Abstract
This study investigated the effects of the isokinetic eccentric training (IET) on the knee extensor and flexor torque and kinematic gait parameters in individuals with ACL reconstruction. Sixteen men with ACL reconstructed (ACLr) whose torque and the gait were evaluated, before and after 12 weeks of IET, was compared to a control group (14 individuals). Student t, MANOVA and ANOVA tests were performed with 5% of significance. The training increased the isometric, concentric at 30 and 120º/s (p < .05) and eccentric at 30º/s (p < .01) extensor torque on the affected limb (AL), and eccentric at 30 and 120º/s (p < .01), on the non-affected limb (NAL). In the flexors, there was an increase on the torque: isometric, concentric at 30º/s and eccentric at 30 and 120º/s (p < .01) in AL and in eccentric at 30 (p < .05) and 120º/s (p< .01) in NAL. With respect to the angular and spatio-temporal variables gait, there was no difference between pre-and post-training in LCAr group. Compared to control group, the cycle time, in two members, was lower in LCAr group, and stride length and cadence were higher in the AL of the LCAr (p < .05). Moreover, the knee flexion-extension angles (minimum and maximum) remained lower in LCAr, pre- and post-training (p < .01). The torque gain associated with eccentric isokinetic training did not affect the kinematic parameters of gait in patients undergoing ACL reconstruction.
Highlights
The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, resulting in pain, instability and difficulty to execute several recreational and athletic activities (Ernst, Saliba, Diduch, Hurwitz, & Ball, 2000)
In order to recover the deficit of strength in the muscles that stabilize the knee, eccentric training has been used in ACL post-surgical rehabilitation (Fogarty, Mahaffey, & Rosene, 2001) and, in comparison to isometric or concentric training, the eccentric training promotes a higher neural activation (LaStayo et al, 2003) and increased muscle strength (Seger & Thorstensson, 2005)
The individuals of the ACL reconstructed (ACLr) group were selected by the Service of Physiotherapy in Health School Center of Federal University of São Carlos (UFSCar/SP/Brazil) based upon the following inclusion criteria: age group between 20 and 50 years old; Body Mass Index (BMI) £ 28 kg/m2; 2 to 5 years of unilateral ACL reconstruction; graft type patellar tendon; post-surgical rehabilitation ≥ 6 months; have returned to daily activities and sports practice; and not showing any pain or knee edema and availability to participate in the study
Summary
The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, resulting in pain, instability and difficulty to execute several recreational and athletic activities (Ernst, Saliba, Diduch, Hurwitz, & Ball, 2000). Despite of the use of protocols aiming to promote the patient return to daily life and sport activities as quickly as possible, deficits above 40% in the quadriceps strength are reported up to the 6 first months of post ACL reconstruction, specially using a patellar tendon (PT) graft (Palmieri-Smith, Thomas, & Wojtys, 2008). Other studies have evaluated effects of treadmill and on ground gait training using self-selected velocity by the individuals during 2 (Moraiti, Stergiou, Vasiliadis, Motsis, & Georgoulis, 2010), 3 (Kurz, Stergiou, Buzzi, & Georgoulis, 2005) and 7 years post ACL reconstruction (Sanford, Zucker-Levin, Williams, Mihallko & Jacobs, 2012) They showed, relative to a control group, differences in the gait kinematics using the trajectory of the movement (Moraiti et al, 2010), lower amplitude of the knee flexion angle (Lyon, Liu, Hung, & Kernozek, 2011), altered dynamic phase (Kurz et al, 2005), and increased valgusvarus moment of the knee, especially during the support phase (Sanford et al, 2012)
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