scholarly journals Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture

2019 ◽  
Vol 28 (8) ◽  
pp. 877-886
Author(s):  
Zakariya Nawasreh ◽  
David Logerstedt ◽  
Adam Marmon ◽  
Lynn Snyder-Mackler
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Acl Rupture ◽  
Mechanical Device ◽  
Mechanical Perturbation ◽  
Perturbation Training ◽  
Manual Group ◽  
Flexion Moment ◽  
Anterior Cruciate

Context:Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists.Objective:To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture.Design:Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis.Setting:A clinical and biomechanical laboratory.Patients:Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study.Intervention:Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group).Outcome Measures:Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training.Results:There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups’ differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group.Conclusion:The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally  effective at improving patients’ perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients’ functional and biomechanical outcomes after ACL rupture.

scholarly journals Perturbation Training Improves Knee Kinematics and Reduces Muscle Co-contraction After Complete Unilateral Anterior Cruciate Ligament Rupture

2005 ◽  
Vol 85 (8) ◽  
pp. 740-749 ◽  
Author(s):  
Terese L Chmielewski ◽  
Wendy J Hurd ◽  
Katherine S Rudolph ◽  
Michael J Axe ◽  
Lynn Snyder-Mackler
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Quadriceps Femoris ◽  
Activity Level ◽  
Acl Rupture ◽  
Perturbation Training ◽  
Peak Knee ◽  
Anterior Cruciate

Abstract Background and Purpose. Dynamic knee stabilization strategies of people who successfully compensate for the absence of an anterior cruciate ligament (ACL) (“copers”) are different from those of people who do not compensate well for the injury (“noncopers”). Early after injury, certain patients (“potential copers”) can increase the likelihood of successfully compensating for the injury by participating in 10 sessions of perturbation training. The purpose of this study was to determine how perturbation training alters muscle co-contraction and knee kinematics in potential copers. Subjects. Seventeen individuals with acute, unilateral ACL rupture who were categorized as potential copers and 17 subjects without injuries who were matched by age, sex, and activity level were recruited for this study. Methods. Motion analysis and electromyographic data were collected as subjects walked across a stationary or moving platform (horizontal translation) before and after perturbation training. Results. Before training, potential copers had higher co-contraction indexes and lower peak knee flexion angles than subjects without injuries. After training, potential copers' movement patterns more closely resembled those of subjects without injuries (ie, they showed reduced co-contraction indexes and increased peak knee flexion angles during stance). Discussion and Conclusion. Perturbation training reduced quadriceps femoris-hamstring muscle and quadriceps femoris-gastrocnemius muscle co-contractions and normalized knee kinematics in individuals with ACL rupture who were classified as potential copers. Findings from this study provide evidence for a mechanism by which perturbation training acts as an effective intervention for promoting coordinated muscle activity in a select population of people with ACL rupture.

Changes in the Trend of Walking Motor Control in Athletes with Anterior Cruciate Ligament Deficiency in Response to Progressive Perturbation Trainings

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Jomhouri S ◽  
◽  
Talebian S ◽  
Vaez Mousavi M ◽  
Hatef B ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Motor Control ◽  
Cruciate Ligament ◽  
Similarity Index ◽  
Training Group ◽  
Mechanical Perturbation ◽  
Anterior Cruciate Ligament Deficiency ◽  
Perturbation Training ◽  
Standard Training ◽  
Anterior Cruciate

Background and Purpose: The beliefs are that sudden and unpredictable balance disturbance by instruments that cause mechanical perturbations can affect individuals with Anterior Cruciate Ligament Deficiency (ACLD) to reach faster and more effective recovery of knee dynamic stabilization strategies to return successfully pre-injury levels. The aim of this study was to investigate the effect of mechanical perturbation training and standard training in the process of changes in motor control during walking task in coper ACLD individuals. Methods: Thirty athletes with a unilateral rupture of the Anterior Cruciate Ligament (ACL), classified as coper, were randomly assigned to perturbation and standard training groups. Intervention training results based on comparison of scores obtained from functional tests in 4 single-leg jump tests, scores of questioners, and surface Electromyography (sEMG) tests were determined between the two groups as well as between the two healthy and ACLD limbs in each group in the walking task. Results: The perturbation training group showed a significant increase in muscle activity in both healthy and ACLD limbs with an increase in similarity index (SI) (p=0.08, ES=0.81), while in the standard training group the results were not significant (p=0.39, ES=0.39). Conclusion: Individuals in the perturbation training group achieved higher scores on all tests compared to the standard training group. This means that the perturbation training group was more mentally and physically prepared in terms of strength, coordination and symmetry between the two limbs to participate in pre-injury sports levels.

Anterior Cruciate Ligament Rupture Associated with Cardiomyopathy in Three Cats

1991 ◽  
Vol 4 (01) ◽  
pp. 35-37 ◽  
Author(s):  
G. O. Janssens ◽  
D. L. Janssens ◽  
L. A. A. Janssens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterior Cruciate Ligament Rupture ◽  
Acl Rupture ◽  
Thoracic Radiography ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Previous Trauma ◽  
History Of ◽  
Anterior Cruciate

SummaryOver a period of 14 years, three cats with anterior cruciate ligament (ACL) rupture were seen in our practice. In all, the rupture had occurred without a history of previous trauma. All were treated surgically. All died within a period of 14 days. The reason of death was in all cases cardiomyopathy. We now suggest that cats with rupture of the anterior cruciate ligament undergo an electrocardiographic recording and eventually an thoracic radiography before surgery is considered. We also suggest that cats with ACL rupture should preferably be treated conservatively.

The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture

2019 ◽  
Vol 47 (14) ◽  
pp. 3365-3372 ◽  
Author(s):  
Dimitris Dimitriou ◽  
Zhongzheng Wang ◽  
Diyang Zou ◽  
Tsung-Yuan Tsai ◽  
Naeder Helmy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Matched Control ◽  
Cruciate Ligament ◽  
Magnetic Resonance Images ◽  
Small Sample ◽  
Transverse Plane ◽  
Acl Rupture ◽  
Coronal Plane ◽  
Predisposing Factor ◽  
Anterior Cruciate

Background: Although the femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the recommendations for the ideal femoral footprint position are mostly based on cadaveric studies with small sample sizes, elderly patients with unknown ACL status, and 2-dimensional techniques. Furthermore, a potential difference in the femoral ACL footprint position and ACL orientation between ACL-ruptured and ACL-intact knees has not been reported in the literature. Hypothesis: The femoral ACL footprint position and ACL orientation vary significantly between ACL-ruptured and matched control ACL-intact knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance images of the knees of 90 patients with an ACL rupture and 90 matched control participants who had a noncontact knee injury without an ACL rupture were used to create 3-dimensional models of the femur and tibia. The ACL footprints were outlined on each model, and their positions (normalized to the lateral condyle width) as well as ACL orientations were measured with an anatomic coordinate system. Results: The femoral ACL footprint in patients with an ACL rupture was located at 36.6% posterior and 11.2% distal to the flexion-extension axis (FEA). The ACL orientation was 46.9° in the sagittal plane, 70.3° in the coronal plane, and 20.8° in the transverse plane. The ACL-ruptured group demonstrated a femoral ACL footprint position that was 11.0% more posterior and 7.7% more proximal than that of the control group (all P < .01). The same patients also exhibited 5.7° lower sagittal elevation, 3.1° higher coronal plane elevation, and 7.9° lower transverse plane deviation (all P < .01). The optimal cutoff value of the femoral ACL footprint position to prevent an ACL rupture was at 30% posterior and 12% distal to the FEA. Conclusion: The ACL femoral footprint position might be a predisposing factor to an ACL rupture. Patients with a >30% posterior and <12% distal position of the femoral ACL footprint from the FEA might have a 51.2-times increased risk of an ACL rupture.

scholarly journals No Association Between Risk of Anterior Cruciate Ligament Rupture and Selected Candidate Collagen Gene Variants in Female Elite Athletes From High-Risk Team Sports

2018 ◽  
Vol 47 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Einar Andreas Sivertsen ◽  
Kari Bente Foss Haug ◽  
Eirik Klami Kristianslund ◽  
Anne-Marie Siebke Trøseid ◽  
Jari Parkkari ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Elite Athletes ◽  
Cruciate Ligament ◽  
Team Sports ◽  
Acl Injury ◽  
Acl Rupture ◽  
Acl Injuries ◽  
Genes Encoding ◽  
Anterior Cruciate

Background: Several single-nucleotide variants (SNVs) in collagen genes have been reported as predisposing factors for anterior cruciate ligament (ACL) tears. However, the evidence is conflicting and does not support a clear association between genetic variants and risk of ACL ruptures. Purpose: To assess the association of previously identified candidate SNVs in genes encoding for collagen and the risk of ACL injury in a population of elite female athletes from high-risk team sports. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 851 female Norwegian and Finnish elite athletes from team sports were included from 2007 to 2011. ACL injuries acquired before inclusion in the cohort were registered by interview. The participants were followed prospectively through 2015 to record new complete ACL injuries. Six selected SNVs were genotyped ( COL1A1: rs1800012, rs1107946; COL3A1: rs1800255; COL5A1: rs12722, rs13946; COL12A1: rs970547). Results: No associations were found between ACL rupture and the SNVs tested. Conclusion: The study does not support a role of the 6 selected SNVs in genes encoding for collagen proteins as risk factors for ACL injury. Clinical Relevance: Genetic profiling to identify athletes at high risk for ACL rupture is not yet feasible.

scholarly journals Anterior Cruciate Ligament Rupture and Osteoarthritis Progression

2012 ◽  
Vol 6 (1) ◽  
pp. 295-300 ◽  
Author(s):  
James Min-Leong Wong ◽  
Tanvir Khan ◽  
Chethan S Jayadev ◽  
Wasim Khan ◽  
David Johnstone
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Degenerative Change ◽  
Acl Rupture ◽  
Osteoarthritis Progression ◽  
Anterior Cruciate ◽  
The Relationship ◽  
Meniscal Damage ◽  
Acl Deficient

Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial. The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations.

Matrix Metalloproteinase Inhibition With Doxycycline Affects the Progression of Posttraumatic Osteoarthritis After Anterior Cruciate Ligament Rupture: Evaluation in a New Nonsurgical Murine ACL Rupture Model

2019 ◽  
Vol 48 (1) ◽  
pp. 143-152 ◽  
Author(s):  
Xueying Zhang ◽  
Xiang-Hua Deng ◽  
Zhe Song ◽  
Brett Croen ◽  
Camila B. Carballo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Matrix Metalloproteinase ◽  
Untreated Control ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Acl Rupture ◽  
Male Mice ◽  
Posttraumatic Osteoarthritis ◽  
Rupture Model ◽  
Anterior Cruciate

Background: Doxycycline has broad-spectrum activity as a matrix metalloproteinase (MMP) inhibitor and thus could reduce the progression of posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) rupture. Hypothesis: Doxycycline would inhibit progression of PTOA in a murine ACL rupture model. Study Design: Controlled laboratory study. Methods: For the in vitro study, cadaveric C57BL/6 male mice knees (N = 108) were used for the development of a nonsurgical ACL rupture model. For the in vivo study, 24 C57BL/6 male mice then underwent ACL rupture with our manual procedure and were divided into 4 groups: untreated control; doxycycline, 10 mg/kg/d; doxycycline, 50 mg/kg/d; and doxycycline, 100 mg/kg/d. Doxycycline was administered in drinking water beginning immediately after ACL rupture. Radiographic imaging and paw prints were evaluated at 3, 7, 14, and 28 days. The foot length and toe spread were analyzed as measures of function. Histology and MMP-13 immunohistochemistry were done at 4 weeks. Results: Radiographs demonstrated anterior tibial subluxation and meniscal extrusion after ACL rupture, confirming knee joint instability without fractures. Statistically significant differences in gait were found between the intact and experimental groups. Histologic examination demonstrated cartilage damage, meniscal tears, and mild osteoarthritis after ACL rupture, similar to what occurs in human patients. Hypertrophy of the posterior horn of the medial and lateral meniscus was found, and tears of the posterior horn of the menisci were common. All doxycycline groups had a lower score than the untreated control group, indicating less cartilage damage. The posterior tibia of the untreated group had the most cartilage damage as compared with the 3 doxycycline groups, with a significant difference between the untreated and 50-mg/kg/d doxycycline groups, suggesting that the latter dose may protect against proteoglycan loss and decrease the progression of osteoarthritis. The nondoxycycline group had the highest synovial inflammation score among all groups, indicating that doxycycline has an inhibitory effect on synovitis. There was significantly lower MMP-13 expression on the tibia in the doxycycline-treated groups, with a positive correlation between doxycycline concentration and MMP-13 inhibition. Conclusion: Modulation of MMP-13 activity by doxycycline treatment may offer a novel biological pathway to decrease the progression of PTOA after ACL rupture. Clinical Relevance: Doxycycline is an approved, readily available drug with infrequent side effects of photosensitivity and gastrointestinal symptoms. Future clinical trials could evaluate doxycycline to reduce or prevent progressive cartilage damage after ACL rupture.

scholarly journals The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hayley M. Carter ◽  
Chris Littlewood ◽  
Kate E. Webster ◽  
Benjamin E. Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Psychological Outcomes ◽  
Risk Of Bias ◽  
Assessment System ◽  
Trial Registration ◽  
Perturbation Training ◽  
Anterior Cruciate

Abstract Background To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). Method A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. Results The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored ‘high’ risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. Conclusion Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport. Trial registration PROSPERO trial registration number. CRD42020162754.

scholarly journals Generation of stem cell-based bioartificial anterior cruciate ligament (ACL) grafts for effective ACL rupture repair

2016 ◽  
Vol 17 (2) ◽  
pp. 448-457 ◽  
Author(s):  
Dimitrios Kouroupis ◽  
Athena Kyrkou ◽  
Eleni Triantafyllidi ◽  
Michalis Katsimpoulas ◽  
George Chalepakis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Stem Cell ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Anterior Cruciate

scholarly journals Factors Associated With Function After Anterior Cruciate Ligament Reconstruction

2009 ◽  
Vol 1 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Trevor A. Lentz ◽  
Susan M. Tillman ◽  
Peter A. Indelicato ◽  
Michael W. Moser ◽  
Steven Z. George ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Psychological Variables ◽  
Cruciate Ligament Reconstruction ◽  
Subjective Form ◽  
Anterior Cruciate ◽  
Tampa Scale For Kinesiophobia

Background: Many individuals do not resume unrestricted, preinjury sports participation after anterior cruciate ligament reconstruction, thus a better understanding of factors associated with function is needed. The purpose of this study was to investigate the association of knee impairment and psychological variables with function in subjects with anterior cruciate ligament reconstruction. Hypothesis: After controlling for demographic variables, knee impairment and psychological variables contribute to function in subjects with anterior cruciate ligament reconstruction. Study Design: Cross-sectional study; Level of evidence, 4a. Methods: Fifty-eight subjects with a unilateral anterior cruciate ligament reconstruction completed a standardized testing battery for knee impairments (range of motion, effusion, quadriceps strength, anterior knee joint laxity, and pain intensity), kinesiophobia (shortened Tampa Scale for Kinesiophobia), and function (International Knee Documentation Committee subjective form and single-legged hop test). Separate 2-step regression analyses were conducted with International Knee Documentation Committee subjective form score and single-legged hop index as dependent variables. Demographic variables were entered into the model first, followed by knee impairment measures and Tampa Scale for Kinesiophobia score. Results: A combination of pain intensity, quadriceps index, Tampa Scale for Kinesiophobia score, and flexion motion deficit contributed to the International Knee Documentation Committee subjective form score (adjusted r2 = 0.67; P < .001). Only effusion contributed to the single-legged hop index (adjusted r2 = 0.346; P = .002). Conclusion: Knee impairment and psychological variables in this study were associated with self-report of function, not a performance test. Clinical Relevance: The results support focusing anterior cruciate ligament reconstruction rehabilitation on pain, knee motion deficits, and quadriceps strength, as well as indicate that kinesiophobia should be addressed. Further research is needed to reveal which clinical tests are associated with performance testing.

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