1
|
Cobian DG, Oppenheim ZR, Roehl TJ, Joachim MR, Heiderscheit BC. Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241253843. [PMID: 38867919 PMCID: PMC11168251 DOI: 10.1177/23259671241253843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 06/14/2024] Open
Abstract
Background Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful. Purpose/Hypothesis The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry. Study Design Case-control study; Level of evidence, 3. Methods A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient. Results Limb-by-time interactions were detected for torque steadiness and activation variability (P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively (P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months (P < .001) and 6 months (P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months (r S = -0.49; P < .01) and 6 months (r S = -0.49; P < .01). Conclusion In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.
Collapse
Affiliation(s)
- Daniel G. Cobian
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Zachary R. Oppenheim
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Tyler J. Roehl
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Joachim
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| |
Collapse
|
2
|
Keogh JAJ, Waddington EE, Masood Z, Mahmood S, Palanisamy AC, Ruder MC, Karsan S, Bishop C, Jordan MJ, Heisz JJ, Kobsar D. Monitoring lower limb biomechanical asymmetry and psychological measures in athletic populations-A scoping review. Scand J Med Sci Sports 2023; 33:2125-2148. [PMID: 37551046 DOI: 10.1111/sms.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Lower limb biomechanics, including asymmetry, are frequently monitored to determine sport performance level and injury risk. However, contributing factors extend beyond biomechanical and asymmetry measures to include psychological, sociological, and environmental factors. Unfortunately, inadequate research has been conducted using holistic biopsychosocial models to characterize sport performance and injury risk. Therefore, this scoping review summarized the research landscape of studies concurrently assessing measures of lower limb biomechanics, asymmetry, and introspective psychological state (e.g., pain, fatigue, perceived exertion, stress, etc.) in healthy, competitive athletes. METHODS A systematic search of MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science Core Collections was designed and conducted in accordance with PRISMA guidelines. Fifty-one articles were included in this review. RESULTS Significant relationships between biomechanics (k = 22 studies) or asymmetry (k = 20 studies) and introspective state were found. Increased self-reported pain was associated with decreased range of motion, strength, and increased lower limb asymmetry. Higher ratings of perceived exertion were related to increased lower limb asymmetry, self-reported muscle soreness, and worse jump performance. Few studies (k = 4) monitored athletes longitudinally throughout one or more competitive season(s). CONCLUSION This review highlights the need for concurrent analysis of introspective, psychological state, and biomechanical asymmetry measures along with longitudinal research to understand the contributing factors to sport performance and injury risk from biopsychosocial modeling. In doing so, this framework of biopsychosocial preventive and prognostic patient-centered practices may provide an actionable means of optimizing health, well-being, and sport performance in competitive athletes.
Collapse
Affiliation(s)
- Joshua A J Keogh
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma E Waddington
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sobia Mahmood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Anil C Palanisamy
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C Ruder
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sameena Karsan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Chris Bishop
- London Sports Institute, Middlesex University, London, UK
| | - Matthew J Jordan
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer J Heisz
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Pethick J, Clark NC, Liew B. Alterations in peripheral joint muscle force control in adults with musculoskeletal disease, injury, surgery, or arthroplasty: A systematic review and meta-analysis. J Electromyogr Kinesiol 2022; 66:102696. [PMID: 35988532 DOI: 10.1016/j.jelekin.2022.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To systematically review and analyse whether musculoskeletal conditions affect peripheral joint muscle force control (i.e. magnitude and/or complexity of force fluctuations). METHODS A literature search was conducted using MEDLINE, CINAHL and SPORTDiscus databases (from inception-8th April 2021) for studies involving: 1) participants with musculoskeletal disease, injury, surgery, or arthroplasty in the peripheral joints of the upper/lower limb; 2) comparison with an unaffected control group or unaffected contralateral limb; and 3) measures of the magnitude and/or complexity of force fluctuations during targeted isometric contractions. The methodological quality of studies was evaluated using a modified Downs and Black Quality Index. Studies were combined using the standardized mean difference (SMD) in a random-effects model. RESULTS 14 studies (investigating 694 participants) were included in the meta-analysis. There was a significant effect of musculoskeletal conditions on peripheral joint muscle force coefficient of variation (CV; SMD = 0.19 [95 % CI 0.06, 0.32]), whereby individuals with musculoskeletal conditions exhibited greater CV than controls. Subgroup analyses revealed that CV was only greater: 1) when comparison was made between symptomatic and asymptomatic individuals (rather than between affected and contralateral limbs; SMD = 0.22 [95 % CI 0.07, 0.38]); 2) for conditions of the knee (SMD = 0.29 [95 % CI 0.14, 0.44]); and 3) for ACL injury post-surgery (SMD = 0.56 [95 % CI 0.36, 0.75]). CONCLUSION Musculoskeletal conditions result in an increase in peripheral joint muscle force CV, with this effect dependent on study design, peripheral joint, and surgical status. The greater force CV is indicative of decreased force steadiness and could have implications for long-term tissue health/day-to-day function.
Collapse
Affiliation(s)
- Jamie Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK.
| | - Nicholas C Clark
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK
| | - Bernard Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK
| |
Collapse
|
4
|
Hipsley A, Hall M, Saxby DJ, Bennell KL, Wang X, Bryant AL. Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:1949-1957. [PMID: 34997247 DOI: 10.1007/s00167-021-06853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. METHODS The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. RESULTS In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. CONCLUSION Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Anthony Hipsley
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.
| | - Michelle Hall
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Gold Coast, Australia.,Gold Coast Orthopaedic Research and Education Alliance, Gold Coast, Australia
| | - Kim L Bennell
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Xinyang Wang
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Beijing Chao-Yang Hospital, Beijing, China
| | - Adam L Bryant
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Rice D, Lewis G, McNair P. Impaired Regulation of Submaximal Force after ACL Reconstruction: Role of Muscle Spindles. Int J Sports Med 2020; 42:550-558. [PMID: 33176382 DOI: 10.1055/a-1292-4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ongoing motor deficits are routinely present following anterior cruciate ligament (ACL) reconstruction, including the ability to regulate muscle force. While such deficits are known, it is unclear why this occurs. The goal of the current study was to investigate the potential influence of muscle spindle input on submaximal force regulation and muscle activity at the knee in people following ACL reconstruction. Fourteen participants (8 female) who were 6-24 months post-ACL reconstruction and 15 control participants (8 female) undertook submaximal force matching and force modulation tasks before and after 20 min of vibration applied to the patella tendon. Across all tasks, the ACL reconstruction participants were poorer at force matching (P=0.007). The effect of vibration was not significant in either group for the force matching tasks (P=0.06), although there was a reduction in maximum voluntary contraction post-vibration in the control group (P<0.001). The ACL reconstruction group also showed evidence of greater activation of the medial hamstring muscles in comparison to controls (P=0.04). Individuals who have undergone ACL reconstruction have a diminished ability to accurately match and regulate submaximal muscle force, but this does not appear to be related to impaired muscle spindle input. Neuromuscular retraining programs that involve force regulation tasks may be necessary to optimize rehabilitation after ACL reconstruction.
Collapse
Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Gwyn Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|