Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation — using the anterior cruciate ligament-injured knee as model
Introduction
The anterior cruciate ligament (ACL) is the commonest ligament injured in the knee, and several studies have evaluated the consequences of such an injury. Rehabilitation programs formerly focused mainly on restoration of muscle strength, but during the last 10 years, the sensory function of ligaments in relation to functional joint stability has been regarded as important in rehabilitation after a ligament injury. Even though this review deals with the lower extremity and knee, the views expressed here may apply to other joints as well and should be of interest for treatment of a ligament injury.
Section snippets
Consequences of a ligament injury on neuromuscular function
The visual, vestibular and somatosensory systems contribute afferent information to the central nervous system (CNS) regarding body position and balance [71]. This neural input is integrated by the CNS to generate a motor response. Sensory receptors are present in the skin, muscles, joints, ligaments and tendons. Since a ligament injury causes a disturbance in the somatosensory system it may affect the central programs and motor response.
Relevance to rehabilitation
The development of rehabilitation programs after an ACL injury or reconstruction is based on theoretical models and clinical experience, and the aims are to restore joint motion, regain muscle strength and function to the preinjury level or a modified level of activity. Some authors report that active rehabilitation is performed for 5–8 months after an ACL injury [38], [86] and up to 1 year after an ACL reconstruction [38], [52].
An efficient function of the leg, hip and trunk muscles is needed
Conclusions
An ACL injury causes changes in neuromuscular function. Several studies show persistent weakness of the quadriceps and a reduction in functional performance, but others report that quadriceps strength and performance is restored. Strength of the hamstring muscles can be restored. Several studies report persistent impairment of proprioception or postural control, while few report normal values. The increase in knee joint laxity after an ACL injury does not correlate with functional outcome,
Eva Ageberg graduated from Lund University, Sweden in 1992. From 1994 she has worked at the Physical Medicine Unit, Department of Rehabilitation, Lund University Hospital. She has specialized in Physiotherapy in Orthopedics, and received her MSc in Physical Therapy in 1998. Her postgraduate studies at the Institute for Musculoskeletal Diseases, Department of Physical Therapy, Lund University, involve assessment of neuromuscular function, mainly postural control, and effects of rehabilitation in
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Eva Ageberg graduated from Lund University, Sweden in 1992. From 1994 she has worked at the Physical Medicine Unit, Department of Rehabilitation, Lund University Hospital. She has specialized in Physiotherapy in Orthopedics, and received her MSc in Physical Therapy in 1998. Her postgraduate studies at the Institute for Musculoskeletal Diseases, Department of Physical Therapy, Lund University, involve assessment of neuromuscular function, mainly postural control, and effects of rehabilitation in individuals with anterior cruciate ligament injury in the knee.