Analyses of dynamic co-contraction level in individuals with anterior cruciate ligament injury.

BACKGROUND A complete understanding of neural mechanisms by which ligament receptors may contribute to joint stability is not well established. It has been suggested that these receptors may be involved in a neuromuscular process related to the modulation of dynamic co-contraction, as a means of guaranteeing functional joint stability. HYPOTHESIS Individuals with ACL injury have diminished dynamic co-contraction. STUDY DESIGN Exploratory, cross-sectional design. METHODS Ten subjects with unilateral ACL injury treated conservatively, and ten subjects without history of injury participated in the study. The co-contraction level was assessed through EMG recordings of the vastus lateralis and biceps femoris before and after a perturbation imposed on the subjects during a walking task. RESULTS Subjects with ACL injury presented significantly lower co-contraction level pre-perturbation (p = 0.045) and post-perturbation (p = 0.046) than those in the control group. CONCLUSIONS The bilateral decrease in muscular co-contraction presented by individuals with ACL injury suggests that ligament and joint receptors may be responsible for a bilateral dynamic increase in muscle and joint stiffness that could result in a greater joint stability. CLINICAL RELEVANCE This study analyzed a neuromuscular mechanism that might contribute to the functional stability of the knee joint.

[1]  K. J. Cole,et al.  Physiologic loading of the anterior cruciate ligament does not activate quadriceps or hamstrings in the anesthetized cat , 1990, The American journal of sports medicine.

[2]  L. Huston,et al.  Neuromuscular Performance in Normal and Anterior Cruciate Ligament-Deficient Lower Extremities , 1994, The American journal of sports medicine.

[3]  E S Grood,et al.  Clinical laxity tests and functional stability of the knee: biomechanical concepts. , 1980, Clinical orthopaedics and related research.

[4]  V. Mountcastle,et al.  THE RELATION OF THALAMIC CELL RESPONSE TO PERIPHERAL STIMULI VARIED OVER AN INTENSIVE CONTINUUM. , 1963, Journal of neurophysiology.

[5]  H. Johansson,et al.  Influence from stretch-sensitive receptors in the collateral ligaments of the knee joint on the γ-muscle-spindle systems of flexor and extensor muscles , 1991, Neuroscience Research.

[6]  Reed Ferber,et al.  Gait mechanics in chronic ACL deficiency and subsequent repair. , 2002, Clinical biomechanics.

[7]  J. O'Connor,et al.  Reflex hamstring contraction latency in anterior cruciate ligament deficiency , 1994, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  J. Cram,et al.  Introduction to Surface Electromyography , 1998 .

[9]  E. Dabezies,et al.  Mechanoreceptors in the human anterior cruciate ligament , 1986, The Anatomical record.

[10]  Eiichi Tsuda,et al.  Direct Evidence of the Anterior Cruciate Ligament-Hamstring Reflex Arc in Humans * , 2001, The American journal of sports medicine.

[11]  F. Noyes,et al.  Rigorous Statistical Reliability, Validity, and Responsiveness Testing of the Cincinnati Knee Rating System in 350 Subjects with Uninjured, Injured, or Anterior Cruciate Ligament-Reconstructed Knees , 1999, The American journal of sports medicine.

[12]  J. Andrews,et al.  The cutting mechanism , 1977, The American journal of sports medicine.

[13]  H Johansson,et al.  Actions on gamma‐motoneurones elicited by electrical stimulation of group I muscle afferent fibres in the hind limb of the cat. , 1983, The Journal of physiology.

[14]  W. Seering,et al.  The function of the primary ligaments of the knee in anterior-posterior and medial-lateral motions. , 1980, Journal of biomechanics.

[15]  F. Noyes,et al.  Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. , 1980, The Journal of bone and joint surgery. American volume.

[16]  R J Johnson,et al.  The role of the musculature in injuries to the medial collateral ligament. , 1979, The Journal of bone and joint surgery. American volume.

[17]  J. Kennedy,et al.  Nerve supply of the human knee and its functional importance , 1982, The American journal of sports medicine.

[18]  D. Daniel,et al.  Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption , 1985, The American journal of sports medicine.

[19]  R. Craik,et al.  Gait analysis : theory and application , 1995 .

[20]  K. Markolf,et al.  In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus. , 1978, The Journal of bone and joint surgery. American volume.

[21]  H. Johansson,et al.  Effects of electrical and natural stimulation of skin afferents on the γ-spindle system of the triceps surae muscle , 1989, Neuroscience Research.

[22]  J. Czerniecki,et al.  A biomechanical evaluation of tibiofemoral rotation in anterior cruciate deficient knees during walking and running , 1988, The American journal of sports medicine.

[23]  O. Bar-or,et al.  Cocontraction and phasic activity during GAIT in children with cerebral palsy. , 1996, Electromyography and clinical neurophysiology.

[24]  A. Lindstrand,et al.  Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients. , 1999, The Journal of orthopaedic and sports physical therapy.

[25]  J. Cholewicki,et al.  Stabilizing Function of Trunk Flexor‐Extensor Muscles Around a Neutral Spine Posture , 1997, Spine.

[26]  R. D'ambrosia,et al.  The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability , 1987, The American journal of sports medicine.

[27]  C. Roberts,et al.  A deficient anterior cruciate ligament does not lead to quadriceps avoidance gait. , 1999, Gait & posture.

[28]  E. Gardner.  The innervation of the knee joint , 1948, The Anatomical record.

[29]  O. Brantigan,et al.  THE MECHANICS OF THE LIGAMENTS AND MENISCI OF THE KNEE JOINT , 1941 .

[30]  H. Skinner,et al.  Functional performance of the knee after intraarticular anesthesia , 1983, The American journal of sports medicine.

[31]  S. Skoglund,et al.  On the reflex effects from the knee joint of the cat. , 1960, Acta physiologica Scandinavica.

[32]  H. Johansson,et al.  Receptors in the knee joint ligaments and their role in the biomechanics of the joint. , 1991, Critical reviews in biomedical engineering.

[33]  M. Turvey.  The bernstein perspective I , 1982 .

[34]  H. Schaible,et al.  New Aspects of the Role of Articular Receptors in Motor Control , 1987 .

[35]  K. Markolf,et al.  Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. , 1976, The Journal of bone and joint surgery. American volume.

[36]  L. Konradsen,et al.  Ankle instability caused by prolonged peroneal reaction time. , 1990, Acta orthopaedica Scandinavica.

[37]  H. Johansson,et al.  Spinal and supraspinal effects of activity in ligament afferents. , 2002, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[38]  R. D'ambrosia,et al.  Muscular coactivation , 1988, The American journal of sports medicine.

[39]  K. A. Provins,et al.  The effect of peripheral nerve block on the appreciation and execution of finger movements , 1958, The Journal of physiology.

[40]  B. Wyke,et al.  The innervation of the knee joint. An anatomical and histological study in the cat. , 1967, Journal of anatomy.

[41]  A. Struppler,et al.  Clinical Aspects of Sensory Motor Integration , 1987, Advances in Applied Neurological Sciences.

[42]  Y. Jammes,et al.  Reliability of burst superimposed technique to assess central activation failure during fatiguing contraction. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[43]  H. Ihara,et al.  Dynamic joint control training for knee ligament injuries , 1986, The American journal of sports medicine.

[44]  T. Andriacchi,et al.  Gait Adaptations by Patients Who Have a Deficient Anterior Cruciate Ligament , 1990 .