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P15

Neuromuscular activity before ACL rupture and during 12 months of rehabilitation – a case report

H. Baur1, A. Gentsch1, J. Frangi1, P. Henle1, A. Blasimann1 (1Bern)


Einleitung

Few studies have shown altered neuromuscular activity after anterior cruciate ligament (ACL) rupture, but little is known about pre-injury levels and the development during rehabilitation after surgery. The aim of this single-case study was to analyze differences in neuromuscular activity in the affected side before and after ACL rupture and reconstruction until 12 months postoperative.

Methodik

Neuromuscular activity of the M. vastus medialis (VM) and lateralis (VL), M. biceps femoris (BF) and M. semitendinosus of the injured extremity of a 30-year old female athlete (semitendinosus graft, meniscal suturing) was recorded by electromyography (EMG) 3 months before injury, before surgery and 3, 6, 9 and 12 months postoperative. After a 6-minute warm-up on a treadmill (5 km/h), where during the last minute EMG activity was recorded, the athlete ascended at self-selected speed 10 times a 6-step stair with force plates located on step 3 and 4. The EMG of each muscle was split into preactivation (PRE), weight acceptance (WA) and push off (PO) phase. Root mean square values were calculated and submaximally normalized with treadmill EMG data.

Resultate

Prior to injury the quadriceps activity showed higher activation of the VM compared to VL in PRE (+46%). The Hamstrings showed a higher activation of the ST compared to BF in PRE (+66%). After injury, the ST activation decreased in PRE (-38%) while the other muscles increased in all gait cycle phases (e.g. in PO VM +122%, VL +137). The main changes occurred between surgery and 3 months in PRE (ST +223%, BF +138%) and PO (ST +115%) as well between 3 and 6 months in WA (VM +158%). After 12 months every muscle in all phases had a higher activation in comparison to preinjury but the differences between VM and VL respectively ST and BF lessened (e.g. VM compared to VL in PRE +21%).

Schlussfolgerungen

Before injury, differences in muscle activity between medial and lateral muscles during stair ascent were detected especially in PRE (medial > lateral), which were less at 12 months. During the rehabilitation the main changes occurred between surgery and 6 months. After 12 months all muscles had a higher activation during all phases. This single case points out, that neuromuscular changes can be achieved during rehabilitation and develops even 9-12 months after initial start.

Bedeutung

Active rehabilitation after ACL and meniscal repair seems to affect neuromuscular control and results in higher activation of the knee stabilizing muscles.