The Relationship between Quadriceps Muscle Force, Knee Flexion, and Anterior Cruciate Ligament Strain in an in Vitro Simulated Jump Landing

ObjectiveTo examine the relationship between the m-CTSIB and Landing Error Scoring System in a sample of collegiate female athletes.BackgroundRecent literature has linked concussion and neuromuscular deficits in the lower extremity after injury. Neuromuscular control is frequently assessed using balance measures for concussion, but also dynamically to identify anterior cruciate ligament injury (ACL) risk via jump-landing movement screening.Design/MethodsThirty-nine healthy, collegiate female soccer (n = 22) and volleyball (n = 17) athletes completed the modified-Clinical Test of Sensory Interaction of Balance (m-CTSIB) and the Landing Error Scoring System (LESS). Measures consisted of total m-CTSIB sway index scores on individual conditions (firm surface eyes open [condition 1] and eyes closed [2], foam surface eyes open [3] and eyes closed [4]), m-CTSIB overall score, and total LESS errors. LESS scores were also categorized into a low (0–4 errors) and high (5 + errors) risk to determine if athletes with worse neuromuscular control on the LESS has worse balance on the m-CTSIB. A Spearman's rank-order correlation was conducted to determine the strength of the relationship between LESS and m-CTSIB performance. A series of Mann-Whitney U test were performed to determine differences between low and high LESS performance on m-CTSIB performance.ResultsThere was a weak, negative correlation between LESS and m-CTSIB performance (rs(37) = −0.153, p = 0.35). Further, there were no differences between the low and high risk LESS groups on sway index scores on conditions 1 (U = 158.5, p = 0.39), 2 (U = 156.0, p = 0.36), 3 (U = 165.5, p = 0.51), or 4 (U = 128.5, p = 0.08), as well as overall m-CTSIB scores (U = 150.5, p = 0.28).ConclusionsThere appears to be a lack of relationship between the LESS and m-CTSIB tests, revealing the independence of static and dynamic lower extremity neuromuscular function. Athletes who may be more at risk for ACL injury due to abnormal jump-landing biomechanics, do not differ from low-risk athletes on baseline balance assessment.

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RE: Oh and Ashton-Miller: Comments on Hashemi et al. “Increasing pre-activation of the quadriceps muscle protects the anterior cruciate ligament during the landing phase of a jump: An in vitro simulation”

The Knee ◽

10.1016/j.knee.2010.05.002 ◽

2010 ◽

Vol 17 (4) ◽

pp. 261-263

Author(s):

Javad Hashemi ◽

Ryan Breighner ◽

Taek-Hyun Jang ◽

Naveen Chandrashekar ◽

Stephen Ekwaro-Osire ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

In Vitro Simulation ◽

Anterior Cruciate

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The Soleus Muscle Acts as an Agonist for the Anterior Cruciate Ligament: An in Vitro Experimental Study

The American Journal of Sports Medicine ◽

10.1177/03635465030310021401 ◽

2003 ◽

Vol 31 (2) ◽

pp. 241-246 ◽

Cited By ~ 55

Author(s):

John J. Elias ◽

Alfred F. Faust ◽

Yung-Hua Chu ◽

Edmund Y. Chao ◽

Andrew J. Cosgarea

Keyword(s):

Anterior Cruciate Ligament ◽

Soleus Muscle ◽

Ligament Reconstruction ◽

Gastrocnemius Muscle ◽

Muscle Force ◽

Cruciate Ligament ◽

Knee Stability ◽

Hamstring Muscles ◽

Anterior Cruciate

Background: Although the quadriceps muscles are known antagonists for the anterior cruciate ligament and the hamstring muscles are known agonists, the influence of the calf muscles on knee stability is not well understood. Hypothesis: The soleus muscle acts as an anterior cruciate ligament agonist and the gastrocnemius muscle acts as an anterior cruciate ligament antagonist. Study Design: Controlled laboratory study. Methods: Six cadaveric knees were tested with individual and combined activation of the gastrocnemius and soleus muscles to determine the influence of simulated muscle contraction on tibiofemoral motion. Results: At all flexion angles, applying the soleus muscle force tended to translate the tibia posteriorly, whereas applying the gastrocnemius muscle force tended to translate the tibia anteriorly. Applying the soleus and gastrocnemius muscle forces together also tended to translate the tibia anteriorly. The average anterior and posterior tibial translations were greatest at 50° of flexion. Conclusions: The soleus muscle is capable of acting as an agonist for the anterior cruciate ligament and the gastrocnemius muscle can act as an antagonist. Clinical Relevance: A better understanding of the agonistic behavior of the soleus muscle on the anterior cruciate ligament may lead to the development of training and rehabilitation strategies that could reduce the incidence of injury and improve function in both patients with anterior cruciate ligament deficiency and patients who have undergone anterior cruciate ligament reconstruction.

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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

Physical Therapy ◽

10.1093/ptj/pzz062 ◽

2019 ◽

Vol 99 (8) ◽

pp. 1010-1019 ◽

Cited By ~ 2

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.

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