1
|
Ekinci M, Demir TB, Sahinkaya T, Yakal S, Polat G, Bayraktar B. The Effect of Gracilis Tendon Preservation on Postoperative Knee Joint Stability and Muscle Strength in Arthroscopic Anterior Cruciate Ligament Reconstruction Surgery. J Knee Surg 2024. [PMID: 38897225 DOI: 10.1055/s-0044-1787829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (p = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.
Collapse
Affiliation(s)
- Mehmet Ekinci
- Department of Orthopaedics and Traumatology, Haseki Education and Training Hospital, Istanbul, Turkey
| | - Taha Bedir Demir
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Turker Sahinkaya
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sertac Yakal
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gokhan Polat
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bulent Bayraktar
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
2
|
Nasr A, McPhee J. Scalable musculoskeletal model for dynamic simulations of lower body movement. Comput Methods Biomech Biomed Engin 2024:1-27. [PMID: 38396368 DOI: 10.1080/10255842.2024.2316240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
A musculoskeletal (MSK) model is an important tool for analysing human motions, calculating joint torques during movement, enhancing sports activity, and developing exoskeletons and prostheses. To enable biomechanical investigation of human motion, this work presents an open-source lower body MSK model. The MSK model of the lower body consists of 7 body segments (pelvis, left/right thigh, left/right leg, and left/right foot). The model has 20 degrees of freedom (DoFs) and 28 muscle torque generators (MTGs), which are developed from experimental data. The model can be modified for different anthropometric measurements and subject body characteristics, including sex, age, body mass, height, physical activity, and skin temperature. The model is validated by simulating the torque within the range of motion (ROM) of isolated movements; all simulation findings exhibit a good level of agreement with the literature.
Collapse
Affiliation(s)
- Ali Nasr
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | - John McPhee
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| |
Collapse
|
3
|
Lu CC, Yao HI, Fan TY, Lin YC, Lin HT, Chou PPH. Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312849. [PMID: 34886588 PMCID: PMC8657930 DOI: 10.3390/ijerph182312849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.
Collapse
Affiliation(s)
- Cheng-Chang Lu
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan;
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsin-I Yao
- Kaohsiung Municipal Kaohsiung Commercial High School, Kaohsiung 800, Taiwan;
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
| | - Tsang-Yu Fan
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
- Doctoral Degree Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Chuan Lin
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Hwai-Ting Lin
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
| | - Paul Pei-Hsi Chou
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
- Correspondence: ; Tel.: +886-7312-1101 (ext. 5751)
| |
Collapse
|
4
|
Czamara A, Krzemińska K, Widuchowski W, Dragan SL. The Muscle Strength of the Knee Joint after ACL Reconstruction Depends on the Number and Frequency of Supervised Physiotherapy Visits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10588. [PMID: 34682334 PMCID: PMC8536018 DOI: 10.3390/ijerph182010588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 01/05/2023]
Abstract
The aim of this study in anterior cruciate ligament reconstruction (ACLR) patients was to assess the effect of six months of supervised physiotherapy with a higher number of visits (SPHNV) compared to supervised physiotherapy with a lower number of visits (SPLNV) on the maximal peak torque (PT) and isometric torque (IT) of values obtained for hamstring (H) and quadriceps (Q) muscles of the knee joints under isokinetic and isometric conditions. Hypothesis: SPHNV improves IT and PT more than SPLNV. Group I had ACLR with a higher number of visits (n = 20), Group II had ACLR with a lower number of visits (n = 20), and Group III served as the control (n = 20). In Groups I and II, IT values were measured for quadriceps and hamstring muscles of the knee joints in the 13th and 24th weeks and for PT in the 18th and 24th weeks after ACLR (60 and 180 °/s). In group III, the measurements were taken once. The isometric torque and isokinetic peak torque values were measured in N*m and they were normalized to body mass as relative IT (RIT) and relative PT (RPT) were expressed in N*m/kg. Results: In both ACLR groups, the RIT and RPT values obtained from the operated knee joints significantly increased in the 24 weeks following ACLR compared to the uninvolved side. Group II had significantly lower RIT and RPT values for quadriceps and hamstring muscles of the operated limbs compared with the uninvolved limbs (p = 0.008, p = 0.001). In group I, the larger number of visits positively correlated with the higher PT for quadriceps and hamstring muscles of the operated and uninvolved knees (from r = 0.506; p = 0.023 too r = 0.566; p = 0.009), respectively. Six months of SPHNV positively correlated with and improved the IT and PT values in patients after ACLR much more significantly than six months of SPLNV.
Collapse
Affiliation(s)
- Andrzej Czamara
- Department of Physiotherapy, The College of Physiotherapy in Wroclaw, 50-038 Wroclaw, Poland
| | - Katarzyna Krzemińska
- Center of Rehabilitation and Medical Education in Wroclaw, 50-038 Wroclaw, Poland;
| | - Wojciech Widuchowski
- District Hospital of Orthopedics and Trauma Surgery, 41-940 Piekary Slaskie, Poland;
| | - Szymon Lukasz Dragan
- Department of Regenerative and Restorative Medicine in Orthopaedics, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| |
Collapse
|
5
|
Alt T, Breitenmoser T, Vonhoegen J, Horn D, Severin J, Nolte K, Knicker AJ, Jaitner T, Strüder HK. The dynamic control ratio masks bilateral asymmetries - A gender-specific analysis of 264 healthy and ACL-injured athletes. Res Sports Med 2021; 30:1-18. [PMID: 34187258 DOI: 10.1080/15438627.2021.1943389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Isokinetic strength tests are frequently applied to assess anterior cruciate ligament (ACL) rehabilitation processes. However, diverging methodologies cause misleading conclusions. This cross-sectional study evaluated the effects of gender (male vs. female), group (healthy vs. ACL-injured) and limb (dominant/healthy vs. non-dominant/ACL-injured) on thigh muscle balance of 138 female and 126 male athletes (50% ACL-injured, averagely 12.8 months after surgery). Balance was analysed between legs (bilateral asymmetry) and between concentric knee extensor (Qcon) and eccentric knee flexor strength (Hecc) (DCR = dynamic control ratio, DCRe = DCR at the equilibrium point). Females were generally 17-27% weaker than males. Independent of gender and time after surgery, ACL-injured athletes demonstrated bilateral asymmetries (7-20%) in peak (PMQcon, PMHecc) and DCRe moments (p ≤0.030; 0.018≤ηp2≤0.215). ACL-injured athletes' affected (24-28%) and unaffected (12-24%) hamstrings and quadriceps peak moments were significantly weaker compared to healthy athletes (p<0.001; 0.061≤ηp2≤0.362). The bilateral asymmetries of PMQcon significantly decreased from early to late self-reported rehabilitation phases (p<0.001; ηp2=0.158). Peak and DCRe moments detected bilateral asymmetries, whereas DCR revealed ~50% false negative attributions. This knowledge provides guidance for future design and interpretation of isokinetic tests.
Collapse
Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany.,Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Thomas Breitenmoser
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jan Vonhoegen
- Department of Orthopaedics and Sports Traumatology, Klinik am Ring, Cologne, Germany
| | - Dennis Horn
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jannik Severin
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Kevin Nolte
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Axel J Knicker
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
| | - Thomas Jaitner
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Heiko K Strüder
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
| |
Collapse
|
6
|
Czamara A, Królikowska A. Two-Plane Assessment of Knee Muscles Isometric and Isokinetic Torques After Anterior Cruciate Ligament Reconstruction. Med Sci Monit 2018; 24:4882-4893. [PMID: 30007063 PMCID: PMC6069442 DOI: 10.12659/msm.908411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background We tested the hypothesis that, in patients participating in 17 weeks of postoperative physiotherapy after anterior cruciate ligament reconstruction (ACLR), maximal isometric torque (IT) and peak torque (PT) generated by the muscles affecting the operated knee joint in the sagittal and transverse planes are not restored. We also present the application of IT and PT measurements of the muscles affecting the knee joint in 2 planes of motion. Material/Methods IT and PT of the knee extensor and flexor muscles and the muscles internally rotating the shin were measured in 30 males who participated in postoperative physiotherapy for 17 weeks after ACLR (ACLR group) and 30 males with no injuries (control group). Results Significantly lower IT and PT values were noted in the operated knee extensors and flexors. The differences were also noted in the PT for the muscles internally rotating the shin and in the IT of those muscles in the position of 25° of internal rotation. Significantly lower relative IT and PT values were noted for studied muscle groups in comparison to the control group. Conclusions Seventeen weeks of postoperative physiotherapy after ACLR did not result in complete restoration of IT and PT of the muscles affecting the operated knee joint, suggesting that even after 17 weeks of physiotherapy following ACLR, athletes may not be ready to return to sports. The results demonstrate the usefulness of biplanar analysis of muscle strength under isometric and isokinetic conditions in the monitoring and assessment of physiotherapeutic procedures.
Collapse
|
7
|
Deng Z, Li Y, Liu H, Li K, Lei G, Lu B. Effect of Posterior Cruciate Ligament Rupture on Biomechanical and Histological Features of Lateral Femoral Condyle. Med Sci Monit 2016; 22:4369-4379. [PMID: 27843134 PMCID: PMC5120644 DOI: 10.12659/msm.900502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this study was to investigate bone mineral density (BMD) and the biomechanical and histological effects of posterior cruciate ligament (PCL) rupture on the lateral femoral condyle. Material/Methods Strain on different parts of the lateral femoral condyle from specimens of normal adult knee joints, including 12 intact PCLs, 6 ruptures of the anterolateral bundle, 6 ruptures of the postmedial bundle, and 12 complete ruptures, was tested when loaded with different loads on the knee at various flexion angles. Lateral femoral condyles were also collected randomly from both the experimental side in which the PCLs were transected and the control side from 4 sets of 12 matched-mode pairs of rabbits at 4, 8, 16, and 24 weeks after surgery, and their BMD and morphological and histological changes were observed. Results Partial and complete rupture of the PCL may cause an abnormal load on all parts of the lateral femoral condyle with any axial loading at all positions. Noticeable time-dependent degenerative histological changes of the lateral femoral condyle were observed in the rabbit model of PCL rupture. All of the PCL rupture groups had a higher expression of matrix metalloproteinase-7 (MMP-7) and collagen type II than the control group at all time points (P<0.05), but no significant difference in BMD (P>0.05). Conclusions Rupture of the PCL may trigger a coordinated response of lateral femoral condyle degeneration in a time-dependent manner, to which the high level of expression of MMP-7 and collagen type II could contribute.
Collapse
Affiliation(s)
- Zhenhan Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Hong Liu
- Operating Room, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Kanghua Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Bangbao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| |
Collapse
|
8
|
Królikowska A, Czamara A, Kentel M. Does Gracilis Tendon Harvest During ACL Reconstruction with a Hamstring Autograft Affect Torque of Muscles Responsible for Shin Rotation? Med Sci Monit 2015; 21:2084-93. [PMID: 26190033 PMCID: PMC4514330 DOI: 10.12659/msm.893930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background A growing body of evidence indicates that in patients after anterior cruciate ligament reconstruction (ACLR) with a combined semitendinosus and gracilis (STGR) graft there are large deficits in the internal rotation strength, which has led some authors to recommend harvest of only ST tendon whenever possible. The purpose of this study was to assess the isometric (IT) and peak torque (PT) of the muscles responsible for shin rotation in patients after ACLR with an ST or with an STGR graft. Material/Methods Twenty patients with an ST graft and 20 patients with a combined STGR graft underwent a 6-month postoperative rehabilitation program after ACLR. At the end of the rehabilitation program, the IT and PT of the muscles responsible for internal (IR) and external rotation (ER) of the shin were measured. The results were compared to the results of a control group. Additionally, to determine the reliability of the dynamometer for clinical research, a test-retest assessment was performed. Results There were no statistically significant differences between the 3 groups of participants. Nevertheless, in the STGR group there was a statistically significant difference between the IT of muscles internally rotating the shin in the involved knee and uninvolved knee at 25° of the internal shin rotation. Conclusions Comparison of IT and PT measurements performed after 24 weeks of postoperative rehabilitation generally showed no differences between patients after ACLR with the use of ST graft and patients who received a combination graft consisting of STGR. Nevertheless, there was an influence of GR harvest on internal shin rotation torque at a deep internal rotation angle.
Collapse
Affiliation(s)
| | - Andrzej Czamara
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
| | - Maciej Kentel
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
| |
Collapse
|
9
|
Kinematics of Rotation in Joints of the Lower Limbs and Pelvis during Gait: Early Results-SB ACLR Approach versus DB ACLR Approach. BIOMED RESEARCH INTERNATIONAL 2015; 2015:707168. [PMID: 25922839 PMCID: PMC4397484 DOI: 10.1155/2015/707168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 01/21/2023]
Abstract
It is difficult to find publications comparing rotation kinematics in large joints of the lower limbs and pelvis during gait in patients after single-bundle (SB) reconstruction of the anterior cruciate ligament (ACLR) with double-bundle (DB) ACLR of the knee. The aim of this study was to compare rotation kinematics in ankle, knee, and hip joints and the pelvis during gait in the 14th week after SB and DB ACLR. The subjects were males after SB (n = 10) and DB (n = 13) ACLR and a control group (n = 15). The values of kinematic parameters were recorded during internal (IR) and external (ER) rotation in the joints during gait using the BTS SMART. The SB ACLR group obtained significantly higher values of ER in the involved knee comparing to DB ACLR and controls and excessive IR in the hip comparing to controls. In the DB ACLR group, excessive ER was noted in the involved leg's foot. Comparing with the DB ACLR and control groups, SB ACLR subjects had more substantial disorders of rotation kinematics in the lower limb joints. However, in both ACLR groups, 14 weeks of postoperative physiotherapy were not enough to fully restore rotation kinematics in joints of the lower limbs during gait.
Collapse
|
10
|
Arnason SM, Birnir B, Guðmundsson TE, Guðnason G, Briem K. Medial hamstring muscle activation patterns are affected 1-6 years after ACL reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2014; 22:1024-9. [PMID: 24067994 DOI: 10.1007/s00167-013-2696-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE Although changes in hamstring muscle morphology after anterior cruciate ligament reconstruction (ACLR) using a semitendinosus autograft hamstrings-gracilis (HG) of the ipsilateral limb are recognized, alterations in muscle activation patterns have not been extensively studied. The purpose of this controlled laboratory trial was therefore to monitor muscle activation levels of the medial (MH) and lateral (LH) hamstring muscles in athletes who had undergone ACLR using a HG autograft and to contrast these to activation levels demonstrated by healthy controls. METHODS Surface electromyography (EMG) was sampled from bilateral hamstring muscles of 18 athletes 1-6 years after ACLR and 18 matched controls (CTRL) during the performance of two dissimilar exercises, both involving eccentric knee flexor activity. Peak normalized muscle activation levels were identified for MH and LH of both limbs during the performance of the Nordic Hamstring (NH) exercise and TRX) hamstring curl (TRX) exercise. RESULTS A statistically significant limb by exercise interaction was found for peak activation levels of LH, due to significant interlimb differences in activation during the performance of the TRX exercise compared to more symmetrical activation during the NH (p < 0.001). A three-way interaction was found for peak activation levels of MH, due to group differences in peak muscle activation between limbs and exercise type (p = 0.025). Whereas CTRL group participants consistently favoured one limb over the other during the performance of both exercises, ACLR participants demonstrated dissimilar peak MH activation patterns between limbs during the performance of the NH exercise compared to the TRX. CONCLUSIONS In light of these results and considering the surgical procedure, patients who undergo ACLR using a HG autograft from the ipsilateral limb may benefit from post-operative rehabilitation that involves muscle activation and strengthening specifically targeting the MH component.
Collapse
Affiliation(s)
- Stefán Magni Arnason
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Saemundargata 2, 101, Reykjavik, Iceland
| | | | | | | | | |
Collapse
|
11
|
Nishihara K, Kawai H, Kanemura N, Hara M, Naruse H, Gomi T. A novel approach for evaluating nerve function in healthy elderly persons: a pilot study. Med Sci Monit 2013; 19:309-16. [PMID: 23624713 PMCID: PMC3659003 DOI: 10.12659/msm.883897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Motor nerve function decreases with age and can cause abnormalities in motor function. Using newly designed methods, we used evoked electromyograms to evaluate change in motor nerve function. Material/Methods Motor function was assessed by grip strength, timed up-and-go test, 5-m normal walk, and 5-m fastest walk. In addition, motor nerve conduction velocity was calculated by measuring latency differences (NCV) in elderly and young subjects. We also investigated motor nerve conduction velocity by correlation coefficient (NCVCC) and the difference between NCV and NCVCC (DNCV). Results Significant differences were observed in the motor function of elderly and young persons in grip strength, the timed up-and-go test, and the 5-m fastest walk; however, no difference was observed in the 5-m normal walk test. NCVCC was lower than NCV in both elderly and young. The correlation coefficient peak of the NCVCC calculation was lower in elderly than in young. A negative correlation was observed between correlation coefficient peak and DNCV in elderly subjects. Conclusions NCVCC compares the overall shape of compound muscle action potential and reflects not only the fastest motor unit, but also the motor nerve conduction velocity of other motor unit components. A significant negative correlation between DNCV and the correlation coefficient peak was observed only in elderly subjects, suggesting that older individuals, including those that maintain a high level of physical strength, experience a loss of motor nerve function. Thus, changes in motor nerve function among elderly persons can potentially be further examined for clinical use.
Collapse
Affiliation(s)
- Ken Nishihara
- Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan.
| | | | | | | | | | | |
Collapse
|
12
|
Mardani-Kivi M, Madadi F, Keyhani S, Karimi-Mobarake M, Hashemi-Motlagh K, Saheb-Ekhtiari K. Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: a cross-sectional study with 1-year follow-up. Med Sci Monit 2013; 18:CR674-9. [PMID: 23111744 PMCID: PMC3560599 DOI: 10.12659/msm.883546] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antero-medial portal (AMP) and trans-tibial (TT) techniques are the most widely used methods for drilling femoral tunnel in ACL reconstructions; yet, debate continues about the preferred method. This study seeks to compare these 2 techniques in patients with ACL tears. MATERIAL/METHODS In this comparative study, all cases of isolated ACL reconstruction using 4-strand hamstring tendon in 2006-2010 were evaluated for eligibility. Of 266 patients, 124 cases (60 TT and 64 AMP), with the mean age of 28.48±8.3, met the inclusion criteria. Both groups were compared in 8 follow-ups from the point of view of time of: return to post-surgical activities (including walking without crutches, normal life activity, jogging, and exercising), maximum range of passive movements, knee instability (Lachman test), functional condition (subjective IKDC and Lysholm knee scores), therapeutic outcomes, and patient's satisfaction with treatment (VAS). RESULTS AMP technique significantly accelerates patients' return to activity. AMP patients achieved full range of motion much sooner than TT cases (P<0.0001). After 1-year follow-up, S-IKDC scores were 94.8 ± 3.9 and 89.2 ± 4.1 and S-LKS scores were 96.1 ± 3 and 92.2 ± 4.1 for AMP and TT groups, respectively (P<0.0001). Knee stability was similar in both groups on Lachman test (P=0.25). AMP group patients (VAS mean score: 9.78 ± 0.4) had greater satisfaction compared to TT group patients (VAS mean score: 9.53 ± 0.5) (P=0.003). CONCLUSIONS AMP technique leads to reduction in time to return to routine activities, better therapeutic outcomes and higher satisfaction rates.
Collapse
Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopedic Research Center, Orthopedic Department, Poursina Hospital, Parastar Street, Rasht, Guilan, Iran.
| | | | | | | | | | | |
Collapse
|