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PubMed2004

Morbidity following anterior cruciate ligament reconstruction using hamstring autograft.

INTRODUCTION: As anterior cruciate ligament (ACL) reconstruction becomes more frequently performed, the expectation of earlier return to activities becomes higher; hence graft selection becomes more important. The use of hamstring tendon autograft is perceived to have less postoperative morbidities. We evaluate the early postoperative complications in this prospective study. MATERIALS AND METHODS: Seventy-six patients operated by the same surgeon were assessed preoperatively, and 3 and 6 months after surgery. The hamstring and quadriceps strength were measured with Biodex machine and the side-to-side laxity measured using KT-1000 instrument. The patients were also assessed for their subjective complaints using IKDC (International Knee Documentation Committee) Knee Scoring System. RESULTS: The strength and endurance index of the quadriceps and hamstrings recovered and improved by the sixth month after surgery. The recovery by the quadriceps muscle is more marked and by the sixth month, it has recovered to more than the preoperative level. As for laxity, the average side-to-side difference at 30 pounds was 2.75 mm by 6 months. Of these patients, the side-to-side difference was less than 5 mm in 66 patients (5 mm as taken to be acceptable for graft success). As for IKDC rating, at the sixth month, 71 patients had normal or near normal knee by their own assessment. No patients had anterior knee pain at rest. Sensory deficits were only present in 3 patients with complaints of numbness over the distribution of the saphenous nerve or its infrapatellar branch. CONCLUSION: Most morbidities are temporal in nature and do not significantly affect the patient's activities.

Adolescent↗

PubMed2005

Effects of changes in skiing posture on the kinetics of the knee joint.

This study was performed to investigate the effects of changes in the skiing posture on mechanical stress across the knee joint. The aim of the present study was to establish a safer form of skiing for the prevention of injury to the anterior cruciate ligament of the knee (ACL). Ten healthy volunteers were placed on a force plate on an artificial slope, and assumed forward and backward bending postures with a single leg by changing their centre of gravity. The knee flexion angles were limited to approximately 30 degrees by orthotics in each posture. Joint moments of the lower extremity were analyzed using a motion analysis system, and the muscle activities of the lower extremity were recorded by EMG and digitised to integrated EMG in each posture. In addition, extrusion of the lower leg by the boot was measured using a force sensor sheet inserted behind the calf. We found that the extension moment of the hip and ankle joints, and muscular activity of the hamstrings were increased in forward bending, whereas the extension moment of the knee and muscular activity of the quadriceps were decreased. Conversely, the muscular activity of the quadriceps, the flexion moment of the hip, extension moment of the knee joint, and pressure of the boot were increased in backward bending, whereas muscular activity of the hamstrings was decreased. The dependency on the hamstrings increased in forward bending in a skiing posture on a slope with slight knee flexion. Therefore, forward bending seemed to be an advantageous posture for the prevention of ACL injury. Conversely, in a backward bending skiing posture, the extension moment of the knee joint produced by muscle contraction of the quadriceps also increased imbalance in the hamstrings. The results of this study suggest that the internal force exerted by the quadriceps, in addition to the passive factor of extrusion of the lower leg by the boot, may contribute to non-contact ACL injury in a backward bending posture while skiing.

Adult↗

PubMed2004

[Comparison of two electrical stimulation protocols on quadriceps muscle after anterior cruciate ligament surgery. Feasability study].

OBJECTIVES: To evaluate the feasibility of a study comparing the effects of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery. MATERIAL: Seven sportsmen with a mean age of 26 yrs were randomly grouped in two: a 20 Hz stimulated group (4 patients) and a 80 Hz stimulated group (3 patients). After surgery all patients received electrical stimulation of the quadriceps femoris, five days a week, for 12 weeks, and had a standard program of voluntary contractions. The main outcome assessed before and three months after surgery were: quadriceps and hamstring peak torque at 90, 180 and 240 degrees /second, maximal isometric quadriceps at 75 degrees of flexion and muscle and subcutaneous fat volumes of the thigh using MRI. RESULTS: After 12 weeks of rehabilitation, the thigh muscle volume deficit of the operated limb was between 3 and 9% in the 20 Hz stimulated group and between 1 and 2% in the 80 Hz stimulated group. Quadriceps peak torque deficit was less than 30% except for two patients in the 20 Hz stimulated group. Maximal isometric quadriceps deficit of the operated limb was higher than 30% except for two patients in the 20 Hz stimulated group. CONCLUSION: The study showed that comparison of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery is possible if stimulation period is not more than four weeks.

Adult↗

PubMed1991

Strength recovery and muscle activation of the knee extensor and flexor muscles after arthroscopic meniscectomy. A pilot study.

Maximal isokinetic strength and electromyographic activity of the operated leg were measured preoperatively and one, two, three, and eight weeks postoperatively after a partial medial meniscectomy by arthroscopy in a group of ten patients. Strength deficits, measured with a Kin-Com dynamometer using a static preloading protocol, were found in comparison with a group of matched healthy subjects preoperatively and three and eight weeks postoperatively in the knee extensors. These deficits were related to previously unreported modifications in the shape of the moment-angle curves and a tendency to lower activation levels of the vastus medialis (VM) but not the vastus lateralis or rectus femoris muscles. No deficits were found in the knee flexors preoperatively or three and eight weeks postoperatively, but the medial hamstrings activation level was lower for movements at 30 degrees per second. During flexion movements, the percentage of coactivation of the antagonist VM was significantly greater than healthy values at 30 degrees and 180 degrees per second. These results clearly indicate that neuromuscular recovery is not complete when return to work is advocated three to four weeks postoperatively. Such findings suggest the need for a rehabilitation program to promote recovery of the knee muscles in workers with a physically demanding occupation.

Adult↗

PubMed2001

Strategies of muscular support of varus and valgus isometric loads at the human knee.

In this paper we studied how subjects activate their muscles in response to static varus and valgus loads at the knee. The muscles' contributions to the external moments were estimated using an EMG driven biomechanical model of the knee. The individual muscle activation and loading patterns were examined to identify the strategies that the nervous system uses to support varus and valgus knee moments. It was found that the (1) co-contraction of the hamstrings and quadriceps, and (2) activation of the gracilis and tensor fascia lata increased with the increasing magnitude of the varus and valgus moments. These 2 activation patterns provided positive support of valgus and varus loads at the knee The sartorius appears to be activated to provide positive support of valgus loads at the knee, whereas during varus moments this muscle increases the varus load on the knee, i.e. provides negative support. Generally, the hamstrings and quadriceps co-contraction contributed to most of the muscular support of the varus and valgus moments. In addition, co-contraction supported 11-14% of the external moment in pure varus and pure valgus respectively. It appears that there are activation strategies with the specific purpose to support varus and valgus moments, albeit small, which suggest dual goals of the neuromotor system during the support of varus and valgus moments.

Adult↗

PubMed1998

Quantification of elastic resistance knee rehabilitation exercises.

Elastic resistance exercises are frequently used for knee rehabilitation following injury and/or surgery. The evidence supporting this mode of rehabilitation is primarily anecdotal, and no biomechanical assessment of elastic resistance exercises has been previously published. The purpose of this project was to quantify muscle activation levels, knee joint angles, and applied force during five rehabilitation exercises utilizing an elastic resistance device. Twelve subjects with no previous knee injury performed double knee dip, hamstring pull, leg press, single knee dip, and side-to-side jump exercises while sagittal plane kinematics, applied force from the elastic resistance device, and electromyographic activity of eight lower extremity muscles were collected. The muscle activation patterns suggest a progressive continuum of rehabilitation exercises that can be applied to nonoperative injuries as well as anterior cruciate ligament reconstructions.

Adult↗

PubMed2002

An electromyographic analysis of sumo and conventional style deadlifts.

PURPOSE: Strength athletes often employ the deadlift in their training or rehabilitation regimens. The purpose of this study was to compare muscle activity between sumo and conventional style deadlifts, and between belt and no-belt conditions. METHODS: Six cameras collected 60-Hz video data and 960-Hz electromyographic data from 13 collegiate football players who performed sumo and conventional deadlifts with and without a lifting belt, employing a 12-RM intensity. Variables measured were knee angles and EMG measurements from 16 muscles. Muscle activity were averaged and compared within three 30-degree knee angle intervals from 90 to 0 degrees during the ascent, and three 30-degree knee angle intervals from 0 to 90 degrees during the descent. RESULTS: Overall EMG activity from the vastus medialis, vastus lateralis, and tibialis anterior were significantly greater in the sumo deadlift, whereas overall EMG activity from the medial gastrocnemius was significantly greater in the conventional deadlift. Compared with the no-belt condition, the belt condition produced significantly greater rectus abdominis activity and significantly less external oblique activity. For most muscles, EMG activity was significantly greater in the knee extending intervals compared with the corresponding knee flexing intervals. Quadriceps, tibialis anterior, hip adductor, gluteus maximus, L3 and T12 paraspinal, and middle trapezius activity were significantly greater in higher knee flexion intervals compared with lower knee flexion intervals, whereas hamstrings, gastrocnemius, and upper trapezius activity were greater in lower knee flexion intervals compared with higher knee flexion intervals. CONCLUSIONS: Athletes may choose to employ either the sumo or conventional deadlift style, depending on which muscles are considered most important according to their training protocols. Moderate to high co-contractions from the quadriceps, hamstrings, and gastrocnemius imply that the deadlift may be an effective closed kinetic chain exercise for strength athletes to employ during knee rehabilitation.

Adult↗

PubMed2005

Jump-land characteristics and muscle strength development in young athletes: a gender comparison of 1140 athletes 9 to 17 years of age.

BACKGROUND: Many authors have speculated that altered neuromuscular control and strength of the lower extremity are responsible for the gender disparity in knee ligament injury rates. HYPOTHESIS: Significant increases in normalized quadriceps and hamstrings strength and limb symmetry on single-legged hop test occur with age. No gender differences in strength occur until age 14 years, after which boys generate greater peak torques than do girls. Age and gender do not influence lower limb alignment on a drop-jump test. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We studied the effects of age and gender in 1140 athletes, 9 to 17 years old, on muscle strength and neuromuscular control during functional activities. Isokinetic quadriceps and hamstrings strength was measured at 300 deg/s. Limb symmetry was assessed with single-legged hop tests. A video drop-jump test determined lower limb alignment in the coronal plane. RESULTS: Extension peak torques significantly increased with age; maximum strength was noted in girls at age 13 years and in boys at age 14 years (P < .001). Although maximum flexion strength occurred in boys at age 14 years (P < .001), girls had only slight increases from ages 9 to 11 years (P = not significant). Boys aged 14 to 17 years had significantly greater normalized isokinetic strength than did age-matched girls. No age or gender effects existed in limb alignment on the drop-jump test or limb symmetry on single-legged hop testing. CONCLUSION: Maximum hamstrings strength was noted in female athletes by age 11 years, compared with age 14 years in male athletes, and a distinct lower limb valgus alignment existed in the majority of all athletes on landing. The absence of a gender difference in lower limb alignment on landing suggests other factors may be responsible for the gender disparity in knee ligament injury rates.

Adolescent↗

PubMed2004

Concentric quadriceps and hamstrings isokinetic strength in volleyball and soccer players.

AIM: Muscular strength is one of the most important components of sport, both for high performance and for injury prevention. One of the most used methods to assess strength muscle balance between dominant (D)/non-dominant (ND) and antagonist/agonist is isokinetic testing. The main purpose of the present study was to describe and to compare isokinetic strength profiles (peak torque, bilateral strength differences between D/ND leg (BD) and hamstrings/quadriceps (H/Q) ratio) in athletes of different sports and positional roles. METHODS: Twenty-eight elite volleyball players and 47 pro soccer players (goalkeepers, n = 5; full-backs, n = 7; defenders, n = 10; midfielders, n = 15; forwards, n = 10) were evaluated using an isokinetic dynamometer (Biodex-System 2). Maximal gravity corrected concentric peak torque of knee extensor and flexor muscles were measured at angular velocities of 360 degrees x s(-1) (6.28 rad x s(-1)) and 90 degrees x s(-1) (1.57 rad x s(-1)). RESULTS: No significant BD were found between soccer and volleyball players with exception of hamstrings at 90 degrees x s(-1) (soccer: 10.6 +/- 8.0% vs volleyball: 6.9 +/- 5.5%). The H/Q ratio was significantly lower in volleyball players at 90 degrees x s(-1) (D: soccer 57.4 +/- 6.7% vs volleyball 50.4 +/- 7.2%; ND: soccer: 56.1 +/- 8.2% vs volleyball: 50.5 +/- 6.4%). No significant differences were found for BD and H/Q ratio in soccer players of different positional roles. CONCLUSION: In general, soccer and volleyball players do not seem to be different concerning BD although a significant difference was observed in hamstrings at 90 degrees x s(-1). Moreover, our data suggest that specific demands of these sports and the different positional roles in soccer did not induce bilateral leg imbalances. However, sport demands seem to influence isokinetic concentric H/Q ratio.

Adult↗

PubMed1995

Electromyographic analysis of the hip and knee during the golf swing.

As golf increases in popularity, more golfers seek the proper mechanics necessary for the perfect golf swing. Surprisingly little scientific work has been published on the contribution of the hip and knee muscles during the golf swing even though most professionals have recognized their vital contribution. Recent studies have described the electromyographic (EMG) muscle activity of the shoulder, back, and trunk during the golf swing. The purpose of this study was to describe the electrical muscle activity in seven hip and knee muscles of both the left (lead) and right (trail) leg in competitive golfers while performing the golf swing. Sixteen golfers were studied with indwelling electrodes and high-speed cinematography. The EMG was synchronized with the film to discern five phases of the golf swing. Means, SDs, and t-tests were done. The results revealed that the trail hip extensors and abductors in conjunction with the lead adductor magus initiated pelvic rotation during forward swing. The lead hamstrings maintained a flexed knee and provided a stable base on which pelvic rotation took place. The peak EMG muscle activity recorded in the hips and knees occurred in an earlier phase than that measured previously in the trunk and shoulder. This confirmed the sequential firing pattern of the hip and knee muscles that takes place during the competitive golf swing. Information gained from this study can be used by players and coaches to optimize performance and to minimize injury.

Adult↗

PubMed2002

Torque-EMG relationships in normal and spastic muscles.

The linearity of the relationship between torque and electromyographic (EMG) activation has been widely debated for years, yet remains unresolved. Despite limitations and possible inaccuracies, an assumption of linearity is often made to simplify the relationship between these variables for computational and descriptive purposes. Although typically derived from isometric test conditions, these relationships have also been extrapolated, perhaps invalidly, to conditions where joint velocity and length are changing. The purpose of this study was to examine the degree of linearity between hamstring and quadriceps torques and their respective EMG signals, and to compare the slopes of these relationships in normal and spastic muscles at varying muscle lengths and conditions. We hypothesized that relationships would be linear for all muscles tested in both subject groups; however, slopes would differ across the two muscles, the three muscle lengths tested, and the two subject groups. We further hypothesized that the degree of linearity during an isotonic task would be less than for the isometric one, particularly for patients with spasticity who may demonstrate abnormal responses to changes in muscle length. Results indicated that torque--EMG relationships were linear for all subjects during isometric contractions, regardless of group, muscle, or knee angle. However, the degree of linearity was significantly less in CP in both conditions; and within the CP group, was less during isotonic compared to isometric conditions. Slope values differed between muscles at some lengths, across muscle lengths in the quadriceps, and subjects with CP showed consistently lower slopes for all quadriceps values. These data in general support the robustness of the linear assumption in isometric conditions for the knee musculature, caution against extrapolation to isotonic conditions particularly for those with movement abnormalities, and suggest that slope differences may provide valuable insights into pathology and warrant further investigation.

Adolescent↗

PubMed2007

Posterior root-muscle reflexes elicited by transcutaneous stimulation of the human lumbosacral cord.

Continuous epidural stimulation of lumbar posterior root afferents can modify the activity of lumbar cord networks and motoneurons, resulting in suppression of spasticity or elicitation of locomotor-like movements in spinal cord-injured people. The aim of the present study was to demonstrate that posterior root afferents can also be depolarized by transcutaneous stimulation with moderate stimulus intensities. In healthy subjects, single stimuli applied through surface electrodes placed over the T11-T12 vertebrae with a mean intensity of 28.6 V elicited simultaneous, bilateral monosynaptic reflexes in quadriceps, hamstrings, tibialis anterior, and triceps surae by depolarization of lumbosacral posterior root fibers. The nature of these posterior root-muscle reflexes was demonstrated by the duration of the refractory period, and by modifying the responses with vibration and active and passive movements. Stimulation over the L4-L5 vertebrae selectively depolarized posterior root fibers or additionally activated anterior root fibers within the cauda equina depending on stimulus intensity. Transcutaneous posterior root stimulation with single pulses allows neurophysiological studies of state- and task-dependent modulations of monosynaptic reflexes at multiple segmental levels. Continuous transcutaneous posterior root stimulation represents a novel, non-invasive, neuromodulative approach for individuals with different neurological disorders.

Adult↗

PubMed1994

Electromyographic analysis of standing posture and demi-plié in ballet and modern dancers.

Surface electromyography was used to analyze lower extremity muscle activity during standing posture and demi-plié in first position with lower extremities turned out, in five ballet and seven modern female professional dancers. In standing posture, increased electromyographic (EMG) activity above baseline was detected most frequently at the medial gastrocnemius (54% standing repetitions) and tibialis anterior (29%) electrodes (all dancers); in ballet dancers, increased EMG activity during standing was significantly less frequent at the medial gastrocnemius, but more frequent at the tibialis anterior, than in modern dancers. In demi-plié, the tibialis anterior had a discrete peak of EMG activity at midcycle in all dancers (97% demi-pliés). All dancers also had midcycle EMG activity in both vastus lateralis and medialis (100% demi-pliés). At the end of rising phase of demi-plié, ballet dancers had greater EMG activity than at midcycle in vastus lateralis (100% demi-pliés) and medialis (92%); in modern dancers, end-rising phase voltage was lower than at midcycle for vastus lateralis (71% demi-pliés) and medialis (83%). Genu recurvatum > or = 10 degrees was observed at the beginning and end of demi-plié in all ballet dancers, but not in modern dancers. There was marked variation of EMG activity during demi-plié in the lateral gastrocnemius, medial gastrocnemius, gluteus maximus, hamstrings, and adductors. The results support the hypothesis that ballet and modern dancers have different patterns of muscle use in standing posture and demi-plié, which in part may be a result of differences in genu recurvatum and turnout between the two groups.

Adult↗

PubMed1983

The treatment of congenital dislocation of the knee with the Pavlik harness.

We have used the Pavlik harness in the treatment of congenital dislocation of the knee in six knees in five patients, with satisfactory results. We believe that the muscles in the thigh which cross both the hip and knee joints, the rectus femoris and hamstrings, play an important role in the spontaneous reduction of the joint. Full correction is not always obtained, our results are comparable with those described by other authors. We consider that the advantages of using the harness are that a spontaneous correction can be obtained, maximal correction can be obtained after three months of treatment and the method is safer than others used.

Braces↗

PubMed1996

Load carriage using packs: a review of physiological, biomechanical and medical aspects.

This paper reviews the biomedical aspects of transporting loads in packs and offers suggestions for improving load-carriage capability. Locating the load mass as close as possible to the body center of gravity appears to result in the lowest energy cost when carrying a pack. Thus, the double pack (half the load on the front of the body and half the load on the back) has a lower energy cost than the backpack. However, backpacks provide greater versatility in most situations. The energy cost of walking with backpack loads increases progressively with increases in load mass, body mass, walking speed or grade; type of terrain also influences energy cost. Predictive equations have been developed for estimating the energy cost of carrying loads during locomotion but these may not be accurate for prolonged (>2 h) or downhill carriage. Training with loads can result in greater energy efficiency since walking with backpack loads over several weeks decreases energy cost. Load-carriage speed can be increased with physical training that involves regular running and resistance training. Erector spinae electrical activity (EMG) is lower during load carriage than in unloaded walking until loads exceed 30-40 kg, at which point erector spinae EMG activity is higher than during unloaded walking. EMGs of the quadriceps and gastrocnemius, but not the tibialis anterior or hamstrings, increase with load. Framed packs with hip belts reduce the electrical activity of the trapezius muscles, presumably by shifting forces from the shoulders to the hips. Increases in the backpack load mass result in increases in forces exerted on the grounds, amount of knee flexion and the forward inclination of the trunk. Compared to backpacks, double packs produce fewer deviations from normal walking. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia (foot pain), rucksack palsy (shoulder traction injury) and knee pain. Closed-cell neoprene insoles and use of an acrylic or nylon sock, combined with a wool sock, reduce blister incidence. A framed pack with a hip belt reduces the incidence of rucksack palsy. Backpack load carriage can be facilitated by lightening loads, optimizing equipment, improving load distribution and by preventive action aimed at reducing the incidence of injury.

Journal Article↗

PubMedDate not supplied

Dynamic joint control training for knee ligament injuries.

The purpose of this study was to introduce dynamic joint control training and to assess its effects in improving neuromuscular coordination of injured knees using the Kin-Com Isokinetic Dynamometer. Although four patients had a sensation of "giving way" on one knee, all eight knees were trained for 3 months using unstable boards with added sudden force given by a therapist. The training group (four patients) was examined during four sessions and the control group (five subjects) was examined during three sessions within a 3 month period. All subjects were instructed to react to the sudden forward movement of the input arm of the Kin-Com Isokinetic Dynamometer with contraction of the hamstring. Results of the first and final trials of peak torque time (PTT) and rising torque value (RTV) of the hamstring between the training and control groups showed significant improvement. There was no correlation between isometric muscle strength (IMS) and PTT in the total 76 sessions. There is a strong implication that simple muscle training does not increase the speed of muscular reaction but dynamic joint control training has the potential to shorten the time lag of muscular reaction.

Adolescent↗

PubMed1998

A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties.

Fourteen patients with a posterior-stabilized prosthesis in one knee and a posterior cruciate-retaining prosthesis in the contralateral knee and both scoring good or excellent on the Hospital for Special Surgery (HSS) knee scale were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean follow-up of 98 months after arthroplasty. The average HSS knee score (93 points) and the average Knee Society score (94 points) were the same for the cruciate-retaining and posterior-stabilized knees. No differences were noted between the cruciate-retaining and the posterior stabilized knees with respect to isokinetic muscle testing parameters (peak torque, endurance, angle of peak torque, and torque acceleration energy) for both quadriceps and hamstrings. No significant differences were found between the cruciate-retaining and the posterior-stabilized knees with regard to gait parameters, knee range of motion, and electromyographic waveforms during level walking and stair climbing. Cruciate-retaining and posterior-stabilized total knee prostheses perform equally well during level gait and stair climbing.

Aged↗

PubMed1998

Is coordination of two-joint leg muscles during load lifting consistent with the strategy of minimum fatigue?

The purpose of this study was to examine if strong correlations reported for a back lift task between activity (EMG) of two-joint rectus femoris (RF), hamstrings (HA), and gastrocnemius (GA) and the difference in the joint moments could be predicted by minimizing an objective function of minimum fatigue. Four subjects lifted barbell weights (9 and 18 kg) using a back lift technique at three speeds normal, slow, and fast. Recorded ground reaction forces and coordinates of the leg joints were used to calculate the resultant joint moments. Surface EMG of five muscles crossing the knee joint were also recorded. Forces of nine muscles were calculated using static optimization and a minimum fatigue criterion. Relationships (i) (RF EMG-HA EMG) vs (knee moment hip moment) and (ii) GA EMG vs. (ankle moment knee moment) were closely related (coefficients of determination were typically 0.9 and higher). Qualitatively similar relationships were predicted by minimizing fatigue. Gastrocnemius and hamstrings had the agonistic action at both joints they cross during load lifting, and their activation and predicted forces increased with increasing flexion knee moments and extension ankle and hip moments. The rectus femoris typically had the antagonistic action at the knee and hip, and its activation and predicted force were low. Patterns of predicted muscle forces were qualitatively similar to the corresponding EMG envelopes (except in phases of low joint moments where accuracy of determining joint moments was presumably poor). It was suggested that muscle coordination in load lifting is consistent with the strategy of minimum muscle fatigue.

Ankle Joint↗