Effect of Eccentric Strengthening After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength

Lepley, Lindsey K.; Palmieri-Smith, Riann M.

doi:10.1123/jsr.22.2.150

Cited by 18 publications

(12 citation statements)

References 12 publications

(51 reference statements)

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“…Palmieri-Smith et al 153 reviewed voluntary quadriceps activation after ACL reconstruction and suggested that clinicians incorporate strategies to decrease arthrogenic muscle inhibition and utilize therapy to decrease muscle atrophy, which could expedite and maximize patient recovery. Lepley and Palmieri-Smith 109 reviewed 4 studies examining eccentric exercise and found that eccentric strengthening maximizes quadriceps function with initiation as early as 3 weeks after ACL reconstruction in 2 studies. Kim et al 94 and Imoto et al 87 reviewed studies evaluating neuromuscular electrical stimulation after ACL reconstruction.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

Anderson

Browning

Urband

et al. 2016

Orthopaedic Journal of Sports Medicine

152

126

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Background:There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL).Purpose:To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded.Results:A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous.Conclusion:A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature.

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Section: Resultsmentioning

confidence: 99%

A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

Anderson

Browning

Urband

et al. 2016

Orthopaedic Journal of Sports Medicine

152

126

View full text Add to dashboard Cite

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“…Given the mounting evidence, the incorporation of eccentrics into a rehabilitation program seems like a reasonable next step. 39 Along those same lines, it is important for researchers to quantify the magnitude of quadriceps strength deficits that lead to altered mechanics and the potential for reinjury. Establishing these criteria will help to better define our clinical standards as to what level of quadriceps strength asymmetry is acceptable at return to activity.…”

Section: Discussionmentioning

confidence: 99%

Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction

2015

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Context:Side-to-side quadriceps strength deficits are linked to hazardous lower extremity mechanics and reduced function at a time when individuals are returned to activity after anterior cruciate ligament (ACL) reconstruction. As a result, generalized criteria have emerged in the literature, wherein researchers are recommending that patients be cleared for participation once side-to-side differences in strength are ≤10% of the noninjured limb. Similar recommendations exist for patient-oriented outcomes (ie, self-reported function and hop tests), where deficits of ≤10% are considered ideal at return to activity. It is unclear how many studies actually achieve these clinically recommended results.Evidence Acquisition:Articles that reported quadriceps strength deficits as compared to the contralateral limb were collected from peer-reviewed sources available on Medline and Web of Science databases (1990 through August 2014). Search terms included the following: anterior cruciate ligament OR ACL AND muscle weakness, anterior cruciate ligament OR ACL AND strength; return-to-activity AND strength; anterior cruciate ligament OR ACL AND quadriceps.Study Design:Clinical review.Level of Evidence:Level 4.Results:Average side-to-side strength deficits at 6 months postreconstruction were 23% ± 8% (range, 3%-40%), while the average at 12 months postsurgery was found to be 14% ± 6% (range, 3%-28%). The average deficits in self-reported function at 6 months (mean, 14% ± 5%) and 12 months postsurgery (mean, 13% ± 6%) were also found to be >10%. Performance on hop tests was found to be less than optimal at 6 months postsurgery (mean, 11% ± 7%), but improved at 12 months postsurgery (mean, 1.3% ± 2%).Conclusion:This review provides an up-to-date account of the typical deficits in strength and patient-oriented outcomes that exist when formalized physical therapy concludes after ACL reconstruction. Based on the studies included, it seems pertinent that researchers and clinicians continue to investigate interventions capable of improving the recovery of quadriceps strength as well as patient-oriented outcomes as the majority of studies report levels that are well below clinical recommendations.

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“…The eccentric protocol described herein has previously been shown in our laboratory to increase muscle strength after ACLR when compared with standard of care. 14,15…”

Section: Methodsmentioning

confidence: 99%

“…The eccentric protocol described herein has previously been shown in our laboratory to increase muscle strength after ACLR when compared with standard of care. 14,15 Patients who were randomly assigned to receive the BFRT intervention underwent BFRT while they performed either the aforementioned concentric-or eccentric-focused leg press. Before initiating the exercise, participants had an Easi-Fit Tourniquet Cuff (Delfi Medical Innovations) applied to the proximal thigh of the surgical limb.…”

Section: Study Interventionsmentioning

confidence: 99%

Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

et al. 2020

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Background: A major goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is restoring quadriceps muscle strength. Unfortunately, current rehabilitation paradigms fall short of this goal, such that substantial quadriceps muscle strength deficits can limit return to play and increase the risk of recurrent injuries. Blood flow restriction training (BFRT) involves the obstruction of venous return to working muscles during exercise and may lead to better recovery of quadriceps muscle strength after ACLR. Purpose: To examine the efficacy of BFRT with high-intensity exercise on the recovery of quadriceps muscle function in patients undergoing ACLR. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 34 patients (19 female, 15 male; mean age, 16.5 ± 2.7 years; mean height, 169.0 ± 19.7 cm; mean weight, 73.2 ± 17.7 kg) scheduled to undergo ACLR were randomly assigned to 1 of 4 groups: concentric (n = 8), eccentric (n = 8), concentric with BFRT (n = 9), and eccentric with BFRT (n = 9). The exercise component of the intervention consisted of patients performing a single-leg isokinetic leg press, at an intensity of 70% of the patients’ 1-repetition maximum during either the concentric or eccentric action, for 4 sets of 10 repetitions 2 times per week for 8 weeks beginning at 10 weeks postoperatively. Patients randomized to the BFRT groups performed the leg-press exercise with a cuff applied to the thigh, set to a limb occlusion pressure of 80%. Isometric and isokinetic (60 deg/s) quadriceps peak torque, quadriceps muscle activation, and rectus femoris muscle volume were assessed before ACLR, after BFRT, and at the time that patients returned to activity and were converted to the change in values from baseline for analysis. Also, 1-way analyses of covariance were used to compare the change in values for each dependent variable between groups after BFRT and at return to activity ( P ≤ .05). Results: No significant differences were found between groups for any outcome measures at either time point ( P > .05). Conclusion: An 8-week BFRT plus high-intensity exercise intervention did not significantly improve quadriceps muscle strength, activation, or volume. On the basis of our findings, the use of BFRT in conjunction with high-intensity resistance exercise in patients undergoing ACLR to improve quadriceps muscle function may not be warranted. Registration: NCT03141801 ( ClinicalTrials.gov identifier)

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Effect of Eccentric Strengthening After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength

Cited by 18 publications

References 12 publications

A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction

Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

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