Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function

Abstract

Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6-25%, P < 0.001-P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION & THE HAMSTRINGS Implications for injury prevention & rehabilitation

“…Proprioceptive and strength deficits (Kramer et al, 1993;Tengman et al, 2014;Timmins et al, 2016a) seem to be reasonable hypotheses, but the current results suggest that poor eccentric strength is an unlikely explanation for high hamstring injury rates in athletes with prior ACLR. Opar and colleagues (2015a) and Timmins and colleagues (2016b) have shown that weakness in the Nordic hamstring exercise was associated with an elevated risk of HSI in elite Australian Rules Football and Soccer cohorts, respectively.…”

“…A number of observational studies (Konrath et al, 2016;Nomura et al, 2015;Takeda et al, 2006) have reported decrements in concentric (Tengman et al, 2014) and eccentric (Tengman et al, 2014;Thomas et al, 2013) knee flexor strength in the years following surgery as well as reduced muscle size (Nomura et al, 2015) and altered muscle architecture of the ST (Timmins et al, 2015). However, these studies are almost always constrained by small sample sizes, and several investigations have found conflicting results regarding the recovery of strength after rehabilitation (Aglietti et al, 1994;Ejerhed et al, 2003).…”

“…Notably, regardless of the chosen graft, deficits in eccentric and concentric knee extensor (Knezevic, Mirkov, Kadija, Nedeljkovic, & Jaric, 2014;Konishi et al, 2007) and flexor (Kramer, Nusca, Fowler, & Webster-Bogaert, 1993;Tengman et al, 2014) strength persist long term and in some cases are found 25 years following surgery (Tengman et al, 2014).…”

“…As major flexors of the knee, the hamstrings provide the greatest active restraint against anterior tibial translation shear forces (Blackburn et al, 2013;Ford et al, 2005;Myer et al, 2009). The ACL runs from the posteromedial aspect of the lateral femoral condyle in the intercondylar notch to the anterior intercondylar area of the tibia as a collection of individual fascicles (Alentorn-Geli et al, 2009a;Arnoczky, 1983;Levangie & Norkin, 2011;Tengman et al, 2014). The ACL's fascicles are divided into anteromedial and posterolateral bands, and the knee angle determines the degree of tension transmitted through each (Arnoczky, 1983).…”

“…A number of observational studies (Konrath et al, 2016;Nomura et al, 2015;Takeda, Kashiwaguchi, Matsuura, Higashida, & Minato, 2006) have reported decrements in concentric (Tengman et al, 2014) and eccentric (Tengman et al, 2014;Thomas, Villwock, Wojtys, & PalmieriSmith, 2013) knee flexor strength in the years following ACLR surgery in addition to reduced ST muscle size (Nomura et al, 2015) and altered BFLongHead muscle architecture (Timmins, Shield, Williams, Lorenzen, & Opar, 2015). It has been suggested that after a significant knee injury, such as an ACL injury, the biomechanics of the lower limb are altered, and these changes increase the risk of future HSI (Verrall et al, 2001).…”