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How does anterior cruciate ligament reconstruction affect the functioning of the brain and spinal cord?A systematic review with meta-analysis

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Journal of Sport and Health Science 2021年第2期10卷 172-181页

作者： Kazandra m.Rodriguez riann m.palmieri-smith Chandramouli Krishnan School of Kinesiology University of MichiganAnn ArborMI 48109USA Department of Orthopaedic Surgery Michigan MedicineAnn ArborMI 48109USA Department of Physical medicine and Rehabilitation Michigan MedicineAnn ArborMI 48108USA Biomedical Engineering University of MichiganAnn ArborMI 48109USA michigan Robotics Institute University of MichiganAnn ArborMI 48109USA

Objective:To examine the effect of anterior cruciate ligament(ACL)reconstruction on spinal-reflex and corticospinal excitability of the quadriceps ***:A comprehensive electronic database search was performed to identify studies that objectively measured Hoffmann reflex to muscle response ratio,motor threshold,and motor evoked potentials after ACL *** standardized mean differences(SmDs)were computed using a random effects meta-analysis ***:A total of 13 studies were eligible for *** Hoffmann reflex to muscle response ratio was significantly higher on both the reconstructed and non-reconstructed legs when compared with the healthy control leg(SmD=0.28,95%confidence interval(95%CI):0.08-0.49,p=0.006 and SmD=0.22,95%CI:0.04-0.40,p=0.016,respectively)but did not differ between legs(SmD=0.10,95%CI:-0.01 to 0.21,p=0.078).The motor threshold was significantly higher on both the reconstructed(SmD=0.76,95%CI:0.40-1.12,pmD=0.47,95%CI:0.00-0.95,p=0.049)when compared with the legs of healthy *** reconstructed leg also had a higher motor threshold when compared with the non-reconstructed leg(SmD=0.20,95%CI:0.06-0.34,p=0.005).These changes were paralleled by bilateral reductions in quadriceps strength(ACL reconstructed:SmD=-0.78,95%CI:-1.07 to-0.49,pmD=-0.32,95%CI:-0.63 to-0.01,p=0.042)and quadriceps voluntary activation(ACL reconstructed:SmD=-0.73,95%CI:-0.97 to-0.50,pmD=-0.55,95%CI:-0.82 to-0.27,pmpared with healthy ***:There is increased excitability of the spinal-reflex pathways and reduced excitability of the corticospinal pathways following ACL *** changes are paralleled by reductions in quadriceps strength and voluntary activation,suggesting that rehabilitation interventions should focus on normalizing the excitability of neural pathways to effectively address quadriceps dysfunction aft

关键词： ACLR Cortical excitability H-reflex Transcranial magnetic stimulation TmS

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Estimates of voluntary activation in individuals with anterior cruciate ligament reconstruction:Effects of type of stimulator,number of stimuli,and quantification technique

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Journal of Sport and Health Science 2022年第1期11卷 85-93页

作者： Steven A.Garcia Kazandra m.Rodriguez Scott R.Brown riann m.palmieri-smith Chandramouli Krishnan School of Kinesiology University of MichiganAnn ArborMI 48109USA Neuromuscular and Rehabilitation Robotics Laboratory(NeuRRo Lab) Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMI 48108USA Department of Orthopaedic Surgery Michigan MedicineUniversity of MichiganAnn ArborMI 48109USA Robotics Institute University of MichiganAnn ArborMI 48109USA

Background:Accurate quantification of voluntary activation is important for understanding the extent of quadriceps dysfunction in individuals with anterior cruciate ligament reconstruction(ACLR).Voluntary activation has been quantified using both percent activation derived from the interpolated twitch technique and central activation ratio(CAR)derived from the burst superimposition technique,as well as by using different types of electrical stimulators and pulse train ***,it is unclear how these parameters affect voluntary activation estimates in individuals with *** study was performed to fill this important knowledge gap in the anterior cruciate ligament ***:Quadriceps strength and voluntary activation were examined in 18 ACLR participants(12 quadriceps/patellartendon graft,6 hamstring tendon graft;time since ACLR:1.06±0.82 years,mean±SD)at 90°of knee flexion using 2 stimulators(Digitimer and Grass)and pulse train conditions(3-pulse and 10-pulse).Voluntary activation was quantified by calculating both CAR and percent ***:Results indicated that voluntary activation was significantly overestimated by CAR when compared with percent activation(pmates were not affected by pulse train conditions when using percent activation;however,3-pulse stimuli resulted in greater overestimation than 10-pulse stimuli when using CAR(p=0.003).Voluntary activation did not differ between stimulators(p>0.05);however,the Digitimer evoked greater torque at rest than the Grass(pm the interpolated twitch technique provides superior estimates of voluntary activation than CAR derived from burst superimposition and is less affected by pulse train conditions or stimulators in individuals with ACLR.

关键词： Anterior cruciate ligament Central activation Inhibition Knee strength Triplet Twitch interpolation

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