A Dynamic Test of Lower Extremity Function Following Anterior Cruciate Ligament Reconstruction and Rehabilitation

Juris, Paul M.; Phillips, Edward M.; Dalpe, Chantell; Edwards, Christina; Gotlin, Robert S.; Kane, Daniel J.

doi:10.2519/jospt.1997.26.4.184

Cited by 60 publications

(42 citation statements)

References 9 publications

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“…21 In the ACLR group, LSI was calculated as shown in Equation 2. Limb symmetry indices greater than 1.00 indicate that the ACLR limb had a greater value for a specific measure than the contralateral limb.…”

Section: Limb Symmetry Indexmentioning

confidence: 99%

“…Between-limbs differences, often referred to as limb asymmetry, have been proposed as a more effective manner to assess lower extremity dysfunction after knee-joint injury. 18,19 Reductions in quadriceps strength, 4,20 functional performance, 21,22 and gait symmetry 23 have been reported after anterior cruciate ligament (ACL) injury and ACLR. To date, the magnitude of asymmetry, or between-limbs differences, in quadriceps motor-neuron-pool excitability, quadriceps activation, and quadriceps cortical excitability has not been studied in patients with ACLR.…”

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confidence: 99%

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Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

105

116

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Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear.Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls.Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women).Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/ kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs.Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group ¼ 0.85 6 0.21, healthy group ¼ 0.97 6 0.14; t 44 ¼ 2.26, P ¼ .03), quadriceps CAR (ACLR group ¼ 0.94 6 0.11, healthy group ¼ 1.00 6 0.08; t 44 ¼ 2.22, P ¼ .04), and quadriceps AMT (ACLR group ¼ 1.13 6 0.18, healthy group ¼ 1.02 6 0.11; t 34 ¼À2.46, P ¼ .04) than the healthy control group.Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.Key Words: quadriceps activation, limb symmetry index, transcranial magnetic stimulation Key PointsThe anterior cruciate ligament reconstruction (ACLR) group exhibited a weaker, less activated quadriceps and less cortical excitability in the reconstructed limb than in the contralateral limb and in the limbs of the healthy control group. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Chronic asymmetry indicated reduced dynamic force absorption at the knee and may explain the increased rate of knee reinjury and chronic joint degeneration after ACLR.

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Section: Limb Symmetry Indexmentioning

confidence: 99%

mentioning

confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

105

116

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“…4,12,16,20,[24][25][26]28,29,34,37 Functional performance tests range from general lower extremity tests to unilateral hopping tests. 1,2,4,6,12,[16][17][18]20,22,24,[29][30][31][32][33]37 Limited studies exist evaluating the presence of functional deficits in patients with FAI. 7,9,10,21,27,39 Even with the small amount of research available, the studies present with conflicting results, adding to the confusion regarding the nature of this condition.…”

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confidence: 99%

The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional Ankle Instability

Caffrey¹,

Docherty²,

Schrader³

et al. 2009

J Orthop Sports Phys Ther

132

129

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How these subjective feelings of giving way affect actual functional performance or sport participation remains an area of debate. While it seems inherent that those with FAI will have "functional" deficits, this has not been consistently reported in the literature.Developed with the intentions of tracking rehabilitation and determining return-to-play criteria, functional performance testing provides an unbiased means of measuring functional ability. 10Most of the research on functional performance testing relates to the knee and, more specifically, to testing individuals with anterior cruciate ligament-deficient and reconstructed knees. 4,12,16,20,[24][25][26]28,29,34,37 Functional performance tests range from general lower extremity tests to unilateral hopping tests. 1,2,4,6,12,[16][17][18]20,22,24,[29][30][31][32][33]37 Limited studies exist evaluating the presence of functional deficits in patients with FAI. 7,9,10,21,27,39 Even with the small amount of research available, the studies present with conflicting results, adding to the confusion regarding the nature of this condition. Studies that used general lower extremity tests, such as the 6-meter shuttle run 9,27 and cocontraction test, 9 found no performance deficits in participants with FAI. Of 6 studies that used unilateral L ateral ankle sprains, which are primarily caused by an inversion stress to the joint, account for 34% of all injuries in athletics. 13 Additionally, up to 40% of individuals report a sense of instability after an initial sprain that may lead to recurrent instability. 15 Functional ankle instability (FAI) is described as a feeling of "giving way" in the ankle joint, [8][9][10][11]15,19,35 which may or may not occur in the presence of laxity of the lateral ligaments. 8,19,21,27 t StuDy DeSign: Experimental laboratory testing using a cross-sectional design. t MethoDS: Sixty college students volunteered for this study. Thirty participants with unilateral ankle instability were placed in the FAI group and 30 participants with no history of ankle injuries were placed in the control group. The FAI group was subsequently further divided to indicate those that reported giving way during the functional test (FAI-GW) and those that did not (FAI-NGW). Time to complete each test was recorded and the mean of 3 trials for each test were used for statistical analysis. To identify performance differences, we used 4 mixed-design 2-way (side-by-group) ANOVAs, 1 for each hop test. A Tukey post hoc test was completed on all significant findings.t reSuLtS: We identified a significant side-bygroup interaction for all 4 functional performance tests (P.05). Specifically, for each functional performance test, the FAI limb performed significantly worse than the contralateral uninjured limb in the FAI-GW group. Additionally, the FAI limb in the FAI-GW group performed worse than the FAI limb in the FAI-NGW group, and the matched limb in the control group in 3 of the 4 functional performance tests.t ConCLuSion: We found that functional performance deficits wer...

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“…hop and stop tests, 22 and vertical jump t e~t s .~-~~T C l i n icians have used single leg hop tests to assess their patients' lower extremity muscular strength and ability to perform tasks that challenge knee stability. Single leg hop tests are also commonly used to evaluate progress in knee rehabilitation programs.…”

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confidence: 99%

Hop Tests as Predictors of Dynamic Knee Stability

Fitzgerald¹,

Lephart²,

Hwang³

et al. 2001

J Orthop Sports Phys Ther

213

149

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Single leg hop tests are commonly used as physical performance measures of function and are also commonly used to evaluate progress in knee rehabilitation programs, particularly for individuals recovering from anterior cruciate ligament injury or reconstructive surgery. While there is some evidence that hop tests may show promise as a predictive measure for identifying individuals who are at risk for recurrent dynamic instability, further work is needed to clearly define the role of hop test measurements for this purpose. The purposes of this clinical commentary are to review the research that has been done to establish hop tests as a physical performance measure of function, to discuss neuromuscular and biomechanical considerations related to hop performance and dynamic knee stability, to discuss existing evidence that supports the potential for hop tests as a predictor of dynamic knee stability, and to discuss considerations for future studies that are designed to more clearly define the role of hop tests in predicting dynamic knee stability. )Orthop Sports Phys Ther 200 l;3 1 :588-597.

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A Dynamic Test of Lower Extremity Function Following Anterior Cruciate Ligament Reconstruction and Rehabilitation

Cited by 60 publications

References 9 publications

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional Ankle Instability

Hop Tests as Predictors of Dynamic Knee Stability

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