Neuromechanical knee joint profiles following ipsilateral hamstring tendons autograft anterior cruciate ligament reconstruction

Open Access
- Author:
- Vairo, Giampietro Luciano
- Graduate Program:
- Kinesiology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 02, 2012
- Committee Members:
- William E Buckley, Committee Chair/Co-Chair
Sayers John Miller Iii, Committee Member
John Henry Challis, Committee Member
Samuel William Monismith, Committee Member - Keywords:
- Anterior cruciate ligament
hamstrings
reconstruction
musculo-articular stiffness - Abstract:
- The prevalence of anterior cruciate ligament (ACL) injury in young, physically active populations represents a critical area of continued investigation in clinical orthopaedics with implications for preserving knee health-related quality of life (HRQL) and addressing related public health care expenses. Clinical management of ACL injury is dependent upon various factors with ACL reconstructive surgery representing a typical mode of treatment. The objective of surgical ACL reconstruction is to restore mechanical joint stability as a means to reestablish correct knee function, improve patient self-reported accounts of knee HRQL and prevent associated musculoskeletal sequelae. Use of the ipsilateral hamstring tendons (HT) autograft has recently gained rising popularity among orthopaedic surgeons as a primary selection of harvest tissue for ACL reconstruction. Consequently, practitioners may be apprehensive to this trend with concern for sacrificing the agonistic function of the hamstrings to the native ACL, or disrupting compensatory knee flexor musculo-articular stiffness (MAS) proposed to augment joint stability in the absence of this focal passive restraint. Although numerous experiments have profiled various resultant hamstring performance indices subsequent to related tendon harvest for ACL reconstruction, no evidence exist profiling knee flexor MAS responses in an associated cohort of patients. This void in the literature warrants attention due to the fact that knee flexor MAS positively correlates with joint stability in young, physically active ACL deficient patients. Thus, the primary aim of this research study was to investigate knee flexor MAS responses to HT autograft harvest in young, physically active patients 12-to-36 months post-ACL reconstruction. Comparisons were made among the involved, contralateral uninvolved, serving as an internal control, and healthy matched control legs. Based on a prior similar experiment specific to the patellar tendon technique, it was hypothesized that knee flexor MAS would not differ among legs. Secondary aims of this research study were to descriptively profile affiliated joint range of motion (ROM) and dynamic postural control as well as hamstrings strength and endurance outcomes in this cohort of patients. Furthermore, associations between knee flexor MAS and subjective as well as objective measures of functional joint capacity were explored. The results of this research study demonstrated that knee flexor MAS was statistically significantly greater in the involved leg compared with the uninvolved and matched legs. However, no statistically significant correlations existed among knee flexor MAS and subjective or objective outcome measures. Conversely, patients exhibited statistically significant deficits in the involved leg compared with the uninvolved and matched legs for knee ROM and dynamic postural control as well as hamstrings strength and endurance. Based on these observations, it can be proposed that HT autograft harvest for ACL reconstruction does not lessen compensatory knee flexor MAS. Yet, clinical insufficiencies persist 12-36 months following surgery in young, physically active patients. These outcomes suggest continued research is warranted to determine the efficacy of associated interventions to reestablish functional joint capacity in related patients. Additionally, orthopaedic medicine and allied health care practitioners may reference the outcomes from this unique experiment to potentially identify clinical management strategies in treating this specific patient population.