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Stenroth L, Bartholdy C, Schwarz Larsen J, Sørensen MS, Smale KB, Flaxman TE, Benoit DL, Krogsgaard MR, Alkjær T. Altered movement strategy during functional movement after an ACL injury, despite ACL reconstruction. Front Sports Act Living 2022; 4:994139. [PMID: 36267483 PMCID: PMC9576999 DOI: 10.3389/fspor.2022.994139] [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: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Knee joint functional deficits are common after anterior cruciate ligament (ACL) injury, but different assessment methods of joint function seem to provide contradicting information complicating recovery monitoring. We previously reported improved perceived knee function and functional performance (forward lunge ground contact time) in patients with an ACL injury from pre to 10 months post ACL reconstruction without improvement in knee-specific biomechanics. To further investigate this discrepancy, we additionally analyzed knee extensor and flexor muscle strength, and movement quality in the forward lunge (subjective and objective evaluations) and performed a full lower limb biomechanical analysis of the forward lunge movement. We included 12 patients with an ACL injury (tested before and after ACL reconstructive surgery) and 15 healthy controls from the previous study to the current investigation. Outcome measures were obtained pre and ~11 months post ACL reconstruction for the patients and at a single time point for the controls. Objective movement quality in the patients with an ACL injury showed an improvement from their pre reconstruction surgery visit to the post reconstruction visit but this was not observable in the subjective evaluation. Knee extensor muscle strength declined after the ACL reconstruction by 29% (p = 0.002) and both knee extensors (p < 0.001) and flexors (p = 0.027) were weaker in the patients post ACL reconstruction compared to healthy controls. ACL injured patients had an altered movement strategy in the forward lunge with reduced knee extensors contribution and increased hip extensor contribution compared to the controls both before and after the reconstruction. The altered movement strategy was associated with knee extensor muscle strength. This explorative study with a limited sample size found that clinicians should be aware that significant functional deficits in the knee extensor muscles, both in isolated muscle strength testing and during a functional movement, may be present although patients perceive an improvement in their knee function and present good functional performance without obvious movement quality issues.
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Affiliation(s)
- Lauri Stenroth
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,*Correspondence: Lauri Stenroth
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jonas Schwarz Larsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kenneth B. Smale
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Teresa E. Flaxman
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Daniel L. Benoit
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada,School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael R. Krogsgaard
- Section for Sports Traumatology, M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Ogborn D. Optimizing Exercise Selection for the Asymmetric Athlete After Anterior Cruciate Ligament Reconstruction. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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