Biomechanical Evaluation of Preoperative Rehabilitation in Patients of Anterior Cruciate Ligament Injury.
ABSTRACT: OBJECTIVES:To investigate the biomechanical characteristics of patients with anterior cruciate ligament (ACL) injury by gait analysis, surface electromyography (SEMG), and proprioception test, and provide rehabilitation suggestions according to the results. METHODS:In this retrospective cohort study, 90 adults with unilateral ACL injury, ranging in age from 19 to 45?years (66 men and 24 women, average age: 30.03?±?7.91) were recruited for this study form May 2018 to July 2019. They were divided into three groups according to the time after the injury: group A (3-week to 1.5-month), group B (1.5-month to 1?year), and group C (more than 1?year). The SEMG signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) and the root mean square (RMS) were used to assess muscular activity. SEMG were used to analyze muscles function, gait analysis was used to evaluate the walking stability, balance and location assessment were used to analyze the proprioception. RESULTS:Through the comparison between bilateral limbs, all muscles strength shown decreased (RF: 239.94?± 129.70 vs 364.81?±?148.98, P = 0.001; VM: 298.88?±?175.41 vs 515.79?±?272.49, P = 0.001; VL:389.54?± 157.97 vs 594.28?±?220.31, P
Project description:Background/Objective:The muscle activity before the initial contact between during jump landings is referred to as the pre-activity. The muscle pre-activity that occur during jump landing are considered to be an important predictor of non-contact anterior cruciate ligament (ACL) injury risk. ACL injury prevention programs have been widely conducted; these programs are generally focused on increasing the muscle pre-activity and include rotational jump landing. The purpose of this study was to investigate the timing of the muscle pre-activity of the hamstrings and quadriceps during 180° and 360° rotational jump landing. Methods:The participants were 10 healthy females. Electromyography was conducted on the knee joint muscles of the left leg (the non-dominant leg) during clockwise 180° and 360° rotational jump landings. Results:The muscle pre-activities during 180° rotational jump landing was VM: 35.68?±?11.22 msec, RF: 38.05?±?14.77 msec, VL: 47.10?±?19.96 msec, BF: 115.63?±?30.48 msec and SM: 136.45?±?47.52 msec. And the muscle pre-activities during 360° rotational jump landing was VM: 45.25?±?17.41 msec, RF: 42.38?±?13.35 msec, VL: 48.75?±?19.20 msec, BF: 132.20?±?46.74 msec and SM: 140.70?±?40.64 msec. For both the 180° rotational jump landing and the 360° jump landing, the pre-activities of the hamstrings occurred significantly earlier than those of the quadriceps (p?<?0.01). Conclusion:The results of the present study indicate that it may be beneficial for ACL injury prevention programs to include rotational jump landing tasks.
Project description:This study was designed to compare proprioception and postural stability in patients with acute (time from injury ? 3 months) and chronic (time from injury > 3 months) ACL tears, and to evaluate the correlation between time interval after ACL injury and proprioception. Thigh muscle strength, postural stability, and joint position sense were compared in 48 patients with acute ACL tears and in 28 with chronic ACL tears. Maximal torque (60°/sec) of the quadriceps and hamstring was evaluated using an isokinetic testing device. Postural stability was determined from the anterior-posterior (APSI), medial-lateral (MLSI), and overall (OSI) stability indices using stabilometry. Joint position sense was also tested by reproduction of passive positioning (RPP). Muscle strengths and stability indices on both the involved and uninvolved sides were similar in the acute and chronic ACL tear groups. RPP on the involved side was significantly greater in the chronic than in the acute ACL tear group (7.8° vs. 5.6°, P = 0.041). Two of three stability indices (APSI, OSI) and RPP were significantly greater on the involved than the uninvolved side in the chronic ACL tear group.
Project description:The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee, with injury usually occurring as a result of multidirectional sports. The incidence of ACL injury has continued to increase, with most patients opting for surgery to improve stability as well as permit a return to sport. Traditional methods of ACL reconstruction can achieve this but are not without their problems, including graft rupture, residual laxity, and donor-site morbidity. There is therefore a requirement for further research into newer, innovative surgical techniques to help improve complication rates. This article describes, with video illustration, ACL reconstruction using a reduced-size bone-patellar tendon-bone autograft with suture tape augmentation. The augmentation acts as a stabilizer during the early stages of graft incorporation while resisting against reinjury during an accelerated recovery. The ability to use a reduced-size graft decreases the donor-site burden, and retention of residual native ACL tissue, when possible, may help with proprioception.
Project description:Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group - CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers.
Project description:Anterior cruciate ligament (ACL) injury is a common problem with consequences ranging from chronic joint instability to early development of osteoarthritis. Recent studies suggest that changes in brain activity (i.e., functional neuroplasticity) may be related to ACL injury. The purpose of this article is to summarize the available evidence of functional brain plasticity after an ACL injury. A scoping review was conducted following the guidelines of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The terms "brain," "activity," "neuroplasticity," "ACL," "injury," and "reconstruction" were used in an electronic search of articles in PubMed, PEDro, CINAHL, and SPORTDiscus databases. Eligible studies included the following criteria: (a) population with ACL injury, (b) a measure of brain activity, and (c) a comparison to the ACL-injured limb (contralateral leg or healthy controls). The search yielded 184 articles from which 24 were included in this review. The effect size of differences in brain activity ranged from small (0.05, ACL-injured vs. noninjured limbs) to large (4.07, ACL-injured vs. healthy control). Moreover, heterogeneity was observed in the methods used to measure brain activity and in the characteristics of the participants included. In conclusion, the evidence summarized in this scoping review supports the notion of functional neuroplastic changes in people with ACL injury. The techniques used to measure brain activity and the presence of possible confounders, as identified and reported in this review, should be considered in future research to increase the level of evidence for functional neuroplasticity following ACL injury.
Project description:The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported.During ACL injury female athletes demonstrate greater lateral trunk and knee abduction angles than ACL-injured male athletes and uninjured female athletes.Cross-section control-cohort design.Analyses of still captures from 23 coronal (10 female and 7 male ACL-injured players and 6 female controls) or 28 sagittal plane videos performing similar landing and cutting tasks. Significance was set at p < or = 0.05.Lateral trunk and knee abduction angles were higher in female compared to male athletes during ACL injury (p < or = 0.05) and trended toward being greater than female controls (p = 0.16, 0.13, respectively). Female ACL-injured athletes showed less forward trunk lean than female controls (mean (SD) initial contact (IC): 1.6 (9.3) degrees vs 14.0 (7.3) degrees, p < or = 0.01).Female athletes landed with greater lateral trunk motion and knee abduction during ACL injury than did male athletes or control females during similar landing and cutting tasks.Lateral trunk and knee abduction motion are important components of the ACL injury mechanism in female athletes as observed from video evidence of ACL injury.
Project description:The mechanism underlying axotomy-induced motoneuron loss is not fully understood, but appears to involve molecular changes within the injured motoneuron and the surrounding local microenvironment (neuropil). The mouse facial nucleus consists of six subnuclei which respond differentially to facial nerve transection at the stylomastoid foramen. The ventromedial (VM) subnucleus maintains virtually full facial motoneuron (FMN) survival following axotomy, whereas the ventrolateral (VL) subnucleus results in significant FMN loss with the same nerve injury. We hypothesized that distinct molecular phenotypes of FMN existed within the two subregions, one responsible for maintaining cell survival and the other promoting cell death. In this study, we used laser microdissection to isolate VM and VL facial subnuclear regions for molecular characterization. We discovered that, regardless of neuronal fate after injury, FMN in either subnuclear region respond vigorously to injury with a characteristic "regenerative" profile and additionally, the surviving VL FMN appear to compensate for the significant FMN loss. In contrast, significant differences in the expression of pro-inflammatory cytokine mRNA in the surrounding neuropil response were found between the two subnuclear regions of the facial nucleus that support a causative role for glial and/or immune-derived molecules in directing the contrasting responses of the FMN to axonal transection.
Project description:INTRODUCTION:An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls. METHODS AND ANALYSIS:The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria. ETHICS AND DISSEMINATION:Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals. PROSPERO REGISTRATION NUMBER:CRD42018108014.
Project description:Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize its complex, three-dimensional geometry and how it relates to knee injury. Further, the tibial spines have not been studied in association with the risk of suffering a non-contact ACL injury. We questioned whether the geometries of the tibial spines are associated with non-contact ACL injury risk, and if this relationship is different for males and females. Bilateral MRI scans were acquired on 88 ACL-injured subjects and 88 control subjects matched for sex, age and sports team. Medial and lateral tibial spine geometries were characterized with measurements of length, width, height, volume and anteroposterior location. Analyses of females revealed no associations between tibial spine geometry and risk of ACL injury. Analyses of males revealed that an increased medial tibial spine volume was associated with a decreased risk of ACL injury (OR?=?0.667 per 100?mm(3) increase). Smaller medial spines could provide less resistance to internal rotation and medial translation of the tibia relative to the femur, subsequently increasing ACL strains and risk of ACL injury.
Project description:Hemophilic arthropathy is the result of repetitive intra-articular bleeding and synovial inflammation. In people with hemophilic arthropathy (PWHA), very little is known about the neural control of individual muscles during movement. The aim of the present study was to assess if the neural control of individual muscles and coordination between antagonistic muscle pairs and joint kinematics during gait are affected in PWHA. Thirteen control subjects (CG) walked overground at their preferred and slow velocity (1 m/s), and 14 PWHA walked overground at the preferred velocity (1 m/s). Joint kinematics and temporal gait parameters were assessed using four inertial sensors. Surface electromyography (EMG) was collected from gluteus maximus (GMAX), gluteus medius (GMED), vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), medial gastrocnemius (MG), lateral gastrocnemius (LG), soleus (SOL), tibialis anterior (TA), semitendinosus (ST), and biceps femoris (BF). Waveforms were compared using the time-series analysis through statistical parametric mapping. In PWHA compared to CG, EMG amplitude during the stance phase was higher for LG (for both velocities of the CG), BF (slow velocity only), and ST (preferred velocity only) (p < 0.05). Co-contraction during the stance phase was higher for MG-TA, LG-TA, VL-BF, VM-ST, LG-VL, and MG-VM (both velocities) (p < 0.05). MG and LG were excited earlier (preferred velocity only) (p < 0.05). A later offset during the stance phase was found for VL, BF, and ST (both velocities), and BF and GMAX (preferred velocity only) (p < 0.05). In addition, the range of motion in knee and ankle joints was lower in PWHA (both velocities) and hip joint (preferred velocity only) (p < 0.05). In conclusion, the neural control of individual muscles and coordination between antagonistic muscles during gait in PWHA differs substantially from control subjects.