A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Musculoskeletal System

Abstract

Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR.

Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study

“…Nagelli et al 41 reported reduced frontal-plane knee motion and increased frontal-plane hip motion during a single-leg drop landing task to be associated with lower scores on the ACL-RSI scale. Common impairments to the neurological system after an ACL injury, such as muscle inhibition, altered muscle activation patterns, decreased knee extension, and joint instability, 33 were also not investigated in the current study. Movement quality/strategies, muscle activation amplitude, and joint stability during dynamic tasks as well as knee extension deficits may, thus, be other factors that could be explored further as contributors to psychological readiness.…”

Risk factors of reoperative post anterior cruciate ligament reconstruction

“…Loss of range of motion (ROM), which can affect functional activities, is one of the alterations that occur both after an injury and after surgery. 12 It is also associated with postoperative problems such as ABSTRACT Background: Anterior Cruciate Ligament (ACL) injury is a knee injury that generally occurs in individuals who are active in sports and can be the end of a career for athletes. ACL injuries usually require surgery.…”