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Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction (ACLR). The purpose of this retrospective research study was to investigate the effects of ISGA ACLR on neuromuscular and biomechanical performance during a single-leg vertical drop landing (VDL), a functional task and associated mechanism of anterior cruciate ligament disruption during physical activity. Fourteen physically active participants 22.5 ± 4.1 years of age and 21.4 ± 10.7 months post ISGA ACLR underwent bilateral neuromuscular, biomechanical and isokinetic strength and endurance evaluations matched to 14 control participants by sex, age, height and mass. Kinetic and kinematic data was obtained with 3-D motion analyses utilizing inverse dynamics while performing single-leg VDLs from a height of 30 cm. Integrated surface electromyography (SEMG) assessments of the quadriceps, hamstrings and gastrocnemius musculature were also conducted. Additionally, knee joint flexion strength (60° s−1) and endurance (240° s−1) measurements were tested via isokinetic dynamometry. No significant differences existed in hip and net summated extensor moments within or between groups. The ISGA ACLR participants recorded significantly decreased peak vertical ground reaction force (VGRF) landing upon the involved lower extremity compared to uninvolved (P = 0.028) and matched (P < 0.0001) controls. Participants having undergone ISGA ACLR also displayed greater peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.020) and matched (P = 0.026) controls at initial ground contact. The ISGA ACLR group furthermore exhibited increased peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.019) and matched (P = 0.007) controls at peak VGRF. Moreover, ISGA ALCR participants demonstrated greater peak knee (P = 0.005) and ankle (P = 0.017) joint flexion angles when landing upon the involved lower extremity compared to the matched control at peak VGRF. The ISGA ACLR group produced significantly greater reactive muscle activation of the vastus medialis (P = 0.013), vastus lateralis (P = 0.008) and medial hamstrings (P = 0.024) in the involved lower extremity compared to the matched control. The ISGA ACLR participants also exhibited greater preparatory (P = 0.033) and reactive (P = 0.022) co-contraction muscle activity of the quadriceps and hamstrings landing upon the involved lower extremity compared to the matched control. In addition, the ISGA ACLR group produced significantly less preparatory (P = 0.005) and reactive (P = 0.010) muscle activation of the gastrocnemius in the involved lower extremity compared to the uninvolved control. No significant differences were present in hamstrings muscular strength and endurance. Harvest of the ISGA for purposes of ACLR does not appear to result in significant neuromuscular, biomechanical or strength and endurance deficiencies due to donor site morbidity. However, it is evident that this specific population exhibits unique neuromuscular and biomechanical adaptations aimed to stabilize the knee previously subjected to ACL trauma and safeguard the ISGA ACLR joint. Co-contraction of quadriceps and hamstrings as well as inhibition of gastrocnemius muscle activation may serve to moderate excessive loads exposed to the intra-articular ISGA during single-leg VDLs. Furthermore, greater muscle activation of the hamstrings in conjunction with increased peak hip, knee and ankle joint flexion angles may assist in enhancing acceptance of VGRF transferred through the kinetic chain following single-leg VDLs.

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Acknowledgments

This study was funded by the National Athletic Trainers’ Association Research and Education Foundation Osternig Masters Grant 310MGP002. The authors thank Drs. James J Irrgang and Jay N Hertel for collaborating with this research study. The authors also express gratitude to Drs. David A Stone, Hussein A Elkousy as well as Mr Robert O Blanc and Buddy Morris for consultation, service and support. Experiments conducted in this research study complied with all current laws of the United States of America.

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Authors and Affiliations

  1. Department of Kinesiology, Athletic Training Research Laboratory, College of Health and Human Development, The Pennsylvania State University, 146 Recreation Building, University Park, PA, 16802, USA

    Giampietro L. Vairo

  2. Department of Exercise and Sports Science, College of Arts and Sciences, The University of North Carolina at Chapel Hill, 305 Woollen Gym, Chapel Hill, NC, 27599-8605, USA

    Joseph B. Myers

  3. Departments of Sports Medicine and Nutrition, Orthopaedic Surgery, Schools of Health and Rehabilitation Sciences, Medicine, University of Pittsburgh, UPMC Center for Sports Medicine, Neuromuscular Research Laboratory, 3200 South Water Street, Pittsburgh, PA, 15203, USA

    Timothy C. Sell, Freddie H. Fu, Christopher D. Harner & Scott M. Lephart

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  1. Giampietro L. Vairo
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Correspondence to Giampietro L. Vairo.

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Vairo, G.L., Myers, J.B., Sell, T.C. et al. Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthr 16, 2–14 (2008). https://doi.org/10.1007/s00167-007-0427-4

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  • DOI: https://doi.org/10.1007/s00167-007-0427-4

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