The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Comparing Changes in Knee Muscle Strength after Reconstruction of the Anterior and Posterior Cruciate Ligaments

  • Hyun, SangWook (Department of Physical Therapy, Daegu Health College Hospital) ;
  • Kim, SoHee (Department of Physical Therapy, Daegu Dalgubeol General Welfare Center) ;
  • Kim, TaeHo (Department of Physical Therapy, College of Rehabilitation Science, Daegu University)
  • Received : 2019.11.04
  • Accepted : 2019.12.10
  • Published : 2019.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to identify changes in knee muscle strength after reconstruction of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Methods: Thirteen subjects (males) with anterior ligament injury and ten subjects (males) with posterior ligament injury voluntarily participated in this study. Both groups were evaluated at the pre-and post-reconstruction stages using an isokinetic dynamometer. Peak torque, total work, and the hamstrings to quadriceps (H/Q) peak torque ratio were calculated at angular velocities of 60°/sec and 180°/sec. Statistical analysis was conducted on SPSS 18.0 for Windows using t-tests to compare mean differences. Results: At an angular velocity of 60°/sec, both the ACL and PCL groups showed a significant increase in muscle strength in the flexors and extensors. Muscle strength in the extensors was significantly increased in the PCL group compared to the ACL group. At an angular velocity of 180°/sec, the ACL group showed a significant increase in muscle endurance in the flexors and extensors, and the PCL group showed a significant increase in muscle endurance in the flexors. At angular velocities of 60°/sec and 180°/sec, the H/Q peak torque ratio increased in the ACL group but decreased in the PCL group. Consequently, the H/Q peak torque ratio was significantly different for the two groups. Conclusion: The results suggest that the patients with ACL injury should focus on strengthening the knee extensors and that the patients with PCL injury need to strengthen the knee flexors.

Keywords

References

  1. Kim DK. The effect of pre-operative exercise training program on laxity and proprioception and knee strength after ACL reconstruction. Sungkyunkwan University. Dissertation of Doctorate Degree. 2008.
  2. Park JT. Effects of the application pre-operative rehabilitation program on isokinetic muscle strength and functional performance after ACL reconstruction. Korea University. Dissertation of Master's Degree. 2018.
  3. Lee SJ. Effects of accelerated rehabilitation exercise on femoral muscle strength and dynamic balance stability in patients after ACL and PCL reconstruction. Kunsan National University. Dissertation of Doctorate Degree. 2018.
  4. Machado F, Debieux P, Kaleka CC et al. Knee isokinetic performance following anterior cruciate ligament reconstruction: patellar tendon versus hamstrings graft. Phys Sportsmed. 2018;46(1):30-5. https://doi.org/10.1080/00913847.2018.1418592
  5. van Melick N, van Cingel RE, Brooijmans F et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50(24):1506-15. https://doi.org/10.1136/bjsports-2015-095898
  6. Acevedo RJ, Rivera-Vega A, Miranda G et al. Anterior cruciate ligament injury: identification of risk factors and prevention strategies. Curr Sports Med Rep. 2014;13(3):186-91. https://doi.org/10.1249/JSR.0000000000000053
  7. Wind WM Jr, Bergfeld JA, Parker RD. Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med. 2004;32(7): 1765-75. https://doi.org/10.1177/0363546504270481
  8. Fukubayashi T, Torzilli PA, Sherman MF et al. An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Joint Surg Am. 1982;64(2):258-64. https://doi.org/10.2106/00004623-198264020-00018
  9. Harner CD, Xerogeanes JW, Livesay GA et al. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995;23(6):736-45. https://doi.org/10.1177/036354659502300617
  10. Hughston JC, Andrews JR, Cross MJ et al. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976;58(2):159-72. https://doi.org/10.2106/00004623-197658020-00001
  11. Boden BP, Sheehan FT, Torg JS et al. Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg. 2010;18(9):520-7. https://doi.org/10.5435/00124635-201009000-00003
  12. Olsen OE, Mtklebust G, Engerbretsen L et al. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. 2004;32(4):1002-12. https://doi.org/10.1177/0363546503261724
  13. Boden BP, Dean GS, Feagin JA et al. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23(6):573-8. https://doi.org/10.3928/0147-7447-20000601-15
  14. Schulz MS, Russe K, Weiler A et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003;123(4):186-91. https://doi.org/10.1007/s00402-002-0471-y
  15. McAllister DR, Petrigliano FA. Diagnosis and treatment of posterior cruciate ligament injuries. Curr Sports Med Rep. 2007;6(5):293-9. https://doi.org/10.1097/01.CSMR.0000306491.23153.08
  16. Fowler PJ, Messieh SS. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. 1987;15(6):553-7. https://doi.org/10.1177/036354658701500606
  17. Kannus P, Bergfeld J, Jarvinen M et al. Injuries to the posterior cruciate ligament of the knee. Sports Med. 1991;12(2):110-31. https://doi.org/10.2165/00007256-199112020-00004
  18. Beynnon BD, Johnson RJ, Abate JA et al. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33(11):1751-67. https://doi.org/10.1177/0363546505279922
  19. Beynnon BD, Johnson RJ, Abate JA et al. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005;33(10):1579-602. https://doi.org/10.1177/0363546505279913
  20. Grindem H, Snyder-Mackler L, Moksnes H et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-8. https://doi.org/10.1136/bjsports-2016-096031
  21. Huber R, Viecelli C, Bizzini M et al. Knee extensor and flexor strength before and after anterior cruciate ligament reconstruction in a large sample of patients: influence of graft type. Phys Sportsmed. 2019;47(1): 85-90. https://doi.org/10.1080/00913847.2018.1526627
  22. Shim JK, Choi HS. Effects of sensorimotor training volume om recovery of knee joint stability in patients following anterior cruciate ligament reconstruction. J Kor Phys Ther. 2016;28(1):27-32. https://doi.org/10.18857/jkpt.2016.28.1.27
  23. Janousek AT, Jones DG, Clatworthy M et al. Posterior cruciate ligament injuries of the knee joint. Sports Med. 1999;28(6):429-41. https://doi.org/10.2165/00007256-199928060-00005
  24. Beynnon BD, Johnson RJ. Anterior cruciate ligament injury rehabilitation in athletes. Biomechanical considerations. Sports Med. 1996;22(1): 54-64. https://doi.org/10.2165/00007256-199622010-00005
  25. Schuttler KF, Ziring E, Ruchholtz S et al. Posterior cruciate ligament injuries. Unfallchirurg. 2017;120(1):55-68. https://doi.org/10.1007/s00113-016-0292-z
  26. Senese M, Greenberg E, Todd Lawrence J et al. Rehabilitation following isolated posterior cruciate ligament reconstruction: a literature review of published protocols. Int J Sports Phys Ther. 2018;13(4):737-51. https://doi.org/10.26603/ijspt20180737
  27. Best R, Begg R. A method for calculating the probability of tripping while walking. J Biomech. 2008;41(5):1147-51. https://doi.org/10.1016/j.jbiomech.2007.11.023
  28. Simonsen EB, Dyhre-Poulsen P, Voigt M et al. Bone-on-bone forces during loaded and unloaded walking. Acta Anat (Basel). 1995;152(2): 133-42. https://doi.org/10.1159/000147692
  29. Lim HW. Evidence-based physical therapy for anterior cruciate ligament injury: literature review. J Kor Phys Ther 2019:31(4):161-168. https://doi.org/10.18857/jkpt.2019.31.4.161
  30. Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait Posture. 1999;9(3):207-31. https://doi.org/10.1016/S0966-6362(99)00009-0
  31. Cromwell RL, Aadland-Monahan TK, Nelson AT et al. Sagittal plane analysis of head, neck, and trunk kinematics and electromyographic activity during locomotion. J Orthop Sports Phys Ther. 2001;31(5):255-62. https://doi.org/10.2519/jospt.2001.31.5.255
  32. Ortega JD, Farley CT. Minimizing center of mass vertical movement increases metabolic cost in walking. J Appl Physiol. 2005;99(6):2099-107. https://doi.org/10.1152/japplphysiol.00103.2005
  33. Petrie RS, Harner CD. Evaluation and management of the posterior cruciate injured knee. Operative Techniques in Sports Medicine. 1999;7(3): 93-103. https://doi.org/10.1016/S1060-1872(99)80003-3
  34. Kim HM. Comparison of functional recovery after rehabilitation exercise between isolated PCL and combined PLC reconstruction. Dankook University. Dissertation of Master's Degree. 2016.
  35. Margheritini F, Rihn J, Musahl V et al. Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review. Sports Med. 2002;32(6):393-408. https://doi.org/10.2165/00007256-200232060-00004
  36. Bin SI, Cho WS, Moon HS et al. Cybex evaluation of muscle strength following arthroscopic anterior cruciate ligament reconstruction. J Korean Orthop Assoc. 1995;30(2):262-8. https://doi.org/10.4055/jkoa.1995.30.2.262
  37. Andrade Mdos S, De Lira CA, Koffes Fde C et al. Isokinetic hamstrings-to-quadriceps peak torque ratio: the influence of sport modality, gender, and angular velocity. J Sports Sci. 2012;30(6):547-53. https://doi.org/10.1080/02640414.2011.644249
  38. Huegel M, Indelicato PA. Trends in rehabilitation following anterior cruciate ligament reconstruction. Clin Sports Med. 1988;7(4):801-11. https://doi.org/10.1016/S0278-5919(20)30886-3