scholarly journals Quadriceps Femoris and Hamstring Muscle Function in a Person With an Unstable Knee

1999 ◽  
Vol 79 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Murray E Maitland ◽  
Stanley V Ajemian ◽  
Esther Suter
Keyword(s):  
Gait Analysis ◽  
Cruciate Ligament ◽  
Specific Treatment ◽  
Knee Extensor ◽  
Left Knee ◽  
Thigh Muscle ◽  
Knee Extensors ◽  
Term Outcome ◽  
Electromyographic Biofeedback ◽  
Muscle Inhibition

Abstract Background and Purpose. The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency.Case Description. The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait.Outcomes. Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed.Discussion. Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.

Quadriceps Activation during Knee Extension Exercises in Patients with ACL Pathologies

2001 ◽  
Vol 17 (2) ◽  
pp. 87-102 ◽  
Author(s):  
Esther Suter ◽  
Walter Herzog ◽  
Robert Bray
Keyword(s):  
Vastus Lateralis ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Muscle ◽  
Knee Extension ◽  
Knee Extensors ◽  
Muscle Inhibition ◽  
The Individual ◽  
Hip Extension ◽  
Acl Deficient

This study assessed muscle inhibition in patients with chronic anterior cruciate ligament (ACL) deficiency or ACL reconstruction. A series of protocols were tested for their effectiveness in increasing activity of the individual knee extensor muscles and decreasing muscle inhibition of the whole quadriceps group. Quadriceps muscle inhibition was measured by superimposing an electrical twitch onto the quadriceps muscle during a maximal voluntary knee extension. The level of activation of the individual knee extensor and knee flexor muscles was assessed via electromyography (EMG). Patients with ACL pathologies showed strength deficits and muscle inhibition in the knee extensors of the involved leg and the contralateral leg. Muscle inhibition was statistically significantly greater in ACL-deficient patients compared to ACL-reconstructed patients. When a knee extension was performed in combination with a hip extension, there was a significant increase,p< 0.05, in activation of the vastus medialis and vastus lateralis muscles compared to isolated knee extension. The use of an anti-shear device, designed to help stabilize the ACL-deficient knee, resulted in increased inhibition in the quadriceps muscle. Furthermore, a relatively more complete activation of the vasti compared to the rectus femoris was achieved during a fatiguing isometric contraction. Based on the results of this study, it is concluded that performing knee extension in combination with hip extension, or performing fatiguing knee extensor contractions, may be more effective in fully activating the vasti muscles than an isolated knee extensor contraction. Training interventions are needed to establish whether these exercise protocols are more effective than traditional rehabilitation approaches in decreasing muscle inhibition and achieving better functional recovery, including equal muscle strength in the injured and the contralateral leg.

Elbow Flexor Inhibition as a Function of Muscle Length

2002 ◽  
Vol 18 (1) ◽  
pp. 46-56 ◽  
Author(s):  
Luciana Brondino ◽  
Esther Suter ◽  
Hae-Dong Lee ◽  
Walter Herzog
Keyword(s):  
Isometric Force ◽  
Knee Extensor ◽  
Elbow Flexor ◽  
Peak Force ◽  
Knee Extensors ◽  
Emg Activity ◽  
Elbow Flexors ◽  
Muscle Inhibition ◽  
Voluntary Contractions ◽  
Maximal Isometric Force

Muscle inhibition (MI) in human knee extensors increases with increasing maximal voluntary force as a function of knee angle. It was speculated that this angle-dependent MI was modulated by force-dependent feedback, likely Golgi tendon organ pathways. Such angle-dependent MI is of clinical and theoretical importance. The purpose of this study was to determine MI in human elbow flexors for maximal voluntary contractions. Muscle inhibition, elbow flexor force, and electromyographic (EMG) activity were measured in 31 volunteers at elbow angles between 30º and 120º. MI and elbow flexor EMG were the same at all elbow angles. Maximal isometric forces were greatest at the 70º angle, and never fell below 70% of the peak force at any of the tested angles. From these results it is concluded that force-dependent modulation of MI did not occur in the elbow flexors, possibly because maximal isometric force remained relatively close (within 30%) to the peak force. In contrast, force-dependent modulation of MI occurred in the knee extensors at the most extended angles, when the average knee extensor force had dropped to 50% or less of the maximal knee extensor force. It is likely that human maximal voluntary contractions are not associated with a given activation. Rather, activation appears to be modulated by force-dependent feedback at force levels below 70% of the absolute peak force, which manifests itself in a change of MI that parallels the level of maximal isometric force in voluntary contractions.

scholarly journals Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Takenori Tomite ◽  
Hidetomo Saito ◽  
Toshiaki Aizawa ◽  
Hiroaki Kijima ◽  
Naohisa Miyakoshi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Left Knee ◽  
Triaxial Accelerometer ◽  
Total Knee ◽  
Conventional Total Knee Arthroplasty ◽  
Anterior Cruciate

One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in thex-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning.

Activity of spindle afferents from cat anterior thigh muscles. I. Identification and patterns during normal locomotion

1985 ◽  
Vol 54 (3) ◽  
pp. 549-564 ◽  
Author(s):  
G. E. Loeb ◽  
J. A. Hoffer ◽  
C. A. Pratt
Keyword(s):  
Activity Patterns ◽  
Muscle Length ◽  
Knee Extensor ◽  
Muscle Spindles ◽  
Swing Phase ◽  
Thigh Muscle ◽  
Knee Extensors ◽  
Nerve Cuff ◽  
Anterior Thigh ◽  
Spike Triggered Averaging

The naturally occurring activity patterns of anterior thigh muscle spindle afferents were recorded during unrestrained treadmill locomotion by means of floating microelectrodes chronically implanted in the fifth lumbar dorsal root ganglion. Conduction velocity of units from primary and secondary endings was determined by spike-triggered averaging of the signals from a chronically implanted nerve cuff. Activity from knee extensor muscle spindles generally occurred during periods of muscle lengthening, but was often greater for small stretches when the muscle was active (during stance phase of walking) than for larger stretches when the muscle was passive (swing phase), indicating fusimotor enhancement of spindle sensitivity in phase with extrafusal muscle recruitment. Activity from spindles in biarticular muscles acting across the knee and hip was more variable and complex than that seen in the pure knee extensors, and frequently included activity during rapid muscle shortening (swing phase) indicative of strong static fusimotor input. Changes in speed of gait caused changes in the range and velocity of muscle length excursions monitored by chronically implanted length gauges, but such changes were accompanied by only modest changes in spindle afferent activity, suggesting concurrent and compensatory changes in fusimotor influence on spindles. Activity from spindle secondary endings was generally lower, more regular, and less velocity dependent than that from primary endings, consistent with their lack of input from the dynamic fusimotor apparatus. The activity of all spindle afferents studied was similarly well modulated during extrafusal activity of the parent muscles, regardless of the kinematic conditions of muscle length and velocity during which this muscle work occurred. This suggests that the fusimotor apparatus is well orchestrated to regulate the static and dynamic sensitivity of primary spindle afferents at levels appropriate to the anticipated motion.

scholarly journals Neuromuscular electrical stimulation in early rehabilitation of patients with postoperative complications after cardiovascular surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Oleinik ◽  
AN Sumin ◽  
AV Bezdenezhnykh
Keyword(s):  
Postoperative Complications ◽  
Cardiovascular Surgery ◽  
Handgrip Strength ◽  
Left Knee ◽  
Baseline Data ◽  
Knee Extensors ◽  
Federal State ◽  
Control Group ◽  
Initial Strength ◽  
Knee Flexors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases Introduction The purpose was to evaluate the effectiveness of NMES in patients with complications after cardiac surgery. Methods This study was 37 patients who had significant postoperative complications after cardiovascular surgery. Participants were randomly - NMES group, n = 18; control, n = 19. It was not possible to blind the investigator. Analyzed basic clinical data. The dynamometry of the muscles upper and lower extremities was carried out, as well as a 6-minute walk test (6MWT). Also, the thickness of the quadriceps was measured using ultrasound.The patients underwent NMES on the quadriceps femoris muscle, daily from the third postoperative day, until discharge. The duration session was 90 minutes. Outcomes No differences were found in the baseline characteristics of the groups, including the results of laboratory and instrumental studies. Groups were comparable in the surgery and perioperative parameteres. The initial strength indicators also had no significant differences in the groups. At discharge knee extensors strength (KES) was significantly higher in the NMES group. The knee flexor strength (KFS) and handgrip strength (HF) increased the same in both groups. The quadriceps crosssectional area (CSA) muscle increased more in the NEMS group than in the control to the time of discharge. Average KES increased to a greater extent in the NMES group. At the same time, average and maximum KFS increased equally in both groups. A 6MWT before discharge did not show a difference between groups (P=.166). The NMES course did not affect the duration of hospitalisation (P=.429). Discussion This pilot study show beneficial effects of NMES on muscle strength in patients with complications after cardiovascular surgery. Physical tests initially and in dynamics NEMS Group (n = 18) Control group (n = 19) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 20,3 [17,9; 26,1] 28,05 [23,8; 36,2] * 20,1 [18,6; 25,4] 22,3 [20,1; 27,1] * 0,004 Left knee extensors strength (kg) 17,75 [15,5; 27,0] 27,45 [22,3; 33,1] * 20,8 [17,5; 24,2] 22,5 [20,1; 25,9] * 0,017 Right knee flexors strength (kg) 14,85 [11,7; 19,5] 17,5 [14,1; 23,4] * 16,9 [13,1; 23,8] 19,2 [12,5; 26,4] * 0,971 Left knee flexors strength (kg) 14,7 [12,6; 19,6] 19,75 [15,9; 24,2] * 16,2, [10,4; 25,1] 18,8 [13,1; 27,7] * 0,889 6-MWT (m) 148,5 [108,5; 174,0] 288,0 [242,0; 319,0] * 169,0 [115,0; 217,0] 315,0 [277,0; 400,0] * 0,166 Right handgrip strength (kg) 24,5 [15,0; 33,0] 25,5 [19,0; 36,0] * 27,0 [18,0; 32,0] 30,0 [20,0; 35,0] * 0,795 Left handgrip strength (kg) 17,0 [12,0; 27,0] 21,0 [15,0; 31,0] * 19,0 [14,0; 29,0] 23,0 [16,0; 30,0] * 0,541 * - p-level from baseline data &lt; 0,05 ** - p-level from baseline data ≥ 0,05

scholarly journals Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes

2021 ◽  
pp. 036354652110266
Author(s):  
Keith A. Knurr ◽  
Stephanie A. Kliethermes ◽  
Mikel R. Stiffler-Joachim ◽  
Daniel G. Cobian ◽  
Geoffrey S. Baer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Collegiate Athletes ◽  
Treadmill Running ◽  
Division I ◽  
P Values ◽  
Peak Knee ◽  
Anterior Cruciate ◽  
Running Biomechanics

Background: Preinjury running biomechanics are an ideal comparator for quantifying recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), allowing for assessments within the surgical and nonsurgical limbs. However, availability of preinjury running biomechanics is rare and has been reported in case studies only. Purpose/Hypothesis: The purpose of this study was to determine if running biomechanics return to preinjury levels within the first year after ACLR among collegiate athletes. We hypothesized that (1) surgical knee biomechanics would be significantly reduced shortly after ACLR and would not return to preinjury levels by 12 months and (2) nonsurgical limb mechanics would change significantly from preinjury. Study Design: Cohort study; Level of evidence, 2. Methods: Thirteen Division I collegiate athletes were identified between 2015 and 2020 (6 female; mean ± SD age, 20.7 ± 1.3 years old) who had whole body kinematics and ground-reaction forces recorded during treadmill running (3.7 ± 0.6 m/s) before sustaining an ACL injury. Running analyses were repeated at 4, 6, 8, and 12 months (4M, 6M, 8M, 12M) after ACLR. Linear mixed effects models were used to assess differences in running biomechanics between post-ACLR time points and preinjury within each limb, reported as Tukey-adjusted P values. Results: When compared with preinjury, the surgical limb displayed significant deficits at all postoperative assessments ( P values <.01; values reported as least squares mean difference [SE]): peak knee flexion angle (4M, 13.2° [1.4°]; 6M, 9.9° [1.4°]; 8M, 9.8° [1.4°]; 12M, 9.0° [1.5°]), peak knee extensor moment (N·m/kg; 4M, 1.32 [0.13]; 6M, 1.04 [0.13]; 8M, 1.04 [0.13]; 12M, 0.87 [0.15]; 38%-57% deficit), and rate of knee extensor moment (N·m/kg/s; 4M, 22.7 [2.4]; 6M, 17.9 [2.3]; 8M, 17.5 [2.4]; 12M, 16.1 [2.6]; 33%-46% deficit). No changes for these variables from preinjury ( P values >.88) were identified in the nonsurgical limb. Conclusion: After ACLR, surgical limb knee running biomechanics were not restored to the preinjury state by 12M, while nonsurgical limb mechanics remained unchanged as compared with preinjury. Collegiate athletes after ACLR demonstrate substantial deficits in running mechanics as compared with preinjury that persist beyond the typical return-to-sport time frame. The nonsurgical knee appears to be a valid reference for recovery of the surgical knee mechanics during running, owing to the lack of change within the nonsurgical limb.

Effects of the use neuromuscular electrical stimulation of the lower extremities in the prehabilitation of patients in a before cardiac surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Oleinik ◽  
AN Sumin ◽  
AV Bezdenezhnykh
Keyword(s):  
Cardiac Surgery ◽  
Handgrip Strength ◽  
Lower Extremities ◽  
Left Knee ◽  
Knee Extensors ◽  
Control Group ◽  
Elective Cardiac Surgery ◽  
Antagonist Muscles ◽  
Muscle Groups ◽  
Knee Flexors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases Aim To evaluate the effects of neuromuscular electrostimulation in the prehabilitation and prevention of muscle weakness in patients awaiting cardiac surgery. Materials and methods 122 patients waiting for elective cardiac surgery were included. Exclusion criteria: age less than 25 and more than 80 years; emergency and urgent surgical interventions; arthropathies; low pain threshold; rhabdomyolysis and other myopathies; cognitive dysfunction. Routine laboratory and instrumental examinations were performed in all patients upon admission to the hospital, as part of a standard examination. 62 patients were randomly selected for the preoperative NMES group, in addition to the standard preoperative preparation and treatment program. The standard program included 60 control patients. Patients of the NMES group underwent quadriceps stimulation for at least 5 sessions, lasting 90 minutes, daily before surgery. Results. The groups were comparable and did not have significant differences in gender and age characteristics, according to the main clinical and anamnestic data and types of operations. Initially, there were no differences in the state of the muscles of the lower extremities, the distance of the six-minute walking test (6MWT), and the strength of the hand grip. After NMES, there was an increase in muscle strength relative to the control group, both stimulated muscle groups and unstimulated antagonist muscles, as well as a greater 6MWT distance and hand compression force. All the differences were significant. Conclusions The course of pre-rehabilitation of NMES before surgery, allowed to maintain, and in some cases improve the condition of the muscle frame of the lower extremities. A positive effect was observed not only in stimulated muscle groups, but also in antagonist muscles Indicators of muscle status NMES (n = 62) Control group (n = 60) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 24,4 [18,3; 31,4] 30,4 [23,8; 36,2]* 24,7 [20,1; 33,2] 22,25 [18,9; 30,4] &lt;0,001 Left knee extensors strength (kg) 23,8 [19,3; 31,3] 29,2 [23,6; 35,4]* 25,75 [19,2; 31,3] 22,9 [18,9; 27,8] &lt;0,001 Right knee flexors strength (kg) 18,9 [13,3; 24,0] 21,7 [16,6; 25,1] 19,55 [13,1; 26,0] 16,7 [12,1; 23,3] 0,006 Left knee flexors strength (kg) 19,3 [14,3; 24,5] 21,9 [17,3; 26,7] 19,5 [13,0; 24,3] 18,2 [13,4; 22,2] 0,005 6-MWT (m) 300,0 [261,0; 371,0] 331,0 [280,0; 375,0] 304,5 [253,0; 380,0] 285,5 [246,0; 342,0] 0,006 Right handgrip strength (kg) 28,5 [20,5; 34,0] 31,5 [22,0; 34,0] 29,0 [19,0; 34,0] 27,0 [19,0; 33,0] 0,054 Left handgrip strength (kg) 25,0 [18,0; 31,0] 25,0 [18,0; 32,0] 24,0 [15,0; 31,0] 22,0 [14,0; 28,0] 0,062 * - p-level from baseline data &lt; 0,05 Abstract Figure. dynamics of stimulated muscles

scholarly journals Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 18 (14) ◽  
pp. 7492
Author(s):  
Tishya L. Wren ◽  
Veronica Beltran ◽  
Mia J. Katzel ◽  
Adriana S. Conrad-Forrest ◽  
Curtis D. VandenBerg
Keyword(s):  
Knee Flexion ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Extensor Mechanism ◽  
Iliotibial Band ◽  
Cruciate Ligament Reconstruction ◽  
Mechanism Function ◽  
Anterior Cruciate ◽  
Knee Extensor Mechanism

Iliotibial band autograft is an increasingly popular option for pediatric anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare recovery of knee extensor mechanism function among pediatric patients who underwent ACLR using iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (PT) autografts. One hundred forty-five pediatric athletes (76 female; age 15.0, range 7–21 years) with recent (3–18 months) unilateral ACLR performed drop-jump landing and 45° cutting with 3D motion capture. Knee extensor mechanism function (maximum knee flexion angle, maximum internal knee extensor moment, energy absorption at knee) during the loading phase (foot contact to peak knee flexion) was compared among graft types (20 IT, 29 HT, 39 QT, 57 PT) and sides (ACLR or contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Overall, knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during both tasks (p < 0.03). All graft types exhibited lower knee extensor moments and energy absorption on the operated side during both movements (p ≤ 0.001). Kinetic asymmetry was significantly lower for IT compared with QT and PT during both movements (p ≤ 0.005), and similar patterns were observed for HT vs. QT and PT (p ≤ 0.07). Asymmetry was similar between IT and HT and between QT and PT. This study found that knee extensor mechanism function recovers fastest in pediatric ACLR patients with IT autografts, followed by HT, in comparison to QT and PT, suggesting that IT is a viable option for returning young athletes to play after ACLR.

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