Abstract
Purpose
This retrospective study compared the influence of perceived sports involvement on lower extremity neuromuscular adaptations during single-leg countermovement jumping (CMJ), perceived knee function and internal health locus of control (HLOC) scores at a minimum 2-year post-anterior cruciate ligament reconstruction. The hypothesis was that subjects with higher-level sports involvement would display significant differences compared to subjects with lower-level sports involvement.
Methods
Uninvolved and involved lower extremity EMG amplitude (1,000 Hz), vertical ground reaction force (VGRF) (500 Hz) and kinematic (60 Hz) displacement differences were determined during single-leg CMJ. These data and International Knee Documentation Committee subjective knee survey scores, Multidimensional Health Locus of Control Survey internal HLOC subscale scores and sports activity characteristics were compared by sports involvement level.
Results
Subjects that regarded themselves as only sporting sometimes (Group 3, n = 26) had lower IKDC survey and internal HLOC scores, were more likely to decrease sports activities by two intensity levels than highly competitive (Group 1, n = 20) and well-trained/frequently sporting (Group 2, n = 24) subjects, and had greater peak landing VGRF differences suggesting decreased involved lower extremity loading compared to Group 2. During propulsion, Group 1 had greater gluteus maximus (GM) and gastrocnemius (G) EMG differences than Groups 2 and 3. Groups 1 and 2 had decreased vastus medialis (VM) EMG differences during propulsion than Group 3. During landing, Group 1 had greater GM and G EMG differences than Group 3.
Conclusion
Subjects with higher-level sports involvement up-regulated involved lower extremity GM and G activation and down-regulated VM activation. This adaptation may enable continued higher-level sports participation while minimizing knee joint forces. Perceived higher-level sports involvement was related to neuromuscular adaptations, better subjective knee function, a more internal HLOC and higher sports activity intensity.
Level of evidence
Therapeutic case series, Level IV.
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References
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery. Two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 39:538–543
Brewer BW, Van Raalte JL, Linder DE (1993) Athletic identity: hercules’ muscles or Achilles Heel? Int J Sport Psychol 24:237–254
Brougham RR, Zail CM, Mendoza CM, Miller JR (2009) Stress, sex differences, and coping strategies among college students. Current Psychology 28:85–97
Chabris C, Simons D (2009) The invisible gorilla. Random House, New York, pp 185–223
Chan DK, Lonsdale C, Ho PY, Yung PS, Chan KM (2009) Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists’ autonomy support beliefs. Arch Phys Med Rehabil 90:1977–1982
Courtney CA, Rine RM (2006) Central somatosensory changes associated with improved dynamic balance in subjects with anterior cruciate ligament deficiency. Gait Posture 24:190–195
Courtney C, Rine RM, Kroll P (2005) Central somatosensory changes and altered muscle synergies in subjects with anterior cruciate ligament deficiency. Gait Posture 22:69–74
Coventry E, O’Connor KM, Hart BA, Earl JE, Ebersole KT (2006) The effect of lower extremity fatigue on shock attenuation during single-leg landing. Clin Biomech (Bristol, Avon) 21:1090–1097
Davis C, Fox J, Brewer H, Ratusny D (1995) Motivations to exercise as a function of personality characteristics, age, and gender. Pers Individ Dif 19:165–174
Derr J (2006) Valid paired data designs: make full use of data without “double dipping”. J Orthop Sports Phys Ther 36:42–44
Gobbi A, Francisco R (2006) Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc 14:1021–1028
Harreld K, Nyland J, Cottrell B, Caborn D (2006) Self-reported patient outcomes after ACL reconstruction with allograft tissue. Med Sci Sports Exerc 38:2058–2067
Heijne A, Axelsson K, Werner S, Biguet G (2008) Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports 18:325–335
Howells BE, Ardern CL, Webster KE (2011) Is postural control restored following anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc 19:1168–1177
Johansson H, Sjolander P, Sojka P (1991) A sensory role for the cruciate ligaments. Clin Orthop Relat Res 268:161–178
Komi PV, Bosco C (1978) Utilization of stored elastic energy in leg extensor muscles by men and women. Med Sci Sports Exerc 10:261–265
Lazarus RS, Folkman S (1984) Stress, Appraisal, and Coping. Springer Publishing Company, New York
Myer GD, Martin L Jr, Ford KR, Paterno MV, Schmitt LC, Heidt RS Jr, Colosimo A, Hewett TE (2012) No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria. Am J Sports Med 40:2256–2263
Nyland J, Cottrell B, Harreld K, Caborn DNM (2006) Self-reported outcomes after anterior cruciate ligament reconstruction: an internal health locus of control score comparison. Arthroscopy 22:1225–1232
Nyland J, Fisher B, Brand E, Krupp R, Caborn DN (2010) Osseous deficits after anterior cruciate ligament injury and reconstruction: a systematic review with suggestions to improve osseous homeostasis. Arthroscopy 26:1248–1257
Nyland J, Johnson DL, Caborn DN, Brindle T (2002) Internal health status belief and lower perceived functional deficit are related among anterior cruciate ligament-deficient patients. Arthroscopy 18:515–518
Nyland J, Klein S, Caborn DN (2010) Lower extremity compensatory neuromuscular and biomechanical adaptations 2–11 years after anterior cruciate ligament reconstruction. Arthroscopy 26:1212–1225
Ortiz A, Olson S, Trudelle-Jackson E, Rosario M, Venegas HL (2011) Landing mechanics during side hopping and crossover hopping maneuvers in noninjured women and women with anterior cruciate ligament reconstruction. PM R 3:13–20
Paterno MV, Ford KR, Myer GD, Heyl R, Hewett TE (2007) Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clin J Sports Med 17:258–262
Ross MD (2010) The relationship between functional levels and fear-avoidance beliefs following anterior cruciate ligament reconstruction. J Orthopaed Traumatol 11:237–243
Sica GT (2006) Bias in research studies. Radiology 238:780–789
Steptoe A, Wardle J (2001) Locus of control and health behavior revisited: a multivariate analysis of young adults from 18 countries. Brit J Psychol 92:659–672
Sutton AJ, Muir KR, Jones AC (1997) Two knees or one person: data analysis strategies for paired joints or organs. Ann Rheum Dis 56:401–402
Taylor SE, Way BM, Seeman TE (2011) Early adversity and adult health outcomes. Dev Psychopathol 23:939–954
Thing LF (2006) “Voices of the broken body”. The resumption of non-professional female players’ sports careers after anterior cruciate ligament injury. The female players’ sports careers after anterior cruciate ligament injury. The female player’s dilemma: is she willing to run the risk? Scand J Med Sci Sports 16:364–375
Thomee P, Wahrborg P, Borjesson M, Thomee R, Eriksson BI, Karlsson J (2007) Determinants of self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury. J Rehabil Med 39:486–492
Valeriani M, Restuccia D, Di Lazaro V, Franceschi F, Fabbriciani C, Tonali P (1999) Clinical and neurophysiological abnormalities before and after reconstruction of the anterior cruciate ligament of the knee. Acta Neurol Scand 99:303–307
Wallston KA (2005) The validity of the multidimensional health locus of control scales. J Health Psychol 10:623–631
Wallston KA, Stein MJ, Smith CA (1994) Form C of the MHLC scales: a condition-specific measure of locus of control. J Pers Assess 63(3):534–553
Webster KE, Feller JA, Lambros C (2008) Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 9:9–15
Williams GN, Chmielewski T, Rudolph KS, Buchanan TS, Snyder-Mackler L (2001) Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 31:546–566
Wojtys EM, Huston LJ (2000) Longitudinal effects of anterior cruciate ligament injury and patellar tendon autograft reconstruction on neuromuscular performance. Am J Sports Med 28:336–344
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Nyland, J., Mauser, N. & Caborn, D.N.M. Sports involvement following ACL reconstruction is related to lower extremity neuromuscular adaptations, subjective knee function and health locus of control. Knee Surg Sports Traumatol Arthrosc 21, 2019–2028 (2013). https://doi.org/10.1007/s00167-013-2366-6
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DOI: https://doi.org/10.1007/s00167-013-2366-6