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Determine the effecttiveness of a cross-education strength training protocol in a group of subjects with an anterior cruciate ligament surgery.
The cross-education (CE) phenomenon has been studied in recent years as a form of gain muscle strength not only in healthy subjects but also in acute injuries such as musculoskeletal disorders and immovilitations. Unilateral training of the not injured limb has been suggested as an option to produce cross-edutation in terms of strength and skills. In addition, functional magnetic resonance imaging have been postulated as a promising tool to study the mechanisms of transfer.
In the context of our study, arthrogenic muscle inhibition (AMI) of knee extensors is a common consequence after ACL repair in which a CE strength training can lead to reduce quadriceps atrophy and its implications in long terms achievements. Thus, an unilateral strength protocol of the uninjuried limb, according to the last Delphi Consensus, will be run for 10 weeks to check the possible benefits of the transfer in a sample of ACL repair.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | Active Comparator | Standard protocol rehabilitation programme for an anterior cruciate ligament repair based on VAN MELICK N, et al 2016. |
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| Cross-education group | Experimental | Standard protocol rehabilitation programme for an anterior cruciate ligament repair based on VAN MELICK N, et al 2016. Additionally a contralateral lower limb strength training. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Best current rehabilitation protocol | Other | Inflamation control and edema with physical agents, recover full pasive and active range of motion, normalize gait pattern, lower limb strengthening (specially quadriceps and hamstrings), neuromuscular control training, cycling, landings and running. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in quadriceps strength. | Isometric Maximal voluntary contraction in 60º/90º of knee extension. Both legs. Patients performed two familiarization trials at 50% of their estimated MVC. Then 3 test of maximal contraction will be done. Measured in newtons. | Pre-surgery and 12 week post-surgery |
| Structural changes in brain. | Fractional anisotropy (FA) and mean diffusivity (MD) will be used for measure white matter microstructure and corticospinal tracts with diffusion tensor imaging (DTI). Voxel-based morphometry (VBM) will be used to measure volumen, thickness and size of white matter in with T1-weighted images. | Pre-surgery and 12 week post-surgery |
| Functional changes in brain | Functional magnetic resonance imaging (fMRI) with active and resting blocks of knee extensions in both legs, and resting-state imaging. Blood-oxygen level dependent (BOLD) will be used for measure functional connectivity in resting and during motor task. | Pre-surgery and 12 week post-surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Limb symmetry index (LSI). | Comparison of both quadriceps MVC. Measured in percentage. | Pre- surgery, 12 week post-surgery |
| Peak rate of force development (RFD). | Explosive strength as the speed which the muscle (quadriceps) can develop force. Measured in newtons per second. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Antonio Cuesta Vargas | Málaga | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33175329 | Background | Manca A, Hortobagyi T, Carroll TJ, Enoka RM, Farthing JP, Gandevia SC, Kidgell DJ, Taylor JL, Deriu F. Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of Cross-Education. Sports Med. 2021 Jan;51(1):11-20. doi: 10.1007/s40279-020-01377-7. | |
| 35279020 | Result |
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| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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Randomized controlled trial, with two parallel groups (control and intervention)
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Assessors are not aware of the allocation group of the participants
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| Cross-training protocol | Other | Beginning on 2º week after ACLR, 2 times per week during 10 weeks, based on isotonic exercise in leg extension and leg press. |
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| Pre- surgery, 12 week post-surgery |
| Muscle activation | Surface eletromyography in the main muscles of quadriceps (rectus femoris, vastus medialis, vasto lateralis) during the MVIC test and double leg squat. Peaks in root-mean-square value (RMS) will be taken for each muscle in each test. | Pre- surgery, 6 week post-surgery, 12 week post-surgery |
| Cross-sectional area of quadriceps | Sonography of quadriceps to determine the cross-sectional area of rectus femoris, vastus medialis and vastus laterlis. Measured in cm2. | Pre- surgery, 12 week post-surgery |
| The International Knee Documentation Committee (IKDC) questionnarie. | IKDC is a reliable and valid measure for ACLR. It consists on 10 items related to knee symptons, knee function and sports activities. Score range from 0 to 100 with higher scores determine less disfunction. | Pre- surgery12 weeks post-surgery |
| The Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. | The KOOS is a self-administered questionnaire with variables related to symptons, pain, quality of life, daily tasks and function and sport activities. Score range 0 to 100 with high scores indicating better and positive knee outcomes. | Pre-surgery, 2 week, 4 week, 6 week, 8 week, 10 week and 12 week post-surgery |
| Muscle thickness of quadriceps. | Measured in cm by ultrasonography in both quadriceps. | Pre- surgery, 12 week post-surgery |
| Single leg stand | Changes in medial-lateral and anterior-posterior center of pressure (mm) and mean velocity changes (mm/s) will be analyzed during single leg stand in both legs with force platforms. | Pre-surgery, 6 week and 12 week post-surgery |
| Double leg squat assessment | Patients will be asked to perform squat in two ways: as deep as the can and also limited to 90º of knee flexion. 3 set of 5 repetitions. Assymmetry in concenctric and eccentric mean force (%) between left and right limb and maximum negative displacement (cm) will be used to measure differences in each limb performance. | Pre-surgery, 6 week and 12 week post-surgery |
| The TSK-11 questionnaire | The Tampa Scale for Kinesiophobia is a self-administered questionnaire to evaluate fear to movement, pain and re-injury. Score range 0 to 11, indicating better results with higher score. | Pre- surgery, 12 week post-surgery |
| Cuyul-Vasquez I, Alvarez E, Riquelme A, Zimmermann R, Araya-Quintanilla F. Effectiveness of Unilateral Training of the Uninjured Limb on Muscle Strength and Knee Function of Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Cross-Education. J Sport Rehabil. 2022 Mar 12;31(5):605-616. doi: 10.1123/jsr.2021-0204. Print 2022 Jul 1. |