Gait adaptations by patients who have a deficient anterior cruciate ligament.

Berchuck, Matthew; Andriacchi, T.P.; Bach, Bernard R.; Reider, Bruce

doi:10.2106/00004623-199072060-00012

Cited by 474 publications

(389 citation statements)

References 0 publications

Supporting

Mentioning

321

Contrasting

Unclassified

Order By: Relevance

“…At the final follow-up (3.7 ± 0.3 years), there was further improvement of proprioception especially in the mid-range position compared with the examination six months after operation, but full restitution of proprioception was again not achieved. The ACL-deficient knee moves along a non-physiological axis 12 which causes disturbance of cortical interpretation as well as damage to the remaining receptors in the capsule and ligaments due to increased laxity. By restoring mechanical stability by ACL reconstruction, these remaining receptors seem to recover and to compensate for the lack of mechanoreceptors in the ACL, especially at the extreme ranges of movement.…”

Section: Discussionmentioning

confidence: 99%

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament

Fremerey

Lobenhoffer

Zeichen

et al. 2000

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

W e assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined.Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. The complex kinematics of the knee depend on both mechanical stability and dynamic interaction between the central nervous system and the joint.1 Proprioception ( Reconstruction of the ACL can be achieved successfully, by a variety of procedures, but many authors have reported poor correlation between the clinical signs, knee assessment scores and function. Some patients who have persistent ligamentous laxity after reconstruction return to full activity without symptoms. Others, with a clinically satisfactory ACL reconstruction, good ligamentous stability and high clinical knee scores, continue to suffer from subjective instability and episodes of giving-way. These patients appear to have poor joint position sense caused by lack of proprioception. The pattern of proprioceptive recovery after ACL reconstruction is still not clear. 1,5 We have therefore investigated the loss of proprioception after acute rupture of the ACL and analysed the potential for the return of proprioception by either intensive rehabilitation or reconstruction in a prospective, longitudinal study. The correlation between proprioception, patient satisfaction, the Lysholm knee score and ligamentous laxity was also assessed. Diagram showing the central control of the CNS and the peripheral control by the muscle-spindle system (M), joint receptors (J) and by mechanoreceptors located in the skin (S) and tendons (T) (␥, gamma efferents; ␣, alpha efferents; MN, motor neurone).

show abstract

Section: Discussionmentioning

confidence: 99%

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament

Fremerey

Lobenhoffer

Zeichen

et al. 2000

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

show abstract

“…Researchers have used the more demanding task of stair climbing to describe changes in a patient's functional performance following surgical interventions such as knee replacements [3][4][5][6]. For example, Andriacchi et al [3] compared a group of patients who had between them five different knee prostheses and concluded that both the kinematic and kinetic results of stair climbing could be used to differentiate between constrained and unconstrained prosthesis designs.…”

Section: Introductionmentioning

confidence: 99%

Knee and hip kinetics during normal stair climbing

2002

View full text Add to dashboard Cite

Understanding joint kinetics during activities of daily living furthers our understanding of the factors involved in joint pathology and the effects of treatment. In this study, we examined hip and knee joint kinetics during stair climbing in 35 young healthy subjects using a subject-specific knee model to estimate bone-on-bone tibiofemoral and patello-femoral joint contact forces. The net knee forces were below one body weight while the peak posterior-anterior contact force was close to one body weight. The peak distal-proximal contact force was on average 3 times body weight and could be as high as 6 times body weight. These contact forces occurred at a high degree of knee flexion where there is a smaller joint contact area resulting in high contact stresses. The peak knee adduction moment was 0.42 (0.15) N m/kg while the flexion moment was 1.16 (0.24) N m/kg. Similar peak moment values, but different curve profiles, were found for the hip. The hip and knee posterio-anterior shear forces and the knee flexion moment were higher during stair climbing than during level walking. The most striking difference between stair ascent and level walking was that the peak patello-femoral contact force was 8 times higher during stair ascent. These data can be used as baseline measures in pathology studies, as input to theoretical joint models, and as input to mechanical joint simulators.

show abstract

“…ACL injured patients eventually develop a greater extensor torque at the hip and a reduced extensor torque at the knee during the stance phases of walking and running [29][30][31][32]. These observations have been supported by increased electromyographic (EMG) activity in the hamstrings and reduced EMG activity in the quadriceps in ACL-deficient patients during the gait cycle [33][34][35][36][37][38][39].…”

Section: Biomechanics In Acl-deficient Knees and Aclr Patientsmentioning

confidence: 90%

“…During this phase of the cycle, the limb accepts full support of the body and attenuates shock via knee flexion, which is controlled by an eccentric contraction of the quadriceps. When symptoms of knee instability are felt, patients alter their movement patterns through reduced knee flexion and internal knee extensor moments [30,41]. The alteration in movement pattern results from the hesitancy to fully activate the quadriceps muscles at a range close to full knee extension.…”

Section: Biomechanics In Acl-deficient Knees and Aclr Patientsmentioning

confidence: 99%

“…The alteration in movement pattern results from the hesitancy to fully activate the quadriceps muscles at a range close to full knee extension. Berchuck et al [30] termed this alteration as "quadriceps avoidance" due to the fact that close to full knee extension, quadriceps contraction may cause anterior tibial translation [42,43] that in turn could result to the symptoms of giving way. The alteration in movement pattern associated with "quadriceps avoidance," may also represent an increase flexor activity of the hamstrings [44], or the gastrocnemius [45] which have been supported by EMG studies.…”

Section: Biomechanics In Acl-deficient Knees and Aclr Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

Shaarani

Moyna

Moran

et al. 2012

ISRN Rehabilitation

View full text Add to dashboard Cite

The rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction requires symmetry in bilateral quadriceps strength and adequate proprioception capabilities prior to return to preoperative level of activity or sport. This is the limiting factor and can delay the time that patients can return to play. There is little literature on pre-operative physiotherapy or prehabilitation of patient with ACL injury. This paper discusses the anatomy, biomechanics, surgical decision making, and the current knowledge of preoperative training or "prehabilitation" in patients awaiting ACL reconstruction.

show abstract

Gait adaptations by patients who have a deficient anterior cruciate ligament.

Cited by 474 publications

References 0 publications

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament

Knee and hip kinetics during normal stair climbing

Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

Contact Info

Product

Resources

About