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The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries. J Clin Med 2023; 12:jcm12031144. [PMID: 36769792 PMCID: PMC9917777 DOI: 10.3390/jcm12031144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.
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De la Fuente C, Weinstein A, Neira A, Valencia O, Cruz-Montecinos C, Silvestre R, Pincheira PA, Palma F, Carpes FP. Biased instantaneous regional muscle activation maps: Embedded fuzzy topology and image feature analysis. Front Bioeng Biotechnol 2022; 10:934041. [PMID: 36619379 PMCID: PMC9813380 DOI: 10.3389/fbioe.2022.934041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
The instantaneous spatial representation of electrical propagation produced by muscle contraction may introduce bias in surface electromyographical (sEMG) activation maps. Here, we described the effect of instantaneous spatial representation (sEMG segmentation) on embedded fuzzy topological polyhedrons and image features extracted from sEMG activation maps. We analyzed 73,008 topographic sEMG activation maps from seven healthy participants (age 21.4 ± 1.5 years and body mass 74.5 ± 8.5 kg) who performed submaximal isometric plantar flexions with 64 surface electrodes placed over the medial gastrocnemius muscle. Window lengths of 50, 100, 150, 250, 500, and 1,000 ms and overlap of 0, 25, 50, 75, and 90% to change sEMG map generation were tested in a factorial design (grid search). The Shannon entropy and volume of global embedded tri-dimensional geometries (polyhedron projections), and the Shannon entropy, location of the center (LoC), and image moments of maps were analyzed. The polyhedron volume increased when the overlap was <25% and >75%. Entropy decreased when the overlap was <25% and >75% and when the window length was <100 ms and >500 ms. The LoC in the x-axis, entropy, and the histogram moments of maps showed effects for overlap (p < 0.001), while the LoC in the y-axis and entropy showed effects for both overlap and window length (p < 0.001). In conclusion, the instantaneous sEMG maps are first affected by outer parameters of the overlap, followed by the length of the window. Thus, choosing the window length and overlap parameters can introduce bias in sEMG activation maps, resulting in distorted regional muscle activation.
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Affiliation(s)
- Carlos De la Fuente
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile,Laboratory of Neuromechanics, Universidade Federal do Pampa, Campus Uruguaiana, Uruguaiana, Brazil,Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile
| | - Alejandro Weinstein
- Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile
| | - Alejandro Neira
- Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Oscar Valencia
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Facultad de Medicina, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rony Silvestre
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile,Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile
| | - Patricio A. Pincheira
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, QLD, Australia,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Felipe Palma
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Facultad de Medicina, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile
| | - Felipe P. Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Campus Uruguaiana, Uruguaiana, Brazil,*Correspondence: Felipe P. Carpes,
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Arhos EK, Di Stasi S, Hartigan EH, Snyder-Mackler L. Males and females have different muscle activity patterns during gait after ACL injury and reconstruction. J Electromyogr Kinesiol 2022; 66:102694. [PMID: 35988533 PMCID: PMC9588796 DOI: 10.1016/j.jelekin.2022.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Kinematic and kinetic changes following anterior cruciate ligament (ACL) rupture and reconstruction (ACLR) have been fundamental to the understanding of mechanical disrupted load as it contributes to the development of posttraumatic osteoarthritis. These analyses overlook the potential contribution of muscle activity as it relates to the joint loading environment. Males and females classified as non-copers present with unique knee kinematics and kinetics after ACL injury. The purpose of this study was to perform sex-specific analyses in these individuals to explore muscle activity timing during gait after ACL rupture. Thirty-nine participants (12 females, 27 males) were enrolled. Muscle activity during gait was evaluated before and after pre-operative physical therapy, and six months after ACLR. Surface electromyography data were evaluated to determine timing (e.g., the time the muscle activity begins ('On') and ends ('Off')) for seven muscles: vastus lateralis and medialis (VL, VM), lateral and medial hamstrings (LH, MH), lateral and medial gastrocnemius (LG, MG), and soleus (SOL). General linear models with generalized estimating equations detected the effects of limb and time for muscle activity timing. Males presented with more limb asymmetries before and after pre-operative PT in the VL On (p < 0.001) and Off (p = 0.007), VM On and Off (p < 0.001), and MH off (p < 0.001), but all limb differences resolved by six months post ACLR. Changes in muscle activity in males were pervasive over time in both limbs. Females presented with no interlimb differences pre-operatively, and only involved limb VL off (p = 0.027) and VM off (p = 0.003) and the LH off in both limbs (p < 0.038) changed over time. Our data indicate that inter-limb differences in muscle activity across time points and changes in muscle activity timing over the course of physical therapy were sex specific. Males presented with more inter-limb differences in muscle activity across time points, and females presented with fewer asymmetries before and after pre-operative physical therapy. These data support that sex-specific adaptations should be taken into consideration when assessing biomechanical changes after ACLR.
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Affiliation(s)
- Elanna K Arhos
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin H Hartigan
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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Arumugam A, Häger CK. Thigh muscle co-contraction patterns in individuals with anterior cruciate ligament reconstruction, athletes and controls during a novel double-hop test. Sci Rep 2022; 12:8431. [PMID: 35589937 PMCID: PMC9119948 DOI: 10.1038/s41598-022-12436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Efficient neuromuscular coordination of the thigh muscles is crucial in maintaining dynamic knee stability and thus reducing anterior cruciate ligament (ACL) injury/re-injury risk. This cross-sectional study measured electromyographic (EMG) thigh muscle co-contraction patterns during a novel one-leg double-hop test among individuals with ACL reconstruction (ACLR; n = 34), elite athletes (n = 22) and controls (n = 24). Participants performed a forward hop followed by a 45° unanticipated diagonal hop either in a medial (UMDH) or lateral direction (ULDH). Medial and lateral quadriceps and hamstrings EMG were recorded for one leg (injured/non-dominant). Quadriceps-to-Hamstring (Q:H) ratio, lateral and medial Q:H co-contraction indices (CCIs), and medial-to-lateral Q:H co-contraction ratio (CCR; a ratio of CCIs) were calculated for three phases (100 ms prior to landing, initial contact [IC] and deceleration phases) of landing. We found greater activity of the quadriceps than the hamstrings during the IC and deceleration phases of UMDH/ULDH across groups. However, higher co-contraction of medial rather than lateral thigh muscles during the deceleration phase of landing was found; if such co-contraction patterns cause knee adduction, a putative mechanism to decrease ACL injury risk, during the deceleration phase of landing across groups warrants further investigation.
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Affiliation(s)
- Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, P.O.Box: 27272, Sharjah, United Arab Emirates
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå, University, 901 87, Umeå, Sweden.
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Blasimann A, Koenig I, Baert I, Baur H, Vissers D. Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review. BMC Sports Sci Med Rehabil 2021; 13:142. [PMID: 34749813 PMCID: PMC8577028 DOI: 10.1186/s13102-021-00370-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. METHODS This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. RESULTS From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. CONCLUSIONS Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.
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Affiliation(s)
- Angela Blasimann
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. .,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Irene Koenig
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Sheikhi B, Letafatkar A, Thomas AC. Comparing myofascial meridian activation during single leg vertical drop jump in patients with anterior cruciate ligament reconstruction and healthy participants. Gait Posture 2021; 88:66-71. [PMID: 34004589 DOI: 10.1016/j.gaitpost.2021.05.006] [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: 02/07/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscles work synergistically to support the body during landing. Myofascial meridians have been described to classify muscles into functional synergies. The role that these functional lines plays in positioning the trunk and lower extremity of patients with anterior cruciate ligament reconstruction (ACLR) and healthy athletes during drop landing tasks remains unclear. RESEARCH QUESTION The purpose of this study was to compare the front and back functional lines (FFL and BFL) muscle activation in patients with ACLR and healthy participants during single leg vertical drop jump (SLVDJ). METHODS Thirty-two male athletes (post-ACLR = 16, healthy = 16) participated (age = 23.3 ± 2.3 years). Superficial electromyography of FFL (adductor longus [AL], rectus abdominis [RA], pectoralis major) and BFL (vastus lateralis [VL], gluteus maximus [GMax], latissimus dorsi [LD]) was collected during the SLVDJ and compared at initial contact and maximum knee flexion between groups using t-tests and limbs using paired-samples t-tests. RESULTS In the FFL, the AL (p < 0.05) and RA (p < 0.05) muscles were more active in the healthy group compared to the ACLR group at initial contact and maximum knee flexion. PM demonstrated greater activation in the healthy group only at maximum knee flexion (p < 0.05). In the BFL, the VL (p < 0.05) and GMax (p < 0.05) muscles were more active in the ACLR group, whereas the LD (p < 0.05) muscles demonstrated greater activation in the healthy group at initial contact and maximum knee flexion. There were no healthy group inter-limb differences in FFL and BFL activation. ACLR participants demonstrated greater non-injured limb VL, AL, GMax and LD activation (p < 0.05) and greater injured limb PM and RA activation (p < 0.05). SIGNIFICANCE Based on the present data, patients after ACLR may present with an alteration in BFL and FFL muscles activation during a drop jump task. Functional line muscles during dynamic activities may change lower extremity positioning and lead to increase ACL injury risk.
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Affiliation(s)
- Bahram Sheikhi
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran.
| | - Amir Letafatkar
- Sport Injury and Corrective Exercises, Kharazmi University, Tehran, Iran.
| | - Abbey C Thomas
- Department of Kinesiology, University of North Carolina at Charlotte Charlotte, NC, United States.
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Behnke AL, Parola LR, Karamchedu NP, Badger GJ, Fleming BC, Beveridge JE. Neuromuscular function in anterior cruciate ligament reconstructed patients at long-term follow-up. Clin Biomech (Bristol, Avon) 2021; 81:105231. [PMID: 33246796 PMCID: PMC7855572 DOI: 10.1016/j.clinbiomech.2020.105231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The permanence of neuromuscular adaptations following anterior cruciate ligament reconstruction is not known. The aim of this study was to compare bilateral muscle co-contraction indices, time to peak ground reaction force, and timing of muscle onset between anterior cruciate ligament reconstruction subjects 10-15 years post reconstruction with those of matched uninjured controls during a one-leg hop landing. METHODS Nine healthy controls and 9 reconstruction subjects were recruited. Clinical and functional knee exams were administered. Lower limb co-contraction indices, time to peak ground reaction force, and muscle onset times were measured bilaterally. Differences in clinical and functional outcomes were assessed with unpaired t-tests, and mixed model repeated measures were used to examine effects of group, limb and interaction terms in electromyography measures. FINDINGS 89% of control knees were clinically "normal", whereas only 33% of reconstructed knees were "normal". Anterior cruciate ligament-reconstructed subjects tended to achieve shorter functional hop distances but demonstrated symmetrical lower limb electromyography measures that were no different from those of controls' with the exception that biceps femoris activation was delayed bilaterally prior to ground contact but was greater during the injury risk phase of landing. INTERPRETATION With the exception of hamstring activation, lower limb electromyography measures were largely similar between ligament-reconstructed and matched control subjects, which was in contrast to the clinical findings. This result brings into question the significance of neuromuscular function at this long-term follow-up but raises new questions regarding the role of symmetry and pre-injury risk.
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Affiliation(s)
- Analicia L Behnke
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Lauren R Parola
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Jillian E Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA; Cleveland Clinic Biomedical Engineering Department, Cleveland, OH, USA.
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Timing of Muscle Activation Is Altered During Single-Leg Landing Tasks After Anterior Cruciate Ligament Reconstruction at the Time of Return to Sport. Clin J Sport Med 2020; 30:e186-e193. [PMID: 30418218 DOI: 10.1097/jsm.0000000000000659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES It is well known that alterations in landing mechanics persist for years after anterior cruciate ligament reconstruction (ACL-R). Nevertheless, existing literature is controversial in reporting successful or unsuccessful recovery of prelanding muscle activation timing after ACL-R. The study aimed at comparing myoelectric and kinematic patterns during landing tasks between ACL-R and healthy subjects. DESIGN Cross-sectional study. SETTING Institutional research laboratory. PATIENTS AND INTERVENTION Fifteen male athletes after ACL-R using patellar tendon and 11 using hamstrings autograft at the time of return to sport were recruited. Fifteen healthy athletes served as control group. Participants performed 4 different single-leg landing tasks arriving onto a force plate. MAIN OUTCOME MEASURES Electromyographic (EMG) activity of knee extensors and flexors, normalized vertical ground reaction force (vGRF), and knee angular displacement were recorded. RESULTS In all the tasks, preimpact EMG duration was longer in ACL-R (112 ± 28 ms in the knee extensors; 200 ± 34 ms in the knee flexors) compared with healthy participants (74 ± 19 ms in the knee extensors; 153 ± 29 ms in the knee flexors; P < 0.05). Initial contact (IC) and maximum postimpact knee angle were lower in ACL-R (9 ± 7 degrees at IC; 39 ± 12 degrees at maximum flexion) compared with healthy participants (17 ± 9 degrees at IC; 52 ± 15 degrees at maximum flexion; P < 0.05). Normalized vGRF was higher in ACL-R compared with healthy participants (3.4 ± 0.5 and 2.7 ± 0.6; P < 0.05). CONCLUSIONS At the time of return to sport, ACL-R subjects showed altered motor control strategies of single-leg landings. These alterations may lead to uncoordinated movement, hence increasing the risk of reinjury.
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Altered Neuromuscular Activity of the Lower-Extremities During Landing Tasks in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review of Electromyographic Studies. J Sport Rehabil 2020; 29:1194-1203. [PMID: 32357316 DOI: 10.1123/jsr.2019-0393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. OBJECTIVE To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. EVIDENCE ACQUISITION Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. EVIDENCE SYNTHESIS Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. CONCLUSIONS Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
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Konishi Y, McNair PJ, Rice DA, Ochiai S, Hagino T. Stretch reflex changes in ACL-deficient individuals and healthy controls during normal and surprise landings. Scand J Med Sci Sports 2020; 30:2342-2351. [PMID: 32854151 DOI: 10.1111/sms.13810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/04/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
No studies in ACL-D individuals have examined neuromuscular adaptations during landing from a jump where an unexpected mechanical event changes the pre-programmed course of movement. The purpose of this study was to compare pre- and post-landing muscle activation in ACL-D individuals and uninjured controls during normal and surprise landings. Nineteen ACL-D and 17 uninjured volunteered. Participants performed repeated single leg landings from 30 and 15 cm heights. During 15 cm landings, a single surprise landing was performed where participants unexpectedly fell through a false surface at 15 cm to the solid floor a further 15 cm below. Electromyography (EMG) amplitude from vastus lateralis (VL), lateral hamstrings (LH), and soleus (Sol) was recorded. Pre-landing (-60 to 0 ms), post-landing short latency (31-60 ms), and post-landing medium latency (61-90 ms) periods were examined. Comparisons in EMG amplitudes were made across limbs (ACL-D, ACL intact, and control) in 30 cm landings. Additionally, the ratio of EMG amplitude in surprise:30 cm normal landings was analyzed. Post-landing LH EMG was reduced in the ACL-D compared to control limbs at short latencies (P < 0.05). Post-landing VL EMG was reduced in the ACL-D and ACL intact compared to the control limb at both latencies (P < 0.05). Surprise landings notably increased post-landing EMG in all muscles, across all limbs (P < 0.001). However, the gain in VL EMG was significantly greater in ACL-D and ACL intact limbs (P < 0.05). These changes in neuromuscular control of ACL-D individuals during expected and surprise landings may have important implications for rehabilitation, instability, and the risk of secondary injury.
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Affiliation(s)
- Yu Konishi
- Department of Physical Education, National Defence Academy of Japan, Kanagawa, Japan
| | - Peter J McNair
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David A Rice
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Satoshi Ochiai
- The Knee Sports Medicine and Knee Center, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Tetsuo Hagino
- The Knee Sports Medicine and Knee Center, National Hospital Organization Kofu National Hospital, Kofu, Japan
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Hatamzadeh M, Hassannejad R, Sharifnezhad A. A new method of diagnosing athlete's anterior cruciate ligament health status using surface electromyography and deep convolutional neural network. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Smale KB, Alkjaer T, Flaxman TE, Krogsgaard MR, Simonsen EB, Benoit DL. Predicting post-operative functional ability from pre-operative measures in ACL-injured individuals. Scand J Med Sci Sports 2019; 30:166-173. [PMID: 31486128 DOI: 10.1111/sms.13549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to quantify the relationship between objective and subjective measures of functional ability and determine if measures in the deficient (ACLd) state were correlated to, and capable of predicting a patient's objective and subjective measures in the reconstructed (ACLr) state. METHODS Twenty ACL-injured participants completed hop and side cut movements prior to and 10 months post-reconstruction. Their subjective measures (Tegner, Lysholm, IKDC, KOOS, and KNEEs) were related to objective measures of functional ability (peak knee flexion, peak knee extensor moment, stiffness, knee joint center excursion (KJCE), and knee joint center boundary). Correlations were used to determine relationships between variables whereas regressions were used to identify ACLd score's predictive ability of an ACLr score. RESULTS Relationships between objective and subjective measures were task and ACL status dependent with KJCE and stiffness most commonly being related to subjective scores. The greatest correlation was between knee stiffness and Tegner in the ACLr group during the side cut (r = 0.69). Peak knee flexion angle (adj. R2 = 0.4-0.66) was the best objective predictor between ACLd and ACLr states while KOOS-ADL had the strongest correlations (r = 0.70-0.77) and Tegner had the greatest predictive power (odds ratio: 1.46-1.86) between states in both tasks. CONCLUSION Objective measures show a wide range of correlation to subjective measures with some being quite strong. Furthermore, objective measures in the ACLd state are more correlated and more often capable of predicting ACLr scores than the subjective measures of functional ability.
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Affiliation(s)
- Kenneth B Smale
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Tine Alkjaer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Daniel L Benoit
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.,School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Pincheira PA, Silvestre R, Armijo-Olivo S, Guzman-Venegas R. Ankle perturbation generates bilateral alteration of knee muscle onset times after unilateral anterior cruciate ligament reconstruction. PeerJ 2018; 6:e5310. [PMID: 30083454 PMCID: PMC6074771 DOI: 10.7717/peerj.5310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to compare muscle activation onset times of knee muscles between the involved and uninvolved knee of patients with unilateral anterior cruciate ligament reconstruction (ACLR), and the uninjured knees of healthy subjects after a controlled perturbation at the ankle level. METHODS Fifty male amateur soccer players, 25 with unilateral ACLR using semitendinosus-gracilis graft (age = 28.36 ± 7.87 years; time after surgery = 9 ± 3 months) and 25 uninjured control subjects (age = 24.16 ± 2.67 years) participated in the study. Two destabilizing platforms (one for each limb) generated a controlled perturbation at the ankle of each participant (30°of inversion, 10°plantarflexion simultaneously) in a weight bearing condition. The muscle activation onset times of semitendinosus (ST) and vastus medialis (VM) was detected through an electromyographic (EMG) analysis to assess the neuromuscular function of knee muscles. RESULTS Subjects with ACLR had significant delays in EMG onset in the involved (VM = 99.9 ± 30 ms; ST = 101.7 ± 28 ms) and uninvolved knee (VM = 100.4 ± 26 ms; ST = 104.7 ± 28 ms) when compared with the healthy subjects (VM = 69.1 ± 9 ms; ST = 74.6 ± 9 ms). However, no difference was found between involved and uninvolved knee of the ACLR group. DISCUSSION The results show a bilateral alteration of knee muscles in EMG onset after a unilateral ACLR, responses that can be elicited with an ankle perturbation. This suggests an alteration in the central processing of proprioceptive information and/or central nervous system re-organization that may affect neuromuscular control of knee muscles in the involved and uninvolved lower limbs.
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Affiliation(s)
- Patricio A. Pincheira
- Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clinica Meds, Santiago, Chile
| | - Susan Armijo-Olivo
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Rodrigo Guzman-Venegas
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
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