liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.ORCID iD: 0000-0002-1929-0605
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (Landstinget i Östergötland; Centre for Public Health Sciences; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum; Folkhälsovetenskapligt centrum)
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3527-5488
2008 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 36, no 2, 298-307 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is no consensus regarding the optimal rehabilitation regimen for increasing quadriceps strength after anterior cruciate ligament (ACL) injury.

Hypothesis: A comprehensive rehabilitation program supplemented with quadriceps strengthening in open kinetic chain (OKC) exercise will increase quadriceps strength and improve knee function without increasing static or dynamic sagittal tibial translation, compared with the same comprehensive rehabilitation program supplemented with quadriceps strengthening in closed kinetic chain (CKC) exercise, in patients with acute ACL deficiency.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Forty-two patients were tested a mean of 43 days (range, 20–96 days) after an ACL injury. Patients were randomized to rehabilitation with CKC quadriceps strengthening (11 men and 9 women) or OKC quadriceps strengthening (13 men and 9 women). Aside from these quadriceps exercises, the 2 rehabilitation programs were identical. Patients were assessed after 4 months of rehabilitation. Sagittal static translation and dynamic tibial translation were evaluated with a CA-4000 electrogoniometer. Muscle strength, jump performance, and muscle activation were also assessed. Functional outcome was evaluated by determining the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score.

Results: There were no group differences in static or dynamic translation after rehabilitation. The OKC group had significantly greater isokinetic quadriceps strength after rehabilitation (P = .009). The hamstring strength, performance on the 1-repetition-maximum squat test, muscle activation, jump performance, and functional outcome did not differ between groups.

Conclusions: Rehabilitation with OKC quadriceps exercise led to significantly greater quadriceps strength compared with rehabilitation with CKC quadriceps exercise. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Patients with ACL deficiency may need OKC quadriceps strengthening to regain good muscle torque.

Place, publisher, year, edition, pages
Sage Publications, 2008. Vol. 36, no 2, 298-307 p.
Keyword [en]
ACL rehabilitation, knee laxity, muscle strength, dynamic stability, electromyography
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-12865DOI: 10.1177/0363546507307867PubMedID: 17940146OAI: oai:DiVA.org:liu-12865DiVA: diva2:17242
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Dynamic knee stability after anterior cruciate ligament injury: Emphasis on rehabilitation
Open this publication in new window or tab >>Dynamic knee stability after anterior cruciate ligament injury: Emphasis on rehabilitation
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction.

Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography.

The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic.

One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test.

Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 115 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1036
Keyword
Rehabilitation, anterior cruciate ligament, knee joint, joint instability, muscle strength, electromyography, ACL reconstruction
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-10498 (URN)978-91-85895-05-2 (ISBN)
Public defence
2008-03-07, Aulan, Hälsans Hus, Universitetssjukhuset, ing 16, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2015-12-18Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMedLink to Ph.D. Thesis

Authority records BETA

Tagesson (Sonesson), SofiÖberg, BirgittaGood, LarsKvist, Joanna

Search in DiVA

By author/editor
Tagesson (Sonesson), SofiÖberg, BirgittaGood, LarsKvist, Joanna
By organisation
PhysiotherapyFaculty of Health SciencesDepartment of Orthopaedics LinköpingOrthopaedics and Sports Medicine
In the same journal
American Journal of Sports Medicine
Surgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 1093 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf