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Dynamic knee stability after anterior cruciate ligament injury: Emphasis on rehabilitation
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
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 [en]
Rehabilitation, anterior cruciate ligament, knee joint, joint instability, muscle strength, electromyography, ACL reconstruction
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-10498ISBN: 978-91-85895-05-2 (print)OAI: oai:DiVA.org:liu-10498DiVA: diva2:17244
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
List of papers
1. Passive and dynamic translation in the knee is not influenced by knee exercises in healthy individuals
Open this publication in new window or tab >>Passive and dynamic translation in the knee is not influenced by knee exercises in healthy individuals
2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 15, no 3, 139-147 p.Article in journal (Refereed) Published
Abstract [en]

No evidence exists that repeated isolated quadriceps contractions lead to increased sagittal plane tibial translation. The purpose was to analyze passive and dynamic tibial translation before, during and after a specific exercise session, including cycling and a maximum number of knee extensions and heel-raises, in healthy individuals. Passive and dynamic sagittal tibial translation was measured on 18 healthy individuals (nine men and nine women) before, during and after a specific exercise session with heavy load, including cycling and maximum number of knee extensions and heel-raises. Sagittal tibial translation during the Lachman test, maximal isometric quadriceps contraction, one-legged squat and gait was registered with the CA-4000 electrogoniometer. The electromyographic (EMG) activity of m. vastus medialis and lateralis, m. gastrocnemius and mm. hamstrings was registered. There was no difference in passive or dynamic sagittal tibial translation during or after the exercise session. No difference could be detected in EMG activity during squat after compared with before the exercise session. In conclusion, the knee exercises did not influence the amount of translation in healthy individuals. The findings indicate that isolated strength training of quadriceps may be included in anterior cruciate ligament rehabilitation programs, even if further specific studies on injured individuals most be performed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2005
Keyword
knee kinematics; EMG; ACL rehabilitation; exercise; squat; knee extension
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-22680 (URN)10.1111/j.1600-0838.2004.00425.x (DOI)15885034 (PubMedID)1970 (Local ID)1970 (Archive number)1970 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
2. Intra‐ and interrater reliability of the establishment of one repetition maximum on squat and seated knee extension
Open this publication in new window or tab >>Intra‐ and interrater reliability of the establishment of one repetition maximum on squat and seated knee extension
2007 (English)In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 21, no 3, 801-807 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of the present study was to develop a systematic procedure for the establishment of 1 repetition maximum (1RM) in order to describe an easily accessible test procedure that is applicable for physical therapists and athletic trainers who manage strength training for healthy individuals and patients. Another purpose was to investigate the intra- and interrater reliability of 1RM of squat on 1 leg and seated knee extension on 1 leg. Estimates of leg strength and ratings of perceived exertion formed the basis of the amount of load selected. The reliability of the procedure was assessed by a test–retest design. One RM was established for 16 and 27 healthy individuals, for squat and knee extension, respectively. The intrarater reliability of 1RM of squat on 1 leg was questionable (intraclass correlation [ICC] 0.64, measurement error 13.1 kg). The interrater reliability of 1RM of squat on 1 leg was clinically acceptable (ICC 0.94, measurement error 5.2 kg). The intrarater and interrater reliability of 1RM of seated knee extension on 1 leg was clinically acceptable (ICC 0.90, measurement error 5.1 kg and ICC 0.96, measurement error 3.2 kg, respectively). In conclusion, both exercises can be used to determine the load in exercise programs. In addition, seated knee extension may be used to evaluate strength. In contrast, squat on 1 leg is more uncertain to use at assessments between different days, which may be due to the complexity of this exercise. The test, performed in the described manner, is suitable for physical therapists, athletic trainers, and strength and conditioning coaches in clinical practice working with strength training and rehabilitation.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2007
Keyword
exercise, lower extremity, rehabilitation
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-12864 (URN)17685713 (PubMedID)
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
3. 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
Open this publication in new window or tab >>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
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
Keyword
ACL rehabilitation, knee laxity, muscle strength, dynamic stability, electromyography
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-12865 (URN)10.1177/0363546507307867 (DOI)17940146 (PubMedID)
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
4. Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction
Open this publication in new window or tab >>Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction
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
Keyword
Rehabilitation, ACL reconstruction, Knee laxity, Knee kinematics, Functional joint stability, Electromyography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12866 (URN)10.1111/j.1600-0838.2009.00903.x (DOI)000273823400019 ()
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: 2017-12-14Bibliographically approved

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Tagesson (Sonesson), Sofi

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