Anterior Cruciate Ligament Strain In Vivo

Abstract

Context:Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process.Objective:To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees.Data Sources:A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included anterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy.Study Selection:Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load.Results:A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance.Conclusion:These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials.

Standards in der Nachbehandlung nach vorderem Kreuzbandersatz im deutschsprachigen Raum

“…Bei der Befragung zur postoperativen Flexionseinschränkung zeigte sich, wie nah die Empfehlungen Pro und Contra eines Verfahrens teilweise zusammen liegen: 45,6 % der Befragten stimmen für eine Einschränkung von 90°und 44,7 % der Befragten gegen jegliche Bewegungseinschränkung. In klinischen und experimentellen Studien zeigte sich, dass die VKB-Belastung am höchsten ist bei 10 -30°-Flexion, bei 30 -60°stetig abnimmt und ab 60°0 % beträgt [3,4,12,22] chanischer Sicht keinen Sinn und wird in den aktuellen Leitlinien der MOON-Gruppe nicht empfohlen. Paradoxerweise findet sich in den kürzlich überarbeiten DGOU-Nachbehandlungsempfehlungen eine Bewegungseinschränkung von Extension/Flexion 0 -0-90°bis zur 6. postoperativen Woche [37,41].…”

“…Das deckt sich auch mit den aktuellen Empfehlungen in der Literatur. In mehreren Arbeiten zeigten Übungen in der geschlossenen Kette im Vergleich zu Trainingseinheiten in offener Kette deutlich weniger Last auf dem vordere Kreuzband [3,4,12,22,27]. Früher freigegeben werden vorsichtige Übungen mit wenig Gewicht in der offenen Kette und/oder Quadricepsübungen mit kurzem Hebel in der offenen Kette, vor allem bei größeren Winkelgraden [36,41].…”

The Influence of Extrinsic Factors on Knee Biomechanics During Cycling: A Systematic Review of the Literature

“…40 Posterior pull of the hamstrings on the tibia when the crank angle is 180° from top dead center may limit ACL strain as the knee approaches its least flexed position of 37°, 41 an angle which is within the range of greatest ACL strain during activities, 0° -50° flexion. 42 While shear forces on the ACL during cycling appear to be low, more research is needed to examine shear forces on the posterior cruciate ligament and patella during cycling. Thus, cyclists with anterior cruciate ligament injury or reconstruction may benefit from a lower saddle height or more forward saddle position.…”

The effects of toe direction on three-dimensional knee kinematics during closed kinetic chain exercise in patients with anterior cruciate ligament deficient knee

“…Besides, an early start of OKC quadriceps exercises had no beneficial effect on quadriceps strength. Concerning the ACL strain, Luque-Seron JA et al suggested that the presence of the joint compressive load of CKC exercises would appear to attenuate the strain increase 12 . Therefore, CKC exercise has been used as a safe and reliable rehabilitation before and after ACL reconstruction surgery especially in the early postoperative period 10 , 13 , 14 …”