scholarly journals Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 49 (6) ◽  
pp. 740-746 ◽  
Author(s):  
Christopher M. Kuenze ◽  
Jay Hertel ◽  
Joseph M. Hart
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Maximal Voluntary Isometric Contraction ◽  
Men And Women ◽  
Central Activation Ratio ◽  
Continuous Exercise ◽  
History Of ◽  
Activation Ratio ◽  
Anterior Cruciate

Context : Sex differences in lower extremity neuromuscular function have been reported after anterior cruciate ligament reconstruction (ACLR). Research evidence supports different levels of fatigability in men and women and between patients with ACLR and healthy controls. The influence of sex on the response to continuous exercise in patients with ACLR is not clear. Objective : To compare quadriceps neuromuscular function after exercise between men and women with ACLR. Design : Descriptive laboratory study. Setting : Laboratory. Patients or Other Participants : Twenty-six active volunteers (13 men [50%]: age = 24.1 ± 4.4 years, height = 179.1 ± 9.8 cm, mass = 80.1 ± 9.4 kg, months since surgery = 43.5 ± 37.0; 13 women [50%]: age = 24.2 ± 5.6 years, height = 163.0 ± 5.9 cm, mass = 62.3 ± 8.3 kg, months since surgery = 45.8 ± 42.7) with a history of unilateral primary ACLR at least 6 months earlier. Intervention(s) : Thirty minutes of continuous exercise comprising 5 separate 6-minute cycles, including 5 minutes of uphill walking and 1 minute of body-weight squatting and step-ups. Main Outcome Measure(s) : Normalized knee-extension maximal voluntary isometric contraction torque, quadriceps superimposed-burst torque, and quadriceps central activation ratio before and after exercise. We performed separate 2 (sex: men, women) × 2 (time: preexercise, postexercise) repeated-measures analyses of variance for the 3 variables. Separate, independent-samples t tests were calculated to compare preexercise with postexercise change in all dependent variables between sexes. Results : A significant group-by-time interaction was present for knee-extension torque (P = .04). The percentage reduction in knee-extension maximal voluntary isometric contraction torque (men = 1.94%, women = −10.32%; P = .02) and quadriceps central activation ratio (men = −1.45%, women = −8.69%; P = .03) experienced by men was less than that observed in women. Conclusions : In the presence of quadriceps dysfunction, female participants experienced greater-magnitude reductions in quadriceps function after 30 minutes of exercise than male participants. This indicates a reduced ability to absorb knee-joint loads, which may have significant implications for reinjury and joint osteoarthritis in women after ACLR.

Quadriceps function in anterior cruciate ligament-deficient knees exercising with transcutaneous electrical nerve stimulation and cryotherapy: a randomized controlled study

2012 ◽  
Vol 26 (11) ◽  
pp. 974-981 ◽  
Author(s):  
Joseph M Hart ◽  
Christopher M Kuenze ◽  
Brian G Pietrosimone ◽  
Christopher D Ingersoll
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Exercise Session ◽  
Central Activation ◽  
Central Activation Ratio ◽  
Extension Force ◽  
Activation Ratio ◽  
Anterior Cruciate ◽  
Anterior Cruciate Ligament Deficient

Objective: To compare strength and quadriceps muscle activation in anterior cruciate ligament-deficient patients who underwent a two-week rehabilitation exercise program using TENS or cryotherapy. Design: Randomized, controlled study. Setting: Clinical research laboratory. Subjects: Thirty patients: 20 males, 10 females, 31.6 (13.0) years, 172.8 (10.0) cm, 75.8 (13.0) kg with diagnosed tear of the anterior cruciate ligament. Interventions: All patients attended four sessions of supervised quadriceps strengthening exercises over two weeks, prior to reconstruction surgery. Patients were randomly allocated ( n = 10/group) to receive exercises alone, exercise while wearing a sensory transcutaneous electrical nerve stimulation (TENS) device on the knee joint for the duration of each daily session, or 20 minutes of knee joint cryotherapy immediately prior to each daily exercise session. Main measures: Normalized knee extension force and quadriceps central activation ratio were measured before and after the first supervised treatment session and within 24 hours of the last session. Results: When accounting for differences in baseline measures, there were no statistically significant group differences immediately following the first exercise session for knee extension force ( P = 0.10) or central activation ratio ( P = 0.30) nor were there statistically significant group differences after the two-week intervention for knee extension force ( P = 0.92) or central activation ratio ( P = 0.94). Effect sizes for the change in knee extension force and central activation ratio after two weeks of therapy were all large. Conclusions: Quadriceps strength and central activation in anterior cruciate ligament deficient patients improved after two weeks of rehabilitaiton exercises, however, there were no significant differences between treatment groups.

scholarly journals Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 51 (1) ◽  
pp. 22-27 ◽  
Author(s):  
John Goetschius ◽  
Joseph M. Hart
Keyword(s):  
Anterior Cruciate Ligament ◽  
Motor Control ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Knee Function ◽  
Cruciate Ligament Reconstruction ◽  
History Of ◽  
Anterior Cruciate

Context  When returning to physical activity, patients with a history of anterior cruciate ligament reconstruction (ACL-R) often experience limitations in knee-joint function that may be due to chronic impairments in quadriceps motor control. Assessment of knee-extension torque variability may demonstrate underlying impairments in quadriceps motor control in patients with a history of ACL-R. Objective  To identify differences in maximal isometric knee-extension torque variability between knees that have undergone ACL-R and healthy knees and to determine the relationship between knee-extension torque variability and self-reported knee function in patients with a history of ACL-R. Design  Descriptive laboratory study. Setting  Laboratory. Patients or Other Participants  A total of 53 individuals with primary, unilateral ACL-R (age = 23.4 ± 4.9 years, height = 1.7 ± 0.1 m, mass = 74.6 ± 14.8 kg) and 50 individuals with no history of substantial lower extremity injury or surgery who served as controls (age = 23.3 ± 4.4 years, height = 1.7 ± 0.1 m, mass = 67.4 ± 13.2 kg). Main Outcome Measure(s)  Torque variability, strength, and central activation ratio (CAR) were calculated from 3-second maximal knee-extension contraction trials (90° of flexion) with a superimposed electrical stimulus. All participants completed the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and we determined the number of months after surgery. Group differences were assessed using independent-samples t tests. Correlation coefficients were calculated among torque variability, strength, CAR, months after surgery, and IKDC scores. Torque variability, strength, CAR, and months after surgery were regressed on IKDC scores using stepwise, multiple linear regression. Results  Torque variability was greater and strength, CAR, and IKDC scores were lower in the ACL-R group than in the control group (P < .05). Torque variability and strength were correlated with IKDC scores (P < .05). Torque variability, strength, and CAR were correlated with each other (P < .05). Torque variability alone accounted for 14.3% of the variance in IKDC scores. The combination of torque variability and number of months after surgery accounted for 21% of the variance in IKDC scores. Strength and CAR were excluded from the regression model. Conclusions  Knee-extension torque variability was moderately associated with IKDC scores in patients with a history of ACL-R. Torque variability combined with months after surgery predicted 21% of the variance in IKDC scores in these patients.

scholarly journals Residual deficits in reactive strength indicate incomplete restoration of athletic qualities following anterior cruciate ligament reconstruction in professional soccer players

2020 ◽  
Author(s):  
Paul J. Read ◽  
William T. Davies ◽  
Chris Bishop ◽  
Sean Mc Auliffe ◽  
Mathew G. Wilson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Soccer Players ◽  
Cruciate Ligament Reconstruction ◽  
Hop Test ◽  
History Of ◽  
Anterior Cruciate

Abstract Context: Deficits in plyometric abilities are common following anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. Objective: Examine the utility of a vertical hop test to assess function following ACLR and establish factors associated with performance. Design: Cross-sectional Setting: Rehabilitation Participants: Soccer players with a history of ACLR (N = 73) and matched controls (N = 195) Main outcome measures: 10 second vertical hop test including measures of jump height, reactive strength index (RSI) and asymmetry. We also examined possible predictors of hop performance including single leg vertical drop jump (SLDVJ), isokinetic knee extension strength, and the international knee documentation committee questionnaire. Results: Significant between-limb differences were identified for the ACLR group only and asymmetry scores increased in those with a history of ACLR (P < 0.001) compared to controls. SLDVJ RSI and knee extension torque were significant predictors of 10 second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). Conclusions: Vertical hop deficits are present following ACLR even after completing a comprehensive rehabilitation program. This may be due to reduced knee extension and reactive strength. Vertical hop tests warrant inclusion as part of return to sport test battery.

Clinical Thresholds for Quadriceps Assessment After Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 24 (1) ◽  
pp. 36-46 ◽  
Author(s):  
Christopher Kuenze ◽  
Jay Hertel ◽  
Susan Saliba ◽  
David R. Diduch ◽  
Arthur Weltman ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Roc Curves ◽  
Knee Extension ◽  
Related Function ◽  
Cruciate Ligament Reconstruction ◽  
Good Patient ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Return To Activity

Context:Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear.Objective:To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR.Design:Descriptive laboratory study.Setting:Laboratory.Patients:22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants.Main Outcome Measures:Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function.Results:Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes.Conclusions:Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.

scholarly journals The Utility of Functional Data Analyses to Reveal Between-Limbs Asymmetries in Those With a History of Anterior Cruciate Ligament Reconstruction

2021 ◽  
Author(s):  
McKenzie S. White ◽  
William Z. Horton ◽  
Julie P. Burland ◽  
Matthew K. Seeley ◽  
Lindsey K. Lepley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Data ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Data Analyses ◽  
History Of ◽  
Anterior Cruciate ◽  
Single Time Point ◽  
Time Point

Context Researchers have traditionally used motion capture to quantify discrete biomechanical data points (peak values) during hop testing. However, these analyses restrict the evaluation to a single time point (ie, certain percentage of stance) and provide only a narrow view of movement. Applying more comprehensive analyses may help investigators identify important characteristics that are masked by the discrete analyses often used to screen patients for activity. Objective To examine the utility of functional data analyses to reveal asymmetries that are undetectable using discrete (ie, single time point) evaluations in participants with a history of anterior cruciate ligament reconstruction (ACLR) who achieved clinical hop symmetry. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Fifteen participants with unilateral ACLR (age = 21 ± 3 years, time from surgery = 4 ± 3 years) and 15 control participants without ACLR (age = 23 ± 2 years). Intervention(s) Lower extremity biomechanics during the triple–hop-for-distance task for the ACLR and contralateral limbs of patients and a representative limb of control participants were measured. Main Outcome Measure(s) Peak sagittal-plane joint power, joint work, and power profiles were determined. Results Using discrete analyses, we identified lower peak knee power and work in the ACLR limb compared with the contralateral and control limbs (P < .05) but were unable to demonstrate differences at the ankle or hip. Using functional data analyses, we observed asymmetries at the ankle, knee, and hip between the ACLR and contralateral or control limbs throughout stance (P < .05) and revealed that these asymmetries stemmed from knee power deficits that were prominent during early loading. Conclusions Despite achieving hop-distance symmetry, the ACLR limbs absorbed less power. Although this information was revealed using the discrete analyses, underlying asymmetries at the ankle and hip were masked. Using functional data analyses, we found interlimb asymmetries at the ankle, knee, and hip throughout ground contact and more fully elucidated the extent and source of asymmetries that can be used by clinicians and researchers alike to guide clinical decision making.

scholarly journals Hip and Knee Kinematics and Kinetics During Landing Tasks After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 53 (2) ◽  
pp. 144-159 ◽  
Author(s):  
Adam S. Lepley ◽  
Christopher M. Kuenze
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Knee Extension ◽  
Injured Limb ◽  
Reaction Forces ◽  
Vertical Ground ◽  
Anterior Cruciate ◽  
Vertical Ground Reaction Forces ◽  
Kinematics And Kinetics

Objective:  To evaluate the current evidence concerning kinematic and kinetic strategies adopted during dynamic landing tasks by patients with anterior cruciate ligament reconstruction (ACLR). Data Sources:  PubMed, Web of Science. Study Selection:  Original research articles that evaluated kinematics or kinetics (or both) during a landing task in those with a history of ACLR were included. Data Extraction:  Methodologic quality was assessed using the modified Downs and Black checklist. Means and standard deviations for knee or hip (or both) kinematics and kinetics were used to calculate Cohen d effect sizes and corresponding 95% confidence intervals between the injured limb of ACLR participants and contralateral or healthy matched limbs. Data were further stratified by landing tasks, either double- or single-limb landing. A random-effects–model meta-analysis was used to calculate pooled effect sizes and 95% confidence intervals. Data Synthesis:  The involved limbs of ACLR patients demonstrated clinically and significantly lower knee-extension moments during double-legged landing compared with healthy contralateral limbs and healthy control limbs (Cohen d range = −0.81 to −1.23) and decreased vertical ground reaction forces when compared with healthy controls, regardless of task (Cohen d range = −0.39 to −1.75). Conclusions:  During single- and double-legged landing tasks, individuals with ACLR demonstrated meaningful reductions in injured-limb knee-extension moments and vertical ground reaction forces. These findings indicate potential unloading of the injured limb after ACLR, which may have significant implications for secondary ACL injury and long-term joint health.

Change in Drop-Landing Mechanics Over 2 Years in Young Athletes After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (11) ◽  
pp. 2608-2616 ◽  
Author(s):  
Matthew P. Ithurburn ◽  
Mark V. Paterno ◽  
Staci Thomas ◽  
Michael L. Pennell ◽  
Kevin D. Evans ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Knee Extension ◽  
Trunk Flexion ◽  
Young Athletes ◽  
Vertical Ground Reaction Force ◽  
Drop Landing ◽  
Vertical Ground ◽  
Anterior Cruciate

Background: While between-limb landing asymmetries after anterior cruciate ligament reconstruction (ACLR) are linked with poor function and risk of additional injury, it is not currently understood how landing symmetry changes over time after ACLR. Purpose/Hypothesis: The purpose was to investigate how double-legged drop vertical jump (DVJ) landing and single-legged drop-landing symmetry changed from the time of return-to-sport (RTS) clearance to 2 years later in a prospective cohort of young athletes after ACLR. It was hypothesized that double-legged DVJ landing and single-legged drop-landing symmetry would improve from the time of RTS to 2 years later. Study Design: Descriptive laboratory study. Methods: The authors followed 64 young athletes with primary, unilateral ACLR for 2 years after RTS clearance. At the time of RTS and 2 years later, between-limb symmetry values for biomechanical variables of interest (VOIs) were calculated with 3-dimensional motion analysis during double-legged DVJ and single-legged drop-landing tasks. VOIs included knee flexion excursion, peak internal knee extension moment, peak vertical ground-reaction force, and peak trunk flexion (for single-legged task only). Symmetry values and proportions of participants meeting 90% symmetry cutoffs were compared between time points. Results: For double-legged DVJ landing, symmetry values for all VOIs and the proportions meeting 90% cutoffs for peak internal knee extension moment and peak vertical ground-reaction force were higher at 2 years after RTS as compared with RTS. For single-legged drop-landing, symmetry values were higher for knee flexion excursion and lower for peak trunk flexion at 2 years after RTS as compared with RTS, but the proportions meeting 90% cutoffs for all VOIs did not differ between time points. Conclusion: Double-legged DVJ landing symmetry improved across VOIs over the 2 years after RTS following ACLR, while single-legged drop-landing did not improve as consistently. The implications of longitudinal landing asymmetry after ACLR should be further studied.

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