Return‐to‐sport quadriceps strength symmetry impacts 5‐year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis

Brunst, Caroline; Ithurburn, Matthew P.; Zbojniewicz, Andrew M.; Paterno, Mark V.; Schmitt, Laura C.

doi:10.1002/jor.25029

Cited by 14 publications

(11 citation statements)

References 51 publications

(104 reference statements)

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“…17 Currently, there is limited evidence showing an association between relaxation times and patient-reported outcome scores or functional testing results after ACLR. 7,26,38,39 In our study, we found that increased cartilage relaxation in the anterolateral tibia and femur was associated with lower hamstring and quadriceps symmetry at 2 years postoperatively. In the STABILITY 1 Study, the ACLR 1 LET group was found to have lower quadriceps torque and power at the 6-month time point.…”

Section: Discussionsupporting

confidence: 50%

Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis

Firth,

Pritchett,

Milner

et al. 2024

Am J Sports Med

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Background: Concerns have arisen that anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) may accelerate the development of posttraumatic osteoarthritis in the lateral compartment of the knee. Purpose/Hypothesis: The purpose of this study was to evaluate whether the augmentation of ACLR with LET affects the quality of lateral compartment articular cartilage on magnetic resonance imaging (MRI) at 2 years postoperatively. We hypothesized that there would be no difference in T1rho and T2 relaxation times when comparing ACLR alone with ACLR + LET. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive subgroup of patients at the Fowler Kennedy Sport Medicine Clinic participating in the STABILITY 1 Study underwent bilateral 3-T MRI at 2 years after surgery. The primary outcome was T1rho and T2 relaxation times. Articular cartilage in the lateral compartment was manually segmented into 3 regions of the tibia (lateral tibia [LT]–1 to LT-3) and 5 regions of the femur (lateral femoral condyle [LFC]–1 to LFC-5). Analysis of covariance was used to compare relaxation times between groups, adjusted for lateral meniscal tears and treatment, cartilage and bone marrow lesions, contralateral relaxation times, and time since surgery. Semiquantitative MRI scores according to the Anterior Cruciate Ligament OsteoArthritis Score were compared between groups. Correlations were used to determine the association between secondary outcomes (including results of the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Lower Extremity Functional Scale, 4-Item Pain Intensity Measure, hop tests, and isokinetic quadriceps and hamstring strength tests) and cartilage relaxation. Results: A total of 95 participants (44 ACLR alone, 51 ACLR + LET) with a mean age of 18.8 years (61.1% female [58/95]) underwent 2-year MRI (range, 20-36 months). T1rho relaxation times were significantly elevated for the ACLR + LET group in LT-1 (37.3 ± 0.7 ms vs 34.1 ± 0.8 ms, respectively; P = .005) and LFC-2 (43.9 ± 0.9 ms vs 40.2 ± 1.0 ms, respectively; P = .008) compared with the ACLR alone group. T2 relaxation times were significantly elevated for the ACLR + LET group in LFC-1 (51.2 ± 0.7 ms vs 49.1 ± 0.7 ms, respectively; P = .03) and LFC-4 (45.9 ± 0.5 ms vs 44.2 ± 0.6 ms, respectively; P = .04) compared with the ACLR alone group. All effect sizes were small to medium. There was no difference in Anterior Cruciate Ligament OsteoArthritis Scores between groups ( P = .99). Weak negative associations ( rs = –0.27 to –0.22; P < .05) were found between relaxation times and quadriceps and hamstring strength in the anterolateral knee, while all other correlations were nonsignificant ( P > .05). Conclusion: Increased relaxation times demonstrating small to medium effect sizes suggested early biochemical changes in articular cartilage of the anterolateral compartment in the ACLR + LET group compared with the ACLR alone group. Further evidence and long-term follow-up are needed to better understand the association between these results and the potential risk of the development of osteoarthritis in our patient cohort.

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Section: Discussionsupporting

confidence: 50%

Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis

Firth,

Pritchett,

Milner

et al. 2024

Am J Sports Med

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“…In addition, previous studies have shown that the reconstructed leg demonstrates lower strength than the contralateral leg, emphasizing the importance of quadriceps and hamstring strength for knee movement control and functional performance. 2,3,27,37 Quadriceps symmetry has also been used as a prerequisite for a successful return to sports after ACLR. 8 These studies used the contralateral leg as a reference and did not analyze whether the contralateral muscle strength was normal.…”

mentioning

confidence: 99%

Bilateral Alterations in Isokinetic Strength and Knee Biomechanics During Side-Cutting 1 Year After Unilateral ACL Reconstruction

et al. 2022

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Background: Individuals with anterior cruciate ligament (ACL) reconstruction (ACLR) are a population that has a higher risk for ACL injury compared with the general population. To reduce the reinjury rate and improve the rehabilitation outcome after ACLR, risk factors for ACL injury have to be addressed. Purpose: To compare the knee biomechanics during side-cutting and isokinetic strength of the thigh muscle of the reconstructed leg with those of the contralateral leg and healthy controls and investigate the knee movement asymmetries in individuals with ACLR. Study Design: Controlled laboratory study. Methods: A total of 16 participants with ACLR (ACLR group; 11.8 ± 1.1 months after reconstruction) and 16 healthy controls (control group) were recruited. Landmark coordinates and ground-reaction forces during side-cutting and isokinetic strength of hamstring and quadriceps were collected. Two-way analysis of variance with the mixed design was performed to compare each dependent variable between groups and across legs. Results: The reconstructed leg had a significantly smaller knee flexion angle ( P = .004) and less quadriceps strength ( P = .003) than the contralateral leg. The knee extension moment and knee external rotation angle were decreased compared with both the contralateral leg ( P = .001, P = .003, respectively) and the healthy control leg ( P = .001, P = .001, respectively). The ACLR group showed greater knee abduction angles ( P = .004) and smaller knee external rotation moments ( P = .006) than the control group. The ACLR group also demonstrated greater asymmetries of knee flexion angle ( P = .015), knee external rotation angle ( P = .001), knee extension moment ( P = .013), knee abduction moment ( P = .001), and quadriceps strength ( P = .046) than the control group. Conclusion: Knee biomechanics in the leg with ACLR were altered mainly in the sagittal plane during side-cutting compared with the contralateral leg. The altered movement patterns between the ACLR and control groups were primarily observed in the frontal and transverse planes. The ACLR group also demonstrated greater asymmetries of sagittal knee movement and concentric quadriceps strength than the control group. Clinical Relevance: Individuals with ACLR showed different alterations in the reconstructed and contralateral leg compared with healthy controls. These results suggest that rehabilitation programs after ACLR should further focus on restoring the knee flexion angle and quadriceps strength. Injury prevention programs need to be further targeted in the altered movement patterns observed between the ACLR and the healthy groups.

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“…31 Impaired quadriceps activation and related decrements in kneeextensor strength correlate with post-ACLR functional outcomes, including pain level, [32][33][34] and direct measures of tibiofemoral and patellofemoral articular cartilage health. [35][36][37][38][39] For many ACLR patients, though, AMI exists for many years post-ACLR, even when knee pain does not, supporting the notion that pain is only one of multiple factors contributing to AMI. Furthermore, the degree to which pain, or any other single factor, contributes to AMI is unclear.…”

Section: Clinical Knee Painmentioning

confidence: 91%

A Review of the Relationships Between Knee Pain and Movement Neuromechanics

Seeley¹,

Lee²,

Son³

et al. 2022

Journal of Sport Rehabilitation

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Context: Knee injury and disease are common, debilitating, and expensive. Pain is a chief symptom of knee injury and disease and likely contributes to arthrogenic muscle inhibition. Joint pain alters isolated motor function, muscular strength, and movement biomechanics. Because knee pain influences biomechanics, it likely also influences long-term knee joint health. Objective: The purpose of this article is 2-fold: (1) review effects of knee pain on lower-extremity muscular activation and corresponding biomechanics and (2) consider potential implications of neuromechanical alterations associated with knee pain for long-term knee joint health. Experimental knee pain is emphasized because it has been used to mimic clinical knee pain and clarify independent effects of knee pain. Three common sources of clinical knee pain are also discussed: patellofemoral pain, anterior cruciate ligament injury and reconstruction, and knee osteoarthritis. Data Sources: The PubMed, Web of Science, and SPORTDiscus databases were searched for articles relating to the purpose of this article. Conclusion: Researchers have consistently reported that knee pain alters neuromuscular activation, often in the form of inhibition that likely occurs via voluntary and involuntary neural pathways. The effects of knee pain on quadriceps activation have been studied extensively. Knee pain decreases voluntary and involuntary quadriceps activation and strength and alters the biomechanics of various movement tasks. If allowed to persist, these neuromechanical alterations might change the response of articular cartilage to joint loads during movement and detrimentally affect long-term knee joint health. Physical rehabilitation professionals should consider neuromechanical effects of knee pain when treating knee injury and disease. Resolution of joint pain can likely help to restore normal movement neuromechanics and potentially improve long-term knee joint health and should be a top priority.

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Return‐to‐sport quadriceps strength symmetry impacts 5‐year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis

Cited by 14 publications

References 51 publications

Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis

Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis

Bilateral Alterations in Isokinetic Strength and Knee Biomechanics During Side-Cutting 1 Year After Unilateral ACL Reconstruction

A Review of the Relationships Between Knee Pain and Movement Neuromechanics

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