ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise Selection

Escamilla, Rafael F.; MacLeod, Toran D.; Wilk, Kevin E.; Paulos, Lonnie E.; Andrews, James R.

doi:10.2519/jospt.2012.3768

Cited by 140 publications

(96 citation statements)

References 61 publications

(150 reference statements)

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“…Loading of ACL has been shown to be minimal in this joint position (Escamilla et al, 2012), which allowed safe testing also postoperatively. Three attempts of 3–4 s MVIC were performed with 3 min rest period in-between to avoid muscle fatigue.…”

Section: Methodsmentioning

confidence: 99%

Short–Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

et al. 2018

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Surgical ACL reconstruction performed with a tourniquet induces compression and ischemic stress of the quadriceps femoris (QF) muscle which can accelerate postoperative weakness. Given that low-load blood flow restricted (BFR) exercise is potent in enhancing muscle oxygenation and vascular function, we hypothesized that short-term preconditioning with low-load BFR exercise can attenuate QF muscle endurance deterioration in the postoperative period. Twenty subjects undergoing arthroscopic ACL reconstruction performed 5 exercise sessions in the last 8 days prior to surgery. They were assigned into either BFR group, performing low-load BFR knee-extension exercise, or SHAM-BFR group, replicating equal training volume with sham occlusion. Blood flow (near-infrared spectroscopy) and surface EMG of QF muscle during sustained isometric contraction at 30% of maximal voluntary isometric contraction (MVIC) torque performed to volitional failure were measured prior to the intervention and again 4 and 12 weeks after surgery. There was an overall decrease (p = 0.033) in MVIC torque over time, however, no significant time-group interaction was found. The time of sustained QF contraction shortened (p = 0.002) in SHAM-BFR group by 97 ± 85 s at week 4 and returned to preoperative values at week 12. No change in the time of sustained contraction was detected in BFR group at any time point after surgery. RMS EMG amplitude increased (p = 0.009) by 54 ± 58% at week 4 after surgery in BFR group only. BFm increased (p = 0.004) by 52 ± 47% in BFR group, and decreased (p = 0.023) by 32 ± 19% in SHAM-BFR group at week 4 after surgery. Multivariate regression models of postoperative changes in time of sustained QF contraction revealed its high correlation (R2 = 0.838; p < 0.001) with changes in BFm and RMS EMG in the SHAM-BFR group, whereas no such association was found in the BFR group. In conclusion, enhanced endurance of QF muscle was triggered by combination of augmented muscle fiber recruitment and enhanced muscle perfusion. The latter alludes to a preserving effect of preconditioning with BFR exercise on density and function of QF muscle microcirculation within the first 4 weeks after ACL reconstruction.

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Section: Methodsmentioning

confidence: 99%

Short–Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

et al. 2018

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“…The specimens were then cyclically loaded to 200 N for 200 cycles. This load was chosen because it lies within the ranges of the load on the ACL during weight-bearing exercises (approximately 150 N) and noneweight-bearing exercises (150 to 350 N) 4 and, for comparison purposes, is consistent with load parameters from other studies. 8,9,13 Each construct was then loaded to failure.…”

Section: Biomechanical Testingmentioning

confidence: 96%

“…3 Fixation methods of these grafts must be strong enough to withstand mechanical loading during injury rehabilitation and daily activities. 4 In some procedures, such as ACL reconstruction, that involve soft-tissue suture fixation over a post, fixation depends not only on the stability of the post screw and the quality of the graft but also on the stability of the stitch in the tendon. In this clinical scenario, elongation of the suture-graft construct is of major concern.…”

mentioning

confidence: 99%

A Biomechanical Comparison of Modified Krackow and Locking Loop Suture Patterns for Soft-Tissue Graft Fixation

Ostrander

Saper

Juelson

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…As is typical of postoperative ACLR rehabilitation regimens, focus should be placed on restoring quadriceps strength, including using open-chain exercises in the protected range from 90° to 60° of knee flexion that limit anterior tibial translation while still allowing isolation of the quadriceps 46. In the event of harvest site morbidity in the rehabilitation period, an approach similar to that taken for quadriceps tendinopathy may be used.…”

Section: Rehabilitationmentioning

confidence: 99%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

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Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.

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ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise Selection

Abstract: is to discuss the biomechanical factors related to ACL loading during common WB and NWB exercises performed during ACL rehabilitation. Clinicians may utilize this review as a guide to exercise selection and progression for patients with ACL pathology or reconstruction.

Cited by 140 publications

References 61 publications

Short–Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

Short–Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

A Biomechanical Comparison of Modified Krackow and Locking Loop Suture Patterns for Soft-Tissue Graft Fixation

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

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