Skip to main content

Effects of fatigue on lower limb, pelvis and trunk kinematics and lower limb muscle activity during single-leg landing after anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages 2550–2558 (2017)Cite this article

Abstract

Purpose

Because there are no studies that have evaluated the effects of fatigue on the kinematics of the trunk and pelvis or on muscle activation in subjects with ACL reconstruction, the aim of this study was to evaluate the effects of fatigue on the lower limb, pelvis and trunk kinematics and lower limb muscle activation in subjects with ACL reconstruction during a single-leg landing compared to a healthy control group.

Methods

The participants included 20 subjects with ACL reconstruction (ACL reconstruction group—ACLRG) and 20 healthy subjects (control group—CG) who were aged between 18 and 35 years. Kinematic and electromyographic analyses were performed during a single-leg landing before and after fatigue. The fatigue protocol included a series of 10 squats, two vertical jumps, and 20 steps.

Results

The effects of fatigue were increased peak trunk flexion and increased activation of the vastus lateralis, biceps femoris (BF) and gluteus maximus (GMax) during the landing phase.

Conclusion

After the fatigue protocol, an increase in peak trunk flexion and activation of the GMax and BF were observed, most likely as a strategy to reduce the load on the ACL. ACL injury prevention programs should include strength and endurance exercises for the hip and trunk extensor muscles so that they can efficiently control trunk flexion during landing.

Level of evidence

Prospective comparative study, Level II.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Armijo-Olivo S, Warren S, Fuentes J, Magee DJ (2011) Clinical relevance vs. statistical significance: using neck outcomes in patients with temporomandibular disorders as an example. Man Ther 16:563–572

    Article  PubMed  Google Scholar 

  2. Blackburn JT, Padua DA (2009) Sagittal-plane trunk position, landing forces, and quadriceps electromyographic activity. J Athl Train 44:174–179

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cesar GM, Pereira VS, Santiago PRP, Benze BG, da Costa PHL, Amorim CF, Serrão FV (2011) Variations in dynamic knee valgus and gluteus medius onset timing in non-athletic females related to hormonal changes during the menstrual cycle. Knee 18:224–230

    Article  PubMed  Google Scholar 

  4. Chaudhari AM, Andriacchi TP (2006) The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury. J Biomech 39:330–338

    Article  PubMed  Google Scholar 

  5. Dare D, Rodeo S (2014) Mechanisms of post-traumatic osteoarthritis after ACL injury. Curr Rheumatol Rep 16:448

    Article  PubMed  Google Scholar 

  6. Decker MJ, Torry MR, Noonan TJ, Riviere A, Sterett WI (2002) Landing adaptations after ACL reconstruction. Med Sci Sports Exerc 34:1408–1413

    Article  PubMed  Google Scholar 

  7. DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W (2004) Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. Am J Sports Med 32:477–483

    Article  PubMed  Google Scholar 

  8. Ford KR, Myer GD, Hewett TE (2003) Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc 35:1745–1750

    Article  PubMed  Google Scholar 

  9. Frank BS, Gilsdorf CM, Goerger BM, Prentice WE, Padua DA (2014) Neuromuscular fatigue alters postural control and sagittal plane hip biomechanics in active females with anterior cruciate ligament reconstruction. Sports Health 6:301–308

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gehring D, Melnyk M, Gollhofer A (2009) Gender and fatigue have influence on knee joint control strategies during landing. Clin Biomech 24:82–87

    Article  Google Scholar 

  11. Gokeler A, Hof AL, Arnold MP, Dijkstra PU, Postema K, Otten E (2010) Abnormal landing strategies after ACL reconstruction. Scand J Med Sci Sports 20:e12–e19

    CAS  Article  PubMed  Google Scholar 

  12. Hantes ME, Tsarouhas A, Giakas G, Spiropoulos G, Sideris V, Christel P, Malizos KN (2012) Effect of fatigue on tibial rotation after single- and double-bundle anterior cruciate ligament reconstruction: a 3-dimensional kinematic and kinetic matched-group analysis. Am J Sports Med 40:2045–2051

    Article  PubMed  Google Scholar 

  13. Hawkins RD, Fuller CW (1999) A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 33:196–203

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001) The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 35:43–47

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Heinert BL, Kernozek TW, Greany JF, Fater DC (2008) Hip abductor weakness and lower extremity kinematics during running. J Sport Rehabil 17:243–256

    Article  PubMed  Google Scholar 

  16. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G (2000) Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol 10:361–374

    CAS  Article  PubMed  Google Scholar 

  17. Hewett TE, Myer GD, Ford KR, Heidt RS, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33:492–501

    Article  PubMed  Google Scholar 

  18. Hollman JH, Galardi CM, Lin I-H, Voth BC, Whitmarsh CL (2014) Frontal and transverse plane hip kinematics and gluteus maximus recruitment correlate with frontal plane knee kinematics during single-leg squat tests in women. Clin Biomech 29:468–474

    Article  Google Scholar 

  19. Iguchi J, Tateuchi H, Taniguchi M, Ichihashi N (2014) The effect of sex and fatigue on lower limb kinematics, kinetics, and muscle activity during unanticipated side-step cutting. Knee Surg Sport Traumatol Arthrosc 22:41–48

    Article  Google Scholar 

  20. Kellis E, Kouvelioti V (2009) Agonist versus antagonist muscle fatigue effects on thigh muscle activity and vertical ground reaction during drop landing. J Electromyogr Kinesiol 19:55–64

    Article  PubMed  Google Scholar 

  21. Kernozek TW, Torry MR, Iwasaki M (2008) Gender differences in lower extremity landing mechanics caused by neuromuscular fatigue. Am J Sports Med 36:554–565

    Article  PubMed  Google Scholar 

  22. Kulas AS, Hortobágyi T, DeVita P (2012) Trunk position modulates anterior cruciate ligament forces and strains during a single-leg squat. Clin Biomech 27:16–21

    Article  Google Scholar 

  23. Lattier G, Millet GY, Martin A, Martin V (2004) Fatigue and recovery after high-intensity exercise. Part II: recovery interventions. Int J Sports Med 25:509–515

    CAS  Article  PubMed  Google Scholar 

  24. Liederbach M, Kremenic IJ, Orishimo KF, Pappas E, Hagins M (2014) Comparison of landing biomechanics between male and female dancers and athletes, part 2: influence of fatigue and implications for anterior cruciate ligament injury. Am J Sports Med 42:1089–1095

    Article  PubMed  Google Scholar 

  25. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769

    Article  PubMed  Google Scholar 

  26. Macdonald JH, Farina D, Marcora SM (2008) Response of electromyographic variables during incremental and fatiguing cycling. Med Sci Sports Exerc 40:335–344

    Article  PubMed  Google Scholar 

  27. McLean SG, Fellin RE, Felin RE, Suedekum N, Calabrese G, Passerallo A, Joy S (2007) Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc 39:502–514

    Article  PubMed  Google Scholar 

  28. Nakagawa TH, Moriya ETU, Maciel CD, Serrão FV (2012) Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 42:491–501

    Article  PubMed  Google Scholar 

  29. Orishimo KF, Kremenic IJ (2006) Effect of fatigue on single-leg hop landing biomechanics. J Appl Biomech 22:245–254

    Article  PubMed  Google Scholar 

  30. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Hewett TE (2011) Effects of sex on compensatory landing strategies upon return to sport after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 41:553–559

    Article  PubMed  Google Scholar 

  31. Powers CM (2010) The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 40:42–51

    Article  PubMed  Google Scholar 

  32. Price RJ, Hawkins RD, Hulse MA, Hodson A (2004) The Football Association medical research programme: an audit of injuries in academy youth football. Br J Sports Med 38:466–471

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Santamaria LJ, Webster KE (2010) The effect of fatigue on lower-limb biomechanics during single-limb landings: a systematic review. J Orthop Sports Phys Ther 40:464–473

    Article  PubMed  Google Scholar 

  34. Sheehan FT, Sipprell WH, Boden BP (2012) Dynamic sagittal plane trunk control during anterior cruciate ligament injury. Am J Sports Med 40:1068–1074

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shimokochi Y, Ambegaonkar JP, Meyer EG, Lee SY, Shultz SJ (2013) Changing sagittal plane body position during single-leg landings influences the risk of non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 21:888–897

    Article  PubMed  Google Scholar 

  36. Webster KE, Santamaria LJ, McClelland JA, Feller JA (2012) Effect of fatigue on landing biomechanics after anterior cruciate ligament reconstruction surgery. Med Sci Sports Exerc 44:910–916

    Article  PubMed  Google Scholar 

  37. Weinhandl JT, O’Connor KM (2010) Assessment of a greater trochanter-based method of locating the hip joint center. J Biomech 43:2633–2636

    Article  PubMed  Google Scholar 

  38. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I (2002) ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech 35:543–548

    Article  PubMed  Google Scholar 

  39. Yu B, Garrett WE (2007) Mechanisms of non-contact ACL injuries. Br J Sports Med 41(Suppl 1):i47–i51

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zebis MK, Bencke J, Andersen LL, Alkjaer T, Suetta C, Mortensen P, Kjaer M, Aagaard P (2011) Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players. Scand J Med Sci Sports 21:833–840

    CAS  Article  PubMed  Google Scholar 

  41. Zebis MK, Bencke J, Andersen LL, Døssing S, Alkjaer T, Magnusson SP, Kjaer M, Aagaard P (2008) The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players. Clin J Sport Med 18:329–337

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful for the support obtained from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES scholarship), Conselho Nacional de Desenvolvimento Científico e Tecnológico (306848/2012-0) and Fundação de Amparo à Pesquisa do Estado de São Paulo (2014/10506-1).

Author information

Affiliations

  1. Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP, CEP: 13565-905, Brazil

    Giovanna Camparis Lessi & Fábio Viadanna Serrão

Authors
  1. Giovanna Camparis Lessi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fábio Viadanna Serrão
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fábio Viadanna Serrão.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to report.

Institutional Review Board

This study was approved by the São Carlos Federal University Ethics Committee for Research on Human Subjects.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lessi, G.C., Serrão, F.V. Effects of fatigue on lower limb, pelvis and trunk kinematics and lower limb muscle activity during single-leg landing after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 2550–2558 (2017). https://doi.org/10.1007/s00167-015-3762-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3762-x

Keywords

  • Anterior cruciate ligament
  • ACL reconstruction
  • Neuromuscular fatigue
  • Kinematics