Download PDF
Int J Sports Med 2021; 42(04): 336-343
DOI: 10.1055/a-1273-8269
Training & Testing

Anterior Cruciate Ligament Reconstructed Female Athletes Exhibit Relative Muscle Dysfunction After Return to Sport

Christiana J. Raymond-Pope 
1   School of Kinesiology, University of Minnesota, Minneapolis
,
Donald R. Dengel
1   School of Kinesiology, University of Minnesota, Minneapolis
,
John S. Fitzgerald
2   Department of Education, Health and Behavior Studies, University of North Dakota, Grand Forks
,
Bradley J. Nelson
3   Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis
,
Tyler A. Bosch
4   College of Education and Human Development, University of Minnesota, Minneapolis
› Author Affiliations Funding: This work was supported by funding from NIH/NIAMS T32 AR050938 “Musculoskeletal Training Grant” (CJRP) and from the North American Society for Pediatric Exercise Medicine (NASPEM) “Marco Cabrera Student Research Award” (CJRP).
› Further Information
Also available at
    Permissions and Reprints

Correction to:

Correction: Anterior Cruciate Ligament Reconstructed Female Athletes Exhibit Relative Muscle Dysfunction After Return to SportInt J Sports Med 2020; 41(14): e19-e19
DOI: 10.1055/a-1303-9991

Abstract

We sought to examine the relationship between upper-leg compartmental lean mass, muscle-specific strength, and explosive strength following anterior cruciate ligament reconstruction. Twleve adolescent female athletes with prior anterior cruciate ligament reconstruction were individually-matched by age (16.4±0.9 vs. 16.4±1.0 yrs.), body mass index (23.2±2.1 vs. 23.2±2.7 kg/m2), and sport to 12 female athlete controls. One total-body and 2 lateral-leg dual X-ray absorptiometry scans measured total/segmental body composition. Isokinetic dynamometry measured knee extensor/flexor peak torque. Squat jumps on force platforms measured bilateral peak vertical ground reaction force. Paired t-tests assessed lean mass, peak torque, and force between previously-injured athletes’ legs and between previously-injured and control athletes’ legs. Previously-injured athletes’ involved vs. non-involved leg demonstrated lower total (7.13±0.75 vs. 7.43±0.99 kg; p<0.01) and anterior (1.49±0.27 vs. 1.61±0.23 kg; p<0.01) and posterior (1.90±0.19 vs. 2.02±0.21 kg; p=0.04) upper-leg lean mass. Involved leg peak torque (1.36±0.31; 1.06±0.27; 0.97±0.19 Nm/kg) was lower vs. non-involved leg (1.71±0.36; 1.24±0.33; 1.04±0.15 Nm/kg; p<0.01−0.02) for extension at 60 and 120°/sec and flexion at 60°/sec and vs. controls’ ‘matched’ leg (1.77±0.40 Nm/kg; p=0.01) for extension at 60°/sec. Involved leg force (296±45N) was lower vs. non-involved leg (375±55N; p<0.01) and vs. controls’ ‘matched’ leg (372±88N; p=0.02). One-year post-anterior cruciate ligament reconstruction, adolescent female athletes’ involved leg demonstrated relative muscle dysfunction.

Key words

ACL - dual X-ray absorptiometry (DXA) - isokinetic dynamometry - squat jump


Publication History

Received: 05 April 2020

Accepted: 18 September 2020

Article published online:
23 October 2020

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Joseph AM, Collins CL, Henke NM. et al. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train 2013; 48: 810-817
    CrossrefPubMedSearch in Google Scholar
  • 2 Paterno MV, Rauh MJ, Schmitt LC. et al. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 2012; 22: 116-121
    CrossrefPubMedSearch in Google Scholar
  • 3 Wiggins AJ, Grandhi RK, Schneider DK. et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Am J Sports Med 2016; 44: 1861-1876
    CrossrefPubMedSearch in Google Scholar
  • 4 Myer GD, Paterno MV, Ford KR. et al. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 2006; 36: 385-402
    CrossrefPubMedSearch in Google Scholar
  • 5 Kyritsis P, Bahr R, Landreau P. et al. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med 2016; 50: 946-951
    CrossrefPubMedSearch in Google Scholar
  • 6 Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Br J Sports Med 2004; 34: 269-280
    CrossrefPubMedSearch in Google Scholar
  • 7 Lynch AD, Logerstedt DS, Grindem H. et al. Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: A Delaware-Oslo ACL cohort investigation. Br J Sports Med 2015; 49: 335-342
    CrossrefPubMedSearch in Google Scholar
  • 8 Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2012; 42: 750-759
    CrossrefPubMedSearch in Google Scholar
  • 09 Grindem H, Eitzen I, Engebretsen L. et al. Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation and knee reinjury: The Delaware-Oslo ACL Cohort Study. J Bone Joint Surg 2014; 96: 1233-1241
    CrossrefPubMedSearch in Google Scholar
  • 10 Grindem H, Snyder-Mackler L, Moksnes H. et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: The Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808
    CrossrefPubMedSearch in Google Scholar
  • 11 Jordan MJ, Aagaard P, Herzog W. Lower limb asymmetry in mechanical muscle function: A comparison between ski racers with and without ACL reconstruction. Clin J Sport Med 2015; 25: e301-e309
    CrossrefPubMedSearch in Google Scholar
  • 12 Paterno MV, Ford KR, Myer GD. et al. Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clin J Sports Med 2007; 17: 258-262
    CrossrefPubMedSearch in Google Scholar
  • 13 Paterno MV, Schmitt LC, Ford KR. et al. Effects of sex on compensatory landing strategies upon return to sport after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2011; 41: 553-559
    CrossrefPubMedSearch in Google Scholar
  • 14 Webster KE, Hewett TE. What is the evidence for and validity of Return-to-Sport testing after anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis. Sports Med 2019; 49: 917-929
    CrossrefPubMedSearch in Google Scholar
  • 15 Konishi Y, Ikeda K, Nishino A. et al. Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament repair. Scand J Med Sci Sports 2007; 17: 656-661
    CrossrefPubMedSearch in Google Scholar
  • 16 Konishi Y, Oda T, Tsukazaki S. et al. Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2011; 19: 641-645
    CrossrefPubMedSearch in Google Scholar
  • 17 Raymond CJ, Bosch TA, Busch FK. et al. Accuracy and reliability of assessing lateral compartmental leg composition using DXA. Med Sci Sports Exerc 2017; 49: 833-839
    CrossrefPubMedSearch in Google Scholar
  • 18 Raymond-Pope CJ, Dengel DR, Fitzgerald JS, Bosch TA. Association of compartmental leg lean mass measured by dual X-ray absorptiometry with force production. J Strength Cond Res 2020; 34: 1690-1696
    CrossrefPubMedSearch in Google Scholar
  • 19 Bishop C, Turner A, Read P. Effects of inter-limb asymmetries on physical and sports performance: a systematic review. J Sports Sci 2018; 36: 1135-1144
    CrossrefPubMedSearch in Google Scholar
  • 20 Shultz SJ, Schmitz RJ. Current understandings and directions for future research. In: Noyes F, Barber-Westin S, Eds. ACL Injuries in the Female Athlete. Berlin: Springer; 2018: 641-666
    Search in Google Scholar
  • 21 Beynnon BD, Vacek PM, Newell MK. et al. The effects of level of competition, sport, and sex on the incidence of first-time noncontact anterior cruciate ligament injury. Am J Sports Med 2014; 42: 1806-1812
    CrossrefPubMedSearch in Google Scholar
  • 22 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 GE Healthcare Lunar. enCORE-based X-ray Bone Densitometer: User Manual. Madison, WI: GE Healthcare, p.59; [cited 2018 July 1]. Available from: www.gehealthcare.com
  • 24 Bell DR, Sanfilippo JL, Binkley N, Heiderscheit BC. Lean mass asymmetry influences force and power asymmetry during jumping in collegiate athletes. J Strength Cond Res 2014; 28: 884-891
    CrossrefPubMedSearch in Google Scholar
  • 25 Parcell AC, Sawyer RD, Tricoli VA, Chinevere TD. Minimum rest period for strength recovery during a common isokinetic testing protocol. Med Sci Sports Exerc 2002; 34: 1018-1022
    CrossrefPubMedSearch in Google Scholar
  • 26 Bobbert MF. Why do people jump the way they do?. Exerc Sport Sci Rev 2001; 29: 95-102
    CrossrefPubMedSearch in Google Scholar
  • 27 Hori N, Newton RU, Kwamori N. et al. Reliability of performance measurements derived from ground reaction force data during countermovement jump and the influence of sampling frequency. J Strength Cond Res 2009; 23: 874-882
    CrossrefPubMedSearch in Google Scholar
  • 28 Impellizzeri FM, Rampinini E, Maffiuletti N, Marcora SM. A vertical jump force test for assessing bilateral strength asymmetry in athletes. Med Sci Sports Exerc 2007; 39: 2044-2050
    CrossrefPubMedSearch in Google Scholar
  • 29 Markovic G, Diszar D, Jukic I, Cardinale M. Reliability and factorial validity of squat and countermovement jump tests. J Strength Cond Res 2004; 18: 551-555
    PubMedSearch in Google Scholar
  • 30 Fitzgerald JS, Johnson L, Tomkinson G. et al. Test-retest reliability of jump execution variables using mechanography: A comparison of jump protocols. J Sports Sci 2017; 36: 963-969
    CrossrefPubMedSearch in Google Scholar
  • 31 Moir GL, Garcia A, Dwyer GB. Intersession reliability of kinematic and kinetic variables during vertical jumps in men and women. Int J Sports Physiol Perform 2009; 4: 317-330
    CrossrefPubMedSearch in Google Scholar
  • 32 Hopkins WG, Marshall SW, Batterham AM, Hanin J. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-12
    CrossrefPubMedSearch in Google Scholar
  • 33 Andersen JL, Lamb SE, Barker KL. et al. Changes in muscle torque following anterior cruciate ligament reconstruction: A comparison between hamstrings and patella tendon graft procedures on 45 patients. Acta Orthop Scand 2002; 73: 546-552
    CrossrefPubMedSearch in Google Scholar
  • 34 Cardone C, Menegassi Z, Emygdio R. Isokinetic assessment of muscle strength following anterior cruciate ligament reconstruction. Isokinet Exerc Sci 2004; 12: 173-177
    CrossrefPubMedSearch in Google Scholar
  • 35 McHugh MP, Tyler TF, Browne MG. et al. Electromyographic predictors of residual quadriceps muscle weakness after anterior cruciate ligament reconstruction. Am J Sports Med 2002; 30: 334-339
    CrossrefPubMedSearch in Google Scholar
  • 36 Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: A randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med 2009; 37: 1958-1966
    CrossrefPubMedSearch in Google Scholar
  • 37 Chmielewski TL, Wilk KE, Snyder-Mackler L. Changes in weight-bearing following injury or surgical reconstruction of the ACL: Relationship to quadriceps strength and function. Gait Posture 2002; 16: 87-95
    CrossrefPubMedSearch in Google Scholar
  • 38 Hewett TE, Myer GD, Ford KR. et al. 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 2005; 33: 492-501
    CrossrefPubMedSearch in Google Scholar
  • 39 Ardern CL, Glasgow P, Schneiders A. et al. Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 2016; 50: 853-864
    CrossrefPubMedSearch in Google Scholar
  • 40 Kuenze CM, Hertel J, Hart JM. Quadriceps muscle function after exercise in men and women with a history of anterior cruciate ligament reconstruction. J Athl Train 2014; 49: 740-746
    CrossrefPubMedSearch in Google Scholar
  • 41 Johnson AK, Palmieri-Smith RM, Lepley LK. Contribution of neuromuscular factors to quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 2018; 53: 347-354
    CrossrefPubMedSearch in Google Scholar
  • 42 Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med 2013; 47: 1120-1126
    CrossrefPubMedSearch in Google Scholar
  • 43 Sonesson S, Kvist J, Ardern C. et al. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: Expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc 2017; 25: 1375-1384
    CrossrefPubMedSearch in Google Scholar