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Hartshorne MT, Turner JA, Cameron KL, Padua DA. Strength of the Uninvolved Limb Following Return to Activity After ACL Injury: Implications for Symmetry as a Marker of Sufficient Strength. Int J Sports Phys Ther 2024; 19:657-669. [PMID: 38835985 PMCID: PMC11144673 DOI: 10.26603/001c.117547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Muscular strength deficits are common after ACL injury. While the Limb Symmetry Index (LSI), using the uninvolved limb as a reference, is widely used, negative strength adaptations may affect both limbs post-injury. It is uncertain how the strength of the uninvolved limb in those with an ACL injury compares to uninjured individuals, making it unclear whether it is appropriate as a benchmark for determining sufficient strength. Purpose To compare the strength of key lower extremity muscles of the uninvolved limb in those with history of ACL injury (ACL-I) to the dominant limb in individuals with no history of ACL injury (control). Study Design Cross-sectional study. Methods: A total of 5,727 military cadets were examined, with 82 females and 126 males in the ACL-I group and 2,146 females and 3,373 males in the control group. Maximum isometric strength was assessed for six muscle groups measured with a hand-held dynamometer. Separate two-way ANOVAs with limb and sex were performed for each muscle group. Results Significant main effects for limb were observed with the uninvolved limb in the ACL-I group displaying greater strength compared to the dominant limb in the control group for the quadriceps, hamstrings, and gluteus medius, but effect sizes were small (Cohen's d <0.25). Significant main effects for sex were observed with greater male muscular strength in all six muscle groups with small to large effect sizes (Cohen's d 0.49-1.46). No limb-by-sex interactions were observed. Conclusions There was no evidence of reduced strength in the uninvolved limb in those with a history of ACL injury compared to the dominant limb in those with no prior ACL injury. This finding suggests that, after clearance to return to activities, the uninvolved limb can be used as a standard for comparison of sufficient strength, including when using the LSI. Level of Evidence: Level 3.
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Affiliation(s)
| | - Jeffrey A Turner
- Human Movement Science CurriculumUniversity of North Carolina at Chapel Hill
| | | | - Darin A Padua
- Department of Exercise and Sport ScienceUniversity of North Carolina at Chapel Hill
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Paredes R, Crasto C, Mesquita Montes A, Arias-Buría JL. Changes in co-contraction magnitude during functional tasks following anterior cruciate ligament reconstruction: A systematic review. Knee 2024; 48:243-256. [PMID: 38781829 DOI: 10.1016/j.knee.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic surgery procedure whose incidence has increased over the past few decades. Nevertheless, it is believed that neuromuscular control remains altered from the early stages after ACLR to later years. Therefore, the aim of this study was to systematically evaluate the magnitude of co-contraction during functional tasks in subjects with unilateral ACLR. METHODS A systematic review design was followed. The search strategy was conducted in PubMed, Scopus, EBSCO, PEDro, Cochrane Library, and Web of Science databases from inception to March 2024. The inclusion criteria involved studies using electromyography (EMG) data to calculate muscle pair activation via the co-contraction index (CCI) in ACLR individuals during functional tasks. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and study quality was evaluated using National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS The search strategy found a total of 792 studies, of which 15 were included in this systematic review after reviewing the eligibility criteria. The magnitude of co-contraction was assessed in a total of 433 ACLR individuals and 206 controls during functional tasks such as hop, drop-land, step-up/step-down, and gait. Overall, approximately 79.6% of individuals who had undergone ACLR exhibited increased levels of co-contraction magnitude in the ACLR limb, while 8.5% showed low co-contraction levels. CONCLUSIONS The findings of the review suggest that, during functional tasks, most individuals who have undergone ACLR exhibit changes of co-contraction magnitude in the involved limb.
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Affiliation(s)
- Ricardo Paredes
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Carlos Crasto
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - António Mesquita Montes
- Escola Superior de Saúde de Santa Maria, Oporto, Portugal; Escola Superior de Saúde do Politécnico do Porto, Oporto, Portugal
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Barbosa O, Kotsifaki R, Whiteley R, King E, Korakakis V. Beware of the "Moving Target" - Uninvolved Limb Strength Increases to Exceed Preoperative Values During Rehabilitation After ACL Reconstruction in Male Professional and Recreational Athletes. J Orthop Sports Phys Ther 2024; 54:1-9. [PMID: 38093493 DOI: 10.2519/jospt.2023.11961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVE: To describe the changes in quadriceps and hamstrings muscle strength in the uninvolved limb of male professional and recreational athletes during rehabilitation after anterior cruciate ligament reconstruction (ACLR) and compare to preoperative strength values. DESIGN: Prospective longitudinal study. METHODS: During rehabilitation, 665 participants who underwent unilateral ACLR performed a strength test preoperatively and every 6 weeks after surgery for up to 9 months. Isokinetic quadriceps and hamstrings strength of the uninvolved limb were measured at an angular velocity of 60°/s and normalized to body weight (N·m/kg). RESULTS: Quadriceps and hamstrings strength of the uninvolved limb gradually increased during rehabilitation until 6 months post-ACLR, and plateaued thereafter. Postoperative quadriceps' strength significantly exceeded preoperative values by 3 months for professional (2.99 N·m/kg; 95% confidence interval [CI]: 2.93, 3.04; P = .007) and by 6 months for recreational athletes (2.77 N·m/kg; 95% CI: 2.71, 2.83; P<.001), and hamstrings exceeded presurgery levels by 4.5 months (1.71 N·m/kg; 95% CI: 1.67, 1.74; P<.001 and 1.43 N·m/kg; 95% CI: 1.40, 1.46; P = .002, professional and recreational athletes respectively). CONCLUSION: In male professional and recreational athletes, uninvolved limb quadriceps and hamstrings strength gradually improved after ACLR, until 6 months after surgery. The uninvolved limb's strength may present as a "moving target" that requires consistent monitoring during rehabilitation. J Orthop Sports Phys Ther 2024;54(4):1-9. Epub 14 December 2023. doi:10.2519/jospt.2023.11961.
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Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators. Sports Health 2024; 16:58-69. [PMID: 36872595 PMCID: PMC10732114 DOI: 10.1177/19417381231155107] [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: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. HYPOTHESIS We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants' zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption. RESULTS Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%). CONCLUSION Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. CLINICAL RELEVANCE Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.
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Affiliation(s)
| | - William M. Adams
- Division of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado
| | - Kelly A. Coleman
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, Connecticut
| | - Rebecca M. Lopez
- University of South Florida, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, Tampa, Florida
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Maciel DG, Dantas GAF, Cerqueira MS, Barboza JAM, Caldas VVDA, de Barros ACM, Varela RR, Magalhães DH, de Brito Vieira WH. Peak torque angle, acceleration time and time to peak torque as additional parameters extracted from isokinetic test in professional soccer players: a cross-sectional study. Sports Biomech 2023; 22:1108-1119. [PMID: 32673150 DOI: 10.1080/14763141.2020.1784260] [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: 03/12/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
This study investigated additional and traditional variables from isokinetic test of thigh muscles in soccer players across different field positions. One hundred and eighty-nine athletes performed maximal concentric isokinetic knee contractions on dominant (DL) and non-dominant limb (NDL) at 60º/s and 240º/s. The additional outcomes peak torque angle (AngPT), acceleration time (AcT) and time to peak torque (TPT) and traditional outcomes Peak torque (PT), total work (TW) and power (Pw) were extracted from the exam. Goalkeepers (GK), side backs (SB), central backs (CB), central defender midfielders (CDM), central attacking midfielders (CAM) and forwards (FW) were considered. Comparisons between limbs and positions demonstrated that SB extensors of the DL presented TPT lower (p = 0.006) and AngPT higher (p = 0.011) than NDL at 60°/s. CDM extensors of the DL showed lower TPT at 60°/s (p = 0.003) and 240°/s (p = 0.024). CAM flexors of the DL showed lower TPT (p = 0.026) and AcT (p = 0.021) at 240°/s than NDL. CB, CDM and CAM extensors of the NDL showed higher PT, TW and Pw than DL (p < 0.05). In conclusion, there are muscle imbalances between limbs in SB, CDM and CAM and across different field positions.
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Affiliation(s)
- Daniel Germano Maciel
- Department of Physical Therapy, Federal University of Rio Grande Do Norte, Natal, Brazil
| | | | | | | | | | | | - Ronan Romeno Varela
- Department of Physical Therapy, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Diego Helps Magalhães
- Department of Physical Therapy, Federal University of Rio Grande Do Norte, Natal, Brazil
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Genç AS, Güzel N, Yılmaz AK, Ermiş E, Pekesen Kurtça M, Agar A, Ceritoğlu KU, Yasul Y, Eseoğlu İ, Kehribar L. Post-Operative Modified All-Inside ACL Reconstruction Technique's Clinical Outcomes and Isokinetic Strength Assessments. Diagnostics (Basel) 2023; 13:2787. [PMID: 37685325 PMCID: PMC10487178 DOI: 10.3390/diagnostics13172787] [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: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. MATERIALS AND METHODS A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). RESULTS There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. CONCLUSIONS Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports.
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Affiliation(s)
- Ahmet Serhat Genç
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Türkiye; (A.S.G.); (N.G.)
| | - Nizamettin Güzel
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Türkiye; (A.S.G.); (N.G.)
| | - Ali Kerim Yılmaz
- Faculty of Yasar Dogu Sport Sciences, Ondokuz Mayıs University, Samsun 55100, Türkiye;
| | - Egemen Ermiş
- Faculty of Yasar Dogu Sport Sciences, Ondokuz Mayıs University, Samsun 55100, Türkiye;
| | | | - Anıl Agar
- Department of Orthopaedics and Traumatology, Fırat University, Elazığ 23119, Türkiye;
| | | | - Yavuz Yasul
- Bafra Vocational School, Ondokuz Mayıs University, Samsun 55400, Türkiye;
| | - İsmail Eseoğlu
- Vocational School of Health Services, Dokuz Eylül University, İzmir 35210, Türkiye;
| | - Lokman Kehribar
- Department of Orthopaedics and Traumatology, Samsun University, Samsun 55090, Türkiye;
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Hart DA. Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle? Front Physiol 2023; 14:1127689. [PMID: 37113695 PMCID: PMC10126777 DOI: 10.3389/fphys.2023.1127689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.
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Sharma KN, Quddus N, Hameed UA, Khan SA, Kumari A, Alghadir AH, Khan M. Mode-specific effects of concentric and eccentric isokinetic training of the hamstring muscle at slow angular velocity on the functional hamstrings-to-quadriceps ratio-a randomized trial. PeerJ 2022; 10:e13842. [PMID: 36196400 PMCID: PMC9527019 DOI: 10.7717/peerj.13842] [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: 02/14/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Previous studies have examined the mode specificity of eccentric and concentric isokinetic training, but have reported conflicting results. Few studies have reported that eccentric and concentric isokinetic training are mode-specific, i.e., they will increase only the eccentric or concentric strength, respectively. Other studies have reported that mode specificity does not exist. Therefore, this study aimed to assess the mode-specific effects of eccentric and concentric isokinetic training of the hamstring muscle at slow angular velocity on eccentric peak torque of the hamstring (PTecc), concentric peak torque of the quadriceps (PTcon), acceleration time of the hamstring (AThams) and quadriceps (ATquad), deceleration time of the hamstring (DThams) and quadriceps (DTquad), time to peak torque of the hamstring (TPThams) and quadriceps (TPTquad), and functional Hamstring-to-Quadriceps ratio (PTecc/PTcon). Subjects A total of 30 participants were randomly divided into eccentric and concentric groups. Methods Two groups pre-test-post-test experimental design was used. In the eccentric and concentric groups, eccentric and concentric isokinetic training of hamstring muscle was performed respectively, at an angular velocity of 60°/s for 6 weeks duration. PTecc, PTcon, AThams, ATquad, DThams, DTquad, TPThams, TPTquad, and PTecc/PTcon were measured before and after the completion of training. Results In the eccentric group, a significant difference (p < 0.05) was observed in PTecc (increased by 21.55%), AThams (decreased by 42.33%), ATquad (decreased by 28.74%), and PTecc/PTcon (increased by 17.59%). No significant difference (p > 0.05) was observed in PTcon, TPThams, TPTquad, DThams, and DTquad. In the concentric group, a significant difference (p < 0.05) was observed in PTecc (increased by 12.95%), AThams (decreased by 27.38%) ATquad (decreased by 22.08%), DTquad (decreased by 26.86%), and PTecc/PTcon (increased by 8.35%). No significant difference (p > 0.05) was observed in PTquad, TPThams, TPTquad, and DThams. Between-group analysis revealed a significant difference (p < 0.05) only in TPTquad; otherwise, in the rest of the parameters, no significant difference (p > 0.05) was observed. Conclusions Both eccentric and concentric isokinetic training of the hamstring for 6 weeks increased PTecc, PTecc/PTcon, and decreased AThams and ATquad. The effects of eccentric and concentric isokinetic training of the hamstring on PTecc, PTecc/PTcon, AThams, and ATquad were not mode specific.
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Affiliation(s)
| | - Nishat Quddus
- Department of Rehabilitation Sciences, Jamia Hamdard University, New Delhi, Delhi, India
| | | | - Sohrab Ahmad Khan
- Department of Rehabilitation Sciences, Jamia Hamdard University, New Delhi, Delhi, India
| | - Anita Kumari
- Dr. Pradeep Sharma’s Pain Management Clinic, New Delhi, Delhi, India
| | - Ahmad H. Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Masood Khan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Genç AS, Güzel N. Traditional and Additional Isokinetic Knee Strength Assessments of Athletes; Post-Operative Results of Hamstring Autograft ACL Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091187. [PMID: 36143864 PMCID: PMC9506231 DOI: 10.3390/medicina58091187] [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: 07/26/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries in athletes, and, accordingly, ACL reconstruction (ACLR) is one of the most common orthopedic surgical procedures performed on athletes. This study aims to compare the 6-month post-operative isokinetic knee strength evaluations of the semitendinous/gracilis (ST/G) ACLR technique performed on healthy (HK) and ACLR knees of athletes. Materials and Methods: A retrospective cohort of 29 athletes from various sports branches who underwent ST/G ACLR technique by the same surgeon were evaluated. The isokinetic knee extension (Ex) and flexion (Flx) strength of the patients on the HK and ACLR sides were evaluated with a series consisting of three different angular velocities (60, 180, and 240°/s). In addition to the traditional evaluations of peak torque (PT) and hamstring/quadriceps (H/Q) parameters, the findings were also evaluated with additional parameters such as the joint angle at peak torque (JAPT), time to peak torque (TPT), and reciprocal delay (RD). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with preoperative levels (p < 0.05). As for the isokinetic PT values, there were significant differences in favor of HK in the 60°/s Flx, 180°, and 240°/s Ex phases (p < 0.05). In addition, there was a significant difference in the 60° and 180°/s Flx phases in RD (p < 0.05). In H/Q ratio, TPT, and JAPT values, no significant difference was observed between HK and ACLR at all angular velocities. Conclusions: The findings showed that the ST/G 6-month post-operative isokinetic knee strength in athletes produced high results in HK, and, when evaluated in terms of returning to sports, the H/Q ratios on the ACLR side were sufficient to make the decision to return to sports. It was found that the ACLR side was slower than the HK side in the reciprocal transitions, particularly in the Flx phase. We believe that this results from the deformation of the hamstring muscle after reconstruction of the ST/G ACLR side.
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Mohammad WS, Elsais WM. Comparison of hip abductor and adductor muscle performance between healthy and osteitis pubis professional footballers. Ir J Med Sci 2022; 192:685-691. [PMID: 35426013 DOI: 10.1007/s11845-022-03010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aimed to compare the concentric and eccentric muscle performance of the hip abductor and adductor muscles at a high angular velocity in football players with osteitis pubis and healthy players. METHODS A total number of 32 male football players with osteitis pubis and 20 healthy footballers were tested using an isokinetic dynamometer at a speed of 180°/s. Hip abductor and adductor peak torque/body weight, time to peak torque, acceleration, and deceleration times produced during concentric and eccentric muscle contraction modes were measured using a Biodex dynamometer. RESULTS Football players with osteitis pubis demonstrated a significantly higher time to peak torque, acceleration, and deceleration times (p < 0.05); however, when compared to healthy athletes, there was no significant change in muscle strength. CONCLUSION The present study showed that football players with osteitis pubis had a reduction in neuromuscular reaction. Therefore, the reaction time of these muscles is critical, and the reduction could result in magnified stresses and/or poorly distributed loads across the musculotendinous structure of the anterior pelvis, which presumably could lead to the development of osteitis pubis. Incorporate findings of the current study in clinical practice could afford critical information when evaluating the hip muscles in football players with osteitis pubis, for pre-screening, enhancing the rehabilitation programs, and guiding the decision of returning to sports after injury.
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Affiliation(s)
- Walaa S Mohammad
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia.
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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11
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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: 18] [Impact Index Per Article: 9.0] [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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Exercise Descriptors That Determine Muscle Strength Gains Are Missing From Reported Anterior Cruciate Ligament Reconstruction Rehabilitation Programs: A Scoping Review of 117 Exercises in 41 Studies. J Orthop Sports Phys Ther 2022; 52:100-112. [PMID: 34784243 DOI: 10.2519/jospt.2022.10651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To (1) describe which strength training exercise descriptors are reported in anterior cruciate ligament reconstruction (ACLR) rehabilitation research, and (2) compare the current standards of reporting ACLR strength training exercise descriptors to international best-practice strength training guidelines. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE, PsycINFO, CINAHL, SPORTDiscus, Academic Search, ERIC, Health Source: Nursing, Health Source: Consumer, MasterFILE, and Africa-Wide Information databases. STUDY SELECTION CRITERIA We included level I to IV studies of ACLR rehabilitation programs with 1 or more reported strength training exercise descriptors. We used a predefined list of 19 exercise descriptors, based on the American College of Sports Medicine (ACSM) exercise recommendations, the Consensus on Exercise Reporting Template (CERT), and the Toigo and Boutellier exercise descriptor framework. DATA SYNTHESIS Completeness and the standard of reporting exercise descriptors in ACLR rehabilitation programs were assessed by means of international best-practice strength training standards. RESULTS We extracted data on 117 exercises from 41 studies. A median of 7 of the 19 possible exercise descriptors were reported (range, 3-16). Reporting of specific exercise descriptors varied across studies, from 95% (name of the strength training exercise) to 5% (exercise aim, exercise order). On average, 46%, 35%, and 43% of the exercise descriptors included in the ACSM, CERT, and Toigo and Boutellier guidelines were reported, respectively. CONCLUSION Key exercise descriptors for muscle strength gains are not reported in studies on ACLR rehabilitation. Only the exercise name, number of exercises, frequency, and experimental period were reported in most of the studies. J Orthop Sports Phys Ther 2022;52(2):100-112. Epub 16 Nov 2021. doi:10.2519/jospt.2022.10651.
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Yılmaz AK, Vural M, Özdal M, Kabadayı M. A comparative study of the acute effects of knee brace vs. kinesiotape on selected isokinetic strength variables of the knee muscles. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Different methods of treatment for preventing knee injuries, enhancing knee strength and minimising post-injury risks have been explored. Among these methods, Kinesio tape (KT) and knee braces (KB) are commonly used. OBJECTIVE : To investigate the acute effects of KT and KB on isokinetic knee strength parameters. METHODS: A total of 15 healthy sedentary male subjects voluntarily participated in the study. Concentric isokinetic knee extension (EX) and flexion (FLX) strength were measured at three sessions: 1. Baseline 2. with KT (’KT’) 3. with KB (’KB’). Tests were performed at 60, 180 and 240∘/s. Peak moment (PM), Hamstring/Quadriceps ratio (HQR), and joint angle at peak moment (JAPM) were measured. RESULTS: ‘KT’ and ‘KB’ were associated with increase in PMEX, PMFLX, HQR at 60 and 240∘/s (p< 0.05) and increased JAPMEX. No significant difference was observed at 180∘/s (p> 0.05). CONCLUSION: In healthy individuals, ‘I’ shape KT and KB positively affect EX and FLX strengths and HQR, especially at low angular velocity.
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Affiliation(s)
- Ali Kerim Yılmaz
- Ondokuz Mayıs University Performance Laboratory, Faculty of Sport Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Vural
- Gaziantep University Performance Laboratory, Faculty of Sport Sciences, Gaziantep University, Gaziantep, Turkey
| | - Mustafa Özdal
- Gaziantep University Performance Laboratory, Faculty of Sport Sciences, Gaziantep University, Gaziantep, Turkey
| | - Menderes Kabadayı
- Ondokuz Mayıs University Performance Laboratory, Faculty of Sport Sciences, Ondokuz Mayıs University, Samsun, Turkey
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Davi SM, Brancati RJ, DiStefano LJ, Lepley AS, Lepley LK. Suppressed quadriceps fascicle behavior is present in the surgical limbs of those with a history of ACL reconstruction. J Biomech 2021; 129:110808. [PMID: 34666248 DOI: 10.1016/j.jbiomech.2021.110808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
The balance of published data have largely focused on adaptations in muscle and fiber size after anterior cruciate ligament reconstruction (ACLR), failing to account for the dynamic changes in the behavior of the muscles' contractile elements that strongly contribute to force production. To better understand the sources of quadriceps dysfunction, the purpose of our research was to determine if alterations in fascicle behavior are present after ACLR. Unilateral ACLR individuals (9 m/9f; 21 ± 3 yrs; 1.74 ± 0.12 m;71.58 ± 13.31 kg; months from surgery:38 ± 36) and healthy controls (3 m/6f; 23 ± 2 yrs; 1.67 ± 0.10 m; 63.51 ± 10.11 kg) participated. In-vivo vastus lateralis fascicle behavior was recorded using ultrasonography during three maximal isokinetic knee extensions (60°·s-1). Fascicle length, angle, and shortening velocity were calculated and analyzed from rest to peak torque. Peak knee extension torque was averaged between isokinetic trials (Nm·kg-1). Group by limb interactions were assessed using separate two-way analyses of variance and were further evaluated by comparing 95% confidence intervals where appropriate. Significant interactions were present for fascicle angle at peak torque (P = 0.01), fascicle length excursion (P = 0.05), fascicle angle excursion (P < 0.01), fascicle shortening velocity (P = 0.05) and strength (P = 0.03). Upon post-hoc evaluation, the surgical limb displayed altered in-vivo fascicle behavior compared to all limbs (P < 0.05) and reduced strength compared to the contralateral and right control limbs (P < 0.05). No other significant interactions were present (P > 0.05). Our data show that those with a history of ACLR have fascicles that are slower, lengthen less and operate with lower angles relative to the axis of force production. Altered fascicle behavior after ACLR may be an important underlying factor to explaining the protracted quadriceps dysfunction.
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Affiliation(s)
- Steven M Davi
- Department of Kinesiology, The University of Connecticut, Storrs, CT, United States
| | | | - Lindsay J DiStefano
- Department of Kinesiology, The University of Connecticut, Storrs, CT, United States
| | - Adam S Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Lindsey K Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States.
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Hart DA, Martin CR, Scott M, Shrive NG. The instrumented sheep knee to elucidate insights into osteoarthritis development and progression: A sensitive and reproducible platform for integrated research efforts. Clin Biomech (Bristol, Avon) 2021; 87:105404. [PMID: 34171651 DOI: 10.1016/j.clinbiomech.2021.105404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis of the knee is a very common condition that has been difficult to treat. The majority of cases are considered idiopathic. Much research effort remains focused on biology rather than the biomechanics of such joints. Some new methods were developed and validated to better appreciate the subtleties of the biomechanical integrity of joints, and how changes in biomechanics can contribute to osteoarthritis. METHODS Over the past 15 years our lab has enhanced the sensitivity of the assessment of knee biomechanics of an instrumented, trained large animal model (sheep) of osteoarthritis and integrated the findings with biological and histological assessments. These new methods include gait analysis before and after injury followed by robotic validation post-sacrifice, and more recently using Fibre Bragg Grating sensors to detect alterations in cartilage stresses. RESULTS A review of the findings obtained with this model are presented. The findings indicate that sheep, like humans, exhibit individual characteristics. They also indicate that joint kinetics, rather than kinematics may better define the alterations induced by injury. With the addition of Fibre Bragg Grating sensors, it has been possible to measure with good accuracy, alterations to cartilage stresses following a controlled knee injury. INTERPRETATION Using this model as Proof of Concept, this sheep system can now be viewed as a sensitive platform to address many questions related to risk for development of idiopathic osteoarthritis of the human knee, the efficacy of potential interventions to correct biomechanical disruptions, and how joint biomechanics and biology are integrated during aging.
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Affiliation(s)
- David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
| | - C Ryan Martin
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Section of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Michael Scott
- Department of Veterinary Clinical & Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Brown C, Marinko L, LaValley MP, Kumar D. Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:2325967121991534. [PMID: 33889639 PMCID: PMC8040575 DOI: 10.1177/2325967121991534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The limb symmetry index may overestimate the recovery of quadriceps muscle strength after anterior cruciate ligament reconstruction. Comparison of individuals who have had anterior cruciate ligament reconstruction with age-, sex-, and activity-matched individuals might be more appropriate to guide rehabilitation interventions. Purpose: To compare the quadriceps strength between the injured limb of people with anterior cruciate ligament reconstruction and the limb of an age-, sex-, and activity-matched control group. Study Design: Systematic review; Level of evidence, 3. Methods: MEDLINE, CINAHL, EMBASE, SCOPUS, and SPORTDiscus were searched between inception and April 2019. Studies were included if they reported the peak quadriceps strength for persons with anterior cruciate ligament reconstruction and age-, sex-, and activity-matched control groups measured using isometric or isokinetic dynamometry. Risk of bias was assessed, and meta-analyses and metaregression (for effect of time since surgery) were performed. Results: A total of 2759 studies were identified and 21 were included for analyses. Quadriceps strength was lower in the limbs with anterior cruciate ligament reconstruction compared with the limb from matched controls within 6 months of anterior cruciate ligament reconstruction (standardized mean difference [SMD], –1.42; 95% CI, –1.62 to –1.23), 6 to 18 months after anterior cruciate ligament reconstruction (SMD, –0.92; 95% CI, –1.18 to –0.66), and >18 to 48 months after anterior cruciate ligament reconstruction (SMD, –0.38; 95% CI, –0.79 to 0.03). Results of the metaregression were significant, with the difference between anterior cruciate ligament reconstruction and matched controls decreasing with time since surgery (P < .001). Conclusion: In people with anterior cruciate ligament reconstruction, the injured limb had lower quadriceps strength compared with the limb of age-, sex-, and activity-matched controls up to 4 years after surgery. Clinicians should consider comparison with matched cohorts for return to sports decision making.
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Affiliation(s)
- Conlan Brown
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Lee Marinko
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Deepak Kumar
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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Burland JP, Lepley AS, Frechette L, Lepley LK. Protracted alterations in muscle activation strategies and knee mechanics in patients after Anterior Cruciate Ligament Reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3766-3772. [PMID: 31897547 DOI: 10.1007/s00167-019-05833-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Altered quadriceps muscle activity can contribute to reduced ability of the muscle to quickly generate force and appropriately attenuate landing forces, exacerbating poor landing and movement strategies commonly seen after anterior cruciate ligament reconstruction (ACLR). The purpose was to evaluate if electromyographic (EMG) activity and knee biomechanics during a single-limb forward hop task are influenced by a history of ACLR. METHODS Twenty-six individuals with a history of unilateral ACLR (age 20.2 ± 2.7 years, height 1.7 ± 0.1 m; weight 69.6 ± 12.4 kg; time from surgery, 2.9 ± 2.7 years; graft type, 21 bone-patellar-tendon bone, 5 hamstring) and 8 healthy controls (age 23.3 ± 1.8 years, height 1.7 ± 0.1 m; mass 66.3 ± 13.9 kg) volunteered. Sagittal plane knee kinetics and EMG of the vastus lateralis were synchronized and measured using a three-dimensional motion analysis system during a single-limb forward hop task. Mixed-effect models were used to assess the effect of group on kinetic and EMG variables. RESULTS Kinetic outcomes (peak and rate of knee extension moment) and temporal muscle activity and activation patterns differed between the ACLR limb and healthy-control limb. Inter-limb asymmetries in the ACLR group were observed for all variables except EMG onset time; no limb differences were observed in the healthy cohort. CONCLUSION Years after ACLR, persistent quadriceps functional deficits are present, contributing to altered neuromuscular control strategies during functional tasks that may increase the risk of reinjury. To counteract these effects, emerging evidence indicates that clinicians could consider the use of motor learning strategies to improve neuromuscular control after ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Adam S Lepley
- University of Michigan, 2126 Observatory Lodge, 1402 Washington Heights, Ann Arbor, MI, 48109, USA
| | | | - Lindsey K Lepley
- University of Michigan, 3745B CCRB, 401 Washtenaw Avenue, Ann Arbor, MI, 48109, USA.
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Nielsen JL, Arp K, Villadsen ML, Christensen SS, Aagaard P. Rate of Force Development Remains Reduced in the Knee Flexors 3 to 9 Months After Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Autografts: A Cross-Sectional Study. Am J Sports Med 2020; 48:3214-3223. [PMID: 33079573 DOI: 10.1177/0363546520960108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a serious injury with a high prevalence worldwide, and subsequent ACL reconstructions (ACLR) appear to be most commonly performed using hamstring-derived (semitendinosus tendon) autografts. Recovery of maximal muscle strength to ≥90% of the healthy contralateral limb is considered an important criterion for safe return to sports. However, the speed of developing muscular force (ie, the rate of force development [RFD]) is also important for the performance of many types of activities in sports and daily living, yet RFD of the knee extensor and flexor muscles has apparently never been examined in patients who undergo ACLR with hamstring autograft (HA). PURPOSE To examine potential deficits in RFD, maximal muscle strength (ie, maximal voluntary isometric contraction [MVIC]), and functional capacity of ACLR-HA limbs in comparison with the healthy contralateral leg and matched healthy controls 3 to 9 months after surgery. STUDY DESIGN Cross-sectional study; Level of evidence: 3. METHODS A total of 23 young patients who had undergone ACLR-HA 3 to 9 months earlier were matched by age to 14 healthy controls; both groups underwent neuromuscular screening. Knee extensor and flexor MVIC and RFD, as well as functional capacity (single-leg hop for distance [SLHD] test, timed single-leg sit-to-stand [STS] test), were assessed on both limbs. Furthermore, patient-reported knee function (Knee injury and Osteoarthritis Outcome Score) was assessed. RESULTS Knee extensor and flexor MVIC and RFD were markedly compromised in ACLR-HA limbs compared with healthy contralateral limbs (MVIC for extensor and flexor, 13% and 26%, respectively; RFD, 14%-17% and 32%-39%) and controls (MVIC, 16% and 31%; RFD, 14%-19% and 30%-41%) (P < .05-.001). Further, ACLR-HA limbs showed reduced functional capacity (reduced SLHD and STS performance) compared with contralateral limbs (SLHD, 11%; STS, 14%) and controls (SLHD, 20%; STS, 31%) (P < .01-.001). Strength (MVIC) and functional (SLHD) parameters were positively related to the duration of time after surgery (P < .05), although this relationship was not observed for RFD and STS. CONCLUSION Knee extensor and flexor RFD and maximal strength, as well as functional single-leg performance, remained substantially reduced in ACLR-HA limbs compared with noninjured contralateral limbs and healthy controls 3 to 9 months after reconstructive surgery.
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Affiliation(s)
- Jakob Lindberg Nielsen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Kamilla Arp
- Department of Orthopedic Surgery, Vejle Hospital, Vejle, Denmark
| | - Mette Lysemose Villadsen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Stine Sommer Christensen
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
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Raymond-Pope CJ, Dengel DR, Fitzgerald JS, Nelson BJ, Bosch TA. Anterior Cruciate Ligament Reconstructed Female Athletes Exhibit Relative Muscle Dysfunction After Return to Sport. Int J Sports Med 2020; 42:336-343. [PMID: 33096577 DOI: 10.1055/a-1273-8269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We sought to examine the relationship between upper-leg compartmental lean mass, muscle-specific strength, and explosive strength following anterior cruciate ligament reconstruction. Twleve adolescent female athletes with prior anterior cruciate ligament reconstruction were individually-matched by age (16.4±0.9 vs. 16.4±1.0 yrs.), body mass index (23.2±2.1 vs. 23.2±2.7 kg/m2), and sport to 12 female athlete controls. One total-body and 2 lateral-leg dual X-ray absorptiometry scans measured total/segmental body composition. Isokinetic dynamometry measured knee extensor/flexor peak torque. Squat jumps on force platforms measured bilateral peak vertical ground reaction force. Paired t-tests assessed lean mass, peak torque, and force between previously-injured athletes' legs and between previously-injured and control athletes' legs. Previously-injured athletes' involved vs. non-involved leg demonstrated lower total (7.13±0.75 vs. 7.43±0.99 kg; p<0.01) and anterior (1.49±0.27 vs. 1.61±0.23 kg; p<0.01) and posterior (1.90±0.19 vs. 2.02±0.21 kg; p=0.04) upper-leg lean mass. Involved leg peak torque (1.36±0.31; 1.06±0.27; 0.97±0.19 Nm/kg) was lower vs. non-involved leg (1.71±0.36; 1.24±0.33; 1.04±0.15 Nm/kg; p<0.01-0.02) for extension at 60 and 120°/sec and flexion at 60°/sec and vs. controls' 'matched' leg (1.77±0.40 Nm/kg; p=0.01) for extension at 60°/sec. Involved leg force (296±45N) was lower vs. non-involved leg (375±55N; p<0.01) and vs. controls' 'matched' leg (372±88N; p=0.02). One-year post-anterior cruciate ligament reconstruction, adolescent female athletes' involved leg demonstrated relative muscle dysfunction.
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Affiliation(s)
| | | | - John S Fitzgerald
- Department of Education, Health and Behavior Studies, University of North Dakota, Grand Forks
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis
| | - Tyler A Bosch
- College of Education and Human Development, University of Minnesota, Minneapolis
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Saeterbakken AH, Solstad TEJ, Behm DG, Stien N, Shaw MP, Pedersen H, Andersen V. Muscle activity in asymmetric bench press among resistance-trained individuals. Eur J Appl Physiol 2020; 120:2517-2524. [PMID: 32856145 PMCID: PMC7560911 DOI: 10.1007/s00421-020-04476-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022]
Abstract
Purpose To determine the effects of asymmetric loads on muscle activity with the bench press. Method Seventeen resistance-trained men performed one familiarization session including testing one repetition maximum (1RM) and three 5 repetition maximum (RM) lifts; using symmetric loads, 5% asymmetric loads, and 10% asymmetric loads. The asymmetric loading (i.e., reduced load on one side) was calculated as 5% and 10% of the subject`s 1RM load. In the experimental session, the three conditions of 5RM were conducted with electromyographic activity from the pectoralis major, triceps brachii, biceps brachii, anterior deltoid, posterior deltoid, and external oblique on both sides of the body. Results On the loaded side, asymmetric loads reduced triceps brachii activation compared to symmetric loads, whereas the other muscles demonstrated similar muscle activity between the three conditions. On the de-loaded side, 10% asymmetry in loading resulted in lower pectoralis major, anterior deltoid, and biceps brachii activation compared to 5% asymmetric and symmetric loading. On the de-loaded side, only pectoralis major demonstrated lower muscle activation than symmetric loads. Furthermore, asymmetric loads increased external oblique activation on both sides compared to symmetric loads. Conclusions Asymmetric bench press loads reduced chest and shoulder muscle activity on the de-loaded side while maintaining the muscle activity for the loaded side. The authors recommend resistance-trained participants struggling with strength imbalances between sides, or activities require asymmetric force generation (i.e., alpine skiing or martial arts), to implement asymmetric training as a supplement to the traditional resistance training.
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Affiliation(s)
- Atle Hole Saeterbakken
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway.
| | - Tom Erik J Solstad
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
| | - Nicolay Stien
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway
| | - Matthew Peter Shaw
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway
| | - Helene Pedersen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway
| | - Vidar Andersen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, PB 133, 6851, Sogndal, Norway
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Davi SM, Lepley AS, Denegar CR, DiStefano LJ, Edgar CM, Lepley LK. Quadriceps Inhibition After Naturally Occurring Patellar Tendon Damage and Pain. J Athl Train 2020; 55:608-614. [PMID: 32348153 DOI: 10.4085/1062-6050-27-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT After knee-joint injury, pain, effusion, and mechanoreceptor damage alter afferent signaling, which can result in quadriceps inhibition and subsequent weakness. The individual contributions of each factor to inhibition remain unclear due to confounding knee-joint injuries and indirect experimental models. OBJECTIVE To characterize the influence of naturally occurring knee damage and pain on quadriceps neuromuscular function in individuals with patellar tendinopathy. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty participants who self-reported patellar tendinopathy (PT) and 10 healthy control individuals underwent ultrasonic tendon assessment. Injured participants were dichotomized by an orthopaedic surgeon into groups with (1) pain and structural tendon abnormality and (2) regional pain alone. MAIN OUTCOME MEASURE(S) Quadriceps inhibition was assessed with the Hoffman reflex and the central activation ratio via the superimposed-burst technique. Normally distributed measures were analyzed using a 1-way analysis of variance and post hoc independent t tests. Kruskal-Wallis tests with post hoc Mann-Whitney U tests were used to analyze nonnormally distributed data. An a priori α level of P ≤ .05 was set. RESULTS Control participants presented with more spinal-reflex excitability (0.37 ± 0.23) than the PT (0.10 ± 0.06; P = .03) and regional-pain (0.18 ± 0.05; P = .02) groups. Knee-extension strength was greater in the control (3.37 ± 0.59 Nm/kg) than in the PT (2.41 ± 0.67 Nm/kg; P = .01) group but not the regional-pain group (3.05 ± 0.66 Nm/kg; P = .24). Control individuals presented with more quadriceps activation (97.93% ± 3.12) than the PT (84.44% ± 16.98; P < .01) and regional-pain (91.17% ± 10.56; P = .01) groups. No differences were present for any measures between the PT and regional-pain groups (P values > .05). CONCLUSIONS Deficits in spinal-reflex excitability, quadriceps activation, and strength were present in both the PT and regional-pain groups. A combination of pain and structural damage appeared to have the greatest negative effect on quadriceps function, as only the PT group presented with neuromuscular outcomes that failed to meet clinical thresholds.
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Affiliation(s)
- Steven M Davi
- Department of Kinesiology, University of Connecticut, Storrs
| | - Adam S Lepley
- School of Kinesiology, University of Michigan, Ann Arbor
| | - Craig R Denegar
- Department of Kinesiology, University of Connecticut, Storrs
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Turpeinen J, Freitas TT, Rubio‐Arias JÁ, Jordan MJ, Aagaard P. Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis. Scand J Med Sci Sports 2020; 30:1572-1585. [DOI: 10.1111/sms.13733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - Tomás T. Freitas
- UCAM Research Center for High Performance Sport Murcia Spain
- NAR—Nucleus of High Performance in Sport São Paulo Brazil
| | - Jacobo Ángel Rubio‐Arias
- UCAM Research Center for High Performance Sport Murcia Spain
- LFE Research Group Department of Health and Human Performance Faculty of Physical Activity and Sport Science‐INEF Universidad Politécnica de Madrid Madrid Spain
| | | | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics SDU Muscle Research Cluster (SMRC) University of Southern Denmark Odense M Denmark
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Barber-Westin S, Noyes FR. One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years. Sports Health 2020; 12:587-597. [PMID: 32374646 DOI: 10.1177/1941738120912846] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. OBJECTIVE To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. DATA SOURCES A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. STUDY SELECTION Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. RESULTS A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. CONCLUSION A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.
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Affiliation(s)
- Sue Barber-Westin
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
| | - Frank R Noyes
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
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Leg asymmetry and muscle function recovery after anterior cruciate ligament reconstruction in elite athletes: a pilot study on slower recovery of the dominant leg. Biol Sport 2020; 37:175-184. [PMID: 32508385 PMCID: PMC7249793 DOI: 10.5114/biolsport.2020.94238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/21/2019] [Accepted: 02/03/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to examine performance in hopping tests in male athletes after anterior cruciate ligament reconstruction (ACLR) in the 4-to-6 months post-surgery period. A total of 36 athletes (24 ACLR and 12 controls) participated in this study. The ACLR group consisted of athletes who had undergone an ACLR on their dominant side (ACL DG n=16) or non-dominant side (ACL NDG n=8). Participants completed the following functional tests: a single-leg hop (SLH), single-leg triple hop (SL3H) and single-leg counter movement jump (SLCMJ), then the limb symmetry index (LSI) was calculated. There were no significant differences between the dominant and the non-dominant legs for all functional tests when comparing the ACL DG and the ACL NDG at 6 months after surgery. At 6 months after ACLR, the LSI of the two legs was within acceptable values, whether the athlete had the operation on their dominant or non-dominant leg (except the mean LSI for the ACL DG in the SLCMJ test). Furthermore, the control group showed higher performances as compared to the ACL group for all variables at 6 months after surgery, despite acceptable LSI. We concluded that an early return to “full participation to training” is not recommended in participants who have undergone an ACLR with patellar tendon grafts.
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Nagai T, Schilaty ND, Laskowski ER, Hewett TE. Hop tests can result in higher limb symmetry index values than isokinetic strength and leg press tests in patients following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:816-822. [PMID: 31025059 PMCID: PMC6814513 DOI: 10.1007/s00167-019-05513-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Quadriceps weakness is a common clinical sign following anterior cruciate ligament injury and reconstruction surgery (ACLR). The aim of this study was to compare strength deficits and the limb symmetry index (LSI) from three different types of functional tests: isokinetic dynamometry, hop test, and leg press. METHODS A total of 26 subjects with ACLR (average 8.3 months post-operation) participated in the study. The peak knee extension torque was tested with isokinetic dynamometry at 60/180/300 °/s (ISO60/180/300). Hop distance was tested during single hop (SH) and triple hop (TH). Unilateral peak leg power (POWER) was tested during a bilateral leg press test. LSI was calculated as the ratio of the involved limb over the uninvolved limb values. Pearson correlation coefficients and paired t-tests were used to establish relationships among ISO60/180/300, SH/TH, and POWER values and compare these values between the limbs, respectively. Within-subject one-way analysis of variance (ANOVA) with post hoc analyses was used to compare LSI values among different tests. RESULTS ISO60/180/300 values were significantly positively correlated with SH/TH and POWER (P < 0.05), while SH/TH and POWER values were not significantly correlated. Significant limb differences were found in all tests (P = 0.001-0.008). ANOVA revealed significant LSI differences among different tests. Specifically, post hoc analyses revealed that LSI during SH was significantly higher than LSI during ISO60. Similarly, LSI during TH was significantly higher than LSIs from ISO60, ISO180, and POWER tests. CONCLUSIONS Peak knee extension torque values were positively associated with hop distance and leg power during the leg press test. However, LSI values should be interpreted with caution as hop tests provided significantly higher LSI values than isokinetic testing. Both isokinetic dynamometry and unilateral leg press machine could be used to isolate and strengthen the quadriceps in the involved limb. The current "gold standard" isokinetic testing at slow speed (ISO60) provided the lowest LSI value among all functional tests; therefore, the current study supported a continued use of isokinetic testing when examining individual's readiness and return-to-sport. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takashi Nagai
- Sports Medicine Center, Mayo Clinic, Rochester, MN, USA. .,Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Nathan D. Schilaty
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA,Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward R. Laskowski
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA,Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Corticomotor function is associated with quadriceps rate of torque development in individuals with ACL surgery. Exp Brain Res 2020; 238:283-294. [PMID: 31897518 DOI: 10.1007/s00221-019-05713-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
Impaired corticomotor function arising from altered intracortical and corticospinal pathways are theorized to impede muscle recovery following anterior cruciate ligament (ACL) surgery, yet functional implications of centrally driven adaptations remain unclear. We aimed to assess relationships between quadriceps corticomotor and neuromechanical function after ACL surgery, and to compare with contralateral and control limbs. 16 individuals after primary, unilateral ACL surgery and 16 sex- and age-matched controls participated. Corticomotor function was assessed using transcranial magnetic stimulation, and quantified via active motor thresholds (AMT), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Neuromechanical function was quantified via electromechanical delay, early and late-phase rate of torque development (RTD0-50, RTD100-200), coefficient of variation, maximal voluntary isometric contraction (MVIC) torque, and central activation ratio. We observed significant correlations in the ACL limbs between: AMT and RTD0-50 (r = - 0.513, p = 0.031), SICI and RTD100-200 (r = 0.501, p = 0.048), AMT and SICI (r = - 0.659, p = 0.010), AMT and ICF (r = 0.579, p = 0.031), RTD0-50 and MVIC (r = 0.504, p = 0.023), and RTD100-200 and MVIC (r = 0.680, p = 0.002). The ACL limbs demonstrated higher AMT compared to controls (44.9 ± 8.4 vs. 30.1 ± 8.2%, p < 0.001), and lesser MVIC torque (2.37 ± 0.52 vs. 2.80 ± 0.59 Nm/kg, p = 0.005) and RTD100-200 (6.79 ± 1.72 vs. 7.90 ± 1.98 Nm/kg/s, p = 0.006) compared to the contralateral limbs. Our findings indicate that lesser corticospinal excitability is associated with lesser early-phase RTD, and greater intracortical inhibition is associated with lesser late-phase RTD. These findings provide evidence of implications of altered intracortical and corticospinal pathways relative to the ability to rapidly generate quadriceps torque following ACL surgery.
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Vidmar MF, Baroni BM, Michelin AF, Mezzomo M, Lugokenski R, Pimentel GL, Silva MF. Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial. Braz J Phys Ther 2019; 24:424-432. [PMID: 31351901 DOI: 10.1016/j.bjpt.2019.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction. METHODS Thirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation. RESULTS IG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17-23% vs. +5-9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test. CONCLUSION Isokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.
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Affiliation(s)
- Marlon Francys Vidmar
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Hospital Ortopédico de Passo Fundo, Passo Fundo, RS, Brazil.
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Márcio Mezzomo
- Hospital Ortopédico de Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Gilnei Lopes Pimentel
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Marcelo Faria Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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