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Anterior cruciate ligament reconstruction improves subjective ability but not neuromuscular biomechanics during dynamic tasks

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to identify high-functioning anterior cruciate ligament-deficient patients and assess the effects of reconstruction on their self-reported functionality, muscle activations and biomechanical properties.

Methods

Twenty young and active patients participated pre- (11.5 ± 14.3 months post-injury) and again 10.5 ± 1.7 months post-reconstruction and were individually matched to 20 healthy controls. Participants completed hop and side cut movements while patient-related outcome measures, lower limb electromyography, kinetic, and whole body kinematic data were collected. One-dimensional statistical parametric mapping was used to test for group differences (healthy vs deficient; deficient vs reconstructed; reconstructed vs healthy).

Results

When comparing healthy to anterior cruciate ligament-deficient participants, all questionnaires indicated significant lower subjective function while the only substantial biomechanical difference between these participants was a decreased knee extensor moment in both the hop (peak difference: 0.63 Nm/kg, p < 0.001) and side cut (peak difference: 0.76 Nm/kg, p < 0.001). When comparing patients’ pre- and post-reconstruction, no biomechanical differences were observed whereas only half of the questionnaires (Tegner, Lysholm, KNEES-ADL, KNEES-Slackness, KNEES-Looseness, KNEES-Sport Behaviour, IKDC, and KOOS-QoL) indicated higher function in the reconstructed state. When comparing the reconstructed patients to the healthy participants, all questionnaires were still significantly higher in the healthy controls. The reconstructed group also had a smaller flexion angle (peak difference: 14.5°, p = 0.007) and knee extensor moment (peak difference: 0.62 Nm/kg, p < 0.001) during the hop and a smaller knee extensor moment (peak difference: 0.90 Nm/kg, p < 0.001) during the side-cut task.

Conclusion

At 10-months post-reconstruction, the current results indicate that in high-functioning anterior cruciate ligament-deficient patients, reconstruction had little impact on objective measures of functional ability during dynamic tasks although self-reported function was improved.

Level of evidence

Therapeutic prospective cohort study, Level II.

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Acknowledgements

The authors would like to thank Ida Fillingnes for her contributions in data collection.

Funding

They would also like to thank the Natural Science and Engineering Research Council for their financial support in the form of a student grant to K.B.S. as well as the Åse and Ejnar Danielsens Fund, the Danish Rheumatism Association, and the Lundbeck Foundation for their financial support in the form of operating grants.

Author information

Authors and Affiliations

  1. School of Human Kinetics, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada

    Kenneth B. Smale & Daniel L. Benoit

  2. School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada

    Teresa E. Flaxman & Daniel L. Benoit

  3. Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark

    Tine Alkjaer & Erik B. Simonsen

  4. Section for Sports Traumatology M51 (a part of IOC Sports Medicine Copenhagen), Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark

    Michael R. Krogsgaard

Authors
  1. Kenneth B. Smale
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  2. Teresa E. Flaxman
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  4. Erik B. Simonsen
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  6. Daniel L. Benoit
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Corresponding author

Correspondence to Daniel L. Benoit.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

This study was approved by the Capital Region of Denmark (H-3-2013-126) and University of Ottawa ethics committees (H06-14-27).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Figure 1

. Flowchart detailing participant compliance and ability to complete hop (H) and side cut (SC) tasks. M – Males; F – Females; ACL-D – Anterior cruciate ligament deficient; ACL-R – anterior cruciate ligament reconstructed. (PNG 118 KB)

Supplementary Figure 2

. Ground reaction forces for the A) hop and B) side cut. Black vertical land indicates initial contact while blue horizontal bar indicates significant (p < 0.05) difference between the healthy (UNINJ) and ACL reconstructed (ACL-R) groups. ACL-D – Anterior cruciate ligament deficient. (PNG 235 KB)

Supplementary Table 1

. Summary of the 20-week standardized rehabilitation program undergone by all ACL-R patients. (DOCX 13 KB)

Supplementary Table 2

. Comparison of subjective scores in low-functioning patients (those who were not willing to complete either hop (H) or side cut (SC) tasks in either of the ACL deficient (ACL-D) or reconstructed (ACL-R) state) and high-functioning patients (those willing to complete either H or SC tasks in both ACL states). * indicates trend towards significance (0.05 < p < 0.1) between low-functioning and those able to complete H. ** indicates significance (p < 0.05) between low-functioning and those able to complete H. † indicates trend towards significance (0.05 < p < 0.1) between low-functioning and those able to complete SC. †† indicates significance (p < 0.05) between low-functioning and those able to complete SC. (DOCX 14 KB)

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Smale, K.B., Flaxman, T.E., Alkjaer, T. et al. Anterior cruciate ligament reconstruction improves subjective ability but not neuromuscular biomechanics during dynamic tasks. Knee Surg Sports Traumatol Arthrosc 27, 636–645 (2019). https://doi.org/10.1007/s00167-018-5189-7

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