Sagittal plane translation of the tibia in anterior cruciate ligament‐deficient knees during commonly used rehabilitation exercises

Abstract

It may be assumed that exercises that provoke high sagittal plane knee translations also induce high stresses on an anterior cruciate ligament substitute and, therefore, these exercises should be limited during the first months after reconstruction. In 18 patients with unilateral anterior cruciate ligament deficiency, sagittal plane knee translations were measured with a goniometer linkage system during common activities. The largest translations were found during low‐speed isokinetic exercises. Further, isokinetic and isometric exercises on the Cybex‐II dynamometer provoked in more than 40% of the patients larger translations on the injured than on the healthy knee. However, isometric exercises without distally applied load only provoked small translation. During bicycling, translations increased with increasing resistance similarly in both limbs. Except for walking downstairs, load‐bearing exercises, such as sitting down and standing up from a chair and walking upstairs, only produced negligible amounts of tibial translation. In conclusion, during the early phase after anterior cruciate ligament reconstruction, activities such as bicycling and some weightbearing exercises seem to be more recommendable than low‐speed isokinetic exercises, isometric contractions at a low knee flexion angle with distally applied load or walking downstairs.

Altered knee kinematics in ACL‐deficient non‐copers: A comparison using dynamic MRI

“…Kizuki et al 24 reported 4.1 mm more A/P translation in ACL-deficient knees relative to the uninjured knees of their subjects as they performed a nonloaded, seated 908 knee extension task in an exercise dynamometer (Biodex Medical Systems, Inc., Shirley, NY). In the above studies, tibial translation was defined as displacement relative to data collected in reference positions, such as non-loaded full extension, 22,23 or a series of values measured as the knee was passively extended. 24 Joint positioning in such reference configurations may itself be affected by pathology; for instance, fixed joint subluxations have been reported in ACL-deficient subjects during standing by Almekinders and Chiavetta.…”

Quantitative evaluation of anterior tibial translation during isokinetic motion in knees with anterior cruciate ligament reconstruction using either patellar or hamstring tendon grafts

“…1). The reproducibility of this system has been reported previously [20] and it has been employed by several investigators to study characteristics of knee motion [9,17,19,21]. It is composed of femoral and tibial frames and three goniometers in a rotation module to measure the relative rotation between the femur and the tibia.…”

“…The system was zeroed with the participant lying relaxed at full knee extension and neutral knee rotation. Following previous reports [9,20,21], the alignment of the potentiometers was checked repeatedly and carefully in the zeroing screen of the computer during exercise. The protocol was repeated with fresh zeroing if values were different from the original.…”

“…The resistance pad (D) of the Biodex is placed on the tibia just above the ankle joint sagittal translation was apparent between the extension and the flexion phase from 90 to 0°. It is generally considered that the slope of this line in exercise represents the relative motion between the measuring arm and the patella during the range of motion [9,20,21]. In this study, ATT was measured in terms of the difference with isokinetic exercise compared to the value for passive extension motion (Fig.…”

“…From 90 to 0°of knee flexion in the extension phase, differences in anterior sagittal displacement between passive and isokinetic motion were measured at every 10°position with the help of a computer (IBM PC/AT compatible EVEREX computer, Fremont, CA, USA) equipped for the CA-4000. Data from the second cycle of each test were used for calculation, as in previous reports [19][20][21].…”