Altered neuromuscular control in the vastus medialis following anterior cruciate ligament injury: A recurrence quantification analysis of electromyogram recruitment

Abstract

BackgroundNeuromuscular deficits exist following anterior cruciate ligament (ACL) injury. To observe these deficits, we examined nonlinear characteristics of vastus medialis electromyography (EMG) signals during submaximal isometric knee extensor contractions. Our purpose was to examine if determinism and entropy in EMG signals reflected neuromuscular control deficits in individuals with ACL-deficient limbs. Methods24 participants (12 male, 12 female, mean age = 18.8 ± 3.1 years) with unilaterally injured ACLs and 25 age-similar healthy controls (11 male, 14 female, mean age = 18.8 ± 3.1 years) volunteered. Isometric knee extensions were tested at 10%, 25%, 35%, and 50% maximum voluntary contractions. Surface electrodes adhered over the vastus medialis captured EMG signals. EMG data were processed with recurrence quantification analyses. Specifically, determinism (an index of system predictability) and entropy (an index of system disorder) were calculated from recurrence plots. FindingsDeterminism and entropy in EMG signals were lower in the injured than uninjured limb, and lower than that from healthy controls (P < .05). InterpretationVastus medialis EMG signals from the injured limb were less predictable and less complex than those from healthy limbs. The findings reflect impaired neuromuscular control in the injured limb's quadriceps and are consistent with a ‘loss of complexity’ hypothesis in physiologic signals emanating from pathologic states. Determinism and entropy in EMG signals may represent biomarkers of one's neuromuscular control system.