The Effect Of Anterior Cruciate Ligament And Medial Meniscus Rupture On Knee Extension And Flexion Isokinetic Peak Torque Strength And Cybex Test Protocol: Case Report

Year 2019, Volume: 14 Issue: 1, 41 - 54, 30.06.2019

Gökhan Umutlu , Ayhan Taner Erdoğan , Nasuh Evrim Acar

https://doi.org/10.33459/cbubesbd.482218

Abstract

Knee extensor and flexor muscles are functioning as
essential dynamic stabilizers during activity and a possible strength loss in
these muscle groups considerably resulted in knee joint stability. According to
these findings, it was aimed to examine the effect of the anterior cruciate
ligament rupture (ACL) and medial meniscus tear of two female basketball
players who injured due to excessive lateral rotation of the knee movement
during competition and whether a Cybex protocol could be useful to improve the
muscle strength parameters applied to the participants 16 weeks after following
an ACL reconstruction surgery. An ACL rehabilitation protocol that enables
different contraction patterns was conducted using a Cybex dynamometer (USA),
which is an isokinetic measuring device, 3 times/week throughout 8 and 12 weeks
based on the examination results of the flexion and extension strengths of the
knee joint of participants. Bilateral knee extension-flexion muscle strength
deficit of the participant following two months of testing session (Extension
Baseline:  26 %, 1st Month: 15%, 2nd
month: 5%; Flexion Baseline: 11%, 1st Month: 19 %, 2nd Month: 8 %); and
following three months of rehabilitation session were found (Extension Baseline:
40%, 1st Month:34 %, 2nd Month: 24 %, 3rd Month: 14%; Flexion Baseline: 19%,
1st Month: 9%, 2nd Month: 5%, 3rd Month: 3%), respectively. As a result, it can
be stated that Cybex protocol, which was started 16 weeks after ACL operations,
accelerated the return to sports by decreasing the strength differences between
the extremities of athletes.

Keywords

Meniscus, Anterior Cruciate Ligament, Peak Torque

Ön Çapraz Bağ ve Medial Menisküs Yırtığının Diz Ekstansiyon ve Fleksiyon İzokinetik Pik Tork Kuvvetine Etkisi ve Cybex Test Protokolü Uygulaması: Vaka Takdimi

Abstract

Diz ekstansör ve fleksör
kasların aktivite esnasında önemli dinamik stabilizörler olmalarının yanı sıra
bu kas grubunda kuvvet değerlerinde meydana gelen bir azalma durumunda diz
eklemi stabilitesi önemli derecede azalmaktadır. Bu bulgulardan hareketle, bu
çalışmada basketbol müsabakasında dizin aşırı lateral rotasyon hareketi yönünde
zorlanması sonucu sağ ve sol dizlerinden sakatlanan iki kadın sporcuda ön
çapraz bağ (ACL) ve medial menisküs yırtığının diz ekstansiyon ve fleksiyon
izokinetik pik tork kuvvet değerleri üzerindeki etkisi ve aynı zamanda
ameliyattan 16 hafta sonra kişiye uygulanan düzenli Cybex test protokolünün kas
kuvvet değerleri üzerindeki etkisini incelemek amaçlanmıştır. Çalışmada yer
alan kadın sporcular diz ekleminin bilateral fleksiyon ve ekstansiyon ön test
ölçüm değerlerine göre Cybex izokinetik dinamometre (ABD) kullanılarak 8 hafta
ve 12 hafta olmak üzere haftada 3 gün farklı kasılma türlerini içeren bir ACL
rehabilitasyon protokolüne tabi tutuldu. Cybex testleri sonucunda iki ay
boyunca teste katılan kadın sporcunun sağ ve sol diz ekstansiyon-fleksiyon pik
tork kuvvet farkı değerleri (Ekstansiyon Bazal: % 26, 1. ay: % 15, 2. ay: %5;
Fleksiyon Bazal: % 11, 1. ay: %19, 2. ay: % 8); üç ay boyunca teste katılan
kadın sporcunun sağ ve sol diz ekstansiyon-fleksiyon pik tork kuvvet farkı
değerleri (Ekstansiyon Bazal: % 40, 1. ay: % 34, 2. ay: % 24; 3. ay: % 14;
Fleksiyon Bazal: % 19, 1. ay: %9, 2. ay: % 5, 3. ay: % 3); olarak bulunmuştur.
ACL ameliyatlarından 16 hafta sonra uygulanmaya başlanan Cybex protokolünün
sporcuların ekstremiteler arası kuvvet farklarını azaltarak spora dönüş
sürecini hızlandırdığı ifade edilebilir.

Keywords

Menisküs, Ön Çapraz Bağ, Pik Tork

References

• Aagaard, P., Simonsen, E.B., Beyer, N., Larsson, B., Magnusson, P. & Kjaer, M. (1997). Isokinetic muscle strength and capacity for muscular knee joint stabilization in elite sailors. International Journal of Sports Medicine, 18(7),521-525.
• Aagaard, P., Simonsen, E.B., Magnusson, S.P., Larsson, B. & Dyhre-Poulsen, P. (1998). A new concept for isokinetic hamstring: quadriceps muscle strength ratio. The American Journal of Sports Medicine, 26(2),231-237.
• Aagaard, P., Simonsen, E.B., Trolle, M., Bangsbo, J. & Klausen, K. (1995). Isokinetic hamstring/quadriceps strength ratio: influence from joint angular velocity, gravity correction and contraction mode. Acta Physiologica Scandinavica, 154(4),421-7.
• Agel, J., Olson, D.E. & Dick, R. (2007). Descriptive epidemiology of collegiate women's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. Journal of Athletic Training, 42,202–10.
• Arendt, E.A., Agel, J. & Dick, R. (1999). Anterior cruciate ligament injury patterns among collegiate men and women. Journal of Athletic Training, 34,86–92.
• Barber-Westin, S.D., Smith, S.T., Campbell, T. & Noyes, F.R. (2010). The drop-jump video screening test: retention of improvement in neuromuscular control in female volleyball players. The Journal of Strength & Conditioning Research, 24(11),3055-62.
• Bennell, K., Wajswelner, H., Lew, P., Schall-Riaucour, A., Leslie, S., Plant, D. & Cirone, J. (1998). Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers. British Journal of Sports Medicine, 32(4),309-14.
• Boden, B.P., Griffin, L.Y. & Garrett, W.E., Jr. (2000). Etiology and prevention of noncontact ACL injury. The Physician and Sportsmedicine, 8,53–60.
• Chappell, J.D., Yu, B., Kirkendall, D.T. & Garrett, W.E. (2002). A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. The American Journal of Sports Medicine, 30,261–267.
• Croce, R.V., Pitetti, K.H., Horvat, M. & Miller, J. (1996). Peak torque, average power, and hamstrings/quadriceps ratios in nondisabled adults and adults with mental retardation. Archives of Physical Medicine and Rehabilitation, 77(4),369-72.
• Emerson, R.J. (1993). Basketball knee injuries and the anterior cruciate ligament. Clinics in Sports Medicine, 12(2),317-28.
• Hewett, T.E., Myer, G.D. & Ford, K.R. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American Journal of Sports Medicine, 33,492–501.
• Hewett, T.E., Myer, G.D. & Ford, K.R. (2006). Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. The American Journal of Sports Medicine, 34(2),299-311.
• Holmes, J.R. & Alderink, G.J. (1984). Isokinetic strength characteristics of the quadriceps femoris and hamstring muscles in high school students. Physical Therapy, 64(6),914-8.
• Huston, L.J. & Wojtys, E.M. (1996). Neuromuscular performance characteristics in elite female athletes. The American Journal of Sports Medicine, 24,427–36. doi: 10.1177/036354659602400405.
• Ireland, M.L. (2002). The female ACL: why is it more prone to injury? Orthopedic Clinics of North America, 33,637–51. doi: 10.1016/S0030-5898(02)00028-7.
• Laird, D.E. (1981). Comparison of quad to ham strength ratios of an intercollegiate soccer team. Athletic Training, 16,66–67.
• Li, R.C., Maffulli, N., Hsu, Y.C. & Chan, K.M. (1996). Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. British Journal of Sports Medicine, 30(2),161-4.
• Lohmander, L.S., Ostenberg, A., Englund, M. & Roos, H. (2004). High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatology, 50,3145–52. doi: 10.1002/art.20589.
• Lund-Hanssen, H., Gannon, J., Engebretsen, L., Holen, K. & Hammer, S. (1996). Isokinetic muscle performance in healthy female handball players and players with a unilateral anterior cruciate ligament reconstruction. Scandinavian Journal of Medicine & Science in Sports, 6(3),172-5.
• Noyes, F.R., Barber-Westin, S.D., Smith, S.T., Campbell, T. & Garrison, T.J. (2012). A training program to improve neuromuscular and performance indices in female high school basketball players. The Journal of Strength & Conditioning Research, 26(3),709-19.
• Raunest, J., Sager, M. & Bürgener, E. (1996). Proprioceptive mechanisms in the cruciate ligaments: An electromyographic study on reflex activity in the thigh muscles. The Journal of Trauma, 41(3),488-93.
• Voskanian, N. (2013). Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Current Reviews in Musculoskeletal Medicine, 6(2), 158–163.