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Vallance P, Malliaras P, Vicenzino B, Kidgell DJ. Determining intracortical, corticospinal and alpha motoneurone excitability in athletes with patellar tendinopathy compared to asymptomatic controls. Scand J Med Sci Sports 2024; 34:e14579. [PMID: 38332685 DOI: 10.1111/sms.14579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Lower capacity to generate knee extension maximal voluntary force (MVF) has been observed in individuals affected with patellar tendinopathy (PT) compared to asymptomatic controls. This MVF deficit is hypothesized to emanate from alterations in corticospinal excitability (CSE). The modulation of CSE is intricately linked to the excitability levels at multiple sites, encompassing neurones within the corticospinal tract (CST), intracortical neurones within the primary motor cortex (M1), and the alpha motoneurone. The aim of this investigation was to examine the excitability of intracortical neurones, CST neurones, and the alpha motoneurone, and compare these between volleyball and basketball athletes with PT and matched asymptomatic controls. METHOD Nineteen athletes with PT and 18 asymptomatic controls participated in this cross-sectional study. Transcranial magnetic stimulation was utilized to assess CST excitability, corticospinal inhibition (silent period, and short-interval cortical inhibition). Peripheral nerve stimulation was used to evaluate lumbar spine and alpha motoneurone excitability, including the evocation of lumbar-evoked potentials and maximal compound muscle action potential (MMAX ), and CSE with central activation ratio (CAR). Knee extension MVF was also assessed. RESULTS Athletes with PT exhibited longer silent period duration and greater electrical stimulator output for MMAX , as well as lower MVF, compared to asymptomatic controls (p < 0.05). CONCLUSION These findings indicate volleyball and basketball athletes with PT exhibit reduced excitability of the alpha motoneurone or the neuromuscular junction, which may be linked to lower MVF. Subtle alterations at specific sites may represent compensatory changes to excitability aiming to maintain efferent drive to the knee extensors.
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Affiliation(s)
- Patrick Vallance
- Monash Musculoskeletal Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Monash Musculoskeletal Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Dawson J Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Obst SJ, Peterson B, Heales LJ. Maximal Lower Limb Strength in Patellar Tendinopathy: A Systematic Review With Meta-Analysis. J Athl Train 2024; 59:159-172. [PMID: 37071550 PMCID: PMC10895401 DOI: 10.4085/1062-6050-0662.22] [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: 04/19/2023]
Abstract
OBJECTIVE To investigate whether lower limb strength is reduced in people with patellar tendinopathy (PT) compared with asymptomatic control individuals or the asymptomatic contralateral limb. DATA SOURCES MEDLINE, PubMed, Scopus, and Web of Science. STUDY SELECTION To be included in the systematic review and meta-analysis, studies were required to be peer reviewed, published in the English language, and case control investigations; include participants with a clinical diagnosis of PT and an asymptomatic control or contralateral limb group; and include an objective measure of lower limb maximal strength. DATA EXTRACTION We extracted descriptive statistics for maximal strength for the symptomatic and asymptomatic limbs of individuals with PT and the limb(s) of the asymptomatic control group, inferential statistics for between-groups differences, participant characteristics, and details of the strength-testing protocol. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for analytical cross-sectional studies. DATA SYNTHESIS Of the 23 included studies, 21 reported knee strength, 3 reported hip strength, and 1 reported ankle strength. Random-effects models (Hedges g) were used to calculate the pooled effect sizes (ESs) of muscle strength according to the direction of joint movement and type of contraction. The pooled ESs (95% CI) for maximal voluntary isometric contraction knee-extension strength, concentric knee-extension strength, and concentric knee-flexion strength were 0.54 (0.27, 0.80), 0.78 (0.30, 1.33), and 0.41 (0.04, 0.78), respectively, with all favoring greater strength in the asymptomatic control group. Researchers of 2 studies described maximal eccentric knee-extensor strength with no differences between the PT and asymptomatic control groups. In 3 studies, researchers measured maximal hip strength (abduction, extension, and external rotation), and all within-study ESs favored greater strength in the asymptomatic control group. CONCLUSIONS Isometric and concentric knee-extensor strength are reduced in people with PT compared with asymptomatic control individuals. In contrast, evidence for reduced eccentric knee-extension strength in people with PT compared with asymptomatic control individuals is limited and inconsistent. Although evidence is emerging that both knee-flexion and hip strength may be reduced in people with PT, more examination is needed to confirm this observation.
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Affiliation(s)
- Steven J Obst
- Musculoskeletal Health and Rehabilitation Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Benjamin Peterson
- Musculoskeletal Health and Rehabilitation Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Luke J Heales
- Musculoskeletal Health and Rehabilitation Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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Mersmann F, Domroes T, Tsai MS, Pentidis N, Schroll A, Bohm S, Arampatzis A. Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes. SPORTS MEDICINE - OPEN 2023; 9:83. [PMID: 37673828 PMCID: PMC10482817 DOI: 10.1186/s40798-023-00627-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND High tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance. METHODS In 44 adolescent athletes (12-17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM. RESULTS Tendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034). DISCUSSIO The study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not provide effective tendon stimulation.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany.
- Berlin School of Movement Science, Berlin, Germany.
| | - Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
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Barroso Rosa S, Grant A, McEwen P. Patient-reported outcome measures for patellofemoral disorders: a systematic review. Arch Orthop Trauma Surg 2023; 143:3919-3927. [PMID: 36260119 DOI: 10.1007/s00402-022-04663-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patellofemoral conditions include, but are not limited to, anterior knee pain syndrome and patellar instability. Patients and surgeons may find it difficult to identify the specific source of the symptoms and clinical scenarios, so patient-reported outcome measures (PROMs) may be a useful diagnostic aid. There are a number of available PROMs for patellofemoral conditions, which are often used indistinctly. This systematic review explores the available PROMs for patellofemoral conditions, their use and methodological quality. METHODS A systematic review was conducted, searching for scientific articles relating to PROMs in patellofemoral conditions, from inception to July 2022. Scoring systems including physician-directed or imagining assessment were not included. All types of conditions in the patellofemoral joint were considered. RESULTS Twenty-two relevant PROMs were encountered, divided into four categories: eight PROMs for anterior knee pain syndrome, five for patellar instability, four for other patellofemoral conditions and five for non-specific PROMs. CONCLUSIONS While many PROMs have been found used in patellofemoral research, only few of them have showed sufficient methodological quality. In addition, PROMs employed in PF literature are often inaccurately chosen. This review may help authors to better understand the characteristics of specific patellofemoral PROMs, in order to select the more appropriate and recommended ones. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sergio Barroso Rosa
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain.
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia.
| | - Andrea Grant
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
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Quadriceps Muscle Action and Association With Knee Joint Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction. J Appl Biomech 2022; 38:328-335. [PMID: 36007878 DOI: 10.1123/jab.2021-0381] [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: 12/06/2021] [Revised: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
Insufficient quadriceps force production and altered knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) may contribute to a heightened risk of osteoarthritis. Quadriceps muscle lengthening dynamics affect force production and knee joint loading; however, no study to our knowledge has quantified in vivo quadriceps dynamics during walking in individuals with ACLR or examined correlations with joint biomechanics. Our purpose was to quantify bilateral vastus lateralis (VL) fascicle length change and the association thereof with gait biomechanics during weight acceptance in individuals with ACLR. The authors hypothesized that ACLR limbs would exhibit more fascicle lengthening than contralateral limbs. The authors also hypothesized that ACLR limbs would exhibit positive correlations between VL fascicle lengthening and knee joint biomechanics during weight acceptance in walking. The authors quantified VL contractile dynamics via cine B-mode ultrasound imaging in 18 individuals with ACLR walking on an instrumented treadmill. In partial support of our hypothesis, ACLR limb VL fascicles activated without length change on average during weight acceptance while fascicle length on the contralateral limb decreased on average. The authors found a positive association between fascicle lengthening and increase in knee extensor moments in both limbs. Our results suggest that examining quadriceps muscle dynamics may elucidate underlying mechanisms relevant to osteoarthritis.
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Waiteman MC, Botta AFB, Perez VO, de Oliveira Silva D, Pazzinatto MF, Magalhães FH, de Azevedo FM, Briani RV. Relationship between vastus medialis Hoffmann reflex excitability and knee extension biomechanics during different tasks in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2022; 91:105544. [PMID: 34896835 DOI: 10.1016/j.clinbiomech.2021.105544] [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: 01/18/2021] [Revised: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired knee extension biomechanics and spinal excitability have been reported in women with patellofemoral pain, but their relationship has not been explored. A significant relationship between them could indicate the need for investigating the potential benefits of disinhibitory interventions for women with patellofemoral pain. Thus, this study aimed to investigate the relationship between vastus medialis Hoffmann reflex and (1) maximal isometric, concentric and eccentric knee extensor strength and rate of torque development; (2) knee extensor torque steadiness; and (3) knee extensor moment during functional tasks; in women with patellofemoral pain. METHODS Spinal excitability of twenty-four participants was assessed by the amplitude of maximal vastus medialis Hoffmann reflex. Knee extensor strength, rate of torque development and torque steadiness were assessed using an isokinetic dynamometer. Knee extensor moment during step-down and stair descent tasks were obtained using a three-dimensional motion analysis system. FINDINGS A moderate negative relationship was found between vastus medialis Hoffmann reflex and knee extensor torque steadiness (r = -0.35; p = 0.05); whereas a moderate positive relationship was found with maximal isometric knee extensor strength (r = 0.37; p = 0.044). No significant relationships were found between vastus medialis Hoffmann reflex and the other variables. INTERPRETATION Our findings provide insight on the relationship between spinal excitability and neuromuscular control of maximal and submaximal isometric torque production in women with patellofemoral pain. Conversely, spinal excitability does not seem to be related with dynamic torques and moments of the knee extensors in women with patellofemoral pain.
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Affiliation(s)
- Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Vitória Ozores Perez
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Marcella Ferraz Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Fernando Henrique Magalhães
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil; School of Arts, Sciences, and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
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Fendri T, Boyas S, Sahli S, Harrabi MA, Chaari F, Rebai H, Beaune B. Patellar tendinopathy impairs postural control in athletes: A case-control study. Phys Ther Sport 2021; 53:14-20. [PMID: 34773760 DOI: 10.1016/j.ptsp.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare postural control performance between athletes with and without patellar tendinopathy (PT). DESIGN Case-control study. PARTICIPANTS Fifty-eight athletes, 29 with PT (PT group: PTG) and 29 healthy ones (control group: CG). MAIN OUTCOME MEASURES Static and dynamic postural control were assessed with a force platform and the Y-Balance Test (Y-BT), respectively. Quadriceps strength of both limbs was evaluated using an isometric dynamometer. RESULTS The PTG exhibited significantly (p < 0.05) higher centre of pressure (CoP) values than the CG on the foam surface, and significantly lower (p < 0.001) anterior, posteromedial and posterolateral normalized reach distances, and composite score in dynamic postural control on the injured limb (IL) compared to non-injured limb (NIL) and dominant limb (DL) of the CG. The quadriceps muscle strength was significantly lower on the IL compared to the NIL (p < 0.01) and DL (p < 0.05) of the CG. CONCLUSION Athletes suffering from PT exhibited worse static and dynamic postural control compared to healthy peers. As players with PT frequently continue training despite their tendon pain, physiotherapists and clinicians should incorporate balance rehabilitation programs in the treatment of these players, not only to prevent further potential injuries but also to enhance sport performance.
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Affiliation(s)
- Thouraya Fendri
- Laboratory 'Education, Motricity, Sports and Health', (EM2S, LR19JS01), High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
| | - Sébastien Boyas
- Laboratory 'Movement, Interactions, Performance', Faculty of Sciences and Technologies, Le Mans University, Le Mans, France.
| | - Sonia Sahli
- Laboratory 'Education, Motricity, Sports and Health', (EM2S, LR19JS01), High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
| | - Mohammed Achraf Harrabi
- Laboratory 'Education, Motricity, Sports and Health', (EM2S, LR19JS01), High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
| | - Fatma Chaari
- Laboratory 'Education, Motricity, Sports and Health', (EM2S, LR19JS01), High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
| | - Haithem Rebai
- Laboratory 'Education, Motricity, Sports and Health', (EM2S, LR19JS01), High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
| | - Bruno Beaune
- Laboratory 'Movement, Interactions, Performance', Faculty of Sciences and Technologies, Le Mans University, Le Mans, France.
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Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil 2021; 31:707-716. [PMID: 34470911 DOI: 10.1123/jsr.2020-0479] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) continues to be a limiting factor in joint rehabilitation as the inability to volitionally activate muscle significantly dampens recovery. New evidence acquired at higher brain centers and in clinical populations continues to reshape our perspective of what AMI is and how to treat it. This review aims to stimulate discussion about the far-reaching effects of AMI by exploring the interconnected pathways by which it evolves. OBJECTIVES To discuss how reflexive inhibition can lead to adaptations in brain activity, to illustrate how changes in descending motor pathways limit our ability to contract muscle following injury, and to summarize the emerging literature on the wide-reaching effects of AMI on other interconnected systems. DATA SOURCES The databases PubMed, SPORTDiscus, and Web of Science were searched for articles pertaining to AMI. Reference lists from appropriate articles were cross-referenced. CONCLUSION AMI is a sequential and cumulative neurological process that leads to complex clinical impairments. Originating with altered afferent information arising from an injured joint, patients experience changes in afferent information, reflexive muscle inhibition, deficiencies in somatosensation, neuroplastic compensations in higher brain centers, and ultimately decreased motor output to the muscle surrounding the joint. Other aspects of clinical function, like muscle structure and psychological responses to injury, are also impaired and influenced by AMI. Removing, or reducing, AMI should continue to be a focus of rehabilitation programs to assist in the optimization of health after joint injury.
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Baumgart C, Grim C, Heiss R, Ehrenstein P, Freiwald J, Hoppe MW. Rehabilitation after a Complete Avulsion of the Proximal Rectus Femoris Muscle: Considerations from a Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168727. [PMID: 34444475 PMCID: PMC8392792 DOI: 10.3390/ijerph18168727] [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: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A complete avulsion of the proximal rectus femoris muscle is a rare but severity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. CASE PRESENTATION The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was observable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cycling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. CONCLUSIONS While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter- and intra-limb compensation strategies.
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Affiliation(s)
- Christian Baumgart
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany;
- Correspondence: ; Tel.: +49-202-4393758
| | - Casper Grim
- Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Am Finkenhuegel 1, 49076 Osnabrueck, Germany;
- Department of Human Science, University of Osnabrueck, Barbarastrasse 22c, 49076 Osnabrueck, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany;
| | - Philipp Ehrenstein
- Practice OrthoPro Duesseldorf, Breitestr 69, 40213 Duesseldorf, Germany;
| | - Jürgen Freiwald
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany;
| | - Matthias Wilhelm Hoppe
- Institute of Movement and Training Science, University of Leipzig, Jahnallee 59, 04109 Leipzig, Germany;
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