Correlation between proprioception, muscle strength, knee laxity, and dynamic standing balance in patients with chronic anterior cruciate ligament deficiency

The Knee ◽  
2009 ◽  
Vol 16 (5) ◽  
pp. 387-391 ◽  
Author(s):  
Hung-Maan Lee ◽  
Cheng-Kung Cheng ◽  
Jiann-Jong Liau
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Standing Balance ◽  
Anterior Cruciate Ligament Deficiency ◽  
Anterior Cruciate

scholarly journals Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

2020 ◽  
Vol 48 (6) ◽  
pp. 1305-1315 ◽  
Author(s):  
Martha M. Murray ◽  
Braden C. Fleming ◽  
Gary J. Badger ◽  
Christina Freiberger ◽  
Rachael Henderson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injuries ◽  
Patient Reported ◽  
Subjective Score ◽  
Anterior Cruciate ◽  
Noninferiority Margin

Background: Preclinical studies suggest that for complete midsubstance anterior cruciate ligament (ACL) injuries, a suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair [BEAR]) may be a viable alternative to ACL reconstruction (ACLR). Hypothesis: We hypothesized that patients treated with BEAR would have a noninferior patient-reported outcomes (International Knee Documentation Committee [IKDC] Subjective Score; prespecified noninferiority margin, –11.5 points) and instrumented anteroposterior (AP) knee laxity (prespecified noninferiority margin, +2-mm side-to-side difference) and superior muscle strength at 2 years after surgery when compared with patients who underwent ACLR with autograft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were enrolled and underwent surgery within 45 days of injury. Patients were randomly assigned to receive either BEAR (n = 65) or autograft ACLR (n = 35 [33 with quadrupled semitendinosus-gracilis and 2 with bone–patellar tendon–bone]). Outcomes—including the IKDC Subjective Score, the side-to-side difference in instrumented AP knee laxity, and muscle strength—were assessed at 2 years by an independent examiner blinded to the procedure. Patients were unblinded after their 2-year visit. Results: In total, 96% of the patients returned for 2-year follow-up. Noninferiority criteria were met for both the IKDC Subjective Score (BEAR, 88.9 points; ACLR, 84.8 points; mean difference, 4.1 points [95% CI, –1.5 to 9.7]) and the side-to-side difference in AP knee laxity (BEAR, 1.61 mm; ACLR, 1.77 mm; mean difference, –0.15 mm [95% CI, –1.48 to 1.17]). The BEAR group had a significantly higher mean hamstring muscle strength index than the ACLR group at 2 years (98.2% vs 63.2%; P < .001). In addition, 14% of the BEAR group and 6% of the ACLR group had a reinjury that required a second ipsilateral ACL surgical procedure ( P = .32). Furthermore, the 8 patients who converted from BEAR to ACLR in the study period and returned for the 2-year postoperative visit had similar primary outcomes to patients who had a single ipsilateral ACL procedure. Conclusion: BEAR resulted in noninferior patient-reported outcomes and AP knee laxity and superior hamstring muscle strength when compared with autograft ACLR at 2-year follow-up in a young and active cohort. These promising results suggest that longer-term studies of this technique are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier)

Balance in Single-Limb Stance in Patients with Anterior Cruciate Ligament Injury

2005 ◽  
Vol 33 (10) ◽  
pp. 1527-1537 ◽  
Author(s):  
Eva Ageberg ◽  
David Roberts ◽  
Eva Holmström ◽  
Thomas Fridén
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Ligament Injury ◽  
Average Speed ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Low Amplitude

Background It has been shown previously that an anterior cruciate ligament injury may affect postural control, measured by balance in single-limb stance. To our knowledge, no studies have reported the influence of measures of impairment on postural control after such an injury. Purpose To assess the influence of knee laxity, proprioception, and muscle strength on balance in single-limb stance and to study the correlation between balance in single-limb stance and subjective estimation of extremity function. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 36 patients with a unilateral, nonoperated, nonacute anterior cruciate ligament injury were examined with regard to anterior knee laxity, proprioception, muscle strength, and stabilometry (amplitude and average speed of the center of pressure movements). Subjective estimation of extremity function was measured on a visual analog scale. Results The multiple regression analysis showed that high knee laxity values were associated with high amplitude values and low average speed. Poor proprioception and high muscle strength values were associated with low average speed among the women only. Low amplitude values correlated with better subjective function. Conclusion Anterior knee laxity, proprioception, and muscle strength seem to play a role in maintaining balance in single-limb stance. Patients with low amplitude values in stabilometry were those with better subjective function.

Comparison of Clinical and Dynamic Knee Function in Patients with Anterior Cruciate Ligament Deficiency

2003 ◽  
Vol 31 (1) ◽  
pp. 68-74 ◽  
Author(s):  
Rohita R. Patel ◽  
Debra E. Hurwitz ◽  
Charles A. Bush-Joseph ◽  
Bernard R. Bach ◽  
Thomas P. Andriacchi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Quadriceps Muscle ◽  
Stair Climbing ◽  
Hamstring Muscle ◽  
Flexion Moment ◽  
Anterior Cruciate ◽  
Normal Strength

Background Whether passive measures of isokinetic muscle strength deficits and knee laxity are related to the dynamic function of the anterior cruciate ligament-deficient knee remains unclear. Hypotheses Arthrometer measurements are not predictive of peak external knee flexion moment (net quadriceps muscle moment), isokinetic quadriceps muscle strength correlates with peak external knee flexion moment (net quadriceps muscle moment), and isokinetic hamstring muscle strength correlates with peak external knee extension moment (net flexor muscle moment). Study Design Cross-sectional study. Methods Gait analysis was used to assess dynamic function during walking, jogging, and stair climbing in 44 subjects with unilateral anterior cruciate ligament deficiency and 44 control subjects. Passive knee laxity and isokinetic quadriceps and hamstring muscle strength were also measured. Results Arthrometer measurements did not correlate with peak external flexion or extension moments in any of the activities tested or with isokinetic quadriceps or hamstring muscle strength. Test subjects also had a significantly reduced peak external flexion moment during all three jogging activities and stair climbing compared with the control subjects and this was correlated with significantly reduced quadriceps muscle strength. Conclusions Absolute knee laxity difference did not correlate with dynamic knee function as assessed by gait analysis and should not be used as a sole predictor for the outcome of treatment. Patients with greater than normal strength in the anterior cruciate ligament-deficient limb performed low- and high-stress activities in a more normal fashion than those with normal or less-than-normal strength.

Rotational Knee Laxity in Anterior Cruciate Ligament Deficiency: An Additional Secondary Sign on MRI

2016 ◽  
Vol 206 (1) ◽  
pp. 151-154 ◽  
Author(s):  
Evangelia E. Vassalou ◽  
Michail E. Klontzas ◽  
Georgios K. Kouvidis ◽  
Paraskevi I. Matalliotaki ◽  
Apostolos H. Karantanas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Anterior Cruciate Ligament Deficiency ◽  
Anterior Cruciate ◽  
Rotational Knee Laxity

Accelerated Versus Nonaccelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction

2011 ◽  
Vol 39 (12) ◽  
pp. 2536-2548 ◽  
Author(s):  
Bruce D. Beynnon ◽  
Robert J. Johnson ◽  
Shelly Naud ◽  
Braden C. Fleming ◽  
Joseph A. Abate ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Acl Reconstruction ◽  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Thigh Muscle ◽  
Anterior Cruciate ◽  
6 Degrees Of Freedom

Background: The relationship between the biomechanical dose of rehabilitation exercises administered after anterior cruciate ligament (ACL) reconstruction and the healing response of the graft and knee is not well understood. Hypothesis: After ACL reconstruction, rehabilitation administered with either accelerated or nonaccelerated programs produces the same change in the knees’ 6 degrees of freedom, or envelope, laxity values. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients who underwent ACL reconstruction with a bone–patellar tendon–bone autograft were randomized to rehabilitation with either accelerated (19 week) or nonaccelerated (32 week) programs. At the time of surgery, and then 3, 6, 12, and 24 months later, the 6 degrees of freedom knee laxity values were measured using roentgen stereophotogrammetric analysis and clinical, functional, and patient-oriented outcome measures. Results: Eighty-five percent of those enrolled were followed through 2 years. Laxity of the reconstructed knee was restored to within the limits of the contralateral, normal side at the time of surgery (baseline) in all participants. Patients in both programs underwent a similar increase in the envelope of knee laxity over the 2-year follow-up interval (anterior-posterior translation 3.2 vs 4.5 mm, and coupled internal-external rotations 2.6° vs 1.9° for participants in the accelerated and nonaccelerated programs, respectively). Those who underwent accelerated rehabilitation experienced a significant improvement in thigh muscle strength at the 3-month follow-up ( P < .05) compared with those who participated in nonaccelerated rehabilitation, but no differences between the programs were seen after this time interval. At the 2-year follow-up, the groups were similar in terms of clinical assessment, patient satisfaction, function, proprioception, and isokinetic thigh muscle strength. Conclusion: Rehabilitation with the accelerated and nonaccelerated programs administered in this study produced the same increase in the envelope of knee laxity. A majority of the increase in the envelope of knee laxity occurred during healing when exercises were advanced and activity level increased. Patients in both programs had the same clinical assessment, functional performance, proprioception, and thigh muscle strength, which returned to normal levels after healing was complete. For participants in both treatment programs, the Knee Injury and Osteoarthritis Outcome Score (KOOS) assessment of quality of life did not return to preinjury levels.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

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