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Clark NC. Sensorimotor control of functional joint stability: Scientific concepts, clinical considerations, and the articuloneuromuscular cascade paradigm in peripheral joint injury. Musculoskelet Sci Pract 2024; 74:103198. [PMID: 39362022 DOI: 10.1016/j.msksp.2024.103198] [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: 08/24/2024] [Revised: 09/22/2024] [Accepted: 09/28/2024] [Indexed: 10/05/2024]
Abstract
Human movement depends on sensorimotor control. Sensorimotor control refers to central nervous system (CNS) control of joint stability, posture, and movement, all of which are effected via the sensorimotor system. Given the nervous, muscular, and skeletal systems function as an integrated "neuromusculoskeletal system" for the purpose of executing movement, musculoskeletal conditions can result in a cascade of impairments that affect negatively all three systems. The purpose of this article is to revisit concepts in joint stability, sensorimotor control of functional joint stability (FJS), joint instability, and sensorimotor impairments contributing to functional joint instability. This article differs from historical work because it updates previous models of joint injury and joint instability by incorporating more recent research on CNS factors, skeletal muscle factors, and tendon factors. The new 'articuloneuromuscular cascade paradigm' presented here offers a framework for facilitating further investigation into physiological and biomechanical consequences of joint injury and, in turn, how these follow on to affect physical activity (functional) capability. Here, the term 'injury' represents traumatic joint injury with a focus is on peripheral joint injury. Understanding the configuration of the sensorimotor system and the cascade of post-injury sensorimotor impairments is particularly important for clinicians reasoning rational interventions for patients with mechanical instability and functional instability. Concurrently, neurocognitive processing and neurocognitive performance are also addressed relative to feedforward neuromuscular control of FJS. This article offers itself as an educational resource and scientific asset to contribute to the ongoing research and applied practice journey for developing optimal peripheral joint injury rehabilitation strategies.
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Affiliation(s)
- Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK, United Kingdom.
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Avedesian JM. Think fast, stay healthy? A narrative review of neurocognitive performance and lower extremity injury. Musculoskelet Sci Pract 2024; 74:103186. [PMID: 39303448 DOI: 10.1016/j.msksp.2024.103186] [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: 08/05/2024] [Revised: 08/30/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Lower extremity (LE) injury has been problematic in athletic populations. While previous research has identified biomechanical and neuromuscular risk factors, more recent efforts have determined that neurocognitive performance (NP) may influence LE injury risk. OBJECTIVES To describe the present findings pertaining to the relationship between NP and LE injury. This review described potential cerebral neural mechanisms underpinning LE injury with a particular emphasis on the role of vision in sensorimotor integration. Lastly, newer technology such as stroboscopic eyewear, smartboards, and virtual/augmented reality were discussed for their utility in assessing and training NP. METHODS Narrative review that described NP and LE injury, as well as plausible mechanisms and training interventions. RESULTS NP appears to influence both LE biomechanics and LE injury risk. Athletes with worse NP demonstrated decreased knee flexion and increased frontal plane knee loading compared to better performing athletes. Most studies determined an association between NP and LE injury risk. Visual motor reaction time, processing speed, and working memory appear to be useful NP measures for identifying athletes at risk for LE injury. Various brain regions including the precuneus and lingual gyrus may be implicated as neural signatures for LE injury. While recently developed technology offer promise, far-transfer effects to LE injury risk reduction have yet to be substantially investigated. CONCLUSIONS NP should be considered an important component for identifying LE injury risk. Sports scientists and clinicians may consider a variety of assessments and interventions to quantify and train NP in conjunction with previously established protocols.
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Schoepp C, Dickschas J, Schmeling A, Perwanger F, Izadpanah K, Praetorius A. Treatment of Arthrogenic-Muscle-Inhibition in patients after knee-surgery with Motion-Activated-Neuromuscular stimulation - a case-series. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024. [PMID: 39231494 DOI: 10.1055/a-2365-9612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Arthrogenic muscle inhibition (AMI) presents a persistent challenge in postoperative knee rehabilitation and is often resistant to standard care. This case series examines the efficacy of Motion-Activated Neuromuscular Electrical Stimulation (mNMES) in addressing AMI refractory to rehabilitation after ACL (revision) surgery, patellar dislocation, trochleoplasty, or conservative treatment of the patellofemoral pain syndrome. Eight patients who had undergone extensive unsuccessful rehabilitation received six weeks of a novel mNMES treatment regimen. Outcome assessments included patient-reported outcome measures (PROMs) and AMI classification. Results revealed significant improvements in pain reduction, knee function, and AMI reduction. Despite study limitations, mNMES demonstrated promising outcomes and could be used as an adjunct to standard rehabilitation, offering potential for enhancing postoperative outcomes in patients refractory to conventional therapy. Further research is required to validate these findings and optimise treatment protocols.
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Affiliation(s)
- Christian Schoepp
- Klinik für Arthroskopische Chrirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
| | - Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, GERMANY
| | | | | | - Kaywan Izadpanah
- Universitätsklinikum Freiburg Chirurgische Universitatsklinik: Universitatsklinikum Freiburg Department Chirurgie, Freiburg, GERMANY
| | - Arthur Praetorius
- Klinik für Arthroskopische Chirurgie, Sportraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
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Grinberg A, Strong A, Häger CK. Longitudinal assessment of knee joint proprioception using weight-bearing and non-weight-bearing tests throughout rehabilitation after anterior cruciate ligament reconstruction. Phys Ther Sport 2024; 70:53-60. [PMID: 39278127 DOI: 10.1016/j.ptsp.2024.08.009] [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: 03/09/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Evaluate active knee joint position sense (JPS) throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR). DESIGN Longitudinal. SETTING Motion laboratory. PARTICIPANTS Twenty-two individuals post-ACLR and 22 activity-matched non-injured controls performed weight-bearing and non-weight-bearing knee JPS tests. The ACLR participants performed at three functional timepoints: T1, able to perform single-leg sit-to-stand; T2, able to hop maximally; T3, cleared for return to sports. Controls performed on one occasion. MAIN OUTCOME MEASURES Constant, absolute, variable errors (CE, AE, VE) and interlimb symmetry estimates (100% signifying perfect symmetry), for 40° and 65° knee flexion target angles. RESULTS For the weight-bearing 40° condition, CE and AE of the ACLR knee significantly increased from T1 to T2 (P = 0.010) and T1 to T3 (P = 0.002). Consequently, interlimb asymmetry for AE significantly increased from T1 (AEsym% = 101.2% ± 55.4%) to T3 (AEsym% = 139.7% ± 54.8%). Compared to controls, AE for the ACLR knee was significantly smaller at T1 (P = 0.016). No other significant differences were observed. CONCLUSIONS Smaller JPS errors at early rehabilitation while weight-bearing may have been due to heightened quadriceps activation and increased γ motor neuron sensitivity, compensating for deficient ACL mechanoreceptors. In contrast, non-weight-bearing testing did not reveal changes over time. Clinicians are advised to consider these distinctions when assessing proprioception at different rehabilitation stages.
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Affiliation(s)
- Adam Grinberg
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Andrew Strong
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Gilliam JR, Sahu PK, Vendemia JMC, Silfies SP. Association between seated trunk control and cortical sensorimotor white matter brain changes in patients with chronic low back pain. PLoS One 2024; 19:e0309344. [PMID: 39208294 PMCID: PMC11361694 DOI: 10.1371/journal.pone.0309344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024] Open
Abstract
Trunk control involves integration of sensorimotor information in the brain. Individuals with chronic low back pain (cLBP) have impaired trunk control and show differences in brain structure and function in sensorimotor areas compared with healthy controls (HC). However, the relationship between brain structure and trunk control in this group is not well understood. This cross-sectional study aimed to compare seated trunk control and sensorimotor white matter (WM) structure in people with cLBP and HC and explore relationships between WM properties and trunk control in each group. Thirty-two people with cLBP and 35 HC were tested sitting on an unstable chair to isolate trunk control; performance was measured using the 95% confidence ellipse area (CEA95) of center-of-pressure tracing. A WM network between cortical sensorimotor regions of interest was derived using probabilistic tractography. WM microstructure and anatomical connectivity between cortical sensorimotor regions were assessed. A mixed-model ANOVA showed that people with cLBP had worse trunk control than HC (F = 12.96; p < .001; ηp2 = .091). There were no differences in WM microstructure or anatomical connectivity between groups (p = 0.564 to 0.940). In the cLBP group, WM microstructure was moderately correlated (|r| = .456 to .565; p ≤ .009) with trunk control. Additionally, the cLBP group demonstrated stronger relationships between anatomical connectivity and trunk control (|r| = .377 to .618 p < .034) compared to the HC group. Unique to the cLBP group, WM connectivity between right somatosensory and left motor areas highlights the importance of interhemispheric information exchange for trunk control. Parietal areas associated with attention and spatial reference frames were also relevant to trunk control. These findings suggest that people with cLBP adopt a more cortically driven sensorimotor integration strategy for trunk control. Future research should replicate these findings and identify interventions to effectively modulate this strategy.
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Affiliation(s)
- John R. Gilliam
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Pradeep K. Sahu
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Jennifer M. C. Vendemia
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Sheri P. Silfies
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
- Physical Therapy Program, University of South Carolina, Columbia, SC, United States of America
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McCarthy-Ryan MF, Mellalieu SD, Jones H, Bruton A, Moore IS. Characterizing Longitudinal Alterations in Postural Control Following Lower Limb Injury in Professional Rugby Union Players. J Appl Biomech 2024; 40:287-295. [PMID: 38866380 DOI: 10.1123/jab.2023-0259] [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: 10/30/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 06/14/2024]
Abstract
Assessment of player's postural control following a lower limb injury is of interest to sports medicine practitioners due to its fundamental role in daily tasks and sporting activities. The aim was to longitudinally monitor professional rugby union players' postural control during each phase of the rehabilitation program (acute, middle, and late) following a lower limb injury. Seven male rugby union players (height 1.80 [0.02] m; mass 100.3 [11.4] kg; age 24 [4] y) sustained a time loss, noncontact lower limb injury. Static postural control was assessed via sway path (in meters), and dynamic postural control was assessed via vertical postural stability index. Group differences (P < .05) were reported across the acute, middle, and late phase. Smaller magnitudes of sway path were observed for eyes-open sway path, and for the middle and late phase smaller magnitudes of vertical postural stability index (P < .05) at the end session compared with first session. Whereas larger magnitudes of vertical postural stability index were found between baseline and the last session (P < .05). Large interindividual and intraindividual variation was apparent across the 3 phases of rehabilitation. Postural control improvements were identified during rehabilitation. However, postural control did not return to baseline, with altered kinetics throughout each rehabilitation phase.
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Affiliation(s)
- Molly F McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Stephen D Mellalieu
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Holly Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Adam Bruton
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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Guan Y, Li J, Wei Y, Shi PT, Yang C, Yun X, Quan Q, Wang WJ, Yu XG, Wei M. Brain functional connectivity alterations in patients with anterior cruciate ligament injury. Brain Res 2024; 1836:148956. [PMID: 38657888 DOI: 10.1016/j.brainres.2024.148956] [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: 01/19/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
Recent advancements in neuroimaging have illustrated that anterior cruciate ligament (ACL) injuries could impact the central nervous system (CNS), causing neuroplastic changes in the brain beyond the traditionally understood biomechanical consequences. While most of previous functional magnetic resonance imaging (fMRI) studies have focused on localized cortical activity changes post-injury, emerging research has suggested disruptions in functional connectivity across the brain. However, these prior investigations, albeit pioneering, have been constrained by two limitations: a reliance on small-sample participant cohorts, often limited to two to three patients, potentially limiting the generalizability of findings, and an adherence to region of interest based analysis, which may overlook broader network interactions. To address these limitations, our study employed resting-state fMRI to assess whole-brain functional connectivity in 15 ACL-injured patients, comparing them to matched controls using two distinct network analysis methods. Using Network-Based Statistics, we identified widespread reductions in connectivity that spanned across multiple brain regions. Further modular connectivity analysis showed significant decreases in inter-modular connectivity between the sensorimotor and cerebellar modules, and intra-modular connectivity within the default-mode network in ACL-injured patients. Our results thus highlight a shift from localized disruptions to network-wide dysfunctions, suggesting that ACL injuries induce widespread CNS changes. This enhanced understanding has the potential to stimulate the development of strategies aiming to restore functional connectivity and improve recovery outcomes.
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Affiliation(s)
- Yu Guan
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Ji Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Yu Wei
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Peng-Tao Shi
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Chen Yang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Xing Yun
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Qi Quan
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Juan Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Xin-Guang Yu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Min Wei
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China.
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Hogg JA, Barger NB, Bruce JR, White CC, Myer GD, Diekfuss JA. Improved Quadriceps Torque Production With Optimized Biofeedback in Patients After Anterior Cruciate Ligament Reconstruction. J Strength Cond Res 2024:00124278-990000000-00510. [PMID: 39074249 DOI: 10.1519/jsc.0000000000004883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Abstract
Hogg, JA, Barger, NB, Bruce, JR, White, CC, Myer, GD, and Diekfuss, JA. Improved quadriceps torque production with optimized biofeedback in patients after anterior cruciate ligament reconstruction. J Strength Cond Res XX(X): 000–000, 2024—Optimizing performance through intrinsic motivation and attention for learning: prevention rehabilitation exercise play (OPTIMAL PREP) training strategies incorporate motor learning principles to enhance movement acquisition and retention. We aimed to use OPTIMAL PREP biofeedback to evaluate its potential to improve quadriceps and hamstring torque production in patients with anterior cruciate ligament reconstruction (ACL-R). Thirteen subjects 23 ± 19 months post ACL-R completed 5 concentric quadriceps/hamstrings repetitions on an isokinetic dynamometer for each limb and counterbalanced condition at 60°·s−1. For the control condition, subjects were instructed to perform the exercise “as hard and fast as possible.” For the OPTIMAL PREP condition, subjects were additionally told that “Research shows that if you focus on moving the line on the screen (external focus) you will exhibit greater quadriceps output (enhanced expectancies)” and were given the choice of graphical representation for the biofeedback (autonomy support). Quadriceps and hamstrings peak torque, rate of force development, and torque-angle waveforms were analyzed with 2 × 2 RMANOVAs (a priori
>0.06). The ACL-R limb demonstrated increased quadriceps peak torque in the OPTIMAL PREP condition than in the control condition (
= 0.13, interaction p = 0.21, pairwise Cohen's d = 0.63). Anterior cruciate ligament reconstruction limb quadriceps deficits remained near terminal extension (14–45°; peak Cohen's d = 0.57, p < 0.001). For hamstrings peak torque, we observed moderate effects for condition (OPTIMAL PREP greater;
= 0.10, p = 0.29) and limb (uninvolved greater;
= 0.13, p = 0.22). Easily implementable OPTIMAL PREP training strategies improved ACL-R limb quadriceps torque production, resulting in between-limb parity. However, asymmetries still existed near terminal extension.
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Affiliation(s)
- Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, Tennessee
| | - Nathan B Barger
- Department of Athletics, The University of Tennessee Chattanooga, Chattanooga, Tennessee
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Charles C White
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Youth Physical Development Center, Cardiff Metropolitan University, Wales, United Kingdom; and
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
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Robey NJ, Buchholz O, Murphy SP, Heise GD. The effect of stroboscopic visual disruption on static stability measures in anterior cruciate ligament reconstructed individuals. Clin Biomech (Bristol, Avon) 2024; 117:106299. [PMID: 38945069 DOI: 10.1016/j.clinbiomech.2024.106299] [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: 01/19/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Those who undergo ACL reconstruction are at an increased risk of suffering a second ACL injury. A suggested rationale for the increased injury risk is sensory reweighting to the visual system to compensate for a lack of somatosensory information from the knee. Understanding this proposed visual reliance may help clinicians improve return to sport outcomes and reduce the risk of a subsequent ACL injury. METHODS Thirteen ACL reconstructed individuals and thirteen matched controls completed two common static postural control assessments under three different visual conditions; eyes open, low visual disruption, and high visual disruption. Center of pressure data was collected for 30 s using force plates. Static postural stability was evaluated using the following: 1) root mean square distance, 2) mean velocity, 3) sway area, and 4) mean frequency. FINDINGS No significant interactions between group and vision were observed. Significant differences between groups were observed for mean frequency in the double-limb stance (p < .05). Additionally, significant differences were observed for visual conditions in both double-limb (mean velocity; p < .05) and single-limb stances (root mean square distance, mean velocity, sway area, and mean frequency; p < .05). INTERPRETATION The findings of the current study suggest that ACL reconstructed individuals, who are at least two years removed from surgery, do not rely on visual information to a greater extent than controls during static postural stability assessments. Stroboscopic glasses may be a cost-effective alternative for rehabilitation purposes compared to the traditional binary eyes open vs. eyes closed methods.
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Affiliation(s)
- Nathan J Robey
- Department of Health and Human Development, Western Washington University, Bellingham, WA, USA.
| | - Otto Buchholz
- Department of Wellness and Movement Sciences, Eastern Washington University, Cheney, WA, USA.
| | - Shane P Murphy
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA.
| | - Gary D Heise
- Sports and Exercise Science, University of Northern Colorado, Greeley, CO, USA.
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Sinsurin K, Kiratisin P, Irawan DS, Vachalathiti R, Richards J. Residual deficits of knee and hip joint coordination and clinical performance after return to sports in athletes with anterior cruciate ligament reconstruction. Knee Surg Relat Res 2024; 36:22. [PMID: 38886848 PMCID: PMC11184681 DOI: 10.1186/s43019-024-00213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Biomechanical changes and neuromuscular adaptations have been suggested as risk factors of secondary injury in individuals after anterior cruciate ligament reconstruction (ACLr). To achieve a better understanding of preventive mechanisms, movement quality is an important factor of consideration. Few studies have explored time-series analysis during landing alongside clinical performance in injured and non-injured individuals. The purpose of the study was to investigate the biomechanical risks of recurrent injury by comparing clinical and jump-landing performance assessments between athletes with ACLr and healthy controls. METHOD This study was observational study. Sixteen athletes with and without ACLr voluntarily participated in clinical and laboratory measurements. Single-leg hop distance, isokinetic tests, landing error score, and limb symmetry index (LSI) were included in clinical report. Lower limb movements were recorded to measure joint biomechanics during multi-directional landings in motion analysis laboratory. Hip-knee angle and angular velocity were explored using discrete time-point analysis, and a two-way mixed analysis of variance (2 × 4, group × jump-landing direction) was used for statistical analysis. Time series and hip-knee coordination analyses were performed using statistical parametric mapping and descriptive techniques. RESULTS Significantly lower single-leg hop distance was noted in ACLr group (158.10 cm) compared to control group (178.38 cm). Although the hip and knee moments showed significant differences between four directions (p < 0.01), no group effect was observed (p > 0.05). Statistical parametric mapping showed significant differences (p ≤ 0.05) between groups for hip abduction and coordinate plot of hip and knee joints. Athletes with ACLr demonstrated a higher velocity of hip adduction. Time-series analysis revealed differences in coordination between groups for frontal hip and knee motion. CONCLUSIONS Athletes with ACLr landed with poor hip adduction control and stiffer knee on the involved side. Multi-directions landing should be considered over the entire time series, which may facilitate improved movement quality and return to sports in athletes with ACLr.
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Affiliation(s)
- Komsak Sinsurin
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Pongthanayos Kiratisin
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand
| | - Dimas Sondang Irawan
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand
- Physical Therapy Department, Faculty of Health Sciences, University of Muhammadiyah Malang, Malang, Indonesia
| | - Roongtiwa Vachalathiti
- Musculoskeletal Physical Therapy Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
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Rodriguez KM, Moon J, Krishnan C, Palmieri-Smith RM. Conditioning of Motor Evoked Responses After Anterior Cruciate Ligament Reconstruction: Effects of Stimulus Intensity. Sports Health 2024:19417381241257258. [PMID: 38864306 DOI: 10.1177/19417381241257258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Operant conditioning of motor evoked torque (MEPTORQUE) can directly target the corticospinal pathway in patients with anterior cruciate ligament (ACL) reconstruction. However, it remains unclear whether operant conditioning can elicit short-term improvements in corticospinal excitability and whether these improvements are influenced by stimulus intensity. HYPOTHESIS Quadriceps MEPTORQUE responses can be upconditioned in a single session and will elicit short-term adaptations in corticospinal excitability, with higher stimulus intensities eliciting greater effects. STUDY DESIGN Randomized controlled laboratory study. LEVEL OF EVIDENCE Level 2. METHODS Thirty-six participants were assessed during a single session of an operant conditioning protocol. Participants were randomized into 1 of 3 groups for stimulus intensity used during operant conditioning based on the participant's active motor threshold (AMT: 100%, 120%, and 140%). Quadriceps MEPTORQUE amplitude was evaluated during a block of control transcranial magnetic stimulation trials (CTRL) to establish baseline corticospinal excitability, and 3 blocks of conditioning trials (COND) during which participants trained to upcondition their MEPTORQUE. MEPTORQUE recruitment curves were collected to evaluate the effect of operant conditioning on acute corticospinal adaptations. RESULTS Participants with ACL reconstruction could upcondition their MEPTORQUE in a single session (P < 0.01; CTRL, 17.27 ± 1.28; COND, 21.35 ± 1.28 [mean ± standard error [SE] in N·m]), but this ability was not influenced by the stimulus intensity used during training (P = 0.84). Furthermore, significant improvements in corticospinal excitability were observed (P = 0.05; PRE, 687.91 ± 50.15; POST, 761.08 ± 50.15 [mean ± SE in N·m %AMT]), but stimulus intensity did not influence corticospinal adaptations (P = 0.67). CONCLUSION Operant conditioning can elicit short-term neural adaptations in ACL-reconstructed patients. Future operant conditioning paradigms may effectively use any of the 3 stimulus intensities studied herein. CLINICAL RELEVANCE Operant conditioning may be a feasible approach to improve corticospinal excitability after ACL reconstruction.
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Affiliation(s)
| | - Jungsun Moon
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, Michigan
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
- Mechanical Engineering, University of Michigan
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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Reuter S, Lambert C, Schadt M, Imhoff AB, Centner C, Herbst E, Stöcker F, Forkel P. Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:73-78. [PMID: 38657648 DOI: 10.1055/a-2285-7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients. METHODS A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured. RESULTS The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115). CONCLUSION Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.
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Affiliation(s)
- Sven Reuter
- SRH University of Applied Sciences Heidelberg: SRH Hochschule Heidelberg, Gera, GERMANY
| | - Christophe Lambert
- Deparment of Trauma and Orthopedic Surgery, University of Witten/Herdecke: Universitat Witten/Herdecke, Cologne, GERMANY
| | - Maja Schadt
- Department of Biomechanics in Sports, Technical University Munich: Technische Universitat Munchen, München, GERMANY
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Munich University of Technology: Technische Universitat Munchen, München, GERMANY
| | - Christoph Centner
- University of Freiburg im Breisgau: Albert-Ludwigs-Universitat Freiburg, Freiburg, GERMANY
| | - Elmar Herbst
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Fabian Stöcker
- Department of Biomechanics in Sports, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
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13
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Paredes R, Crasto C, Mesquita Montes A, Arias-Buría JL. Changes in co-contraction magnitude during functional tasks following anterior cruciate ligament reconstruction: A systematic review. Knee 2024; 48:243-256. [PMID: 38781829 DOI: 10.1016/j.knee.2024.05.005] [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: 10/10/2023] [Revised: 03/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic surgery procedure whose incidence has increased over the past few decades. Nevertheless, it is believed that neuromuscular control remains altered from the early stages after ACLR to later years. Therefore, the aim of this study was to systematically evaluate the magnitude of co-contraction during functional tasks in subjects with unilateral ACLR. METHODS A systematic review design was followed. The search strategy was conducted in PubMed, Scopus, EBSCO, PEDro, Cochrane Library, and Web of Science databases from inception to March 2024. The inclusion criteria involved studies using electromyography (EMG) data to calculate muscle pair activation via the co-contraction index (CCI) in ACLR individuals during functional tasks. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and study quality was evaluated using National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS The search strategy found a total of 792 studies, of which 15 were included in this systematic review after reviewing the eligibility criteria. The magnitude of co-contraction was assessed in a total of 433 ACLR individuals and 206 controls during functional tasks such as hop, drop-land, step-up/step-down, and gait. Overall, approximately 79.6% of individuals who had undergone ACLR exhibited increased levels of co-contraction magnitude in the ACLR limb, while 8.5% showed low co-contraction levels. CONCLUSIONS The findings of the review suggest that, during functional tasks, most individuals who have undergone ACLR exhibit changes of co-contraction magnitude in the involved limb.
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Affiliation(s)
- Ricardo Paredes
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Carlos Crasto
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - António Mesquita Montes
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Zuleger TM, Slutsky-Ganesh AB, Grooms DR, Yuan W, Barber Foss KD, Howell DR, Myer GD, Diekfuss JA. High magnitude exposure to repetitive head impacts alters female adolescent brain activity for lower extremity motor control. Brain Res 2024; 1828:148785. [PMID: 38272157 PMCID: PMC11110884 DOI: 10.1016/j.brainres.2024.148785] [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: 10/27/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Contact and collision sport participation among adolescent athletes has raised concerns about the potential negative effects of cumulative repetitive head impacts (RHIs) on brain function. Impairments from RHIs and sports-related concussions (SRC) may propagate into lingering neuromuscular control. However, the neural mechanisms that link RHIs to altered motor control processes remain unknown. The purpose of this study was to isolate changes in neural activity for a lower extremity motor control task associated with the frequency and magnitude of RHI exposure. A cohort of fifteen high school female soccer players participated in a prospective longitudinal study and underwent pre- and post-season functional magnetic resonance imaging (fMRI). During fMRI, athletes completed simultaneous bilateral ankle, knee, and hip flexion/extension movements against resistance (bilateral leg press) to characterize neural activity associated with lower extremity motor control. RHI data were binned into continuous categories between 20 g - 120 g (defined by progressively greater intervals), with the number of impacts independently modeled within the fMRI analyses. Results revealed that differential exposure to high magnitude RHIs (≥90 g - < 110 g and ≥ 110 g) was associated with acute changes in neural activity for the bilateral leg press (broadly inclusive of motor, visual, and cognitive regions; all p < 0.05 & z > 3.1). Greater exposure to high magnitude RHIs may impair lower extremity motor control through maladaptive neural mechanisms. Future work is warranted to extend these mechanistic findings and examine the linkages between RHI exposure and neural activity as it relates to subsequent neuromuscular control deficits.
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Affiliation(s)
- Taylor M Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; University of Cincinnati, Neuroscience Graduate Program, Cincinnati, OH, USA.
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
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15
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Bilateral neuromuscular control in patients one year after unilateral ACL rupture or reconstruction. A cross-sectional study. Heliyon 2024; 10:e24364. [PMID: 38268828 PMCID: PMC10803901 DOI: 10.1016/j.heliyon.2024.e24364] [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: 07/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Objectives To compare bilateral neuromuscular control in patients one year after anterior cruciate ligament reconstruction (ACL-R) or conservative treatment (ACL-C) to healthy controls (ACL-I). Design Cross-sectional study. Setting Electromyography of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded during stair descent and anterior tibial translation. Each step of stair descent was divided into pre-activity, weight-acceptance and push-off phase. Pre-activation, short, medium (MLR) and long latency responses (LLR) were defined for reflex activity. Participants N = 38 patients one year after ACL reconstruction (ACL-R), N = 26 participants with conservative treatment one year after ACL rupture (ACL-C), N = 38 healthy controls with an intact ACL (ACL-I). Main outcome measures Normalized root mean squares per muscle and phase (α = 0.05). Results During stair descent, within-group leg differences were found for the quadriceps in ACL-R during all phases and for the BF in ACL-C during weight-acceptance. Between-group leg differences were found for BF in both patient groups compared to ACL-I during push-off.Between-group differences in pre-activation for VM between ACL-R and ACL-C, and between ACL-C and ACL-I were found, and as LLR between patients and ACL-R versus ACL-I. Pre-activation of BF and MLR of ST differed for each patient group compared to ACL-I. Conclusions Bilateral neuromuscular alterations are still present one year after ACL rupture or reconstruction.
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Aglaja Busch
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopedics, 14469, Potsdam, Germany
| | - Philipp Henle
- Lindenhof Group AG, Sonnenhof Orthopaedic Center, 3006, Bern, Switzerland
- University of Bern, Bern University Hospital, Inselspital, Department of Orthopaedic Surgery and Traumatology, 3010, Bern, Switzerland
| | - Sven Bruhn
- University of Rostock, Institute of Sports Science, 18051, Rostock, Germany
| | - Dirk Vissers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
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16
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Vitharana TN, King E, Moran K. Sensorimotor Dysfunction Following Anterior Cruciate Ligament Reconstruction- an Afferent Perspective: A Scoping Review. Int J Sports Phys Ther 2024; 19:1410-1437. [PMID: 38179582 PMCID: PMC10761632 DOI: 10.26603/001c.90862] [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: 01/30/2023] [Accepted: 10/19/2023] [Indexed: 01/06/2024] Open
Abstract
Background Sensorimotor dysfunction is thought to occur following anterior cruciate ligament (ACL) injury which may have implications on future reinjury risk. Dysfunction has been demonstrated within the efferent component of the sensorimotor system. However, no reviews have examined the two main components of the afferent system: the visual and somatosensory systems. Hypothesis/Purpose This study aimed to report differences in function (central processing and local processing) within the (1) somatosensory and (2) visual systems between individuals following anterior cruciate ligament reconstruction (ACLR) and healthy controls (between-subject). The study also aimed to report differences in function within the two systems between the two limbs of an individual following ACLR (within-subject). Study Design Scoping review. Methods A search was conducted in PubMed, SPORTDiscus, CINAHL, Medline and Embase up until September 2021. Level I-IV studies assessing somatosensory and visual systems were included if they compared ACLR limbs to the uninjured contralateral limb (within-subject) or a healthy control limb (between-group). The function of somatosensory and visual systems was assessed across both central processing (processing of information in the central cortex) and local processing (all other assessments outside of central processing of information). Results Seventy studies were identified (52 somatosensory, 18 visual). Studies examining somatosensory central processing demonstrated significant differences; 66% of studies exhibited within-subject differences and 100% of the studies exhibited between-group differences. Studies examining local somatosensory processing had mixed findings; 40% of the 'joint position sense (JPS)' and 'threshold to detect motion (TTDM)' studies showed significant within-subject differences (JPS=0.8°-3.8° and TTDPM=0.2°-1.4°) and 42% demonstrated significant between-group differences (JPS=0.4°-5° and TTDPM=0.3°-2.8°). Eighty-three percent of visual central processing studies demonstrated significant dysfunction between-groups with no studies assessing within-subject differences. Fifty percent of the studies examining local visual processing demonstrated a significant between-group difference. Conclusion Significant differences in central processing exist within somatosensory and visual systems following ACLR. There is mixed evidence regarding local somatosensory and visual processing. Increased compensation by the visual system and local visual processing dysfunction may occur in conjunction with somatosensory dysfunction.
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Affiliation(s)
- Thilina N Vitharana
- Sports Medicine Sports Surgery Clinic
- School of Health and Human Performance Dublin City University
| | - Enda King
- Qatar Orthopaedic and Sports Medicine Hospital
- Department of Life Sciences University of Roehampton
| | - Kieran Moran
- School of Health and Human Performance Dublin City University
- Insight Centre for Data Analytics Dublin City University
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17
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Riehm CD, Zuleger T, Diekfuss JA, Arellano E, Myer GD. The Evolution of Neuroimaging Technologies to Evaluate Neural Activity Related to Knee Pain and Injury Risk. Curr Rev Musculoskelet Med 2024; 17:14-22. [PMID: 38109007 PMCID: PMC10766917 DOI: 10.1007/s12178-023-09877-5] [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] [Accepted: 11/26/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW In this review, we present recent findings and advancements in the use of neuroimaging to evaluate neural activity relative to ACL injury risk and patellofemoral pain. In particular, we describe prior work using fMRI and EEG that demonstrate the value of these techniques as well as the necessity of continued development in this area. Our goal is to support future work by providing guidance for the successful application of neuroimaging techniques that most effectively expose pain and injury mechanisms. RECENT FINDINGS Recent studies that utilized both fMRI and EEG indicate that athletes who are at risk for future ACL injury exhibit divergent brain activity both during active lower extremity movement and at rest. Such activity patterns are likely due to alterations to cognitive, visual, and attentional processes that manifest as coordination deficits during naturalistic movement that may result in higher risk of injury. Similarly, in individuals with PFP altered brain activity in a number of key regions is related to subjective pain judgements as well as measures of fear of movement. Although these findings may begin to allow objective pain assessment and identification, continued refinement is needed. One key limitation across both ACL and PFP related work is the restriction of movement during fMRI and EEG data collection, which drastically limits ecological validity. Given the lack of sufficient research using EEG and fMRI within a naturalistic setting, our recommendation is that researchers target the use of mobile, source localized EEG as a primary methodology for exposing neural mechanisms of ACL injury risk and PFP. Our contention is that this method provides an optimal balance of spatial and temporal resolution with ecological validity via naturalistic movement.
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Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Taylor Zuleger
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Neuroscience Graduate Program, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Emilio Arellano
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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18
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Combalia A, Sanchez-Vives MV, Donegan T. Immersive virtual reality in orthopaedics-a narrative review. INTERNATIONAL ORTHOPAEDICS 2024; 48:21-30. [PMID: 37566225 PMCID: PMC10766717 DOI: 10.1007/s00264-023-05911-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management. METHODS The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies. RESULTS Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients' attention, anxiety reduction, and specific virtual-body transformations. CONCLUSION Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas.
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Affiliation(s)
- A Combalia
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), c. Villarroel, 170, 08036, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain.
| | - M V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain.
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
| | - T Donegan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
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Qiu J, Jiang T, Ong MTY, He X, Choi CY, Fu SC, Fong DTP, Yung PSH. Bilateral impairments of quadriceps neuromuscular function occur early after anterior cruciate ligament injury. Res Sports Med 2024; 32:72-85. [PMID: 35635286 DOI: 10.1080/15438627.2022.2079986] [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: 02/24/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
The study aimed to investigate the impairments in quadriceps neuromuscular function, including strength, rate of torque development (RTD) and activation failure (QAF) early after an ACL injury. A cross-sectional study was conducted. Thirty physically active patients with a primary ACL injury within three months, aged 18 to 40 years old, and who were scheduled for ACL reconstruction were included. Thirty matched healthy controls were also recruited. All the outcomes were measured on an isokinetic dynamometer with knee flexion at 45°. Quadriceps strength was measured by maximal voluntary isometric contractions (MVIC). Early (RTD0-50) and late (RTD100-200) phases of RTD were retrieved from the MVIC test from 0 to 50 ms and 100-200 ms, respectively. QAF was quantified by the central activation ratio (CAR) measured by superimposed burst technique. The results of Mann-Whitney U test showed that compared with the healthy limbs, the injured limbs of the ACL group showed lower quadriceps strength (P < 0.001), RTD0-50 (P < 0.001) and RTD100-200 (P < 0.001); the uninjured limbs showed lower quadriceps strength (P = 0.009), RTD0-50 (P = 0.006) as well as greater QAF (P = 0.010). To conclude, bilateral quadriceps suffered from neuromuscular impairments early after an ACL injury.
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Affiliation(s)
- Jihong Qiu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tianzhi Jiang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
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20
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Reiche E, Collins K, Genoese F, Walaszek M, Triplett A, Kuenze C, Harkey M, Baez S. Lower Extremity Reaction Time in Individuals With Contact Versus Noncontact Anterior Cruciate Ligament Injuries After Reconstruction. J Athl Train 2024; 59:66-72. [PMID: 37248503 PMCID: PMC10783466 DOI: 10.4085/1062-6050-0428.22] [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] [Indexed: 05/31/2023]
Abstract
CONTEXT Deficits in perceptual-motor function, like visuomotor reaction time (VMRT), are risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Noncontact ACL injuries have been associated with slower reaction time, but whether this association exists for patients with contact ACL injuries is unknown. Exploring differences in VMRT among individuals with contact versus noncontact ACL injuries may provide a more comprehensive understanding of modifiable risk factors. OBJECTIVE To compare lower extremity VMRT (LEVMRT) in individuals with contact or noncontact ACL injuries after ACL reconstruction (ACLR). DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 36 participants with primary, unilateral ACLR completed an LEVMRT assessment (contact ACL injury = 20 [56%], noncontact ACL injury = 16 [44%]). MAIN OUTCOME MEASURE(S) The LEVMRT was assessed bilaterally and collected using a series of wireless light discs deactivated by individuals with their feet. The ACLR-active LEVMRT (ie, ACLR limb is deactivating lights) and ACLR-stable LEVMRT were compared using separate analyses of covariance to determine the association with contact or noncontact injury using time since surgery as a covariate. RESULTS After controlling for time since surgery, a difference and large effect size between groups was found for the ACLR-stable LEVMRT (P = .010; η2 = 0.250) but not for the ACLR-active (P = .340; η2 = 0.065) condition. The contact group exhibited slower ACLR-stable LEVMRT (521.7 ± 59.3 milliseconds) than the noncontact group (483.4 ± 83.9 milliseconds). CONCLUSIONS Individuals with contact ACL injury demonstrated a slower LEVMRT while their ACLR limb was stabilizing. The group differences during the ACLR-stable LEVMRT task might indicate deficits in perceptual-motor function when the surgical limb maintains postural control during a reaction time task. After ACLR, individuals with contact injuries may need additional motor learning interventions to enhance perceptual-motor functioning.
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Affiliation(s)
- Elaine Reiche
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | | | | | - Ashley Triplett
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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21
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Calisti M, Mohr M, Federolf P. Bilateral Deficits in Dynamic Postural Stability in Females Persist Years after Unilateral ACL Injury and Are Modulated by the Match between Injury Side and Leg Dominance. Brain Sci 2023; 13:1721. [PMID: 38137169 PMCID: PMC10741660 DOI: 10.3390/brainsci13121721] [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: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Previous research has documented brain plasticity after an anterior cruciate ligament (ACL) tear and suggests that these neural adaptations contribute to poorer motor control. Since both brain hemispheres show adaptations, we hypothesized that reduced dynamic stability occurs not only in the injured, but also the contralateral, uninjured leg. Further, given brain hemispheric specialization's impact on motor coordination, we hypothesized the need to consider the injury side. A total of 41 female athletes and 18 controls performed single-leg jump-landings. Dynamic postural stability was measured as time-to-stabilization (TTS). We found reduced medio-lateral dynamic stability for the ACL injured leg (p = 0.006) with a similar trend for the contralateral leg (p = 0.050) compared to the control group. However, when distinguishing between injuries to the dominant and non-dominant legs, we found increased medio-lateral TTS only if the injury had occurred on the dominant side where landings on injured (p = 0.006) and contralateral (p = 0.036) legs required increased TTS. Assessments of dynamic stability, e.g., in the context of return-to-sport, should consider the injury side and compare results not only between the injured and the contralateral leg, but also to uninjured controls. Future research should not pool data from the dominant-leg ACL with non-dominant-leg ACL injuries when assessing post-injury motor performance.
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Affiliation(s)
| | | | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.C.); (M.M.)
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23
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Flore Z, Hambly K, De Coninck K, Welsch G. [Time-loss and recurrence rates after lateral ankle ligament sprains in male elite football players: summary of a systematic review and meta-analysis]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2023; 37:182-186. [PMID: 37075778 DOI: 10.1055/a-2047-9031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
A literature search was conducted to systematically review and meta-analyse time-loss and recurrence rates of lateral ankle sprains (LAS) in male professional football players. Six electronic databases were screened separately for time-loss and recurrence rates after lateral ankle sprains in elite football players. A total of 13 (recurrence) and 12 (time-loss) studies met the previously defined inclusion criteria. The total sample size of the recurrence studies was 36.201 participants (44.404 overall initial injuries, 7944 initial ankle sprain (AS) injuries, 1193 recurrent AS injuries). 16.442 professional football players (4893 initial AS injuries, 748 recurrent AS injuries) were subsequently meta-analysed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df=12; Q=19.53; I2=38.57%) was determined based on the random-effects model. A total of 7736 participants were part of the time-loss studies (35.888 total injuries, 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92, median: 14.95, min: 9.55; max: 52.9). A priori, we determined considerable heterogeneity (CI: 18.15-22.08; df=11; Q=158; I2=93%). There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with high recurrence rates in professional football players. The high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. However, heterogeneous data lead to difficulties regarding the aspect of comparability.
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Affiliation(s)
- Zacharias Flore
- School of Sport and Exercise Sciences, Canterbury, UK, University of Kent at Canterbury: University of Kent, Canterbury, UNITED KINGDOM
- UKE-Athleticum, Hamburg, DE, Universitätsklinikum Hamburg-Eppendorf: Universitatsklinikum Hamburg-Eppendorf, Hamburg, GERMANY
| | - Karen Hambly
- School of Sport and Exercise Sciences, Canterbury, UK, University of Kent at Canterbury: University of Kent, Canterbury, UNITED KINGDOM
| | - Kyra De Coninck
- School of Sport and Exercise Sciences, Canterbury, UK, University of Kent at Canterbury: University of Kent, Canterbury, UNITED KINGDOM
| | - Götz Welsch
- UKE-Athleticum, Hamburg, DE, Universitätsklinikum Hamburg-Eppendorf: Universitatsklinikum Hamburg-Eppendorf, Hamburg, GERMANY
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24
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Schnittjer AJ, Kim H, Lepley AS, Onate JA, Criss CR, Simon JE, Grooms DR. Organization of sensorimotor activity in anterior cruciate ligament reconstructed individuals: an fMRI conjunction analysis. Front Hum Neurosci 2023; 17:1263292. [PMID: 38077185 PMCID: PMC10704895 DOI: 10.3389/fnhum.2023.1263292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups. Methods Eighteen participants with left knee ACLR and 18 control participants performed a knee flexion/extension motor control task during functional magnetic resonance imaging (fMRI). A conjunction analysis was conducted to determine the degree of overlap in brain activity for involved and uninvolved limb knee motor control between groups. Results The ACLR group had a statistically higher mean percent signal change in the sensorimotor cortex for the involved > uninvolved contrast compared to the control group. Brain activity between groups statistically overlapped in sensorimotor regions of the cortex and cerebellum for both group contrasts: involved > uninvolved and uninvolved > involved. Relative to the control group, the ACLR group uniquely activated superior parietal regions (precuneus, lateral occipital cortex) for involved limb motor control. Additionally, for involved limb motor control, the ACLR group displayed a medial and superior shift in peak voxel location in frontal regions; for parietal regions, the ACLR group had a more posterior and superior peak voxel location relative to the control group. Conclusion ACLR may result in unique activation of the sensorimotor cortex via a cortically driven sensory integration strategy to maintain involved limb motor control. The ACLR group's unique brain activity was independent of strength, self-reported knee function, and time from surgery.
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Affiliation(s)
- Amber J. Schnittjer
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, United States
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
| | - HoWon Kim
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, United States
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
| | - Adam S. Lepley
- School of Kinesiology, Exercise and Sports Science Initiative, University of Michigan, Ann Arbor, MI, United States
| | - James A. Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Cody R. Criss
- OhioHealth Riverside Methodist Hospital, Columbus, OH, United States
| | - Janet E. Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
| | - Dustin R. Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
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25
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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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26
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular control in males and females 1 year after an anterior cruciate ligament rupture or reconstruction during stair descent and artificial tibial translation. Sci Rep 2023; 13:15316. [PMID: 37714980 PMCID: PMC10504317 DOI: 10.1038/s41598-023-42491-6] [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: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
Neuromuscular alterations are reported in patients with anterior cruciate ligament reconstruction (ACL-R) and conservative treatment (copers with ACL deficiency, ACL-C). However, it is unclear whether sex influences neuromuscular control. The objective was to investigate differences in neuromuscular control regarding sex and treatment type one year after ACL rupture in comparison to a group with an intact ACL (ACL-I). Electromyography of vastus medialis (VM) and lateralis, biceps femoris (BF) and semitendinosus (ST) was recorded in ACL-R (N = 38), ACL-C (N = 26), and ACL-I (N = 38) during stair descent and reflex activity by anterior tibial translation while standing. The movements of stair descent were divided into pre-activity, weight-acceptance and push-off phases, reflex activity in pre-activation, short, medium (MLR), and long latency responses (LLR). Normalized root mean squares for each muscle of involved and matched control limb per phase were calculated and analyzed with two-way ANOVA (α = 0.05). During stair descent, neuromuscular differences of BF were significant during push-off only (p = 0.001). Males of ACL-R and ACL-C had higher BF activity compared to ACL-I (p = 0.009, 0.007 respectively). During reflex activity, VM and BF were significantly different between treatment groups for pre-activation (p = 0.013, 0.035 respectively). VM pre-activation of females was higher in ACL-R compared to ACL-C (p = 0.018), and lower in ACL-C compared to ACL-I (p = 0.034). Males of ACL-R showed higher VM and less BF pre-activation (p = 0.025, p = 0.003 respectively) compared to ACL-I. Males of ACL-C had less BF pre-activation compared to ACL-I (p = 0.019). During MLR, intra-group differences in ST were found for treatment (p = 0.011) and females of ACL-R compared to ACL-I (p = 0.015). During LLR, overall intra-group differences in VM were present for treatment (p = 0.034) and in females (ACL-R versus ACL-C (p = 0.015), ACL-I (p = 0.049), respectively). One year after an ACL rupture, neuromuscular alterations persist regardless of treatment and sex. Standard rehabilitation protocols may not be able to restore neuromuscular control. Future research should include long-term follow up and focus on exercises targeting neuromuscular function.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Aglaja Busch
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock, Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Farraye BT, Simon JE, Chaput M, Kim H, Monfort SM, Grooms DR. Development and Reliability of a Visual-Cognitive Reactive Triple Hop Test. J Sport Rehabil 2023; 32:802-809. [PMID: 37328155 PMCID: PMC10883464 DOI: 10.1123/jsr.2022-0398] [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: 11/10/2022] [Revised: 03/07/2023] [Accepted: 05/01/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Current lower-extremity return to sport testing primarily considers the physical status of an athlete; however, sport participation requires continuous cognitive dual-task engagement. Therefore, the purpose was to develop and evaluate the reliability of a visual-cognitive reactive (VCR) triple hop test that simulates the typical sport demand of combined online visual-cognitive processing and neuromuscular control to improve return to sport testing after lower-extremity injury. DESIGN Test-retest reliability. METHODS Twenty-one healthy college students (11 females, 23.5 [3.7] y, 1.73 [0.12] m, 73.0 [16.8] kg, Tegner Activity Scale 5.5 [1.1] points) participated. Participants performed a single-leg triple hop with and without a VCR dual task. The VCR task incorporated the FitLight system to challenge peripheral response inhibition and central working memory. Maximum hop distance, reaction time, cognitive errors, and physical errors were measured. Two identical testing visits were separated by 12 to 17 days (14 [1] d). RESULTS Traditional triple hop (intraclass correlation coefficients: ICC(3,1) = .96 [.91-.99]; standard error of the measurement = 16.99 cm) and the VCR triple hop (intraclass correlation coefficients(3,1) = .92 [.82-.97]; standard error of the measurement = 24.10 cm) both demonstrated excellent reliability for the maximum hop distance, and moderate reliability for the VCR triple hop reaction time (intraclass correlation coefficients(3,1) = .62 [.09-.84]; standard error of the measurement = 0.09 s). On average, the VCR triple hop resulted in a hop distance deficit of 8.17% (36.4 [5.1] cm; P < .05, d = 0.55) relative to the traditional triple hop. CONCLUSIONS Hop distance on the VCR triple hop had excellent test-retest reliability and induced a significant physical performance deficit when compared with the traditional triple hop assessment. The VCR triple hop reaction time also demonstrated moderate reliability.
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Affiliation(s)
- Byrnadeen T Farraye
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH,USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH,USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
| | - Meredith Chaput
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH,USA
| | - HoWon Kim
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH,USA
| | - Scott M Monfort
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT,USA
| | - Dustin R Grooms
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH,USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH,USA
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28
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Di Giminiani R, Marinelli S, La Greca S, Di Blasio A, Angelozzi M, Cacchio A. Neuromuscular Characteristics of Unilateral and Bilateral Maximal Voluntary Isometric Contractions following ACL Reconstruction. BIOLOGY 2023; 12:1173. [PMID: 37759573 PMCID: PMC10525486 DOI: 10.3390/biology12091173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m2), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m2). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant (p > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally (p < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally (p < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally (p < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
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Affiliation(s)
- Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano Marinelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano La Greca
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. D’Annunzio’ University of Chieti-Pescara, 66013 Chieti, Italy;
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
| | - Angelo Cacchio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
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Park-Braswell K, Shultz SJ, Ross SE, Sunnassee D, Grooms DR, Schmitz RJ. The Impact of Differential Knee Laxity on Brain Activation During Passive Knee Joint Loading. J Orthop Res 2023; 42:10.1002/jor.25664. [PMID: 37442639 PMCID: PMC10851619 DOI: 10.1002/jor.25664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Although higher anterior knee laxity is an established risk factor of ACL injury, underlying mechanisms are uncertain. While decreased proprioception and altered movement patterns in individuals with anterior knee laxity have been identified, the potential impact of higher laxity on brain activity is not well understood. Thus, the purpose of this study is to identify the impact of different magnitudes of knee laxity on brain function during anterior knee joint loading. Twenty-seven healthy and active female college students without any previous severe lower leg injuries volunteered for this study. Anterior knee laxity was measured using a knee arthrometer KT-2000 to assign participants to a higher laxity (N=15) or relatively lower laxity group (N=12). Functional magnetic resonance images were obtained during passive anterior knee joint loading in a task-based design using a 3T MRI scanner. Higher knee laxity individuals demonstrated diminished cortical activation in the left superior parietal lobe during passive anterior knee joint loading. Less brain activation in the regions associated with awareness of bodily movements in females with higher knee laxity may indicate a possible connection between brain activity and knee laxity. The results of this study may help researchers and clinicians develop effective rehabilitation programs for individuals with increased knee laxity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Scott E. Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Devdass Sunnassee
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA
- Division of Physical Therapy & Division of Athletic Training, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Gateway MRI Center University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Zandiyeh P, Parola LR, Costa MQ, Hague MJ, Molino J, Fleming BC, Beveridge JE. Long-Term Bilateral Neuromuscular Function and Knee Osteoarthritis after Anterior Cruciate Ligament Reconstruction. Bioengineering (Basel) 2023; 10:812. [PMID: 37508839 PMCID: PMC10376226 DOI: 10.3390/bioengineering10070812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Neuromuscular function is thought to contribute to posttraumatic osteoarthritis (PTOA) risk in anterior cruciate ligament (ACL)-reconstructed (ACLR) patients, but sensitive and easy-to-use tools are needed to discern whether complex muscle activation strategies are beneficial or maladaptive. Using an electromyography (EMG) signal analysis technique coupled with a machine learning approach, we sought to: (1) identify whether ACLR muscle activity patterns differed from those of healthy controls, and (2) explore which combination of patient outcome measures (thigh muscle girth, knee laxity, hop distance, and activity level) predicted the extent of osteoarthritic changes via magnetic resonance imaging (MRI) in ACLR patients. Eleven ACLR patients 10-15 years post-surgery and 12 healthy controls performed a hop activity while lower limb muscle EMG was recorded bilaterally. Osteoarthritis was evaluated based on MRI. ACLR muscle activity patterns were bilaterally symmetrical and differed from those of healthy controls, suggesting the presence of a global adaptation strategy. Smaller ipsilateral thigh muscle girth was the strongest predictor of inferior MRI scores. The ability of our EMG analysis approach to detect meaningful neuromuscular differences that could ultimately be related to thigh muscle girth provides the foundation to further investigate a direct link between muscle activation patterns and PTOA risk.
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Affiliation(s)
- Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA;
| | - Lauren R. Parola
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Meggin Q. Costa
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Madalyn J. Hague
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Janine Molino
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Biostatistics, Epidemiology, Research Design, & Informatics Core, Rhode Island Hospital, Providence, RI 02903, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Galonski T, Mansfield C, Moeller J, Miller R, Rethman K, Briggs MS. Does graded motor imagery benefit individuals with knee pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:130-139. [PMID: 37330758 DOI: 10.1016/j.jbmt.2023.05.005] [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: 06/22/2022] [Revised: 03/05/2023] [Accepted: 05/01/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Evaluate how Graded Motor Imagery (GMI) may be used in those with knee pain, if individuals with knee pain present with a central nervous system (CNS) processing deficit, and if GMI is associated with improved outcomes. METHODS An electronic database search was conducted of PubMed, SPORTDiscus, CINHAL, MEDLINE, Google Scholar, and Sports Medicine Education Index using keywords related to GMI and knee pain. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Out of the 13,224 studies reviewed, 14 studies were included that used GMI for knee pain. Effect sizes were reported with standardized mean differences (SMD). RESULTS Individuals with knee osteoarthritis demonstrated poor performance with correctly identifying images of left or right knees, and GMI improved performance. In contrast, individuals with an anterior cruciate ligament injury demonstrated no evidence of CNS processing deficit and mixed outcomes with GMI. Meta-analysis was limited to individuals post total knee arthroplasty showing low certainty that GMI can improve quadriceps force production [SMD 0.64 (0.07,1.22)], but evidence of no effect to reduce pain or improve Timed up and Go performance and self-reported function. CONCLUSIONS Graded motor imagery may be an effective intervention for individuals with knee osteoarthritis. However, there was limited evidence that GMI was effective for an anterior cruciate ligament injury.
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Affiliation(s)
- Taylor Galonski
- Health Science, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA; School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA.
| | - Josh Moeller
- Biological Sciences, College of Arts and Sciences, The Ohio State University, 484 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Ricky Miller
- Biological Sciences, College of Arts and Sciences, The Ohio State University, 484 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Katherine Rethman
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA; School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA; Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43202, USA
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Grueva-Pancheva T, Stambolieva K. Effectiveness of early onset of rehabilitation on the postural stability after anterior cruciate ligament reconstruction. J Bodyw Mov Ther 2023; 35:43-48. [PMID: 37330801 DOI: 10.1016/j.jbmt.2023.04.039] [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: 11/12/2021] [Revised: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The objective of this study was to evaluate the early onset of rehabilitation on restoring the postural stability of patients after anterior cruciate ligament reconstruction (ACLR) at the 3rd postoperative month. METHODS Forty patients after ACLR and twenty healthy controls took part in the investigation. The patients were divided into two groups, depending on the start of their proprioceptive rehabilitation program: an experimental group - on the 5th day after the surgery and a control group - on around the 30th postoperative day. Postural stability was investigated by static posturographic tests on stable and foam surfaces with open and closed eyes. RESULTS The patients from the experimental group showed lower amplitudes and velocities of the postural sways than the patients from the control group at the 3rd postoperative month. We found that the early start of the proprioceptive rehabilitation affects more the amplitude than the velocity of the postural sway which remains significantly high in both directions compared to the conventional rehabilitation. CONCLUSION The early start of the rehabilitation has a beneficial role in the recovery of the postural stability in the 3rd postoperative month, especially in more challenging conditions for keeping the equilibrium, which contributes to the minimizes the risk of a second anterior cruciate ligament injury after patients' return to their usual sport and daily activities routine.
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Affiliation(s)
- Tanya Grueva-Pancheva
- Department of Theory and Methods of Kinesitherapy, National Sports Academy, Sofia, Bulgaria
| | - Katerina Stambolieva
- Department of Cognitive Psychophysiology, Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
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Zavala P, Vannatta CN, Kernozek TW, Rutherford DN. Dynamic postural control in injured collegiate cross-country runners is not associated with running-related injury. Gait Posture 2023; 104:77-82. [PMID: 37343398 DOI: 10.1016/j.gaitpost.2023.06.002] [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: 11/28/2022] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Biomechanical factors have been associated with running-related injury, but associations are unclear. Dynamic postural stability may be a factor related to injury that has not been studied extensively. RESEARCH QUESTION Does dynamic postural control differ in those with a history of running-related injury or those who go on to sustain a running-related injury? METHODS Sixty-five (45 injured; 20 uninjured) and fifty-eight (13 injured; 45 uninjured) collegiate cross-country runners were available for our retrospective and prospective analyses. Time to stabilization and dynamic postural stability index were collected during two separate jump landing tasks (forward and lateral direction) for each leg. Retrospective injury was tabulated by a running history survey. Prospective injuries were recorded by a licensed athletic trainer during the competitive season. Differences in postural stability were compared between injured and uninjured groups and between limbs using two-way ANOVA's. An overall group by leg comparison was completed for each task. RESULTS The non-dominant limb demonstrated better postural stability indices regardless of injury history. An interaction was observed between limbs and history of injury for the anterior-posterior time to stabilization for the lateral task. The non-dominant limb demonstrated better medio-lateral postural stability indices and time to stabilization during the lateral task, regardless of prospective injury. SIGNIFICANCE Dynamic postural stability was reduced in the dominant limb, but no clear differences were seen between injured and uninjured runners. This suggests dynamic postural stability may be altered in individuals with a history of a running-related injury, but no relationship to subsequent injury was substantiated. Further work is needed to understand how dynamic postural stability may be related to running-related injury.
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Affiliation(s)
- Pedro Zavala
- Sports Physical Therapy Department, Gundersen Health System, 3111 Gundersen Drive, Onalaska, WI 54650, USA
| | - Charles Nathan Vannatta
- Sports Physical Therapy Department, Gundersen Health System, 3111 Gundersen Drive, Onalaska, WI 54650, USA; La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA.
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Drew N Rutherford
- La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
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Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [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: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
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Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
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Kiani Haft Lang M, Mofateh R, Orakifar N, Goharpey S. Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study. J Sport Rehabil 2023:1-10. [PMID: 37185456 DOI: 10.1123/jsr.2022-0288] [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: 07/31/2022] [Revised: 01/22/2023] [Accepted: 02/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Only 55% of anterior cruciate ligament-reconstructed (ACLR) athletes return to competitive sports. This brings into question the usefulness of current return to sport (RTS) criteria. High cognitive demand of sport environment clarifies the value of incorporating neurocognitive tests when making decisions regarding the time of RTS. This preliminary study aimed to compare the neurocognitive functions between healthy controls and ACLR male athletes who passed or failed RTS criteria. METHODS A total of 45 male football players, including 15 ACLR who passed RTS criteria, 15 ACLR who did not pass, and 15 healthy controls participated in this cross-sectional study. The Cambridge Neuropsychological Test Automated Battery was used to measure a battery of neurocognitive tasks, including speed of response, sustained attention, working memory, cognitive flexibility, and response inhibition. RESULTS The results revealed that compared with both the ACLR-passed and healthy groups, the ACLR-failed group showed greater values of 5-choice movement time (P = .02, P = .01, respectively) but lower values of stop signal reaction time (P = .03, P = .001, respectively) and proportion of successful stops variables (P = .02). In addition, compared with the healthy group, both the ACLR-failed and ACLR-passed groups indicated greater values in between errors (P < .001, P = .008, respectively) and reaction latency variables (P = .002, P = .01, respectively) but lower values of A' (P < .001, P = .007, respectively), probability of hit (P < .001, P = .03, respectively), and percent correct trials variables (P = .006, P = .02, respectively). CONCLUSIONS Our findings indicated deficits in neurocognitive functions in ACLR male athletes. In addition, poor performance in sustained attention, working memory, and cognitive flexibility measures observed in the ACLR-passed group highlighted the necessity for using a multimodal approach via implementation of neurocognitive measures in conjunction with the functional and muscular assessments when making RTS decisions.
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Affiliation(s)
- Maryam Kiani Haft Lang
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
- Student Research Committee, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Razieh Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Neda Orakifar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Shahin Goharpey
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
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Alessandro C, Prashara A, Tentler DP, Tresch MC. Inhibition of knee joint sensory afferents alters covariation across strides between quadriceps muscles during locomotion. J Appl Physiol (1985) 2023; 134:957-968. [PMID: 36759157 PMCID: PMC10069963 DOI: 10.1152/japplphysiol.00591.2022] [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: 10/05/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Sport-related injuries to articular structures often alter the sensory information conveyed by joint structures to the nervous system. However, the role of joint sensory afferents in motor control is still unclear. Here, we evaluate the role of knee joint sensory afferents in the control of quadriceps muscles, hypothesizing that such sensory information modulates control strategies that limit patellofemoreal joint loading. We compared locomotor kinematics and muscle activity before and after inhibition of knee sensory afferents by injection of lidocaine into the knee capsule of rats. We evaluated whether this inhibition reduced the strength of correlation between the activity of vastus medialis (VM) and vastus lateralis (VL) both across strides and within each stride, coordination patterns that limit net mediolateral patellofemoral forces. We also evaluated whether this inhibition altered correlations among the other quadriceps muscle activity, the time-profiles of individual EMG envelopes, or movement kinematics. Neither the EMG envelopes nor limb kinematics was affected by the inhibition of knee sensory afferents. This perturbation also did not affect the correlations between VM and VL, suggesting that the regulation of patellofemoral joint loading is mediated by different mechanisms. However, inhibition of knee sensory afferents caused a significant reduction in the correlation between vastus intermedius (VI) and both VM and VL across, but not within, strides. Knee joint sensory afferents may therefore modulate the coordination between the vasti muscles but only at coarse time scales. Injuries compromising joint afferents might result in altered muscle coordination, potentially leading to persistent internal joint stresses and strains.NEW & NOTEWORTHY Sensory afferents originating from knee joint receptors provide the nervous system with information about the internal state of the joint. In this study, we show that these sensory signals are used to modulate the covariations among the activity of a subset of vasti muscles across strides of locomotion. Sport-related injuries that damage joint receptors may therefore compromise these mechanisms of muscle coordination, potentially leading to persistent internal joint stresses and strains.
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Affiliation(s)
- Cristiano Alessandro
- Department of Neuroscience, Northwestern University, Chicago, Illinois, United States
- School of Medicine and Surgery/Sport and Exercise Medicine, University of Milano-Bicocca, Milan, Italy
| | - Adarsh Prashara
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
| | - David P Tentler
- Department of Neuroscience, Northwestern University, Chicago, Illinois, United States
| | - Matthew C Tresch
- Department of Neuroscience, Northwestern University, Chicago, Illinois, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Brain activation and single-limb balance following anterior cruciate ligament reconstruction. Clin Neurophysiol 2023; 149:88-99. [PMID: 36933325 DOI: 10.1016/j.clinph.2023.02.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To compare brain activity between individuals with anterior cruciate ligament reconstruction (ACLR) and controls during balance. To determine the influence of neuromodulatory interventions (external focus of attention [EF] and transcutaneous electrical nerve stimulation [TENS]) on cortical activity and balance performance. METHODS Individuals with ACLR (n = 20) and controls (n = 20) performed a single-limb balance task under four conditions: internal focus (IF), object-based-EF, target-based-EF, and TENS. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in theta and alpha-2 frequency bands. RESULTS Participants with ACLR had higher motor-planning (d = 0.5), lower sensory (d = 0.6), and lower motor activity (d = 0.4-0.8), while exhibiting faster sway velocity (d = 0.4) than controls across all conditions. Target-based-EF decreased motor-planning (d = 0.1-0.4) and increased visual (d = 0.2), bilateral sensory (d = 0.3-0.4), and bilateral motor (d = 0.4-0.5) activity in both groups compared to all other conditions. Neither EF conditions nor TENS changed balance performance. CONCLUSIONS Individuals with ACLR exhibit lower sensory and motor processing, higher motor planning demands, and greater motor inhibition compared to controls, suggesting visual-dependence and less automatic balance control. Target-based-EF resulted in favorable reductions in motor-planning and increases in somatosensory and motor activity, transient effects in line with impairments after ACLR. SIGNIFICANCE Sensorimotor neuroplasticity underlies balance deficits in individuals with ACLR. Neuromodulatory interventions such as focus of attention may induce favorable neuroplasticity along with performance benefits.
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Affiliation(s)
- David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA; Dept. of Physical Therapy & Athletic Training, College of Health & Rehabilitation Science: Sargent College, Boston University, Boston, MA, USA; Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Matt S Stock
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.
| | - Amanda M Murray
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA.
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Inhibition of Motor Planning and Response Selection after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2023; 55:440-449. [PMID: 36731010 DOI: 10.1249/mss.0000000000003072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to compare cortical motor planning activity during response selection and motor execution processes between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a reaction time and response selection task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a lateralized choice reaction time (e.g., Go/NoGo) task. Electrocortical activity and reaction time were recorded concurrently using electroencephalography and inertial measurement units. Separate stimulus locked and response-locked event-related potentials were computed for each limb. The lateralized readiness potential (LRP) was computed as the interhemispheric differences between waveforms and the mean LRP area and onset latency were recorded. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) and the associations between LRP characteristics and response performance (number of errors) were assessed. RESULTS Participants with ACLR have had smaller LRP area during periods of response selection ( P = 0.043, d = 0.4) and motor execution ( P = 0.015, d = 0.5) and committed more errors in both Go ( P < 0.001, d = 0.8) and NoGo ( P = 0.032, d = 0.5) response conditions. There were no differences in latency of response selection or motor execution. Participants with ACLR had higher active motor thresholds ( P < 0.001, d = 1.3) than controls, which was weakly associated with smaller LRP areas ( r = 0.32-0.42, P < 0.05). CONCLUSIONS The ACLR group demonstrated greater motor planning and response inhibition during a choice reaction time task. More errant performance also suggests poorer decision making in the presence of a "speed-accuracy" trade-off. Key features of the sample, including lower corticospinal excitability, lend support to an interpretation of widespread cortical inhibition contributing to impairments in response selection and motor execution.
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Affiliation(s)
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
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Kim H, Onate JA, Criss CR, Simon JE, Mischkowski D, Grooms DR. The relationship between drop vertical jump action-observation brain activity and kinesiophobia after anterior cruciate ligament reconstruction: A cross-sectional fMRI study. Brain Behav 2023; 13:e2879. [PMID: 36602922 PMCID: PMC9927857 DOI: 10.1002/brb3.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Injury and reconstruction of anterior cruciate ligament (ACL) result in central nervous system alteration to control the muscles around the knee joint. Most individuals with ACL reconstruction (ACLR) experience kinesiophobia which can prevent them from returning to activity and is associated with negative outcomes after ACLR. However, it is unknown if kinesiophobia alters brain activity after ACL injury. OBJECTIVES To compare brain activity between an ACLR group and matched uninjured controls during an action-observation drop vertical jump (AO-DVJ) paradigm and to explore the association between kinesiophobia and brain activity in the ACLR group. METHODS This cross-sectional study enrolled 26 individuals, 13 with ACLR (5 males and 8 females, 20.62 ± 1.93 years, 1.71 ± 0.1 m, 68.42 ± 14.75 kg) and 13 matched uninjured controls (5 males and 8 females, 22.92 ± 3.17 years, 1.74 ± 0.10 m, 70.48 ± 15.38 kg). Individuals were matched on sex and activity level. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) to evaluate the level of movement-related fear. To assay the brain activity associated with a functional movement, the current study employed an action-observation/motor imagery paradigm during functional magnetic resonance imaging (fMRI). RESULTS The ACLR group had lower brain activity in the right ventrolateral prefrontal cortex relative to the uninjured control group. Brain activity of the left cerebellum Crus I and Crus II, the right cerebellum lobule IX, amygdala, middle temporal gyrus, and temporal pole were positively correlated with TSK-11 scores in the ACLR group. CONCLUSION Brain activity for the AO-DVJ paradigm was different between the ACLR group and uninjured controls. Secondly, in participants with ACLR, there was a positive relationship between TSK-11 scores and activity in brain areas engaged in fear and cognitive processes during the AO-DVJ paradigm.
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Affiliation(s)
- HoWon Kim
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Translational Biomedical Sciences Program, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - James A Onate
- Division of Athletic Training, School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Cody R Criss
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Heritage Fellow, Translational Biomedical Sciences Program, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Janet E Simon
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Dominik Mischkowski
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Psychology Department, College of Arts and Sciences, Ohio University, Athens, Ohio, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
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Culiver A, Grooms D, Edwards N, Schmitt L, Oñate J. A Preliminary Investigation into the Neural Correlates of Knee Loading during a Change of Direction Task in Individuals after Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2023; 18:70-80. [PMID: 36793571 PMCID: PMC9897027 DOI: 10.26603/001c.57782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background Central nervous system (CNS) function after ACLR, quantified by the blood oxygen level dependent (BOLD) response, is altered in regions of sensory function during knee movement after ACLR. However, it is unknown how this altered neural response may manifest in knee loading and response to sensory perturbations during sport specific movements. Purpose To investigate the relationship among CNS function and lower extremity kinetics, under multiple visual conditions, during 180° change of direction task in individuals with a history of ACLR. Methods Eight participants, 39.3 ± 37.1 months after primary, left ACLR performed repetitive active knee flexion and extension of their involved knee during fMRI scanning. Participants separately performed 3D motion capture analysis of a 180° change of direction task under full vision (FV) and stroboscopic vision (SV) conditions. A neural correlate analysis was performed to associate BOLD signal to knee loading of the left lower extremity. Results Involved limb peak internal knee extension moment (pKEM) was significantly lower in the SV condition (1.89 ± 0.37 N*m/Kg) compared to the FV condition (2.0 ± 0.34 N*m/Kg) (p = .018). Involved limb pKEM during the SV condition was positively correlated with BOLD signal in the contralateral precuneus and superior parietal lobe (Voxels: 53; p = .017; z-stat max: 6.47; MNI peak: 6, -50, 66). Conclusion There is a positive association between involved limb pKEM in the SV condition and BOLD response in areas of visual-sensory integration. Activation of contralateral precuneus and superior parietal lobe brain regions may be a strategy to maintain joint loading when vision is perturbed. Level of Evidence Level 3.
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Affiliation(s)
- Adam Culiver
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Dustin Grooms
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions Ohio University
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions Ohio University
- 5. Ohio Musculoskeletal and Neurological Institute Ohio University
| | - Nathan Edwards
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Laura Schmitt
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Physical Therapy, School of Health and Rehabilitation Sciences Ohio State University
| | - James Oñate
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Athletic Training, School of Health and Rehabilitation Sciences Ohio State University
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Criss CR, Lepley AS, Onate JA, Simon JE, France CR, Clark BC, Grooms DR. Neural Correlates of Self-Reported Knee Function in Individuals After Anterior Cruciate Ligament Reconstruction. Sports Health 2023; 15:52-60. [PMID: 35321615 PMCID: PMC9808834 DOI: 10.1177/19417381221079339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjuries are common and disability levels are high, even years after therapy and return to activity. Prolonged knee dysfunction may result in part from unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Indeed, "upstream" neurological adaptations occurring after injury may explain these persistent functional deficits. Despite evidence for injury consequences extending beyond the joint to the nervous system, the link between neurophysiological impairments and patient-reported measures of knee function remains unclear. HYPOTHESIS Patterns of brain activation for knee control are related to measures of patient-reported knee function in individuals after ACL reconstruction (ACL-R). STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS In this multicenter, cross-sectional study, participants with unilateral ACL-R (n = 25; 10 men, 15 women) underwent task-based functional magnetic resonance imaging testing. Participants performed repeated cycles of open-chain knee flexion/extension. Neural activation patterns during the movement task were quantified using blood oxygen level-dependent (BOLD) signals. Regions of interest were generated using the Juelich Histological Brain Atlas. Pearson product-moment correlations were used to determine the relationship between mean BOLD signal within each brain region and self-reported knee function level, as measured by the International Knee Documentation Committee index. Partial correlations were also calculated after controlling for time from surgery and sex. RESULTS Patient-reported knee function was positively and moderately correlated with the ipsilateral secondary somatosensory cortex (r = 0.57, P = 0.005) and the ipsilateral supplementary motor area (r = 0.51, P = 0.01). CONCLUSION Increased ipsilateral secondary sensorimotor cortical activity is related to higher perceived knee function. CLINICAL RELEVANCE Central nervous system mechanisms for knee control are related to subjective levels of knee function after ACL-R. Increased neural activity may reflect central neuroplastic strategies to preserve knee functionality after traumatic injury.
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Affiliation(s)
- Cody R. Criss
- Translational Biomedical Sciences,
Graduate College, Ohio University, Athens, Ohio
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Cody R Criss, W283 Grover
Center, 1 Ohio University, Athens, OH 45701 (
) (Twitter: @criss_cody)
| | - Adam S. Lepley
- Exercise and Sport Science Initiative,
School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - James A. Onate
- School of Health and Rehabilitation
Sciences, The Ohio State University, Columbus, Ohio
| | - Janet E. Simon
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
| | - Christopher R. France
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Psychology, College of
Arts and Sciences, Ohio University, Athens, Ohio
| | - Brian C. Clark
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Biomedical Sciences,
Ohio University, Athens, Ohio
- Department of Geriatric Medicine, Ohio
University, Athens, Ohio
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
- Division of Physical Therapy, School
of Rehabilitation and Communication Sciences, College of Health Sciences and
Professions, Ohio University, Athens, Ohio
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The Relationship Between Health-Related Quality of Life and Lower-Extremity Visuomotor Reaction Time in Young Adult Women Following Ankle Sprain. J Sport Rehabil 2023; 32:433-439. [PMID: 36848899 DOI: 10.1123/jsr.2022-0199] [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: 05/25/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 03/01/2023]
Abstract
CONTEXT Many individuals who sustain a lateral ankle sprain (LAS) fail to return to prior activity due to residual symptoms; and report elevated levels of injury-related fear, decreased function, and decreased health-related quality of life (HRQOL). Additionally, individuals with history of LAS exhibit deficits in neurocognitive functional measures like visuomotor reaction time (VMRT), which contributes to worse patient-reported outcome scores. The aim of this study was to examine the relationship between HRQOL and lower-extremity (LE) VMRT in individuals with LAS history. DESIGN Cross-sectional. METHODS Young adult female volunteers with history of LAS (n = 22; age = 24 [3.5] y; height = 163.1 [9.8] cm; mass = 65.1 [11.5] kg; and time since last LAS = 67.8 [50.5] mo) completed HRQOL outcomes including the following: (1) Tampa Scale of Kinesiophobia-11, (2) Fear-Avoidance Beliefs Questionnaire, (3) Penn State Worry Questionnaire, (4) modified Disablement in the Physically Active Scale, and (5) Foot and Ankle Disability Index (FADI). Additionally, participants completed a LE-VMRT task by responding to a visual stimulus using their foot to deactivate light sensors. Participants completed trials bilaterally. Separate Spearman rho correlations were performed to assess the relationship between patient-reported outcomes assessing constructs of HRQOL and LE-VRMT bilaterally. Significance was set at P < .05. RESULTS There was a strong, significant negative correlation between FADI-Activities of Daily Living (ρ = -.68; P = .002) and FADI-Sport (ρ = -.76; P = .001) scores and injured limb LE-VMRT; moderate, significant negative correlations between the uninjured limb LE-VMRT and FADI-Activities of Daily Living (ρ = -.60; P = .01) and FADI-Sport (ρ = -.60; P = .01) scores; and moderate, significant positive correlations between the injured limb LE-VMRT and modified Disablement in the Physically Active Scale-Physical Summary Component (ρ = .52; P = .01) and modified Disablement in the Physically Active Scale-Total (ρ = .54; P = .02) scores. All other correlations were not statistically significant. CONCLUSIONS Young adult women with history of LAS demonstrated an association between self-reported constructs of HRQOL and LE-VMRT. As LE-VMRT is a modifiable injury risk factor, future studies should examine the effectiveness of interventions designed to improve LE-VMRT and the impact on self-reported HRQOL.
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Wojtys EM. The Missing Link. Sports Health 2023; 15:9-10. [PMID: 36377111 PMCID: PMC9808830 DOI: 10.1177/19417381221138769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Patel HH, Berlinberg EJ, Nwachukwu B, Williams RJ, Mandelbaum B, Sonkin K, Forsythe B. Quadriceps Weakness is Associated with Neuroplastic Changes Within Specific Corticospinal Pathways and Brain Areas After Anterior Cruciate Ligament Reconstruction: Theoretical Utility of Motor Imagery-Based Brain-Computer Interface Technology for Rehabilitation. Arthrosc Sports Med Rehabil 2022; 5:e207-e216. [PMID: 36866306 PMCID: PMC9971910 DOI: 10.1016/j.asmr.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/09/2022] [Indexed: 12/29/2022] Open
Abstract
Persistent quadriceps weakness is a problematic sequela of anterior cruciate ligament reconstruction (ACLR). The purposes of this review are to summarize neuroplastic changes after ACL reconstruction; provide an overview of a promising interventions, motor imagery (MI), and its utility in muscle activation; and propose a framework using a brain-computer interface (BCI) to augment quadriceps activation. A literature review of neuroplastic changes, MI training, and BCI-MI technology in postoperative neuromuscular rehabilitation was conducted in PubMed, Embase, and Scopus. Combinations of the following search terms were used to identify articles: "quadriceps muscle," "neurofeedback," "biofeedback," "muscle activation," "motor learning," "anterior cruciate ligament," and "cortical plasticity." We found that ACLR disrupts sensory input from the quadriceps, which results in reduced sensitivity to electrochemical neuronal signals, an increase in central inhibition of neurons regulating quadriceps control and dampening of reflexive motor activity. MI training consists of visualizing an action, without physically engaging in muscle activity. Imagined motor output during MI training increases the sensitivity and conductivity of corticospinal tracts emerging from the primary motor cortex, which helps "exercise" the connections between the brain and target muscle tissues. Motor rehabilitation studies using BCI-MI technology have demonstrated increased excitability of the motor cortex, corticospinal tract, spinal motor neurons, and disinhibition of inhibitory interneurons. This technology has been validated and successfully applied in the recovery of atrophied neuromuscular pathways in stroke patients but has yet to be investigated in peripheral neuromuscular insults, such as ACL injury and reconstruction. Well-designed clinical studies may assess the impact of BCI on clinical outcomes and recovery time. Quadriceps weakness is associated with neuroplastic changes within specific corticospinal pathways and brain areas. BCI-MI shows strong potential for facilitating recovery of atrophied neuromuscular pathways after ACLR and may offer an innovative, multidisciplinary approach to orthopaedic care. Level of Evidence V, expert opinion.
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Affiliation(s)
- Harsh H. Patel
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Elyse J. Berlinberg
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Riley J. Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Bert Mandelbaum
- Department of Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, U.S.A
| | | | - Brian Forsythe
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois,Address correspondence to Brian Forsythe, M.D., 1611 W. Harrison St, Suite 360, Chicago, IL 60621
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45
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Flore Z, Hambly K, De Coninck K, Welsch G. Time-loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta-analysis. Scand J Med Sci Sports 2022; 32:1690-1709. [PMID: 35904448 PMCID: PMC9804772 DOI: 10.1111/sms.14217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 01/09/2023]
Abstract
A literature search was conducted to systematically review and meta-analyze time-loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time-loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case-control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time-loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time-loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta-analyzed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df = 12; Q = 19.53; I2 = 38.57%) based on the random-effects model was determined. A total of 7736 participants were part of the time-loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15-22.08; df = 11; Q = 158; I2 = 93%), so that the data on time-loss are only presented descriptively. There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%-12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.
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Affiliation(s)
- Zacharias Flore
- University of Kent, School of Sport and Exercise SciencesCanterburyUK,Hamburger SV, Fußball AGHamburgGermany,University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany
| | - Karen Hambly
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Kyra De Coninck
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Götz Welsch
- University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany,Department of Trauma and Orthopaedic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Graft Intra-Articular Remodeling and Bone Incorporation in ACL Reconstruction: The State of the Art and Clinical Implications. J Clin Med 2022; 11:jcm11226704. [PMID: 36431181 PMCID: PMC9693137 DOI: 10.3390/jcm11226704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft's anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury.
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular Control During Stair Descent and Artificial Tibial Translation After Acute ACL Rupture. Orthop J Sports Med 2022; 10:23259671221123299. [PMID: 36263309 PMCID: PMC9575465 DOI: 10.1177/23259671221123299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) rupture has direct effect on passive and
active knee stability and, specifically, stretch-reflex excitability. Purpose/Hypothesis: The purpose of this study was to investigate neuromuscular activity in
patients with an acute ACL deficit (ACL-D group) compared with a matched
control group with an intact ACL (ACL-I group) during stair descent and
artificially induced anterior tibial translation. It was hypothesized that
neuromuscular control would be impaired in the ACL-D group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Surface electromyographic (EMG) activity of the vastus medialis (VM), vastus
lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles was
recorded bilaterally in 15 patients with ACL-D (mean, 13.8 days [range, 7-21
days] since injury) and 15 controls with ACL-I during stair descent and
artificially induced anterior tibial translation. The movements of stair
descent were divided into preactivity, weight acceptance, and push-off
phases. Reflex activity during anterior tibial translation was split into
preactivity and short, medium, and late latency responses. Walking on a
treadmill was used for submaximal EMG normalization. Kruskal-Wallis test and
post hoc analyses with Dunn-Bonferroni correction were used to compare
normalized root mean square values for each muscle, limb, movement, and
reflex phase between the ACL-D and ACL-I groups. Results: During the preactivity phase of stair descent, the hamstrings of the involved
leg of the ACL-D group showed 33% to 51% less activity compared with the
matched leg and contralateral leg of the ACL-I group (P
< .05). During the weight acceptance and push-off phases, the VL revealed
a significant reduction (approximately 40%) in the involved leg of the ACL-D
group compared with the ACL-I group. At short latency, the BF and ST of the
involved leg of the ACL-D group showed a significant increase in EMG
activity compared with the uninvolved leg of the ACL-I group, by a factor of
2.2 to 4.6. Conclusion: In the acute phase after an ACL rupture, neuromuscular alterations were found
mainly in the hamstrings of both limbs during stair descent and reflex
activity. The potential role of prehabilitation needs to be further
studied.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Angela Blasimann, MSc, Department of Health Professions, Bern
University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland
()
| | - Aglaja Busch
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,University Outpatient Clinic, Sports Medicine & Sports
Orthopedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern,
Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock,
Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland
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Grooms DR, Diekfuss JA, Slutsky-Ganesh AB, DiCesare CA, Bonnette S, Riley MA, Kiefer AW, Wohl TR, Criss CR, Lamplot J, Thomas SM, Foss KDB, Faigenbaum AD, Wong P, Simon JE, Myer GD. Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics. J Athl Train 2022; 57:911-920. [PMID: 35271709 PMCID: PMC9842124 DOI: 10.4085/1062-6050-0548.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Neuromuscular training (NMT) facilitates the acquisition of new movement patterns that reduce the anterior cruciate ligament injury risk. However, the neural mechanisms underlying these changes are unknown. OBJECTIVE To determine the relationship between brain activation and biomechanical changes after NMT with biofeedback. DESIGN Cohort study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty female high school soccer athletes, with 10 in an augmented NMT group and 10 in a control (no training) group. MAIN OUTCOME MEASURE(S) Ten participants completed 6 weeks of NMT augmented with real-time biofeedback to reduce knee injury-risk movements, and 10 participants pursued no training. Augmented neuromuscular training (aNMT) was implemented with visual biofeedback that responded in real time to injury-risk biomechanical variables. A drop vertical jump with 3-dimensional motion capture was used to assess injury-risk neuromuscular changes before and after the 6-week intervention. Brain-activation changes were measured using functional magnetic resonance imaging during unilateral knee and multijoint motor tasks. RESULTS After aNMT, sensory (precuneus), visual-spatial (lingual gyrus), and motor-planning (premotor) brain activity increased for knee-specific movement; sensorimotor cortex activity for multijoint movement decreased. The knee-abduction moment during landing also decreased (4.66 ± 5.45 newton meters; P = .02; Hedges g = 0.82) in the aNMT group but did not change in the control group (P > .05). The training-induced increased brain activity with isolated knee movement was associated with decreases in knee-abduction moment (r = 0.67; P = .036) and sensorimotor cortex activity for multijoint movement (r = 0.87; P = .001). No change in brain activity was observed in the control group (P > .05). CONCLUSIONS The relationship between neural changes observed across tasks and reduced knee abduction suggests that aNMT facilitated recruitment of sensory integration centers to support reduced injury-risk mechanics and improve sensorimotor neural efficiency for multijoint control. Further research is warranted to determine if this training-related multimodal neuroplasticity enhances neuromuscular control during more complex sport-specific activities.
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Affiliation(s)
- Dustin R. Grooms
- Ohio Musculoskeletal and Neurological Institute, Waltham, MA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Alexis B. Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- Department of Kinesiology, University of North Carolina Greensboro
| | | | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH
| | - Michael A. Riley
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, OH
| | - Adam W. Kiefer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Timothy R. Wohl
- Ohio Musculoskeletal and Neurological Institute, Waltham, MA
| | - Cody R. Criss
- Ohio Musculoskeletal and Neurological Institute, Waltham, MA
| | - Joseph Lamplot
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Staci M. Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH
| | - Kim D. Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | | | - Phil Wong
- Department of Diagnostic Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University School of Medicine, Atlanta, GA
| | - Janet E. Simon
- Ohio Musculoskeletal and Neurological Institute, Waltham, MA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
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49
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Monfort SM, Simon JE, Miko SC, Grooms DR. Effects of cognitive- and motor-dual tasks on postural control regularity following anterior cruciate ligament reconstruction. Gait Posture 2022; 97:109-114. [PMID: 35917701 PMCID: PMC10871862 DOI: 10.1016/j.gaitpost.2022.07.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND High injury rates following anterior cruciate ligament reconstruction (ACLR) motivate the need to better understand lingering movement deficiencies following return to sport. Athletic competition involves various types of sensory, motor, and cognitive challenges; however, postural control deficiencies during this spectrum of conditions are not well understood following ACLR. RESEARCH QUESTION To what extent is postural control altered following ACLR in the presence of sensory, motor, and cognitive challenges, and does postural control correlate with patient-reported symptoms? METHODS Fourteen individuals following ACLR (4 m/10 f, 21.2 ± 2.4 yr, 76.9 ± 19.1 kg, 1.70 ± 0.14 m) and fourteen matched healthy controls (4 m/10 f, 21.2 ± 1.4 yr, 75.4 ± 15.3 kg, 1.70 ± 0.15 m) participated in the study. Participants completed single-leg balance, ACLR limb or matched side for controls, under four conditions: 1) eyes open, 2) eyes closed, 3) visual-cognitive dual task (i.e., reverse digit span), and 4) motor dual task (i.e., catching a ball). Sample entropy (SEn) was calculated for each balance condition to characterize regularity of center of pressure control. Participants also completed patient-reported outcomes to characterize self-reported knee function, symptoms, and fear. A mixed effects model tested for differences in SEn between balance conditions, and Spearman correlations tested for relationships between SEn and patient-reported outcomes. RESULTS A significant Group-by-Condition interaction was detected (P = 0.043). While the motor dual task and eyes closed balance conditions were associated with the lowest SEn for both groups, only the visual-cognitive dual task condition demonstrated a significant difference between groups, with the ACLR group having lower SEn [95% confidence interval for ΔSEn: (0.03, 0.35)]. Lower KOOS-Sport scores were associated with decreased SEn for the ACLR group (ρ = 0.81, P < 0.001). SIGNIFICANCE These findings are consistent with ACLR individuals using a less automatic approach to postural control compared to controls, particularly when presented with a visual-cognitive challenge. Altered neuromuscular control persists well after ACLR surgery and can be related to patient-reported outcomes.
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Affiliation(s)
- Scott M Monfort
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, USA.
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA; School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| | - Sarah C Miko
- School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA; School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA; School of Rehabilitation and Communication Sciences, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
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50
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Preliminary brain-behavioral neural correlates of anterior cruciate ligament injury risk landing biomechanics using a novel bilateral leg press neuroimaging paradigm. PLoS One 2022; 17:e0272578. [PMID: 35951584 PMCID: PMC9371272 DOI: 10.1371/journal.pone.0272578] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/21/2022] [Indexed: 01/02/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury risk reduction strategies primarily focus on biomechanical factors related to frontal plane knee motion and loading. Although central nervous system processing has emerged as a contributor to injury risk, brain activity associated with the resultant ACL injury-risk biomechanics is limited. Thus, the purposes of this preliminary study were to determine the relationship between bilateral motor control brain activity and injury risk biomechanics and isolate differences in brain activity for those who demonstrate high versus low ACL injury risk. Thirty-one high school female athletes completed a novel, multi-joint leg press during brain functional magnetic resonance imaging (fMRI) to characterize bilateral motor control brain activity. Athletes also completed an established biomechanical assessment of ACL injury risk biomechanics within a 3D motion analysis laboratory. Knee abduction moments during landing were modelled as a covariate of interest within the fMRI analyses to identify directional relationships with brain activity and an injury-risk group classification analysis, based on established knee abduction moment cut-points. Greater landing knee abduction moments were associated with greater lingual gyrus, intracalcarine cortex, posterior cingulate cortex and precuneus activity when performing the bilateral leg press (all z > 3.1, p < .05; multiple comparison corrected). In the follow-up injury-risk classification analysis, those classified as high ACL injury-risk had greater activity in the lingual gyrus, parietal cortex and bilateral primary and secondary motor cortices relative to those classified as low ACL injury-risk (all z > 3.1, p < .05; multiple comparison corrected). In young female athletes, elevated brain activity for bilateral leg motor control in regions that integrate sensory, spatial, and attentional information were related to ACL injury-risk landing biomechanics. These data implicate crossmodal visual and proprioceptive integration brain activity and knee spatial awareness as potential neurotherapeutic targets to optimize ACL injury-risk reduction strategies.
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