Effects of Delayed-Onset Muscle Pain on Respiratory Muscle Function.

BACKGROUND: Delayed-onset muscle soreness (DOMS) has been widely examined in the peripheral muscles; however, studies showing the potential effects of DOMS on respiratory function are limited. HYPOTHESIS: DOMS in trunk muscles has a negative effect on respiratory function parameters, respiratory muscle strength, respiratory muscle endurance, and exercise capacity. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: In 24 healthy participants with a mean age of 21 ± 2 years, DOMS was induced for the trunk muscles with a load equal to 80% of the maximum repetitive voluntary contraction. Pulmonary function parameters, respiratory muscle strength and endurance, exercise capacity, pain, fatigue, and dyspnea perception severity were recorded before DOMS and at 24 and 48 hours after DOMS. RESULTS: After DOMS, decreases were observed in respiratory function parameters, namely, forced vital capacity, forced expiratory volume in the first second, vital capacity, and 25% to 75% flow rate value of forced expiratory volume (25% to 75%) (P = 0.02, P = 0.02, P < 0.01, P = 0.01, respectively). Maximal inspiratory pressure and exercise capacity also decreased (P = 0.02, P < 0.01, respectively). No difference was observed between all 3 measurements of maximal expiratory pressure (MEP) and MEP% values (P1 = P2 = P3 ≥ 0.99). The results of the respiratory muscle endurance tests did not reveal a significant difference in terms of load and time in all 3 conditions (P > 0.05). CONCLUSION: After DOMS, there was a 4% to 7.5% decrease in respiratory function parameters, and a 6.6% decrease in respiratory muscle strength. CLINICAL RELEVANCE: The occurrence of DOMS before a competition can have a detrimental impact on pulmonary performance. Hence, it is imperative to consider this factor when devising training and exercise programs. In addition, the development of treatment protocols becomes crucial if DOMS arises.

The Effect of Yoga Practice on Cervical Tactile Acuity and Body Awareness.

Body-mind-based holistic methods of relaxation and improved well-being, such as yoga and meditation, improve body awareness and have often been used to enhance quality of life and the ability to cope with pain. We aimed to compare tactile sensory acuity and body awareness in healthy sedentary individuals who practiced yoga regularly and in control participants who had not practiced yoga. Participants were 60 individuals, aged between 18 and 35 years who were divided into two groups according to whether they had previously practiced yoga. We used the two-point discrimination (TPD) test to determine participants' tactile acuity, as measured with a digital calliper at the C7, C5, C3, C1 and T1 spinal segments and with the Body Awareness Questionnaire (BAQ). The TPD measurements of individuals who practiced yoga and meditation had a lower discriminatory threshold compared to those who had not practiced yoga (p < .001), and the self-reported BAQ score of yoga practitioners was higher than that of the controls (p < .001). We found a positive correlation between the length of the prior duration of yoga experience and self-reported body awareness (r = .567, p < .001). There was a significant negative correlation (r = -.379, p = .015) between the C5 segment and the TPD measurements, but not for the other cervical spinal segments (p > .05). There was a negative correlation between the length of prior yoga practice and the TPD measurements in all cervical segments (p < .001). The most negative correlation was found at the C7 segment (r = -.844, p < .001) and the least negative correlation was found at the C3 segment (r = -.669, p < .001). These data suggest that yoga and meditation practices may improve well-being and diminish pain by increasing body awareness and tactile sensory acuity in the cervical region.

Effect of Q-angle, lateral distal tibial angle and hip muscle torques on ankle injury.

BACKGROUND: The ankle sprain is the most common ankle injury. Although the factors that increase the risk of ankle injury are included in the literature, the definitive evidence is controversial. OBJECTIVE: The aim of our study was to examine whether Q-angle, lateral distal tibial angle (LDTA), and hip muscle torque are associated with ankle sprain. METHODS: Thirty-six individuals who underwent an axial X-ray examination of the lower extremity following ankle sprain were included. The Q-angle and LDTA were measured on the axial knee X-rays on both sides. The isometric muscle strength was measured with a digital handheld dynamometer for the quadriceps femoris muscle, the gluteus medius muscle and the gluteus maximus muscle. Muscle torques were calculated by multiplying isometric muscle strength values with the distance to the joint center. RESULTS: Discrimination analysis shows that the gluteus maximus (0.90), gluteus medius (0.49), quadriceps femoris muscle torques (0.34), and lateral distal tibial angle (0.43) were the factors that most contributed to ankle sprain. No significant relationship was found between the Q-angle and ankle sprain (p = 0.603). A strong relationship was found between LDTA, quadriceps femoris, gluteus medius and gluteus maximus muscle torques and ankle sprain (p = 0.014, p < 0.001, p = 0.011, p = 0.002, respectively). CONCLUSIONS: In conclusion, the torques of the proximal muscle may be more related than the Q-angle to lateral ankle sprain injury. Individuals with high LDTA should also be carefully examined for the risk of ankle sprain.

Validity and reliability of Turkish transcultural adaptation of the Prosthetic Limb Users Survey of Mobility.

BACKGROUND: Amputee-specific, self-assessment mobility scales are essential to evaluate mobility in lower-limb amputees. OBJECTIVES: To evaluate the validity and reliability of a Turkish translation and adaptation of the Prosthetic Limb Users Survey of Mobility. STUDY DESIGN: This is a validation study. METHODS: Turkish translation of the Prosthetic Limb Users Survey of Mobility (PLUS-M-T) from its original was performed following the rules of intercultural adaptation and translation methods. The PLUS-M-T and its 12-item short form were applied to '100 induviduals with limb loss twice in 3-day intervals. The structural validity analysis was determined by calculating the correlation with the Amputee Mobility Scale, which is a valid, reliable scale for assessing the functional level in amputees. The Cronbach alpha coefficient was calculated to analyze the internal consistency. The interclass correlation coefficient (ICC) and Spearman correlation coefficient (r) were calculated, and the test-retest reliability was determined. RESULTS: A positive, high correlation was found between the first application and its repetition of both PLUS-M-T (ICC = 0.85, r = 0.94, P < 0.001) and 12-item short form (ICC = 0.92, r = 0.93, P < 0.001). The internal consistency was high for both PLUS-M-T (Cronbach alpha = 0.94) and 12-item short form (Cronbach alpha = 0.91). A positive, high correlation was found between the scores obtained from the Amputee Mobility Scale and PLUS-M-T (r = 0.84, P < 0.001) and 12 question short form (r = 0.77, P < 0.001). CONCLUSION: Turkish translation of the PLUS-M questionnaire is a valid and reliable scale for assessing the mobility of individuals who have undergone lower-extremity amputation using a prosthesis.

Comparison of the Effectiveness of Kinesiology Taping and Rigid Taping on Ankle Kinematics During Drop Landing in Individuals with Lateral Ankle Injury.

BACKGROUND: Lateral ankle sprain is an injury that often occurs during sports or daily life activities. Athletic tape and kinesiology tape applications are among the external support treatment options especially for athletes to support the ankle and protect it from recurrent sprains. We sought to compare the kinematic stabilization effects of different ankle taping applications on the ankle joint during drop landing in individuals with a history of unilateral lateral ankle injury. METHODS: In this randomized controlled study, 30 volunteers with unilateral ankle injury were evaluated. The participants were asked to land on one leg on the involved side and the contralateral side from a 30-cm-high platform. The same practice was repeated after applying kinesiology tape and rigid tape to the injured foot. Kinematic analysis of the foot and ankle was performed by recording three-dimensional spatial position information at a speed of 240 frames per second using infrared cameras. RESULTS: The highest inversion angles of the involved foot at initial contact and 150 msec after initial contact were higher than those of the uninvolved side (P = .03 and P = .04, respectively). There was no significant difference in ankle kinematic values in the involved foot among kinesiology taping, athletic taping, and no taping applications (P = .74). CONCLUSIONS: People with lateral ankle sprains show reduced inversion during landing. There were no significant differences among kinesiology taping, athletic taping, and no taping on the injured foot in terms of ankle kinematics. Care should be taken when using taping materials as protective measures for sports activities.

The effect of elastic therapeutic taping and rigid taping on pain, functionality, and tissue temperature in lumbar radiculopathy: a randomized controlled study.

PURPOSE: To compare the therapeutic effects of different taping materials and techniques on pain, functionality, and tissue temperature in patients with lumbar radiculopathy. Methods: Patients with lumbar radiculopathy were included in the study (n = 51). Patients were randomly divided into three groups, which were the elastic taping (n = 17), rigid taping (n = 17), and placebo taping groups (n = 17). All patients were enrolled in a physiotherapy and rehabilitation program that included thermotherapy, electrotherapy, and exercise five times a week for 2 weeks. The pain was measured before and after treatment using the Visual Analogue Scale. Functionality and quality of life were measured using the Oswestry Low Back Pain Disability Questionnaire and Roland-Morris Disability Questionnaire. The tissue temperature of the treated area in the lumbar region was measured by digital electronic infra-red thermography. Results: After the treatment, pain, functionality, and quality of life were improved in all groups (p < 0.05). Elastic taping was more effective in decreasing pain and increasing functionality than placebo taping (p < 0.05), but no difference was observed between placebo taping and rigid tapping. Local tissue temperature did not change before and after treatment in the elastic taping group (p > 0.05). Tissue temperature increased in the rigid and placebo taping groups (p < 0.05). Conclusion: Taping therapy in patients with lumbar radiculopathy has a positive effect on pain and functional status. Elastic taping can be recommended for clinical use because its effect is superior in some recovery parameters and its ease of use.

The effects of clinical pilates exercises on functional disability, pain, quality of life and lumbopelvic stabilization in pregnant women with low back pain: A randomized controlled study.

BACKGROUND: Although the Pilates method has been reported to be effective in women with low back pain (LBP), the efficacy of Pilates exercises in pregnant women with LBP has not been evaluated widely. OBJECTIVE: The purpose of this study was to determine the effects of clinical Pilates exercises on lumbopelvic stabilization, pain, disability and quality of life in pregnant women with LBP. METHODS: Fourty pregnant women were randomized into either a Pilates exercise group (n= 20) or control group (n= 20). Subjects in the Pilates exercise group performed the exercises two times a week for eight weeks. Subjects in the control group followed regular prenatal care. Lumbopelvic stabilization was assessed with a pressure biofeedback unit, pain with the Visual Analog Scale, disability with the Oswestry Low Back Pain Questionnaire and quality of life with the Nottingham Health Profile (NHP). RESULTS: Pain and disability were significantly improved in the Pilates exercise group after intervention (p= 0.03, p< 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises (p= 0.048, p= 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group (p> 0.05). CONCLUSIONS: Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.

Hot and cold knees: exploring differences in patella skin temperature in patients with patellofemoral pain.

OBJECTIVES: To investigate the distribution of patella skin temperature (Tsk) measurements and to explore the presence of temperature subgroups in patellofemoral pain (PFP) patients. DESIGN: Cross-sectional observational study design. PARTICIPANTS: One dataset of 58 healthy participants and 232 PFP patients from three different datasets. MAIN OUTCOME MEASURES: Patella skin temperature, measured by physiotherapists using a low cost hand held digital thermometer. The distribution of patella skin temperature was assessed and compared across datasets. To objectively determine the clinically meaningful number of subgroups, we used the average silhouette method. Finite mixture models were then used to examine the presence of PFP temperature subgroups. Receiver operating characteristic curves were used to estimate optimal patella Tsk thresholds for allocation of participants into the identified subgroups. RESULTS: In contrast to healthy participants, the patella skin temperature had an obvious bimodal distribution with wide dispersion present across all three PFP datasets. The fitted finite mixture model suggested three temperature subgroups (cold, normal and hot) that had been recommended by the average silhouette method with discrimination cut-off thresholds for subgroup membership based on receiver operating curve analysis of Cold=<30.0°C; Normal 30.0-35.2°C; Hot ≥35.2°C. CONCLUSION: A low cost hand held digital thermometer appears to be a useful clinical tool to identify three PFP temperature subgroups. Further research is recommended to deepen understanding of these clinical findings and to explore the implications to different treatments.

The reliability and validity of the Turkish version of the oxford shoulder instability score.

Background: The aim of this study was to adapt the Oxford Shoulder Instability Score to Turkish culture and test its reliability and validity.Methods: This study included 118 patients with shoulder instability. Confirmatory factor analyses, and correlation coefficient between Oxford Shoulder Instability Score and Short Form 36 were calculated in order to test construct validity. Internal consistency was tested using Cronbach's alpha. Pearson correlation were calculated to test reliability. Differential item functioning analysis was performed to detect whether items exhibited differences according to gender.Results: Confirmatory factor analysis indicating the single structure of the Oxford Shoulder Instability Score was confirmed. Cronbach's alpha was calculated as 0.87 for the whole scale. There were positive and strong correlations between the first and follow-up assessments (r = 0.86, p < 0.01). The Turkish version of OSIS showed moderate and significant correlations with domains of the SF-36 in general. Results also showed that there was no item exhibiting differential item functioning analysis in the Turkish version of Oxford Shoulder Instability Score.Conclusion: The Turkish version of the Oxford Shoulder Instability Score is a reliable, valid, reproducible and practical tool. It can be used for patients with shoulder disorders and is recommended for clinical use.Implications for RehabilitationOxford Shoulder Instability Score is a 12-item tool measuring health-related quality of life and shoulder functions.Since the Turkish version of the Oxford Shoulder Instability Score is confirm to be a reliable, valid, and reproducible tool, it can be used in clinics to assess the functional status in patient with shoulder instability.It can be recommended to identify improvements in patients with shoulder problems for research purposes as well.

Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?

BACKGROUND: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. HYPOTHESIS: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. STUDY DESIGN: Prospective crossover intervention. LEVEL OF EVIDENCE: Level 3. METHODS: Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. RESULTS: In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the "weak and pronated foot" and the "weak and tight" subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the "strong" subgroup (P = 0.006). CONCLUSION: Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. CLINICAL RELEVANCE: Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.

Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

OBJECTIVES: This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. PATIENTS AND METHODS: The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. RESULTS: Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. CONCLUSION: The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

The reliability and validity of the Turkish version of the Oxford Elbow Score.

BACKGROUND: Objective measures of outcome ensure reliable decisions with regard to treatment planning. Oxford Elbow Score (OES) is one of the common outcome measures used for assessing quality of life of patients with elbow disorders. OES consists of three domains: pain, elbow function and social/psychological. The aim of this study is to test the validity and reliability of the Turkish version of the OES. METHODS: The study's sample includes 82 patients with elbow problems. The original version of the OES was translated into Turkish using the Isis Outcomes Translation and Linguistic Validation Process. The construct validity of the Turkish version of the OES was tested using a confirmatory factor analysis. For internal consistency, Cronbach's alpha was calculated. A Pearson correlation and a dependent sample t test were utilised for reproducibility of the OES. For convergent validity, the correlation coefficients were calculated between the domains of the OES and Short Form 36 (SF36). An independent sample t test was calculated to determine if there was a significant difference between the scores of the participants from the upper and lower groups. RESULTS: Confirmatory factor analysis (CFA) indicates that the three-factor structure of the OES was confirmed. Most of the fit indices are at the expected level, except for a root mean square error of approximation and an adjusted goodness of fit index. Cronbach's alpha was calculated as 0.91 for the whole scale. The results showed that there are positive and high correlations between the first and follow-up assessments (r = 0.89, p < 0.0001). The Turkish OES version and its dimensions have moderate and significant correlations with domains of SF36 in general. The test results indicated that the mean of each item on three domains of the OES was higher for the upper 27 %, and this difference was significant at the 0.01 level. CONCLUSIONS: The Turkish version of the OES is a reliable, valid, reproducible and practical tool. It can be used for patients with elbow disorders and is recommended for clinician use.

Acute physiological responses to physiotherapy applications pre and post autologous stem cell transplantation: an experimental study.

OBJECTIVE: We aimed to investigate the acute physiological responses (APR) to physiotherapy applications in patients undergoing autologous stem cell transplantation (ASCT), the difference between pre- and post-ASCT according to APR. METHODS: Twenty-six patients who were hospitalized for ASCT attended regular physiotherapy program. APR was recorded in the beginning and at the end of each exercise session. The differences in APR were calculated for each session. The mean values of the differences in APR were computed in pre-conditioning, pre-, and post-ASCT. Daily complete blood counts were also recorded during ASCT. RESULTS: Hemoglobin and platelet counts were significantly lower pre- and post-ASCT. Neutrophil counts were significantly lower post-ASCT. The difference in systolic blood pressure (SBP) in the beginning and at the end of the exercise sessions was significantly higher post-ASCT in comparison to pre-ASCT. CONCLUSION: There was no significant change in APR except the SBP which suggests that similar level of exercise intensity could be tolerated in pre- and post-ASCT periods as well as preconditioning.

Is there a relationship between tracking ability, joint position sense, and functional level in patellofemoral pain syndrome?

PURPOSE: This prospective cohort study investigated proprioception and motor control changes in patients with patellofemoral pain syndrome (PFPS), and how these changes related to knee function, pain, muscle strength and muscle endurance. METHODS: The study included 43 women diagnosed with unilateral patellofemoral pain syndrome. Thirty-one healthy women were recruited as control group. Peak quadriceps femoris and hamstring muscle isokinetic torques were recorded at 60 and 180°/s. Joint position sense was tested by active reproduction of joint position during horizontal squat performance. Muscle coordination and motor control ability were tested by a multi-joint lower limb tracking-trajectory test. Muscle endurance was tested using a computerized functional squat system. Severity of pain in during stair ascent/descent, squatting, and prolonged sitting with knees 90° flexed were measured using a 10 category modified visual analogue scale. Functional levels of patients were determined using Kujala patellofemoral scores. RESULTS: Active reproduction of joint position did not differ between PFPS and control groups. However, tracking-trajectory error was significantly higher in PFPS group than control subjects. Hamstring and quadriceps peak isokinetic torque and muscle endurance scores were significantly lower in the PFPS group. Kujala patellofemoral score displayed significant relationships with peak isokinetic quadriceps torque, knee pain, and joint position sense scores. Pain during stair descent, sitting, and quadriceps torque at 180°/s explained 57.7 % of the variation in Kujala patellofemoral score. CONCLUSION: Although lower extremity joint position sense did not differ between groups, the PFPS group displayed a target-trajectory muscular coordination deficit, decreased muscular endurance, and decreased muscular strength compared to control group subjects. Pain level directly related to motor control performance while joint position sense scores did not. Knee pain and impaired strength related more to functional performance impairment than joint position sense scores in patients with PFPS.

Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft.

OBJECTIVE: The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. METHODS: Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery, quadriceps and hamstring torque values were recorded using an isokinetic dynamometer. Computerized coordination and proprioception tests (Functional Squat System; Monitored Rehab System) were performed to determine the deficits in joint position sense. The anterior translation test was performed using a Kneelax 3 arthrometer to determine knee laxity. RESULTS: Side-to-side differences between groups for hamstring and quadriceps muscle strength, concentric and eccentric motor coordination and anterior tibial laxity were not significantly different (p>0.05). CONCLUSION: No statistically significant differences in functional outcome were found 1 year after the ACL reconstruction using Endobutton post-fixation and femoral transfixation with hamstring tendon graft. Deficits in hamstring-quadriceps muscle strength, motor coordination and proprioception were still found in both groups. We therefore recommend that long-term follow-up and rehabilitation including neuromuscular exercises should be continued for longer than one year after ACL reconstruction.

Tracking ability, motor coordination, and functional determinants after anterior cruciate ligament reconstruction.

CONTEXT: The development pattern of motor coordination, strength, and functional ability during recovery from anterior cruciate ligament (ACL) reconstruction. OBJECTIVE: To investigate the relationship between motor coordination, functional ability, and strength after ACL reconstruction. DESIGN: Prospective clinical follow-up study. SETTING: Sports-injury research laboratory. PARTICIPANTS: 20 subjects who underwent ACL reconstruction. INTERVENTIONS: Real-time eccentric and concentric motor coordination were tested by a multijoint lower limb tracking-trajectory test, quadriceps and hamstring isokinetic strength were assessed by isokinetic dynamometer, and functional performance was tested with a single-leg-hop test 6 and 12 mo after ACL reconstruction. MAIN OUTCOME MEASURES: Percentage deficits of the involved lower extremity for target-tracking ability, peak torque, total work parameters of isokinetic strength, and single-leg-hop distance. RESULTS: Deficits in hamstring-quadriceps isokinetic muscle strength and single-leg-hop distance significantly decreased from the 6th to the 12th mo after surgery (P < .05). There were no significant differences in muscle concentric and eccentric motor-coordination deficits of the involved side (P > .05). CONCLUSIONS: Although muscle strength and functional performance clearly increased from the 6th to the 12th mo after surgery, coordination characteristics of involved side remained low. This pattern demonstrated that motor-coordination progression was not affected by strength development. Patients continued to have significant motor-coordination deficits even 12 mo postsurgery. Therefore, the authors recommend that neuromuscular-coordination exercises be included in long-term rehabilitation programs to improve motor coordination.

Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction.

PURPOSE: To evaluate muscle torque, lower extremity coordination, and knee laxity after ACL reconstruction comparing patients operated on with semitendinosus graft (ST) and patients with combined semitendinosus and gracilis (STGR) grafts. METHODS: Forty-six subjects who underwent ST (n = 23) or STGR harvest (n = 23) ACL reconstruction participated in this study. Quadriceps and hamstring torque were recorded using an isokinetic dynamometer. The anterior tibial translation was measured using the Kneelax 3 Arthrometer. The eccentric and concentric motor coordination was tested by multi-joint lower-limb tracking-trajectory test. All measurements were taken 12 months after surgery. Side-to-side differences were determined for all subjects. RESULTS: Side-to-side differences in extensor peak torque at 180°/s and 60°/s did not differ between semitendinosus (ST) and semitendinosus + gracilis (STGR) groups (n.s.). However, side-to-side differences in flexor peak torque were significantly higher at 60°/s for the STGR group than the ST group (P = 0.002). Side-to-side differences in eccentric and concentric parts of tracking-trajectory test and anterior tibial translation did not differ between the STGR and the ST groups (n.s.). CONCLUSION: The outcomes of this study suggested that additional harvest of gracilis did not influence lower extremity motor control, quadriceps muscle torque, and anterior tibial translation; however, it affected knee flexion isokinetic torque negatively at low angular velocity. This finding could be important for functional activity or sports with high demands on hamstring muscle strength. It is recommended that gracilis muscle should be preserved as possible during ACL reconstruction. LEVEL OF EVIDENCE: Prospective comparative study, Level II.