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Norris R, Morrison S, Price A, Pulford S, Meira E, O'Neill S, Williams H, Maddox TW, Carter P, Oldershaw RA. Inline dynamometry provides reliable measurements of quadriceps strength in healthy and ACL-reconstructed individuals and is a valid substitute for isometric electromechanical dynamometry following ACL reconstruction. Knee 2024; 46:136-147. [PMID: 38142660 DOI: 10.1016/j.knee.2023.12.006] [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: 08/23/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Quadriceps strength testing is recommended to guide rehabilitation and mitigate the risk of second injury following anterior cruciate ligament (ACL) reconstruction. Hand-held dynamometry is a practical alternative to electromechanical dynamometry but demonstrates insufficient reliability and criterion validity in healthy and ACL-reconstructed participants respectively. The purpose of this study is to investigate the reliability and concurrent validity of inline dynamometry for measuring quadriceps strength. The hypotheses are that intra-class correlation coefficient (ICC) values will be >0.90 for reliability and concurrent validity. METHODS This was a cross sectional study using a within-participant, repeated measures design. Isometric quadriceps testing was performed at 60° knee flexion in 50 healthy and 52 ACL-reconstructed participants. Interrater reliability, intrarater reliability, and concurrent validity of inline dynamometry was investigated through calculation of ICCs, Bland-Altman analysis, linear regression, standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS The lower bounds of the 95% confidence intervals were >0.90 for all reliability and validity ICCs in healthy and ACL-reconstructed participants, except for intrarater reliability in healthy participants using absolute scores (ICC = 0.936 [95% CI 0.890-0.963]). In ACL-reconstructed participants, Bland-Altman bias was 0.01 Nm/kg for absolute and average scores, limits of agreement were -11.74% to 12.59% for absolute scores, the SEM was 0.13Nm/kg (95% CI 0.10-0.17) and the MDC was 0.36Nm/kg (95% CI 0.28 - 0.47). CONCLUSION Inline dynamometry is a reliable and economical alternative to electromechanical dynamometry for the assessment of quadriceps strength following ACL-reconstruction. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT05109871).
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Affiliation(s)
- Richard Norris
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7AL, United Kingdom; Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, United Kingdom.
| | - Scot Morrison
- Physio Praxis PLLC, University Place, WA, USA; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37124 Verona, Italy
| | - Alan Price
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7AL, United Kingdom
| | - Sian Pulford
- Department of Medical Therapy and Support Services, Royal Liverpool and Broadgreen University Hospital NHS Trust, Thomas Dr, Liverpool L14 3LB, United Kingdom
| | - Erik Meira
- Physical Therapy Science Communication Group, Happy Valley, Oregon, USA
| | - Seth O'Neill
- School of Healthcare, Life Sciences, University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - Huw Williams
- Department of Medical Therapy and Support Services, Royal Liverpool and Broadgreen University Hospital NHS Trust, Thomas Dr, Liverpool L14 3LB, United Kingdom
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, United Kingdom; Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE, United Kingdom
| | - Paul Carter
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7AL, United Kingdom
| | - Rachel A Oldershaw
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, United Kingdom; MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
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Losciale JM, Truong LK, Zhang K, Scarr T, Xie H, Li LC, Mitchell C, Hunt MA, Whittaker JL. The association between knee muscle performance and clinical outcomes of knee function 1-4 years after a sport-related knee joint injury. Phys Ther Sport 2023; 64:147-155. [PMID: 37922747 DOI: 10.1016/j.ptsp.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Estimate the association between index leg knee muscle strength and rate of torque development (RTD), and self-reported and performance-based (i.e., hop) knee function in persons 1-4 years after a sport-related knee joint injury. METHODS Data were collected at baseline of a clinical trial. Assessments included the Knee injury and Osteoarthritis Outcome Score Sport & Recreation subscale (KOOSsport), 6-m timed hop (TH), and peak concentric isokinetic knee extensor and flexor torque and isometric RTD. Associations between peak torque and RTD with KOOSsport and TH were assessed using multivariable regression with nonlinear transformations. RESULTS 53 participants (64.2% female) were included. Knee extensor peak torque was nonlinearly related to TH time, with a strong inverse relationship at lower torque values that changed as torque increased. Results were inconsistent for flexor peak torque, extensor RTD and flexor RTD, with inconsistencies in relationship shape and estimates of association between primary and sensitivity analyses. There was no association between strength/RTD and KOOSsport. CONCLUSION There was a nonlinear relationship between knee extensor strength and hop function, with lower strength being associated with a stronger relationship. As strength values increased, the relationship attenuated. Knee extensor and flexor strength, or RTD, were not associated with self-reported function.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Thomas Scarr
- Allan McGavin Sports Medicine Clinic, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Cameron Mitchell
- Department of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada.
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Knurr KA, Cobian DG, Kliethermes SA, Stiffler-Joachim MR, Heiderscheit BC. The Influence of Quadriceps Strength and Rate of Torque Development on the Recovery of Knee Biomechanics During Running After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3171-3178. [PMID: 37681433 PMCID: PMC10985737 DOI: 10.1177/03635465231194617] [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] [Indexed: 09/09/2023]
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), altered surgical knee biomechanics during running is common. Although greater quadriceps strength is associated with more symmetrical running knee kinetics after ACLR, abnormal running mechanics persist even after resolution of quadriceps strength deficits. As running is a submaximal effort task characterized by limited time to develop knee extensor torque, quadriceps rate of torque development (RTD) may be more closely associated with recovery of running knee mechanics than peak torque (PT). PURPOSE To assess the influence of recovery in quadriceps PT and RTD symmetry on knee kinematic and kinetic symmetry during running over the initial 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 39 Division I collegiate athletes (106 testing sessions; 19 female) completed serial isometric performance testing and running analyses between 3 and 24 months after ACLR. Athletes performed maximal and rapid isometric knee extension efforts with each limb to assess PT and RTD between-limb symmetry indices (PTLSI and RTDLSI), respectively. Peak knee flexion difference (PKFDIFF) and peak knee extensor moment limb symmetry index (PKEMLSI) during running were computed. Multivariable linear mixed-effects models assessed the influence of PTLSI and RTDLSI on PKFDIFF and PKEMLSI over the initial 2 years after ACLR. RESULTS Significant main effects of RTDLSI (P < .001) and time (P≤ .02) but not PTLSI (P≥ .24) were observed for both PKFDIFF and PKEMLSI models. For a 10% increase in RTDLSI, while controlling for PTLSI and time, a 0.9° (95% CI, 0.5°-1.3°) reduction in PKFDIFF and a 3.5% (95% CI, 1.9%-5.1%) increase in PKEMLSI are expected. For every month after ACLR, a 0.2° (95% CI, 0.1°-0.4°) reduction in PKFDIFF and a 1.3% (95% CI, 0.6%-2.0%) increase in PKEMLSI are expected, controlling for PTLSI and RTDLSI. CONCLUSION Quadriceps RTDLSI was more strongly associated with symmetrical knee biomechanics during running compared with PTLSI or time throughout the first 2 years after ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, Division of Geriatrics, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Knurr KA, Lyon JP, Haack CR, Kliethermes SA, Cobian DG, Stiffler-Joachim MR, Binkley NC, Scerpella TA, Heiderscheit BC. Quadriceps Performance and Running Biomechanics Influence Femur BMD Changes after ACL Reconstruction in Collegiate Athletes. Med Sci Sports Exerc 2023; 55:1540-1547. [PMID: 37101347 PMCID: PMC10523868 DOI: 10.1249/mss.0000000000003186] [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] [Indexed: 04/28/2023]
Abstract
PURPOSE Reduced bone mineral density of the distal femur (BMD DF ) can persist long term after anterior cruciate ligament reconstruction (ACLR), even in athletes who return to high levels of competition. These deficits may have implications for the onset and progression of knee osteoarthritis. It is unknown if clinically modifiable factors are associated with losses in BMD DF . This study evaluated the potential influence of knee extensor peak torque (PT), rate of torque development (RTD), as well as peak knee flexion (PKF) angle and peak knee extensor moment (PKEM) during running, on longitudinal changes in BMD DF post-ACLR. METHODS After ACLR, 57 Division I collegiate athletes underwent serial whole-body dual-energy x-ray absorptiometry (DXA) scans between 3 and 24 months post-ACLR. Of these, 43 athletes also had isometric knee extensor testing (21 female, 105 observations), and 54 had running analyses (26 female, 141 observations). Linear mixed-effects models, controlling for sex, assessed the influence of surgical limb quadriceps performance (PT and RTD), running mechanics (PKF and PKEM), and time post-ACLR on BMD DF (5% and 15% of femur length). Simple slope analyses were used to explore interactions. RESULTS Athletes with RTD less than 7.20 (N·m)·kg -1 ·s -1 (mean) at 9.3 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.03). Athletes with PKEM during running less than 0.92 (N·m)·kg -1 (-1 SD below mean) at 9.8 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.02). Significant slopes were not detected at -1 SD below the mean for PT (1.75 (N·m)·kg -1 , P = 0.07) and PKF (31.3°, P = 0.08). CONCLUSIONS Worse quadriceps RTD and running PKEM were associated with a greater loss of BMD DF between 3 and 24 months post-ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
| | - James P. Lyon
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Colten R. Haack
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A. Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Daniel G. Cobian
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Neil C. Binkley
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI
| | - Tamara A. Scerpella
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Bryan C. Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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Farmer B, Anderson D, Katsavelis D, Bagwell JJ, Turman KA, Grindstaff TL. Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction. J Orthop Res 2022; 40:200-207. [PMID: 33934379 PMCID: PMC8560653 DOI: 10.1002/jor.25073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/25/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Following anterior cruciate ligament (ACL) reconstruction limb dominance for performing tasks is not considered when making rehabilitation progression decisions. The purpose of this study was to determine if strength and functional outcomes differ between individuals who injured their preferred or nonpreferred jumping limb and to determine if these same outcomes differ between individuals who injured their preferred or nonpreferred limb used to kick a ball. A secondary purpose was to determine the association of quadriceps strength and single-leg forward hop performance with patient self-reported function. Forty individuals with ACL reconstruction (age = 20.0 ± 4.6 years, height = 174.2 ± 12.7 cm, mass = 71.2 ± 12.7 kg, time since surgery = 5.3 ± 0.8 months) were included in the study. Primary outcome measures included, International Knee Documentation Committee Subjective Knee Form (IKDC) scores, quadriceps limb symmetry index (LSI) values, and single-leg forward hop LSI values. Limb preference was defined two ways, kicking a ball and performing a unilateral jump. There were no significant differences between groups based on injury to the preferred limb to kick a ball for any of the outcome variables. Individuals who injured their nonpreferred jumping limb demonstrated significantly (p = 0.05, d = 0.77) lower single-leg forward hop LSI values (81.1% ± 19.5%) compared to individuals who injured their preferred jumping limb (94.1% ± 12.6%), but demonstrated no differences in IKDC scores or quadriceps LSI values. Quadriceps LSI and single-leg forward hop LSI explained 73% of the variance in IKDC scores, but quadriceps LSI had the strongest association (r = 0.790). These findings suggests that limb preference influences single forward hop LSI values and should be considered following ACL reconstruction.
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Affiliation(s)
- Brooke Farmer
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | | | - Dimitrios Katsavelis
- Department of Exercise Science and Pre-Health Professions, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Jennifer J. Bagwell
- Department of Physical Therapy, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA, USA
| | | | - Terry L. Grindstaff
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE, USA
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Tavakkoli Oskouei S, Malliaras P, D Hill K, Garofolini A, Clark R, Perraton L. Assessment of ankle plantar flexor neuromuscular properties: A reliability study. J Electromyogr Kinesiol 2021; 61:102603. [PMID: 34563759 DOI: 10.1016/j.jelekin.2021.102603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022] Open
Abstract
This study aimed to determine test-retest reliability of ankle plantar flexor neuromuscular properties in healthy people to improve understanding of additional measurement and analysis procedures that may be used in outcome assessment. Ten healthy participants (age 29.60 ± 5.36 years) volunteered. Isometric torquemax, rate of torque development (RTD), rate of electromyography rise (RER), impulse, electromechanical delay (EMD), torque steadiness, and torque sensing were obtained during two testing sessions 60 min apart. ICC values ranged from 0.81 to 0.99, indicating good to excellent test-retest reliability. Lower bands of the 95% CIs were all above 0.75 apart from the early phase measures (≤50 ms) derived from explosive torque-time and EMG-time curves, which were between 0.32 and 0.73, indicating poor to moderate reliability. Heteroscedasticity was observed for RTD, impulse, and EMD. LOA as a function of the mean (X̅) for these measures ranged from meandifference ± 0.25X̅ to ± 0.68X̅. EMD showed excellent reliability (ICC = 0.90; 95% CI [0.63, 0.98]). Torque sensing and torque steadiness showed good reliability (0.81 ≤ ICC ≤ 0.89). Thus, ankle plantar flexor neuromuscular properties showed good to excellent test-retest reliability. However, reliability of measures in the early phase of muscle contraction were consistently lower than the late phase.
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Affiliation(s)
- Sanam Tavakkoli Oskouei
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Keith D Hill
- Ageing and Independent Living (RAIL) Research Centre, Monash University, Victoria, Australia
| | | | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Luke Perraton
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Changes in the Plantar Flexion Torque of the Ankle and in the Morphological Characteristics and Mechanical Properties of the Achilles Tendon after 12-Week Gait Retraining. Life (Basel) 2020; 10:life10090159. [PMID: 32842586 PMCID: PMC7555353 DOI: 10.3390/life10090159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose: Although the Achilles tendon (AT) is the largest and strongest tendon, it remains one of the most vulnerable tendons among elite and recreational runners. The present study aims to explore the effects of 12-week gait retraining (GR) on the plantar flexion torque of the ankle and the morphological and mechanical properties of the AT. Methods: Thirty-four healthy male recreational runners (habitual rearfoot strikers) who never tried to run in minimal shoes were recruited, and the intervention was completed (20 in the GR group vs. 14 in the control (CON) group). The participants in the GR group were asked to run in minimal shoes (INOV-8 BARE-XF 210) provided by the investigators with forefoot strike patterns during the progressive 12-week GR. Meanwhile, the participants in the CON group were instructed to run in their own running shoes, which they were familiar with, with original foot strike patterns and intensities. The morphological properties of the AT, namely, length and cross-sectional area (CSA), were obtained by using an ultrasound device. A dynamometer was utilized simultaneously to measure and calculate the plantar flexion torque of the ankle, the rate of torque development, the peak force of the AT, and the stress and strain of the AT. Results: After 12-week GR, the following results were obtained: (1) A significant time effect in the peak ankle plantarflexion torque was observed (p = 0.005), showing a 27.5% increase in the GR group; (2) A significant group effect in the CSA was observed (p = 0.027), specifically, the increase in CSA was significantly larger in the GR group than the CON group; (3) A significant time effect in the peak AT force was observed (p = 0.005), showing a 27.5% increase in the GR group. Conclusion: The effect of 12 weeks of GR is an increase in AT CSA, plantar flexor muscle strength of the ankle, and peak AT force during a maximal voluntary isometric contraction test. These changes in AT morphology and function could be positive for tendon health and could prevent future AT injury.
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Step descent strategy is altered bilaterally despite unilateral muscle strength impairment after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1508-1515. [PMID: 31201440 PMCID: PMC6911032 DOI: 10.1007/s00167-019-05554-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Muscle weakness and difficulty descending stairs are common after unilateral total knee arthroplasty (TKA), but the relationship between each is unclear. The purpose of this study was to compare lower extremity muscle strength, lower extremity support moments during step descent, and assess relationships between each. METHODS The study included 40 subjects (20 post-TKA, 20 control). Knee extensor, hip abductor, and hip external rotator strength were measured and biomechanical analyses of step descent performed. Patients with TKA were assessed 3 and 6 months post-surgery. RESULTS At 3 and 6 months post-TKA, operated limb hip external rotator and knee extensor strength were impaired compared to the non-operated limb (p < 0.01); however, no between-limb differences were observed during step descent. Compared to the control group, hip external rotator and knee extensor strength, total lower extremity support moment, and knee support moment during step descent were impaired post-TKA (p < 0.05). At 6 months post-TKA, knee extensor and hip external rotator strength correlated with total support moment during step descent (rs = 0.40, 0.41, p < 0.02). Hip abductor and external rotator strength negatively correlated with knee support moment during step descent (rs = - 0.35, - 0.39, p < 0.03). CONCLUSIONS Persistent operative limb knee extensor and hip external rotator muscle weakness are noted following unilateral TKA. Despite unilateral weakness, bilateral alterations in step descent strategy occur following TKA. Patients with TKA utilize hip musculature to reduce knee muscle demand during step descent, possibly contributing to limitations in long-term step descent performance.
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Lisee C, Birchmeier T, Yan A, Kuenze C. Associations between isometric quadriceps strength characteristics, knee flexion angles, and knee extension moments during single leg step down and landing tasks after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2019; 70:231-236. [PMID: 31669921 DOI: 10.1016/j.clinbiomech.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unclear of how peak knee extension torque and early rate of torque development outcomes are related to lower extremity loading and sagittal plane movement in activities of daily living and landing tasks despite consistent deficits after anterior cruciate ligament reconstruction. The purpose of this cross-section study is to assess the ability of quadriceps strength characteristics to predict movement patterns during a step down and single leg drop crossover hopping tasks. METHODS Fifty-two individuals with a unilateral history of anterior cruciate ligament reconstruction completed three trials of the step down and crossover hopping tasks on their involved limb. Participants completed three isometric knee extension contractions at 90° knee flexion with visual feedback to assess peak knee extension torque and rate of torque development during the first 0-100 ms and 100-200 ms of the contraction. FINDINGS Peak knee extension torque explained the greatest variance in peak knee extension moment (R2 = 40.4%, p < 0.001) and knee flexion angle (R2 = 46.7%, p < 0.001) during the crossover hop landing. Rate of torque development (0-100 ms) was the only predictor of knee flexion angle (R2 = 19.8%, p = 0.01) at initial contact during the crossover hopping landing. Rate of torque development (100-200 ms) explained 17.6% of the variance in peak knee extension moment during the step down (p = .03). INTERPRETATION Peak knee extension torque and early rate of torque development outcomes demonstrate limited relationships between movement of activities of daily living and sport-specific tasks. These limitations should be considered when interpreting the results of isometric strength testing in a clinical setting.
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Affiliation(s)
- Caroline Lisee
- Michigan State University, Department of Kinesiology, College of Education, East Lansing, MI, USA.
| | - Thomas Birchmeier
- Michigan State University, Department of Kinesiology, College of Education, East Lansing, MI, USA
| | - Arthur Yan
- Michigan State University, Division of Sports Medicine, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Christopher Kuenze
- Michigan State University, Department of Kinesiology, College of Education, East Lansing, MI, USA; Michigan State University, Division of Sports Medicine, College of Osteopathic Medicine, East Lansing, MI, USA
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Kline PW, Jacobs CA, Duncan ST, Noehren B. Rate of torque development is the primary contributor to quadriceps avoidance gait following total knee arthroplasty. Gait Posture 2019; 68:397-402. [PMID: 30594013 PMCID: PMC6384120 DOI: 10.1016/j.gaitpost.2018.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Following rehabilitation for total knee arthroplasty, "quadriceps avoidance gait", defined by limited knee flexion angle excursion during walking, persists and contributes to poor long-term outcomes. Given the presence of several post-surgical impairments, identifying the contribution of multiple factors to knee flexion angle excursion is important to developing targeted interventions to improve recovery after total knee arthroplasty. RESEARCH QUESTIONS Which outcomes continue to improve following rehabilitation for total knee arthroplasty? What are the primary contributors to impaired knee flexion angle excursion during walking following total knee arthroplasty? METHODS Peak muscle strength and rate of torque development of the quadriceps, hip abductors, and hip external rotators, five-time sit-to-stand test, Knee Injury & Osteoarthritis Outcome Score, and gait mechanics were assessed in 24 participants at three and six months post-surgery. Paired sample t-tests or Wilcoxon Signed-Rank tests were used to compare outcomes between assessments. Stepwise multiple linear regression were used to assess the contribution of each measure to knee flexion angle excursion. RESULTS Significant improvements were noted in all outcomes except hip external rotation rate of torque development, gait speed, and knee flexion angle excursion. Quadriceps rate of torque development and knee pain significantly contributed to knee flexion angle excursion at three months (Adjusted R2 = 0.342), while quadriceps rate of torque development and peak hip external rotation strength significantly contributed at six months (Adjusted R2 = 0.436). SIGNIFICANCE While higher pain levels at three months and greater peak hip external rotation muscle strength at six months contribute to impaired knee flexion angle excursion, quadriceps rate of torque development was the primary contributor to knee flexion angle excursion at both three and six months after surgery. Implementing strategies to maximize quadriceps rate of torque development during rehabilitation may help to reduce quadriceps avoidance gait after total knee arthroplasty.
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Affiliation(s)
- Paul W. Kline
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200
| | - Cale A. Jacobs
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508
| | - Stephen T. Duncan
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508
| | - Brian Noehren
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508,Division of Physical Therapy, College of Health Sciences, University of Kentucky, Room 204D Wethington Building, 900 South Limestone St, Lexington, KY, USA 40536
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