Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament.

Snyder‐Mackler, Lynn; Luca, P F De; Williams, Patrick Ryan; Eastlack, Marty; Bartolozzi, Arthur R.

doi:10.2106/00004623-199404000-00010

Cited by 281 publications

(212 citation statements)

References 25 publications

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“…As a relative magnitude, it avoids the potential errors of latency, where the starting point of the movement may be difficult to determine. These findings support pathophysiological interpretations suggested by other authors from clinical data, including lack of proprioception and inefficient muscular reaction (Snyder-Mackler et al 1994, Williams et al 2004. Although stable (SR) knees permit a better muscular response than chronically unstable ones (UNR), there is insufficient proprioceptive output from the knee-both in stable and unstable knees, with and without reconstruction-to obtain a normal response to stimuli.…”

Section: Discussionsupporting

confidence: 89%

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction

et al. 2008

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Background Operative and nonoperative treatment of anterior cruciate ligament (ACL) injuries is often associated with a lack of proprioception and persistent muscle weakness of unknown origin.Methods This long-term study in the cat experimentally compares both neural and muscular activity in the articular nerves of the knee (PAN and MAN), quadriceps and hamstrings, in the chronic unstable knee, and in the reconstructed knee. We also investigated changes in neuromuscular response due to the mechanical competence of the graft, comparing stable and unstable reconstructed knees.Results We found increased periarticular muscle activity during anterior tibial translation in chronically unstable knees. Both reconstructed and non-reconstructed knees lost fast reactive activity in the articular nerves. When stability was recovered after reconstruction, the knees showed a more adjusted-although incomplete-muscular reaction.Interpretation ACL-injured knees in the cat, with or without reconstruction, show definite abnormalities in neuromuscular reaction in the long term. Regaining stability with a competent graft in the reconstructed knee is crucial for reduction of this anomalous reaction.

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Section: Discussionsupporting

confidence: 89%

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction

et al. 2008

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“…Activation failure has been demonstrated in our laboratory using the methods employed in this study in healthy, active, elderly individuals [26]; those with patellar contusion [ 191; those with end-stage knee osteoarthritis and after total knee arthroplasty [27]. We previously only demonstrated significant activation deficits after anterior cruciate ligament injury in one small subpopulation of anterior cruciate ligament deficient subjects where nine of 12 subjects had inhibition [21]. Our study, like the others, had a small sample size and did not represent a consecutive sample [21].…”

Section: Introductionmentioning

confidence: 73%

“…The highest value was used if multiple trials were performed. Quadriceps inhibition was defined as any voluntary activation value < 0.95 [21].…”

Section: Procedures Quadriceps Strength and Activationmentioning

confidence: 99%

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture

Chmielewski

Stackhouse

Axe

et al. 2004

Journal Orthopaedic Research

128

106

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Background Weakness of the quadriceps femoris muscle after anterior cruciate ligament injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after anterior cruciate ligament injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute anterior cruciate ligament injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the anterior cruciate ligament injured limbs than the uninvolved limbs, that the incidence of inhibition in the anterior cruciate ligament deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender.Study design: Prospective, descriptive. Methods: One hundred consecutive patients with acute anterior cruciate ligament rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t-tests were used to compare side-to-side differences in quadriceps strength. Independent t-tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals.Results: The average iqvolved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 per cent and uninvolved side quadriceps was 31 per cent after acute anterior cruciate ligament rupture. The incidence of incomplete activation bilaterally was 21 per cent. There was no difference in incidence of quadriceps inhibition by gender.Conclusion: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side.Clinical relevance: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit may be affected by the presence of voluntary activation failure in the uninvolved side.

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“…28,29 After the investigator determined that the knee-extension torque had reached a plateau representing the MVIC, a 100-millisecond train of 10 square-wave pulses of electrical stimulation at an intensity of 125 V, a pulse duration of 600 l, and a frequency of 100 pulses per second was delivered to the quadriceps using a Grass S88 dual-output, square-pulse stimulator (Grass-Telefactor, West Warwick, RI) with the STMISOC stimulus-isolation unit (BIOPAC Systems, Inc) and two 335-in (7.62-312.7-cm) pregelled stimulating electrodes placed over the proximal vastus lateralis and distal vastus medialis. This stimulus produced a transient increase in torque (T SIB ), known as a superimposed burst, that was compared with the average torque value for a manually identified 200-millisecond window immediately before the stimulation (T MVIC ; Figure 3).…”

Section: Knee-extension Strength and Quadriceps Central Activation Ratiomentioning

confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

109

116

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Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear.Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls.Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women).Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/ kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs.Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group ¼ 0.85 6 0.21, healthy group ¼ 0.97 6 0.14; t 44 ¼ 2.26, P ¼ .03), quadriceps CAR (ACLR group ¼ 0.94 6 0.11, healthy group ¼ 1.00 6 0.08; t 44 ¼ 2.22, P ¼ .04), and quadriceps AMT (ACLR group ¼ 1.13 6 0.18, healthy group ¼ 1.02 6 0.11; t 34 ¼À2.46, P ¼ .04) than the healthy control group.Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.Key Words: quadriceps activation, limb symmetry index, transcranial magnetic stimulation Key PointsThe anterior cruciate ligament reconstruction (ACLR) group exhibited a weaker, less activated quadriceps and less cortical excitability in the reconstructed limb than in the contralateral limb and in the limbs of the healthy control group. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Chronic asymmetry indicated reduced dynamic force absorption at the knee and may explain the increased rate of knee reinjury and chronic joint degeneration after ACLR.

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Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament.

Cited by 281 publications

References 25 publications

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

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