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Published in: Journal of Orthopaedic Surgery and Research 1/2009

Open Access 01-12-2009 | Research article

Effect of cross exercise on quadriceps acceleration reaction time and subjective scores (Lysholm questionnaire) following anterior cruciate ligament reconstruction

Authors: Maria G Papandreou, Evdokia V Billis, Emmanouel M Antonogiannakis, Nikos A Papaioannou

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2009

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Abstract

Background

Anterior cruciate ligament (ACL) injury or reconstruction can cause knee impairments and disability. Knee impairments are related to quadriceps performance – accelerated reaction time (ART) – and disability to performance of daily living activities which is assessed by questionnaires such as the Lysholm knee score. The purposes of this study were to investigate the effect of cross exercise, as supplementary rehabilitation to the early phase of ACL reconstruction: a) on quadriceps ART at the angles 45°, 60° and 90° of knee flexion and, b) on the subjective scores of disability in ACL reconstructed patients.

Methods

42 patients who underwent ACL reconstruction were randomly divided into 3 groups, two experimental and one control. All groups followed the same rehabilitation program. The experimental groups followed 8 weeks of cross eccentric exercise (CEE) on the uninjured knee; 3 d/w, and 5 d/w respectively.
Quadriceps ART was measured at 45°, 60° and 90° of knee flexion pre and nine weeks post-operatively using an isokinetic dynamometer. Patients also completed pre and post operatively the Lysholm questionnaire whereby subjective scores were recorded.

Results

Two factor ANOVA showed significant differences in ART at 90° among the groups (F = 4.29, p = 0.02, p < 0.05). Post hoc Tukey HSD analysis determined that the significant results arose from the first experimental group in comparison to the control (D = -0.83, p = 0.01). No significant differences were revealed at 45° and 60°.
Significant differences were also found in the Lysholm score among the groups (F = 4.75, p = 0.01, p < 0.05). Post hoc analysis determined that the above significant results arose from the first experimental group in comparison with the control (D = 7.5, p < 0.01) and from the second experimental in comparison with the control (D = 3.78, p = 0.03).

Conclusion

CEE showed improvements on quadriceps ART at 90° at a sequence of 3 d/w and in the Lysholm score at a sequence of 3 d/w and 5 d/w respectively on ACL reconstructed patients.
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Literature
1.
go back to reference McHuge PM, Tyler FT, Glein WG, Nicholas JS: Preoperative indicators of motion loss and weakness following anterior cruciate ligament reconstruction. JOSPT. 1998, 27: 407-411.CrossRef McHuge PM, Tyler FT, Glein WG, Nicholas JS: Preoperative indicators of motion loss and weakness following anterior cruciate ligament reconstruction. JOSPT. 1998, 27: 407-411.CrossRef
2.
go back to reference Lephart MS, Perrin HD, Fu HF, Gieck HJ, McCue CF, Irrgang JJ: Relationship between selected physical characteristics and functional capacity in the anterior cruciate ligament insufficient athlete. JOSPT. 1992, 16: 174-181.CrossRefPubMed Lephart MS, Perrin HD, Fu HF, Gieck HJ, McCue CF, Irrgang JJ: Relationship between selected physical characteristics and functional capacity in the anterior cruciate ligament insufficient athlete. JOSPT. 1992, 16: 174-181.CrossRefPubMed
3.
go back to reference Risberg AM, Holm I, Tjomsland O, Ljunggren E, Ekeland A: Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. JOSPT. 1999, 29: 400-412.CrossRefPubMed Risberg AM, Holm I, Tjomsland O, Ljunggren E, Ekeland A: Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. JOSPT. 1999, 29: 400-412.CrossRefPubMed
4.
go back to reference Tegner Y, Lyshom J: Rating systems in the evaluation of knee ligament injuries. Cl Orth and Rel Res. 1985, 198: 43-49. Tegner Y, Lyshom J: Rating systems in the evaluation of knee ligament injuries. Cl Orth and Rel Res. 1985, 198: 43-49.
5.
go back to reference Keays SL, Bullock-Saxton J, Keays AC: Strength and function before and after anterior cruciate ligament reconstruction. Clin Orth and Rel Res. 2000, 373: 174-183. 10.1097/00003086-200004000-00021.CrossRef Keays SL, Bullock-Saxton J, Keays AC: Strength and function before and after anterior cruciate ligament reconstruction. Clin Orth and Rel Res. 2000, 373: 174-183. 10.1097/00003086-200004000-00021.CrossRef
6.
go back to reference Konishi Y, Fucubayashi T, Takeshita D: Possible mechanism of quadriceps femoris weakness in patients with ruprured anterior cruciate ligament. Med and Science in Sports and Ex. 2002, 34: 1414-1418. 10.1097/00005768-200209000-00003.CrossRef Konishi Y, Fucubayashi T, Takeshita D: Possible mechanism of quadriceps femoris weakness in patients with ruprured anterior cruciate ligament. Med and Science in Sports and Ex. 2002, 34: 1414-1418. 10.1097/00005768-200209000-00003.CrossRef
7.
go back to reference Snyder-Mackler L, De Luca P, Williams PW, Eastlack EM, Bartolozzi RA: Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament. The J of Bone and Joint Surg. 1994, 76-A: 555-560. Snyder-Mackler L, De Luca P, Williams PW, Eastlack EM, Bartolozzi RA: Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament. The J of Bone and Joint Surg. 1994, 76-A: 555-560.
8.
go back to reference Arangio G, Chen C, Kalady M: Thigh muscle size and strength anterior cruciate ligament reconstruction and rehabilitation. JOSPT. 1997, 26: 238-243.CrossRefPubMed Arangio G, Chen C, Kalady M: Thigh muscle size and strength anterior cruciate ligament reconstruction and rehabilitation. JOSPT. 1997, 26: 238-243.CrossRefPubMed
9.
go back to reference Suter E, Herzog W: Extent of muscle inhibition as a function of knee angle. J of Electromyography and Kinesiology. 1996, 7: 123-130. 10.1016/S1050-6411(96)00028-4.CrossRef Suter E, Herzog W: Extent of muscle inhibition as a function of knee angle. J of Electromyography and Kinesiology. 1996, 7: 123-130. 10.1016/S1050-6411(96)00028-4.CrossRef
10.
go back to reference Aune A, Cawley P, Ekeland A: Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation. The Am J of Sports Med. 1997, 25: 187-190. 10.1177/036354659702500208.CrossRef Aune A, Cawley P, Ekeland A: Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation. The Am J of Sports Med. 1997, 25: 187-190. 10.1177/036354659702500208.CrossRef
11.
go back to reference Beynnon D, Fleming C, Johnson J: Anterior cruciate ligament strain behaviour during rehabilitation exercise in vivo. Am J of Sports Med. 1995, 23: 24-34. 10.1177/036354659502300105.CrossRef Beynnon D, Fleming C, Johnson J: Anterior cruciate ligament strain behaviour during rehabilitation exercise in vivo. Am J of Sports Med. 1995, 23: 24-34. 10.1177/036354659502300105.CrossRef
12.
go back to reference Dienst M, Burks R, Greis P: Anatomy and biomechanics of the anterior cruciate ligament. Orth Clin of North Am. 2002, 33: 605-660. 10.1016/S0030-5898(02)00010-X.CrossRef Dienst M, Burks R, Greis P: Anatomy and biomechanics of the anterior cruciate ligament. Orth Clin of North Am. 2002, 33: 605-660. 10.1016/S0030-5898(02)00010-X.CrossRef
13.
go back to reference Durselen L, Claes L, Liefer H: The influence of muscle forces and external loads on cruciate ligament strain. Am J of Sports Med. 1995, 23: 129-136. 10.1177/036354659502300122.CrossRef Durselen L, Claes L, Liefer H: The influence of muscle forces and external loads on cruciate ligament strain. Am J of Sports Med. 1995, 23: 129-136. 10.1177/036354659502300122.CrossRef
14.
go back to reference Fleming D, Renstrom a, Beynnon D: The effect of weight bearing and external loading on anterior cruciate ligament strain. J of Biom. 2001, 34: 163-170. 10.1016/S0021-9290(00)00154-8.CrossRef Fleming D, Renstrom a, Beynnon D: The effect of weight bearing and external loading on anterior cruciate ligament strain. J of Biom. 2001, 34: 163-170. 10.1016/S0021-9290(00)00154-8.CrossRef
15.
go back to reference LoPesti C, Kirkendall T, Street M: Quadriceps insufficiency following repair of the anterior cruciate ligament. JOSPT. 1988, 9: 245-249.CrossRef LoPesti C, Kirkendall T, Street M: Quadriceps insufficiency following repair of the anterior cruciate ligament. JOSPT. 1988, 9: 245-249.CrossRef
16.
go back to reference Beynnon D, Uh S, Johnson J: Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J of Sports Med. 2005, 33: 347-359. 10.1177/0363546504268406.CrossRef Beynnon D, Uh S, Johnson J: Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J of Sports Med. 2005, 33: 347-359. 10.1177/0363546504268406.CrossRef
17.
go back to reference Zhou S: Chronic neural adaptations to unilateral exercise: Mechanisms of cross education. Ex Sports Science Review. 2000, 4: 177-184. Zhou S: Chronic neural adaptations to unilateral exercise: Mechanisms of cross education. Ex Sports Science Review. 2000, 4: 177-184.
18.
go back to reference Kristeva R, Cheyne D, Deecke L: Neuromagnetic fields accompanying unilateral and bilateral voluntary movement topography and analysis of cortical sources. Electroencephalography and Cl Neurophysiology. 1991, 81: 284-298. 10.1016/0168-5597(91)90015-P.CrossRef Kristeva R, Cheyne D, Deecke L: Neuromagnetic fields accompanying unilateral and bilateral voluntary movement topography and analysis of cortical sources. Electroencephalography and Cl Neurophysiology. 1991, 81: 284-298. 10.1016/0168-5597(91)90015-P.CrossRef
19.
go back to reference Hortobagyi T, Lambert J, Hill P: Greater cross education following training with muscle lengthening than shortening. Med and Science in Sports and Ex. 1997, 29: 107-112.CrossRef Hortobagyi T, Lambert J, Hill P: Greater cross education following training with muscle lengthening than shortening. Med and Science in Sports and Ex. 1997, 29: 107-112.CrossRef
20.
go back to reference Housh TJ, Housh DJ, Weir JP, Weir LL: Effects of eccentric only resistance training and detraining. Int J of Sports Med. 1996, 17: 145-148. 10.1055/s-2007-972823.CrossRef Housh TJ, Housh DJ, Weir JP, Weir LL: Effects of eccentric only resistance training and detraining. Int J of Sports Med. 1996, 17: 145-148. 10.1055/s-2007-972823.CrossRef
21.
go back to reference Weir JP, Housh DJ, Housh TJ, Weir LL: The effect of unilateral concentric weight training and detraining on joint angle specificity, cross training, and the bilateral deficit. JOSPT. 1997, 25: 264-270.CrossRefPubMed Weir JP, Housh DJ, Housh TJ, Weir LL: The effect of unilateral concentric weight training and detraining on joint angle specificity, cross training, and the bilateral deficit. JOSPT. 1997, 25: 264-270.CrossRefPubMed
22.
go back to reference Weir JP, Housh JD, Housh JT, Weir LL: The effect of unilateral eccentric weight training and detraining on joint angle specificity, cross training, and the bilateral deficit. JOSPT. 1995, 22: 207-215.CrossRefPubMed Weir JP, Housh JD, Housh JT, Weir LL: The effect of unilateral eccentric weight training and detraining on joint angle specificity, cross training, and the bilateral deficit. JOSPT. 1995, 22: 207-215.CrossRefPubMed
23.
go back to reference Weir JP, Housh TJ, Weir LL, Johnson OG: Effects of unilateral isometric strength training on joint angle specificity and cross education. Eur J of Applied Phys. 1995, 70: 337-343. 10.1007/BF00865031.CrossRef Weir JP, Housh TJ, Weir LL, Johnson OG: Effects of unilateral isometric strength training on joint angle specificity and cross education. Eur J of Applied Phys. 1995, 70: 337-343. 10.1007/BF00865031.CrossRef
24.
go back to reference Hortobagyi T, Barrier J, Beard D, Braspennincx J, Koens P, Devita P, Dempsey L, Lambert J: Greater initial adaptations to submaximal muscle lengthening than maximal shortening. J of Applied Phys. 1996, 81: 1677-1682. Hortobagyi T, Barrier J, Beard D, Braspennincx J, Koens P, Devita P, Dempsey L, Lambert J: Greater initial adaptations to submaximal muscle lengthening than maximal shortening. J of Applied Phys. 1996, 81: 1677-1682.
25.
go back to reference Hortobagyi T, Hill J, Houmard J: Adaptive responses to muscle lenghtening and shortening in humans. J of Applied Phys. 1996, 80: 765-772. Hortobagyi T, Hill J, Houmard J: Adaptive responses to muscle lenghtening and shortening in humans. J of Applied Phys. 1996, 80: 765-772.
26.
go back to reference Hortobagyi T, Scott K, Lambert J, Hamilton G, Tracy J: Cross education of muscle strength is greater with stimulated than voluntary contractions. Motor Control. 1999, 3: 205-219.PubMed Hortobagyi T, Scott K, Lambert J, Hamilton G, Tracy J: Cross education of muscle strength is greater with stimulated than voluntary contractions. Motor Control. 1999, 3: 205-219.PubMed
27.
go back to reference LaStayo CP, Woolf MJ, Lewek DM, Snyder-Mackler L, Reich T, Lindstedt LS: Eccentric muscle contractions: Their contribution to injury, prevention, rehabilitation and sport. JOSPT. 2003, 33: 557-571. 10.1016/S8756-3282(03)00249-7.CrossRefPubMed LaStayo CP, Woolf MJ, Lewek DM, Snyder-Mackler L, Reich T, Lindstedt LS: Eccentric muscle contractions: Their contribution to injury, prevention, rehabilitation and sport. JOSPT. 2003, 33: 557-571. 10.1016/S8756-3282(03)00249-7.CrossRefPubMed
28.
go back to reference Papandreou M, Papaioannou N, Antonogiannakis E, Zeeris H: The effect of cross exercise on quadriceps strength in different knee angles after the anterior cruciate ligament reconstruction. Br J of Biometricity. 2007, 1: 123-137. Papandreou M, Papaioannou N, Antonogiannakis E, Zeeris H: The effect of cross exercise on quadriceps strength in different knee angles after the anterior cruciate ligament reconstruction. Br J of Biometricity. 2007, 1: 123-137.
29.
go back to reference Arai M, Shimizu H, Shimizu E: Effects of the use of cross education to the affected side through various resistive exercises of the sound side and settings of the length of the affected muscles. Hir J of Med and Science. 2001, 50: 65-73. Arai M, Shimizu H, Shimizu E: Effects of the use of cross education to the affected side through various resistive exercises of the sound side and settings of the length of the affected muscles. Hir J of Med and Science. 2001, 50: 65-73.
31.
go back to reference Shelbourne D, Foulk A: Timing of surgery in acute ACL ligament tears on the return of quadriceps muscle strength after reconstruction using an autogenous patellar tendon graft. The Am J of Sports Med. 1995, 23: 686-689. 10.1177/036354659502300609.CrossRef Shelbourne D, Foulk A: Timing of surgery in acute ACL ligament tears on the return of quadriceps muscle strength after reconstruction using an autogenous patellar tendon graft. The Am J of Sports Med. 1995, 23: 686-689. 10.1177/036354659502300609.CrossRef
32.
go back to reference Wasilewski A, Covall J, Cohen S: Effect of surgical timing on recovery and associated injuries after ACL ligament reconstruction. The Am J of Sports Med. 1993, 21: 38-342.CrossRef Wasilewski A, Covall J, Cohen S: Effect of surgical timing on recovery and associated injuries after ACL ligament reconstruction. The Am J of Sports Med. 1993, 21: 38-342.CrossRef
33.
go back to reference Karlson J, Steiner M, Brown C: Anterior cruciate ligament reconstruction using gracilis and semitendinodus tendons. JOSPT. 1994, 22: 659-666. Karlson J, Steiner M, Brown C: Anterior cruciate ligament reconstruction using gracilis and semitendinodus tendons. JOSPT. 1994, 22: 659-666.
34.
go back to reference Wilk EK, Reinold MM, Hooks RT: Recent advances in the rehabilitation of isolated and combined anterior cruciate ligaments injuries. Orth Cl of North Am. 2003, 34: 107-137. 10.1016/S0030-5898(02)00064-0.CrossRef Wilk EK, Reinold MM, Hooks RT: Recent advances in the rehabilitation of isolated and combined anterior cruciate ligaments injuries. Orth Cl of North Am. 2003, 34: 107-137. 10.1016/S0030-5898(02)00064-0.CrossRef
35.
go back to reference Majima T, Yasuda K, Tago H, Tanabe Y, Minami A: Rehabilitation after hamstring anterior cruciate ligament reconstruction. Cl Orth and Rel Res. 2002, 397: 370-380. 10.1097/00003086-200204000-00043.CrossRef Majima T, Yasuda K, Tago H, Tanabe Y, Minami A: Rehabilitation after hamstring anterior cruciate ligament reconstruction. Cl Orth and Rel Res. 2002, 397: 370-380. 10.1097/00003086-200204000-00043.CrossRef
36.
go back to reference Morrissey CM, Harman AE, Johnson JM: Resistance training modes: specificity and effectiveness. Med and Science in Sports and Exerc. 1995, 27: 648-660.CrossRef Morrissey CM, Harman AE, Johnson JM: Resistance training modes: specificity and effectiveness. Med and Science in Sports and Exerc. 1995, 27: 648-660.CrossRef
37.
go back to reference Ploutz LL, Tesch PE, Biro L, Gary ED: Effect of resistance training on muscle use during exercise. J of Applied Phys. 1994, 76: 1675-1681. Ploutz LL, Tesch PE, Biro L, Gary ED: Effect of resistance training on muscle use during exercise. J of Applied Phys. 1994, 76: 1675-1681.
38.
go back to reference Pincivero M, Lephart M, Karunakara A: Reliability and precision of isokinetic strength and muscular endurance of the quadriceps and hamstrings. Intern J of Sports Med. 1997, 18: 113-117. 10.1055/s-2007-972605.CrossRef Pincivero M, Lephart M, Karunakara A: Reliability and precision of isokinetic strength and muscular endurance of the quadriceps and hamstrings. Intern J of Sports Med. 1997, 18: 113-117. 10.1055/s-2007-972605.CrossRef
39.
go back to reference Pavone E, Moffat M: Isometric torque of the quadriceps femoris after concentric, eccentric and isometric training. Arch of Phys Med and Rehab. 1985, 66: 168-170. Pavone E, Moffat M: Isometric torque of the quadriceps femoris after concentric, eccentric and isometric training. Arch of Phys Med and Rehab. 1985, 66: 168-170.
40.
go back to reference Williams NG, Taylor CD, Gangel JT, Uhorchak MJ, Arciero AR: Comparison of the single assessment numeric evaluation method and the Lyshom score. Clin Orth and Rel Res. 1999, 373: 184-192. 10.1097/00003086-200004000-00022.CrossRef Williams NG, Taylor CD, Gangel JT, Uhorchak MJ, Arciero AR: Comparison of the single assessment numeric evaluation method and the Lyshom score. Clin Orth and Rel Res. 1999, 373: 184-192. 10.1097/00003086-200004000-00022.CrossRef
41.
go back to reference ACSM Position Stand: Recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med and Science in Sports and Exerc. 1998, 30: 975-991. 10.1097/00005768-199806000-00032.CrossRef ACSM Position Stand: Recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med and Science in Sports and Exerc. 1998, 30: 975-991. 10.1097/00005768-199806000-00032.CrossRef
Metadata
Title
Effect of cross exercise on quadriceps acceleration reaction time and subjective scores (Lysholm questionnaire) following anterior cruciate ligament reconstruction
Authors
Maria G Papandreou
Evdokia V Billis
Emmanouel M Antonogiannakis
Nikos A Papaioannou
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2009
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-4-2

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