PDF
Abstract
Objective: An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR).
Methods: Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months–1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters.
Results: Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs.
Conclusion: Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.
Keywords
Anterior Cruciate Ligament Reconstruction
/
Gait
/
Lower Limbs
/
Surface Electromyography
Cite this article
Download citation ▾
Xipeng Wu,, Hao Zhang,, Hongxing Cui,, Wenbin Pei,, Yixuan Zhao,, Shanshan Wang,, Zhijie Cao,, Wei Li,.
Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction.
Orthopaedic Surgery, 2025, 17(1): 62-70 DOI:10.1111/os.14256
| [1] |
Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, et al. Return to sport after anterior cruciate ligament injury: panther symposium ACL injury return to sport consensus group. Knee Surg Sports Traumatol Arthrosc. 2020; 28(8): 2403–2414.
|
| [2] |
Cheney S, Chiaia TA, de Mille P, Boyle C, Ling D. Readiness to return to sport after ACL reconstruction: a combination of physical and psychological factors. Sports Med Arthrosc Rev. 2020; 28(2): 66–70.
|
| [3] |
Jeong J, Choi DH, Shin CS. Core strength training can Alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury. Am J Sports Med. 2021; 49(1): 183–192.
|
| [4] |
Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord. 2020; 21(1): 647.
|
| [5] |
Kakavas G, Malliaropoulos N, Bikos G, Pruna R, Valle X, Tsaklis P, et al. Periodization in anterior cruciate ligament rehabilitation: a novel framework. Med Princ Pract. 2021; 30(2): 101–108.
|
| [6] |
Pezzullo DJ, Fadale P. Current controversies in rehabilitation after anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2010; 18(1): 43–47.
|
| [7] |
Vigotsky AD, Halperin I, Lehman GJ, Trajano GS, Vieira TM. Interpreting signal amplitudes in surface electromyography studies in sport and rehabilitation sciences. Front Physiol. 2018; 8: 985.
|
| [8] |
Sherman DA, Glaviano NR, Norte GE. Hamstrings neuromuscular function after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Med. 2021; 51(8): 1751–1769.
|
| [9] |
Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, et al. Clinical relevance of state-of-the-art analysis of surface electromyography in cerebral palsy. Front Neurol. 2020; 11: 583296.
|
| [10] |
Medved V, Medved S, Kovač I. Critical appraisal of surface electromyography (sEMG) as a taught subject and clinical tool in medicine and kinesiology. Front Neurol. 2020; 11: 560363.
|
| [11] |
Balbinot G, Li G, Wiest MJ, Pakosh M, Furlan JC, Kalsi-Ryan S, et al. Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review. J Neuroeng Rehabil. 2021; 18(1): 105.
|
| [12] |
Papagiannis GI, Triantafyllou AI, Roumpelakis IM, Zampeli F, Garyfallia Eleni P, Koulouvaris P, et al. Methodology of surface electromyography in gait analysis: review of the literature. J Med Eng Technol. 2019; 43(1): 59–65.
|
| [13] |
Perraton L, Clark R, Crossley K, Pua YH, Whitehead T, Morris H, et al. Impaired voluntary quadriceps force control following anterior cruciate ligament reconstruction: relationship with knee function. Knee Surg Sports Traumatol Arthrosc. 2017; 25(5): 1424–1431.
|
| [14] |
Andrade R, Pereira R, van Cingel R, Staal JB, Espregueira-Mendes J. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). Br J Sports Med. 2020; 54(9): 512–519.
|
| [15] |
Buckthorpe M. Recommendations for movement Re-training after ACL reconstruction. Sports Med. 2021; 51(8): 1601–1618.
|
| [16] |
Zebis MK, Sørensen MH, Lauridsen HB, Bencke J, Andersen CH, Carlsbæk JB, et al. Electromyography evaluation of bodyweight exercise progression in a validated anterior cruciate ligament injury rehabilitation program: a cross-sectional study. Am J Phys Med Rehabil. 2019; 98(11): 998–1004.
|
| [17] |
Arhos EK, Capin JJ, Buchanan TS, Snyder-Mackler L. Quadriceps strength symmetry does not modify gait mechanics after anterior cruciate ligament reconstruction, rehabilitation, and return-to-sport training. Am J Sports Med. 2021; 49(2): 417–425.
|
| [18] |
Chen S, Lach J, Lo B, Yang GZ. Toward pervasive gait analysis with wearable sensors: a systematic review. IEEE J Biomed Health Inform. 2016; 20(6): 1521–1537.
|
| [19] |
Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech (Bristol, Avon). 2007; 22(5): 543–550.
|
| [20] |
Hohmann E, Tetsworth K, Glatt V. The hamstring/quadriceps ratio is an indicator of function in ACL-deficient, but not in ACL-reconstructed knees. Arch Orthop Trauma Surg. 2019; 139(1): 91–98.
|
| [21] |
Thomas AC, Villwock M, Wojtys EM, Palmieri-Smith RM. Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. J Athl Train. 2013; 48(5): 610–620.
|
| [22] |
White K, Di Stasi SL, Smith AH, Snyder-Mackler L. Anterior cruciate ligament-specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial. BMC Musculoskelet Disord. 2013; 14: 108.
|
| [23] |
Buckthorpe M, Danelon F, La Rosa G, Nanni G, Stride M, Della Villa F. Recommendations for hamstring function recovery after ACL reconstruction. Sports Med. 2021; 51(4): 607–624.
|
| [24] |
Erickson LN, Lucas KCH, Davis KA, Jacobs CA, Thompson KL, Hardy PA, et al. Effect of blood flow restriction training on quadriceps muscle strength, morphology, physiology, and knee biomechanics before and after anterior cruciate ligament reconstruction: protocol for a randomized clinical trial. Phys Ther. 2019; 99(8): 1010–1019.
|
| [25] |
Hasegawa S, Kobayashi M, Arai R, Tamaki A, Nakamura T, Moritani T. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol. 2011; 21(4): 622–630.
|
| [26] |
Jakobsen MD, Sundstrup E, Andersen CH, Persson R, Zebis MK, Andersen LL. Effectiveness of hamstring knee rehabilitation exercise performed in training machine vs. elastic resistance: electromyography evaluation study. Am J Phys Med Rehabil. 2014; 93(4): 320–327.
|
| [27] |
Khaiyat OA, Norris J. Electromyographic activity of selected trunk, core, and thigh muscles in commonly used exercises for ACL rehabilitation. J Phys Ther Sci. 2018; 30(4): 642–648.
|
| [28] |
Ogrodzka-Ciechanowicz K, Głąb G, Ślusarski J, Gądek A. Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial. BMC Musculoskelet Disord. 2021; 22(1): 975.
|
RIGHTS & PERMISSIONS
2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.