, contact and shear forces were compared between compartments and exercises, whereas muscle and average maximum femoral forces were compared only between exercises. Results With the exception of squats, all therapeutic exercises imposed higher forces to the tibiofemoral joint compared to gait. Likewise, patellofemoral forces were greater during all exercises when compared to gait. Greater compartmental contact forces were accompanied by greater compartmental shear forces. Furthermore, force distribution over the medial and lateral compartments varied between exercises. With increased knee flexion, more force was imposed on the posterior portion of the condyles. Conclusion These results suggest that with careful selection of exercises, forces on an injured zone of the joint can be reduced, as the force distribution differs strongly between exercises. Based on the results, a graded exercise program for progressive knee joint loading during rehabilitation can be conceptualized. J Orthop Sports Phys Ther 2018;48(3):162-173. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7459.
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