Submaximal fatigue of the hamstrings impairs specific reflex components and knee stability

Rupture of the anterior cruciate ligament (ACL) is one of the most serious sports-related injuries and requires long recovery time. The quadriceps and hamstring muscles are functionally important to control stability of the knee joint complex. Fatigue, however, is an important factor that may influence stabilizing control and thus cause ACL injuries. The objective of this study was therefore to assess how submaximal fatigue exercises of the hamstring muscles affect anterior tibial translation as a direct measure of knee joint stability. While 15 test participants were standing upright with the knees in 30° of flexion, anterior tibial translation was induced by a force of 315 N. Two linear potentiometers placed on the tibial tuberosity and the patella recorded tibial motion relative to the femur. Reflex latencies and neuromuscular hamstring activity were determined using surface electromyography (EMG). Muscle fatigue produced a significant longer latency for the monosynaptic reflex latencies, whereas no differences in the latencies of the medium latency component were found. Fatigue significantly reduced EMG amplitudes of the short and medium latency components. These alterations were in line with significantly increased anterior tibial translation. Our results suggest that hamstring fatigue is effectively associated with mechanical loss of knee stability. This decrease in joint stability may at least in part explain higher risk of ACL injury, especially in fatigued muscles. Furthermore, we discuss why the present findings indicate that reduced motor activity rather than the extended latency of the first hamstring response is the reason for possible failure.