Co-activation during gait following anterior cruciate ligament reconstruction

Blackburn, J. Troy; Pietrosimone, Brian; Goodwin, Jonathan S.; Johnston, Christopher; Spang, Jeffrey T.

doi:10.1016/j.clinbiomech.2019.05.010

Cited by 24 publications

(23 citation statements)

References 39 publications

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“…11,12 Additionally, the ACLR limb displays greater quadriceps/hamstrings coactivation compared to contralateral and healthy control limbs that are associated with aberrant gait biomechanics. 13 Collectively, these data suggest that a gait biomechanics profile consisting of smaller sagittal plane knee angles and moments, and greater frontal plane knee moments, loading rates, and coactivation potentially contributes to PTOA development following ACLR.…”

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confidence: 80%

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Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury

Blackburn

Padua

Pietrosimone

et al. 2020

Journal Orthopaedic Research

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Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of posttraumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was to evaluate the effects of whole-body vibration (WBV) and local muscle vibration (LMV) on gait biomechanics in individuals with ACLR. Seventy-five volunteers (time since ACLR 27 ± 16 months) were randomized to WBV, LMV, or Control interventions. Walking biomechanics were assessed prior to and following a single exposure to the interventions.Outcomes included pre-post change scores in the ACLR limb for the peak vertical ground reaction force (vGRF) and its loading rate, peak internal knee extension (KEM) and abduction moments, and peak knee flexion and varus angles. LMV produced a significant decrease in the vGRF loading rate (−3.6 BW/s) that was greater than the changes in the WBV (−0.3 BW/s) and Control (0.5 BW/s) groups. Additionally, WBV produced an increase in the peak KEM (0.27% BW × Ht) that was greater than the change in the Control group (−0.17% BW × Ht) but not the LMV group (0.01% BW × Ht). Lower KEM and greater loading rates have been linked to declines in joint health following ACLR.WBV acutely increased the peak KEM and LMV decreased loading rates. These data suggest that vibration has the potential to mitigate aberrant gait biomechanics, and may represent an effective approach for reducing PTOA risk following ACLR.

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“…Additionally, greater coactivation of the quadriceps and hamstrings during walking has been reported following ACLR and is associated with aberrant gait biomechanics, including smaller peak KEM. 13 As such, changes in quadriceps and hamstrings EMG activity could partially explain the changes in gait biomechanics.…”

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confidence: 99%

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury

Blackburn

Padua

Pietrosimone

et al. 2020

Journal Orthopaedic Research

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“…36,45,46 Notably, higher muscle co-contraction around the knee joint can result in increased tibiofemoral compression forces, 47 which may have a detrimental effect as they potentially hasten the degeneration of the joint. 48,49 Although non-significant, the trend of less knee range of motion in the sagittal plane during landing for those with higher fear of reinjury (HIGH-FEAR 25.7°, LOW-FEAR 27.3°, CTRL 28.8°, P = .085) may additionally have increased the tibiofemoral compression forces, considering the function of the knee joint to act as a damper during impact. Consequently, our results may suggest that individuals with…”

Section: [H2]fear and Biomechanical Landing Patternsmentioning

confidence: 95%

Fear of Reinjury Following Anterior Cruciate Ligament Reconstruction Is Manifested in Muscle Activation Patterns of Single-Leg Side-Hop Landings

2021

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Objective The purpose of this study was to determine whether fear of re-injury is manifested in joint kinematics and muscle activation patterns during landings of a standardized rebound side-hop (SRSH), or in patient-reported outcome measures (PROMs), among individuals with anterior cruciate ligament reconstruction (ACLR). Methods In this cross-sectional observational study, 38 individuals within 2 years post-ACLR were grouped into HIGH-FEAR (n = 21, median 11.2 months post-surgery) or LOW-FEAR (n = 17, median 10.1 months post-surgery) based on a discriminating question (Q9; Tampa Scale of Kinesiophobia-17). These individuals and 39 asymptomatic controls performed the SRSH. Three-dimensional motion recordings were used to calculate trunk, hip, and knee joint angles at initial contact, and range of respective joint motion during landing. Surface electromyography registered mean amplitudes and co-contraction indexes for thigh muscles during pre-activation (50 ms) and landing phases. PROMs of knee function, knee health, and physical activity were also analyzed. Results The HIGH-FEAR and LOW-FEAR classification was corroborated by distinct Tampa Scale of Kinesiophobia-17 total and subscale scores and revealed distinguishable muscle activation patterns. HIGH-FEAR demonstrated higher biceps femoris electromyography amplitude and higher anterior-posterior co-contraction index during landing than both LOW-FEAR and controls. However, there were no fear-related differences for kinematics or PROMs. Instead, both ACLR subgroups showed different kinematics at initial contact to controls; HIGH-FEAR with more trunk, hip, and knee flexion, and LOW-FEAR with more hip and knee flexion. Conclusion Individuals with ACLR who had high fear of re-injury seem to have adopted a protective strategy with higher muscular activation patterns, presumably to stabilize the knee joint, compared to individuals with low fear of re-injury and controls. SRSH landing kinematics or knee-related PROMs may not be as sensitive to fear of re-injury. Impact Fear of reinjury following anterior cruciate ligament (ACL) injury should be evaluated as an independent psychological outcome throughout rehabilitation after ACLR for improved return to sport transition. Lay Summary If you have an ACL injury treated with reconstructive surgery, you might have a high fear of reinjury, and that can change how you activate the muscles around your knee. Your physical therapist can do a simple screening test in addition to functional tests to help reduce your fear and improve your treatment outcomes.

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“…Poorer somatosensory function is also associated with higher loading rates during gait in healthy individuals and individuals with knee osteoarthritis, but a lack of correlation was reported in the lone study, to our knowledge, that has evaluated this association following ACLR . Greater co‐activation of the knee flexors and extensors during walking has been reported in osteoarthritic and ACL‐deficient knees, as well as individuals with ACLR . Somatosensory dysfunction potentially leads to the perception of instability which can be countered by heightened co‐activation of the surrounding musculature, but may result in limb stiffening (e.g., less knee flexion), thus leading to high‐rate loading and increasing tibiofemoral compressive force .…”

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“…10 Greater co-activation of the knee flexors and extensors during walking has been reported in osteoarthritic 23 and ACL-deficient 24 knees, as well as individuals with ACLR. 25 Somatosensory dysfunction potentially leads to the perception of instability which can be countered by heightened co-activation of the surrounding musculature, but may result in limb stiffening (e.g., less knee flexion), thus leading to high-rate loading and increasing tibiofemoral compressive force. 23,24,26,27 Additionally, improving somatosensory function reduces loading rates and co-activation during gait in individuals with knee osteoarthritis.…”

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Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction

Blackburn

Pietrosimone

Spang

et al. 2019

Journal Orthopaedic Research

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Osteoarthritis is common following anterior cruciate ligament reconstruction (ALCR), and aberrant gait biomechanics are considered a primary contributor. Somatosensory dysfunction potentially alters gait biomechanics, but this association is unclear. Therefore, the purposes of this investigation were to compare somatosensory function between limbs and evaluate associations between somatosensory function and gait biomechanics linked to osteoarthritis development in individuals with ALCR. Seventy‐three volunteers with ALCR participated. Gait biomechanics (peak vertical ground reaction force magnitude and loading rate, peak internal knee extension and valgus moments, peak knee flexion and varus angles, and quadriceps/hamstrings co‐activation) were assessed as subjects walked at their preferred speed. The somatosensory function was assessed via joint position sense error (knee flexion) and vibratory perception threshold (femoral epicondyles, malleoli, and first metatarsal). Though somatosensory function did not differ between the ACLR and contralateral limbs, poorer joint position sense in the ACLR limb was associated with lower loading rates and internal knee extension moments, and greater co‐activation. Poorer vibratory perception at the medial and lateral malleoli and first metatarsal head in the ACLR limb was associated with lower loading rates, greater internal knee valgus moments and varus angles, and greater co‐activation. Poorer vibratory perception at the medial malleolus and first metatarsal head in the contralateral limb was associated with greater peak knee varus angles and internal knee valgus moments. These results suggest that future research evaluating rehabilitation approaches for improving somatosensory function is warranted as a potential approach for restoring normal gait biomechanics and reducing osteoarthritis risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:620–628, 2020

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Co-activation during gait following anterior cruciate ligament reconstruction

Cited by 24 publications

References 39 publications

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury

Fear of Reinjury Following Anterior Cruciate Ligament Reconstruction Is Manifested in Muscle Activation Patterns of Single-Leg Side-Hop Landings

Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction

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