Neuromuscular control in patients with acute ACL injury during stair ascent – a pilot study Busch A1,2, Henle P3, Boesch L1, Blasimann A1,Baur H1,2 1Berner
Fachhochschule, Fachbereich Gesundheit, Physiotherapie, Bern, Schweiz 2University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopaedics 3Sonnenhof Orthopaedic Center, Department of Knee Surgery and Sports Traumatology
Deutscher olympischer Sportärztekongress 2018 - Hamburg
Results
Background Anterior cruciate ligament (ACL) rupture is one of the most severe knee injuries[4].
healthy vs. injured group: ACL-I vs. ACL-D
ACL-D: healthy vs. injured knee
Several studies have shown altered kinematics and kinetics in ACL deficient patients (ACL-D) compared to healthy persons[5]. Attributed to adaptations of neuromuscular activity due to changed sensorimotor control. However, only few studies investigating neuromuscular alterations. The purpose of this study was to investigate neuromuscular activity during stair ascent in patients with acute ACL tear.
Method Electromyography (EMG) recording of the M. vastus medialis (VM) and lateralis (VL), M. biceps femoris (BF) and M. semitendinosus (ST) in 9 acute ACL-D (rupture 1-3 weeks prior to test) and 9 ACL-I matched subjects (tab. 1). 6-minute walking warm-up on a treadmill (5 km/h) with EMG recordings used for submaximal EMG normalization. Functional task: ascended 20 times a 6-step stair at self-selected speed with force plates located on step 3 and 4 to split the movement into pre-activation (PRE), weight-acceptance (WA) and push-off phase (PO).
Fig. 1: Normalized neuromuscular activity comparing ACL-I and ACL-D in the different movement phases
Fig. 2: Intra-individual comparison of the ACL-D normalized neuromuscular activity in the intact and deficient leg.
ACL-D showed in all muscles a reduced activation (ca. 50 %, p≤0.05) compared to ACL-I during PRE. During WA, quadriceps activity in ACL-D was also reduced (ca. 50 %; p≤0.05) but only slightly reduced in BF and ST (ca. 16 %, p>0.05).
Fig. 1: Stair ascent (lateral view)
Fig. 2: Stair ascent (posterior view)
The root mean squares were calculated and normalized. Comparisons between deficient leg and matched uninjured leg of healthy controls and between patient’s deficient leg and the contralateral side (α = 0.05). Tab. 1: Characteristics of participants
Characteristics Age – years Height – cm Weight – kg Female (%) KOOS* (total max: 168)
ACL-I (N=9) 30 ± 5 174 ± 8 74 ± 8 44 166 ± 1
ACL-D (N=9) 30 ± 8 176 ± 7 70 ± 9 44 112 ± 28
VAS** – pain pre/post Tegner score*** (max: 10)
0.11 / 0.27 5 ± 1
0.76 / 1.36 6±2
During PO, the hamstrings displayed a lower activation in ACL-D (ca. 35 %; p≤0.05) but not in VM and VL (fig. 1). The intra-group comparisons showed less consistent differences in the VL and BF during PRE and WA (ca. –29 % in the ACL-D leg) but not in VM and ST. During PO, quadriceps activity was enhanced by 10 % in the ACL-D leg, whereas hamstring activity did not differ (fig. 2).
Discussion During stair ascent altered muscle activity due to injury was detected especially during PRE.
Legend: * Knee Injury and Osteoarthrosis Outcome Score[2]. ** Visual analogue scale: indicates values on a 0-10 cm scale. *** Tegner activity score (pre injury) range from 0 (sick leave or disability pension) to 10 (competitive sport on professional level)[3]
Neuromuscular control seems to be altered in both extremities following unilateral ACL injury which should be considered during rehabilitation. However, neuromuscular functions cannot be restored after ACLreconstruction and rehabilitation[1].
Literature [1] [2] [3] [4]
Hall M, Stevermer C, Gillette J. Muscle activity amplitudes and co-contraction during stair ambulation following anterior cruciate ligament reconstruction. J Electromyography and Kinesiology (2015) 25, 298-304. Roos E, Lohmander L (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health and Quality of Life Outcomes, 1: 64. Tegner Y, Lysholm J (1985). Rating system in the evaluation of knee ligament injuries. Clinical orthopaedics and related research, 198, 43-9. Wiggins A, Grandhi R, Schneider D, Stanfield D, Webster K, Myer G (2016). Risk of secondary injury in young athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med, 44 (7), 1861-76. [5] Zhao C, Lin C, Wang W, Zeng C, Fang H, Pan J, Cai D. Kinematics of anterior cruciate ligament-deficient knees in a Chinese population during stair ascent. J Orthop Surg and Res (2016) 11 (1):89.
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