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05.01.2021 | Systematic Review

Assessment of Quadriceps Corticomotor and Spinal-Reflexive Excitability in Individuals with a History of Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

verfasst von: Justin L. Rush, Neal R. Glaviano, Grant E. Norte

Erschienen in: Sports Medicine | Ausgabe 5/2021

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Abstract

Background

Differences in the excitability of motor generating neural pathways are reported following anterior cruciate ligament reconstruction (ACLR) that is associated with quadriceps dysfunction and theorized to prevent the full recovery of muscle function.

Objective

The aims of this systematic review and meta-analysis were to compare quadriceps neural excitability between the involved ACLR limb, the uninvolved limb, and uninjured controls, and to determine at what time intervals these differences are present after surgery.

Methods

We conducted a search of PubMed, SPORTDiscus, Embase, and Web of Science, and extracted measures assessing difference of quadriceps spinal-reflexive, corticospinal, and intracortical excitability from studies that compared (1) involved limb to the uninvolved limb, (2) involved limb to a control limb, or (3) uninvolved limb to a control limb. We stratified time at 24 months, since this represents a period of heightened risk for reinjury. A modified Downs and Black checklist and Egger’s test were used to determine the methodological quality of individual studies and risk of bias between studies.

Results

Fourteen studies comprising 611 participants (371 individuals with a history of ACLR; median time from surgery: 31.5 months; range 0.5–221.1 months) were included in the review. Overall, the involved (g = 0.60, 95% CI [0.24, 0.96]) and uninvolved (g = 0.49, 95% CI [0.00, 0.98]) limbs exhibited greater motor threshold (MT) in comparison to uninjured controls. Motor-evoked potential (MEP) amplitudes were greater in the uninvolved limb in comparison to uninjured controls (g = 0.31, 95% CI [0.03, 0.59]). Lesser intracortical inhibition was exhibited in the uninvolved limb compared to uninjured controls (g = 0.54, 95% CI [0.14, 0.93]). When stratified by time from surgery, MEP amplitudes were greater in the uninvolved limb compared to uninjured controls (g = 0.33, 95% CI [0.03, 0.63]) within the first 24 months after surgery. When evaluated more than 24 months after surgery, the involved limb exhibited greater Hoffmann reflex (H-reflex) compared to uninjured controls (g = 0.38, 95% CI [0.00, 0.77]). MT were greater in the involved limb (g = 0.93, 95% CI [− 0.01, 1.88]) and uninvolved limb (g = 0.57, 95% CI [0.13, 1.02]) compared to uninjured controls. MEP amplitudes in the involved limb were lesser compared to uninjured controls when evaluated more than 24 months after ACLR (g = -1.11, 95% CI [− 2.03, − 0.20]).

Conclusions

The available evidence supports that there are neural excitability differences within the corticospinal tract in individuals with ACLR when compared to uninjured controls. Future research should focus further on longitudinal assessments of neural excitability prior to and following ACLR. Identifying interventions aimed to facilitate corticospinal excitability after ACLR appears to be warranted to improve quadriceps function.

Trial Registration

Registered through PROSPERO CRD42020158714.

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Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34(9):1512–32.PubMed

Thomas AC, Villwock M, Wojtys EM, Palmieri-Smith RM. Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. J Athl Train. 2013;48(5):610–20.PubMedPubMedCentral

Palmieri-Smith RM, Lepley LK. Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med. 2015;43(7):1662–9.PubMedPubMedCentral

Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM. Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc. 2008;16(11):1009–16.PubMed

Lisee C, Lepley AS, Birchmeier T, O’Hagan K, Kuenze C. Quadriceps strength and volitional activation after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Health. 2019;11(2):163–79.PubMedPubMedCentral

Lepley LK, Palmieri-Smith RM. Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sports Phys Ther. 2015;45(12):1017–25.PubMedPubMedCentral

Lewek M, Rudolph K, Axe M, Snyder-Mackler L. The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon). 2002;17(1):56–63.

Oberlander KD, Bruggemann GP, Hoher J, Karamanidis K. Altered landing mechanics in ACL-reconstructed patients. Med Sci Sports Exerc. 2013;45(3):506–13.PubMed

Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.PubMedPubMedCentral

10.

Shimizu T, Samaan MA, Tanaka MS, Pedoia V, Souza RB, Li X, et al. Abnormal biomechanics at 6 months are associated with cartilage degeneration at 3 years after anterior cruciate ligament reconstruction. Arthroscopy. 2019;35(2):511–20.PubMed

11.

Lepley AS, Gribble PA, Thomas AC, Tevald MA, Sohn DH, Pietrosimone BG. Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: A 6-month longitudinal investigation. Scand J Med Sci Sports. 2015;25(6):828–39.PubMed

12.

Pietrosimone BG, Lepley AS, Ericksen HM, Clements A, Sohn DH, Gribble PA. Neural excitability alterations after anterior cruciate ligament reconstruction. J Athl Train. 2015;50(6):665–74.PubMedPubMedCentral

13.

Needle AR, Lepley AS, Grooms DR. Central nervous system adaptation after ligamentous injury: a summary of theories, evidence, and clinical interpretation. Sports Med. 2017;47(7):1271–88.PubMed

14.

Grooms DR, Page SJ, Nichols-Larsen DS, Chaudhari AM, White SE, Onate JA. Neuroplasticity associated with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2017;47(3):180–9.PubMed

15.

Hopkins JT, Ingersoll CD. Arthogenic muscle inhibition: a limiting factor in joint rehabiliation. J Sport Rehabil. 2000;9(2):135–59.

16.

Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. 2010;40(3):250–66.PubMed

17.

Hart JM, Bessette M, Choi L, Hogan MV, Diduch D. Sensory response following knee joint damage in rabbits. BMC Musculoskelet Disord. 2014;28(15):139.

18.

Hoffman M, Koceja DM. Hoffmann reflex profiles and strength ratios in postoperative anterior cruciate ligament reconstruction patients. Int J Neurosci. 2000;104(1–4):17–27.PubMed

19.

Palmieri RM, Tom JA, Edwards JE, Weltman A, Saliba EN, Mistry DJ, et al. Arthrogenic muscle response induced by an experimental knee joint effusion is mediated by pre- and post-synaptic spinal mechanisms. J Electromyogr Kinesiol. 2004;14(6):631–40.PubMed

20.

Hart JM, Kuenze CM, Diduch DR, Ingersoll CD. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. J Athl Train. 2014;49(6):733–9.PubMedPubMedCentral

21.

Burland JP, Lepley AS, DiStefano LJ, Lepley LK. Alterations in physical and neurocognitive wellness across recovery after ACLR: A preliminary look into learned helplessness. Phys Ther Sport. 2019;40:197–207.PubMed

22.

Palmieri RM, Ingersoll CD, Hoffman MA. The Hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research. J Ath Train. 2004;39(3):268–77.

23.

Lepley AS, Ly MT, Grooms DR, Kinsella-Shaw JM, Lepley LK. Corticospinal tract structure and excitability in patients with anterior cruciate ligament reconstruction: a DTI and TMS study. Neuroimage Clin. 2020;25:102157.PubMed

24.

Scheurer SA, Sherman DA, Glaviano NR, Ingersoll CD, Norte GE. Corticomotor function is associated with quadriceps rate of torque development in individuals with ACL surgery. Exp Brain Res. 2020;238(2):283–94.PubMed

25.

Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: a cross-sectional study. J Athl Train. 2018;53(5):475–85.PubMedPubMedCentral

26.

Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Ath Train. 2015;50(3):303–12.

27.

Lepley AS, Grooms DR, Burland JP, Davi SM, Kinsella-Shaw JM, Lepley LK. Quadriceps muscle function following anterior cruciate ligament reconstruction: systemic differences in neural and morphological characteristics. Exp Brain Res. 2019;237(5):1267–78.PubMed

28.

Krishnan C, Washabaugh EP, Dutt-Mazumder A, Brown SR, Wojtys EM, Palmieri-Smith RM. Conditioning brain responses to improve quadriceps function in an individual with anterior cruciate ligament reconstruction. Sports Health. 2019;5:1941738119835163.

29.

Lepley LK, Grooms DR, Burland JP, Davi SM, Mosher JL, Cormier ML, et al. Eccentric cross-exercise after anterior cruciate ligament reconstruction: novel case series to enhance neuroplasticity. Phys Ther Sport. 2018;34:55–65.PubMed

30.

Murley GS, Tan JM, Edwards RM, De Luca J, Munteanu SE, Cook JL. Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon. Scand J Med Sci Sports. 2014;24(3):535–41.PubMed

31.

Rossini PM, Rossi S. Transcranial magnetic stimulation: diagnostic, therapeutic, and research potential. Neurology. 2007;68(7):484–8.PubMed

32.

Groppa S, Oliviero A, Eisen A, Quartarone A, Cohen LG, Mall V, et al. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol. 2012;123(5):858–82.PubMedPubMedCentral

33.

Ward SH, Blackburn JT, Padua DA, Stanley LE, Harkey MS, Luc-Harkey BA, et al. Quadriceps neuromuscular function and jump-landing sagittal-plane knee biomechanics after anterior cruciate ligament reconstruction. J Athl Train. 2018;53(2):135–43.PubMedPubMedCentral

34.

Lepley AS, Ericksen HM, Sohn DH, Pietrosimone BG. Contributions of neural excitability and voluntary activation to quadriceps muscle strength following anterior cruciate ligament reconstruction. Knee. 2014;21(3):736–42.PubMed

35.

Pietrosimone BG, Lepley AS, Ericksen HM, Gribble PA, Levine J. Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil. 2013;22(1):1–6.PubMed

36.

Chen R. Interactions between inhibitory and excitatory circuits in the human motor cortex. Exp Brain Res. 2004;154(1):1–10.PubMed

37.

Luc-Harkey BA, Harkey MS, Pamukoff DN, Kim RH, Royal TK, Blackburn JT, et al. Greater intracortical inhibition associates with lower quadriceps voluntary activation in individuals with ACL reconstruction. Exp Brain Res. 2017;235(4):1129–37.PubMed

38.

Burland JP, Lepley AS, Cormier M, DiStefano LJ, Lepley LK. Examining the relationship between neuroplasticity and learned helplessness after ACLR: early versus late recovery. J Sport Rehabil. 2020;8:1–8.

39.

Zarzycki R, Morton SM, Charalambous CC, Pietrosimone B, Williams GN, Snyder-Mackler L. Athletes after anterior cruciate ligament reconstruction demonstrate asymmetric intracortical facilitation early after surgery. J Orthop Res. 2020;50(9):516–22.

40.

Paterno MV. Incidence and predictors of second anterior cruciate ligament injury after primary reconstruction and return to sport. J Ath Train. 2015;50(10):1097–9.

41.

Heroux ME, Tremblay F. Corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2006;14(9):823–33.PubMed

42.

Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedPubMedCentral

43.

van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review G. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976). 2003;28(12):1290–9.

44.

Neal BS, Lack SD, Lankhorst NE, Raye A, Morrissey D, van Middelkoop M. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2019;53(5):270–81.PubMed

45.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum Associates; 1988.

46.

Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):1567–73.PubMedPubMedCentral

47.

Harkey M, Luc B, Lepley A, Grindstaff T, Gribble P, Blackburn JT, et al. Spinal reflex excitability does not associate with persistent muscle inhibition after anterior cruciate ligament reconstruction. Med Sci Sports Exerc. 2016;48(5):403.

48.

Zarzycki R, Morton SM, Charalambous CC, Marmon A, Snyder-Mackler L. Corticospinal and intracortical excitability differ between athletes early after ACLR and matched controls. J Orthop Res. 2018;36(11):2941–8.PubMed

49.

Park J, Hopkins JT. Induced anterior knee pain immediately reduces involuntary and voluntary quadriceps activation. Clin J Sport Med. 2013;23(1):19–24.PubMed

50.

Palmieri-Smith RM, Villwock M, Downie B, Hecht G, Zernicke R. Pain and effusion and quadriceps activation and strength. J Ath Train. 2013;48(2):186–91.

51.

Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, et al. Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med. 2010;38(11):2201–10.PubMed

52.

Lepley AS, Pietrosimone B, Cormier ML. Quadriceps function, knee pain, and self-reported outcomes in patients with anterior cruciate ligament reconstruction. J Athl Train. 2018;53(4):337–46.PubMedPubMedCentral

53.

Norte GE, Hertel JN, Saliba SA, Diduch DR, Hart JM. Quadriceps and patient-reported function in ACL-reconstructed patients: a principal component analysis. J Sport Rehabil. 2018;25:1–9.

54.

Groppa S, Schlaak BH, Munchau A, Werner-Petroll N, Dunnweber J, Baumer T, et al. The human dorsal premotor cortex facilitates the excitability of ipsilateral primary motor cortex via a short latency cortico-cortical route. Hum Brain Mapp. 2012;33(2):419–30.PubMed

55.

Kernozek TW, Ragan RJ. Estimation of anterior cruciate ligament tension from inverse dynamics data and electromyography in females during drop landing. Clin Biomech (Bristol, Avon). 2008;23(10):1279–86.

56.

Weinhandl JT, Earl-Boehm JE, Ebersole KT, Huddleston WE, Armstrong BS, O’Connor KM. Anticipatory effects on anterior cruciate ligament loading during sidestep cutting. Clin Biomech (Bristol, Avon). 2013;28(6):655–63.

57.

Norte GE, Hertel JN, Saliba SA, Diduch DR, Hart JM. Quadriceps neuromuscular function in patients with and without knee osteoarthritis following anterior cruciate ligament reconstruction. Osteoarthr Cartil. 2018;26:S252–3.

58.

Harkey MS, Luc-Harkey BA, Lepley AS, Grindstaff TL, Gribble P, Blackburn JT, et al. Persistent muscle inhibition after anterior cruciate ligament reconstruction: role of reflex excitability. Med Sci Sports Exerc. 2016;48(12):2370–7.PubMed

59.

Oiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(2):171–7.

60.

Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012;40(1):41–8.PubMed

61.

Zarzycki R, Morton SM, Charalambous CC, Pietrosimone B, Williams GN, Snyder-Mackler L. Examination of corticospinal and spinal reflexive excitability during the course of postoperative rehabilitation after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2020;50(9):516–22.PubMed

62.

Stinear CM, Byblow WD. Role of intracortical inhibition in selective hand muscle activation. J Neurophysiol. 2003;89(4):2014–20.PubMed

63.

Hopkins JT, Ingersoll CD, Krause BA, Edwards JE, Cordova ML. Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability. Med Sci Sports Exerc. 2001;33(1):123–6.PubMed

64.

Hopkins JT, Ingersoll CD, Edwards JE, Cordova ML. Changes in soleus motoneuron pool excitability after artificial knee joint effusion. Arch Phys Med Rehabil. 2000;81(9):1199–203.PubMed

65.

Palmieri RM, Ingersoll CD, Edwards JE, Hoffman MA, Stone MB, Babington JP, et al. Arthrogenic muscle inhibition is not present in the limb contralateral to a simulated knee joint effusion. Am J Phys Med Rehabil. 2003;82(12):910–6.PubMed

66.

Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. 2019;53(5):289–98.PubMed

67.

Harkey MS, Gribble PA, Pietrosimone BG. Disinhibitory interventions and voluntary quadriceps activation: a systematic review. J Athl Train. 2014;49(3):411–21.PubMedPubMedCentral

68.

Pietrosimone BG, Hart JM, Saliba SA, Hertel J, Ingersoll CD. Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Med Sci Sports Exerc. 2009;41(6):1175–81.PubMed

69.

Hopkins J, Ingersoll CD, Edwards J, Klootwyk TE. Cryotherapy and transcutaneous electric neuromuscular stimulation decrease arthrogenic muscle inhibition of the vastus medialis after knee joint effusion. J Ath Train. 2002;37(1):25–31.

70.

Pietrosimone B, McLeod MM, Florea D, Gribble PA, Tevald MA. Immediate increases in quadriceps corticomotor excitability during an electromyography biofeedback intervention. J Electromyogr Kinesiol. 2015;25(2):316–22.PubMed

71.

Bruce AS, Howard JS, Van HW, McBride JM, Needle AR. The effects of transcranial direct current stimulation on chronic ankle instability. Med Sci Sports Exerc. 2020;52(2):335–44.PubMed

72.

Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;15(527 Pt 3):633–9.

73.

Gruber M, Linnamo V, Strojnik V, Rantalainen T, Avela J. Excitability at the motoneuron pool and motor cortex is specifically modulated in lengthening compared to isometric contractions. J Neurophysiol. 2009;101(4):2030–40.PubMed

74.

Bodkin SG, Norte GE, Hart JM. Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL-reconstruction. Scand J Med Sci Sports. 2019;29(5):716–24.PubMed

75.

Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps function and patient-reported outcomes after anterior cruciate ligament reconstruction in patients with or without knee osteoarthritis. J Ath Train. 2018;53(10):965–75.

76.

Ward SH, Pearce A, Bennell KL, Peitrosimone B, Bryant AL. Quadriceps cortical adaptations in individuals with an anterior cruciate ligament injury. Knee. 2016;23(4):582–7.PubMed

77.

Héroux ME, Tremblay F. Corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2006;14(9):823–33.PubMed

Titel: Assessment of Quadriceps Corticomotor and Spinal-Reflexive Excitability in Individuals with a History of Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis
verfasst von: Justin L. Rush
Neal R. Glaviano
Grant E. Norte
Publikationsdatum: 05.01.2021
Verlag: Springer International Publishing
Erschienen in: Sports Medicine / Ausgabe 5/2021
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI: https://doi.org/10.1007/s40279-020-01403-8

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Assessment of Quadriceps Corticomotor and Spinal-Reflexive Excitability in Individuals with a History of Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background

Objective

Methods

Results

Conclusions

Trial Registration

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Abstract

Background

Objective

Methods

Results

Conclusions

Trial Registration

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