The Muscle Strength of the Knee Joint after ACL Reconstruction Depends on the Number and Frequency of Supervised Physiotherapy Visits

The aim of this study in anterior cruciate ligament reconstruction (ACLR) patients was to assess the effect of six months of supervised physiotherapy with a higher number of visits (SPHNV) compared to supervised physiotherapy with a lower number of visits (SPLNV) on the maximal peak torque (PT) and isometric torque (IT) of values obtained for hamstring (H) and quadriceps (Q) muscles of the knee joints under isokinetic and isometric conditions. Hypothesis: SPHNV improves IT and PT more than SPLNV. Group I had ACLR with a higher number of visits (n = 20), Group II had ACLR with a lower number of visits (n = 20), and Group III served as the control (n = 20). In Groups I and II, IT values were measured for quadriceps and hamstring muscles of the knee joints in the 13th and 24th weeks and for PT in the 18th and 24th weeks after ACLR (60 and 180 °/s). In group III, the measurements were taken once. The isometric torque and isokinetic peak torque values were measured in N*m and they were normalized to body mass as relative IT (RIT) and relative PT (RPT) were expressed in N*m/kg. Results: In both ACLR groups, the RIT and RPT values obtained from the operated knee joints significantly increased in the 24 weeks following ACLR compared to the uninvolved side. Group II had significantly lower RIT and RPT values for quadriceps and hamstring muscles of the operated limbs compared with the uninvolved limbs (p = 0.008, p = 0.001). In group I, the larger number of visits positively correlated with the higher PT for quadriceps and hamstring muscles of the operated and uninvolved knees (from r = 0.506; p = 0.023 too r = 0.566; p = 0.009), respectively. Six months of SPHNV positively correlated with and improved the IT and PT values in patients after ACLR much more significantly than six months of SPLNV

Diagnostic value of the hamstring to quadriceps ratio in monitoring of the effectiveness of supervised 6-month physiotherapy in males after Anterior Cruciate Ligament Reconstruction (ACLR)

The aim of the study was to assess the usefulness of isometric torque (IT) and peak torque (PT) of the hamstring to quadriceps muscles ratio (H/Q ratio) in monitoring the effectiveness of physiotherapy (PH) in males after ACLR. Hypothesis: The H/Q ratio is a diagnostic tool for monitoring of the effectiveness of the 6- month PH after ACLR. Methods: Twenty males 6 months after ACLR (ACLR group) and 20 male controls underwent IT and PT (60°/s and 180°/s) bilateral measurements of H and Q muscles. The IT and PT were normalized to body mass, and expressed as relative IT (RIT) and relative PT (RPT). The RIT and RPT H/Q ratios, and Limb Symmetry Index (LSI) were calculated. Results: In the ACLR group, the RIT for the H and Q, the RIT for the H/Q ratio and most of the RPT, as well as the H/Q ratio, ROM and LSI values of the operated knee, were not significantly different (NSD) than those of the non-operated side (NOS) or the control group. The between-group comparison of the H/Q ratio for RIT and RPT weren’t NSD. The isokinetic test at 180 °/s showed lower RPT, H/Q ratio and LSI values for the Q muscle than those of the NOS (p = 0.042, p = 0.001). Conclusions: The H/Q ratio, in combination with the RIT, RPT and LSI, is a useful diagnostic tool for monitoring the effectiveness of 6-month PH after ACLR. Restoring the correct H/Q ratio can reduce the risk factor for ACL graft rupture

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

This study investigates whether double-leg and single-leg vertical hops (VH) landing between-limb symmetry in males, an average of two years after anterior cruciate ligament (ACL) reconstruction (ACLR), is associated with postoperative physiotherapy supervision duration. Thirty-eight healthy controls and thirty-eight males after primary unilateral ACLR, with the use of ipsilateral semitendinosus and gracilis tendon autograft, on average two years before, underwent bilateral peak vertical ground reaction force (vGRF) measurements during double-leg and single-leg VH landing, using two force plates. The vGRF was normalized to the body mass (vGRF BM). The vGRF BM limb symmetry index (LSI) was calculated. Tests for dependent and independent samples and linear Pearson’s correlation coefficient (r) calculations were performed. There were significant between-leg differences in the double-leg (p < 0.001) vGRF BM values. The longer the postoperative physiotherapy supervision duration was, the higher the double-leg VH LSI values (r = 0.727; p < 0.001). There was also a significant but weak positive association between the single-leg VH landing LSI value and the physiotherapy supervision duration (r = 0.333; p = 0.041). Between-limb symmetry during double-leg VH landing in males, an average of two years after ACLR, was correlated with postoperative physiotherapy supervision duration. Fully supervised postoperative physiotherapy for a minimum of six months is more effective for improving VH landing limb symmetry in patients after ACLR

Evaluation of loading symmetry of the lower limbs during vertical hops landing in men, on average 2 years after the anterior cruciate ligament reconstruction and supervised postoperative physiotherapy, lasting less than 6 months

Wstęp. Celem pracy była ocena symetrii obciążania kończyn dolnych w fazie lądowania skoków u mężczyzn średnio dwa lata po rekonstrukcji więzadła krzyżowego przedniego (ACL) stawu kolanowego i nadzorowanej pooperacyjnej fizjoterapii trwającej krócej niż sześć miesięcy. Materiał i metody. Badany materiał stanowiło 15 mężczyzn, średnio 112,60±43,88 tygodni od rekonstrukcji ACL (Grupa ACLR) oraz 15 mężczyzn bez uszkodzeń narządu ruchu w przeszłości (Grupa kontrolna). Średni czas trwania pooperacyjnej nadzorowanej fizjoterapii w Grupie ACLR wyniósł 14,67±5,30 tygodni. W obu badanych grupach, przy wykorzystaniu dwóch platform tensometrycznych, wykonano obustronnie pomiar składowej pionowej sił reakcji podłoża (vGRF) w fazie lądowania skoków obunóż i jednonóż. Uzyskane wyniki znormalizowano do masy ciała badanego (vGRF [BM]) oraz obliczono wskaźnik symetrii kończyn (LSI). Wyniki. W Grupie ACLR wartości vGRF [BM] uzyskane w kończynie operowanej były istotnie statystycznie niższe niż w kończynie nieoperowanej w fazie lądowania skoków obunóż (p=0,001) i jednonóż (p=0,045). Wartości LSI vGRF [BM] w fazie lądowania skoków obunóż były istotnie statystycznie gorsze w Grupie ACLR niż w Grupie kontrolnej (p<0,001). W fazie lądowania skoków jednonóż, wartości LSI nie różniły się pomiędzy badanymi grupami. Wnioski. U mężczyzn, średnio dwa lata po rekonstrukcji ACL stawu kolanowego, zaobserwowano istotne zaburzenia symetrii obciążania kończyn dolnych w fazie lądowania skoków. Badani mężczyźni znacznie bardziej w fazie lądowania obciążali kończynę nieoperowaną niż kończynę operowaną. Asymetria występowała w większym stopniu w czasie skoków obunóż niż podczas skoków jednonóż. Ze względu na niewielką liczebność próby, badania należy traktować jako pilotażowe.Background. The aim of the study was to assess the symmetry of load exerted on the lower limbs during the landing phase of hops in males after anterior cruciate ligament (ACL) reconstruction (ACLR) and the controlled postoperative physiotherapy procedure, lasting less than six months. Material and methods. The sample included 15 males, on average 112.60±43.88 weeks after ACL reconstruction (ACLR group) and 15 males with no history of injuries within the musculoskeletal system (control group). The mean duration of the postoperative supervised physiotherapeutic procedure was 14.67±5.30 in ACLR group. In both groups, the ground reaction force compound (vGRF) was measured bilaterally during the landing phase of single and double leg hops. The obtained results were normalized to the patient’s body mass (vGRF [BM]) and the leg symmetry index (LSI) was calculated. Results. In ACLR group, the vGRF [BM] values obtained for the operated leg were statistically significantly lower than those obtained for the uninvolved leg in the landing phase of double leg hops (p=0.001) and single leg hops (p=0.045). The LSI vGRF [BM] values, obtained during the landing phase of double leg hops, were significantly worse in the ACLR group than in the control group (p<0.001). In the landing phase of single leg hops, no between group differences were found in LSI values. Conclusions. Significant disorders in lower limb load symmetry were observed in male patients during the landing phase, on average two years after ACLR. The studied patients exerted a significantly more substantial load on the uninvolved leg as compared with the operated leg. A higher asymmetry was noted during double leg hops as compared with single leg hops. Due to the small sample size, the study should be regarded as a pilot research

Kinematics of Rotation in Joints of the Lower Limbs and Pelvis during Gait: Early Results—SB ACLR Approach versus DB ACLR Approach

It is difficult to find publications comparing rotation kinematics in large joints of the lower limbs and pelvis during gait in patients after single-bundle (SB) reconstruction of the anterior cruciate ligament (ACLR) with double-bundle (DB) ACLR of the knee. The aim of this study was to compare rotation kinematics in ankle, knee, and hip joints and the pelvis during gait in the 14th week after SB and DB ACLR. The subjects were males after SB (n=10) and DB (n=13) ACLR and a control group (n=15). The values of kinematic parameters were recorded during internal (IR) and external (ER) rotation in the joints during gait using the BTS SMART. The SB ACLR group obtained significantly higher values of ER in the involved knee comparing to DB ACLR and controls and excessive IR in the hip comparing to controls. In the DB ACLR group, excessive ER was noted in the involved leg's foot. Comparing with the DB ACLR and control groups, SB ACLR subjects had more substantial disorders of rotation kinematics in the lower limb joints. However, in both ACLR groups, 14 weeks of postoperative physiotherapy were not enough to fully restore rotation kinematics in joints of the lower limbs during gait

Posturographic weight-bearing distribution and posturographic CoP shifts and surface area of the CoP.

<p>Posturographic weight-bearing distribution and posturographic CoP shifts and surface area of the CoP.</p

Summary of the posturographic weight-bearing distribution and posturographic CoP shifts and surface area of the CoP (as shown in Table 2).

<p>Summary of the posturographic weight-bearing distribution and posturographic CoP shifts and surface area of the CoP (as shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165583#pone.0165583.t002" target="_blank">Table 2</a>).</p