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| Name | Class |
|---|---|
| University of Bergen | OTHER |
| Norwegian Fund for Postgraduate Training in Physiotherapy | OTHER |
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Background:
An estimated 4000 Anterior Cruciate Ligament Injuries (ACL) occur annually in Norway (Granan et al., 2004). 1630 primary ACL reconstructions were performed in Norway in 2008 (Norwegian Arthroplasty Register, 2009). Approximately 120 of these ACL reconstructions were performed at Haraldsplass Deaconess Hospital.
Physical therapists at our hospital are responsible for postoperative outpatient controls of patients with a reconstructed anterior cruciate ligament. A clinical observation is that stair walking (especially downstairs) may be problematic up to 6 months after ACL reconstruction. One reason may be that the quadriceps muscle is unable to control the knee when the subject is walking downstairs, and that the knee is perceived to be unstable. Other contributing factors may be pain and swelling.
It is of interest to know which pre and post operative factors can predict measured and patient reported function 6 months after ACL reconstruction. Previous research shows that predictive factors for clinical outcome after ACL reconstruction are anterior knee pain (Heijne et al., 2009), preoperative electromyography, early postoperative strength (McHugh et al., 2002), preoperative quadriceps muscle strength deficits, meniscus injury and pain (Eitzen et al., 2009), obesity, smoking and serious chondrosis (Kowalchuk et al., 2009).
Purpose:
Methods:
The investigators wish to recruit 35 people scheduled for anterior cruciate ligament (ACL) reconstruction with hamstrings tendon graft.
Patients will be asked to write a training diary.
Data will be collected 1 day preoperatively, 2 days, 6 weeks, 3 months and 6 months post operatively.
Ethics:
All participants will have to give informed consent before inclusion. All information obtained through the surveys will be treated confidentially. Participation is completely voluntary.
References:
GRANAN, L., ENGEBRETSEN, L. & BAHR, R. (2004) Kirurgi ved fremre korsbåndskader i Norge - sett fra et idrettsmedisinsk perspektiv. Tidsskr Nor Lægeforen, 124, 928-930.
NASJONALT REGISTER FOR LEDDPROTESER (2009) Nasjonalt korsbĂĄndregister. Ortopedisk klinikk Haukeland Universitets Sykehus.
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| Measure | Description | Time Frame |
|---|---|---|
| Asymmetry in step time between the affected and unaffected leg during down stairs walking. | A triaxial kinematic sensor (XSens Mtx) positioned at the level of the lower trunk will be used to identify foot strike and separate left and right steps. | 6 months postoperatively |
| Isokinetic muscle strength measured with a fixed dynamometer (isok BI con/con 60/60 240/240 BIODEX). | 6 months postoperatively | |
| Single leg hop test for distance, a 6-m timed hop test, a triple hop test for distance, a crossover hop test for distance (Noyes et al, 1991). | 6 months postoperatively | |
| Self reported function. | International Knee Documentation Committee 2000 subjective knee evaluation form. | 6 months post operatively |
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores on a visual analog scale | 1 day preoperatively | |
| Degree of swelling measured with The Modified Stroke Test (Logerseth at al, 2010). | 1 day preoperatively | |
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Inclusion Criteria:
Exclusion Criteria:
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Patients planned for reconstruction of the anterioir crucuate ligament with hamstrings graft.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Willemijn Vervaat, MSc | Contact | 004755978618 | wive@haraldsplass.no |
| Name | Affiliation | Role |
|---|---|---|
| Willemijn Vervaat, MSc | Haraldsplass Deaconess Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Haraldsplass Deaconess hospital | Recruiting | Bergen | 5096 | Norway |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 14730723 | Background | Adlerton AK, Moritz U, Moe-Nilssen R. Forceplate and accelerometer measures for evaluating the effect of muscle fatigue on postural control during one-legged stance. Physiother Res Int. 2003;8(4):187-99. doi: 10.1002/pri.289. | |
| 3491982 | Background | Arvidsson I, Arvidsson H, Eriksson E, Jansson E. Prevention of quadriceps wasting after immobilization: an evaluation of the effect of electrical stimulation. Orthopedics. 1986 Nov;9(11):1519-28. doi: 10.3928/0147-7447-19861101-08. |
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| The circumference around the center of the patella will be measured to assess for swelling around the knee joint. |
| 1 day preoperatively |
| Passive range of movement compared to the healthy knee, measured with a goniometer. | 1 day preoperatively |
| Isokinetic muscle strength measured with a fixed dynamometer (isok BI con/con 60/60 240/240 BIODEX) | 1 day preoperatively |
| Asymmetry in step time between the affected and unaffected leg during down stairs walking. | A triaxial kinematic sensor (XSens Mtx) positioned at the level of the lower trunk will be used to identify foot strike and separate left and right steps. | 1 day preoperatively |
| Self reported function | International Knee Documentation Committee 2000 subjective knee evaluation form | 1 day preoperatively |
| Muscle atrophy in the quadriceps muscle will be measured 12 and 17 cm above the medial knee joint line. | 1 day preoperatively |
| Passive range of movement compared to the healthy knee, measured with a goniometer. | at discharge |
| Pain scores on a visual analog scale. | at discharge |
| Difficulties with walking downstairs on a visual analog scale. | 1 day preoperative |
| Pain scores on a visual analog scale. | 6 weeks post operatively |
| Difficulties with walking down stairs on a visual analog scale. | 6 weeks postoperatively |
| Degree of swelling measured with The Modified Stroke Test (Logerseth at al, 2010). | 6 weeks postoperatively |
| The circumference around the center of the patella will be measured to assess for swelling around the knee joint. | 6 weeks postoperatively |
| Passive range of movement compared to the healthy knee will be measured with a goniometer. | 6 weeks postoperatively |
| Asymmetry in step time between the affected and unaffected leg during down stairs walking. | A triaxial kinematic sensor (XSens Mtx) positioned at the level of the lower trunk will be used to identify foot strike and separate left and right steps. | 6 weeks postoperatively |
| Muscle atrophy in the quadriceps muscle will be measured 12 and 17 cm above the medial knee joint line. | 6 weeks postoperatively |
| Knee joint laxity measured with knee laxity testing device (KT 1000). | 6 weeks postoperatively |
| Asymmetry in step time between the affected and unaffected leg during down stairs walking. | A triaxial kinematic sensor (XSens Mtx) positioned at the level of the lower trunk will be used to identify foot strike and separate left and right steps. | 3 months postoperatively |
| Pain scores on a visual analog scale. | 3 months postoperatively |
| Difficulties with walking down stairs on a visual analog scale. | 3 months postoperatively |
| Degree of swelling measured with The Modified Stroke Test (Logerseth at al, 2010). | 3 months postoperatively |
| The circumference around the center of the patella will be measured to assess for swelling around the knee joint. | 3 months postoperatively |
| Passive range of movement compared to the healthy knee, measured with a goniometer. | 3 months postoperatively |
| Muscle atrophy in the quadriceps muscle will be measured 12 and 17 cm above the medial knee joint line. | 3 months postoperatively |
| Knee joint laxity measured with a knee laxity testing device (KT 1000). | 3 months postoperatively |
| 9167814 | Background | Bjordal JM, Arnly F, Hannestad B, Strand T. Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med. 1997 May-Jun;25(3):341-5. doi: 10.1177/036354659702500312. |
| 7810787 | Background | Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994 Sep-Oct;22(5):632-44. doi: 10.1177/036354659402200511. |
| 17210423 | Background | de Jong SN, van Caspel DR, van Haeff MJ, Saris DB. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy. 2007 Jan;23(1):21-8, 28.e1-3. doi: 10.1016/j.arthro.2006.08.024. |
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| 19224907 | Background | Eitzen I, Holm I, Risberg MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009 May;43(5):371-6. doi: 10.1136/bjsm.2008.057059. Epub 2009 Feb 17. |
| 19487126 | Background | Helbostad JL, Vereijken B, Hesseberg K, Sletvold O. Altered vision destabilizes gait in older persons. Gait Posture. 2009 Aug;30(2):233-8. doi: 10.1016/j.gaitpost.2009.05.004. Epub 2009 May 31. |
| 17897830 | Background | Hodt-Billington C, Helbostad JL, Moe-Nilssen R. Should trunk movement or footfall parameters quantify gait asymmetry in chronic stroke patients? Gait Posture. 2008 May;27(4):552-8. doi: 10.1016/j.gaitpost.2007.07.015. Epub 2007 Sep 25. |
| 11560085 | Background | Holder-Powell HM, Di Matteo G, Rutherford OM. Do knee injuries have long-term consequences for isometric and dynamic muscle strength? Eur J Appl Physiol. 2001 Aug;85(3-4):310-6. doi: 10.1007/s004210100474. |
| 2036801 | Background | Johansson H, Sjolander P, Sojka P. Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng. 1991;18(5):341-68. |
| 19409302 | Background | Kowalchuk DA, Harner CD, Fu FH, Irrgang JJ. Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2009 May;25(5):457-63. doi: 10.1016/j.arthro.2009.02.014. |
| 12016072 | Background | McHugh MP, Tyler TF, Browne MG, Gleim GW, Nicholas SJ. Electromyographic predictors of residual quadriceps muscle weakness after anterior cruciate ligament reconstruction. Am J Sports Med. 2002 May-Jun;30(3):334-9. doi: 10.1177/03635465020300030601. |
| 11415804 | Background | Moe-Nilssen R. A new method for evaluating motor control in gait under real-life environmental conditions. Part 2: Gait analysis. Clin Biomech (Bristol). 1998 Jun;13(4-5):328-335. doi: 10.1016/s0268-0033(98)00090-4. |
| 11415803 | Background | Moe-Nilssen R. A new method for evaluating motor control in gait under real-life environmental conditions. Part 1: The instrument. Clin Biomech (Bristol). 1998 Jun;13(4-5):320-327. doi: 10.1016/s0268-0033(98)00089-8. |
| 16531394 | Background | Moe-Nilssen R, Helbostad JL, Akra T, Birdedal L, Nygaard HA. Modulation of gait during visual adaptation to dark. J Mot Behav. 2006 Mar;38(2):118-25. doi: 10.3200/JMBR.38.2.118-125. |
| 14623667 | Background | Myklebust G, Holm I, Maehlum S, Engebretsen L, Bahr R. Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med. 2003 Nov-Dec;31(6):981-9. doi: 10.1177/03635465030310063901. |
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| 17895440 | Background | Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O. Physical fatigue affects gait characteristics in older persons. J Gerontol A Biol Sci Med Sci. 2007 Sep;62(9):1010-5. doi: 10.1093/gerona/62.9.1010. |
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