Influence of patellar ligament insertion angle on quadriceps usage during walking in anterior cruciate ligament reconstructed subjects (original) (raw)
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Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees
Journal of Biomechanics, 2010
This study tested the hypotheses that in patients with a successful anterior cruciate ligament (ACL) reconstruction, the internal-external rotation, varus-valgus, and knee flexion position of reconstructed knees would be different from uninjured contralateral knees during walking. Twentysix subjects with unilateral ACL reconstructions (avg 31 yrs, 1.7 m, 68 kg, 15 female, 24 mo past reconstruction) and no other history of serious lower limb injury walked at a self-selected speed in the gait laboratory, with the uninjured contralateral knee as a matched control. Kinematic measurements of tibiofemoral motion were made using a previously-described point-cluster technique. Repeated-measures ANOVA (α=0.017) was used to compare ACL-reconstructed knees to their contralateral knees at four distinct points during the stance phase of walking. An offset towards external tibial rotation in ACL-reconstructed knees was maintained over all time points (95% CI 2.3±1.3°). Twenty-two out of twenty-six individuals experienced an average external tibial rotation offset throughout stance phase. Varus-valgus rotation and knee flexion were not significantly different between reconstructed and contralateral knees. These findings show that differences in tibial rotation during walking exist in ACL reconstructed knees compared to healthy contralateral knees, providing a potential explanation why these patients are at higher risk of knee osteoarthritis in the long-term.
Quadriceps Function in ACL Reconstructed Patients With and Without Knee Osteoarthritis
Post-traumatic quadriceps dysfunction is well-documented following anterior cruciate ligament reconstruction (ACL-R), and is associated with impairments detrimental to joint-specific and global health, including decreased physical activity, accelerated onset of knee joint osteoarthritis, and decreased quality of life. Since articular cartilage degeneration is irreversible, the hallmark for prevention is early detection with thorough evaluation of quadriceps neuromuscular function. Neuromuscular adaptations are theorized to arise from alterations in spinal-mediated and corticospinal pathways, and if unaddressed, may present a limiting factor in recovery from ACL-R. The specific origins of impairment have been theorized as a way to address subtle underlying factors impeding the recovery of quadriceps function following ACL-R. By understanding the temporal nature of neuromuscular adaptations, clinicians and researchers can improve patient care. The focus of manuscript 1 was to compare quadriceps neuromuscular function at clinically relevant time points following ACL-R, including patients who experienced post-traumatic knee osteoarthritis. We found that patients early (< 1 year), late (> 2 years), and with osteoarthritis after ACL-R exhibited quadriceps weakness and decreased corticospinal input to the quadriceps compared to healthy individuals. The focus of manuscript 2 was to identify the relationship between objective measures of quadriceps function and patient-reported outcomes at clinically relevant time points following ACL-R, including patients who experienced post-traumatic knee osteoarthritis. We found that perceived knee function and global health status were best explained by objective measures of quadriceps function in patients early and with osteoarthritis after ACL-R. Both limb symmetry and unilateral limb performance were meaningful to patients early, and unilateral limb performance was meaningful to patients with osteoarthritis after ACL-R. Measures of isokinetic quadriceps strength (torque, work, power) consistently demonstrated the strongest relationships with patient-reported outcomes. The focus of manuscript 3 was to investigate the underlying constructs of lower extremity muscle function that uniquely describe aspects of quadriceps neuromuscular function in patients after ACL-R. We found that unique constructs of peripheral, central, and combined peripheral and central muscle function are likely to exist in ACL-R patients. Quadriceps function (total work at 90°/sec, active motor threshold, and central activation) of the involved limb was able to discriminate best between ACL-R patients and healthy individuals compared to the uninvolved limb or limb symmetry. It is unclear if early changes in strength, endurance, voluntary activation, and corticospinal excitability perpetuate long-term muscle dysfunction; however, the temporal relationships of these measures may be a contributing factor to long-term outcomes. If left unaddressed, the progressive nature of contributing factors may result in irreversible joint injury.
Gait knee kinematics after ACL reconstruction: 3D assessment
International Orthopaedics, 2014
Purpose While many studies about anterior-cruciateligament-deficient (ACLD) patients have demonstrated functional adaptations to protect the knee joint, an increasing number of patients undergo ACL reconstruction (ACLR) surgery in order to return to their desired level of activity. The purpose of this study was to compare 3D kinematic patterns between individuals having undergone ACLR with their healthy contralateral knee and a control group. Methods Three-dimensional kinematic data were obtained from 15 patients pre-and post-ACLR, 15 contralateral knees and 15 healthy controls. Data were recorded during treadmill walking at self-selected speed. Flexion/ extension, external/internal tibial rotation, adduction/ abduction and anterior/posterior tibial translation were compared between groups. Results ACLR knees showed a significantly higher kneejoint extension during the entire stance phase compared with ACLD knees. However, ACLR knees still showed a deficit of extension compared with healthy control knees. In the axial plane, there was no significant difference in pre-and postoperative kinematic data. Significant difference was achieved between ACLR knees and healthy control knees, specifically between 28 and 34 % and 44 and 54 % of the gait cycle. There was no significant difference in anterior-posterior translation or coronal plane between groups. Conlusion Following ACL reconstruction, patients have better clinical and kinematic parameters. Despite improvements, knee kinematics during gait in the ACLR group differed from the control group. These kinematic changes could lead to abnormal loading in the knee joint and initiate the process for future chondral degeneration.
Clinical Predictors of Knee Mechanics at Return to Sport after ACL Reconstruction
Medicine and Science in Sports and Exercise, 2016
Purpose-Despite significant rehabilitation, many athletes experience protracted weakness and faulty mechanics following anterior cruciate ligament reconstruction (ACLR). Clinical tests performed early in rehabilitation that predict knee mechanics at return-to-sport are virtually unknown and critically needed to guide clinical decision making. The purpose of this study is to determine if quadriceps strength, Y-Balance anterior reach distance (YB-A), and single-limb stepdown test performance (SLSD) conducted 3 months post-ACLR are predictive of knee flexion excursion (KFLEX) and knee extensor moment (KEM) during running 6 months post-ACLR. Methods-Thirty (16 F) subjects were collected 3 and 6 months post-ACLR. Age 21.3±7.6 years, mass 69.85±11.4 kg, height 1.73±0.09 m. At 3 months post-ACLR, subjects performed isometric quadriceps strength testing, YB-A, and SLSD assessments. At 6 months post-ACLR, subjects underwent 3-D motion analysis while running on an instrumented treadmill. Pearson's correlation coefficients and stepwise multiple regression were used to assess the relationships of 3 month and 6 month variables. Results-Quadriceps strength (r=.493, p<0.01), YB-A (r=.394, p=0.03), and SLSD (r=.648, p<0.01) were significantly correlated to KFLEX. Quadriceps strength (.505, p<0.01) and SLSD (. 541, p<0.01) were significantly correlated with KEM, while YB-A (.276, p=0.06) was not. SLSD and quadriceps strength were predictive of KEM (Adj R 2 .36, p=.001) while only SLSD was predictive of KFLEX (Adj R 2 .40, p<.001). Conclusions-After ACLR, better performance in SLSD and quadriceps strength 3 months post-surgery is predictive of improved sagittal plane knee mechanics during running 6 months post-surgery.
The purpose of this study was to examine the relationship among isokinetic knee extensor strength in 60°/sec, hop and vertical jump strength tests, and to determine differences between the involved and uninvolved leg in soccer players after anterior cruciate ligament (ACL) reconstruction. Materials and methods: Thirty-seven soccer players (mean age: 25.16±6.5 years) who had undergone arthroscopic ACL reconstruction using bone-patellar tendon-bone at a 6 month follow-up participated into isokinetic measurement in 60°/sec (CYBEX 6000), hop and vertical jump (VJ) strength tests including involved and uninvolved leg. Mean time for testing was 26 weeks following surgery. Results: Uninvolved leg test results were better then involved leg results (p<0.05). Correlation coefficients between 60°/sec extensor peak torque (PT) and hop test results with involved and uninvolved legs were r= .38 (p<0.05), r=0.60 (p<0.01), respectively. Correlation coefficients between 60°/sec extensor PT and VJ test results with involved and uninvolved legs were r=0.22 (p>0.05), r=0.15 (p>0.05), respectively. The mean quadriceps muscle strength of the injured side was 75 % of that of the uninjured side. Conclusion: The results of this study suggested that knee extensor strength and hop tests of both sides were effective in the functional performance of the lower limb following ACL reconstruction. Knee functions tests were suggested as a reference guide for the outcome of rehabilitation program.
Journal of Sports Sciences, 2018
The purposes of this study were to analyse (a) if "angle-specific" (AS) flexor and extensor torques were different between ACL-reconstructed and uninvolved limbs, (b) the difference in peak torque occurrence angles for concentric and eccentric knee flexor and extensor torques between involved and uninvolved limbs and (c) if AS concentric and eccentric knee flexor and extensor torques are determinants of performance in the "single-leg hop test" (SLHT) and "vertical jump and reach test" (VJRT) in ACL-reconstructed legs. Twenty-seven male ACL-reconstructed volunteers were included in the study. Isokinetic knee muscle strength, SLHT and VJRT were performed 6 months after ACL reconstruction. No difference was found in extremity and knee joint angle interaction for concentric and eccentric flexor and extensor torques (p > 0.05). Peak torque occurrence angles were not different between involved and uninvolved limbs (p > 0.05). In involved extremities, concentric knee extensor strength at 90°was a determinant of SLHT performance (R 2 = 0.403, p < 0.05), and concentric knee extensor strength at 60°w as a determinant of VJRT (R 2 = 0.224, p < 0.05). Assessment of AS concentric knee extensor strength at 60°and 90°might be important, because these were determinants of functional test performance.