title: Neuromuscular and psychological influences on range of motion recovery in anterior cruciate ligament reconstruction patients.
abstract: To identify distinguishing characteristics for knee surgery patients who experience a protracted recovery process, we sought to determine if there is an association between the neuromuscular stretch reflex and psychological factors of pain perception and anxiety on the range of motion (ROM) recovery rate of post-operative anterior cruciate ligament reconstruction (ACLR) rehabilitation patients. The ACLR participants were categorized into a slow recovery group (SRG: >6 weeks to recover 0-125 degrees knee flexion [n=10]) and a normal recovery group (NRG: <6 weeks to recovery 0-125 degrees knee flexion [n=12]). Control participants (n=22) were age, gender and activity-level matched to the surgical participants. Neuromuscular testing consisted of sagittal plane video kinematics of the Wartenberg Pendulum Test for determining lower limb stiffness indices and electromyography-monitored patellar tendon tap reflex responses. Psychological and health status assessments consisted of the State-Trait Anxiety Inventory and SF-36 Health Survey. Data revealed that neuromuscular reflex profiles, lower limb stiffness indices, pain, anxiety and SF-36 indices of function were not significantly different between the two surgical groups (SRG and NRG). The surgical groups exhibited significantly greater pain (2.67+/-2.27 SRG, 1.49+/-1.15 NRG) than the control group (p.05). SF-36 indices were significantly lower for the surgical groups for total score (546.55+/-94.70 SRG, 577.57+/-125.58 NRG), function 69.00+/-20.24 SRG, 67.08+/-19.12 NRG), role physical (53.75+/-22.85 SRG, 53.12+/-23.15 NRG), social (76.24+/-25.31 SRG, 65.62+/-27.24 NRG), and emotional (82.49+/-19.81 SRG, 81.38+/-23.02 NRG) subscales (p.05). These results suggest that neuromuscular reflex responses, visual analogue scale (VAS) pain, and anxiety are not distinguishing factors for ROM recovery rate between the SRG and NRG. Decreased SF-36 indices, including pain as it influences function, though clinically relevant factors, were not statistically associated with post-operative ROM recovery rate.
authors.affiliation: Department of Kinesiology, Biokinetics Research Laboratory, Athletic Training Division, Temple University, Philadelphia, PA 19022, USA. khemsley@temple.edu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hemsley
authors.forename: Michael
authors.initials: M
authors.lastname: Sitler
authors.forename: Ray
authors.initials: R
authors.lastname: Moyer
authors.forename: Carol
authors.initials: C
authors.lastname: Oatis
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001007:Anxiety / Q000175:diagnosis; D001696:Biomechanical Phenomena; D004576:Electromyography; D005260:Female; D006304:Health Status; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology*; D016059:Range of Motion, Articular; D011930:Reaction Time; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012026:Reflex, Stretch