Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction

Hunt, Michael A.; Ciacca, Stephen R. Di; Jones, Ian; Padfield, Beverley; Birmingham, Trevor B.

doi:10.3138/physio.62.3.235

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…A reduction in range of motion after ACLR, especially a loss of knee extension at heel strike, 24,46,57 is similarly thought to contribute to development of PFOA by shifting patellar joint reaction forces to regions of trochlear and patellar cartilage that may not be able to adapt to the new loading pattern, initiating a degenerative pathway. 54 Accordingly, in a hop-test study of 45 participants between 1 and 2 years after ACLR, Culvenor et al 14 found that patients with at least partial-thickness cartilage lesions to the patellar or femoral trochlear surfaces by MRI (termed “early PFOA”) demonstrated greater peak knee flexion angle with a trend for greater flexion at first contact than did patients without evidence of early PFOA.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

Erhart‐Hledik

Asay

et al. 2021

Am J Sports Med

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Background: Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. Purpose: To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time–enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. Study Design: Cross-sectional study; Level of evidence, 3. Methods: MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. Results: Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = −0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = −0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values ( R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees ( P = .029, .001, and .044, respectively). Conclusion: Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

Erhart‐Hledik

Asay

et al. 2021

Am J Sports Med

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“…Post‐operative deficits in knee extension have been shown to be predictive of an increased risk for OA in the ACLR knee . Motion analysis studies have found kinematic changes to the ACLR knee in all three planes, including an increase in knee flexion, a shift towards external tibial rotation, and a shift toward varus rotation . Furthermore, studies of quasi‐static weight‐bearing function after ACL reconstruction have observed a consistent anterior shift in the relative tibial position, even in knees judged to be clinically stable .…”

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confidence: 99%

Gait mechanics 2 years after anterior cruciate ligament reconstruction are associated with longer‐term changes in patient‐reported outcomes

Erhart‐Hledik

Chu

Asay

et al. 2016

Journal Orthopaedic Research

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This study tested the hypothesis that side-to-side differences in knee gait mechanics 2 years after anterior cruciate ligament (ACL) reconstruction are associated with long-term (~8 years post-reconstruction) changes in patient-reported outcome scores. Sixteen subjects (5 males; age: 29.1 ± 7.1 years) with primary unilateral ACL reconstruction were gait tested at baseline (2.2 ± 0.3 years post-ACL reconstruction) and filled out KOOS and Lysholm surveys. At long-term follow-up (7.7 ± 0.7 years post-ACL reconstruction), the same subjects completed KOOS and Lysholm surveys. Pearson correlation coefficients assessed relationships between side-to-side differences in kinematics and kinetics at baseline and changes in Lysholm and KOOS Pain/QOL scores from 2 to 8 years post-ACL reconstruction. Significant associations were seen between greater average varus rotation (Lysholm: R =−0.654, p =0.006) and less anterior femoral displacement (Lysholm: R =0.578, p =0.019) during stance of the ACL reconstructed knee versus the contralateral knee at baseline and worse follow-up outcome scores. Significant associations were seen between greater peak knee flexion moment (KOOS Pain: R =−0.572, p =0.026; KOOS QOL: R =−0.636, p =0.011), peak knee adduction moment (Lysholm: R =−0.582, p =0.018; KOOS Pain: R =−0.742, p =0.002; KOOS QOL: R =−0.551, p =0.033), and peak internal rotation moment (Lysholm: R =0.525, p =0.037; KOOS Pain: R =0.815, p <0.001; KOOS QOL: R =0.777, p =0.001) in the ACL reconstructed knee at baseline with worse follow-up outcomes. The results of this study support the hypotheses that early changes in gait mechanics following ACL reconstruction are associated with longer-term clinical changes in patient-reported outcomes, suggesting that biomechanical markers obtained as early as 2 years after ACL reconstruction may be useful to understand clinical outcomes in this population.

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“…Eine Einschränkung der Arbeit ist die Größe der Stichprobe. Mit 13 untersuchten Proband(inn)en ist sie zwar klein, allerdings ist sie vergleichbar mit verschiedenen randomisierten kontrollierten Studien, die sich mit der AOT [16][29] [34], mit der Extension des Kniegelenks oder mit der Kniebeweglichkeit nach einer VKB-Plastik [8][30] [35] beschäftigten. Mit dieser Probandenanzahl ist unsere Studie als eine Pilotstudie zu betrachten: Die Ergebnisse sollten zwar vorsichtig bewertet werden, aber dazu ermutigen, in diese Richtung weiter zu forschen.…”

Section: Limitationenunclassified

Der Effekt von Action Observation Therapy auf die Extension nach einer vorderen Kreuzbandplastik: eine randomisierte kontrollierte Pilotstudie

Doutressoulles¹,

Richter

2021

MSK – Muskuloskelettale Physiotherapie

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ZusammenfassungEine bekannte Komplikation nach einer Plastik des vorderen Kreuzbandes (VKB) ist das Extensionsdefizit (ED). Ziel dieser Studie war, zu erforschen, ob eine zusätzlich zu den klassischen Streckübungen eingesetzte einmalige Anwendung der „Action Observation Therapy“ (AOT) die Extension des Kniegelenks nach einer VKB-Plastik deutlicher verbessert als eine Therapiesitzung ohne AOT.13 Proband(inn)en mit ED nach einer VKB-Plastik wurden in eine AOT-Gruppe (n = 8) und eine Kontrollgruppe (n = 5) randomisiert. Jede Gruppe erhielt eine Therapiesitzung. Die Therapie bestand aus dem Betrachten eines Videos, gefolgt von aktiven Extensionsübungen, wobei das Video der AOT-Gruppe Extensionsübungen und das der Kontrollgruppe Landschaftsaufnahmen zeigte. Primäres Outcome war das Bewegungsausmaß der aktiven Extension, als sekundäre Outcomes wurden das Bewegungsausmaß der passiven Extension und die Heel-Height Difference (HHD) gemessen. Die Messungen erfolgten direkt vor und nach der Behandlung.Die aktive Extension verbesserte sich sowohl in der AOT-Gruppe (von ∅ –2,0° (± 6,3) auf ∅ 0,8° (± 3,9), p = 0,036) als auch in der Kontrollgruppe (von ∅ –8,2° (± 5,5) auf ∅ –5,6° (± 4,7), p = 0,049). Die aktive Extension war in der AOT-Gruppe nach der Intervention signifikant besser als in der Kontrollgruppe (p = 0,023). Für die passive Extension und die HHD gab es keine signifikanten Unterschiede zwischen beiden Gruppen.Bei Patient(inn)en nach einer VKB-Plastik zeigte sich in der Gruppe mit AOT eine bessere aktive Knieextension als in der Kontrollgruppe ohne AOT. Weitere Arbeiten mit einer größeren Stichprobe und einer längeren Verlaufskontrolle sind notwendig, um diese Ergebnisse zu bestätigen.

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Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction

Cited by 8 publications

References 29 publications

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

Gait mechanics 2 years after anterior cruciate ligament reconstruction are associated with longer‐term changes in patient‐reported outcomes

Der Effekt von Action Observation Therapy auf die Extension nach einer vorderen Kreuzbandplastik: eine randomisierte kontrollierte Pilotstudie

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