Effect of Eccentric Strengthening After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength

2013 ◽  
Vol 22 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Lindsey K. Lepley ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Attractive Alternative ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Rehabilitation Period ◽  
Anterior Cruciate

Clinical Scenario:Interventions aimed at safely overloading the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction are essential to reducing quadriceps muscle weakness that often persists long after the rehabilitation period. Despite the best efforts of clinicians and researchers to improve ACL rehabilitation techniques, a universally effective intervention to restore preinjury quadriceps strength has yet to be identified. A muscle’s force-producing capacity is most optimal when an external force exceeds that of the muscle while the muscle lengthens. Hence, the potential to improve muscle strength by overloading the tissue is greater with eccentric strengthening than with concentric strengthening. Traditionally, the application of early postoperative high-intensity eccentric resistance training to the ACL-reconstructed limb has been contraindicated, as there is potential for injury to the ACL graft, articular cartilage, or surrounding soft-tissue structures. However, recent evidence suggests that the application of early, progressive, high-force eccentric resistance exercises to the involved limb can be used to safely increase muscle volume and strength in ACL-reconstructed individuals. As a result, eccentric strengthening may be another attractive alternative to traditional concentric strengthening to improve quadriceps strength after ACL reconstruction.Focused Clinical Question:In patients who have undergone ACL reconstruction, is there evidence to suggest that eccentric exercise positively affects postoperative quadriceps strength?

Current Evidence in Anterior Cruciate Ligament Rehabilitation: Neuromuscular Electrical Stimulation Combined With a Strengthening Program: A Critically Appraised Topic

2017 ◽  
Vol 22 (6) ◽  
pp. 5-11
Author(s):  
Michael E. Lynch ◽  
Christine A. Lauber
Keyword(s):  
Anterior Cruciate Ligament ◽  
Electrical Stimulation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Strength ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Bottom Line ◽  
Anterior Cruciate

Clinical Question:Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?Clinical Bottom Line:There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.

Kinesiophobia After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals

2015 ◽  
Vol 24 (4) ◽  
pp. 434-439 ◽  
Author(s):  
Arika L. Cozzi ◽  
Kristina L. Dunn ◽  
Josie L. Harding ◽  
Tamara C. Valovich McLeod ◽  
Cailee E. Welch Bacon
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
The United States ◽  
Full Potential ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Physically Active ◽  
Acl Rehabilitation ◽  
Anterior Cruciate

Clinical Scenario:There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a preinjury level. Despite physical improvements with ACL-rehabilitation protocols, however, there are still a substantial number of individuals who do not return to preinjury level, particularly physically active individuals, of whom only 63% return to their full potential preinjury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. In addition, research concerning the topic of kinesiophobia (ie, fear of reinjury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or reinjury. Kinesiophobia may have a significant impact on physically active individuals, considering the proportion of patients who do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients’ perceived physical-impairment levels after ACL reconstruction.Focused Clinical Question:Is kinesiophobia associated with self-perceived levels of knee function after ACL reconstruction?

scholarly journals Michigan Initiative for Anterior Cruciate Ligament Rehabilitation (MiACLR): A Protocol for a Randomized Clinical Trial

2020 ◽  
Vol 100 (12) ◽  
pp. 2154-2164
Author(s):  
Kazandra Rodriguez ◽  
Steven A Garcia ◽  
Cathie Spino ◽  
Lindsey K Lepley ◽  
Yuxi Pang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Neurological Deficits ◽  
Secondary Outcome ◽  
Patient Reported ◽  
Anterior Cruciate

Abstract Objective Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR. Methods This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging). Impact The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.

scholarly journals Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial

2019 ◽  
Vol 99 (8) ◽  
pp. 1010-1019 ◽  
Author(s):  
Lauren N Erickson ◽  
Kathryn C Hickey Lucas ◽  
Kylie A Davis ◽  
Cale A Jacobs ◽  
Katherine L Thompson ◽  
...  
Keyword(s):  
Blood Flow ◽  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Knee Biomechanics ◽  
Flow Restriction ◽  
Anterior Cruciate

Abstract Background Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads. Objective The objective is to evaluate the effect of BFRT on quadriceps strength and knee biomechanics and to identify the potential mechanism(s) of action of BFRT at the cellular and morphological levels of the quadriceps. Design This will be a randomized, double-blind, placebo-controlled clinical trial. Setting The study will take place at the University of Kentucky and University of Texas Medical Branch. Participants Sixty participants between the ages of 15 to 40 years with an ACL tear will be included. Intervention Participants will be randomly assigned to (1) physical therapy plus active BFRT (BFRT group) or (2) physical therapy plus placebo BFRT (standard of care group). Presurgical BFRT will involve sessions 3 times per week for 4 weeks, and postsurgical BFRT will involve sessions 3 times per week for 4 to 5 months. Measurements The primary outcome measure was quadriceps strength (peak quadriceps torque, rate of torque development). Secondary outcome measures included knee biomechanics (knee extensor moment, knee flexion excursion, knee flexion angle), quadriceps muscle morphology (physiological cross-sectional area, fibrosis), and quadriceps muscle physiology (muscle fiber type, muscle fiber size, muscle pennation angle, satellite cell proliferation, fibrogenic/adipogenic progenitor cells, extracellular matrix composition). Limitations Therapists will not be blinded. Conclusions The results of this study may contribute to an improved targeted treatment for the protracted quadriceps strength loss associated with anterior cruciate ligament injury and reconstruction.

Which Outcome Measures Should Be Used to Determine Readiness to Play After ACL Reconstruction?

2014 ◽  
Vol 23 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Luke M. Mueller ◽  
Ben A. Bloomer ◽  
Chris J. Durall
Keyword(s):  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Injured Knee

Clinical Scenario:Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.Focused Clinical Question:Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?

scholarly journals Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
S. R. Shaarani ◽  
N. Moyna ◽  
R. Moran ◽  
J. M. O'Byrne
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Current Knowledge ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Limiting Factor ◽  
Anterior Cruciate Ligament Injuries ◽  
Preoperative Training ◽  
Anterior Cruciate

The rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction requires symmetry in bilateral quadriceps strength and adequate proprioception capabilities prior to return to preoperative level of activity or sport. This is the limiting factor and can delay the time that patients can return to play. There is little literature on pre-operative physiotherapy or prehabilitation of patient with ACL injury. This paper discusses the anatomy, biomechanics, surgical decision making, and the current knowledge of preoperative training or “prehabilitation” in patients awaiting ACL reconstruction.

scholarly journals Effect of knee angle on quadriceps strength and activation after anterior cruciate ligament reconstruction

2015 ◽  
Vol 119 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Chandramouli Krishnan ◽  
Paul Theuerkauf
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Contractile Property ◽  
Knee Angle ◽  
Peripheral Muscle ◽  
Anterior Cruciate

Quadriceps strength and activation deficits after anterior cruciate ligament (ACL) injury or surgery are typically evaluated at joint positions that are biomechanically advantageous to the quadriceps muscle. However, the effect of knee joint position and the associated changes in muscle length on strength and activation is currently unknown in this population. Here, we examined the effect of knee angle on quadriceps strength, activation, and electrically evoked torque in individuals with ACL reconstruction. Furthermore, we evaluated whether knee angle mediated the relationship between quadriceps weakness and functional performance after ACL reconstruction. Knee strength and activation were tested bilaterally at 90° and 45° of knee flexion in 11 subjects with ACL reconstruction using an interpolated triplet technique. The magnitude of electrically evoked torque at rest was used to quantify peripheral muscle contractile property changes, and the single-leg hop for distance test was used to evaluate functional performance. The results indicated that although quadriceps strength deficits were similar between knee angles, voluntary activation deficits were significantly higher in the reconstructed leg at 45° of knee flexion. On the contrary, the side-to-side evoked torque at rest ratio [i.e., (reconstructed/nonreconstructed) × 100] was significantly lower at 90° than at 45° of knee flexion. The association between quadriceps strength and functional performance was stronger at 45° of knee flexion. The results provide novel evidence that quadriceps activation is selectively affected at 45° of knee flexion and emphasize the importance of assessing quadriceps strength and activation at this position when feasible because it better captures activation deficits.

Factors That Predict Sagittal Plane Knee Biomechanical Symmetry After Anterior Cruciate Ligament Reconstruction: A Decision Tree Analysis

2021 ◽  
pp. 194173812110049
Author(s):  
Riann M. Palmieri-Smith ◽  
Michael T. Curran ◽  
Steven A. Garcia ◽  
Chandramouli Krishnan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Knee Biomechanics ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Biomechanical knee asymmetry is commonly present after anterior cruciate ligament (ACL) reconstruction. Factors that could assist in identification of asymmetrical biomechanics after ACL reconstruction could help clinicians in making return-to-play decisions. The purpose of this study is to determine factors that may contribute to knee biomechanical asymmetry present after ACL reconstruction. Hypothesis: We hypothesized that quadriceps strength and activation and patient-reported function would allow for identification of patients with symmetrical knee biomechanics. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Thirty-one subjects (18 women; time since ACL reconstruction = 284.4 ± 53.6 days) who underwent ACL reconstruction and were to return to activity were recruited. Participants completed bilateral assessments of isokinetic quadriceps strength, quadriceps activation using the superimposed burst technique, and biomechanical function testing during a single-leg forward hop. The International Knee Documentation Committee (IKDC) subjective knee form was also completed. Symmetry values were calculated for each variable. Decision trees were utilized to determine which input factors (quadriceps strength symmetry, quadriceps activation symmetry, IKDC score, age, sex, height, mass, graft type) were able to identify participants who had symmetrical knee flexion angles (KFAs) and extension moments. Angles and moments were considered symmetrical if symmetry values were ≥90%. Results: Quadriceps strength and activation symmetry were able to predict whether a patient landed with symmetrical or asymmetrical KFAs, with thresholds of 77.2% strength symmetry and 91.3% activation symmetry being established. Patient-reported function and quadriceps strength were factors that allowed for classification of participants with symmetrical/asymmetrical knee extension moments, with thresholds of 89.1 for the IKDC and 80.0% for quadriceps strength symmetry. Conclusions: Quadriceps strength contributed to both models and appears to be a critical factor for achieving symmetrical knee biomechanics. High patient-reported function and quadriceps activation are also important for restoring knee biomechanical symmetry after ACL reconstruction. Clinical Relevance: Quadriceps strength and activation and patient-reported function may be able to assist clinicians in identifying ACL patients with symmetrical/asymmetrical knee biomechanics.

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

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Hayley Carter ◽  
Chris Littlewood ◽  
Kate E. Webster ◽  
Benjamin E. Smith
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Risk Of Bias ◽  
Postoperative Outcomes ◽  
Perturbation Training ◽  
Operative Outcomes ◽  
Anterior Cruciate

Introduction: The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee with annual incidence rates of ruptures reported at 68.6 per 100,000. ACL ruptures are commonly treated with surgical reconstruction which aims to restore knee stability and maximise functional capacity to allow individuals to return to their preinjury level of physical activity. Prior to ACL reconstruction (ACLR), preoperative rehabilitation, commonly termed prehabilitation (PreHab), has been suggested to physically and mentally prepare patients for surgery and postoperative rehabilitation. No previous systematic review has specifically evaluated the effectiveness of PreHab on postoperative outcomes. A 2017 systematic review did investigate prehabilitation, but of the included eight RCTs only two included post-operative outcomes and not all RCTs included surgery in the treatment pathway. Hypotheses: To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). Methods: 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. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. Conclusion: 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. There is no consensus on the optimum PreHab programme content, frequency and length; this requires future consideration including the development of PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness.

scholarly journals Futsal Player Rehabilitation after Anterior Cruciate Ligament (ACL) Reconstruction

2018 ◽  
Vol 10 (1) ◽  
pp. 62
Author(s):  
Cosmin DAMIAN ◽  
Mirela DAMIAN
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Sport Activity ◽  
Knee Injuries ◽  
Quadriceps Muscle ◽  
Rehabilitation Program ◽  
Cardiovascular Fitness ◽  
Rehabilitation Protocol ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) tears are one of the most common knee injuries in sports. This research provide a scientific basis for the rehabilitation protocol after anterior cruciate ligament (ACL) reconstruction and present a subject experiences in the rehabilitation process after surgery, using futsal specific exercises with the purpose of returning in 6 months to sport activity. The subject which was tested is 18-years-old male, futsal player with anterior cruciate ligament (ACL) reconstruction with a hamstrings autograft. The rehabilitation protocol spans over a 6 month period and was divided into 4 phases [table1], for a total of about 288 sessions. The rehabilitation protocol it started a 7 day after surgery, at a rate of 2 sessions a day, 6 days a week The goals and exercise for each phase involve: range of motion (ROM), flexibility, normalizing gait, activation of the quadriceps muscle, strength and endurance, proprioception, cardiovascular fitness, specific technical and tactical futsal skills. The criteria for each phase progression were evaluated with Lower Extremity Functional Scale (LEFS). This study case suggests a high rehabilitation after ACL reconstruction, the key elements in the rehabilitation program is specificity goal and exercises of futsal game, performed in a individual and team training. Organizing the rehabilitation protocol with addressability and specificity of futsal exercises is necessary to speed up recovery.

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