The effect of rehabilitation and return to activity on anterior-posterior knee displacements after anterior cruciate ligament reconstruction

1993 ◽  
Vol 21 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Sue D. Barber-Westin ◽  
Frank R. Noyes
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Posterior Knee ◽  
Return To Activity ◽  
Anterior Posterior

scholarly journals Continued Improvements in Quadriceps Strength and Biomechanical Symmetry of the Knee After Postoperative Anterior Cruciate Ligament Reconstruction Rehabilitation: Is It Time to Reconsider the 6-Month Return-to-Activity Criteria?

2018 ◽  
Vol 53 (6) ◽  
pp. 535-544 ◽  
Author(s):  
Michael T. Curran ◽  
Lindsey K. Lepley ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Return To Activity

Context: Patients who undergo anterior cruciate ligament reconstruction (ACLR) present with strength and biomechanical deficits at return to activity (RTA). Deficits in strength and biomechanical symmetry impair function during activity and may predispose patients to subsequent injury.Objective: To compare strength and biomechanical function in patients with ACLR at RTA and more than 12 months post-ACLR.Design: Descriptive laboratory study.Setting: Research laboratory.Patients or Other Participants: A total of 20 participants (12 females, 8 males; age = 21.40 ± 5.60 years, height = 171.3 ± 10.2 cm, mass = 73.21 ± 19.41 kg) who had undergone ACLR and were cleared to RTA were recruited.Intervention(s): Strength was measured during knee extension and evaluated by the isometric and isokinetic quadriceps index. Biomechanical function was evaluated using symmetry values for sagittal-plane knee-joint rotations, changes in sagittal-plane knee-joint rotation, knee-extension moments, and changes in knee-extension moment that were recorded during a single-legged forward hop.Main Outcome Measure(s): Self-reported function was measured using the International Knee Documentation Committee Subjective Knee Evaluation Form. Participants were assessed at RTA (212.25 ± 28.11 days) and more than 12 months post-ACLR (556.25 ± 230.89 days).Results: At RTA, strength and biomechanical values were less than 80% symmetric. We observed improvements from RTA to more than 12 months post-ACLR for the isometric quadriceps index (F1,18 = 29.22, P < .001), isokinetic quadriceps index (F1,18 = 10.88, P = .004), sagittal-plane knee-joint rotations (F1,19 = 9.58, P = .006), change in sagittal-plane knee-joint rotations (F1,19 = 7.83, P = .01), knee-extension moments (F1,19 = 5.73, P = .03), change in knee-extension moments (F1,19 = 21.10, P < .001), and self-perceived function (F1,19 = 11.50, P = .003). Of the 7 variables that showed improvement at more than 12 months post-ACLR, only 3 met the recommended criteria (≥90%).Conclusions: Patients with ACLR showed asymmetry in strength and biomechanics at RTA. These asymmetries, along with self-perceived function, improved over time. However, despite improvements in strength and biomechanics at RTA, asymmetries of more than 10% were still present more than 12 months post-ACLR.

scholarly journals Contribution of Neuromuscular Factors to Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 53 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Alexa K. Johnson ◽  
Riann M. Palmieri-Smith ◽  
Lindsey K. Lepley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Return To Activity ◽  
Torque Development

Context:  To quantify quadriceps weakness after anterior cruciate ligament reconstruction (ACLR), researchers have often analyzed only peak torque. However, analyzing other characteristics of the waveform, such as the rate of torque development (RTD), time to peak torque (TTP), and central activation ratio (CAR), can lend insight into the underlying neuromuscular factors that regulate torque development. Objective:  To determine if interlimb neuromuscular asymmetry was present in patients with ACLR at the time of clearance to return to activity. Design:  Cross-sectional study. Setting:  Laboratory. Patients or Other Participants:  A total of 10 individuals serving as controls (6 men, 4 women; age = 23.50 ± 3.44 years, height = 1.73 ± 0.09 m, mass = 71.79 ± 9.91 kg) and 67 patients with ACLR (43 men, 24 women; age = 21.34 ± 5.73 years, height = 1.74 ± 0.11 m, mass = 77.85 ± 16.03 kg, time postsurgery = 7.52 ± 1.36 months) participated. Main Outcome Measure(s):  Isokinetic (60°/s) and isometric quadriceps strength were measured. Peak torque, TTP, and RTD were calculated across isometric and isokinetic trials, and CAR was calculated from the isometric trials via the superimposed burst. Repeated-measures analyses of variance were used to compare limbs in the ACLR and control groups. Results:  No between-limbs differences were detected in the control group (P > .05). In the ACLR group, the involved limb demonstrated a longer TTP for isokinetic strength (P = .04; Cohen d effect size [ES] = 0.18; 95% confidence interval [CI] = −0.16, 0.52), lower RTD for isometric (P < .001; Cohen d ES = 0.73; 95% CI = 0.38, 1.08) and isokinetic (P < .001; Cohen d ES = 0.84; 95% CI = 0.49, 1.19) strength, lower CAR (P < .001; Cohen d ES = 0.37; 95% CI = 0.03, 0.71), and lower peak torque for isometric (P < .001; Cohen d ES = 1.28; 95% CI = 0.91, 1.65) and isokinetic (P < .001; Cohen d ES = 1.15; 95% CI = 0.78, 1.52) strength. Conclusions:  Interlimb asymmetries at return to activity after ACLR appeared to be regulated by several underlying neuromuscular factors. We theorize that interlimb asymmetries in isometric and isokinetic quadriceps strength were associated with changes in muscle architecture. Reduced CAR, TTP, and RTD were also present, indicating a loss of motor-unit recruitment or decrease in firing rate.

scholarly journals Quadriceps Function, Knee Pain, and Self-Reported Outcomes in Patients With Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 53 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Adam S. Lepley ◽  
Brian Pietrosimone ◽  
Marc L. Cormier
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Knee Function ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Quadriceps Function ◽  
Return To Activity

Context:  Interactions among muscle strength, pain, and self-reported outcomes in patients with anterior cruciate ligament reconstruction (ACLR) are not well understood. Clarifying these interactions is of clinical importance because improving physical and psychological function is thought to optimize outcomes after ACLR. Objective:  To examine the relationships among neuromuscular quadriceps function, pain, self-reported knee function, readiness to return to activity, and emotional response to injury both before and after ACLR. Design:  Descriptive laboratory study. Patients or Other Participants:  Twenty patients (11 females and 9 males; age = 20.9 ± 4.4 years, height = 172.4 ± 7.5 cm, weight = 76.2 ± 11.8 kg) who were scheduled to undergo unilateral ACLR. Main Outcome Measure(s):  Quadriceps strength, voluntary activation, and pain were measured at presurgery and return to activity, quantified using maximal voluntary isometric contractions (MVICs), central activation ratio, and the Knee Injury and Osteoarthritis Outcome Score pain subscale, respectively. Self-reported knee function, readiness to return to activity, and emotional responses to injury were evaluated at return to activity using the International Knee Documentation Committee questionnaire (IKDC), ACL Return to Sport After Injury scale (ACL-RSI), and Psychological Response to Sport Injury Inventory (PRSII), respectively. Pearson product moment correlations and linear regressions were performed using raw values and percentage change scores. Results:  Presurgical levels of pain significantly predicted 31% of the variance in the ACL-RSI and 29% in the PRSII scores at return to activity. The MVIC and pain collected at return to activity significantly predicted 74% of the variance in the IKDC, whereas only MVIC significantly predicted 36% of the variance in the ACL-RSI and 39% in the PRSII scores. Greater increases in MVIC from presurgery to return to activity significantly predicted 49% of the variance in the ACL-RSI and 59% of the variance in the IKDC scores. Conclusion:  Decreased quadriceps strength and higher levels of pain were associated with psychological responses in patients with ACLR. A comprehensive approach using traditional rehabilitation that includes attention to psychological barriers may be an effective strategy to improve outcomes in ACLR patients.

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