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Drigny J, Reboursière E, Praz C, Guermont H, Hulet C, Gauthier A. Changes in passive hamstring stiffness after primary anterior cruciate ligament reconstruction: A prospective study with comparison of healthy controls. Clin Biomech (Bristol, Avon) 2024; 112:106168. [PMID: 38219455 DOI: 10.1016/j.clinbiomech.2023.106168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The mechanical properties of knee flexors muscles contribute to reducing anterior cruciate ligament loading. This case-control study evaluated the passive knee flexors stiffness after primary anterior cruciate ligament reconstruction with comparison of healthy controls. METHODS After anterior cruciate ligament reconstruction, 88 participants (24.5 [8.6] years, 56,8% males) had two isokinetic tests at 4 and 8 postoperative months with measurement of the passive resistive torque of knee flexors and extensors/flexors strength. In the control group, 44 participants (24.5 [4.3] years, 56,8% males) had one visit with the same procedures. Passive knee flexors stiffness was calculated as the slope of the passive torque-angle curve on the last 10° of knee extension (Nm/°). We investigated the impact of timing and type of surgery (autograft and combined meniscus repair) and persistent knee extension deficits on knee flexors stiffness. FINDINGS At 4 and 8 postoperative months, passive knee flexors stiffness was lower on the operated limb than on the non-operated limb (P < 0.001) but both limbs had significant lower values than controls (P < 0.001). Stiffness was positively correlated with knee flexors strength (P < 0.010), and knee flexors stiffness at 4 months was lower in individuals who underwent surgery <6 months from injury (P = 0.040). Knee extension deficit or the type of surgery did not have a significant influence on knee flexors stiffness. INTERPRETATION Similarly to neuromuscular factors that are traditionally altered after anterior cruciate ligament reconstruction, evaluating passive knee flexors stiffness changes over time could provide supplementary insights into postoperative muscle recovery.
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Affiliation(s)
- Joffrey Drigny
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France.
| | | | - Cesar Praz
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Henri Guermont
- Service de Médecine du Sport, CHU de Caen Normandie, 14000 Caen, France
| | - Christophe Hulet
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
| | - Antoine Gauthier
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
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Bühl L, Müller S, Nüesch C, Boyer KA, Casto E, Mündermann A, Egloff C. Ambulatory knee biomechanics and muscle activity 2 years after ACL surgery: InternalBrace TM-augmented ACL repair versus ACL reconstruction versus healthy controls. BMC Musculoskelet Disord 2023; 24:785. [PMID: 37794432 PMCID: PMC10548591 DOI: 10.1186/s12891-023-06916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Little is known about knee mechanics and muscle control after augmented ACL repair. Our aim was to compare knee biomechanics and leg muscle activity during walking between the legs of patients 2 years after InternalBraceTM-augmented anterior cruciate ligament repair (ACL-IB) and between patients after ACL-IB and ACL reconstruction (ACL-R), and controls. METHODS Twenty-nine ACL-IB, 27 sex- and age-matched ACL-R (hamstring tendon autograft) and 29 matched controls completed an instrumented gait analysis. Knee joint angles, moments, power, and leg muscle activity were compared between the involved and uninvolved leg in ACL-IB (paired t-tests), and between the involved legs in ACL patients and the non-dominant leg in controls (analysis of variance and posthoc Bonferroni tests) using statistical parametric mapping (SPM, P < 0.05). Means and 95% confidence intervals (CI) of differences in discrete parameters (DP; i.e., maximum/minimum) were calculated. RESULTS Significant differences were observed in ACL-IB only in minimum knee flexion angle (DP: 2.4°, CI [-4.4;-0.5]; involved > uninvolved) and maximum knee flexion moment during stance (-0.07Nm/kg, CI [-0.13;-0.00]; involved < uninvolved), and differences between ACL-IB and ACL-R only in maximum knee flexion during swing (DP: 3.6°, CI [0.5;7.0]; ACL-IB > ACL-R). Compared to controls, ACL-IB (SPM: 0-3%GC, P = 0.015; 98-100%, P = 0.016; DP: -6.3 mm, CI [-11.7;-0.8]) and ACL-R (DP: -6.0 mm, CI [-11.4;-0.2]) had lower (maximum) anterior tibia position around heel strike. ACL-R also had lower maximum knee extension moment (DP: -0.13Nm/kg, CI [-0.23;-0.02]) and internal knee rotation moment (SPM: 34-41%GC, P < 0.001; DP: -0.03Nm/kg, CI [-0.06;-0.00]) during stance, and greater maximum semitendinosus activity before heel strike (DP: 11.2%maximum voluntary contraction, CI [0.1;21.3]) than controls. CONCLUSION Our results suggest comparable ambulatory knee function 2 years after ACL-IB and ACL-R, with ACL-IB showing only small differences between legs. However, the differences between both ACL groups and controls suggest that function in the involved leg is not fully recovered and that ACL tear is not only a mechanical disruption but also affects the sensorimotor integrity, which may not be restored after surgery. The trend toward fewer abnormalities in knee moments and semitendinosus muscle function during walking after ACL-IB warrants further investigation and may underscore the importance of preserving the hamstring muscles as ACL agonists. LEVEL OF EVIDENCE Level III, case-control study. TRIAL REGISTRATION clinicaltrials.gov, NCT04429165 (12/06/2020).
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Affiliation(s)
- Linda Bühl
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland.
| | - Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Erica Casto
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
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Dong W, Beynnon BD. A prospective study of joint position sense after anterior cruciate ligament injury, reconstruction with a bone-patella tendon-bone graft, and rehabilitation. Knee 2023; 42:51-56. [PMID: 36893696 DOI: 10.1016/j.knee.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Disruption of the anterior cruciate ligament (ACL) is associated with significant biomechanical and neuromuscular changes including deficits in joint proprioception. While previous studies have assessed joint position sense (JPS) in ACL deficient knees, methods have varied and few have done so with prospective study designs. The specific aim of this investigation was to determine the effect(s) of ACL reconstruction and recovery time may have on JPS. METHODS In this prospective study, we assess the effects of ACL reconstruction and rehabilitation on joint position sense in a temporal study. Twelve patients with unilateral ACL injuries were assessed pre-operatively and at 2, 4, 8 months post-op. JPS measurements were performed, while the subject was standing, with passive-active (P-A) and active-active (A-A) tests. Comparisons between the injured/reconstructed and contralateral, uninjured knee were evaluated in terms of real and absolute mean errors. RESULTS There were no statistically significant differences between the injured/reconstructed and contralateral/normal side with P-A or A-A testing at 2, 4, or 8 months. CONCLUSION We conclude that there is no difference in joint position sense between the injured and contralateral leg after ACL disruption and reconstruction beginning as early as 2 months post-op. This study provides further evidence that knee proprioception is not altered by ACL injury and reconstruction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Willie Dong
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA; Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA; Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA.
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Reliability of the active knee joint position sense test and influence of limb dominance and sex. Sci Rep 2023; 13:152. [PMID: 36599861 PMCID: PMC9813362 DOI: 10.1038/s41598-022-26932-2] [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: 06/22/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
The output of a sensorimotor performance can be measured with the joint position sense (JPS) test. However, investigations of leg dominance, sex and quality measures on this test are limited. Therefore, these potential influencing factors as well as reliability and consistency measures were evaluated for angular reproduction performance and neuromuscular activity during the active knee JPS test in healthy participants. Twenty healthy participants (10 males; 10 females; age 29 ± 8 years; height 165 ± 39 cm; body mass 69 ± 13 kg) performed a seated knee JPS test with a target angle of 50°. Measurements were conducted in two sessions separated by two weeks and consisted of two blocks of continuous angular reproduction (three minutes each block). The difference between reproduced and target angle was identified as angular error measured by an electrogoniometer. During reproduction, the neuromuscular activity of the quadriceps muscle was assessed by surface electromyography. Neuromuscular activity was normalized to submaximal voluntary contraction (subMVC) and displayed per muscle and movement phase. Differences between leg dominance and sex were calculated using Friedman-test (α = 0.05). Reliability measures including intraclass correlation coefficient (ICC), Bland-Altman analysis (bias ± limits of agreement (LoA)) and minimal detectable change (MDC) were analysed. No significant differences between leg dominance and sex were found in angular error and neuromuscular activity. Angular error demonstrated inter-session ICC scores of 0.424 with a bias of 2.4° (± 2.4° LoA) as well as MDC of 6.8° and moderate intra-session ICC (0.723) with a bias of 1.4° (± 1.65° LoA) as well as MDC of 4.7°. Neuromuscular activity for all muscles and movement phases illustrated inter-session ICC ranging from 0.432 to 0.809 with biases between - 2.5 and 13.6% subMVC and MDC from 13.4 to 63.9% subMVC. Intra-session ICC ranged from 0.705 to 0.987 with biases of - 7.7 to 2.4% subMVC and MDC of 2.7 to 46.5% subMVC. Leg dominance and sex seem not to influence angular reproduction performance and neuromuscular activity. Poor to excellent relative reliability paired with an acceptable consistency confirm findings of previous studies. Comparisons to pathological populations should be conducted with caution.
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