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Knurr KA, Cobian DG, Kliethermes SA, Joachim MR, Heiderscheit BC. Effect of Running Speed on Knee Biomechanics in Collegiate Athletes Following Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:1233-1241. [PMID: 38377013 PMCID: PMC11178460 DOI: 10.1249/mss.0000000000003409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Athletes after anterior cruciate ligament reconstruction (ACLR) demonstrate altered surgical knee running kinematics and kinetics compared with the nonsurgical limb and healthy controls. The effect of running speed on biomechanics has not been formally assessed in athletes post-ACLR. The purpose of this study was to characterize how knee biomechanics change with running speed between 3.5-7 (EARLY) and 8-13 (LATE) months post-ACLR. METHODS Fifty-five Division I collegiate athletes post-ACLR completed running analyses (EARLY: n = 40, LATE: n = 41, both: n = 26) at 2.68, 2.95, 3.35, 3.80, and 4.47 m·s -1 . Linear mixed-effects models assessed the influence of limb, speed, time post-ACLR, and their interactions on knee kinematics and kinetics. RESULTS A significant limb-speed interaction was detected for peak knee flexion, knee flexion excursion, and rate of knee extensor moment ( P < 0.02), controlling for time. From 3.35 to 4.47 m·s -1 , knee flexion excursion decreased by -2.3° (95% confidence interval, -3.6 to -1.0) in the nonsurgical limb and -1.0° (95% confidence interval, -2.3 to -0.3) in the surgical limb. Peak vertical ground reaction force, peak knee extensor moment, and knee negative work increased similarly with speed for both limbs ( P < 0.002). A significant limb-time interaction was detected for all variables ( P < 0.001). Accounting for running speed, improvements in all surgical limb biomechanics were observed from EARLY to LATE ( P < 0.001), except for knee flexion at initial contact ( P = 0.12), but between-limb differences remained ( P < 0.001). CONCLUSIONS Surgical and nonsurgical knee biomechanics increase similarly with speed in collegiate athletes at EARLY and LATE, with the exception of peak knee flexion, knee flexion excursion, and rate of knee extensor moment. Surgical knee biomechanics improved from EARLY and LATE, but significant between-limb differences persisted.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
| | - Daniel G. Cobian
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A. Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Mikel R. Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Bryan C. Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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Lee H, Clinger D, Oh M, Han S, Allen SP, Page GL, Bruening DA, Hyldahl RD, Hopkins JT, Seeley MK. Relationships Between Running Biomechanics and Femoral Articular Cartilage Thickness and Composition in Anterior Cruciate Ligament Reconstruction Patients. Scand J Med Sci Sports 2024; 34:e14675. [PMID: 38864455 DOI: 10.1111/sms.14675] [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: 01/12/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Although individuals with anterior cruciate ligament reconstruction (ACLR) are at high risk for posttraumatic osteoarthritis, mechanisms underlying the relationship between running and knee cartilage health remain unclear. OBJECTIVE We aimed to investigate how 30 min of running influences femoral cartilage thickness and composition and their relationships with running biomechanics in patients with ACLR and controls. METHODS Twenty patients with ACLR (time post-ACLR: 14.6 ± 6.1 months) and 20 matched controls participated in the study. A running session required both groups to run for 30 min at a self-selected speed. Before and after running, we measured femoral cartilage thickness via ultrasound imaging. A MRI session consisted of T2 mapping. RESULTS The ACLR group showed longer T2 relaxation times in the medial femoral condyle at resting compared with the control group (central: 51.2 ± 16.6 vs. 34.9 ± 13.2 ms, p = 0.006; posterior: 50.2 ± 10.1 vs. 39.8 ± 7.4 ms, p = 0.006). Following the run, the ACLR group showed greater deformation in the medial femoral cartilage than the control group (0.03 ± 0.01 vs. 0.01 ± 0.01 cm, p = 0.001). Additionally, the ACLR group showed significant negative correlations between resting T2 relaxation time in the medial femoral condyle and vertical impulse (standardized regression coefficients = -0.99 and p = 0.004) during running. CONCLUSIONS Our findings suggest that those who are between 6 and 24 months post-ACLR have degraded cartilage composition and their cartilage deforms more due to running vGRF.
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Affiliation(s)
- Hyunwook Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dallin Clinger
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Minsub Oh
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Seunguk Han
- Division of Sport Science, Pusan National University, Pusan, South Korea
| | - Steven P Allen
- Department of Electric and Computer Engineering, Brigham Young University, Provo, Utah, USA
| | - Garritt L Page
- Department of Statistics, Brigham Young University, Provo, Utah, USA
| | - Dustin A Bruening
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Robert D Hyldahl
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
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Hartshorne MT, Turner JA, Cameron KL, Padua DA. Strength of the Uninvolved Limb Following Return to Activity After ACL Injury: Implications for Symmetry as a Marker of Sufficient Strength. Int J Sports Phys Ther 2024; 19:657-669. [PMID: 38835985 PMCID: PMC11144673 DOI: 10.26603/001c.117547] [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: 01/04/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Muscular strength deficits are common after ACL injury. While the Limb Symmetry Index (LSI), using the uninvolved limb as a reference, is widely used, negative strength adaptations may affect both limbs post-injury. It is uncertain how the strength of the uninvolved limb in those with an ACL injury compares to uninjured individuals, making it unclear whether it is appropriate as a benchmark for determining sufficient strength. Purpose To compare the strength of key lower extremity muscles of the uninvolved limb in those with history of ACL injury (ACL-I) to the dominant limb in individuals with no history of ACL injury (control). Study Design Cross-sectional study. Methods: A total of 5,727 military cadets were examined, with 82 females and 126 males in the ACL-I group and 2,146 females and 3,373 males in the control group. Maximum isometric strength was assessed for six muscle groups measured with a hand-held dynamometer. Separate two-way ANOVAs with limb and sex were performed for each muscle group. Results Significant main effects for limb were observed with the uninvolved limb in the ACL-I group displaying greater strength compared to the dominant limb in the control group for the quadriceps, hamstrings, and gluteus medius, but effect sizes were small (Cohen's d <0.25). Significant main effects for sex were observed with greater male muscular strength in all six muscle groups with small to large effect sizes (Cohen's d 0.49-1.46). No limb-by-sex interactions were observed. Conclusions There was no evidence of reduced strength in the uninvolved limb in those with a history of ACL injury compared to the dominant limb in those with no prior ACL injury. This finding suggests that, after clearance to return to activities, the uninvolved limb can be used as a standard for comparison of sufficient strength, including when using the LSI. Level of Evidence: Level 3.
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Affiliation(s)
| | - Jeffrey A Turner
- Human Movement Science CurriculumUniversity of North Carolina at Chapel Hill
| | | | - Darin A Padua
- Department of Exercise and Sport ScienceUniversity of North Carolina at Chapel Hill
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Cobian DG, Knurr KA, Joachim MR, Bednarek AL, Broderick AM, Heiderscheit BC. Does It Matter? Isometric or Isokinetic Assessment of Quadriceps Strength Symmetry 9 Months After ACLR in Collegiate Athletes. Sports Health 2024:19417381241247819. [PMID: 38742396 DOI: 10.1177/19417381241247819] [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: 05/16/2024] Open
Abstract
BACKGROUND Greater quadriceps strength symmetry is associated with better outcomes after anterior cruciate ligament reconstruction (ACLR). Isometric and isokinetic assessments of quadriceps strength inform therapeutic exercise prescription and return-to-sport decisions. It is unclear whether isometric and isokinetic measures provide similar information post-ACLR. HYPOTHESIS Quadriceps strength symmetry is similar between isometric and isokinetic assessments. Isokinetic and isometric strength symmetries have similar associations to functional knee kinetics and self-reported knee function. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS NCAA Division I athletes (N = 35), 8.9 ± 2.5 months post-ACLR completed isometric and isokinetic quadriceps strength assessments, countermovement jumps (CMJs), and treadmill running. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC). Agreement between isometric and isokinetic strength symmetry was assessed using Bland-Altman analysis, with associations to functional knee kinetics and IKDC assessed using Pearson correlations and linear regressions. RESULTS Mean difference in quadriceps strength symmetry between isokinetic and isometric assessments was 1.0% (95% limits of agreement of -25.1% to 23.0%). Functional knee kinetics during running and CMJ were moderately to strongly associated with isometric strength symmetry (r = 0.64-0.80, P < 0.01) and moderately associated with isokinetic strength symmetry (r = 0.41-0.58, P < 0.01). IKDC scores were weakly to moderately associated with isometric (r = 0.39, P = 0.02) and isokinetic (r = 0.49, P < 0.01) strength symmetry. CONCLUSION Isokinetic and isometric assessments of quadriceps strength symmetry in collegiate athletes 9 months post-ACLR demonstrated strong agreement. Quadriceps strength symmetry is associated with functional knee kinetic symmetry post-ACLR. CLINICAL RELEVANCE Considerable individual variation suggests mode of contraction should be consistent throughout postoperative assessment. Isometric strength symmetry may be a better indicator of functional knee kinetic symmetry, while isokinetic strength symmetry may be associated more closely with patient-reported outcomes.
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Affiliation(s)
- Daniel G Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Doctor of Physical Therapy Program, University of Wisconsin-Madison, Madison, Wisconsin
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Keith A Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Doctor of Physical Therapy Program, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mikel R Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amy L Bednarek
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Andrew M Broderick
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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Hill M, Kiesewetter P, Milani TL, Mitschke C. An Investigation of Running Kinematics with Recovered Anterior Cruciate Ligament Reconstruction on a Treadmill and In-Field Using Inertial Measurement Units: A Preliminary Study. Bioengineering (Basel) 2024; 11:404. [PMID: 38671825 PMCID: PMC11048090 DOI: 10.3390/bioengineering11040404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) may affect movement even years after surgery. The purpose of this study was to determine possible interlimb asymmetries due to ACLR when running on a treadmill and in field conditions, with the aim of contributing to the establishment of objective movement assessment in real-world settings; moreover, we aimed to gain knowledge on recovered ACLR as a biomechanical risk factor. Eight subjects with a history of unilateral ACLR 5.4 ± 2.8 years after surgery and eight healthy subjects ran 1 km on a treadmill and 1 km on a concrete track. The ground contact time and triaxial peak tibial accelerations were recorded using inertial measurement units. Interlimb differences within subjects were tested and compared between conditions. There were no significant differences between limbs in the ACLR subjects or in healthy runners for any of the chosen parameters on both running surfaces. However, peak tibial accelerations were higher during field running (p-values < 0.01; Cohen's d effect sizes > 0.8), independent of health status. To minimize limb loading due to higher impacts during field running, this should be considered when choosing a running surface, especially in rehabilitation or when running with a minor injury or health issues.
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Affiliation(s)
| | | | | | - Christian Mitschke
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany; (M.H.); (P.K.); (T.L.M.)
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Barbosa O, Kotsifaki R, Whiteley R, King E, Korakakis V. Beware of the "Moving Target" - Uninvolved Limb Strength Increases to Exceed Preoperative Values During Rehabilitation After ACL Reconstruction in Male Professional and Recreational Athletes. J Orthop Sports Phys Ther 2024; 54:1-9. [PMID: 38093493 DOI: 10.2519/jospt.2023.11961] [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] [Indexed: 03/13/2024]
Abstract
OBJECTIVE: To describe the changes in quadriceps and hamstrings muscle strength in the uninvolved limb of male professional and recreational athletes during rehabilitation after anterior cruciate ligament reconstruction (ACLR) and compare to preoperative strength values. DESIGN: Prospective longitudinal study. METHODS: During rehabilitation, 665 participants who underwent unilateral ACLR performed a strength test preoperatively and every 6 weeks after surgery for up to 9 months. Isokinetic quadriceps and hamstrings strength of the uninvolved limb were measured at an angular velocity of 60°/s and normalized to body weight (N·m/kg). RESULTS: Quadriceps and hamstrings strength of the uninvolved limb gradually increased during rehabilitation until 6 months post-ACLR, and plateaued thereafter. Postoperative quadriceps' strength significantly exceeded preoperative values by 3 months for professional (2.99 N·m/kg; 95% confidence interval [CI]: 2.93, 3.04; P = .007) and by 6 months for recreational athletes (2.77 N·m/kg; 95% CI: 2.71, 2.83; P<.001), and hamstrings exceeded presurgery levels by 4.5 months (1.71 N·m/kg; 95% CI: 1.67, 1.74; P<.001 and 1.43 N·m/kg; 95% CI: 1.40, 1.46; P = .002, professional and recreational athletes respectively). CONCLUSION: In male professional and recreational athletes, uninvolved limb quadriceps and hamstrings strength gradually improved after ACLR, until 6 months after surgery. The uninvolved limb's strength may present as a "moving target" that requires consistent monitoring during rehabilitation. J Orthop Sports Phys Ther 2024;54(4):1-9. Epub 14 December 2023. doi:10.2519/jospt.2023.11961.
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7
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Pamukoff DN, Holmes SC, Heredia CE, Shumski EJ, Garcia SA, Montgomery MM. Cartilage deformation following a walking bout in individuals with anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:349-359. [PMID: 37772457 DOI: 10.1002/jor.25694] [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: 05/26/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
The purpose was to (1) compare the effect of a walking bout on femoral cartilage deformation between limbs with and without anterior cruciate ligament reconstruction (ACLR) and (2) examine the association between gait kinetics and the magnitude of cartilage deformation. A total of 30 individuals with primary unilateral ACLR completed this study [14 male, 16 female; age = 22.57 (3.78) years; body mass index (BMI) = 25.88 (5.68) kg/m2 ; time since ACLR = 61.00 (16.43) months]. Overground walking biomechanics were assessed on day 1, and a 30-min walking bout or 30-min resting bout (control) were completed on days 2 and 3 (counterbalanced order). Femoral cartilage thickness was measured using ultrasound before, immediately following, and 30-min following each intervention. Linear mixed effects models compared the effect of walking on cartilage thickness between the ACLR and contralateral limbs after adjusting for sex, BMI, speed, and the number of steps. Stepwise regression examined the association between the external knee flexion and adduction moments and cartilage deformation following walking. There was a significant limb × time interaction for medial cartilage thickness. Post hoc analyses indicated that cartilage thickness decreased immediately following walking in the contralateral but not ACLR limb. Main effects of limb were observed for medial, central, and lateral cartilage thickness indicating thicker cartilage in the ACLR compared with contralateral limb. A higher knee adduction moment was associated with greater cartilage deformation in the ACLR limb. Femoral cartilage in the ACLR limb exhibited a less dynamic response to walking than the uninvolved limb, which may be due to habitual underloading during gait.
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Affiliation(s)
- Derek N Pamukoff
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | | | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa M Montgomery
- Department of Kinesiology, California State University, Fullerton, Fullerton, California, USA
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Diamond LE, Saxby DJ. Substantial side-to-side differences in knee cartilage contact area exist in healthy knees-Should we reconsider comparing to the contralateral side after ligament reconstruction? Osteoarthritis Cartilage 2023; 31:1418-1419. [PMID: 37467876 DOI: 10.1016/j.joca.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
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Johnson AK, Heebner NR, Hunt ER, Conley CE, Jacobs CA, Ireland ML, Abt JP, Lattermann C. Pain Early After Anterior Cruciate Ligament Reconstruction is Associated With 6-Month Loading Mechanics During Running. Sports Health 2023; 15:908-916. [PMID: 36519181 PMCID: PMC10606962 DOI: 10.1177/19417381221139478] [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] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) results in persistent altered knee biomechanics, but contributing factors such as pain or patient function, leading to the altered loading, are unknown. HYPOTHESIS Individuals with worse self-reported pain after ACLR would have poorer biomechanics during running, and poor loading mechanics would be present in the ACLR limb compared with contralateral and control limbs. STUDY DESIGN Cohort pilot study. LEVEL OF EVIDENCE Level 3. METHODS A total of 20 patients after ACLR (age, 18.4 ± 2.7 years; height, 1.7 ± 0.1 m; mass, 84.2 ± 19.4 kg) completed visual analog scale and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1 and 6 months postsurgery. At 6 months postsurgery, patients underwent biomechanical testing during running. A total of 20 control individuals also completed running biomechanical analyses. Associations between patient outcomes and biomechanics were conducted, and differences in running biomechanics between groups were analyzed. RESULTS KOOS pain score 1 month after surgery was associated with peak ACLR knee abduction moment (R2 = 0.35;P = 0.01). At 6-months, KOOS sport score was related to peak abduction moment in the ACLR limb (R2 = 0.23; P = 0.05). For change scores, the improvement in pain scores related to ACLR limb peak knee abduction moment (R2 = 0.55; P = 0.001). The ACLR limb had lower knee excursion, extension moments, and ground-reaction forces compared with the uninvolved and control limb. The uninvolved limb also had higher ground-reaction forces compared with the ACLR limb and control limb. CONCLUSION These results suggest that patient-reported outcomes 1 and 6 months after surgery are associated with running mechanics 6 months after ACLR. Further, the underloading present in the ACLR limb and overloading in the uninvolved limb indicates greater need for running rehabilitation after ACLR. CLINICAL RELEVANCE Understanding pain and how it may be linked to movement dysfunction is important for improving long-term outcomes.
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Affiliation(s)
- Alexa K. Johnson
- Orthopaedic Rehabilitation and Biomechanics Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Nicholas R. Heebner
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Emily R. Hunt
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Caitlin E.W. Conley
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Mary L. Ireland
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - John P. Abt
- Children’s Health, Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas
| | - Christian Lattermann
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Knurr KA, Cobian DG, Kliethermes SA, Stiffler-Joachim MR, Heiderscheit BC. The Influence of Quadriceps Strength and Rate of Torque Development on the Recovery of Knee Biomechanics During Running After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3171-3178. [PMID: 37681433 PMCID: PMC10985737 DOI: 10.1177/03635465231194617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), altered surgical knee biomechanics during running is common. Although greater quadriceps strength is associated with more symmetrical running knee kinetics after ACLR, abnormal running mechanics persist even after resolution of quadriceps strength deficits. As running is a submaximal effort task characterized by limited time to develop knee extensor torque, quadriceps rate of torque development (RTD) may be more closely associated with recovery of running knee mechanics than peak torque (PT). PURPOSE To assess the influence of recovery in quadriceps PT and RTD symmetry on knee kinematic and kinetic symmetry during running over the initial 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 39 Division I collegiate athletes (106 testing sessions; 19 female) completed serial isometric performance testing and running analyses between 3 and 24 months after ACLR. Athletes performed maximal and rapid isometric knee extension efforts with each limb to assess PT and RTD between-limb symmetry indices (PTLSI and RTDLSI), respectively. Peak knee flexion difference (PKFDIFF) and peak knee extensor moment limb symmetry index (PKEMLSI) during running were computed. Multivariable linear mixed-effects models assessed the influence of PTLSI and RTDLSI on PKFDIFF and PKEMLSI over the initial 2 years after ACLR. RESULTS Significant main effects of RTDLSI (P < .001) and time (P≤ .02) but not PTLSI (P≥ .24) were observed for both PKFDIFF and PKEMLSI models. For a 10% increase in RTDLSI, while controlling for PTLSI and time, a 0.9° (95% CI, 0.5°-1.3°) reduction in PKFDIFF and a 3.5% (95% CI, 1.9%-5.1%) increase in PKEMLSI are expected. For every month after ACLR, a 0.2° (95% CI, 0.1°-0.4°) reduction in PKFDIFF and a 1.3% (95% CI, 0.6%-2.0%) increase in PKEMLSI are expected, controlling for PTLSI and RTDLSI. CONCLUSION Quadriceps RTDLSI was more strongly associated with symmetrical knee biomechanics during running compared with PTLSI or time throughout the first 2 years after ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, Division of Geriatrics, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Knurr KA, Lyon JP, Haack CR, Kliethermes SA, Cobian DG, Stiffler-Joachim MR, Binkley NC, Scerpella TA, Heiderscheit BC. Quadriceps Performance and Running Biomechanics Influence Femur BMD Changes after ACL Reconstruction in Collegiate Athletes. Med Sci Sports Exerc 2023; 55:1540-1547. [PMID: 37101347 PMCID: PMC10523868 DOI: 10.1249/mss.0000000000003186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE Reduced bone mineral density of the distal femur (BMD DF ) can persist long term after anterior cruciate ligament reconstruction (ACLR), even in athletes who return to high levels of competition. These deficits may have implications for the onset and progression of knee osteoarthritis. It is unknown if clinically modifiable factors are associated with losses in BMD DF . This study evaluated the potential influence of knee extensor peak torque (PT), rate of torque development (RTD), as well as peak knee flexion (PKF) angle and peak knee extensor moment (PKEM) during running, on longitudinal changes in BMD DF post-ACLR. METHODS After ACLR, 57 Division I collegiate athletes underwent serial whole-body dual-energy x-ray absorptiometry (DXA) scans between 3 and 24 months post-ACLR. Of these, 43 athletes also had isometric knee extensor testing (21 female, 105 observations), and 54 had running analyses (26 female, 141 observations). Linear mixed-effects models, controlling for sex, assessed the influence of surgical limb quadriceps performance (PT and RTD), running mechanics (PKF and PKEM), and time post-ACLR on BMD DF (5% and 15% of femur length). Simple slope analyses were used to explore interactions. RESULTS Athletes with RTD less than 7.20 (N·m)·kg -1 ·s -1 (mean) at 9.3 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.03). Athletes with PKEM during running less than 0.92 (N·m)·kg -1 (-1 SD below mean) at 9.8 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.02). Significant slopes were not detected at -1 SD below the mean for PT (1.75 (N·m)·kg -1 , P = 0.07) and PKF (31.3°, P = 0.08). CONCLUSIONS Worse quadriceps RTD and running PKEM were associated with a greater loss of BMD DF between 3 and 24 months post-ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
| | - James P. Lyon
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Colten R. Haack
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A. Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Daniel G. Cobian
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Neil C. Binkley
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI
| | - Tamara A. Scerpella
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Bryan C. Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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12
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Cognetti DJ, Lynch TB, Rich E, Bedi A, Dhawan A, Sheean AJ. Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09844-0. [PMID: 37243966 PMCID: PMC10382434 DOI: 10.1007/s12178-023-09844-0] [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: 05/10/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE OF REVIEW To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes. RECENT FINDINGS Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures. These facts underscore the need for continued investigation into the potential detrimental effects of regional anesthetic and intraoperative tourniquet use on postoperative quadriceps function, with an outward focus on innovation within the field of postoperative rehabilitation. Neuromuscular stimulation, nutritional supplementation, cryotherapy, blood flow restriction (BFR), and open-chain exercises are all potential additions to postoperative regimens. There is compelling literature to suggest that these modalities are efficacious and may diminish the magnitude and duration of postoperative QD. A clear understanding of QD, with respect to its pathophysiology, should guide perioperative treatment and rehabilitation strategies and influence ongoing rehabilitation-based research and innovation. Moreover, clinicians must appreciate the magnitude of QD's effect on diminished clinical outcomes, risk for re-injury and patients' ability (or inability) to return to pre-injury level of activity following knee joint preservation procedures.
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Affiliation(s)
- Daniel J Cognetti
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
| | - Thomas B Lynch
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Elizabeth Rich
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State Health, Hershey, PA, 17033, USA
| | - Andrew J Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
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13
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Kocak UZ, Knurr KA, Cobian DG, Heiderscheit BC. Beyond peak torque: Longitudinal analysis of angle-specific isokinetic knee torques in collegiate athletes post-ACLR. Phys Ther Sport 2023; 61:11-19. [PMID: 36841117 PMCID: PMC10330311 DOI: 10.1016/j.ptsp.2023.02.004] [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: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To investigate changes in angle-specific knee extensor torque between limbs from 4 to 12 months post-anterior cruciate ligament reconstruction(ACLR) in Division I collegiate athletes at two different isokinetic velocities. DESIGN Case-series study. SETTING Laboratory-based. PARTICIPANTS Isokinetic knee flexion and extension assessments of 17 athletes (11 female) at 4, 8, and 12 months after ACLR with bone-patellar tendon-bone autograft were evaluated. MAIN OUTCOME MEASURES Angle-specific curve analyses were performed using statistical parametric mapping for torque data obtained between 14 and 101° at 60°/s and 240°/s velocities. RESULTS At 60°/s, knee extensor torque of the operated limb increased between 4 and 8 months (18-101°,p < 0.001), 4 and 12 months (28-101°,p < 0.001), and 8 and 12 months post-surgery (62-70°,p = 0.002, and 79-90°,p < 0.001). Knee extensor torque was lower in the operated limb compared to the non-operated limb at 4 (47-97°,p < 0.001) and 8 months (65-90°,p < 0.001) for 60°/s, at 4 (21-89°,p < 0.001) and 8 months (50-77°,p < 0.001) for 240°/s, with no between-limb differences at 12 months post-ACLR for both velocities. CONCLUSIONS Operated limb knee extensor torque increased throughout the majority of knee range of motion from 4 to 12 months post-ACLR at both isokinetic velocities, while non-operated limb torque only improved through a reduced arc of motion in greater knee flexion angles.
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Affiliation(s)
- Umut Z Kocak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - Keith A Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel G Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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14
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Alzakerin HM, Halkiadakis Y, Morgan KD. A new metric for characterizing limb loading dynamics in post anterior cruciate ligament reconstruction individuals. Gait Posture 2023; 102:193-197. [PMID: 37037090 DOI: 10.1016/j.gaitpost.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/08/2022] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Unresolved neuromuscular deficits often persist in post-anterior cruciate ligament reconstruction (ACLR) individuals manifesting as altered impact and active peak force production during running that can contribute to detrimental limb loading. Elevated impact and active peaks are common in pathological populations indicating a stiffer limb loading strategy. Although impact and active peaks are sensitive to changes in limb loading, to our knowledge, there are no established, standardized measures or cutoff criteria to differentiate between healthy and pathological limb loading. However, prior studies have demonstrated that the ratio between traditional biomechanical measures can be used to successfully establish quantifiable and graphical ranges to delineate between healthy and pathological movement. RESEARCH QUESTION Therefore, this study sought to exploit the impact-to-active peak ratio to generate a new, standardized metric to quantify and characterize limb loading dynamics in healthy controls and post-ACLR individuals during running. METHODS Twenty-eight post-ACLR individuals and 18 healthy controls performed a running protocol. Impact peak and active peak data were extracted from their strides as they ran at a self-selected speed. A linear regression model was fit to the healthy control data and the models 95 % prediction intervals were used to define a boundary region of healthy limb loading dynamics. RESULTS The post-ACLR individuals produced a higher impact-to-active peak ratio than the healthy controls indicating that they adopted a stiffer limb loading strategy. The boundary regions derived from the impact and active peak model successfully classified the healthy controls and post-ACLR individual's limb loading dynamics with an accuracy, sensitivity, and specificity of 89 %, 100 %, and 75 %, respectively. SIGNIFICANCE The ability to effectively evaluate limb loading dynamics using impact and active peaks can provide clinicians with a new, non-invasive metric to quantify and characterize healthy and pathological movement in a clinical setting.
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Affiliation(s)
| | - Yannis Halkiadakis
- Biomedical Engineering, School of Engineering, University of Connecticut, Storrs, CT, USA
| | - Kristin D Morgan
- Biomedical Engineering, School of Engineering, University of Connecticut, Storrs, CT, USA
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15
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Chaney GK, Krause DA, Hollman JH, Anderson VA, Heider SE, Thomez S, Vaughn SN, Schilaty ND. Recurrence quantification analysis of isokinetic strength tests: A comparison of the anterior cruciate ligament reconstructed and the uninjured limb. Clin Biomech (Bristol, Avon) 2023; 104:105929. [PMID: 36893524 PMCID: PMC10122704 DOI: 10.1016/j.clinbiomech.2023.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Despite widespread use of return to sport testing following anterior cruciate ligament reconstruction, studies suggest inadequacy in current testing criteria, such as limb symmetry index calculations, to determine athletes' readiness to return to play. Recurrence quantification analysis, an emerging non-linear data analysis tool, may reveal subtle neuromuscular differences between the injured and uninjured limb that are not captured by traditional testing. We hypothesized that isokinetic torque curve data of the injured limb would demonstrate lower determinism and entropy as compared to the uninjured limb. METHODS 102 patients (44 M, 58F, 10 ± 1 months post-anterior cruciate ligament reconstruction) underwent isokinetic quadriceps strength testing using a HumacNorm dynamometer. Patients completed maximum effort knee extension and flexion at 60°/sec. Data were post-processed with a MATLAB CRQA Graphical User Interface and determinism and entropy values were extracted. Paired-sample t-tests (α = 0.05) were used to compare data from the injured and uninjured limb. FINDINGS Determinism and entropy values in the torque curves were lower in the injured limb than the uninjured limb (p < 0.001). Our findings indicate there is less predictability and complexity present in the torque signals of injured limbs. INTERPRETATION Recurrence quantification analysis can be used to assess neuromuscular differences between limbs in patients who have undergone anterior cruciate ligament reconstruction. Our findings offer further evidence that there are changes to the neuromuscular system which persist following reconstruction. Further investigation is needed to establish thresholds of determinism and entropy values needed for safe return to sport and to evaluate the utility of recurrence quantification analysis as a return to sport criterion.
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Affiliation(s)
- Grace K Chaney
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - David A Krause
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - John H Hollman
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Vanessa A Anderson
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sarah E Heider
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sean Thomez
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Shaelyn N Vaughn
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA.
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16
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Dauty M, Menu P, Daley P, Grondin J, Quinette Y, Crenn V, Fouasson-Chailloux A. Knee Strength Assessment and Clinical Evaluation Could Predict Return to Running after Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Procedure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13396. [PMID: 36293974 PMCID: PMC9603555 DOI: 10.3390/ijerph192013396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Muscle knee strength is a major parameter that allows return to running. Isokinetic strength parameters may predict return to running 4 months after ACLR using the bone-patellar-tendon-bone procedure. MATERIALS AND METHODS The isokinetic knee strength of 216 patients (24.5 ± 5 years) was measured 4 months after surgery, and progressive return to running was allowed. The effectiveness of return to running was reported at 6 months. Return to running prediction was established using multivariate logistic regression. Predictive parameters were presented with a ROC curve area to define the best cut-off, with sensibility (Se) and specificity (Sp). RESULTS A model was established, including the limb symmetry index (LSI), and 103 patients (47.6%) were able to run between the fourth and the sixth month after surgery. These patients presented significantly fewer knee complications, a better Lysholm score, a better Quadriceps and Hamstring LSI and better quadriceps strength reported for body weight on the operated limb. The best model was established including the Quadriceps and Hamstring LSI at 60°/s and the Lysholm score. The cut-off for Quadriceps LSI was 60% (ROC curve area: 0.847; Se: 77.5%; Sp: 77%), for Hamstring LSI 90% (ROC curve area: 0.716; Se: 65.7%; Sp: 60.2%) and for Lyshom score 97 points (ROC curve area: 0.691; Se: 65%; Sp: 66%). CONCLUSION Four months after ACLR using a bone-patellar-tendon-bone procedure, the Quadriceps and Hamstring LSI associated to the Lysholm score could help make the decision to allow return to running.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
| | - Yonis Quinette
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, 44042 Nantes, France
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17
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Pamukoff DN, Holmes SC, Garcia SA, Vakula MN, Shumski EJ, Moffit TJ. Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics. J Orthop Res 2022; 41:994-1003. [PMID: 36205181 DOI: 10.1002/jor.25451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/06/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
Body mass index (BMI) and history of anterior cruciate ligament reconstruction (ACLR) independently influence gait biomechanics and knee osteoarthritis risk, but the interaction between these factors is unclear. The purpose of this study was to compare gait biomechanics between individuals with and without ACLR, and with and without overweight/obesity. We examined 104 individuals divided into four groups: with and without ACLR, and with low or high BMI (n = 26 per group). Three-dimensional gait biomechanics were evaluated at preferred speed. The peak vertical ground reaction force, knee flexion angle and excursion, external knee flexion moment, and external knee adduction moment were extracted for analysis. Gait features were compared between groups using 2 (with and without overweight/obesity) × 2 (with and without ACLR) analysis of variance. Primary findings indicated that those with ACLR and high BMI had a larger external knee adduction moment compared with those with low BMI and with (p = 0.004) and without ACLR (p = 0.005), and compared with those without ACLR and high BMI (p = 0.001). The main effects of ACLR and BMI group were found for the knee flexion moment, and those with ACLR and with high BMI had lower knee flexion moments compared with those without ACLR (p = 0.031) and with low BMI (p = 0.021), respectively. Data suggest that individuals with ACLR and high BMI may benefit from additional intervention targeting the knee adduction moment. Moreover, lower external knee flexion moments in those with high BMI and ACLR were consistent, but high BMI did not exacerbate deficits in the knee flexion moment in those with ACLR. [Correction added on 9 November 2022, after first online publication: In the preceding sentence, for clarity, the words "reductions in the lower" was removed from the initial sentence to read "Moreover, lower external knee flexion moments".].
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Affiliation(s)
- Derek N Pamukoff
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael N Vakula
- Department of Kinesiology & Health Science, Utah State University, Logan, Utah, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Tyler J Moffit
- Department of Kinesiology, California State University, Bakersfield, California, USA
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18
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Manchado I, Motta LM, Blanco G, González J, Garcés GL. Isometric Knee Muscle Strength and Patient-Reported Measures Five Years after Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Autograft Hamstring Tendon Harvesting. J Clin Med 2022; 11:jcm11195682. [PMID: 36233550 PMCID: PMC9572358 DOI: 10.3390/jcm11195682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
There is some controversy regarding the use of one or two hamstring tendons for anterior cruciate ligament reconstruction (ACLR). In this study, two cohorts of 22 male patients underwent an ACLR with hamstring tendon autografts. One cohort was reconstructed through an all-inside technique with the semitendinosus tendon (ST group) and the other with the semitendinosus and gracilis tendons (ST-G group). Anterior tibial translation (ATT), Lysholm, and IKDC scores were assessed preoperatively and five years postoperation. Additionally, isometric knee muscle strength was manually measured in both groups and in another cohort of 22 uninjured control male subjects five years after the operation. There were no significant differences in ATT and Lysholm scores between the operated groups. The IKDC score was lower in the ST-G group than in the ST group—9.57 (CI 14.89−4.25) (p < 0.001). No significant differences between injured and uninjured knees were detected in hamstring to quadriceps ratio strength and quadriceps limb symmetry index of the two operated groups, but the hamstring limb symmetry index was significantly lower in the ST-G group than in the ST and control groups. This study shows that using an ST-G autograft for ACLR yielded less flexor strength and worse results in some patient-reported outcome measures (PROM) than using an ST autograft five years after the operation. The observed results let us suggest that the use of one autograft hamstring tendon for ACLR is clinically preferable to the use of two hamstring tendons.
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Affiliation(s)
- Ignacio Manchado
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
| | - Luci M. Motta
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
| | | | - Jesús González
- Unidad de Investigación, Hospital Dr Negrin, 35007 Las Palmas, Spain
| | - Gerardo L. Garcés
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas, Spain
- Correspondence: ; Tel.: +34-696-471-915
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19
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Suzuki M, Ishida T, Samukawa M, Matsumoto H, Ito Y, Aoki Y, Tohyama H. Rate of Torque Development in the Quadriceps after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autografts in Young Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11761. [PMID: 36142034 PMCID: PMC9517280 DOI: 10.3390/ijerph191811761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
This study aims to compare the limb symmetry index (LSI) of the rate of torque development (RTD) of the quadriceps with that of the peak torque after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STG) autografts and to investigate the associations of the LSI of torque parameters with patient-reported knee function. The participants included 23 female athletes after ACLR with STG grafts. Isometric quadriceps tests were performed using an isokinetic dynamometer. The peak torque, RTD100 (0 to 100 ms) and RTD200 (100 to 200 ms) were determined using torque-time curves. Comparisons of the LSI of torque parameters was performed by ANOVA. Univariate regression analysis was used to examine the relationship between the LSI of torque parameters and the patient-reported knee function. The LSIs of the peak torque and RTD200 were significantly lower than that of the RTD100 (p = 0.049, p = 0.039, respectively). Regression analysis showed that the LSI of the peak torque was associated with the patient-reported knee function (R2 = 0.40, p = 0.001). It would be useful to evaluate the peak torque in young female athletes under the age of 18 and at 8-10 months after ACLR with STG grafts.
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Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Yu Ito
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo 060-0908, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
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Powers CM, Straub RK. Quadriceps strength symmetry predicts vertical ground reaction force symmetry during running in patients who have undergone ACL reconstruction. Phys Ther Sport 2022; 57:89-94. [PMID: 35961193 DOI: 10.1016/j.ptsp.2022.07.012] [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: 05/31/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether quadriceps strength symmetry can predict peak vertical ground reaction force (vGRF) running force symmetry in patients who have undergone ACL reconstruction (ACLR). We also sought to determine a cutoff for quadriceps strength symmetry to identify patients at risk for vGRF running asymmetry. DESIGN Retrospective cross-sectional. SETTING Clinical facility. METHODS Bilateral quadriceps strength and vGRF data during running were obtained from 79 patients 26-30 weeks post ACLR. Linear regression was used to determine if quadriceps strength symmetry predicted peak vGRF running force symmetry. Classification and regression tree (CART) analysis was used to determine the cutoff value for quadriceps strength symmetry to identify patients at risk for vGRF running asymmetry. RESULTS Increased quadriceps strength symmetry predicted increased vGRF running symmetry (R2 = 0.20). CART analysis revealed that patients with quadriceps strength symmetry less than or equal to 88% were at highest risk for vGRF running asymmetry (R2 = 26%). CONCLUSION Greater quadriceps strength symmetry is predictive of greater vGRF running force symmetry in patients who have undergone ACLR. This finding highlights the need for clinicians to consider the degree of quadriceps strength symmetry before initiating a return to running program.
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Affiliation(s)
- Christopher M Powers
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA.
| | - Rachel K Straub
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA
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21
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Association Between the Functional Movement Screen and Landing Kinematics in Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2022; 31:842-848. [PMID: 35413683 DOI: 10.1123/jsr.2021-0345] [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: 09/21/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to compare functional movement screen (FMS) scores and drop vertical jump (DVJ) kinematics between those with and without anterior cruciate ligament reconstruction (ACLR), and to evaluate the association between FMS composite score and DVJ kinematics. DESIGN Cross-sectional. PARTICIPANTS Sixty individuals with and without a history of ACLR. MAIN OUTCOME MEASURES Composite FMS score and the dorsiflexion, knee-flexion, hip-flexion, knee abduction, hip adduction, and trunk-flexion angles during a DVJ. RESULTS The FMS scores did not differ between groups (P > .05). There were smaller peak and initial contact hip-flexion angles in the ACLR and contralateral limbs compared with controls, and smaller peak dorsiflexion angles in the ACLR compared with contralateral limbs (P < .05). Lower FMS score was associated with a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the ACLR limb (ΔR2 = .14-.23); a smaller peak dorsiflexion angle and smaller peak knee-flexion angle in the contralateral limb (ΔR2 = .17-.19); and a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the control limb (ΔR2 = .16-.22). CONCLUSION The FMS scores did not differ between groups, but were associated with DVJ kinematics and should be a complementary rather than substitute assessment.
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22
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Bilateral muscle atrophy after anterior cruciate ligament reconstruction in rats: Protective effects of anti-inflammatory drug celecoxib. Knee 2022; 35:201-212. [PMID: 35381572 DOI: 10.1016/j.knee.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle atrophy after anterior cruciate ligament (ACL) reconstruction occurs bilaterally and contributes to a decrease in muscle strength. However, effective treatment strategies for ACL reconstruction-induced muscle atrophy have not been established. We examined the effects of anti-inflammatory drug on muscle atrophy after ACL reconstruction. MATERIALS AND METHODS Rats were divided into groups according to treatment received: untreated control (n = 4), arthrotomy (n = 6), ACL transection (n = 7), ACL reconstruction (n = 8), and ACL reconstruction plus anti-inflammatory drug celecoxib (CBX; 50 mg/kg/day) administration (n = 8). At one-week post-surgery, the muscle fiber cross-sectional area (CSA) in the rectus femoris (RF) and semitendinosus (ST) was measured to assess muscle atrophy. In addition, we examined joint swelling and serum C‑reactive protein (CRP) levels to assess local and systemic inflammation, respectively. RESULTS Each additional procedure (i.e., arthrotomy, ACL transection, and ACL reconstruction) gradually decreased the muscle fiber CSAs in the RF and ST on both operated and contralateral sides. The degree of muscle fiber atrophy on the operated side was larger than that detected on the contralateral side. Moreover, ACL reconstruction induced joint swelling on the operated side and tended to increase serum CRP levels. CBX lessened the RF atrophy on both sides and was associated with less joint swelling and a smaller increase CRP level; however, it did not affect ST atrophy on either side. CONCLUSIONS Anti-inflammatory treatments after ACL reconstruction may be effective in lessening muscle atrophy in the quadriceps, but not in the hamstrings.
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Tourville TW, Voigt TB, Choquette RH, Failla MJ, Endres NK, Slauterbeck JR, Beynnon BD, Toth MJ. Skeletal muscle cellular contractile dysfunction after anterior cruciate ligament reconstruction contributes to quadriceps weakness at 6-month follow-up. J Orthop Res 2022; 40:727-737. [PMID: 33969521 PMCID: PMC8578585 DOI: 10.1002/jor.25065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Muscle dysfunction following anterior cruciate ligament reconstruction (ACLR) may evolve from alterations in muscle contractility at the myofilament protein level. Using a prospective, within-subject case-control design, we evaluated cellular-level contractility, cross-sectional area (CSA), and myosin heavy chain (MHC) isoform expression on single muscle fibers 3 weeks post ACLR, and evaluated their relationship to whole muscle strength and patient-oriented outcomes 6 months post operation. Biopsies of the vastus lateralis were performed 3 weeks post ACLR in 11 subjects (5 females, mean age ± SD = 24.7 ± 6.5 years, height = 172.7 ± 8.2 cm, mass = 75.7 ± 12.5 kg) following first-time ACL rupture and whole muscle strength and self-reported pain, function, and quality of life assessed 6 months post ACLR. At 3 weeks post ACLR, force production was reduced (p < 0.01) in MHC I (-36%) and IIA (-48%) fibers compared with the non-injured leg. When force production was expressed relative to CSA to account for fiber atrophy, reductions remained in MHC IIA fibers (-40%; p < 0.001), but MHC I fibers showed only a trend toward being lower (-13%; p = 0.09). Finally, skeletal muscle fiber functional deficits at 3 weeks post ACLR were associated with whole muscle weakness and less favorable patient-reported outcomes at 6-month follow-up. Thus, ACLR promotes early cellular contractile dysfunction that may contribute to decreased whole muscle strength and patient function, and increased patient-reported symptoms, at 6-month follow-up.
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Affiliation(s)
- Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Michael J. Toth
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
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24
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Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31:694-706. [PMID: 35168201 DOI: 10.1123/jsr.2021-0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1) neural pathways involved in the AMI pathogenesis following ACL injury; (2) consequence of AMI on muscle function, joint biomechanics, and patient function; and (3) development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.
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25
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Jafarnezhadgero AA, Pourrahimghoroghchi A, Darvishani MA, Aali S, Dionisio VC. Analysis of ground reaction forces and muscle activity in individuals with anterior cruciate ligament reconstruction during different running strike patterns. Gait Posture 2021; 90:204-209. [PMID: 34509043 DOI: 10.1016/j.gaitpost.2021.09.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction provides successful clinical outcomes. However, reconstruction cannot restore normative lower limb mechanics during running. While numerous studies have investigated running characteristics in individuals with anterior cruciate ligament reconstruction, no study has been compared foot strike patterns among them. RESEARCH QUESTION If ground reaction forces and lower extremity muscle activities in individuals with anterior cruciate ligament reconstruction and healthy control ones differ during three running strike patterns? METHODS In this cross-sectional study, fourteen healthy adult males and fourteen adult males with anterior cruciate ligament reconstruction were recruited to participate. Surface electromyography of selected lower limb muscles and ground reaction forces were measured during three-strike patterns: rearfoot strike pattern, midfoot strike pattern, and forefoot strike pattern during barefoot running (∼ 3.3 m/s). RESULTS The results revealed that the strike patterns influenced the peak lateral ground reaction force (P < 0.001) and peak vertical impact ground reaction force (P = 0.002) during the stance phase of running for both groups. The strike pattern also influenced the tibialis anterior (P < 0.001) and vastus lateralis (P = 0.035) activities during the early stance phase for both groups. However, the vastus medialis (P = 0.030) presented reduced activity, and the biceps femoris (P = 0.039) presented increased activity in the anterior cruciate ligament reconstruction group. Tibialis anterior (P = 0.021), gastrocnemius medialis (P < 0.001) and vastus medialis (P < 0.001) presented lesser activity irrespective of strike patterns in the anterior cruciate ligament reconstruction group. SIGNIFICANCE Running with a forefoot strike pattern may be associated with lesser rearfoot eversion due to lower peak lateral ground reaction forces than running with a rearfoot strike pattern or midfoot strike pattern. Moreover, the altered muscle activities could contribute to the elevated risk of future joint injury in the anterior cruciate ligament reconstruction population.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Sport Managements and Biomechanics, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Ameneh Pourrahimghoroghchi
- Department of Sport Managements and Biomechanics, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Mohammad Abdollahpour Darvishani
- Department of Sport Managements and Biomechanics, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Shirin Aali
- Sport Science Department, Farhangian University, Tehran, Iran
| | - Valdeci Carlos Dionisio
- Physical Education and Physiotherapy Faculty, Federal University of Uberlândia, Uberlândia, Brazil
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26
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Ogborn D. Optimizing Exercise Selection for the Asymmetric Athlete After Anterior Cruciate Ligament Reconstruction. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Knurr KA, Kliethermes SA, Stiffler-Joachim MR, Cobian DG, Baer GS, Heiderscheit BC. Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes. Am J Sports Med 2021; 49:2607-2614. [PMID: 34260290 PMCID: PMC8338897 DOI: 10.1177/03635465211026665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preinjury running biomechanics are an ideal comparator for quantifying recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), allowing for assessments within the surgical and nonsurgical limbs. However, availability of preinjury running biomechanics is rare and has been reported in case studies only. PURPOSE/HYPOTHESIS The purpose of this study was to determine if running biomechanics return to preinjury levels within the first year after ACLR among collegiate athletes. We hypothesized that (1) surgical knee biomechanics would be significantly reduced shortly after ACLR and would not return to preinjury levels by 12 months and (2) nonsurgical limb mechanics would change significantly from preinjury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Thirteen Division I collegiate athletes were identified between 2015 and 2020 (6 female; mean ± SD age, 20.7 ± 1.3 years old) who had whole body kinematics and ground-reaction forces recorded during treadmill running (3.7 ± 0.6 m/s) before sustaining an ACL injury. Running analyses were repeated at 4, 6, 8, and 12 months (4M, 6M, 8M, 12M) after ACLR. Linear mixed effects models were used to assess differences in running biomechanics between post-ACLR time points and preinjury within each limb, reported as Tukey-adjusted P values. RESULTS When compared with preinjury, the surgical limb displayed significant deficits at all postoperative assessments (P values <.01; values reported as least squares mean difference [SE]): peak knee flexion angle (4M, 13.2° [1.4°]; 6M, 9.9° [1.4°]; 8M, 9.8° [1.4°]; 12M, 9.0° [1.5°]), peak knee extensor moment (N·m/kg; 4M, 1.32 [0.13]; 6M, 1.04 [0.13]; 8M, 1.04 [0.13]; 12M, 0.87 [0.15]; 38%-57% deficit), and rate of knee extensor moment (N·m/kg/s; 4M, 22.7 [2.4]; 6M, 17.9 [2.3]; 8M, 17.5 [2.4]; 12M, 16.1 [2.6]; 33%-46% deficit). No changes for these variables from preinjury (P values >.88) were identified in the nonsurgical limb. CONCLUSION After ACLR, surgical limb knee running biomechanics were not restored to the preinjury state by 12M, while nonsurgical limb mechanics remained unchanged as compared with preinjury. Collegiate athletes after ACLR demonstrate substantial deficits in running mechanics as compared with preinjury that persist beyond the typical return-to-sport time frame. The nonsurgical knee appears to be a valid reference for recovery of the surgical knee mechanics during running, owing to the lack of change within the nonsurgical limb.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Geoffrey S. Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA,Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA,Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA,Corresponding Author: Bryan C. Heiderscheit, PT, PhD, Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Avenue, Madison, WI 53705-2281, USA ()
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28
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Stiffler-Joachim MR, Lukes DH, Kliethermes SA, Heiderscheit BC. Lower Extremity Kinematic and Kinetic Asymmetries during Running. Med Sci Sports Exerc 2021; 53:945-950. [PMID: 33148971 DOI: 10.1249/mss.0000000000002558] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The primary aims of this investigation were to describe the magnitude of asymmetries of common variables during running among healthy athletes and to determine if sex and speed influence magnitudes of asymmetry. METHODS This study analyzed routinely collected running gait data on healthy Division I collegiate athletes. All athletes had no history of lower extremity surgery, no lower extremity injuries for 3 months before testing, and running data available at 2.68, 2.95, 3.35, 3.80, and 4.47 m·s-1. Asymmetries were calculated for ground reaction forces, spatiotemporal metrics, joint kinematics, and joint kinetics. Separate linear mixed-effects models assessed the influence of sex, speed, and the interaction on asymmetries of interest. z Scores were calculated for significant effects to further assess the magnitude of differences. RESULTS Results from 204 athletes were included. The magnitude of asymmetry varied depending on the variable of interest, with asymmetries ≤3° observed for joint kinematics and greater asymmetries observed among joint work asymmetries ranging from 10% to 40%. No significant interactions between sex and speed were observed. Differences in sex and speed were noted; however, the effect sizes were very small based on z score comparison (-0.17 ≤ z ≤ 0.36) and were unlikely to be meaningful. CONCLUSIONS The magnitude of asymmetry varies considerably depending on the running gait variable. Interpretation of between-limb asymmetry in running mechanics needs to be specific to the variable of interest, whereas sex or running speed seem to be minor factors.
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Affiliation(s)
| | - Drew Henry Lukes
- Sports Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI
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Brown C, Marinko L, LaValley MP, Kumar D. Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:2325967121991534. [PMID: 33889639 PMCID: PMC8040575 DOI: 10.1177/2325967121991534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The limb symmetry index may overestimate the recovery of quadriceps muscle strength after anterior cruciate ligament reconstruction. Comparison of individuals who have had anterior cruciate ligament reconstruction with age-, sex-, and activity-matched individuals might be more appropriate to guide rehabilitation interventions. Purpose: To compare the quadriceps strength between the injured limb of people with anterior cruciate ligament reconstruction and the limb of an age-, sex-, and activity-matched control group. Study Design: Systematic review; Level of evidence, 3. Methods: MEDLINE, CINAHL, EMBASE, SCOPUS, and SPORTDiscus were searched between inception and April 2019. Studies were included if they reported the peak quadriceps strength for persons with anterior cruciate ligament reconstruction and age-, sex-, and activity-matched control groups measured using isometric or isokinetic dynamometry. Risk of bias was assessed, and meta-analyses and metaregression (for effect of time since surgery) were performed. Results: A total of 2759 studies were identified and 21 were included for analyses. Quadriceps strength was lower in the limbs with anterior cruciate ligament reconstruction compared with the limb from matched controls within 6 months of anterior cruciate ligament reconstruction (standardized mean difference [SMD], –1.42; 95% CI, –1.62 to –1.23), 6 to 18 months after anterior cruciate ligament reconstruction (SMD, –0.92; 95% CI, –1.18 to –0.66), and >18 to 48 months after anterior cruciate ligament reconstruction (SMD, –0.38; 95% CI, –0.79 to 0.03). Results of the metaregression were significant, with the difference between anterior cruciate ligament reconstruction and matched controls decreasing with time since surgery (P < .001). Conclusion: In people with anterior cruciate ligament reconstruction, the injured limb had lower quadriceps strength compared with the limb of age-, sex-, and activity-matched controls up to 4 years after surgery. Clinicians should consider comparison with matched cohorts for return to sports decision making.
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Affiliation(s)
- Conlan Brown
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Lee Marinko
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Deepak Kumar
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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30
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Qiu J, Ong MTY, Leong HT, He X, Fu SC, Yung PSH. Effects of Whole-Body Vibration Therapy on Quadriceps Function in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:216-226. [PMID: 33813953 DOI: 10.1177/19417381211004937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Quadriceps dysfunction is common for patients after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration (WBV) could effectively treat quadriceps dysfunction. OBJECTIVE To summarize WBV protocols for patients with ACLR and to evaluate the effects of WBV on quadriceps function. DATA SOURCES PubMed, CINAHL, SportDiscus, Web of Science, Medline, and Embase were searched from inception to January 2020. STUDY SELECTION Randomized controlled trials recruiting patients with ACLR, using WBV as intervention, and reporting at least 1 of the following outcomes, strength, rate of torque development (RTD), and voluntary activation ratio of quadriceps, were included. STUDY DESIGN Systematic review. EVIDENCE LEVEL Level 3. METHODS This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality of evidence was determined by PEDro criteria and GRADE system. Participant characteristics, interventions, and the relevant results of the included studies were extracted and synthesized in a narrative way. RESULTS In total, 8 studies were included. Of these, 2 studies had serious risk of bias. Five of 8 studies implemented a series of WBV program ranging from 2 to 10 weeks in duration, while the other 3 studies implemented a single session of WBV. Eight WBV protocols were reported. The reported outcomes consisted of quadriceps strength, RTD, and central activation ratio. WBV protocols were heterogeneous. Low quality of evidence supported that exclusive conventional rehabilitation was more effective than exclusive WBV therapy in increasing quadriceps strength. Low quality of evidence supported that WBV combined with conventional rehabilitation was more beneficial in increasing quadriceps strength when compared with conventional rehabilitation alone. Very low quality of evidence supported the efficacy of a single session of WBV on quadriceps function. CONCLUSIONS There is no standardized WBV protocol for patients with ACLR, and the effectiveness of WBV in rehabilitation on quadriceps function remains inconclusive.
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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
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hio Teng Leong
- 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
| | - 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
| | - 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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Association between Kinesiophobia and Gait Asymmetry after ACL Reconstruction: Implications for Prevention of Reinjury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063264. [PMID: 33809935 PMCID: PMC8004266 DOI: 10.3390/ijerph18063264] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/17/2022]
Abstract
Gait asymmetries have been documented in individuals after anterior cruciate ligament (ACL) reconstruction (ACLR). The relationship between gait asymmetry and associated psychological factors, however, is not yet known. This study aimed to examine the relationship between kinesiophobia (fear of reinjury) and asymmetry of vertical ground reaction force (vGRF) and lower-extremity muscular activity in individuals after ACLR during gait. Twenty-eight males with a history of ACLR participated in the study. Force plate and surface electromyography was used to record peak vGRF and muscular activity. The Tampa Scale of Kinesiophobia (TSK-11) was used to measure kinesiophobia. Spearman’s rank correlations analysis was used to examine the relationship between TSK-11 scores and both gait asymmetry variables. There was a significant positive relationship between TSK-11 and asymmetry of the second peak of vGRF (rs = 0.531, p = 0.002). In addition, there was a significant positive association between asymmetry of rectus femoris activity (rs = 0.460, p = 0.007) and biceps femoris activity (rs = 0.429, p = 0.011) in the contact phase. Results revealed a significant relationship between kinesiophobia and asymmetry in muscle activity and vGRF in different phases of the gait cycle. Interventions addressing kinesiophobia early in the rehabilitation after ACLR may support the restoration of gait symmetry, facilitate a more rapid return to sport, and reduce the risk of ACL reinjury.
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Alzakerin HM, Halkiadakis Y, Morgan KD. Force and Rate Metrics Provide Return-to-Sport Criterion after ACL Reconstruction. Med Sci Sports Exerc 2021; 53:275-279. [PMID: 32701872 DOI: 10.1249/mss.0000000000002472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Peak vertical ground reaction force and linear loading rate can be valuable metrics for return-to-sport assessment because they represent limb loading dynamics; yet, there is no defined cutoff criterion to differentiate between healthy and altered limb loading. Studies have shown that healthy individuals exhibit strong first-order relationships between gait variables whereas individuals with pathological conditions did not. Thus, this study sought to explore and exploit this first-order relationship to define a region of healthy limb dynamics, which individuals with pathological conditions would reside outside of, to rapidly assess individuals with altered limb loading dynamics for return to sport. We hypothesized that there would be a strong first-order linear relationship between vertical ground reaction force peak force and linear loading rate in healthy controls' limbs, which could be exploited to identify abnormal limb loading dynamics in post-anterior cruciate ligament reconstruction (ACLR) individuals. METHODS Thirty-one post-ACLR individuals and 31 healthy controls performed a running protocol. A first-order regression analysis modeled the relationship between peak vertical ground reaction forces and linear vertical ground reaction force loading rate in the healthy control limbs to define a region of healthy dynamics to evaluate post-ACLR reconstructed limb dynamics. RESULTS A first-order regression model aided in the determination of cutoff criteria to define a region of healthy limb dynamics. Ninety percent of the post-ACLR reconstructed limbs exhibited abnormal limb dynamics based on their location outside of the region of healthy dynamics. CONCLUSION This approach successfully delineated between healthy and abnormal limb loadings dynamics in controls and post-ACLR individuals. The findings demonstrate how force and loading rate-dependent metrics can help develop criteria for individualized post-ACLR return-to-sport assessment.
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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Bodkin SG, Weltman AL, Hart JM. ISB clinical biomechanics award winner 2019: Knee extensor fatigue resistance in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2021; 81:105242. [PMID: 33309931 DOI: 10.1016/j.clinbiomech.2020.105242] [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: 06/18/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals following anterior cruciate ligament reconstruction demonstrate quadriceps weakness throughout the post-operative recovery and at the time of returning to sport. This is often accompanied with patterns of quadriceps fatigue resistance. As such, fatigue may be an identifier of individuals with delayed recovery. The purpose was to assess quadriceps fatigue in anterior cruciate ligament reconstructed patients at the time of return to sport in comparison to healthy controls. METHODS A total of 215 individuals, 120 following anterior cruciate ligament reconstruction (21.0 (2.9) years, 63 Female, 5.96 (0.48) months post-surgery) and 95 healthy controls (21.5 (8.4) years, 49 Female), participated in this study. All participants completed a 30-s knee extensor maximum voluntary isometric contraction. Knee extensor strength, limb symmetry index, and fatigue (%) were compared between groups. Between-limb fatigue comparisons were made through the Fatigue Index Limb Difference = [(Involved Limb Fatigue Index) - (Uninvolved Limb Fatigue Index)]. FINDINGS Individuals following anterior cruciate ligament reconstruction (18.7 (10.9)%, -5.6 (11.2)) demonstrated lower values of unilateral fatigue and Fatigue Index Limb Difference compared to healthy participants (22.5 (8.2)%, P = .002; 2.2 (7.9), P < .001). For anterior cruciate ligament reconstructed patients, there was a weak, negative, significant relationship between the involved limb strength and fatigue (r = -0.184, P = .048). There was no relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.137, P = .142). For Healthy individuals, there was a positive, moderate relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.400, P < .001). INTERPRETATION Individuals following anterior cruciate ligament reconstruction demonstrate fatigue resistance compared to healthy active controls and greater resistance to fatigue in their involved limb compared to their contralateral limb.
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Affiliation(s)
- Stephan G Bodkin
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Arthur L Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joe M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Burland JP, Lepley AS, Frechette L, Lepley LK. Protracted alterations in muscle activation strategies and knee mechanics in patients after Anterior Cruciate Ligament Reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3766-3772. [PMID: 31897547 DOI: 10.1007/s00167-019-05833-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Altered quadriceps muscle activity can contribute to reduced ability of the muscle to quickly generate force and appropriately attenuate landing forces, exacerbating poor landing and movement strategies commonly seen after anterior cruciate ligament reconstruction (ACLR). The purpose was to evaluate if electromyographic (EMG) activity and knee biomechanics during a single-limb forward hop task are influenced by a history of ACLR. METHODS Twenty-six individuals with a history of unilateral ACLR (age 20.2 ± 2.7 years, height 1.7 ± 0.1 m; weight 69.6 ± 12.4 kg; time from surgery, 2.9 ± 2.7 years; graft type, 21 bone-patellar-tendon bone, 5 hamstring) and 8 healthy controls (age 23.3 ± 1.8 years, height 1.7 ± 0.1 m; mass 66.3 ± 13.9 kg) volunteered. Sagittal plane knee kinetics and EMG of the vastus lateralis were synchronized and measured using a three-dimensional motion analysis system during a single-limb forward hop task. Mixed-effect models were used to assess the effect of group on kinetic and EMG variables. RESULTS Kinetic outcomes (peak and rate of knee extension moment) and temporal muscle activity and activation patterns differed between the ACLR limb and healthy-control limb. Inter-limb asymmetries in the ACLR group were observed for all variables except EMG onset time; no limb differences were observed in the healthy cohort. CONCLUSION Years after ACLR, persistent quadriceps functional deficits are present, contributing to altered neuromuscular control strategies during functional tasks that may increase the risk of reinjury. To counteract these effects, emerging evidence indicates that clinicians could consider the use of motor learning strategies to improve neuromuscular control after ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Adam S Lepley
- University of Michigan, 2126 Observatory Lodge, 1402 Washington Heights, Ann Arbor, MI, 48109, USA
| | | | - Lindsey K Lepley
- University of Michigan, 3745B CCRB, 401 Washtenaw Avenue, Ann Arbor, MI, 48109, USA.
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Huang YL, Chang E, Johnson ST, Pollard CD, Hoffman MA, Norcross MF. Explosive Quadriceps Strength and Landing Mechanics in Females with and without Anterior Cruciate Ligament Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7431. [PMID: 33065986 PMCID: PMC7599476 DOI: 10.3390/ijerph17207431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/02/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
Lower explosive quadriceps strength, quantified as rate of torque development (RTD), may contribute to landing mechanics associated with anterior cruciate ligament (ACL) injury risk. However, the association between quadriceps RTD and landing mechanics during high demand tasks remains unclear. Therefore, this study investigated the influence of quadriceps RTD on sagittal plane landing mechanics during double-leg jump landings (DLJL) and single-leg jump cuts (SLJC) in females with and without ACL reconstruction (ACLR). Quadriceps RTD was measured during isometric muscle contractions. Landing mechanics were collected during DLJL and SLJC tasks. Separate stepwise multiple linear regression models determined the amount of variance in sagittal plane landing mechanics that could be explained by quadriceps RTD, group (ACLR or Control), and their interaction. The results indicate that greater quadriceps RTD is associated with lower loading rate (p = 0.02) and longer time to peak vertical ground reaction force (p = 0.001) during SLJC, regardless of ACLR status. As greater loading rate may lead to higher risk of ACL injuries and post-traumatic knee osteoarthritis post-ACLR, explosive muscle strength interventions might be useful for individuals with and without ACLR to facilitate the use of safer landing mechanics.
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Affiliation(s)
- Yu-Lun Huang
- Department of Kinesiology, College of Education and Human Sciences, University of Wisconsin–Eau Claire, Eau Claire, WI 54702, USA
| | - Eunwook Chang
- Department of Kinesiology, Inha University, Incheon 22212, Korea
| | - Samuel T. Johnson
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
| | - Christine D. Pollard
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University-Cascades, Bend, OR 97701, USA;
| | - Mark A. Hoffman
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
| | - Marc F. Norcross
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (S.T.J.); (M.A.H.); (M.F.N.)
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Alzakerin HM, Halkiadakis Y, Morgan KD. Classification of Post-Anterior Cruciate Ligament Reconstruction Running Dynamics using Non-Traditional Features. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4811-4814. [PMID: 33019067 DOI: 10.1109/embc44109.2020.9176602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Despite extensive rehabilitation, nearly half of all post-anterior cruciate ligament reconstruction (ACLR) individuals are unable to perform dynamic tasks at the level they did prior to their injury. This inability can be attributed to unresolved neuromuscular deficits that manifest as altered limb dynamics. While traditional discrete metrics; such as peak vertical ground reaction force (vGRF) and peak knee flexion angle, have been used to successfully differentiate between healthy and pathological running dynamics, recent studies have shown that non-traditional metrics derived from autoregressive (AR) modeling and Smoothed Pseudo Wigner-Ville (SPWV) analysis techniques can also successfully delineate between healthy and pathological populations and could potentially possess greater sensitivity than the traditional metrics. Thus, the objective of this study was to compare the performance of classification models generated from traditional and nontraditional metrics collected from healthy controls and post-ACLR individuals during a running protocol. We hypothesized that the non-traditional metric-based classification model would outperform the traditional metric based model. Thirty-one controls and 31 post-ACLR individuals performed a running protocol from which the traditional metrics - peak vGRF, linear vGRF loading rate and peak knee flexion angle - and nontraditional metrics - dynamic vGRF ratio, AR model coefficients, and a SPWV derived low frequency-high frequency ratio - were extracted from vGRF and knee flexion running waveforms. The results indicated that a fine Gaussian SVM classification model derived from the non-traditional metrics had an accuracy of 87%, specificity of 83% and sensitivity of 61% and it outperformed the classification model derived from traditional metrics. These findings indicate that additional, valuable information can be ascertained from non-traditional metrics that evaluate waveform dynamics. Additionally, it suggests that this or similar models can be used to track the restoration of healthy running dynamics in post-ACLR individuals during rehabilitation.
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The Relationship Between Vertical Ground Reaction Force, Loading Rate, and Sound Characteristics During a Single-Leg Landing. J Sport Rehabil 2020; 29:541-546. [DOI: 10.1123/jsr.2018-0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/31/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
Context:Landing kinetic outcomes are associated with injury risk and may be persistently altered after anterior cruciate ligament injury or reconstruction. However, it is challenging to assess kinetics clinically. The relationship between sound characteristics and kinetics during a limited number of functional tasks has been supported as a potential clinical alternative.Objective:To assess the relationship between kinetics and sound characteristics during a single-leg landing task.Design:ObservationalSetting:Laboratory.Participants:There was total of 26 healthy participants (15 males/11 females, age = 24.8 [3.6] y, height = 176.0 [9.1] cm, mass = 74.9 [14.4] kg, Tegner Activity Scale = 6.1 [1.1]).Intervention:Participants completed single-leg landings onto a force plate while audio characteristics were recorded.Main Outcome Measures:Peak vertical ground reaction force, linear loading rate, instantaneous loading rate, peak sound magnitude, sound frequency were measured. Means and SDs were calculated for each participant’s individual limbs. Spearman rho correlations were used to assess the relationships between audio characteristics and kinetic outcomes.Results:Peak sound magnitude was positively correlated with normalized peak vertical ground reaction force (ρ = .486,P = .001); linear loading rate (ρ = .491,P = .001); and instantaneous loading rate (ρ = .298,P = .03). Sound frequency was negatively correlated with instantaneous loading rate (ρ = −.444,P = .001).Conclusions:Peak sound magnitude may be more helpful in providing feedback about an individual’s normalized vertical ground reaction force and linear loading rate, and sound frequency may be more helpful in providing feedback about instantaneous loading rate. Further refinement in sound measurement techniques may be required before these findings can be applied in a clinical population.
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Turpeinen J, Freitas TT, Rubio‐Arias JÁ, Jordan MJ, Aagaard P. Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis. Scand J Med Sci Sports 2020; 30:1572-1585. [DOI: 10.1111/sms.13733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - Tomás T. Freitas
- UCAM Research Center for High Performance Sport Murcia Spain
- NAR—Nucleus of High Performance in Sport São Paulo Brazil
| | - Jacobo Ángel Rubio‐Arias
- UCAM Research Center for High Performance Sport Murcia Spain
- LFE Research Group Department of Health and Human Performance Faculty of Physical Activity and Sport Science‐INEF Universidad Politécnica de Madrid Madrid Spain
| | | | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics SDU Muscle Research Cluster (SMRC) University of Southern Denmark Odense M Denmark
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Garcia SA, Moffit TJ, Vakula MN, Holmes SC, Montgomery MM, Pamukoff DN. Quadriceps Muscle Size, Quality, and Strength and Self-Reported Function in Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:246-254. [PMID: 31951147 DOI: 10.4085/1062-6050-38-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Ultrasound imaging provides a cost-effective method of measuring quadriceps morphology, which may be related to self-reported function after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To compare quadriceps morphology and strength between limbs in individuals with ACLR and matched control limbs and determine their associations with self-reported function. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-two individuals with ACLR (females = 66%; age = 21.8 ± 2.6 years; time since ACLR = 50.5 ± 29.4 months) and 37 controls (females = 73%; age = 21.7 ± 1.2 years). MAIN OUTCOME MEASURE(S) Quadriceps peak torque (PT) and rate of torque development were assessed bilaterally. Ultrasonography was used to measure the cross-sectional area (CSA) and echo intensity (EI) of the rectus femoris, vastus lateralis (VL), and vastus medialis. Self-reported function was assessed via the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Paired-samples t tests were calculated to compare involved and uninvolved limbs. Independent t tests were conducted to compare groups (α = .05). Linear regression was performed to analyze associations between quadriceps function and self-reported function after accounting for time since ACLR, activity level, and sex, and models for EI added subcutaneous fat as a covariate. RESULTS Isometric PT did not differ between limbs or groups. Involved limbs had a lower rate of torque development compared with the control (P = .01) but not the uninvolved limbs (P = .08). Vastus lateralis CSA was smaller in the involved than in the uninvolved (P < .01) but not the control limbs (P = .10). Larger VL CSA (ΔR2 = 0.103) and lower VL EI (ΔR2 = 0.076) were associated with a higher IKDC score (P < .05). Larger VL CSA was associated with greater KOOS Symptoms (ΔR2 = 0.09, P = .043) and Sport and Recreation (ΔR2 = 0.125, P = .014) scores. Lower VL EI was associated with higher KOOS Symptoms (ΔR2 = 0.104, P = .03) and Quality of Life (ΔR2 = 0.113, P = .01) scores. Quadriceps PT and rate of torque development were not associated with IKDC or KOOS subscale scores. CONCLUSIONS Quadriceps morphology was associated with self-reported function in individuals with ACLR and may provide unique assessments of quadriceps function.
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Affiliation(s)
| | - Tyler J Moffit
- Department of Kinesiology, California State University, Bakersfield
| | - Mike N Vakula
- Department of Kinesiology and Health Science, Utah State University, Logan
| | - Skylar C Holmes
- Department of Kinesiology, California State University, Fullerton
| | | | - Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton
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Gonzales JM, Galpin AJ, Montgomery MM, Pamukoff DN. Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern. J Sports Sci 2019; 37:2184-2190. [PMID: 31170885 DOI: 10.1080/02640414.2019.1626050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running. Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness.
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Affiliation(s)
- Joseph M Gonzales
- a Department of Kinesiology, California State University , Fullerton , CA , USA.,b Center for Sport Performance, California State University , Fullerton , CA , USA
| | - Andrew J Galpin
- a Department of Kinesiology, California State University , Fullerton , CA , USA.,b Center for Sport Performance, California State University , Fullerton , CA , USA
| | - Melissa M Montgomery
- a Department of Kinesiology, California State University , Fullerton , CA , USA.,b Center for Sport Performance, California State University , Fullerton , CA , USA
| | - Derek N Pamukoff
- a Department of Kinesiology, California State University , Fullerton , CA , USA.,b Center for Sport Performance, California State University , Fullerton , CA , USA
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Pairot-de-Fontenay B, Willy RW, Elias ARC, Mizner RL, Dubé MO, Roy JS. Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Med 2019; 49:1411-1424. [DOI: 10.1007/s40279-019-01120-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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