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Kim M, Gu M, Kim HY, Kim J, Lee JH, Lee HY. Assessment of arthrogenic quadriceps muscle inhibition by physical examination in the supine position during isometric contraction is feasible as demonstrated by electromyography: a cross-sectional study. J Orthop Surg Res 2024; 19:458. [PMID: 39095797 PMCID: PMC11297743 DOI: 10.1186/s13018-024-04949-9] [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: 05/31/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Preventing severe arthrogenic muscle inhibition (AMI) after knee injury is critical for better prognosis. The novel Sonnery-Cottet classification of AMI enables the evaluation of AMI severity but requires validation. This study aimed to investigate the electromyography (EMG) patterns of leg muscles in the examination position from the classification during isometric contraction to confirm its validity. We hypothesised that the AMI pattern, which is characterised by quadriceps inhibition and hamstring hypercontraction, would be detectable in the supine position during isometric contraction. METHODS Patients with meniscal or knee ligament injuries were enrolled between August 2023 and May 2024. Surface EMG was assessed during submaximal voluntary isometric contractions (sMVIC) at 0° extension in the supine position for the vastus medialis (VM) and vastus lateralis (VL) muscles and at 20° flexion in the prone position for the semitendinosus (ST) and biceps femoris (BF) muscles. Reference values for normalisation were obtained from the EMG activity during the gait of the uninjured leg. The Kruskal-Wallis test was used to compare the activation patterns of the muscle groups within the same leg, and the post-hoc tests were conducted using the Mann-Whitney U test and Bonferroni correction. RESULTS Electromyographic data of 40 patients with knee injuries were analyzed. During sMVIC, the extensor and flexor muscles of the injured leg showed distinct behaviours (P < 0.001), whereas the uninjured side did not (P = 0.144). In the injured leg, the VM differed significantly from the ST (P = 0.018), and the VL differed significantly from the ST and BF (P = 0.001 and P = 0.026, respectively). However, there were no statistically significant differences within the extensor muscle groups (VM and VL, P = 0.487) or flexor muscle groups (ST and BF, P = 0.377). CONCLUSION AMI was detectable in the examination position suggested by the Sonnery-Cottet classification. The flexor and extensor muscles of the injured leg exhibited distinct activation behaviours, with inhibition predominantly occurring in the quadriceps muscles, whereas the hamstrings showed excitation.
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Affiliation(s)
- Minhee Kim
- Department of Physical Therapy, College of Health Science, Eulji University, Seongnam, Republic of Korea
| | - Minseo Gu
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Jinee Kim
- Physical Therapy and Rehabilitation Centre, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Jeong-Hoon Lee
- Physical Therapy and Rehabilitation Centre, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea.
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Republic of Korea.
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Stofberg JPJ, Aginsky K, van Aswegen M, Kramer M. Changes in isometric mid-thigh pull peak force and symmetry across anterior cruciate ligament reconstruction rehabilitation phases. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1418270. [PMID: 39036284 PMCID: PMC11258044 DOI: 10.3389/fresc.2024.1418270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/23/2024]
Abstract
Background Whether functionally relevant strength assessments, such as the isometric mid-thigh pull (IMTP), can be used either bilaterally or unilaterally to evaluate and guide rehabilitation progress in those with anterior cruciate ligament reconstruction (ACLR) is under-researched. This study assessed changes in peak force (PF) and asymmetry across 3 phases for bilateral and unilateral IMTP assessments in patients with ACLR. Peak isometric force from the IMTP was compared to peak torque from isokinetic dynamometry as well as against a cohort of healthy, uninjured individuals. Method Participants (ACLR, n = 15) completed bilateral and unilateral IMTP assessments at weeks 12 (baseline), 16 (phase 3), and 20 (phase 4) of rehabilitation to evaluate changes in PF and asymmetry. Asymmetry was evaluated using the asymmetry angle. Isometric data from the IMTP were compared to that from an isokinetic dynamometer as well as against a cohort of healthy, uninjured participants (n = 63) allowing for a detailed analysis of limb-specific force production. Results The PF during the bilateral IMTP increased for both the injured (0.94 N/kg) and uninjured (0.26 N/kg) limbs from baseline to phase 4, whereas the PF of the injured limb increased by 1.5 N/kg during the unilateral IMTP in the same time frame. Asymmetry values systematically reduced by ∼1% and ∼0.5% for the bilateral and unilateral IMTP tests from baseline to phase 4. Significant differences in PF of the injured limb were evident between those with ACLR and healthy controls across all phases (p = 0.022-0.001). The rate of progression in PF capacity was dependent on test type, amounting to 0.1 and 0.2 body weights per week for the bilateral and unilateral IMTP respectively. Small-to-large correlations (r = 0.12-0.88) were evident between IMTP PF and peak torque from the isokinetic dynamometer as well as between asymmetry metrics from both tests. Conclusion The findings suggest that IMTP PF has potential for monitoring changes in PF and asymmetry during the ACLR rehabilitation progress. Both injured limb and uninjured limb show improvement in force-generating capacity, implying a positive adaptation to rehabilitation protocols. The findings highlight that ACLR is a unilateral injury that requires bilateral rehabilitation.
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Affiliation(s)
- Johannes P. J. Stofberg
- Centre for Health and Human Performance (CHHP), North-West University, Potchefstroom, South Africa
| | - Kerith Aginsky
- Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Mariaan van Aswegen
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Mark Kramer
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
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Schilaty ND, Bates NA. Commentary on "The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes". JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:373-375. [PMID: 38043909 PMCID: PMC11117014 DOI: 10.1016/j.jshs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL 33620, USA; Department of Medical Engineering, University of South Florida, Tampa, FL 33620, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL 33620, USA.
| | - Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Girdwood M, Culvenor AG, Patterson B, Haberfield M, Rio EK, Hedger M, Crossley KM. No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury. Br J Sports Med 2024; 58:500-510. [PMID: 38537939 DOI: 10.1136/bjsports-2023-107536] [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] [Accepted: 02/28/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE We aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and SportDiscus to 28 February 2023. ELIGIBILITY CRITERIA Primary ACL injury with mean age 18-40 years at time of injury. Studies had to measure hip and/or lower-leg muscle strength quantitatively (eg, dynamometer) and report muscle strength for the ACL-injured limb compared with: (i) an uninjured control group and/or (ii) the uninjured contralateral limb. Risk of bias was assessed according to Cochrane Collaboration domains. RESULTS Twenty-eight studies were included (n=23 measured strength ≤12 months post-ACL reconstruction). Most examined hip abduction (16 studies), hip extension (12 studies) and hip external rotation (7 studies) strength. We found no meaningful difference in muscle strength between people or between limbs for hip abduction, extension, internal rotation, flexion or ankle plantarflexion, dorsiflexion (estimates ranged from -9% to +9% of comparator). The only non-zero differences identified were in hip adduction (24% stronger on ACL limb (95% CI 8% to 42%)) and hip external rotation strength (12% deficit on ACL limb (95% CI 6% to 18%)) compared with uninjured controls at follow-ups >12 months, however both results stemmed from only two studies. Certainty of evidence was very low for all outcomes and comparisons, and drawn primarily from the first year post-ACL reconstruction. CONCLUSION Our results do not show widespread or substantial muscle weakness of the hip and lower-leg muscles after ACL injury, contrasting deficits of 10%-20% commonly reported for knee extensors and flexors. As it is unclear if deficits in hip and lower-leg muscle strength resolve with appropriate rehabilitation or no postinjury or postoperative weakness occurs, individualised assessment should guide training of hip and lower-leg strength following ACL injury. PROSPERO REGISTRATION NUMBER CRD42020216793.
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Affiliation(s)
- Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Brooke Patterson
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie Kendra Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
- The Victorian Institute of Sport, Melbourne, Victoria, Australia
- The Australian Ballet, Melbourne, Victoria, Australia
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Murgier J, Zunzarren G, Garet B. Comment on: "Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study". J Sport Rehabil 2024; 33:1-2. [PMID: 37935190 DOI: 10.1123/jsr.2023-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Jérôme Murgier
- Service de chirurgie orthopédique, Clinique Aguiléra, Biarritz, France
| | | | - Bertrand Garet
- Cabinet de rééducation neuro musculaire, Biarritz, France
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Zarrin M, Nakhostin Ansari N, Naghdi S, Hasson S, Forogh B, Rezaee M. Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial. J Acupunct Meridian Stud 2023; 16:193-202. [PMID: 37885255 DOI: 10.51507/j.jams.2023.16.5.193] [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: 07/17/2023] [Revised: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Background : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion : The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.
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Affiliation(s)
- Milad Zarrin
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Di Giminiani R, Marinelli S, La Greca S, Di Blasio A, Angelozzi M, Cacchio A. Neuromuscular Characteristics of Unilateral and Bilateral Maximal Voluntary Isometric Contractions following ACL Reconstruction. BIOLOGY 2023; 12:1173. [PMID: 37759573 PMCID: PMC10525486 DOI: 10.3390/biology12091173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m2), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m2). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant (p > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally (p < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally (p < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally (p < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
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Affiliation(s)
- Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano Marinelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano La Greca
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. D’Annunzio’ University of Chieti-Pescara, 66013 Chieti, Italy;
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
| | - Angelo Cacchio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
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Zunzarren G, Garet B, Vinciguerra B, Murgier J. Persistence of neuromuscular activation deficit in the lower limb at 3-years of follow-up after ACL reconstruction surgery. Knee 2023; 43:97-105. [PMID: 37385113 DOI: 10.1016/j.knee.2023.06.006] [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: 03/28/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Almost all patients experience neuromuscular disorders of the quadriceps after knee trauma or surgery such as anterior cruciate ligament (ACL) reconstruction. This phenomenon is described in literature as arthrogenic muscle inhibition (AMI). It can be detrimental to patients and cause complications. However, few studies have evaluated the long-term persistence of deficits arising from this, following ACL reconstruction. PURPOSE By comparing neuromuscular activation in the lower limb after ACL reconstruction with the unaffected lower limb, after more than 3-years of follow-up, this study aimed to evaluate the possible persistence of long-term deficits after surgery. METHODS Fifty-one patients who underwent ACL reconstruction in 2018 were included in the study, with a minimum follow-up of 3 years. The neuromuscular activation deficit was assessed using the Biarritz Activation Score-Knee (BAS-K), whose intra- and inter-observer reproducibility was also evaluated. The ACL-RSI, KOOS, SANE Leg, Tegner and IKDC scores were also evaluated. RESULTS The mean BAS-K score of the knee that underwent surgery was 21.8/50 versus 37.9/50 in the healthy knee (p < 0.05). The SANE leg score was 76.8/100 versus 97.6/100 (p < 0.05). The mean IKDC was 84.17 (±12.7). The mean KOOS was 86.2 (±9.2). The mean ACL-RSI was 70 (±7.9) and the Tegner score was 6.3 (±1.2). Intra- and inter-observer reproducibility was satisfactory for the BAS-K score. CONCLUSION We found that the neuromuscular activation deficit was high (roughly 42%) at more than 3-years of follow-up after ACL reconstruction. The deficit is not limited to the quadriceps and affects the whole limb. Our findings highlight the need for appropriate rehabilitation after ACL surgery, targeting the corticospinal level in particular. LEVEL OF EVIDENCE III prognostic retrospective case-control study.
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Affiliation(s)
- G Zunzarren
- Cabinet de Médecine du Sport, 64200 Biarritz, France
| | - B Garet
- Cabinet de Rééducation Neuro Musculaire, 64200 Biarritz, France
| | - B Vinciguerra
- Clinique Aguiléra, 21 rue de l'Estagnas, Service de Chirurgie Orthopédique, 64200 Biarritz, France
| | - J Murgier
- Clinique Aguiléra, 21 rue de l'Estagnas, Service de Chirurgie Orthopédique, 64200 Biarritz, France
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