Protracted alterations in muscle activation strategies and knee mechanics in patients after Anterior Cruciate Ligament Reconstruction

  • Julie P. Burland
  • Adam S. Lepley
  • Laura Frechette
  • Lindsey K. LepleyEmail author



Altered quadriceps muscle activity can contribute to reduced ability of the muscle to quickly generate force and appropriately attenuate landing forces, exacerbating poor landing and movement strategies commonly seen after anterior cruciate ligament reconstruction (ACLR). The purpose was to evaluate if electromyographic (EMG) activity and knee biomechanics during a single-limb forward hop task are influenced by a history of ACLR.


Twenty-six individuals with a history of unilateral ACLR (age 20.2 ± 2.7 years, height 1.7 ± 0.1 m; weight 69.6 ± 12.4 kg; time from surgery, 2.9 ± 2.7 years; graft type, 21 bone-patellar-tendon bone, 5 hamstring) and 8 healthy controls (age 23.3 ± 1.8 years, height 1.7 ± 0.1 m; mass 66.3 ± 13.9 kg) volunteered. Sagittal plane knee kinetics and EMG of the vastus lateralis were synchronized and measured using a three-dimensional motion analysis system during a single-limb forward hop task. Mixed-effect models were used to assess the effect of group on kinetic and EMG variables.


Kinetic outcomes (peak and rate of knee extension moment) and temporal muscle activity and activation patterns differed between the ACLR limb and healthy-control limb. Inter-limb asymmetries in the ACLR group were observed for all variables except EMG onset time; no limb differences were observed in the healthy cohort.


Years after ACLR, persistent quadriceps functional deficits are present, contributing to altered neuromuscular control strategies during functional tasks that may increase the risk of reinjury. To counteract these effects, emerging evidence indicates that clinicians could consider the use of motor learning strategies to improve neuromuscular control after ACLR.

Level of evidence



Neuromuscular control ACL injury Biomechanics Quadriceps function 



This study was in part supported by the International Society of Biomechanics Student Congress Travel Grant 2019.

Author contributions

JB, AL, and LL are responsible for the design of the study. JB and LF were responsible for all recruitment and data collection procedures. JB, AL, LF and LL participated in the data analysis and interpretation. JB and LL drafted the manuscript. All authors read and approved the final manuscript.


No funding was provided for the completion of this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was agreed by the ethical committee of the institution.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020

Authors and Affiliations

  • Julie P. Burland
    • 1
  • Adam S. Lepley
    • 2
  • Laura Frechette
    • 1
  • Lindsey K. Lepley
    • 3
    Email author
  1. 1.University of ConnecticutStorrsUSA
  2. 2.University of MichiganAnn ArborUSA
  3. 3.University of MichiganAnn ArborUSA

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