Early Quadriceps Wasting after Anterior Cruciate Ligament Reconstruction in Young Adults: A Prospective Study

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. The weakness of quadriceps muscle is a sequele of ACL tear that can persist even after reconstruction. Muscle wasting if identified in early postoperative period can help to formulate structured protocols for rehabilitation that can help patient to recover. Best available method for scan of the same includes Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, but it is neither accessible nor affordable to masses of population. Aim: To evaluate the quadriceps thickness using an easily available modality i.e., Ultrasonography (USG) and thigh circumference to detect early wasting. Materials and Methods: This prospective longitudinal study was done on 48 patients between the ages of 18-45 years with ACL tear operated arthroscopically. After six months of surgery, all patients were evaluated for quadriceps thickness using USG and thigh circumference using traditional measuring tape at the same points. Paired t-test was used for evaluation of the results. Results: This study quantifies quadriceps thickness using USG at two distinct levels of the thigh and found a significant deficit of 13.05% in the involved extremity at 1/3rd of femur length from knee joint and a deficit of 11.72% in involved extremity at 2/3rd of femur length from knee joint. This study established that the quadriceps of the involved extremity definitely goes under atrophy despite early rehabilitation. Also, there was a deficit of 5.04% in thigh circumference at 1/3rd of femur length from knee joint and 4.43% at 2/3rd of femur length from knee joint in the operated limb. There was no positive correlation between both the methods. Conclusion: This study concluded that USG is an easily available and affordable method to determine quadriceps thickness and it’s wasting early in the postoperative rehabilitation phase. It can assist in establishing early vigorous rehabilitation protocols. The traditional method of measuring thigh circumference using measuring tape to quantify quadriceps muscle bulk can be misleading as its underestimates the atrophy due to various factors.

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Quadriceps Muscle Function After Rehabilitation With Cryotherapy in Patients With Anterior Cruciate Ligament Reconstruction

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.39 ◽

2014 ◽

Vol 49 (6) ◽

pp. 733-739 ◽

Cited By ~ 25

Author(s):

Joseph M. Hart ◽

Christopher M. Kuenze ◽

David R. Diduch ◽

Christopher D. Ingersoll

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Muscle Function ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

Intervention Period ◽

Maximal Voluntary Isometric Contraction ◽

P 16 ◽

Anterior Cruciate ◽

Rehabilitation Exercises

Context: Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. Objective: To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. Intervention(s): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. Main Outcome Measure(s): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period. Results: After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). Conclusions: After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.

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Water Treadmill Therapy After Reconstruction of the Anterior Cruciate Ligament ACL – Case Report

Acta Balneologica ◽

10.36740/abal202002105 ◽

2020 ◽

Vol 62 (2) ◽

pp. 99-102

Author(s):

Agnieszka Maruszewska ◽

Lech Panasiuk

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Cruciate Ligament ◽

Full Range ◽

Mass Gain ◽

Quadriceps Muscle ◽

Lower Limbs ◽

Knee Ligament ◽

Anterior Cruciate ◽

Water Treadmill

Introduction: The knee joint is one of the most commonly injured joints, especially among physically active persons. In turn, the anterior cruciate ligament (ACL) is the knee ligament which is most frequently torn. Water treadmill therapy is one of the forms of rehabilitation available for patients after ACL reconstruction. Materials and Method: The case of a 38-year-old woman is presented who during parachute jumping sustained injury to the knee joint on landing. Using the magnetic resonance imaging (MRI) a tear of the ACL was diagnosed. Physiotherapeutic examination was performed: palpation and visual observation of both knee joints: assessment of position of the patella and the axes of the lower limbs, assessment of joint temperature, patella ballottement sign, and tenderness. In order to objectively monitor the progress of therapy measurements were taken of the circumference of the lower limbs, and pain complains assessed according to the VAS scale. Eight weeks after reconstruction of the anterior cruciate ligament, the patient underwent 30 treadmill therapy treatments. Results: Quadriceps muscle mass gain and reduction of the knee joint swelling were observed. Full range of knee joint motion was confirmed, and lack of pain in the medial compartment of the knee joint. Conclusions: Water treadmill therapy is an effective supplementation of the process of patient rehabilitation after reconstruction of the anterior cruciate ligament.

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Impact of Physiotherapy rehabilitation program on postoperative ACL tear patient on prognosis leading to maintain consistency in sport

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2777 ◽

2020 ◽

Vol 11 (3) ◽

pp. 4821-4825

Author(s):

Prasad Risaldar ◽

Akshata Raut ◽

Dushyant Bawiskar ◽

Waqar M. Naqvi

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Cruciate Ligament ◽

Rehabilitation Program ◽

Clinical Findings ◽

Acl Tear ◽

Anterior Cruciate ◽

Typical Treatment ◽

Joint Integrity ◽

Loss Of Strength

Anterior cruciate ligament (ACL) injury is a devastating injury that occurs at high frequency during involvement in competitive sporting activity. Typical treatment of ACL damage is a reconstruction of the anterior cruciate ligament (ACLR). It is projected that between 50 percent and 60 percent of ACL injured athletes will return to competitive sport. Athletes undergoing ACLR surgery are recommended for comprehensive rehab and preparedness to rebuild knee joint integrity and specific functional criteria to direct the comeback to sport to protect against secondary ACL damage.Patient main concerns were pain, with loss of strength and stability at the knee joint, the clinical findings found that there was a marked decrease in range of motion (ROM), and decreased strength of the quadriceps and the hamstrings.Diagnosis of case was grade 2 ACL tear which was confirmed by the MRI reports.The patient showed a great co-operation during the intervention period and now the subject is able to maintain his consistency in his sport. The outcome measures of physical therapy intervention progressed him in an enhanced athlete with return to his sport.

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Femur-tibia Angle and Patella-tibia Angle: New Indicators for Diagnosing Anterior Cruciate Ligament Tears in Magnetic Resonance Imaging

10.21203/rs.3.rs-751415/v1 ◽

2021 ◽

Author(s):

Zeng Li ◽

Mengyuan Li ◽

Yan Du ◽

Hai Jiang ◽

Yuanchen Ma ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Cruciate Ligament ◽

Area Under The Curve ◽

Roc Curves ◽

Youden Index ◽

Control Group ◽

Acl Tear ◽

Anterior Cruciate ◽

Arthroscopic Knee

Abstract Background: Torn anterior cruciate ligament (ACL) contributes to internal rotation of tibia. However, there is no indicator in MRI to reflect the rotation of knee joint. So the purpose of this study is to introduce two new measurements in MRI, femur-tibia angle (FTA) and patella-tibia angle (PTA), which reflect the rotation of knee joint and assess their role in diagnosing ACL tears.Methods: Present study retrospectively reviewed the cases of primary arthroscopic knee surgery from January 2018 to December 2019 from the Arthroscopy Database at Guangdong Provincial People's Hospital. Firstly, comparisons of different measurements were conducted between the ACL tears group and isolated meniscus injury group. Then, the measurements were tested in diagnosing complete or partial ACL tears. Diagnostic performance of different measurements was assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve and cutoff values were determined by Youden index. Results: FTA and PTA in ACL tears group had 4.79 and 7.36 degrees more than that of control group (p = 0.022 and < 0.001, respectively). Besides, ACL angle and distance of anterior tibial subluxation (D) also showed significant differences (p<0.05). In distinguishing complete ACL tear with intact ACL, the ROC curves indicated that ACL angle had the highest AUC of 0.906 (95% CI: 0.833-0.978) while AUC of PTA was 0.849 (95% CI: 0.763-0.936) and AUC of FTA was 0.809 (95% CI: 0.710-0.908). In distinguishing partial ACL tear with intact ACL, the ROC curves showed that FTA and PTA had the highest AUCs of 0.847 and 0.813 with 95% CI of 0.737-0.957 and 0.680-0.947, respectively. In contrast, the AUCs of ACL angle and D were only 0.519 and 0.387 with 95% CI of 0.292-0.745 and 0.227-0.546.Conclusion: Present study introduced two new quantitative parameters, FTA and PTA, to assess the rotation of knee joint. FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear with intact ACL which was poorly diagnosed in MRI.

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Orthopedic Anterior Cruciate Ligament Evaluator (OR.A.C.L.E): A Preliminary Design

Volume 3: Biomedical and Biotechnology Engineering ◽

10.1115/imece2015-50929 ◽

2015 ◽

Author(s):

Davide Piovesan ◽

David Church ◽

Sean Herron ◽

Calvin Oldham ◽

Mollie Sebald ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Physical Examination ◽

Physical Therapist ◽

Cruciate Ligament ◽

Rapid Prototype ◽

Cost Effective ◽

Acl Tear ◽

Anterior Cruciate ◽

Injured Knee

An anterior cruciate ligament (ACL) tear is one of the most prominent, and debilitating injuries currently to athletes. Physical therapist students need to be able to practice common physical examination techniques regularly and repeatedly in order to gain the skills necessary to accurately diagnose an ACL tear. A cost effective, adjustable knee apparatus that could mimic the behavior of both a healthy and an injured knee joint may mitigate this problem. We built an apparatus mimicking the geometry and function of a knee joint, including the effect of forces and stiffness proper of knee ligaments. SimWise 4D was used to dynamically simulate an anatomically approximated model of the knee joint during physical examination conditions. The numerical simulation tested the displacement between the femur and the tibia with and without an ACL ligament. The SimWise 4D simulation gave an increase in displacement of 1.58 mm or 30% after removing the ACL, which is comparable with known displacements in human test subjects. Finally, a design for a 3D rapid prototype is proposed and fabricated with fusion deposition modeling (FDM).

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The Analysis of Proprioception Alteration during First Five Months after Anterior Cruciate Ligament Reconstruction

Baltic Journal of Sport and Health Sciences ◽

10.33607/bjshs.v1i84.293 ◽

2018 ◽

Vol 1 (84) ◽

Author(s):

Vilma Jurevičienė ◽

Albertas Skurvydas ◽

Juozas Belickas ◽

Giedra Bušmanienė ◽

Dovilė Kielė ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Angular Velocity ◽

Knee Joint ◽

Cruciate Ligament ◽

Position Sense ◽

Joint Position Sense ◽

Joint Position ◽

Starting Position ◽

Angular Velocities ◽

Anterior Cruciate

Research background and hypothesis. Proprioception is important in the prevention of injuries as reduced proprioception is one of the factors contributing to injury in the knee joint, particularly the ACL. Therefore, proprioception appears not only important for the prevention of ACL injuries, but also for regaining full function after ACL reconstruction.Research aim. The aim of this study was to understand how proprioception is recovered four and five months after anterior cruciate ligament (ACL) reconstruction.Research methods. The study included 15 male subjects (age – 33.7 ± 2.49 years) who had undergone unilateral ACL reconstruction with a semitendinosus/gracilis (STG) graft in Kaunas Clinical Hospital. For proprioceptive assessment, joint position sense (JPS) was measured on both legs using an isokinetic dynamometer (Biodex), at knee flexion of 60° and 70°, and at different knee angular velocities of 2°/s and 10°/s. The patients were assessed preoperatively and after 4 and 5 months, postoperatively.Research results. Our study has shown that the JPS’s (joint position sense) error scores to a controlled active movement is significantly higher in injured ACL-deficient knee than in the contralateral knee (normal knee) before surgery and after four and five months of rehabilitation. After 4 and 5 months of rehabilitation we found significantly lower values in injured knees compared to the preoperative data. Our study has shown that in injured knee active angle reproduction errors after 4 and 5 months of rehabilitation were higher compared with the ones of the uninjured knee. Proprioceptive ability on the both legs was independent of all differences angles for target and starting position for movement. The knee joint position sense on both legs depends upon the rate of two different angular velocities and the mean active angle reproduction errors at the test of angular velocity slow speed was the highest compared with the fast angular velocity. Discussion and conclusions. In conclusion, our study shows that there was improvement in mean JPS 4 and 5 months after ACL reconstruction, but it did not return to normal indices.Keywords: knee joint, joint position sense, angular velocity, starting position for movement.

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Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0039-1700495 ◽

2019 ◽

Author(s):

Willem M.P. Heijboer ◽

Mathijs A.M. Suijkerbuijk ◽

Belle L. van Meer ◽

Eric W.P. Bakker ◽

Duncan E. Meuffels

Keyword(s):

Anterior Cruciate Ligament ◽

Linear Regression ◽

Multiple Linear Regression ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Linear Regression Analysis ◽

Multiple Linear Regression Model ◽

Gracilis Tendon ◽

Thigh Circumference ◽

Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

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