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Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.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 Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3527-5488
2010 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 20, no 1, 154-164 p.Article in journal (Refereed) Published
Abstract [en]

Background: It is unclear which rehabilitation exercises involve adequate muscle activationwithout excessive anterior tibial translation after ACL reconstruction.

Hypothesis: ACL reconstruction will reduce dynamic tibial translation to the level observedin the uninjured knee. The muscle recruitment pattern will be altered 5 weeks after ACLreconstruction, and some rehabilitation exercises will be more beneficial than others due tovarying amounts of dynamic tibial translation and muscle activation.

Study Design: Descriptive Laboratory Study.

Methods: Sagittal tibial translation and muscle activation were measured with the Lachmantest (static translation) and 7 rehabilitation exercises (dynamic translation) in 19 patients.Results obtained 5 weeks after ACL reconstruction were compared to those obtained beforethe injury (ACL-deficient knee) and in the uninjured knee.

Results: Five weeks after ACL reconstruction the seated knee extension producedsignificantly more anterior tibial translation than the straight leg raise and standing on one leg.The static and dynamic tibial translations measured in ACL reconstructed knees were similarto those measured in uninjured knees. After ACL reconstruction, the patients used a jointstiffening strategy that employed more hamstring activation and reduced the dynamic tibialtranslation.

Conclusions: ACL reconstruction reduced dynamic tibial translation compared to thatobserved before treatment. The muscle recruitment pattern in exercises was altered after ACLreconstruction.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2010. Vol. 20, no 1, 154-164 p.
Keyword [en]
Rehabilitation, ACL reconstruction, Knee laxity, Knee kinematics, Functional joint stability, Electromyography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-12866DOI: 10.1111/j.1600-0838.2009.00903.xISI: 000273823400019OAI: oai:DiVA.org:liu-12866DiVA: diva2:17243
Note

On the day of the defence day the status of this article was: Submitted.

Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2015-12-18Bibliographically 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

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Tagesson (Sonesson), SofiÖberg, BirgittaKvist, Joanna

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