A Neuromuscular Mechanism of Posttraumatic Osteoarthritis Associated with ACL Injury

Palmieri-Smith, Riann M.; Thomas, Abbey C.

doi:10.1097/jes.0b013e3181aa6669

Cited by 205 publications

(207 citation statements)

References 31 publications

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“…35 This reflex arc is destroyed during the severing of the ACL and is usually not reinnervated with patellar or hamstring tendon grafts. While the contribution of the ACL-hamstrings reflex arc to proprioception and its role in the prevention of ACL rupture is controversial, 49,50 the functional innervation observed in some models of repair will only further enhance the recovery potential of the ACL. 49,50 In our BLB grafts, we have observed innervation of the grafts as early as 3-months after implantation (see Fig.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

Smietana

Kostrominova

et al. 2012

Tissue Engineering Part A

114

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The anterior cruciate ligament (ACL), a major stabilizer of the knee, is commonly injured. Because of its intrinsic poor healing ability, a torn ACL is usually reconstructed by a graft. We developed a multi-phasic, or boneligament-bone, tissue-engineered construct for ACL grafts using bone marrow stromal cells and sheep as a model system. After 6 months in vivo, the constructs increased in cross section and exhibited a well-organized microstructure, native bone integration, a functional enthesis, vascularization, innervation, increased collagen content, and structural alignment. The constructs increased in stiffness to 52% of the tangent modulus and 95% of the geometric stiffness of native ACL. The viscoelastic response of the explants was virtually indistinguishable from that of adult ACL. These results suggest that our constructs after implantation can obtain physiologically relevant structural and functional characteristics comparable to those of adult ACL. They present a viable option for ACL replacement.

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Section: Discussionmentioning

confidence: 99%

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

Smietana

Kostrominova

et al. 2012

Tissue Engineering Part A

114

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show abstract

“…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%

“…10,15 The importance of quadriceps function after ACLR cannot be overstated because reduced quadriceps function consistently has been related to long-term quadriceps weakness 10,14 and physical performance 3,16,17 and has been hypothesized to increase the risk for knee-joint osteoarthritis. 7 Assessment and comparison of range of motion and strength are common clinical tools used to track progress throughout the rehabilitation process. Between-limbs differences, often referred to as limb asymmetry, have been proposed as a more effective manner to assess lower extremity dysfunction after knee-joint injury.…”

mentioning

confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

109

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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“…17 The quadriceps play a critical role in joint stability and dynamic function at the knee, including force attenuation and resisting knee-adduction moments during the stance phase in walking gait. 3,11,18,19 Prolonged strength deficits may result in altered gait patterns and instability that can predispose individuals post-APM to reinjury and may accelerate joint degeneration. 2,3,9,11,13 Identifying these deficits and appropriate methods to restore quadriceps strength remains a concern in the rehabilitation process of individuals who may return to activity shortly after APM.…”

mentioning

confidence: 99%

Effects of Arthroscopic Partial Meniscectomy on Quadriceps Strength: A Systematic Review

McLeod¹,

Gribble²,

Pfile³

et al. 2012

Journal of Sport Rehabilitation

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Context: Arthroscopic partial meniscectomy (APM) after meniscal tear has been widely accepted and associated with quick return to activity. Unfortunately, meniscectomy is associated with risk for knee osteoarthritis, which may be attributed to postsurgical quadriceps weakness. This has important implications, as the quadriceps play a prominent role in knee stabilization and energy attenuation in the lower extremity. Objective: To determine the magnitude of interlimb quadriceps strength deficits in people with unilateral APM by systematically reviewing the current literature. Evidence Acquisition: The Web of Knowledge databases were searched on September 22, 2010, using terms meniscus OR meniscectomy AND quadriceps strength OR quadriceps weakness. Included articles were written in English, reporting means and SDs of isokinetic peak torque at 60° and 180°/s for both limbs. Evidence Synthesis: Four articles were included in the final analysis. Effect sizes and 95% confidence intervals (CI) were calculated between limbs for periods less than 1 mo, 1-3 mo, 3-6 mo, and more than 6 mo. Conclusion: Homogeneous effect sizes indicate quadriceps weakness in the involved limb. Effects were strong at less than 1 mo (d = -1.01 to -1.62), while weak to strong effects were found for 1-3 mo (d = -0.40 to -8.04) and 3-6 mo (d = -0.40 to -5.11). Weak effects were found at more than 6 mo (d = -0.30 to -0.37). Definitive effects with a CI not crossing zero were found in 65% of the data. Although APM patients return to function within weeks after surgery, prolonged quadriceps strength deficits may increase the risk of knee-joint degeneration. Furthermore, evidence of bilateral dysfunction after unilateral injury may suggest that neuromuscular deficits post-APM are greater than the interlimb differences found in this review. Further research should be conducted to determine the nature of strength deficits and the best methods for restoring strength after APM.

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A Neuromuscular Mechanism of Posttraumatic Osteoarthritis Associated with ACL Injury

Cited by 205 publications

References 31 publications

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Effects of Arthroscopic Partial Meniscectomy on Quadriceps Strength: A Systematic Review

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