scholarly journals Neuromuscular Training Versus Strength Training During First 6 Months After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

2007 ◽  
Vol 87 (6) ◽  
pp. 737-750 ◽  
Author(s):  
May Arna Risberg ◽  
Inger Holm ◽  
Grethe Myklebust ◽  
Lars Engebretsen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Strength Training ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Short Form ◽  
Cruciate Ligament ◽  
Secondary Outcome ◽  
Neuromuscular Training ◽  
Anterior Cruciate

Background and Purpose The purpose of this study was to determine the effect of a 6-month neuromuscular training (NT) program versus a traditional strength training (ST) program following anterior cruciate ligament (ACL) reconstruction. Subjects Seventy-four subjects with ACL reconstruction participated in the study. Methods The study was a randomized, single-blinded, controlled trial. The NT and ST groups were tested preoperatively and at 3 and 6 months. The main outcome measure was the Cincinnati Knee Score. Secondary outcome measures were visual analog scales (VASs) for pain and function, the 36-Item Short-Form Health Survey (SF-36), hop tests, isokinetic muscle strength, proprioception, and static and dynamic balance tests. Results The NT group demonstrated significantly improved Cincinnati Knee Scores and VAS scores for global knee function compared with the ST group at the 6-month follow-up. There were no significant differences between the groups for the other outcome measures (ie, hop, balance, proprioception, and muscle strength tests). Discussion and Conclusion The results of this study suggest that exercises included in the NT program should be part of the rehabilitation program following ACL reconstruction.

Tracking Ability, Motor Coordination, and Functional Determinants After Anterior Cruciate Ligament Reconstruction

2011 ◽  
Vol 20 (2) ◽  
pp. 207-218 ◽  
Author(s):  
Hayri Baran Yosmaoglu ◽  
Gül Baltaci ◽  
Defne Kaya ◽  
Hamza Ozer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Acl Reconstruction ◽  
Functional Ability ◽  
Motor Coordination ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Isokinetic Strength ◽  
Tracking Ability ◽  
Anterior Cruciate

Context:The development pattern of motor coordination, strength, and functional ability during recovery from anterior cruciate ligament (ACL) reconstruction.Objective:To investigate the relationship between motor coordination, functional ability, and strength after ACL reconstruction.Design:Prospective clinical follow-up study.Setting:Sports-injury research laboratory.Participants:20 subjects who underwent ACL reconstruction.Interventions:Real-time eccentric and concentric motor coordination were tested by a multijoint lower limb tracking-trajectory test, quadriceps and hamstring isokinetic strength were assessed by isokinetic dynamometer, and functional performance was tested with a single-leg-hop test 6 and 12 mo after ACL reconstruction.Main Outcome Measures:Percentage deficits of the involved lower extremity for target-tracking ability, peak torque, total work parameters of isokinetic strength, and single-leg-hop distance.Results:Deficits in hamstring–quadriceps isokinetic muscle strength and single-leg-hop distance significantly decreased from the 6th to the 12th mo after surgery (P < .05). There were no significant differences in muscle concentric and eccentric motor-coordination deficits of the involved side (P > .05).Conclusions:Although muscle strength and functional performance clearly increased from the 6th to the 12th mo after surgery, coordination characteristics of involved side remained low. This pattern demonstrated that motor-coordination progression was not affected by strength development. Patients continued to have significant motor-coordination deficits even 12 mo postsurgery. Therefore, the authors recommend that neuromuscular-coordination exercises be included in long-term rehabilitation programs to improve motor coordination.

scholarly journals Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Autograft Versus Allograft Tissue

2009 ◽  
Vol 2 (1) ◽  
pp. 56-72 ◽  
Author(s):  
Lisa M. Tibor ◽  
Joy L. Long ◽  
Peter L. Schilling ◽  
Ryan J. Lilly ◽  
James E. Carpenter ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Sample Size ◽  
Randomized Clinical Trial ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Allograft Reconstruction ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity. Objective: To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions. Data Sources: Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies. Study Selection: Inclusion criteria for studies were as follows: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990. Data Extraction: Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores. Results: More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between studies. The sample size necessary for a randomized clinical trial to detect a difference between autograft and allograft reconstruction varied, depending on the outcome. Conclusions: With the current literature, only KT-1000 arthrometer assessment demonstrated more laxity with allograft reconstruction. A randomized clinical trial directly comparing allograft to autograft ACL reconstruction is warranted, but a multicenter study would be required to obtain an adequate sample size.

scholarly journals Michigan Initiative for Anterior Cruciate Ligament Rehabilitation (MiACLR): A Protocol for a Randomized Clinical Trial

2020 ◽  
Vol 100 (12) ◽  
pp. 2154-2164
Author(s):  
Kazandra Rodriguez ◽  
Steven A Garcia ◽  
Cathie Spino ◽  
Lindsey K Lepley ◽  
Yuxi Pang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Neurological Deficits ◽  
Secondary Outcome ◽  
Patient Reported ◽  
Anterior Cruciate

Abstract Objective Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR. Methods This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging). Impact The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.

scholarly journals Baseline Analysis of Patients Presenting for Surgical Review of Anterior Cruciate Ligament Rupture Reveals Heterogeneity in Patient-Reported Outcome Measures

2020 ◽  
Author(s):  
Chee Han Ting ◽  
Corey Scholes ◽  
David Zbrojkiewicz ◽  
Christopher Bell
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cluster Membership ◽  
Patient Reported ◽  
Rehabilitation Protocols ◽  
Anterior Cruciate

AbstractDespite the establishment of successful surgical techniques and rehabilitation protocols for anterior cruciate ligament (ACL) reconstruction, published return to sport rates are less than satisfactory. This has led orthopaedic surgeons and researchers to develop more robust patient selection methods, and investigate prognostic patient characteristics. No previous studies have integrated baseline characteristics and responses to patient-reported outcome measures (PROMs) of patients with ACL rupture presenting for surgical review. Patients electing to undergo ACL reconstruction under the care of a single orthopaedic surgeon at a metropolitan public hospital were enrolled in a clinical quality registry. Patients completed Veterans RAND 12-item Health Survey (VR-12) Physical Component Summary and Mental Component Summary scores, Tegner activity scale, and International Knee Documentation Committee (IKDC) questionnaires at presentation. Total scores were extracted from the electronic registry, and a machine learning approach (k-means) was used to identify subgroups based on similarity of questionnaire responses. The average scores in each cluster were compared using analysis of variance (ANOVA; Kruskal–Wallis) and nominal logistic regression was performed to determine relationships between cluster membership and patient age, gender, body mass index (BMI), and injury-to-examination delay. A sample of 107 patients with primary ACL rupture were extracted, with 97 (91%) available for analysis with complete datasets. Four clusters were identified with distinct patterns of PROMs responses. These ranged from lowest (Cluster 1) to highest scores for VR-12 and IKDC (Cluster 4). In particular, Cluster 4 returned median scores within 6 points of the patient acceptable symptom state for the IKDC score for ACL reconstruction (70.1, interquartile range: 59–78). Significant (p < 0.05) differences in PROMs between clusters were observed using ANOVA, with variance explained ranging from 40 to 69%. However, cluster membership was not significantly associated with patient age, gender, BMI, or injury-to-examination delay. Patients electing to undergo ACL reconstruction do not conform to a homogenous group but represent a spectrum of knee function, general physical and mental health, and preinjury activity levels, which may not lend itself to uniform treatment and rehabilitation protocols. The factors driving these distinct responses to PROMs remain unknown but are unrelated to common demographic variables.

scholarly journals Study of proprioception and muscle strength following arthroscopic anterior cruciate ligament reconstruction

2021 ◽  
Vol 7 (3) ◽  
pp. 502
Author(s):  
Shankarlinga S. ◽  
Basavaraj S. Kyavater ◽  
Manik Rana
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Graft ◽  
Cruciate Ligament Reconstruction ◽  
Knee Mechanics ◽  
Anterior Cruciate

<p><strong>Background:</strong> Mechanoreceptors plays a vital role in knee mechanics. Since there are controversies surrounding the overall recovery time of proprioception following surgery, it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction and to investigate the relationship between proprioception and muscle strength following surgery.</p><p><strong>Methods: </strong>Current study is combined prospective and retrospective study done at K. S. hospital Koppal, spanning for a period of one year (December 2019 to December 2020). All patients presented with isolated anterior cruciate ligament (ACL) tear were included in the study. Patients were treated by arthroscopic ACL reconstruction with hamstring graft only and followed up for a period of year. Outcome measures include centre of mass proprioception in AP and medio-lateral direction and muscular strength through force gauze in Newton.</p><p><strong>Results:</strong> 26 patients (mean age 33) were included in the study, all ACL tears were treated by arthroscopic ACL reconstruction with hamstring graft and they underwent varying period of rehabilitation.</p><p><strong>Conclusions:</strong> This study shows that our understanding of biomechanics of ACL reconstructed knees is still evolving, and proprioception is found to be a key factor in determining post-op recovery. ACL remnant preservation intra-op along with proper mechanical positioning of the graft may help in better proprioception and functional outcome following the reconstruction.</p>

Negative Effects on Postural Control After Anterior Cruciate Ligament Reconstruction as Measured by the Balance Error Scoring System

2013 ◽  
Vol 22 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Mason D. Smith ◽  
David R. Bell
Keyword(s):  
Anterior Cruciate Ligament ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Scoring System ◽  
Cruciate Ligament ◽  
Balance Deficits ◽  
Balance Error Scoring System ◽  
Anterior Cruciate ◽  
Balance Error

Context:Anterior cruciate ligament (ACL) reconstruction is the standard of care for individuals with ACL rupture. Balance deficits have been observed in patients with ACL reconstruction (ACLR) using advanced posturography, which is the current gold standard. It is unclear if postural-control deficits exist when assessed by the Balance Error Scoring System (BESS), which is a clinical assessment of balance.Objective:The purpose of this study is to determine if postural-control deficits are present in individuals with ACLR as measured by the BESS.Participants:Thirty participants were included in this study. Fifteen had a history of unilateral ACLR and were compared with 15 matched controls.Interventions:The BESS consists of 3 stances (double-limb, single-limb, and tandem) on 2 surfaces (firm and foam). Participants begin in each stance with hands on their hips and eyes closed while trying to stand as still as possible for 20 s.Main Outcome Measures:Each participant performed 3 trials of each stance (18 total), and errors were assessed during each trial and summed to create a total score.Results:We observed a significant group × stance interaction (P = .004) and a significant main effect for stance (P < .001). Post hoc analysis revealed that the ACLR group had worse balance on the single-leg foam stance than did controls. Finally, the reconstructed group had more errors when total BESS score was examined (P = .02).Conclusions:Balance deficits exist in individuals with ACLR as measured by the BESS. Total BESS score was different between groups. The only condition that differed between groups was the single-leg stance on the unstable foam surface.

Anterior-Cruciate-Ligament Reconstruction Using Doubled Hamstring-Tendon Autograft

2005 ◽  
Vol 14 (4) ◽  
pp. 279-293 ◽  
Author(s):  
Yoshiko Hasebe ◽  
Yoshie Tanabe ◽  
Kazunori Yasuda
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Acl Reconstruction ◽  
Performance Test ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Postoperative Recovery ◽  
Performance Tests ◽  
Hamstring Autograft ◽  
Anterior Cruciate

Context:Anterior cruciate ligament (ACL) reconstruction with doubled hamstring autograft might not sufficiently improve fundamental sports abilities of patients with ACL-deficient knees.Objective:To clarify whether ACL reconstruction using the hamstring graft can improve fundamental sports abilities.Design:Patients were examined twice, preoperatively and 2 years postoperatively, using the conventional evaluation scales and performance tests.Participants:15 athletic patients with ACL reconstruction using hamstring autograft.Measurements:A stairs-run test and figure-8 one-leg hop test. Muscle strength and knee stability were measured with Cybex® II and KT-2000® arthrometers, respectively.Results:There were no significant differences between the preoperative and postoperative results in the performance tests. The degree of postoperative recovery in the subjective score, the anterior translation of the tibia, and the isokinetic muscle strength was not significantly correlated with the degree of restoration in each performance test.Conclusions:Postoperative restoration as measured by conventional evaluation scales is not correlated with restoration of sports abilities in patients with ACL insufficiency.

Accelerated Versus Nonaccelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction

2011 ◽  
Vol 39 (12) ◽  
pp. 2536-2548 ◽  
Author(s):  
Bruce D. Beynnon ◽  
Robert J. Johnson ◽  
Shelly Naud ◽  
Braden C. Fleming ◽  
Joseph A. Abate ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Acl Reconstruction ◽  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Thigh Muscle ◽  
Anterior Cruciate ◽  
6 Degrees Of Freedom

Background: The relationship between the biomechanical dose of rehabilitation exercises administered after anterior cruciate ligament (ACL) reconstruction and the healing response of the graft and knee is not well understood. Hypothesis: After ACL reconstruction, rehabilitation administered with either accelerated or nonaccelerated programs produces the same change in the knees’ 6 degrees of freedom, or envelope, laxity values. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients who underwent ACL reconstruction with a bone–patellar tendon–bone autograft were randomized to rehabilitation with either accelerated (19 week) or nonaccelerated (32 week) programs. At the time of surgery, and then 3, 6, 12, and 24 months later, the 6 degrees of freedom knee laxity values were measured using roentgen stereophotogrammetric analysis and clinical, functional, and patient-oriented outcome measures. Results: Eighty-five percent of those enrolled were followed through 2 years. Laxity of the reconstructed knee was restored to within the limits of the contralateral, normal side at the time of surgery (baseline) in all participants. Patients in both programs underwent a similar increase in the envelope of knee laxity over the 2-year follow-up interval (anterior-posterior translation 3.2 vs 4.5 mm, and coupled internal-external rotations 2.6° vs 1.9° for participants in the accelerated and nonaccelerated programs, respectively). Those who underwent accelerated rehabilitation experienced a significant improvement in thigh muscle strength at the 3-month follow-up ( P < .05) compared with those who participated in nonaccelerated rehabilitation, but no differences between the programs were seen after this time interval. At the 2-year follow-up, the groups were similar in terms of clinical assessment, patient satisfaction, function, proprioception, and isokinetic thigh muscle strength. Conclusion: Rehabilitation with the accelerated and nonaccelerated programs administered in this study produced the same increase in the envelope of knee laxity. A majority of the increase in the envelope of knee laxity occurred during healing when exercises were advanced and activity level increased. Patients in both programs had the same clinical assessment, functional performance, proprioception, and thigh muscle strength, which returned to normal levels after healing was complete. For participants in both treatment programs, the Knee Injury and Osteoarthritis Outcome Score (KOOS) assessment of quality of life did not return to preinjury levels.

Sign in / Sign up

Export Citation Format

Share Document