Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care
Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energ...
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| Veröffentlicht in: | Orthopaedic journal of sports medicine 2019-10, Vol.7 (10), p.2325967119870155-2325967119870155 |
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| creator | Garrison, J. Craig Hannon, Joseph Goto, Shiho Kosmopoulos, Victor Aryal, Subhash Bush, Curtis Bothwell, James M. Singleton, Steven B. |
| description | Background:
Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R).
Purpose:
To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points.
Study Design:
Case series; Level of evidence, 4.
Methods:
Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05.
Results:
Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical (P < .0003) and nonsurgical (P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P = .0201) of surgical limb knee EAC, explaining 12.92% of the varianc |
| doi_str_mv | 10.1177/2325967119870155 |
| format | Article |
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Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R).
Purpose:
To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points.
Study Design:
Case series; Level of evidence, 4.
Methods:
Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05.
Results:
Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical (P < .0003) and nonsurgical (P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P = .0201) of surgical limb knee EAC, explaining 12.92% of the variance.
Conclusion:
The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.]]></description><identifier>ISSN: 2325-9671</identifier><identifier>EISSN: 2325-9671</identifier><identifier>DOI: 10.1177/2325967119870155</identifier><identifier>PMID: 31632992</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Joint and ligament injuries ; Knee ; Orthopedics ; Sports medicine</subject><ispartof>Orthopaedic journal of sports medicine, 2019-10, Vol.7 (10), p.2325967119870155-2325967119870155</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019.</rights><rights>The Author(s) 2019. This work is licensed under the Creative Commons Attribution – Non-Commercial – No Derivatives License http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2019 2019 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-4a68ab2bd2ab2f5cb129a01028dc04629c8a47847c5415651a2c985b008e37883</citedby><cites>FETCH-LOGICAL-c462t-4a68ab2bd2ab2f5cb129a01028dc04629c8a47847c5415651a2c985b008e37883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778990/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778990/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,21966,27853,27924,27925,44945,45333,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31632992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garrison, J. Craig</creatorcontrib><creatorcontrib>Hannon, Joseph</creatorcontrib><creatorcontrib>Goto, Shiho</creatorcontrib><creatorcontrib>Kosmopoulos, Victor</creatorcontrib><creatorcontrib>Aryal, Subhash</creatorcontrib><creatorcontrib>Bush, Curtis</creatorcontrib><creatorcontrib>Bothwell, James M.</creatorcontrib><creatorcontrib>Singleton, Steven B.</creatorcontrib><title>Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care</title><title>Orthopaedic journal of sports medicine</title><addtitle>Orthop J Sports Med</addtitle><description><![CDATA[Background:
Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R).
Purpose:
To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points.
Study Design:
Case series; Level of evidence, 4.
Methods:
Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05.
Results:
Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical (P < .0003) and nonsurgical (P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P = .0201) of surgical limb knee EAC, explaining 12.92% of the variance.
Conclusion:
The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.]]></description><subject>Joint and ligament injuries</subject><subject>Knee</subject><subject>Orthopedics</subject><subject>Sports medicine</subject><issn>2325-9671</issn><issn>2325-9671</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kcFvFCEUxonR2Kb27smQePEyLTDDABeTzdjappsYq54Jw7zZpZmFFZjG_vey3VprEznAy3u_74PHQ-gtJSeUCnHKasZVKyhVUhDK-Qt0uEtVu9zLJ_EBOk7phpQlOVW1eI0OatrWTCl2iG6vPABeBjM4v8KLMUPEi25ZXePLhK9hMhkGnAP-OpshOgvbhL_lCH6V19j4Ad_Lz35l8MkFjz-5cYRStpDwwsaQEs5rwF3w2fl53uAw4s5EeINejWZKcPxwHqEf52ffu4tq-eXzZbdYVrZpWa4a00rTs35gZR-57SlThlDC5GBJIZSVphGyEZY3lLecGmaV5H1pFWohZX2EPu59t3O_gcGCz9FMehvdxsQ7HYzT_1a8W-tVuNWtEFIpUgw-PBjE8HOGlPXGJQvTZDyEOWlWE1Er3pK6oO-foTdhjr60VyjKRMs5oYUie-r-dyKMj4-hRO_mqp_PtUjePW3iUfBnigWo9kAyK_h7638NfwOJXakK</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Garrison, J. Craig</creator><creator>Hannon, Joseph</creator><creator>Goto, Shiho</creator><creator>Kosmopoulos, Victor</creator><creator>Aryal, Subhash</creator><creator>Bush, Curtis</creator><creator>Bothwell, James M.</creator><creator>Singleton, Steven B.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191001</creationdate><title>Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care</title><author>Garrison, J. Craig ; Hannon, Joseph ; Goto, Shiho ; Kosmopoulos, Victor ; Aryal, Subhash ; Bush, Curtis ; Bothwell, James M. ; Singleton, Steven B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-4a68ab2bd2ab2f5cb129a01028dc04629c8a47847c5415651a2c985b008e37883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Joint and ligament injuries</topic><topic>Knee</topic><topic>Orthopedics</topic><topic>Sports medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garrison, J. Craig</creatorcontrib><creatorcontrib>Hannon, Joseph</creatorcontrib><creatorcontrib>Goto, Shiho</creatorcontrib><creatorcontrib>Kosmopoulos, Victor</creatorcontrib><creatorcontrib>Aryal, Subhash</creatorcontrib><creatorcontrib>Bush, Curtis</creatorcontrib><creatorcontrib>Bothwell, James M.</creatorcontrib><creatorcontrib>Singleton, Steven B.</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Orthopaedic journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garrison, J. Craig</au><au>Hannon, Joseph</au><au>Goto, Shiho</au><au>Kosmopoulos, Victor</au><au>Aryal, Subhash</au><au>Bush, Curtis</au><au>Bothwell, James M.</au><au>Singleton, Steven B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care</atitle><jtitle>Orthopaedic journal of sports medicine</jtitle><addtitle>Orthop J Sports Med</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>7</volume><issue>10</issue><spage>2325967119870155</spage><epage>2325967119870155</epage><pages>2325967119870155-2325967119870155</pages><issn>2325-9671</issn><eissn>2325-9671</eissn><abstract><![CDATA[Background:
Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R).
Purpose:
To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points.
Study Design:
Case series; Level of evidence, 4.
Methods:
Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05.
Results:
Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical (P < .0003) and nonsurgical (P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P = .0201) of surgical limb knee EAC, explaining 12.92% of the variance.
Conclusion:
The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.]]></abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31632992</pmid><doi>10.1177/2325967119870155</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Orthopaedic journal of sports medicine, 2019-10, Vol.7 (10), p.2325967119870155-2325967119870155 |
| issn | 2325-9671 2325-9671 |
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| source | DOAJ Directory of Open Access Journals; Sage Journals GOLD Open Access 2024; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Joint and ligament injuries Knee Orthopedics Sports medicine |
| title | Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care |
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