title: Knee muscle activity during gait in patients with anterior cruciate ligament injury: a systematic review of electromyographic studies.
abstract: OBJECTIVE
  This review compared knee muscle activity between ACL-deficient (ACLD) patients and healthy controls during gait, to find out whether the available electromyography (EMG) studies support Quadriceps (Q-ceps) inhibition or hamstring facilitation during gait in ACLD patients.
  
  
  METHODS
  A systematic review was conducted to retrieve the EMG studies of knee muscles during gait in ACLD patients. Cochrane library, PubMed, Medline, Ovid, CINAHL and Science Direct databases were searched entries from 1995 through October 2014 using the terms "anterior cruciate ligament" OR "ACL", "electromyography" Or "EMG" "gait" Or "walking". Articles that assessed subjects with ACL rupture that used surface EMG to assess the knee muscle activity were included. The quality of the included papers was assessed using the Critical Appraisal Skills Programme tool for observational studies.
  
  
  RESULTS
  In total, 13 studies met the inclusion criteria. Seven studies consistently found no significant difference in magnitude of activity or timing of Q-ceps muscle between the chronic ACLD patients and control subjects. Two studies on acute ACLD patients and three studies on ACLD patients with unstable knee found the significantly reduced Q-ceps activity compared to control subjects. Six studies showed the significantly greater hamstring activity, and three studies found prolonged duration of activity in ACLD patients compared to the control subjects.
  
  
  CONCLUSIONS
  This review highlighted that the results of the studies are in favour of increased hamstring muscular activity. However, decreased Q-ceps activation exists in the acute stage and in ACLD patients that experience knee instability (non-copers).
  
  
  METHODS
  III.
authors.affiliation: Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Shanbehzadeh
authors.affiliation: University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan. Mohseni_Bandpei@yahoo.com.|Iranian Research Centre on Aging, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar Alley, daneshjoo Blv, Tehran, Iran. Mohseni_Bandpei@yahoo.com.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Mohseni Bandpei
authors.affiliation: Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.|Neuromuscular Rehabilitation Research Centre, Rehabilitation Faculty, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ehsani
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D005684:Gait / Q000502:physiology*; D000070633:Hamstring Muscles / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007717:Knee / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D052097:Quadriceps Muscle / Q000503:physiopathology*; D016138:Walking / Q000502:physiology
keywords: Anterior cruciate ligament injury; Electromyography; Gait