Dynamic stability in the anterior cruciate ligament deficient knee

Rudolph, Katherine S.; Axe, Michael J.; Buchanan, Thomas S.; Scholz, John P.; Snyder‐Mackler, Lynn

doi:10.1007/s001670000166

Cited by 358 publications

(469 citation statements)

References 25 publications

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“…These results are in agreement with the fact that both muscles, Hamstrings (knee flexor) and Quadriceps (knee extensor), are stabilizing the knee when the ACL is ruptured (Chmielewski et al, 2001;Rudolph et al, 2001). These muscles control the joint to avoid high displacements of the tibia with respect to the femur.…”

supporting

confidence: 89%

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Analysis of muscle synergies and activation–deactivation patterns in subjects with anterior cruciate ligament deficiency during walking

Serrancolí

Monllau

Font-Llagunes

2016

Clinical Biomechanics

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Background: The knowledge of muscle activation patterns when doing a certain task in subjects with anterior cruciate ligament deficiency could help to improve their rehabilitation treatment. The goal of this study is to identify differences in such patterns between anterior cruciate ligament-deficient and healthy subjects during walking.Methods: Electromyographic data for eight muscles were measured in a sample of eighteen subjects with anterior cruciate ligament deficiency, in both injured (Ipsilateral group) and non-injured (Contralateral group) legs, and a sample of ten healthy subjects (Control group). The analysis was carried out at two levels: activation-deactivation patterns and muscle synergies. Muscle synergy components were calculated using a non-negative matrix factorization algorithm. Findings:The results showed that there was a higher co-contraction in injured than in healthy subjects. Although all muscles are activated similarly since all subjects developed the same task (walking), some differences could be observed among analyzed groups.Interpretation: The observed differences in the synergy components of injured subjects suggested that those individuals alter muscle activation patterns to stabilize the knee joint. This analysis could provide valuable information for the physiotherapist to identify alterations in muscle activation patterns during the follow-up of the subject's rehabilitation.

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supporting

confidence: 89%

“…Regarding subjects with ACL deficiency, differences have been observed at the joint level as well as at individual EMG signals (Houck et al, 2007;Knoll et al, 2004;Rudolph et al, 2001;Serrancoli et al, 2014).…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Analysis of muscle synergies and activation–deactivation patterns in subjects with anterior cruciate ligament deficiency during walking

Serrancolí

Monllau

Font-Llagunes

2016

Clinical Biomechanics

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“…Although patients were instructed at the time of MRI testing to relax their leg and not resist the applied loads; some muscle activation was likely to occur to maintain that position for the full scan time affecting stability measurement. Because quadriceps strength and ROM are considered factors that affect knee stability, the excellent ROM and quadriceps strength in our cohort may have contributed to the lack of statistical significance in the stability measures [29,37]. In addition, 11 patients had meniscal pathology, composing less than one-third of the meniscus, at the time of their ACL reconstruction.…”

Section: Discussionmentioning

confidence: 95%

“…Anatomic placement is considered optimal to provide maximum stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel [1,11,23,26]; however, the results of this approach have sometimes been disappointing because a more vertical graft could limit rotational stability [37,45]. Some have therefore suggested that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial drilling portal [8,13,20].…”

Section: Introductionmentioning

confidence: 99%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

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“…Over the last decade, muscle activation patterns in gait have drawn considerable attention in the knee osteoarthritis literature. It was often reported that patients co-contract longer, co-contract more, or have higher muscle activity during walking than controls (e.g., Benedetti et al, 1999;Briem et al, 2007;Childs et al, 2004;Heiden et al, 2009;Hortobágyi et al, 2005;Hubley-Kozey et al, 2006;Lewek et al, 2003;Rudolph et al, 2001;Schmitt and Rudolph, 2007;Zeni et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Fallah-Yakhdani¹,

Bafghi²,

Meijer³

et al. 2012

Clinical Biomechanics

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Background: Knee osteoarthritis patients co-contract in knee-related muscle pairs during walking. The determinants of this co-contraction remain insufficiently clear. Methods: A heterogeneous group of 14 patients was measured before and one year after knee arthroplasty, and compared to 12 healthy peers and 15 young subjects, measured once. Participants walked on a treadmill at several imposed speeds. Bilateral activity of six muscles was registered electromyographically, and cocontraction time was calculated as percentage of stride cycle time. Local dynamic stability and variability of sagittal plane knee movements were determined. The surgeon's assessment of alignment was used. Preoperatively, multivariate regressions on co-contraction time were used to identify determinants of cocontraction. Post-operatively it was assessed if predictor variables had changed in the same direction as co-contraction time. Findings: Patients co-contracted longer than controls, but post-operatively, differences with the healthy peers were no longer significant. Varus alignment predicted co-contraction time. No patient had post-operative varus alignment. The patients' unaffected legs were more unstable, and instability predicted co-contraction time in both legs. Post-operatively, stability normalised. Longer unaffected side co-contraction time was associated with reduced affected side kinematic variability. Post-operatively, kinematic variability had further decreased. Interpretations: Varus alignment and instability are determinants of co-contraction. The benefits of cocontraction in varus alignment require further study. Co-contraction probably increases local dynamic stability, which does not necessarily decrease the risk of falling. Unaffected side co-contraction contributed to decreasing affected side variability, but other mechanisms than co-contraction may also have played a role in decreasing variability.

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Dynamic stability in the anterior cruciate ligament deficient knee

Cited by 358 publications

References 25 publications

Analysis of muscle synergies and activation–deactivation patterns in subjects with anterior cruciate ligament deficiency during walking

Analysis of muscle synergies and activation–deactivation patterns in subjects with anterior cruciate ligament deficiency during walking

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

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