Sagittal plane knee joint moments following anterior cruciate ligament injury and reconstruction: A systematic review

Hart, Joseph M.; Ko, Jia-Wei Kevin; Konold, Timothy R.; Pietrosimione, Brian

doi:10.1016/j.clinbiomech.2009.12.004

Cited by 130 publications

(148 citation statements)

References 49 publications

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“…3,4 This persistent dysfunction may reduce the ability of individuals with ACLR to adapt to the demands of physical activity, resulting in abnormal knee-joint loading. [5][6][7] Researchers 8,9 have hypothesized that the combination of joint trauma from initial injury and surgery, along with long-term functional adaptation due to persistent lower extremity neuromuscular dysfunction, may predispose individuals with ACLR to higher rates of reinjury and knee-joint osteoarthritis. Understanding the clinical and neurophysiologic manifestations of quadriceps dysfunction after ACLR is essential to developing targeted treatment and clearer criteria for return to activity.…”

mentioning

confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

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105

116

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Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear.Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls.Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women).Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/ kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs.Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group ¼ 0.85 6 0.21, healthy group ¼ 0.97 6 0.14; t 44 ¼ 2.26, P ¼ .03), quadriceps CAR (ACLR group ¼ 0.94 6 0.11, healthy group ¼ 1.00 6 0.08; t 44 ¼ 2.22, P ¼ .04), and quadriceps AMT (ACLR group ¼ 1.13 6 0.18, healthy group ¼ 1.02 6 0.11; t 34 ¼À2.46, P ¼ .04) than the healthy control group.Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.Key Words: quadriceps activation, limb symmetry index, transcranial magnetic stimulation Key PointsThe anterior cruciate ligament reconstruction (ACLR) group exhibited a weaker, less activated quadriceps and less cortical excitability in the reconstructed limb than in the contralateral limb and in the limbs of the healthy control group. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Chronic asymmetry indicated reduced dynamic force absorption at the knee and may explain the increased rate of knee reinjury and chronic joint degeneration after ACLR.

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confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

Self Cite

105

116

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“…Decreased heel loading is probably the result of altered gait characteristics in ACL-deficient patients. In the literature, the most commonly emphasized gait abnormality for ACL-deficient patients is quadriceps avoidance gait, defined as decreased external flexion moment of the knee (reduced quadriceps contraction) at the midstance phase of gait to prevent excessive anterior tibial translation (4,10,11). Two possible mechanisms were reported for walking with a quadriceps avoidance gait; one of them is the reduced knee flexion angle in the midstance phase of gait (in 72% of patients), and the other one is leaning forward during midstance (increased hip external flexion moment) (12).…”

Section: Discussionmentioning

confidence: 99%

“…Following the reconstruction procedure, biomechanical changes and abnormal gait patterns, which can cause early onset osteoarthritis and inadequate patient satisfaction, can be assessed successfully with gait analysis (4). However, the complexity of procedure and its utility in quantitative measurement of the rehabilitation process is not practical.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of plantar pressure distributions in patients with anteriorcruciate ligament deficiency: preoperative and postoperative changes

et al. 2017

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Background/aim: Anterior cruciate ligament (ACL) deficiency results in several kinematic changes in the lower extremities. The aim of this study is to define the plantar pressure parameters in ACL-deficient patients and to show the effect of ACL reconstruction on dynamic plantar pressure.Materials and methods: Forty patients with unilateral ACL rupture and 40 healthy controls were included in this study. Dynamic plantar pressures of both groups were recorded by the EMED SF-2 system during level walking. Thirteen of the patients who had ACL reconstructions with hamstring autografts (HS group) were reevaluated at an average of 14.5 months following the ACL reconstructions.Results: ACL-deficient patients had significantly lower hindfoot (P = 0.007) but higher midfoot pressure values (P = 0.03) on their ipsilateral foot compared to control group subjects. Ipsilateral hindfoot pressures were also found to be significantly lower than those of the contralateral foot (P = 0.001). Hindfoot pressure values of the HS group were increased in postoperative measurements (P = 0.01). Conclusion:ACL-deficient patients have altered plantar pressure distributions and ACL reconstructions restore these changes to normal. Pedobarography might be used as a practical method for dynamic functional assessment of ACL-deficient patients.

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“…Nevertheless, because of the anthropometrics affecting the raw joint moment, such as height and weight, which differ according to the subject, analyzing the joint motion is problematic. Therefore, performing a normalization process to reduce the differences has been recommended (Hart et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Three Normalization Methods for 3D Joint Moment in the Asymmetric Rotational Human Movements in Golf Swing Analysis

Lee

et al. 2015

Journal of Biosystems Engineering

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Purpose: From the perspective of biomechanics, joint moments quantitatively show a subject's ability to perform actions. In this study, the effect of normalization in the fast and asymmetric motions of a golf swing was investigated by applying three different normalization methods to the raw joint moment. Methods: The study included 13 subjects with no previous history of musculoskeletal diseases. Golf swing analyses were performed with six infrared cameras and two force plates. The majority of the raw peak joint moments showed a significant correlation at p < 0.05. Additionally, the resulting effects after applying body weight (BW), body weight multiplied by height (BWH), and body weight multiplied by leg length (BWL) normalization methods were analyzed through correlation and regression analysis. Results: The BW, BWH, and BWL normalization methods normalized 8, 10, and 11 peak joint moments out of 18, respectively. The best method for normalizing the golf swing was found to be the BWL method, which showed significant statistical differences. Several raw peak joint moments showed no significant correlation with measured anthropometrics, which was considered to be related to the muscle coordination that occurs in the swing of skilled professional golfers. Conclusions: The results of this study show that the BWL normalization method can effectively remove differences due to physical characteristics in the golf swing analysis.

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Sagittal plane knee joint moments following anterior cruciate ligament injury and reconstruction: A systematic review

Cited by 130 publications

References 49 publications

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Evaluation of plantar pressure distributions in patients with anteriorcruciate ligament deficiency: preoperative and postoperative changes

Comparison of Three Normalization Methods for 3D Joint Moment in the Asymmetric Rotational Human Movements in Golf Swing Analysis

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