Proprioception in the cruciate deficient knee

Corrigan, John; Cashman, W. F.; Brady, Michael P.

doi:10.1302/0301-620x.74b2.1544962

Cited by 278 publications

(186 citation statements)

References 18 publications

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“…Although the mechanical contribution of the ligament is well documented, recent information suggests that it may have an important sensory role in initiating protective reflexes to control surrounding muscle tone through the 1a-musclespindle to the afferent-nerve system. [1][2][3][4] Many studies have shown the existence of several types of mechanoreceptor in human and animal ACLs.5-8 Whether these mechanoreceptors and their associated functions are restored after reconstruction of the ACL is uncertain. 1,5 Our aim therefore was to determine whether regenerated nerve fibres and mechanoreceptors in the reconstructed ACL could respond to mechanical loads applied to the ligament and to test for afferent impulses and somatosensory evoked potentials (SEPs), which would indicate functional restoration of axons and mechanoreceptors.…”

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Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

Ochi

Iwasa

Uchio

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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W e have determined whether somatosensory evoked potentials (SEPs) were detectable after direct mechanical stimulation of normal, injured and reconstructed anterior cruciate ligaments (ACLs) during arthroscopy. We investigated the position sense of the knee before and after reconstruction, and correlated the SEP with instability.Reproducible SEPs were detected in all 19 normal ACLs and in 36 of 38 ACLs reconstructed during a period of 13 months. Of the 45 injured ACLs, reproducible SEPs were detected in 26. The mean difference in anterior displacement in the SEP-positive group of the injured ACL group was significantly lower than that in the SEP-negative group. In the reconstructed group, the postoperative position sense was significantly better than the preoperative position sense. Our results indicate not only that sensory reinnervation occurs in the reconstructed ACL, but also that the response to mechanical loads can be restored, and is strongly related to improvement in position sense. Very little information is available regarding the sensory role of the anterior cruciate ligament (ACL). Although the mechanical contribution of the ligament is well documented, recent information suggests that it may have an important sensory role in initiating protective reflexes to control surrounding muscle tone through the 1a-musclespindle to the afferent-nerve system. [1][2][3][4] Many studies have shown the existence of several types of mechanoreceptor in human and animal ACLs.5-8 Whether these mechanoreceptors and their associated functions are restored after reconstruction of the ACL is uncertain. 1,5 Our aim therefore was to determine whether regenerated nerve fibres and mechanoreceptors in the reconstructed ACL could respond to mechanical loads applied to the ligament and to test for afferent impulses and somatosensory evoked potentials (SEPs), which would indicate functional restoration of axons and mechanoreceptors. Patients and MethodsWe enrolled 110 patients (110 knees) with intact posterior cruciate ligaments (PCL), but with knee injuries, into the study. Their mean age was 31 years (9 to 66). All gave consent and the protocol was approved by the Ethical Board of our institution. In four knees, mechanical stimulation of the intact PCL produced no cortical SE, because of technical defects and these individuals were excluded leaving 106 knees (106 patients, 49 men and 57 women) for analysis.The patients were placed into one of three groups. Group I comprised 21 men and 24 women of mean age 29.8 years with an injury to their ACL, who had been diagnosed with anterior instability before arthroscopy. They underwent an arthroscopically-assisted reconstruction of the ligament. In this group the ACL had been ruptured, but remnants were observed bridging the femur and tibia. These attachment sites were not anatomical and the bridging tissue was flimsy. Knees in which the remnant of the ACL was attached to the PCL were excluded from group I, since the mechanical stimulation of the remnant through its attachment could ind...

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confidence: 99%

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Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

Ochi

Iwasa

Uchio

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…Therefore, some authors have indicated the physical training of eccentric strength as an effective strategy for preventing injuries related to landing from a jump [12,33,34]. Furthermore, corrigan et al [35] reported that posterior stabilization of the knee joint through hamstrings strengthening potentially caused a reduction in anterolateral translation and decreased the incidence of AcL injury. strong hamstrings may protect AcL from excessive strain in athletes [12,32,33].…”

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A comparison of isokinetic knee strength and power output ratios between female basketball and volleyball players

Kabaciński¹,

Murawa²,

Fryzowicz³

et al. 2018

Hum Mov.

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Purpose. Tests such as the counter movement jump (cMJ) and squat jump (sJ) allow for determining the ratio of maximal power output generated during sJ to cMJ (s/c). The isokinetic peak torque ratio of the hamstrings contracting eccentrically to the quadriceps contracting concentrically (H/Q) is defined as functional H/Q. The purpose of this study was to compare the s/c and functional H/Q between female basketball and volleyball players. Methods. The total of 14 female basketball players (age, 19.8 ± 1.4 years) and 12 female volleyball players (age, 22.3 ± 4.2 years) participated in the study. A piezoelectric force platform was used for the cMJ and sJ. Moreover, isokinetic tests of the hamstrings and quadriceps muscle torque during eccentric and concentric contraction were performed. Results. The results of the s/c and functional H/Q at 90 deg · s -1 /60 deg · s -1 velocities were higher in basketball players (87.3 ± 9.1% and 91.4 ± 9.3%, respectively) than in volleyball players (83.1 ± 9.8% and 83.6 ± 16.5%, respectively). No significant differences in s/c or functional H/Q values between the two groups were found (p > 0.05). Conclusions. Decreasing the s/c may result from an improvement in the power output during cMJ and a better utilization of the stretch-shortening cycle effect. Balancing the functional H/Q through increasing the eccentric hamstrings strength can provide dynamic knee joint stabilization.

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“…After ACLR, surgery afferent information is altered, which results in a disruption in the pathway between the patient's center of gravity and base of support [27]. Improving neuromuscular reaction time to imposed loads enhances dynamic stabilization around the knee and thus protects the static reconstructed tissue from overstress or re-injury [28].…”

Section: Neuromuscular Trainingmentioning

confidence: 99%

ACL Rehabilitation Progression: Where Are We Now?

Cavanaugh

Powers

2017

Curr Rev Musculoskelet Med

122

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Purpose of Review With the increase of publications available to the rehabilitation specialist, there is a need to identify a progression to safely progress the patient through their postoperative ACL reconstruction rehabilitation program. Rehabilitation after ACL reconstruction should follow an evidence-based functional progression with graded increase in difficulty in activities. Recent Findings Clinicians should be discouraged not to use strict time frames and protocols when treating patients following ACL reconstruction. Rather, guidelines should be followed that allow the rehabilitation specialists to progress the patient as improvements in strength, edema, proprioception, pain, and range of motion are demonstrated. Prior to returning to sport, specific objective quantitative and qualitative criteria should be met. The time from surgery should not be the only consideration. Summary The rehabilitation specialist needs to take into account tissue healing, any concomitant procedures, patellofemoral joint forces, and the goals of the patient in crafting a structured rehabilitation program. Achieving symmetrical full knee extension, decreasing knee joint effusion, and quadriceps activation early in the rehabilitation process set the stage for a safe progression. Weight bearing is begun immediately following surgery to promote knee extension and hinder quadriceps inhibition. As the patient progresses through their rehabilitative course, the rehabilitation specialist should continually challenge the patient as is appropriate based upon their goals, their levels of strength, amount of healing, and the performance of the given task.

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Proprioception in the cruciate deficient knee

Cited by 278 publications

References 18 publications

Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

A comparison of isokinetic knee strength and power output ratios between female basketball and volleyball players

ACL Rehabilitation Progression: Where Are We Now?

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