Impaired Regulation of Submaximal Force after ACL Reconstruction: Role of Muscle Spindles

2020 ◽  
Author(s):  
David Rice ◽  
Gwyn Lewis ◽  
Peter McNair
Keyword(s):  
Acl Reconstruction ◽  
Muscle Spindle ◽  
Muscle Force ◽  
Cruciate Ligament ◽  
Maximum Voluntary Contraction ◽  
Muscle Spindles ◽  
Voluntary Contraction ◽  
Motor Deficits ◽  
Control Group ◽  
Force Matching

AbstractOngoing motor deficits are routinely present following anterior cruciate ligament (ACL) reconstruction, including the ability to regulate muscle force. While such deficits are known, it is unclear why this occurs. The goal of the current study was to investigate the potential influence of muscle spindle input on submaximal force regulation and muscle activity at the knee in people following ACL reconstruction. Fourteen participants (8 female) who were 6−24 months post-ACL reconstruction and 15 control participants (8 female) undertook submaximal force matching and force modulation tasks before and after 20 min of vibration applied to the patella tendon. Across all tasks, the ACL reconstruction participants were poorer at force matching (P=0.007). The effect of vibration was not significant in either group for the force matching tasks (P=0.06), although there was a reduction in maximum voluntary contraction post-vibration in the control group (P<0.001). The ACL reconstruction group also showed evidence of greater activation of the medial hamstring muscles in comparison to controls (P=0.04). Individuals who have undergone ACL reconstruction have a diminished ability to accurately match and regulate submaximal muscle force, but this does not appear to be related to impaired muscle spindle input. Neuromuscular retraining programs that involve force regulation tasks may be necessary to optimize rehabilitation after ACL reconstruction.

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

2020 ◽  
Vol 29 (1) ◽  
pp. 87-92
Author(s):  
Takuma Hoshiba ◽  
Hiroki Nakata ◽  
Yasuaki Saho ◽  
Kazuyuki Kanosue ◽  
Toru Fukubayashi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Position Sense ◽  
Matching Task ◽  
Control Group ◽  
Knee Position ◽  
Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

A Randomized Clinical Trial to Evaluate Attached Hamstring Anterior Cruciate Ligament Graft Maturity With Magnetic Resonance Imaging

2018 ◽  
Vol 46 (5) ◽  
pp. 1143-1149 ◽  
Author(s):  
Shaohua Liu ◽  
Hong Li ◽  
Hongyue Tao ◽  
Yaying Sun ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Control Group ◽  
Study Group ◽  
Tibial Insertion ◽  
Significant Difference ◽  
The Difference ◽  
Anterior Cruciate

Background: The hamstring tendons are commonly harvested for anterior cruciate ligament (ACL) reconstruction with detachment of the tibial insertion. Retaining the insertion may help to preserve vascularity and viability of the graft and bypass the stages of avascular necrosis and revascularization, which might be beneficial to graft maturity. Purpose: To investigate and compare graft maturity by magnetic resonance imaging (MRI) after ACL reconstruction with preservation or detachment of hamstring tendon tibial insertion at up to 2 years. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Forty-five patients (age range, 18-45 years) undergoing isolated ACL reconstruction with hamstring tendon were enrolled and randomized to 2 groups. The tibial insertion of the hamstring tendon was preserved in the study group (n = 21) and detached in the control group (n = 24). Patients had follow-up at 3, 6, 12, and 24 months, which consisted of the following: (1) clinical examination and (2) MRI evaluation of graft signal intensity based on signal/noise quotient (SNQ) values. Finally, 18 patients in the study group and 19 in the control group received full follow-up evaluation (ie, at all 4 time points). Results: All knees acquired full range of motion at 24 months without significant laxity. At each time point, the KT-1000 arthrometer revealed no significant difference between groups; the clinical scores significantly improved in both groups, although the difference between groups was not significant. In the control group, the SNQ value increased from 3 months, peaked at 6 months, and then decreased (3 months, 21.4 ± 12.7; 6 months, 25.6 ± 12; 12 months, 18.3 ± 7.7; 24 months, 15.3 ± 6.3). However, the insertion-preserved graft in the study group maintained relatively lower and unchanged signal intensity throughout all time points (3 months, 15.0 ± 11.2; 6 months, 14.9 ± 6.3; 12 months, 12.6 ± 7.0; 24 months, 14.6 ± 7.0). Between groups, there was no significant difference at 3 or 24 months ( P = .11 and .75, respectively), while the SNQ values were significantly lower in the study group versus the control group at 6 and 12 months ( P = .002 and .02, respectively). Conclusion: The insertion-detached hamstring tendon grafts underwent a significantly increasing change in signal intensity during the first 2 years after ACL reconstruction, while the insertion-preserved grafts kept a relatively lower and unchanged signal intensity. The difference was most significant at 6 and 12 months postoperatively.

scholarly journals Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

2020 ◽  
Vol 10 (10) ◽  
pp. 3378
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexander Akhpashev ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Control Group ◽  
Cycle Duration ◽  
Post Surgery ◽  
Before And After ◽  
Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

scholarly journals Proprioception following the Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Tendon Allograft

2019 ◽  
Vol 33 (07) ◽  
pp. 722-727 ◽  
Author(s):  
Enes Büyükafşar ◽  
Selda Başar ◽  
Ulunay Kanatli
Keyword(s):  
Acl Reconstruction ◽  
Patient Group ◽  
Knee Flexion ◽  
Tibialis Anterior ◽  
Cruciate Ligament ◽  
Standing Position ◽  
Control Group ◽  
Tibialis Anterior Tendon ◽  
Tendon Allograft ◽  
Anterior Cruciate

AbstractAfter the anterior cruciate ligament (ACL) reconstruction, a loss of proprioception is observed and it can continue years after the operation. The aim of this study is to evaluate proprioception in standing position at different knee flexion angles in patients who underwent ACL reconstruction with tibialis anterior tendon allograft. The study included 34 patients who underwent ACL reconstruction with tibialis anterior tendon allograft and 34 healthy individuals. Proprioception was evaluated in standing position at 15°, 30°, 60° flexion angles with the active joint position sense (AJPS) method using digital inclinometer. Proprioception deviation angle was found to be higher in the operated leg at 30° and 60° flexion angles in the patient group compared with the other leg (p < 0.05), the biggest proprioception difference was between the 15° and 60° flexion angles in both the patient and the control group (p < 0.05) that the difference between 15° and 30° flexion angles is lowest (p < 0.05), and that these differences are higher in the operated leg of the patient group compared with the other leg of the patient group and to the dominant leg of the control group (p < 0.05). As approximately 4 years after ACL reconstruction with tibialis anterior tendon allograft, loss of proprioception at 60° knee flexion continued, ACL injury related to loss of proprioception may occur at angles higher than 30° flexion. Thus, patients may be provided with proprioception-enhancing rehabilitation in the long term, particularly, at flexion angles above medium levels.

scholarly journals Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Adam T. Hexter ◽  
Anita Sanghani-Kerai ◽  
Nima Heidari ◽  
Deepak M. Kalaskar ◽  
Ashleigh Boyd ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Stromal Cells ◽  
Femoral Tunnel ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Control Group ◽  
Tendon Allograft ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

scholarly journals Crossfit Practice: An Electromyographic Analysis of Masticatory Muscles

2020 ◽  
Author(s):  
Nayara Soares da Silva ◽  
Marcelo Palinkas ◽  
Evandro Marianetti Fioco ◽  
Edson Donizetti Verri ◽  
Saulo César Vallin Fabrin ◽  
...  
Keyword(s):  
Maximum Voluntary Contraction ◽  
Masticatory Muscles ◽  
Voluntary Contraction ◽  
Control Group ◽  
Electromyographic Activity ◽  
Physical Conditioning ◽  
Striated Muscles ◽  
Functional Changes ◽  
Significant Difference ◽  
The Impact

Abstract Background: CrossFit is a regular high-intensity physical conditioning exercise for skeletal striated muscles, which promotes functional changes in the human body. The aim of this study was to investigate the impact of CrossFit exercise on the electromyographic activity of the masseter and temporalis muscles. Methods: Forty participants were divided into two groups: athletes who practiced CrossFit (n=20) and controls who did not practice sports (n=20). The electromyographic activities of the masseter and temporalis muscles were measured using mandibular tasks at rest, protrusion, right laterality, left laterality, and dental clenching in maximum voluntary contraction and habitual chewing of peanuts and raisins. Both the groups were matched for age, sex, and body mass index. The data were analyzed using the t-test with a 5% significance level. Results: Reduced electromyographic activities were found in all mandibular tasks in the CrossFit group than in the control group, with a significant difference for the right masseter (p=0.01), left masseter (p=0.001), and left temporal muscles (p=0.001) at mandibular rest; right (p=0.001) and left (p=0.001) masseter in chewing of peanuts. Conclusion: The results of this study suggest that CrossFit promotes positive changes in electromyographic activity of the masticatory muscles, especially in the mandibular rest and chewing of hard food. CrossFit exercise practiced within the appropriate technical protocols improves masticatory muscle function.

scholarly journals The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 5 (5) ◽  
pp. 624-629 ◽  
Author(s):  
Alan Goce Andonovski ◽  
Sonja Topuzovska ◽  
Milan Samardziski ◽  
Zoran Bozinovski ◽  
Biljana Andonovska ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Control Group ◽  
Single Bundle ◽  
Knee Stability ◽  
The Mean ◽  
Anterior Cruciate ◽  
Proprioceptive Function

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05).  Tegner and Lysholm scores showed no difference between the groups.CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

scholarly journals Effect of Thrombocyte-rich Plasma on Prevention of Tunnel Enlargement in Anterior Cruciate Ligament (ACL) Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0005
Author(s):  
Serkan Sözkesen ◽  
Hüseyin Gökhan Karahan ◽  
Serhan Yağdı ◽  
Ahmet Kurtulmuş ◽  
Cemil Kayalı ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Treatment Protocol ◽  
Control Group ◽  
Imaging Method ◽  
Slice Thickness ◽  
Tunnel Enlargement ◽  
Minimum Age

This study was conducted to 44 patients, to whom both hamstring tendon autograft and transtibial ACL reconstruction were applied, having treatment in Clinic of Orthopedics and Traumatology in İzmir Bozyaka Training and Research Hospital between dates of March 2014 and July 2015. Treatment group (18 patients, subjected to PRP) and control group (26 patients) selected with random method were taken. Minimum age in the treatment group was 16 and maximum age was 38, having an average of (26±6,96). Minimum age in the treatment group was 14 and maximum age was 43, having an average of (26,54±7,93). In this group, 27 patients have had operation on right knee (61%), 17 patients on left knee (39%). Follow up period after surgery is at least 4 months, at most 16 months, with an average period of 12 months. Injury reason of ACL was sport injury for 36 patients, injury of falling down from height for 1 patient and injury of occupational accident for 6 patients. Reasons of application of these patients are distrust for 30 patients, pain for 10 patients and locked-in findings for 4 patients. General physical examinations of these patients were performed prior to surgery, and direct graphy and MR imaging method was used for the patients. The patients were evaluated with IKDC score, Lysholm score, Tegner activity scale, KT-1000 arthrometer device and multi-slice tomography in preoperative and postoperative methods. The same physical treatment protocol was applied for all patients. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial plans after 64-slice MSCT scanning. BT slice thickness was calculated as 1 mm using automatic software with 0.75 mm retrorecons. Measurements were evaluated by the same radiology expert. On comparison of radiological data between both groups, although tunnel enlargement is less in PRP-administered group for femoral tunnel, the result was not significant statistically. No difference was seen between clinical examination results and used grading scales. It was seen that PRP use was not effective in preventing or decreasing femoral and tibial tunnel enlargement in patients having ACL reconstruction with Hamstring. There was a decrease in tunnel enlargement in case of the use of PRP, however, this decrease was not clinically significant. In line with these data, routine use of PRP is not recommended for the prevention of tunnel enlargement after ACL reconstruction. KeyWords: Thrombocyte-rich plasma (PRP), Tunnel enlargement, ACL reconstruction, BT scan

Factors Affecting Force Loss With Prolonged Stretching

2001 ◽  
Vol 26 (3) ◽  
pp. 262-272 ◽  
Author(s):  
David G. Behm ◽  
Duane C. Button ◽  
Jeremy C. Butt
Keyword(s):  
Maximal Voluntary Contraction ◽  
Muscle Activation ◽  
Maximum Voluntary Contraction ◽  
Voluntary Contraction ◽  
Control Group ◽  
Tetanic Force ◽  
Factors Affecting ◽  
Passive Stretching ◽  
Interpolated Twitch Technique ◽  
Muscle Compliance

The purpose of this study was to investigate factors underlying the force loss occurring after prolonged, static, passive stretching. Subjects were tested before and 5-10 min following 20 min of static, passive stretching of the quadriceps (N = 12) or a similar period of no stretch (control, N = 6). Measurements included isometric maximal voluntary contraction (MVC) force, surface integrated electromyographic (iEMG) activity of the quadriceps and hamstrings, evoked contractile properties (twitch and tetanic force), and quadriceps inactivation as measured by the interpolated twitch technique (ITT). Following stretching, there was a significant 12% decrement in MVC with no significant changes in the control group. Muscle inactivation as measured by the ITT and iEMG increased by 2.8% and 20.2%, respectively. While twitch forces significantly decreased 11.7%, there was no change in tetanic force post-stretch. Although possible increases in muscle compliance affected twitch force, a lack of tetanic force change would suggest that post-stretch force decrements are more affected by muscle inactivation than changes in muscle elasticity. Key Words: antagonist, electromyography, maximum voluntary contraction, muscle activation, twitch, tetanus

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