Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction

Castanharo, Raquel; Luz, Bruno S. da; Bitar, Alexandre Carneiro; D’Elia, Caio Oliveira; Castropil, Wagner; Duarte, Marcos

doi:10.1007/s00776-011-0118-3

Cited by 58 publications

(72 citation statements)

References 9 publications

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“…Our results showed that maximal hip and knee power was not different between legs. Our findings contrast with those of Castanharo et al, 17 who observed a decrease in the maximal knee power and similar maximal hip power during a bilateral squat jump. However, they did not measure the total power or maximal ankle power.…”

Section: Joint Kineticscontrasting

confidence: 99%

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Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

Fontenay

Argaud

Blache

et al. 2014

Journal of Athletic Training

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Context: Asymmetries subsist after anterior cruciate ligament reconstruction (ACL-R), and it is unclear how lower limb motion is altered in the context of a dynamic movement.Objective: To highlight the alterations observed in the injured limb (IL) during the performance of a dynamic movement after ACL-R.Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 11 men (age ¼ 23.3 6 3.8 years, mass ¼ 81.2 6 17.0 kg) who underwent ACL-R took part in this study 7.3 6 1.1 months (range ¼ 6-9 months) after surgery.Intervention(s): Kinematic and kinetic analyses of a singlelegged squat jump were performed. The uninjured leg (UL) was used as the control variable.Main Outcome Measure(s): Kinematic and kinetic variables.Results: Jump height was 24% less for the IL than the UL (F 1,9 ¼ 23.3, P ¼ .001), whereas the push-off phase duration was similar for both lower limbs (P ¼ .96). Knee-joint extension (F 1,9 ¼ 11.4, P ¼ .009), and ankle plantar flexion (F 1,9 ¼ 22.6, P ¼ .001) were less at takeoff for the IL than the UL. The hip angle at takeoff was not different between lower limbs (P ¼ .09). We found that total moment was 14% less (F 1,9 ¼ 11.1, P ¼ .01) and total power was 35% less (F 1,9 ¼ 24.2, P ¼ .001) for the IL than the UL. Maximal hip (P ¼ .09) and knee (P ¼ .21) power was not different between legs. The IL had 34% less maximal ankle power (F 1,9 ¼ 11.3, P ¼ .009) and 31% less angular velocity of ankle plantar flexion (F 1,9 ¼ 17.8, P ¼ .004) than the UL.Conclusions: At 7.3 months after ACL-R, motion alterations were present in the IL, leading to a decrease in dynamic movement performance. Enhancing the tools for assessing articular and muscular variables during a multijoint movement would help to individualize rehabilitation protocols after ACL-R.Key Words: knee, dynamic movement, hop test, rehabilitation Key PointsKinematic and kinetic alterations were demonstrated in the injured leg at 7.3 months after anterior cruciate ligament reconstruction. These alterations led to decreased jump height during a single-legged squat jump in the injured leg. Enhancing tools for assessing articular and muscular variables during a multijoint movement would help to individualize rehabilitation protocols after anterior cruciate ligament reconstruction.

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Section: Joint Kineticscontrasting

confidence: 99%

“…However, they did not measure the total power or maximal ankle power. The different outcomes between their study 17 and ours could be related to the nature of the activity performed. Indeed, different motion strategies are adopted for double-legged and singlelegged jumps.…”

Section: Joint Kineticscontrasting

confidence: 55%

Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

Fontenay

Argaud

Blache

et al. 2014

Journal of Athletic Training

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“…31 During sport-related jumping tasks, alterations in force-attenuation and force-generation strategies, as well as multidimensional kinematic and kinetic asymmetries of the hips and knees, have been identified up to 4 years after ACLR. 20,26,89,123,126 …”

Section: Acl Injury Risk Factorsmentioning

confidence: 99%

“…Epidemiological data highlight the biomechanical factors related to second–ACL injury risk 126 and the overlapping profile with primary-injury risk, 61 suggesting that there may be negative, additive effects of these neuromuscular deficits on second-injury risk. In addition, there is growing evidence for altered contralateral-limb loading post-ACLR during sports-related activities, 20,26,123,126 which may explain, in part, the increased rate of contralateral-limb ACL rupture in young, active individuals. 17,79,125,160 The influence of trunk position and control on second–ACL injury incidence has not been empirically tested but may also be considered a plausible risk factor, as increased knee abduction loading appears to be directly influenced by trunk positioning during athletic maneuvers.…”

Section: Acl Injury Risk Factorsmentioning

confidence: 99%

Neuromuscular Training to Target Deficits Associated With Second Anterior Cruciate Ligament Injury

Stasi¹,

Myer²,

Hewett

2013

Journal of Orthopaedic & Sports Physical Therapy

145

144

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Synopsis Successful return to previous level of activity following anterior cruciate ligament (ACL) reconstruction is not guaranteed, and the prevalence of second ACL injury may be as high as 30%. In particular, younger athletes who return to sports activities within the first several months after ACL reconstruction may be at significantly greater risk of a second ACL rupture compared to older, less active individuals. Significant neuromuscular deficits and functional limitations are commonly identified in athletes following ACL reconstruction, and these abnormal movement and neuromuscular control profiles may be both residual of deficits existing prior to the initial injury and exacerbated by the injury and subsequent ACL reconstruction surgery. Following ACL reconstruction, neuromuscular deficits are present in both the surgical and nonsurgical limbs, and accurately predict second-ACL injury risk in adolescent athletes. While second ACL injury in highly active individuals may be predicated on a number of modifiable and nonmodifiable factors, clinicians have the greatest potential to address the modifiable postsurgical risk factors through targeted neuromuscular interventions. This manuscript will (1) summarize the neuromuscular deficits commonly identified at medical discharge to return to sport, (2) provide the evidence underlying second-ACL injury risk factors, (3) propose a method to assess the modifiable deficits related to second-ACL injury risk, and (4) outline a method of intervention to prevent second ACL injury. The program described in this clinical commentary was developed with consideration for the modifiable factors related to second-injury risk, the principles of motor learning, and careful selection of the exercises that may most effectively modify aberrant neuromuscular patterns. Future validation of this evidence-based, late-phase rehabilitation program may be a critical factor in maximizing return-to-activity success and reduction of second-injury risk in highly active individuals. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2013;43(11):777–792. Epub 10 October 2013. doi:10.2519/jospt.2013.4693

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“…These sex differences in muscle function may help to explain the persistent biomechanical differences present during gait 8 and jump landings. 9,10 Suboptimal outcomes related to sex may increase the risk for posttraumatic knee-joint osteoarthritis after ACLR. At an average follow-up of 7.8 years after ACLR, females were more likely than males to exhibit radiologic signs of osteoarthritis.…”

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confidence: 99%

Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Hart

2014

Journal of Athletic Training

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Context: Sex differences in lower extremity neuromuscular function have been reported after anterior cruciate ligament reconstruction (ACLR). Research evidence supports different levels of fatigability in men and women and between patients with ACLR and healthy controls. The influence of sex on the response to continuous exercise in patients with ACLR is not clear.Objective: To compare quadriceps neuromuscular function after exercise between men and women with ACLR.Design: Descriptive laboratory study. Setting: Laboratory.Patients or Other Participants: Twenty-six active volunteers (13 men [50%]: age ¼ 24.1 6 4.4 years, height ¼ 179.1 6 9.8 cm, mass ¼ 80.1 6 9.4 kg, months since surgery ¼ 43.5 6 37.0; 13 women [50%]: age ¼ 24.2 6 5.6 years, height ¼ 163.0 6 5.9 cm, mass ¼ 62.3 6 8.3 kg, months since surgery ¼ 45.8 6 42.7) with a history of unilateral primary ACLR at least 6 months earlier. Intervention(s):Thirty minutes of continuous exercise comprising 5 separate 6-minute cycles, including 5 minutes of uphill walking and 1 minute of body-weight squatting and stepups.Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction torque, quadriceps superimposed-burst torque, and quadriceps central activation ratio before and after exercise. We performed separate 2 (sex: men, women) 3 2 (time: preexercise, postexercise) repeatedmeasures analyses of variance for the 3 variables. Separate, independent-samples t tests were calculated to compare preexercise with postexercise change in all dependent variables between sexes.Results: A significant group-by-time interaction was present for knee-extension torque (P ¼ .04). The percentage reduction in knee-extension maximal voluntary isometric contraction torque (men ¼ 1.94%, women ¼ À10.32%; P ¼ .02) and quadriceps central activation ratio (men ¼ À1.45%, women ¼ À8.69%; P ¼ .03) experienced by men was less than that observed in women.Conclusions: In the presence of quadriceps dysfunction, female participants experienced greater-magnitude reductions in quadriceps function after 30 minutes of exercise than male participants. This indicates a reduced ability to absorb knee-joint loads, which may have significant implications for reinjury and joint osteoarthritis in women after ACLR.Key Words: knee injury, fatigue, quadriceps activation Key PointsAfter anterior cruciate ligament reconstruction, quadriceps muscle dysfunction may reduce the ability to dynamically absorb knee-joint loading during activity. Compared with women, the quadriceps muscle in men is less susceptible to fatigue after anterior cruciate ligament reconstruction; however, sex differences have not been investigated. In the presence of preexercise quadriceps muscle dysfunction, women experienced greater reductions in normalized knee-extension maximal voluntary isometric torque and quadriceps central activation ratio after 30 minutes of exercise than men. The greater magnitude of exercise-induced alterations observed in women compared with men may put them at increased risk for reinju...

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Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction

Cited by 58 publications

References 9 publications

Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

Neuromuscular Training to Target Deficits Associated With Second Anterior Cruciate Ligament Injury

Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction

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