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Kositsky A, Stenroth L, Barrett RS, Korhonen RK, Vertullo CJ, Diamond LE, Saxby DJ. Muscle Morphology Does Not Solely Determine Knee Flexion Weakness After Anterior Cruciate Ligament Reconstruction with a Semitendinosus Tendon Graft: A Combined Experimental and Computational Modeling Study. Ann Biomed Eng 2024; 52:1313-1325. [PMID: 38421479 PMCID: PMC10995045 DOI: 10.1007/s10439-024-03455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The distal semitendinosus tendon is commonly harvested for anterior cruciate ligament reconstruction, inducing substantial morbidity at the knee. The aim of this study was to probe how morphological changes of the semitendinosus muscle after harvest of its distal tendon for anterior cruciate ligament reconstruction affects knee flexion strength and whether the knee flexor synergists can compensate for the knee flexion weakness. Ten participants 8-18 months after anterior cruciate ligament reconstruction with an ipsilateral distal semitendinosus tendon autograft performed isometric knee flexion strength testing (15°, 45°, 60°, and 90°; 0° = knee extension) positioned prone on an isokinetic dynamometer. Morphological parameters extracted from magnetic resonance images were used to inform a musculoskeletal model. Knee flexion moments estimated by the model were then compared with those measured experimentally at each knee angle position. A statistically significant between-leg difference in experimentally-measured maximal isometric strength was found at 60° and 90°, but not 15° or 45°, of knee flexion. The musculoskeletal model matched the between-leg differences observed in experimental knee flexion moments at 15° and 45° but did not well estimate between-leg differences with a more flexed knee, particularly at 90°. Further, the knee flexor synergists could not physiologically compensate for weakness in deep knee flexion. These results suggest additional factors other than knee flexor muscle morphology play a role in knee flexion weakness following anterior cruciate ligament reconstruction with a distal semitendinosus tendon graft and thus more work at neural and microscopic levels is required for informing treatment and rehabilitation in this demographic.
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Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher J Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Kenneally-Dabrowski C, Serpell BG. Where to next for hamstrings? A biomechanical and anatomical perspective. Br J Sports Med 2024; 58:287-288. [PMID: 38049986 DOI: 10.1136/bjsports-2023-107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Claire Kenneally-Dabrowski
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Benjamin G Serpell
- Geelong Cats, Geelong, Victoria, Australia
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
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Hjaltadóttir AÞ, Hafsteinsson D, Árnason Á, Briem K. Musculoskeletal ultrasound imaging of proximal and distal hamstrings cross sectional area in individuals with history of anterior cruciate ligament reconstruction. Physiother Theory Pract 2024; 40:487-493. [PMID: 36263941 DOI: 10.1080/09593985.2022.2135980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasound (US) imaging is used by physical therapists for diagnosis and assessment of musculoskeletal injury and follow-up. PURPOSE The aim was to identify long-term effects of graft harvesting on hamstrings muscle mass among athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS Twenty-eight participants (ages 18-55) were recruited: 18 with history of ACLR using semitendinosus (ST) autograft and 10 healthy controls. Images of the cross-sectional area (CSA) of ST and biceps femoris (BF) were captured at 30% and 70% of the distance from the ischial tuberosity to the popliteal crease. A mixed model ANOVA was used to identify inter-limb differences in the CSA of ST and BF at each location, for each group. RESULTS Inter-limb differences were found for the CSA of ST but not BF across both locations for the ACLR group, not controls (p < .001). Within the ACLR group, ST atrophy of the injured limb was relatively greater at the distal vs. proximal location (p < .001). CONCLUSION US imaging identified selective atrophy of ST on the injured side with no compensatory hypertrophy of BF. Specific rehabilitation may influence muscle mass of medial vs. lateral hamstrings muscle groups after ACLR using a ST graft, and monitored with US imaging.
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Affiliation(s)
- Andrea Þórey Hjaltadóttir
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Physiotherapy Garðabær, Garðaflöt 16-18, 210 Garðabær, Iceland
- Department of orthopaedics, Landspitali University Hospital, Fossvogur, 103 Reykjavík, Iceland
| | - Daði Hafsteinsson
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Árni Árnason
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
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du Moulin W, Bourne M, Diamond LE, Konrath J, Vertullo C, Saxby DJ. Moment arm and torque generating capacity of semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction: A simulation study. J Orthop Res 2024. [PMID: 38400545 DOI: 10.1002/jor.25814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Altered semitendinosus (ST) morphology and distal tendon insertion following anterior cruciate ligament reconstruction (ACLR) may reduce knee flexion torque generating capacity of the hamstrings via impaired ST force generation and/or moment arm. This study used a computational musculoskeletal model to simulate mechanical consequences of tendon harvest for ACLR on ST function by modeling changes in ST muscle tendon insertion point, moment arm, and torque generating capacity across a physiological range of motion. Simulated ST function was then compared between ACLR and uninjured contralateral limbs. Magnetic resonance imaging from 18 individuals with unilateral history of ACLR involving a hamstring autograft was used to analyse bilateral hamstring muscle (ST, semimembranosus, bicep femoris long head and short head) morphology and distal ST tendon insertion. The ACLR cohort was sub-grouped into those with and without ST regeneration. For each participant with ST regeneration (n = 7), a personalized musculoskeletal model was created including postoperative remodeling of ST using OpenSim 4.1. Knee flexion and internal rotation moment arms and torque generating capacities of hamstrings were evaluated. Bilateral differences were calculated with an asymmetry index (%) ([unaffected limb-affected limb]/[unaffected limb + affected limb]*100%). Smaller moment arms or knee torques within injured compared to uninjured contralateral limbs were considered a deficit. Compared to uninjured contralateral limbs, ACLR limbs with tendon regeneration (n = 7) had minor reductions in knee flexion (5.80% [95% confidence interval (CI) = 3.97-7.62]) and internal rotation (4.92% [95% CI = 2.77-7.07]) moment arms. Decoupled from muscle morphology, altered ST moment arms in ACLR limbs with tendon regeneration resulted in negligible deficits in knee flexion (1.20% [95% CI = 0.34-2.06]) and internal rotation (0.24% [95% CI = 0.22-0.26]) torque generating capacity compared to uninjured contralateral limbs. Coupled with muscle morphology, ACLR limbs with tendon regeneration had substantial deficits in knee flexion (19.32% [95% CI = 18.35-20.28]) and internal rotation (15.49% [95% CI = 14.56-16.41]) torques compared to uninjured contralateral limbs. Personalized musculoskeletal models with measures of ST distal insertion and muscle morphology provided unique insights into post-ACLR ST and hamstring function. Deficits in knee flexor and internal rotation moment arms and torque generating capacities were evident in those with ACLR even when tendon regeneration occurred. Future studies may wish to implement this framework in personalized musculoskeletal models following ACLR to better understand individual muscle function for injury prevention and treatment evaluation.
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Affiliation(s)
- William du Moulin
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Jason Konrath
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Principia Technology, Crawley, Australia
| | - Christopher Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Knee Research Australia, Gold Coast, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
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du Moulin W, Kositsky A, Bourne MN, Diamond LE, Tudor F, Vertullo C, Saxby DJ. Study protocol for double-blind, randomised placebo-controlled trial evaluating semitendinosus function and morbidity following tendon harvesting for anterior cruciate ligament reconstruction augmented by platelet-rich plasma. BMJ Open 2022; 12:e061701. [PMID: 36123079 PMCID: PMC9486297 DOI: 10.1136/bmjopen-2022-061701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is debilitating, often requiring surgical reconstruction. An ACL reconstruction (ACLR) using a tendon autograft harvested from the semitendinosus results in substantial injury to the donor muscle. Following ACLR, patients rarely return to their preinjury level of physical activity, are at elevated risk of secondary lower limb injuries and early onset knee osteoarthritis. To date, no randomised controlled trial has evaluated the efficacy of platelet-rich plasma (PRP) in aiding knee function and semitendinosus morphology of following ALCR. METHODS AND ANALYSIS This is a multicentre double-blind randomised placebo-controlled trial. Fifty-four ACLR patients aged 18-50 years will be randomised to receive either a single application of PRP (ACLR+) or placebo saline (ACLR) into the semitendinosus harvest zone at the time of surgery. All patients will undergo normal postoperative rehabilitation recommended by the attending orthopaedic surgeon or physiotherapist. The primary outcome measure is between-limb difference (ACLR compared with intact contralateral) in isometric knee flexor strength at 60o knee flexion, collected 10-12 months postsurgery. This primary outcome measure will be statistically compared between groups (ACLR+ and standard ACLR). Secondary outcome measures include bilateral assessments of hamstring muscle morphology via MRI, biomechanical and electromyographic parameters during an anticipated 45° running side-step cut and multidirectional hopping task and patient-reported outcomes questionaries. Additionally, patient-reported outcomes questionaries will be collected before (baseline) as well as immediately after surgery, and at 2-6 weeks, 3-4 months, 10-12 months and 22-24 months postsurgery 10-12 months following surgery. ETHICS AND DISSEMINATION Ethics approval has been granted by Griffith University Human Research Ethics Committee, Greenslopes Research and Ethics Committee, and Royal Brisbane & Women's Hospital Human Research Ethics Committee. Results will be submitted for publication in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER ACTRN12618000762257p.
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Affiliation(s)
- William du Moulin
- School of Health Sciences and Social Work, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
| | - Adam Kositsky
- School of Health Sciences and Social Work, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
| | - Laura E Diamond
- School of Health Sciences and Social Work, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
| | - Francois Tudor
- Orthopaedics, Gold Coast University Hospital Network, Gold Coast, Queensland, Australia
| | - Christopher Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - David J Saxby
- School of Health Sciences and Social Work, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, Queensland, Australia
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