Laxity, instability, and functional outcome after ACL injury: copers versus noncopers

Eastlack, Marty; Axe, Michael J.; Snyder‐Mackler, Lynn

doi:10.1097/00005768-199902000-00002

Cited by 292 publications

(271 citation statements)

References 25 publications

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“…Quadriceps strength and not degree of laxity separated ACL deficient copers from non-copers in a study by Eastlock et al [5]. Quadriceps muscle performance and pain explained most of the variability in knee function after ACL reconstruction in a study by Risberg et al [19].…”

Section: Let Us First Consider the Open Kinetic Chain Situationmentioning

confidence: 98%

Quadriceps protects the anterior cruciate ligament

Bodor

2001

Journal Orthopaedic Research

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The aim of this study is to show that the quadriceps is the primary muscular restraint to anterior tibia1 translation during closed kinetic chain activities such as running, jumping, walking, and standing. It is my hypothesis that the quadriceps vector is directed superiorly during open kinetic chain knee extension and inferiorly during closed kinetic chain knee extension. My methods involve vector analysis based on a lateral radiograph of the normal human knee and muscle ultrasound. My results show that the quadriceps vector is directed superiorly for open kinetic chain knee extension and inferiorly for closed kinetic chain knee extension. The inferiorly directed quadriceps vector has an anterior femoral-tibia1 or posterior tibial-femoral component, which protects the anterior cruciate ligament (ACL) from anterior tibial-femoral shear. Therefore during closed kinetic chain activities, the quadriceps protects the ACL regardless of the activity of the hamstrizgs. Given that the quadriceps is much stronger than the hamstrings, has better leverage at low knee flexion angles, and a favorable vector with regard to the ACL during closed kinetic chain activities, and since most activities of daily living, sports, and non-contact ACL injuries occur with the foot on the ground, then it can be concluded that the quadriceps is theprimary ACLprotagonist. My findings have the following implications: (1) weak quadriceps are a risk factor for non-contact ACL injuries, (2) strong quadriceps are important for ACL injury prevention and rehabilitation, and (3) preservation of quadriceps strength is an important surgical goal.

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Section: Let Us First Consider the Open Kinetic Chain Situationmentioning

confidence: 98%

Quadriceps protects the anterior cruciate ligament

Bodor

2001

Journal Orthopaedic Research

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“…All single legged hop tests were supervised by the same physical therapist (HM). The functional examination consists of four previously described and validated single legged hop tests [11,15,17,42]. The tests include (1) the single hop test, (2) the triple hop test, (3) the triple crossover hop test, and (4) the six meter timed hop test.…”

Section: Performance Based Functional Hop Testsmentioning

confidence: 99%

Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study

Moksnes

Engebretsen

Risberg

2007

Knee Surg Sports Traumatol Arthr

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There is limited scientific knowledge on ACL injuries in children 12 years or younger. Substantial controversy exists on treatment algorithms and there are no published data on performance-based functional outcome. Classification of adult ACL injured subjects as copers and non-copers is common, but no study has classified knee function in children using performance-based functional test after ACL injury. The aim of the present study was to evaluate the medium-term functional outcome among children with ACL injury and to classify them as copers and noncopers. Children 12 years or younger who were referred to our institution from 1996 to 2004 with an ACL injury were included. Twenty non-operated subjects (21 knees) and six ACL reconstructed subjects (7 knees) were examined at a minimum of 2 years after ACL injury or reconstruction. Four single-legged hop tests, isokinetic muscle strength measurements, and three functional questionnaires (IKDC 2000, KOS-ADLS and Lysholm) were used as outcome measurements. Children who had resumed their pre-injury activity level and performed above 90% on all hop tests were classified as copers following non-operative treatment and ACL reconstruction. The 26 children were on average 10.1 years at the time of injury. Of the non-operated children, 65% had returned to pre-injury activity level, and 50% were classified as copers. Copers scored significantly better than non-copers on single hop for distance, IKDC 2000, and Lysholm score. Of the non-operated children, 9.5% had suffered a secondary meniscus injury. Of the ACL reconstructed subjects, 67% were classified as copers at follow-up. Non-operated ACL-deficient children demonstrated excellent knee function on performance-based single-legged hop tests and 65% had returned to pre-injury activity level. Delayed ACL reconstruction resulted in success for a majority of the ACL-reconstructed children. Treatment algorithms for ACL-injured children are discussed.

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“…Various jump tests are often used to evaluate function in patients with lower extremity injuries, as well as to evaluate functional performance in athletes (Noyes et al, 1991, Östenberg et al, 1998, Eastlack et al, 1999, Svantesson et al, 2001. Jump tests such as CMJ, SJ and Hopping have been used to evaluate the loading of the Achilles tendon (Komi et al, 1992).…”

Section: Strength and Functional Testsmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Laxity, instability, and functional outcome after ACL injury: copers versus noncopers

Cited by 292 publications

References 25 publications

Quadriceps protects the anterior cruciate ligament

Quadriceps protects the anterior cruciate ligament

Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

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