Functional Training for the Restoration of Dynamic Stability in the PCL-Injured Knee

1999 ◽  
Vol 8 (4) ◽  
pp. 362-378 ◽  
Author(s):  
Paul A. Borsa ◽  
Eric L. Sauers ◽  
Scott M. Lephart
Keyword(s):  
Dynamic Stability ◽  
Management Strategy ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Joint Stability ◽  
Kinetic Chain ◽  
Functional Training ◽  
Rehabilitation Protocols ◽  
Research Findings ◽  
Injured Knee

Functional training for the purpose of restoring dynamic joint stability has received considerable interest in recent years. Contemporary functional training programs are being designed to complement, rather than replace, traditional rehabilitation protocols. The purpose of this clinical commentary is to present a management strategy for restoring dynamic stability in the posterior cruciate ligament (PCL)-injured knee. The strategy presented integrates five key concepts: (a) planned variation of exercise, (b) outcomes-based assessment, (c) kinetic chain exercise, (d) proprioception and neuromuscular control, and (e) specificity of activity. Pertinent research findings and a clinical rationale are provided for using functional training in the restoration of dynamic stability in the PCL-injured knee.

scholarly journals Which assessments are used to analyze active knee stability after an anterior cruciate ligament injury to determine readiness to return to sports?

2020 ◽  
Author(s):  
Blasimann Angela ◽  
Koenig Irene ◽  
Baert Isabel ◽  
Baur Heiner ◽  
Vissers Dirk
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Acl Injury ◽  
Risk Of Bias ◽  
Return To Sports ◽  
Joint Stability ◽  
Active Joint ◽  
Wide Range ◽  
Anterior Cruciate

AbstractBackgroundAdequate neuromuscular control of the knee for active joint stability could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury, either treated conservatively or surgically. However, it is unclear which measurements should be used to assess neuromuscular control of the knee for a safe return to sports (RTS).PurposeTo summarize assessments for neuromuscular control of the knee in athletes after an ACL injury to decide upon readiness towards a successful return to sports (RTS).Study designSystematic review, level of evidence 4MethodsThis systematic review followed the guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-analyses (PRISMA) and has been listed in PROSPERO (CRD42019122188). The databases MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception until March 2019. The search was updated with e-mail alerts from the searched databases until December 2019 and yielded to studies identifying assessments using electromyography (EMG) for neuromuscular control during dynamic activities in patients with an ACL rupture or repair. All included articles were assessed for risk of bias with a modified Downs and Black checklist.ResultsA total of 1178 records were identified through database search. After screening for title, abstract and content regarding in- and exclusion criteria, 31 articles could be included for analysis. Another six articles could be included from hand search of reference lists of the included articles, resulting in a total of 37 articles. Surface EMG was used in all studies as method to assess neuromuscular control. However, there was a wide range of tasks, interventions, muscles measured, and outcomes used. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results.ConclusionsDespite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon a safe RTS in adult patients after an ACL injury.Clinical relevanceFuture studies should aim at finding valid and reliable assessments for neuromuscular control to judge upon readiness towards RTS.What is known about the subjectThe recurrence rates even after successful surgery and subsequent rehabilitation in ACL patients are high (up to 30%), with a re-injury of the ipsilateral knee, an injury of the opposite leg, muscle injuries on the ipsilateral side or even bilateral consequences and an increased risk for knee osteoarthritis. Furthermore, the diagnostic outcomes used to determine RTS after an ACL tear are numerous. However, they are not always functional and do not sufficiently reflect neuromuscular control abilities of ACL patients. Currently, decisions regarding joint stability for RTS are based on subjective clinical assessments (passive joint stability) and physical test batteries (e.g. hop tests as surrogates for active joint stability). Additional knowledge regarding objective neuromuscular measures closes the gap between the two mentioned currently available evaluations. Up to date, it is unclear which measurements should be used to assess neuromuscular control of the knee for a safe RTS.What this study adds to existing knowledgeSurface electromyography is the choice of method to assess neuromuscular control of the knee during active tasks in adult ACL patients. However, it remains unclear which outcome variables would be best to judge upon readiness towards RTS or which dynamic tasks should be used for RTS.

Current Protocols and Procedures for Anterior Cruciate Ligament Reconstruction and Rehabilitation

1994 ◽  
Vol 3 (3) ◽  
pp. 204-217 ◽  
Author(s):  
Michael R. McCarthy ◽  
Barton P. Buxton ◽  
W. Douglas B. Hiller ◽  
James R. Doyle ◽  
Denis Yamada
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Kinetic Chain ◽  
Closed Type ◽  
Rehabilitation Protocols ◽  
Arthroscopically Assisted ◽  
Anterior Cruciate ◽  
Open Versus ◽  
Bone Autograft ◽  
Question Survey

In an attempt to quantify the current standards in surgical procedures and rehabilitation protocols utilized to treat patients with anterior cruciate ligament (ACL)-deficient knees, a 19-question survey was sent to members of the Hawaii Orthopedic Association. The findings indicated that only 54% (30/56) of the respondents were performing ACL reconstructions, of which 87% (26/30) were performing an intra-articular procedure and none were performing extra-articular procedures exclusively. The findings further indicate that 80% (24/30) of the 30 respondents performing ACL reconstructions were using an arthroscopically assisted, bone-tendon-bone autograft procedure. However, in marked contrast to the uniformity that existed concerning the surgical procedure, there was a drastic difference in the rehabilitation protocols and procedures that were recommended postoperatively. The most apparent differences in rehabilitation protocols existed in the utilization and initiation of open versus closed type kinetic chain exercises and activities.

The Effect of Select Shoulder Exercises on Strength, Active Angle Reproduction, Single-Arm Balance, and Functional Performance

2004 ◽  
Vol 13 (1) ◽  
pp. 75-95 ◽  
Author(s):  
Darin A. Padua ◽  
Kevin M. Guskiewicz ◽  
William E. Prentice ◽  
Robert E. Schneider ◽  
Edgar W. Shields
Keyword(s):  
Dynamic Stability ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Functional Performance ◽  
Neuromuscular Control ◽  
Healthy Individuals ◽  
Kinetic Chain ◽  
Significant Group ◽  
Shoulder Strength ◽  
Post Hoc

Objective:To determine whether select shoulder exercises influence shoulder-rotation strength, active angle reproduction (AAR), single-arm dynamic stability, and functional throwing performance in healthy individuals.Design:Pretest–posttest.Setting:Laboratory.Participants:54, randomly placed in 4 training groups.Intervention:Four 5-week training protocols.Main Outcome Measures:Average shoulder-rotation torque, AAR, single-arm dynamic stability, and functional throwing performance.Results:Repeated-measures ANOVAs revealed a significant group-by-test interaction for average torque (P> .05). Post hoc analyses revealed significantly increased average torque in the open kinetic chain and proprioceptive neuromuscular facilitation (PNF) groups after training. AAR and sway velocity were not affected in any of the groups (P> .05), but functional performance revealed a significant group-by-test interaction (P< .05). Post hoc analysis demonstrated that the PNF group significantly improved after training (P< .05).Conclusions:Shoulder strength can be improved in healthy individuals, but improvements depend on the exercise performed. Shoulder proprioception and neuromuscular control were unchanged in all groups, but functional performance improved in the PNF group

scholarly journals Reliability and Validity of DPA-1 Testing After Anterior Cruciate Ligament Reconstruction

Medicina ◽  
2012 ◽  
Vol 48 (2) ◽  
pp. 14
Author(s):  
Sigitas Kamandulis ◽  
Agnė Kanavolaitė ◽  
Albertas Skurvydas ◽  
Laimutis Škikas ◽  
Dalia Mickevičienė ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Reliability And Validity ◽  
Neuromuscular Control ◽  
Peak Torque ◽  
Movement Speed ◽  
Human Hand ◽  
Anterior Cruciate ◽  
Injured Knee

There is a lack of equipment and methods for the reliable and valid measurements of human neuromuscular control. To overcome this limitation, an analyzer of dynamic parameters (DPA-1) of human hand and leg movements was constructed by Kaunas University of Technology and “Katra” engineers in collaboration with the Lithuanian Academy of Physical Education. The aim of the study was to determine the reliability and validity of the tests performed on the DPA-1 in healthy and injured subjects after the anterior cruciate ligament (ACL) reconstruction surgery. Material and Methods. The men who had undergone a unilateral ACL reconstruction (n=17, on the average 3.8 months [SD, 2.1] after the surgery) and healthy untrained men (n=17) performed the research protocol twice within 24 hours in between. Average reaction time, mean and maximal movement speed, time to reach maximal speed, and movement distance of the right and left feet for the patients and of the dominant foot for the healthy subjects using the DPA-1 as well as the scores of isokinetic muscle strength and self-assessment tests were registered. Results. There was a significantly reduced concentric peak torque on the injured knee compared with the uninjured knee during knee extension, and the mean score of the Lysholm scale for the injured knee was 69.1 (SD, 13.7) (P<0.05, compared between legs). The test-retest reliability for all the DPA-1 tests varied from 0.68 to 0.94 (P<0.05). However, there were no significant differences in most variables measured by the DPA-1 between injured knee, uninjured knee, and control knee. Conclusions. The results revealed low validity of the DPA-1 tests for the evaluation of patients following ACL surgery, despite the reliability of these tests varied from moderate to very high.

Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs

1992 ◽  
Vol 05 (04) ◽  
pp. 158-162 ◽  
Author(s):  
D. Blackketter ◽  
J Harari ◽  
J. Dupuis
Keyword(s):  
Mechanical Properties ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Biomechanical Properties ◽  
Fibular Head ◽  
Joint Stability ◽  
Collateral Ligament ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.

scholarly journals Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1035
Author(s):  
Eva-Maria Winkelmeyer ◽  
Justus Schock ◽  
Lena Marie Wollschläger ◽  
Philipp Schad ◽  
Marc Sebastian Huppertz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Joint Stability ◽  
Anatomic Landmarks ◽  
Human Knee Joint ◽  
Custom Made ◽  
Tibial Translation

While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.

Alterations in Quadriceps Neurologic Complexity After Anterior Cruciate Ligament Reconstruction

2020 ◽  
pp. 1-6
Author(s):  
Steven M. Davi ◽  
Colleen K. Woxholdt ◽  
Justin L. Rush ◽  
Adam S. Lepley ◽  
Lindsey K. Lepley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Vastus Lateralis ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Electromyographic Activity ◽  
Vastus Medialis ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Context: Traditionally, quadriceps activation failure after anterior cruciate ligament reconstruction (ACLR) is estimated using discrete isometric torque values, providing only a snapshot of neuromuscular function. Sample entropy (SampEn) is a mathematical technique that can measure neurologic complexity during the entirety of contraction, elucidating qualities of neuromuscular control not previously captured. Objective: To apply SampEn analyses to quadriceps electromyographic activity in order to more comprehensively characterize neuromuscular deficits after ACLR. Design: Cross-sectional. Setting: Laboratory. Participants: ACLR: n = 18; controls: n = 24. Interventions: All participants underwent synchronized unilateral quadriceps isometric strength, activation, and electromyography testing during a superimposed electrical stimulus. Main Outcome Measures: Group differences in strength, activation, and SampEn were evaluated with t tests. Associations between SampEn and quadriceps function were evaluated with Pearson product–moment correlations and hierarchical linear regressions. Results: Vastus medialis SampEn was significantly reduced after ACLR compared with controls (P = .032). Vastus medialis and vastus lateralis SampEn predicted significant variance in activation after ACLR (r2 = .444; P = .003). Conclusions: Loss of neurologic complexity correlates with worse activation after ACLR, particularly in the vastus medialis. Electromyographic SampEn is capable of detecting underlying patterns of variability that are associated with the loss of complexity between key neurophysiologic events after ACLR.

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