Quadriceps and Patient-Reported Function in ACL-Reconstructed Patients: A Principal Component Analysis

Norte, Grant E.; Hertel, Jay; Saliba, Susan A.; Diduch, David R.; Hart, Joseph M.

doi:10.1123/jsr.2017-0080

Cited by 17 publications

(20 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…27,28 Therefore, we conducted subanalyses using surgical-limb values to complement our analyses using symmetry measures. Consistent with the findings of Norte at al, 32 we identified stronger associations between strength and functional outcomes than limb-symmetry indices in the surgical limb. Particularly for the association between strength and hop-test results, the results justified the use of surgical-limb values.…”

Section: Neuromuscular Deficitssupporting

confidence: 91%

Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction

Hunnicutt

McLeod

Slone

et al. 2020

Journal of Athletic Training

View full text Add to dashboard Cite

Context Persistent neuromuscular deficits in the surgical limb after anterior cruciate ligament reconstruction (ACLR) have been repeatedly described in the literature, yet little is known regarding their association with physical performance and patient-reported function. Objective To describe (1) interlimb differences in neuromuscular and functional outcomes and (2) the associations of neuromuscular outcomes with measures of physical and knee-related patient-reported function. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Thirty individuals after primary, unilateral ACLR (19 males; age = 21.5 years [range, 14–41 years]; 8 months [range = 6–23 months] postsurgery). Main Outcome Measure(s) Knee-extensor isometric and isokinetic peak torque was measured with an isokinetic dynamometer. Cross-sectional area (CSA) was measured bilaterally for each of the quadriceps muscles via magnetic resonance imaging. We measured quadriceps central activation bilaterally via the superimposed-burst technique. Physical performance (single-legged hop tests, step length via spatiotemporal gait analysis) and patient-reported outcomes (International Knee Documentation Committee questionnaire and Knee Injury and Osteoarthritis Outcome Score Sport and Recreation subscale) were also recorded. We conducted Wilcoxon signed rank tests to identify interlimb differences. Spearman ρ correlation analyses revealed associations between limb symmetry and neuromuscular and functional outcomes, as well as with patient-reported function. Results Deficits in the surgical limb as compared with the nonsurgical limb were present for all outcomes (P values < .05). Greater single-legged hop-test symmetry (83%) was significantly correlated with greater symmetry in knee-extensor isometric (63%; rs = 0.567, P = .002) and isokinetic (68%; rs = 0.540, P = .003) strength, as well as greater cross-sectional area of the vastus medialis (78%; rs = 0.519, P = .006) and vastus lateralis (82%; rs = 0.752, P < .001). A higher International Knee Documentation Committee questionnaire score (82.2) was significantly correlated with greater symmetry in knee-extensor isokinetic strength (rs = 0.379, P = .039). Conclusions Although deficits were observed in the surgical limb for all neuromuscular measures, greater symmetry in the size and strength of the quadriceps, rather than activation, was more strongly associated with physical performance after ACLR. Greater symmetry in strength was also more strongly associated with patient-reported function.

show abstract

Section: Neuromuscular Deficitssupporting

confidence: 91%

Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction

Hunnicutt

McLeod

Slone

et al. 2020

Journal of Athletic Training

View full text Add to dashboard Cite

show abstract

“…Isokinetic, concentric knee extensor strength was measured at 90°/s from a Biodex System 3 Dynamometer (Biodex Inc Shirley, NY) as previously described. 13 The patients were seated in 85 degrees of hip flexion with their arms across the chest and a lap belt worn for the duration of testing. The patients performed as many warm-up trials at 90°/s until they were familiar and comfortable with the task.…”

Section: Knee Extensor Strengthmentioning

confidence: 99%

“…The H-reflex was used to quantify spinal-mediated inhibition of the vastus medialis (VM) using the same methods as previously described. 13 The distal VM was shaved, cleaned, and debrided, prior to placing two surface electromyography (EMG) electrodes to the skin. A ground-electrode was placed over the distal anteromedial tibia of the contralateral limb.…”

Section: Spinal Reflex Excitabilitymentioning

confidence: 99%

“…Active motor threshold was used to quantify corticospinal excitability of the VM using transcranial magnetic stimulation as previously described. 13 Patients were seated in the dynamometer at 85 degrees of hip flexion and 90 degrees of knee flexion. For all trials, the patient was asked to match an isometric knee extension force equal to 5% of their previously established MVIC.…”

Section: Corticospinal Excitabilitymentioning

confidence: 99%

“…12 Decreased measures of quadriceps strength, low voluntary activation, and impaired measures of spinal and corticospinal excitability have been reported following ACLR compared to healthy, active controls. 13,14 Spinalmediated adaptations have been reported to resolve within 6 months; however, corticospinal impairments develop and persist beyond this time point. 15 Conflicting evidence has been reported regarding the relationships between measures of corticospinal excitability and quadriceps function, 14,16 which may be due to the broad range of time since surgery within the participants in these studies (54.4 ± 40.9 months).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL‐reconstruction

Bodkin

Norte

Hart

2019

Scandinavian Med Sci Sports

Self Cite

View full text Add to dashboard Cite

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.Purpose: To investigate relationships between quadriceps strength and neural activity, and to establish a clinical threshold of corticospinal excitability able to discriminate between patients with quadriceps strength indicative of satisfactory and unsatisfactory knee function after ACLR. Methods: A total of 29 patients following primary, unilateral ACL-reconstruction (11 female, 23.2 ± 8.1 years of age, 7.3 ± 2.5 months since surgery) participated.Subjective knee function was quantified using the International Knee Documentation Committee (IKDC) subjective evaluation. Peak isokinetic knee extensor torque was assessed at 90°/s. Quadriceps corticospinal excitability was quantified via active motor threshold (AMT, %2-Tesla) using transcranial magnetic stimulation during a 5% maximal voluntary isometric contraction of the quadriceps. Pearson's r correlations were used to assess the relationship between peak knee extensor torque and AMT. Receiver operating characteristic (ROC) curves were used to establish a threshold of (a) mass-normalized peak knee extensor torque to discriminate satisfactory knee function (IKDC ≥ 75.9%), and (b) AMT to discriminate quadriceps strength indicative of satisfactory knee function. Likelihood ratios (LR) and the magnitude of change in pre-post-test probability were calculated for each threshold. Results: Active motor threshold was negatively correlated with mass-normalized peak knee extensor torque (r = −0.503, P = 0.005). Knee extensor torque ≥1.23 Nm/ kg was an excellent discriminator of satisfactory knee function (AUC = 0.890, P = 0.002; (+)LR = 9.56). An AMT ≤50.5% was an excellent discriminator of quadriceps strength indicative of satisfactory knee function following ACLR (AUC = 0.839, P = 0.005; (+)LR = 23.75). Conclusion: Lower corticospinal excitability was associated with lower quadriceps strength. An AMT above 50.5% was found to decrease the probability of having satisfactory knee strength by over 62%. K E Y W O R D Santerior cruciate ligament, arthrogenic muscle inhibition, muscle function, patient acceptable symptom state, return to play | 717 BODKIN et al.

show abstract

Quadriceps muscle function following anterior cruciate ligament reconstruction: systemic differences in neural and morphological characteristics

et al. 2019

View full text Add to dashboard Cite

Quadriceps and Patient-Reported Function in ACL-Reconstructed Patients: A Principal Component Analysis

Cited by 17 publications

References 29 publications

Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction

Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction

Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL‐reconstruction

Quadriceps muscle function following anterior cruciate ligament reconstruction: systemic differences in neural and morphological characteristics

Contact Info

Product

Resources

About