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Anterior cruciate ligament injury after more than 20 years: II. Concentric and eccentric knee muscle strength
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Sor-Trondelag University College, Trondheim, Norge.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.ORCID iD: 0000-0002-8818-3408
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2014 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 6, e501-e509 p.Article in journal (Refereed) Published
Abstract [en]

The long-term consequences on knee muscle strength some decades after rupture of the anterior cruciate ligament (ACL) are not established. The aims of our study were to examine peak torque more than 20 years after ACL injury and to compare their knee muscle strength to that of healthy controls. We tested 70 individuals with unilateral ACL injury 23 ± 2 years after injury, whereof 33 (21 men) were treated with physiotherapy in combination with ACL reconstruction (ACLR) and 37 (23 men) with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls (21 men). A Kin-Com® dynamometer (90°/s) was used to measure peak torque in knee flexion and extension in both concentric and eccentric contractions. Knee extension peak torque, concentric and eccentric, was ∼10% lower for the injured leg compared with the non-injured leg for both ACLR (P < 0.001; P < 0.001) and ACLPT (P = 0.007; P = 0.002). The ACLPT group also showed reduced eccentric knee flexion torque of the injured leg (P = 0.008). The strength of the non-injured leg in both ACL groups was equal to that of controls. No difference was seen for those with no-or-low degree of knee osteoarthritis compared to those with moderate-to-high degree of osteoarthritis. ACL injury may lead to a persistent reduction of peak torque in the injured leg, which needs to be considered across the lifespan.

Place, publisher, year, edition, pages
2014. Vol. 24, no 6, e501-e509 p.
Keyword [en]
Isokinetic, peak torque, long-term consequences, cross-sectional design
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-86713DOI: 10.1111/sms.12215ISI: 000345703300011PubMedID: 24684507Scopus ID: 2-s2.0-84912048217OAI: oai:DiVA.org:umu-86713DiVA: diva2:703215
Funder
Swedish Research Council, K2008-70X-20845-01-3Swedish Research Council, K2011-69X-21876-01-3Swedish National Centre for Research in Sports, P2012-0008
Available from: 2014-03-05 Created: 2014-03-05 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Long-term consequences of anterior cruciate ligament injury: knee function, physical activity level, physical capacity and movement pattern
Open this publication in new window or tab >>Long-term consequences of anterior cruciate ligament injury: knee function, physical activity level, physical capacity and movement pattern
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Knee function after more than 20 years post injury is rarely described and none of the few follow-up studies have evaluated functional performance tasks. This thesis investigated self-reported knee function, physical activity level, physical capacity and movement pattern in the long-term perspective (on average 23 years) in persons who had suffered a unilateral ACL injury, treated either with physiotherapy in combination with surgery (ACLR, n=33) or physiotherapy alone (ACLPT, n=37) and compared to age-and-gender matched controls (n=33).

 This thesis shows that regardless of treatment, there are significant negative long-term consequences on self-reported knee function and physical activity more than 20 years after injury. In comparison to the controls, the ACL-groups (ACLR and ACLPT) had lower knee function as measured by the Lysholm score and the Knee injury and Osteoarthritis Outcome Score (KOOS). The persons with an ACL injury also had a lower knee-specific physical activity level (Tegner activity scale), while no differences were seen in general physical activity level (International Physical Activity Questionnaire, IPAQ) compared to healthy controls. Regarding physical capacity, both ACL groups showed inferior jump capacity in the injured leg compared to the non-injured leg. However, compared to controls the ACL-injured had a relatively good jump performance. Knee extension peak torque, concentric and eccentric, was also lower for the injured leg compared to the non-injured leg for both ACLR and ACLPT. In addition, the ACLPT group showed reduced eccentric knee flexion torque of the injured leg. The non-injured leg, on the other hand, showed almost equal jump capacity and strength as controls. Balance in single-limb stance (30s) was inferior in persons who had an ACL injury. This was true for both the injured and non-injured leg and regardless of treatment. Movement pattern during the one-leg hop was analysed by a set of kinematic variables consisting of knee angles (flexion, abduction, rotation) and Centre of Mass (CoM) placement in relation to the knee and ankle joints. Both ACLR and ACLPT displayed movement pattern asymmetries between injured and non-injured legs. In comparison to controls, the ACLR group had a similar movement pattern with the exception of larger external knee rotation at Initial contact and less maximum internal rotation during the Landing. ACLPT showed several differences compared to controls both regarding knee angles and CoM placement. The ACL-injured persons with no-or-low knee osteoarthritis (OA) had better knee function as reflected by higher scores on Lysholm and KOOS subscale ‘symptom’ compared to those with moderate-to-high OA. The degree of OA had no influence on reported physical activity level, jump capacity, peak torque or the kinematic variables.

 In conclusion, this thesis indicates that persons with a unilateral ACL injury, regardless of treatment, have some negative long-term consequences e.g. self-reported knee function, knee-specific activity level, strength and balance deficits, when compared to age-and-gender matched controls. The results, however, also indicate that the ACL-injured can manage reasonably well in some jumps and general activity level but have an inferior performance in more knee-demanding tasks. The ACLR group had similar movement pattern with the exception of knee rotation, indicating that a reconstruction may restore the knee biomechanics to some extent. The ACLPT group on the other hand, seem to use compensatory movement strategies showing several differences compared to controls.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 73 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1631
Keyword
ACL injury, cross-sectional design, isokinetic, peak torque, centre of pressure, kinematics
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-86715 (URN)978-91-7601-005-1 (ISBN)
Public defence
2014-03-28, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, K2008-70X-20845-01-3Swedish Research Council, K2011-69X-21876-01-3Swedish National Centre for Research in Sports, P2012-0008
Available from: 2014-03-07 Created: 2014-03-05 Last updated: 2015-01-21Bibliographically approved

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