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Long-term consequences of anterior cruciate ligament injury: knee function, physical activity level, physical capacity and movement pattern
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
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 [en]
ACL injury, cross-sectional design, isokinetic, peak torque, centre of pressure, kinematics
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-86715ISBN: 978-91-7601-005-1 (print)OAI: oai:DiVA.org:umu-86715DiVA: diva2:703234
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
List of papers
1. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function
Open this publication in new window or tab >>Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function
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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, e491-e500 p.Article in journal (Refereed) Published
Abstract [en]

Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR), and 37 treated with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6–25%,P < 0.001–P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

Keyword
Limb Symmetry Index, cross sectional design, jump, movement fear, International Physical Activity Questionnaire
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-86712 (URN)10.1111/sms.12212 (DOI)000345703300010 ()24673102 (PubMedID)2-s2.0-84912048905 (Scopus ID)
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
2. Anterior cruciate ligament injury after more than 20 years: II. Concentric and eccentric knee muscle strength
Open this publication in new window or tab >>Anterior cruciate ligament injury after more than 20 years: II. Concentric and eccentric knee muscle strength
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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.

Keyword
Isokinetic, peak torque, long-term consequences, cross-sectional design
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-86713 (URN)10.1111/sms.12215 (DOI)000345703300011 ()24684507 (PubMedID)2-s2.0-84912048217 (Scopus ID)
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
3. Deficits in single-limb stance more than 20 years after ACL injury
Open this publication in new window or tab >>Deficits in single-limb stance more than 20 years after ACL injury
2013 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 15, no 2, 78-85 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate the long-term effect on balance during single-limb stance after unilateral anterior cruciate ligament (ACL) injury across two groups who had rehabilitation including ACL reconstruction (ACLR) or a tailored physiotherapy program (ACLTPP), compared with knee-healthy controls.

Methods: Single-limb stance was monitored for floor-supports with the contralateral foot. Single-limb stance without floor-supports was assessed with analyses of center of pressure (CoP) for further discrimination. Comparisons were made between ACLR (n = 28) and ACLTPP (n = 28) and with controls (n = 18). The injured and uninjured legs were compared within ACL-injured subjects.

Results: Single-limb balance was equally inferior in both ACL-injured groups and on both legs compared with knee-healthy controls. In ACLR and ACLTPP, 39% and 50%, respectively, failed to stand on one leg without floor-supports with the contralateral foot. No contralateral supports occurred in knee-healthy controls. CoP measures for subjects who stood without contralateral floor-supports did not reveal any further differences. Older age and higher body mass index (BMI) correlated with larger migration of CoP.

Conclusion: Inability to stand without contralateral supports showed that balance in single-limb stance was inferior in ACL-injured subjects, independently of which initial treatment that was given. Age and BMI need consideration in studies assessing balance in single-limb stance.

Keyword
Balance, CoP, knee, long-term perspective
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-80262 (URN)10.3109/21679169.2013.791718 (DOI)
External cooperation:
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2017-12-06Bibliographically approved
4. One-leg hop more than 20 years after ACL injury: kinematic analysis of persons treated with physiotherapy with or without surgery compared to healthy controls
Open this publication in new window or tab >>One-leg hop more than 20 years after ACL injury: kinematic analysis of persons treated with physiotherapy with or without surgery compared to healthy controls
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-86714 (URN)
Funder
Swedish Research Council, K2008-70X-20845-01-3
Available from: 2014-03-05 Created: 2014-03-05 Last updated: 2015-01-21Bibliographically approved

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