Evaluation of neuromuscular control after anterior cruciate ligament rupture : development of objective criteria to assess sensorimotor competence
A rupture of the anterior cruciate ligament (ACL) is a frequent injury in physically active individuals with young women at highest risk. It is known that ACL ruptures induce altered knee biomechanics - these changes are referred to neuromuscular adaptations due to altered sensorimotor control. Regardless of treatment (surgical reconstruction or rehabilitation alone), the consequences after ACL rupture are often poor knee-related quality of life, reduced knee function, or even posttraumatic knee osteoarthritis in the long run. Furthermore, the re-injury rates sum up to 20 – 40% which is unacceptably high. Even though almost all patients return to sports (RTS), not everyone achieves pre-injury levels of physical activity. To judge upon readiness for RTS, physical performance tests such as strength and hop tests are used to assess neuromuscular control. However, most of these tests lack validity. In addition, the outcomes do not adequately reflect the level of neuromuscular control needed for a safe RTS as they are not close enough to muscle physiology. Moreover, evidence concerning neuromuscular control for functional stability during activities of daily life (ADL) or in doing sports is sparse. Therefore, this PhD project aimed to explore neuromuscular control of knee stabilizing muscles in patients with unilateral ACL rupture, in the acute phase and after one year, RTS respectively. The research includes a systematic literature review and three cross-sectional studies investigating differences in neuromuscular control regarding sex, treatment modality and injured versus non-involved leg. The systematic literature review provides outcomes of electromyography (EMG) assessing neuromuscular control of the knee during ADL and sports. So far, none of the included research projects used EMG outcomes to judge upon readiness to RTS. In the cross-sectional studies, patients were assessed either pre-operatively within three weeks after ACL rupture, or one year after reconstruction, rehabilitation respectively. Healthy, matched participants served as control group. Neuromuscular control of quadriceps and hamstring muscles was measured by EMG during stair walking (functional task, ADL) and during anterior tibial translation (reflex activity, simulation of injury mechanism). The findings from this PhD thesis emphasize the need for more specific rehabilitation protocols to focus on restoring neuromuscular control of both legs to the level of healthy controls, and to consider sex- and treatment-specific aspects in patients after ACL rupture. The thesis concludes by suggesting future research including long-term follow up, exploring the potential role of prehabilitation, and using EMG-related outcomes to assess neuromuscular control in people after ACL rupture.
Antwerp : University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy , 2023
258 p.
Supervisor: Vissers, Dirk [Supervisor]
Supervisor: Heiner, Baur [Supervisor]
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Creation 09.11.2023
Last edited 10.11.2023
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