Effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Haifeng ^1,2 ,  LU Wei ^1,2 , LIANG Daqiang ^1,2 , GENG Hongli ^1,2 , ZHU Weimin ^1,2 , OUYANG Kan ^1,2 , LI Hao ^1,2 , PENG Liangquan ^1,2 , FENG Wenzhe ^1,2 , ZHONG Mingjin ^1,2 , CHEN Kang ^1,2 , LI Ying ^1,2 , DENG Zhenhan ^1,2 ,  WANG Daping ^1,2

1. Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangzhou, 518000, P.R.China;
2. Sports Medicine Engineering Technology Research Center of Guangdong Province, Shenzhen Guangdong, 518000, P.R.China;

Corresponding?author：

LU Wei, Email: winerl@sina.com; WANG Daping, Email: dapingwang@medmail.com.cn

Keywords：

Anterior cruciate ligament reconstruction; isokinetic training; remodeling; rehabilitation

DOI：

10.7507/1002-1892.201902059

Video：

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Objective To investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic.Methods Between August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group (n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining.Results The invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups (P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups (P<0.05). But there was no significant difference between the two groups (t=0.868, P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups (P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group (P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant (P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy (P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group (P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups (P>0.05), and the histological score of the isokinetic group was superior to the control group (P<0.05).Conclusion On the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.

Citation： LIU Haifeng, LU Wei, LIANG Daqiang, GENG Hongli, ZHU Weimin, OUYANG Kan, LI Hao, PENG Liangquan, FENG Wenzhe, ZHONG Mingjin, CHEN Kang, LI Ying, DENG Zhenhan, WANG Daping. Effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1088-1094. doi: 10.7507/1002-1892.201902059 Copy

1.	Sander TL, Maradit Kremers H, Bryan AJ, et al. Incidence of anterior cruciate ligament tears and reconstruction: A 21-year population-based study. Am J Sports Med, 2016, 44(6): 1502-1507.
2.	Baverel L, Demey G, Odri GA, et al. Do outcomes of outpatient ACL reconstruction vary with graft type? Orthop Traumatol Surg Res, 2015, 101(7): 803-806.
3.	Friedmann-Bette B, Profit F, Gwechenberger T, et al. Strength training effects on muscular regeneration after ACL reconstruction. Med Sci Sports Exerc, 2018, 50(6): 1152-1161.
4.	Kuenze CM, Blemker SS, Hart JM. Quadriceps function relates to muscle size following ACL reconstruction. J Orthop Res, 2016, 34(9): 1656-1662.
5.	Baroni BM, Rodrigues R, Franke RA, et al. Time course of neuromuscular adaptations to knee extensor eccentric training. Int J Sports Med, 2013, 34(10): 904-911.
6.	Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2008, 16(9): 834-842.
7.	吳冰, 陸偉, 王大平, 等. 前交叉韌帶重建術后 MRI 評分與臨床膝關節主、客觀功能評分的對比研究. 中國臨床解剖學雜志, 2016, 34(6): 677-684.
8.	Kondo E, Yasuda K. Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability. Arthroscopy, 2007, 23(11): 1198-1209.
9.	Lee JH, Bae DK, Song SJ, et al. Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts. Arthroscopy, 2010, 26(1): 41-49.
10.	Weiler A, Peters G, M?urer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6): 751-761.
11.	Dong S, Xie G, Zhang Y, et al. Ligamentization of autogenous hamstring grafts after anterior cruciate ligament reconstruction: Midterm versus long-term results. Am J Sports Med, 2015, 43(8): 1908-1917.
12.	Schilaty ND, Bates NA, Sanders TL, et al. Incidence of second anterior cruciate ligament tears (1990-2000) and associated factors in a specific geographic locale. Am J Sports Med, 2017, 45(7): 1567-1573.
13.	Otzel DM, Chow JW, Tillman MD. Long-term deficits in quadriceps strength and activation following anterior cruciate ligament reconstruction. Phys Ther Sport, 2015, 16(1): 22-28.
14.	Fukunaga T, Johnson CD, Nicholas SJ, et al. Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 573-579.
15.	Cvjetkovic DD, Bijeljac S, Palija S, et al. Isokinetic testing in evaluation rehabilitation outcome after ACL reconstruction. Med Arch, 2015, 69(1): 21-23.
16.	Zwolski C, Schmitt LC, Quatman-Yayes C, et al. The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med, 2015, 43(9): 2242-2249.
17.	章聞捷, 葉祥明, 張大威, 等. 腘繩肌等速離心訓練對前交叉韌帶重建術后膝關節功能的影響. 中國運動醫學雜志, 2017, 36(9): 805-809.
18.	Claes S, Verdonk P, Forsyth R, et al. The " ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med, 2011, 39(11): 2476-2483.
19.	Papageorgiou CD, Ma CB, Abramowitch SD, et al. A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med, 2001, 29(5): 620-626.
20.	張明宇, 張亮, 鄭江, 等. 前交叉韌帶重建術后運動員等速肌力訓練的研究. 實用骨科雜志, 2016, 22(12): 1080-1082.
21.	Devan MR, Pescatello LS, Faghri P, et al. A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities. J Athl Train, 2004, 39(3): 263-267.
22.	吳冰, 丘志河, 李盛, 等. 自體腘繩肌腱移植重建前交叉韌帶后移植物的組織學研究. 中國修復重建外科雜志, 2018, 32(7): 873-879.
23.	Falconiero RP, DiStefano VJ, Cook TM. Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans. Arthroscopy, 1998, 14(2): 197-205.

1. Sander TL, Maradit Kremers H, Bryan AJ, et al. Incidence of anterior cruciate ligament tears and reconstruction: A 21-year population-based study. Am J Sports Med, 2016, 44(6): 1502-1507.
2. Baverel L, Demey G, Odri GA, et al. Do outcomes of outpatient ACL reconstruction vary with graft type? Orthop Traumatol Surg Res, 2015, 101(7): 803-806.
3. Friedmann-Bette B, Profit F, Gwechenberger T, et al. Strength training effects on muscular regeneration after ACL reconstruction. Med Sci Sports Exerc, 2018, 50(6): 1152-1161.
4. Kuenze CM, Blemker SS, Hart JM. Quadriceps function relates to muscle size following ACL reconstruction. J Orthop Res, 2016, 34(9): 1656-1662.
5. Baroni BM, Rodrigues R, Franke RA, et al. Time course of neuromuscular adaptations to knee extensor eccentric training. Int J Sports Med, 2013, 34(10): 904-911.
6. Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2008, 16(9): 834-842.
7. 吳冰, 陸偉, 王大平, 等. 前交叉韌帶重建術后 MRI 評分與臨床膝關節主、客觀功能評分的對比研究. 中國臨床解剖學雜志, 2016, 34(6): 677-684.
8. Kondo E, Yasuda K. Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability. Arthroscopy, 2007, 23(11): 1198-1209.
9. Lee JH, Bae DK, Song SJ, et al. Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts. Arthroscopy, 2010, 26(1): 41-49.
10. Weiler A, Peters G, M?urer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6): 751-761.
11. Dong S, Xie G, Zhang Y, et al. Ligamentization of autogenous hamstring grafts after anterior cruciate ligament reconstruction: Midterm versus long-term results. Am J Sports Med, 2015, 43(8): 1908-1917.
12. Schilaty ND, Bates NA, Sanders TL, et al. Incidence of second anterior cruciate ligament tears (1990-2000) and associated factors in a specific geographic locale. Am J Sports Med, 2017, 45(7): 1567-1573.
13. Otzel DM, Chow JW, Tillman MD. Long-term deficits in quadriceps strength and activation following anterior cruciate ligament reconstruction. Phys Ther Sport, 2015, 16(1): 22-28.
14. Fukunaga T, Johnson CD, Nicholas SJ, et al. Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 573-579.
15. Cvjetkovic DD, Bijeljac S, Palija S, et al. Isokinetic testing in evaluation rehabilitation outcome after ACL reconstruction. Med Arch, 2015, 69(1): 21-23.
16. Zwolski C, Schmitt LC, Quatman-Yayes C, et al. The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med, 2015, 43(9): 2242-2249.
17. 章聞捷, 葉祥明, 張大威, 等. 腘繩肌等速離心訓練對前交叉韌帶重建術后膝關節功能的影響. 中國運動醫學雜志, 2017, 36(9): 805-809.
18. Claes S, Verdonk P, Forsyth R, et al. The " ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med, 2011, 39(11): 2476-2483.
19. Papageorgiou CD, Ma CB, Abramowitch SD, et al. A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med, 2001, 29(5): 620-626.
20. 張明宇, 張亮, 鄭江, 等. 前交叉韌帶重建術后運動員等速肌力訓練的研究. 實用骨科雜志, 2016, 22(12): 1080-1082.
21. Devan MR, Pescatello LS, Faghri P, et al. A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities. J Athl Train, 2004, 39(3): 263-267.
22. 吳冰, 丘志河, 李盛, 等. 自體腘繩肌腱移植重建前交叉韌帶后移植物的組織學研究. 中國修復重建外科雜志, 2018, 32(7): 873-879.
23. Falconiero RP, DiStefano VJ, Cook TM. Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans. Arthroscopy, 1998, 14(2): 197-205.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament reconstruction

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