Considerations with Open Kinetic Chain Knee Extension Exercise Following ACL Reconstruction

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

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Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-006-0246-z ◽

2007 ◽

Vol 15 (4) ◽

pp. 402-414 ◽

Cited By ~ 60

Author(s):

Annette Heijne ◽

Suzanne Werner

Keyword(s):

Acl Reconstruction ◽

Patellar Tendon ◽

Outcome Study ◽

Kinetic Chain ◽

Open Kinetic Chain ◽

Late Start ◽

Hamstring Grafts

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Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-007-0313-0 ◽

2007 ◽

Vol 15 (4) ◽

pp. 472-473 ◽

Cited By ~ 3

Author(s):

Annette Heijne ◽

Suzanne Werner

Keyword(s):

Acl Reconstruction ◽

Patellar Tendon ◽

Outcome Study ◽

Kinetic Chain ◽

Open Kinetic Chain ◽

Late Start ◽

Hamstring Grafts

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Characteristics of anterior tibial translation with active and isokinetic knee extension exercise before and after ACL reconstruction

Journal of Orthopaedic Science ◽

10.1007/s007760200057 ◽

2002 ◽

Vol 7 (3) ◽

pp. 341-347 ◽

Cited By ~ 4

Author(s):

Hiroshi Higuchi ◽

Masanori Terauchi ◽

Masashi Kimura ◽

Kenji Shirakura ◽

Masayoshi Katayama ◽

...

Keyword(s):

Acl Reconstruction ◽

Knee Extension ◽

Anterior Tibial Translation ◽

Anterior Tibial ◽

Before And After ◽

Tibial Translation ◽

Knee Extension Exercise

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ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211056873 ◽

2021 ◽

pp. 194173812110568

Author(s):

Alexander W. Brinlee ◽

Scott B. Dickenson ◽

Airelle Hunter-Giordano ◽

Lynn Snyder-Mackler

Keyword(s):

Injury Prevention ◽

Acl Reconstruction ◽

Clinical Data ◽

Practice Guidelines ◽

Cruciate Ligament ◽

Return To Sport ◽

Acl Injury ◽

Quadriceps Strength ◽

Kinetic Chain ◽

Open Kinetic Chain

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians’ current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Evidence Acquisition: Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Study Design: Clinical review. Level of Evidence: Level 5. Results: Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey–Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Conclusion: Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. Strength of Recommendation Taxonomy (SORT): B.

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Motor unit discharge rate and the estimated synaptic input to the vasti muscles is higher in open compared with closed kinetic chain exercise

Journal of Applied Physiology ◽

10.1152/japplphysiol.00310.2019 ◽

2019 ◽

Vol 127 (4) ◽

pp. 950-958 ◽

Cited By ~ 8

Author(s):

Gennaro Boccia ◽

Eduardo Martinez-Valdes ◽

Francesco Negro ◽

Alberto Rainoldi ◽

Deborah Falla

Keyword(s):

Motor Unit ◽

Synaptic Input ◽

Discharge Rate ◽

Knee Extension ◽

Kinetic Chain ◽

Unit Discharge ◽

Leg Press ◽

Motor Unit Discharge ◽

Open Kinetic Chain ◽

Closed Kinetic Chain

Conflicting results have been reported on whether closed kinetic chain exercises (such as a leg press) may induce more balanced activation of vastus medialis (VM) and lateralis (VL) muscles compared with open kinetic chain exercise (such as pure knee extension). This study aimed to 1) compare between-vasti motor unit activity and 2) analyze the combined motor unit behavior from both muscles between open and closed kinetic chain exercises. Thirteen participants (four women, mean ± SD age: 27 ± 5 yr) performed isometric knee extension and leg press at 10, 30, 50, 70% of the maximum voluntary torque. High density surface EMG signals were recorded from the VM and VL and motor unit firings were automatically identified by convolutive blind source separation. We estimated the total synaptic input received by the two muscles by analyzing the difference in discharge rate from recruitment to target torque for motor units matched by recruitment threshold. When controlling for recruitment threshold and discharge rate at recruitment, the motor unit discharge rates were higher for knee extension compared with the leg press exercise at 50% [estimate = 1.2 pulses per second (pps), standard error (SE) = 0.3 pps, P = 0.0138] and 70% (estimate = 2.0 pps, SE = 0.3 pps, P = 0.0001) of maximal torque. However, no difference between the vasti muscles were detected in both exercises. The estimates of synaptic input to the muscles confirmed these results. In conclusion, the estimated synaptic input received by VM and VL was similar within and across exercises. However, both muscles had higher firing rates and estimated synaptic input at the highest torque levels during knee extension. Taken together, the results show that knee-extension is more suitable than leg-press exercise at increasing the concurrent activation of the vasti muscles. NEW & NOTEWORTHY There is a significant debate on whether open kinetic chain, single-joint knee extension exercise can influence the individual and combined activity of the vasti muscles compared with closed kinetic chain, multijoint leg press exercise. Here we show that attempting to change the contribution of either the vastus medialis or vastus lateralis via different forms of exercise does not seem to be a viable strategy. However, the adoption of open kinetic chain knee extension induces greater discharge rate and estimated synaptic input to both vasti muscles compared with the leg press.

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