Biomechanical Evaluation of Preoperative Rehabilitation in Patients of Anterior Cruciate Ligament Injury

Abstract

Objectives: To investigate the biomechanical characteristics of patients with anterior cruciate ligament (ACL) injury by gait analysis, surface electromyography (SEMG), and proprioception test, and provide rehabilitation suggestions according to the results.Methods: In this retrospective cohort study, 90 adults with unilateral ACL injury, ranging in age from 19 to 45 years (66 men and 24 women, average age: 30.03 AE 7.91) were recruited for this study form May 2018 to July 2019. They were divided into three groups according to the time after the injury: group A (3-week to 1.5-month), group B (1.5-month to 1 year), and group C (more than 1 year). The SEMG signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) and the root mean square (RMS) were used to assess muscular activity. SEMG were used to analyze muscles function, gait analysis was used to evaluate the walking stability, balance and location assessment were used to analyze the proprioception.Results: Through the comparison between bilateral limbs, all muscles strength shown decreased (RF: 239.94 AE 129.70 vs 364.81 AE 148.98, P = 0.001; VM: 298.88 AE 175.41 vs 515.79 AE 272.49, P = 0.001; VL:389.54 AE 157.97 vs 594.28 AE 220.31, P < 0.001) and the division of proprioception became larger (tandem position: 7.79 AE 1.57 vs 6.33 AE 1.49, P = 0.001; stance with one foot: 8.13 AE 0.84 vs 7.1 AE 0.57, P = 0.003; variance of 30 : 6.96 AE 3.15 vs 4.45 AE 1.67, P = 0.03; variance of 60 : 4.64 AE 3.38 vs 2.75 AE 1.98, P = 0.044) in the injured side when compared to the non-injured and 26 gait parameters were shown difference in group A. In group B, the muscle strength of VL shown decreased (VL: 381.23 AE 142.07 vs 603.9 AE 192.72, P < 0.001) and the division of location of 30 became larger (7.62 AE 4.98 vs 4.33 AE 3.24, P = 0.028) in the injured side when compared to the non-injured side and there were eight gait parameters that showed differences. In group C, the muscle strength and proprioception showed no differences and only 16 gait parameters showed differences between the bilateral limbs. Conclusion:The results proved the deterioration of proprioception in 30 of injured side will not recover and non-injury side and will become worse after 1 year from the injury; among the VL, VM, and RF, the recovery rate of VL is the slowest and bilateral straight leg raising (SLR) (30 ) is the best way to train it; the gait stability will be worse after 1 year from the injury. Therefore, we suggest that the training for proprioception in 30 and VL are important for the rehabilitation, and the ACL reconstruction should be performed within 1 year. AE 62.75 205.55 AE 86.79 0.158 216.15 AE 61.52 196.07 AE 44.06 0.152 VL 382.7 AE 136.09 439.62 AE 119.74 0.091 287.18 AE 106.76 374.9 AE 103.22 0.002* 363.7 AE 98.95 408.1 AE 83.12 0.065 243.77 AE 91.62 281.47 AE 84.63 0.103 258.88 AE 79.23 231.9 AE 91.51 0.227 248.63 AE 86.51 217.35 AE 79.63 0.151 Group C RF 269.16 AE 74.43 310.44 AE 93.12 0.063 213.53 AE 92.05 267.27 AE 139.1 0...

Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction

“…Although several studies have demonstrated better proprioception on the healthy side than on the affected side after ACL injury or reconstruction, it has also been shown that ACL injury not only decreases proprioception on the affected side, but also affects proprioception on the healthy side. Li et al similarly found that the unaffected side would decline with the decrease of proprioception on the affected side one year after ACL injury [30]. Other studies have shown that ACL injury not only leads to unilateral proprioception loss, but also to contralateral knee joint proprioception loss [31][32].…”

Surface electromyography characteristics of patients with anterior cruciate ligament injury in different rehabilitation phases

“…Muscle atrophy appears to occur regardless of the type of graft used to reconstruct the ACL and often occurs bilaterally ( Papannagari et al, 2006 ). The pattern of muscle strength decline is not the same for different muscles, Li et al showed that Among the VL, VM, and RF, the recovery rate of VL is the slowest ( Li et al, 2020 ). Kim et al also found significant differences in the recovery rates of extensor muscles and flexor muscles of knee ( Kim et al, 2015 ).…”

“…Similarly, when walking quickly, the patient was required to walk for 5 min at the fastest speed and the analysis test process was carried out for 3 min in the middle. The patient laid supine on the bed, baseline SEMG signals were measured during a state of muscle relaxation, then raised the leg 30° or 60° and dorsiflexed of the ankle, and maintained this position for 10 s ( Li et al, 2020 ; Mitchell et al, 2022 ; Molina-Cárdenas et al, 2022 ). The experiment was repeated three times.…”

Comment on “Biomechanical Evaluation of Preoperative Rehabilitation in Patients of Anterior Cruciate Ligament Injury”

“…We appreciate that Li et al 1 have provided us with a clinically meaningful study. We would welcome comments by the authors as this would help to further support the findings of this important study.…”

“…Dear Editor, I n a recent issue of Orthopaedic Surgery, Li W and his colleagues published an article entitled "Biomechanical Evaluation of Preoperative Rehabilitation in Patients of Anterior Cruciate Ligament (ACL) Injury" 1 , which we read with great interest. We congratulate the authors for their efforts.…”