An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation.
OBJECTIVE
The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often without appropriate control groups. We measured a broad array of neuromuscular functions between legs of ACL patients and compared outcomes to age, sex, and physical activity matched controls.


METHODS
Thirty-two ACL-deficient patients (208 ± 145 days post-injury) and active and less-active controls (N = 20 each) participated in the study. We measured single- and multi-joint neuromuscular function in both legs in each group and expressed the overall neuromuscular function in each leg by calculating a mean z-score across all neuromuscular measures. A group by leg MANOVA and ANOVA were performed to examine group and leg differences for the selected outcomes.


RESULTS
After an ACL injury, duration (-4.3 h/week) and level (Tegner activity score of -3.9) of sports activity decreased and was comparable to less-active controls. ACL patients showed bilateral impairments in the star excursion balance test compared to both control groups (P ≤ 0.004) and for central activation ratio compared to active controls (P ≤ 0.002). There were between-leg differences within each group for maximal quadriceps and hamstring strength, voluntary quadriceps activation, star excursion balance test performance, and single-leg hop distance (all P < 0.05), but there were no significant differences in quadriceps force accuracy and variability, knee joint proprioception, and static balance. Overall neuromuscular function (mean z-score) did not differ between groups, but ACL patients' non-injured leg displayed better neuromuscular function than the injured leg (P < 0.05).


CONCLUSIONS
Except for poorer dynamic balance and reduced quadriceps activation, ACL patients had no bilateral neuromuscular deficits despite reductions in physical activity after injury. Therapists can use the non-injured leg as a reference to assess the injured leg's function for tasks measured in the present study, excluding dynamic balance and quadriceps activation. Rehabilitation after an ACL injury should be mainly focused on the injured leg.


METHODS
III.
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9700 AD, Groningen, The Netherlands. t.d.zult@umcg.nl.
Tjerk
T
Zult
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9700 AD, Groningen, The Netherlands.
Alli
A
Gokeler
Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
Jos J A M
JJ
van Raay
Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
Reinoud W
RW
Brouwer
Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Inge
I
Zijdewind
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9700 AD, Groningen, The Netherlands.
Tibor
T
Hortobágyi
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000502:physiology*; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D006801:Humans; D007719:Knee Joint; D007866:Leg / Q000502:physiology*; D008297:Male; D009119:Muscle Contraction; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D052097:Quadriceps Muscle / Q000502:physiology*; D055815:Young Adult
ACL deficient; Bilateral impairment; Force accuracy; Force variability; Maximal voluntary force; Postural balance; Proprioception; Twitch interpolation
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