Dynamic Restraint Capacity of the Hamstring Muscles Has Important Functional Implications After Anterior Cruciate Ligament Injury and Anterior Cruciate Ligament Reconstruction

Abstract 

Bryant AL, Creaby MW, Newton RU, Steele JR. Dynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction.

Objective

The purpose of this study was to investigate the relation between knee functionality of anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstruction (ACLR) patients and hamstring antagonist torque generated during resisted knee extension.

Design

Cross-sectional.

Setting

Laboratory based.

Participants

Male ACLD subjects (n=10) (18–35y) and 27 matched males who had undergone ACLR (14 patella tendon [PT] grafts and 13 combined semitendinosus/gracilis tendon grafts).

Interventions

Not applicable.

Main Outcome Measures

Knee functionality was rated (0- to 100-point scale) by using the Cincinnati Knee Rating System. Using electromyography data from the semitendinosus (ST) and biceps femoris muscles, we created a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10° intervals from 80° to 10° knee flexion.

Results

Pearson product-moment correlations revealed that more functional ACLD subjects generated significantly (P<.05) higher hamstring antagonist torque throughout knee extension. In contrast, more functional PT subjects produced significantly lower hamstring antagonist torque at 80° to 70° knee flexion, whereas no significant associations were found between hamstring antagonist torque and knee functionality for the ST/gracilis tendon subjects.

Conclusions

An increased hamstring antagonist torque generated by the more functional ACLD subjects, reflective of increased hamstring contractile force, is thought to represent a protective mechanism to compensate for mechanical instability. The restoration of anterior knee stability through ACLR negates the need for augmented hamstring antagonist torque.

Key Words: Anterior cruciate ligament, Rehabilitation

List of Abbreviations: ACL, anterior cruciate ligament, ACLD, anterior cruciate ligament deficient, ACLR, anterior cruciate ligament reconstruction, ANOVA, analysis of variance, ATT, anterior tibial translation, BF, biceps femoris, EMG, electromyography, G, gracilis, iEMG, integrated electromyography, PCSA, physiologic cross-sectional area, PT, patella tendon, ROM, range of motion, SM, semimembranosus, ST, semitendinosus