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Hay AM, Rhoades MJ, Bangerter S, Ferguson SA, Lee H, T. Gill M, Page GL, Pope A, Measom GJ, Hager RL, Seeley MK. Serum Cartilage Oligomeric Matrix Protein Concentration Increases More After Running Than Swimming for Older People. Sports Health 2024; 16:534-541. [PMID: 37697665 PMCID: PMC11195858 DOI: 10.1177/19417381231195309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis is common in older people. Serum cartilage oligomeric matrix protein (sCOMP) is a biomarker of knee articular cartilage metabolism. The purpose of this study was 2-fold: to (1) determine acute effects of running and swimming on sCOMP concentration in older people; and (2) investigate relationships between sCOMP concentration change due to running and swimming and measures of knee health in older people. HYPOTHESES Running would result in greater increase in sCOMP concentration than swimming, and increase in sCOMP concentration due to running and swimming would associate positively with measures of poor knee health. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 20 participants ran 5 km and 19 participants swam 1500 m. sCOMP concentration was measured immediately before, immediately after, and 15, 30, and 60 minutes after running or swimming. sCOMP concentration change due to running and swimming was compared. Correlations between sCOMP concentration change due to running and swimming, and other measures of knee health were evaluated, including the Tegner Activity Scale and Knee injury and Osteoarthritis Outcome Score. RESULTS sCOMP concentration increased 29% immediately after running, relative to baseline, but only 6% immediately after swimming (P < 0.01). No significant relationship was observed between acute sCOMP change due to running and swimming, and observed measures of knee health (P > 0.05). Participants with clinically relevant knee symptoms exhibited greater sCOMP concentration before and after running and swimming (P = 0.03) and had greater body mass (P = 0.04). CONCLUSION Running results in greater acute articular cartilage metabolism than swimming; however, the chronic effects of this are unclear. Older people with clinically relevant knee symptoms possess greater sCOMP concentration and are heavier, independent of exercise mode and physical activity level. CLINICAL RELEVANCE These results describe the effects of exercise (running and swimming) for older physically active persons, with and without knee pain.
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Affiliation(s)
- Alexandra M. Hay
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | | | | | - Seth A. Ferguson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Martha T. Gill
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Garritt L. Page
- Department of Statistics, Brigham Young University, Provo, Utah
| | - Andrew Pope
- Department of Statistics, Brigham Young University, Provo, Utah
| | - Gary J. Measom
- Department of Nursing, Utah Valley University, Orem, Utah
| | - Ronald L. Hager
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Matthew K. Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
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Armitano-Lago C, Evans-Pickett A, Davis-Wilson H, Munsch A, Longobardi L, Willcockson H, Schwartz TA, Franz JR, Pietrosimone B. Modifying loading during gait leads to biochemical changes in serum cartilage oligomeric matrix protein concentrations in a subgroup of individuals with anterior cruciate ligament reconstruction. Clin Rheumatol 2024; 43:1363-1373. [PMID: 38358589 DOI: 10.1007/s10067-024-06898-4] [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: 12/19/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Strong observational evidence has linked changes in limb loading during walking following anterior cruciate ligament reconstruction (ACLR) to posttraumatic osteoarthritis (PTOA). It remains unknown if manipulating peak loading influences joint tissue biochemistry. Thus, the purpose of this study is to determine whether manipulating peak vertical ground reaction force (vGRF) during gait influences changes in serum cartilage oligomeric matrix protein (sCOMP) concentrations in ACLR participants. METHODS Forty ACLR individuals participated in this randomized crossover study (48% female, age = 21.0 ± 4.4 years, BMI = 24.6 ± 3.1). Participants attended four sessions, wherein they completed one of four biofeedback conditions (habitual loading (no biofeedback), high loading (5% increase in vGRF), low loading (5% decrease in vGRF), and symmetrical loading (between-limb symmetry in vGRF)) while walking on a treadmill for 3000 steps. Serum was collected before (baseline), immediately (acute post), 1 h (1 h post), and 3.5 h (3.5 h post) following each condition. A comprehensive general linear mixed model was constructed to address the differences in sCOMP across all conditions and timepoints in all participants and a subgroup of sCOMP Increasers. RESULTS No sCOMP differences were found across the entire cohort. In the sCOMP Increasers, a significant time × condition interaction was found (F9,206 = 2.6, p = 0.009). sCOMP was lower during high loading than low loading (p = 0.009) acutely (acute post). At 3.5 h post, sCOMP was higher during habitual loading than symmetrical loading (p = 0.001). CONCLUSION These data suggest that manipulating lower limb loading in ACLR patients who habitually exhibit an acute increase in sCOMP following walking results in improved biochemical changes linked to cartilage health. Key Points • This study assesses the mechanistic link between lower limb load modification and joint tissue biochemistry at acute and delayed timepoints. • Real-time biofeedback provides a paradigm to experimentally assess the mechanistic link between loading and serum biomarkers. • Manipulating peak loading during gait resulted in a metabolic effect of lower sCOMP concentrations in a subgroup of ACLR individuals. • Peak loading modifications may provide an intervention strategy to mitigate the development of PTOA following ACLR.
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Affiliation(s)
- Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Amanda Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Lara Longobardi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Helen Willcockson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Bjornsen E, Berkoff D, Blackburn JT, Davis-Wilson H, Evans-Pickett A, Franz JR, Harkey MS, Horton WZ, Lisee C, Luc-Harkey B, Munsch AE, Nissman D, Pfeiffer S, Pietrosimone B. Sustained Limb-Level Loading: A Ground Reaction Force Phenotype Common to Individuals at High Risk for and Those With Knee Osteoarthritis. Arthritis Rheumatol 2024; 76:566-576. [PMID: 37961759 DOI: 10.1002/art.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The objective of this study was to compare the vertical (vGRF), anterior-posterior (apGRF), and medial-lateral (mlGRF) ground reaction force (GRF) profiles throughout the stance phase of gait (1) between individuals 6 to 12 months post-anterior cruciate ligament reconstruction (ACLR) and uninjured matched controls and (2) between ACLR and individuals with differing radiographic severities of knee osteoarthritis (KOA), defined as Kellgren and Lawrence (KL) grades KL2, KL3, and KL4. METHODS A total of 196 participants were included in this retrospective cross-sectional analysis. Gait biomechanics were collected from individuals 6 to 12 months post-ACLR (n = 36), uninjured controls matched to the ACLR group (n = 36), and individuals with KL2 (n = 31), KL3 (n = 67), and KL4 osteoarthritis (OA) (n = 26). Between-group differences in vGRF, apGRF, and mlGRF were assessed in reference to the ACLR group throughout each percentage of stance phase using a functional linear model. RESULTS The ACLR group demonstrated lower vGRF and apGRF in early and late stance compared to the uninjured controls, with large effects (Cohen's d range: 1.35-1.66). Conversely, the ACLR group exhibited greater vGRF (87%-90%; 4.88% body weight [BW]; d = 0.75) and apGRF (84%-94%; 2.41% BW; d = 0.79) than the KL2 group in a small portion of late stance. No differences in mlGRF profiles were observed between the ACLR and either the uninjured controls or the KL2 group. The magnitude of difference in GRF profiles between the ACLR and OA groups increased with OA disease severity. CONCLUSION Individuals 6 to 12 months post-ACLR exhibit strikingly similar GRF profiles as individuals with KL2 KOA, suggesting both patient groups may benefit from targeted interventions to address aberrant GRF profiles.
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Affiliation(s)
| | - David Berkoff
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | | | | | - Jason R Franz
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | | | | | - Caroline Lisee
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Amanda E Munsch
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | - Daniel Nissman
- University of North Carolina at Chapel Hill, Chapel Hill
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Buck AN, Lisee C, Bjornsen E, Büttner C, Birchmeier T, Nilius A, Favoreto N, Spang J, Blackburn T, Pietrosimone B. Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:464-475. [PMID: 38051127 PMCID: PMC10922289 DOI: 10.1249/mss.0000000000003330] [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: 12/07/2023]
Abstract
PURPOSE To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared with their habitual speed and uninjured matched-controls. METHODS Gait biomechanics were collected on 30 ACLR individuals (20 females; age, 22.0 ± 4.2 yr; body mass index, 24.0 ± 3.0 kg·m -2 ) at their habitual speed and at 1.3 m·s -1 , a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, body mass index: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s -1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s -1 vs controls. RESULTS In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s -1 ) and 1.3 m·s -1 (1.29 ± 0.05 m·s -1 ). Compared with controls (habitual speed: 1.34 ± 0.12 m·s -1 ), the ACLR group while walking at 1.3 m·s -1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13-28, 78-90% stance phase), greater midstance vGRF (47-61%), smaller early-to-midstance knee flexion angle (KFA; 1-44%), greater mid-to-late stance KFA (68-73, 96-101%), greater internal knee abduction moment (69-101%), and smaller internal knee extension moment (4-51, 88-96%). CONCLUSIONS Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls.
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Affiliation(s)
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Thomas Birchmeier
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Natalia Favoreto
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lisee C, Evans-Pickett A, Davis-Wilson H, Munsch AE, Longobardi L, Schwartz TA, Lalush D, Franz JR, Pietrosimone B. Delayed cartilage oligomeric matrix protein response to loading is associated with femoral cartilage composition post-ACLR. Eur J Appl Physiol 2023; 123:2525-2535. [PMID: 37326876 DOI: 10.1007/s00421-023-05253-w] [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: 12/07/2022] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To determine associations between immediate and delayed response of serum cartilage oligomeric matrix protein (sCOMP) to loading (i.e., 3000 walking steps) and femoral cartilage interlimb T1ρ relaxation times in individual's post-anterior cruciate ligament reconstruction (ACLR). METHODS This cross-sectional study included 20 individuals 6-12 months following primary ACLR (65% female, 20.5 ± 4.0 years old, 24.9 ± 3.0 kg/m2, 7.3 ± 1.5 months post-ACLR). Serum samples were collected prior to, immediately following, and 3.5 h following walking 3000 steps on a treadmill at habitual walking speed. sCOMP concentrations were processed using enzyme-linked immunosorbent assays. Immediate and delayed absolute sCOMP responses to loading were evaluated immediately and 3.5 h post-walking, respectively. Participants underwent bilateral magnetic resonance imaging with T1ρ sequences to calculate resting femoral cartilage interlimb T1ρ relaxation time ratios between limbs (i.e., ACLR/Uninjured limb). Linear regression models were fitted to determine associations between sCOMP response to loading and femoral cartilage T1ρ outcomes controlling for pre-loading sCOMP concentrations. RESULTS Greater increases in delayed sCOMP response to loading were associated with greater lateral (∆R2 = 0.29, p = 0.02) but not medial (∆R2 < 0.01, p = 0.99) femoral cartilage interlimb T1ρ ratios. Associations between immediate sCOMP response to loading with femoral cartilage interlimb T1ρ ratios were weak and non-significant (∆R2 range = 0.02-0.09, p range = 0.21-0.58). CONCLUSION Greater delayed sCOMP response to loading, a biomarker of cartilage breakdown, is associated with worse lateral femoral cartilage composition in the ACLR limb compared to the uninjured limb. Delayed sCOMP response to loading may be a more indicative metabolic indicator linked to deleterious changes in composition than immediate sCOMP response.
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Affiliation(s)
- Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA.
| | - Alyssa Evans-Pickett
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
| | | | - Amanda E Munsch
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lara Longobardi
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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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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Kal E, Ellmers T, Hogg J, Slutsky-Ganesh AB, Bonnette S, Thomas S, Riehm CD, Myer GD, Diekfuss JA. Optimal Training for Movement Acquisition and Transfer: Does "Externally Focused" Visual Biofeedback Promote Implicit Motor Learning? J Athl Train 2023; 58:648-654. [PMID: 36094615 PMCID: PMC10569250 DOI: 10.4085/1062-6050-0166.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Visual biofeedback has been shown to facilitate injury-resistant movement acquisition in adolescent athletes. Visual biofeedback is typically thought to foster implicit learning by stimulating athletes to focus attention externally (on movement outcome). However, biofeedback may also induce explicit learning if the athlete uses the visual information to consciously guide movement execution (via an internal focus). OBJECTIVE To determine the degree to which athletes reported statements indicating implicit or explicit motor learning after engaging in a visual biofeedback intervention. DESIGN Prospective cohort study. SETTING Three-dimensional motion-analysis laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-five adolescent female soccer athletes (age = 15.0 ± 1.5 years, height = 165.7 ± 5.9 cm, mass = 59.4 ± 10.6 kg). INTERVENTIONS Standard 6-week neuromuscular training intervention (three 90-minute sessions/wk), with added visual biofeedback sessions (2 sessions/wk). For the biofeedback training, participants performed squatting and jumping movements while interacting with a visual rectangular stimulus that mapped key parameters associated with injury risk. After the last biofeedback session in each week, participants answered open-ended questions to probe learning strategies. MAIN OUTCOME MEASURE(S) Responses to the open-ended questions were categorized as externally focused (ie, on movement outcome, suggestive of implicit learning), internally focused (ie, on movement itself, suggestive of explicit learning), mixed focus, or other. RESULTS A total of 171 open-ended responses were collected. Most of the responses that could be categorized (39.2%) were externally focused (41.8%), followed by mixed (38.8%) and internally focused (19.4%). The frequency of externally focused statements increased from week 1 (18%) to week 6 (50%). CONCLUSIONS Although most statements were externally focused (suggesting implicit learning), the relatively large proportion of internal- and mixed-focus statements suggested that many athletes also engaged in explicit motor learning, especially in early practice sessions. Therefore, biofeedback may affect motor learning through a mixture of implicit and explicit learning.
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Affiliation(s)
- Elmar Kal
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
- Centre for Cognitive Neuroscience, Brunel University London, United Kingdom
| | - Toby Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
- Centre for Cognitive Neuroscience, Brunel University London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom
| | - Jennifer Hogg
- Department of Health and Human Performance, University of Tennessee, Chattanooga
| | - Alexis B. Slutsky-Ganesh
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- Emory Sports Medicine Center, Atlanta, GA
- Department of Kinesiology, University of North Carolina, Greensboro
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, OH
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, OH
| | - Christopher D. Riehm
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- Emory Sports Medicine Center, Atlanta, GA
| | - Gregory D. Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- Emory Sports Medicine Center, Atlanta, GA
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, OH
| | - Jed A. Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
- Emory Sports Medicine Center, Atlanta, GA
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Evans-Pickett A, Davis-Wilson HC, Johnston CD, Blackburn JT, Hackney AC, Pietrosimone B. Immediate Effects of Walking With a Knee Brace After Anterior Cruciate Ligament Reconstruction: A Biomechanical, Biochemical, and Structural Approach. J Athl Train 2023; 58:542-553. [PMID: 35119477 PMCID: PMC10496450 DOI: 10.4085/1062-6050-0700.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown. OBJECTIVE To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months). INTERVENTION(S) Gait biomechanics were assessed during braced and unbraced conditions on separate days. MAIN OUTCOME MEASURE(S) Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol. RESULTS Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions. CONCLUSIONS Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Physical Therapy Department, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Christopher D. Johnston
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Athletic Training, High Point University, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony C. Hackney
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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Evans-Pickett A, Lisee C, Zachary Horton W, Lalush D, Nissman D, Troy Blackburn J, Spang JT, Pietrosimone B. Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:1771-1781. [PMID: 35700436 PMCID: PMC9481723 DOI: 10.1249/mss.0000000000002969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Greater articular cartilage T1ρ magnetic resonance imaging relaxation times indicate less proteoglycan density and are linked to posttraumatic osteoarthritis development after anterior cruciate ligament reconstruction (ACLR). Although changes in T1ρ relaxation times are associated with gait biomechanics, it is unclear if excessive or insufficient knee joint loading is linked to greater T1ρ relaxation times 12 months post-ACLR. The purpose of this study was to compare external knee adduction (KAM) and flexion (KFM) moments in individuals after ACLR with high versus low tibiofemoral T1ρ relaxation profiles and uninjured controls. METHODS Gait biomechanics were collected in 26 uninjured controls (50% females; age, 22 ± 4 yr; body mass index, 23.9 ± 2.8 kg·m -2 ) and 26 individuals after ACLR (50% females; age, 22 ± 4 yr; body mass index, 24.2 ± 3.5 kg·m -2 ) at 6 and 12 months post-ACLR. ACLR-T1ρ High ( n = 9) and ACLR-T1ρ Low ( n = 17) groups were created based on 12-month post-ACLR T1ρ relaxation times using a k-means cluster analysis. Functional analyses of variance were used to compare KAM and KFM. RESULTS ACLR-T1ρ High exhibited lesser KAM than ACLR-T1ρ Low and uninjured controls 6 months post-ACLR. ACLR-T1ρ Low exhibited greater KAM than uninjured controls 6 and 12 months post-ACLR. KAM increased in ACLR-T1ρ High and decreased in ACLR-T1ρ Low between 6 and 12 months, both groups becoming more similar to uninjured controls. There were scant differences in KFM between ACLR-T1ρ High and ACLR-T1ρ Low 6 or 12 months post-ACLR, but both groups demonstrated lesser KFM compared with uninjured controls. CONCLUSIONS Associations between worse T1ρ profiles and increases in KAM may be driven by the normalization of KAM in individuals who initially exhibit insufficient KAM 6 months post-ACLR.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California at Santa Cruz, Santa Cruz, CA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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10
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Lynch P, Broderick P, Monaghan K. Sensory substitution for orthopaedic gait rehabilitation: A systematic review and meta-analysis for clinical practice guideline development. Heliyon 2022; 8:e10986. [PMID: 36254278 PMCID: PMC9568842 DOI: 10.1016/j.heliyon.2022.e10986] [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: 03/23/2022] [Revised: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Sensory Substitution is a biofeedback intervention whereby at least sensory system is utilised to supplement environmental information which is traditionally gathered by another sense. Objective To present an evidence-based overview of the feasibility and effectiveness of wearable Sensory Substitution devices on gait outcomes in orthopaedic patient populations. Methods This Systematic Review and Meta-Analysis was reported according to the PRISMA 2020 statement. PubMed, the Cochrane Library, Web of science and PEDro were searched for relevant published literature. Inclusion criteria limited the search strictly to patients diagnosed with an orthopaedic condition and who were randomly grouped to a Sensory Substitution intervention or conventional therapy/training or an equivalent placebo intervention. Results Nine Randomised Controlled Trials and three Crossover Trials investigating the effectiveness of Sensory Substitution supplemented gait training were identified and included participants with a variety of orthopaedic conditions. Meta-Analyses revealed positive findings of feasibility as well as statistical and clinical effect of the interventions in improving measures of gait speed, weight-bearing control, measures of functionality and subjective self-reporting. Meta-Analyses also revealed the interventions effects were not significant in the management of pain and retention of gait speed. Negatively reinforced Sensory Substitution biofeedback was statistically and clinically effective, whilst positively reinforced biofeedback was not. Conclusion For orthopaedic patient populations to improve gait speed, weight-bearing control, functionality, pain and self-report measures, the authors recommend a Sensory Substitution supplemented gait training programme with negative biofeedback on performance. The intervention should be undertaken for 20 min per day, 3 days per week for 5 weeks. The intervention should coincide with structured analgesia administration to facilitate effective pain management. Limitations of the data included some low sample sizes and large age-ranges. No financial support was provided for this study.
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Affiliation(s)
- Peter Lynch
- Biomedical Science Research Group (HEAL), School of Science, Atlantic Technological University (ATU), Sligo, Ireland
- Neuroplasticity Research Group, School of Science, Atlantic Technological University (ATU), Sligo, Ireland
| | - Patrick Broderick
- Biomedical Science Research Group (HEAL), School of Science, Atlantic Technological University (ATU), Sligo, Ireland
- Neuroplasticity Research Group, School of Science, Atlantic Technological University (ATU), Sligo, Ireland
| | - Kenneth Monaghan
- Biomedical Science Research Group (HEAL), School of Science, Atlantic Technological University (ATU), Sligo, Ireland
- Neuroplasticity Research Group, School of Science, Atlantic Technological University (ATU), Sligo, Ireland
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11
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Lisee C, Davis-Wilson H, Evans-Pickett A, Horton WZ, Blackburn T, Franz JR, Thoma L, Spang JT, Pietrosimone B. Linking Gait Biomechanics and Daily Steps After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:709-716. [PMID: 35072659 PMCID: PMC9255696 DOI: 10.1249/mss.0000000000002860] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Aberrant biomechanics and altered loading frequency are associated with poor knee joint health in osteoarthritis development. After anterior cruciate ligament reconstruction (ACLR), individuals demonstrate underloading (lesser vertical ground reaction force (vGRF)) with stiffened knee gait biomechanics (lesser knee extension moment (KEM) and knee flexion angle) and take fewer daily steps as early as 6 months after surgery. The purpose of this cross-sectional laboratory study is to compare gait biomechanics throughout stance between individuals 6-12 months after ACLR who take the lowest, moderate, and highest daily steps. METHODS Individuals with primary, unilateral history of ACLR between the ages of 16 and 35 yr were included (n = 36, 47% females; age, 21 ± 5 yr; months since ACLR, 8 ± 2). Barefoot gait biomechanics of vGRF (body weight), KEM (body weight × height), and knee flexion angle during stance were collected and time normalized. Average daily steps were collected via a waist-mounted accelerometer in free-living settings over 7 d. Participants were separated into tertiles based on lowest daily steps (3326-6042 daily steps), moderate (6043-8198 daily steps), and highest (8199-12,680 daily steps). Biomechanical outcomes of the ACLR limb during stance were compared between daily step groups using functional waveform gait analyses. RESULTS There were no significant differences in sex, body mass index, age, or gait speed between daily step groups. Individuals with the lowest daily steps walk with lesser vGRF and lesser KEM during weight acceptance, and lesser knee flexion angle throughout stance in the ACLR limb compared with individuals with highest and moderate daily steps. CONCLUSIONS After ACLR, individuals who take the fewest daily steps also walk with lesser vGRF during weight acceptance and a stiffened knee strategy throughout stance. These results highlight complex interactions between joint loading parameters after ACLR.
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Affiliation(s)
- Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
| | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California Santa Cruz, Santa Cruz, California
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Louise Thoma
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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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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