scholarly journals Fracture of the Patella During Rehabilitation of the Knee Extensor Muscles Following Reconstruction of the Anterior Cruciate Ligament

1993 ◽  
Vol 3 (2) ◽  
pp. 118-122 ◽  
Author(s):  
Côme S. Bouchard ◽  
Germain Thériault ◽  
Janik M. Gauthier ◽  
François Morin ◽  
Jean-Aimé Simoneau
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Extensor Muscles ◽  
Anterior Cruciate ◽  
Knee Extensor Muscles

scholarly journals No Relationship Between Preoperative and Early Postoperative Strength After ACL Reconstruction

2020 ◽  
Vol 29 (5) ◽  
pp. 583-587
Author(s):  
Pier Paolo Mariani ◽  
Luca Laudani ◽  
Jacopo E. Rocchi ◽  
Arrigo Giombini ◽  
Andrea Macaluso
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Strength ◽  
Maximal Voluntary Isometric Contraction ◽  
Extensor Muscles ◽  
Flexor Muscles ◽  
Anterior Cruciate ◽  
Tendon Autograft ◽  
Knee Extensor Muscles

Context: All rehabilitative programs before anterior cruciate ligament (ACL) reconstructive surgery, which are focused on recovery of proprioception and muscular strength, are defined as prehabilitation. While it has shown that prehabilitation positively affects the overall outcome after ACL reconstruction, it is still controversial whether preoperatively enhancing quadriceps strength has some beneficial effect on postoperative strength, mainly during the first period. Objective: To determine whether there is any relationship between preoperative and early postoperative quadriceps strength. Design: Case control. Setting: University research laboratory. Participants: Fifty-nine males (18–33 y; age: 23.69 [0.71] y) who underwent ACL reconstruction with patellar-tendon autograft were examined the day before surgery, and at 60 and 90 days after surgery. Main Outcome Measures: The limb symmetry index (LSI) was quantified for maximal voluntary isometric contraction of the knee extensor muscles and of the knee flexor muscles at 90° joint angle. A k-means analysis was performed on either quadriceps or hamstrings LSI before surgery to classify the patients in high and low preoperative LSI clusters. Differences in postoperative LSI were then evaluated between the high and low preoperative LSI clusters. Results: Following surgery, there were no differences in the quadriceps LSI between patients with high and low preoperative quadriceps LSI. Sixty days after surgery, the hamstrings LSI was higher in patients with high than low preoperative hamstrings LSI (84.0 [13.0]% vs 75.4 [15.9]%; P < .05). Conclusions: Findings suggest that quadriceps strength deficit is related to the ACL injury and increases further after the reconstruction without any correlation between the preoperative and postoperative values. Therefore, it appears that there is no need to delay surgery in order to increase the preoperative quadriceps strength before surgery.

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.

Measuring the force perception in knee flexor/ extensor muscles in patients with anterior cruciate ligament injury and healthy subjects

2021 ◽  
pp. 1-8
Author(s):  
Bahram Amirshakeri ◽  
Minoo Khalkhali Zavieh ◽  
Mandana Rezaei ◽  
Hakimeh Adigozali
Keyword(s):  
Anterior Cruciate Ligament ◽  
Healthy Subjects ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Injured Limb ◽  
Knee Flexor ◽  
Force Perception ◽  
Extensor Muscles ◽  
Anterior Cruciate ◽  
Flexion And Extension

BACKGROUND: Force perception as a contributor to the neuromuscular control of the knee joint may be altered after anterior cruciate ligament (ACL) injury. OBJECTIVE: This study aimed to compare the force perception accuracy in the knee joints of patients with ACL injury and healthy subjects. METHODS: Twenty-six patients with ACL injury and 26 healthy subjects participated in this case-control study. Participants were asked to produce 50% of the maximum voluntary isometric contraction of the knee muscles as a target force and reproduce it in their limbs in flexion and extension directions. RESULTS: There were significant interactions between group and condition as well as group, condition, and limb in the force perception error respectively (P< 0.05). The highest amount of error was seen in the contralateral limb of the ACL injury group when the reference force was produced in the injured limb (P< 0.05). CONCLUSION: The findings revealed that the force perception accuracy in the knee flexor/extensor muscles of individuals with ACL injury is impaired. Moreover, error is most evident when the patient produces force in the injured limb and replicates it in the uninjured limb in both flexion and extension directions. Therefore, the rehabilitation programs should encompass neuromuscular training in both quadriceps and hamstrings after ACL injury.

scholarly journals Disruption of the knee extensor apparatus complicating anterior cruciate ligament reconstruction

2013 ◽  
Vol 60 (2) ◽  
pp. 13-21 ◽  
Author(s):  
Miroslav Milankov ◽  
Vaso Kecojevic ◽  
Predrag Rasovic ◽  
Nemanja Kovacevic ◽  
Nemanja Gvozdenovic ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Rare Complication ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Patellar Ligament ◽  
Local Bone ◽  
Extensor Apparatus ◽  
Anterior Cruciate ◽  
Bone Autograft

Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 2215 reconstructions of the anterior cruciate ligament of the knee using bonepatellar tendon-bone technique, and 10 patients had fracture of the patella (0.45%), and fore patients had rupture of the patellar tendon(0.18%). The fracture of the patella in two patients was treated nonoperatively and 8 patients was treated with operative reduction and osteosynthesis. Reconstruction of the patellar ligament in four patients with a rupture of patellar tendon (0.18%) was performed by a technique previously published with BTB allograft taken from the local bone bank. The mean Lysholm score was 90 (85-100), and all of them have continued to engage in sporting activities. In all patients the Lachman test was with the firm stop compared to the other leg. Xray changes in the patella were found in 2 patients, who had multifragmentary fractures of the patella. Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment disruption of the knee extensor apparatus after the reconstruction of the anterior cruciate ligament is a operative reconstruction, which allows continuation of the rehabilitation program.

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