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Neuromuscular Response to Cyclic Loading of the Anterior Cruciate Ligament

Paola Sbriccoli, MD, PhD^*,, Moshe Solomonow, PhD, MD(Hon)^*,, Bing-He Zhou, EE^*, Yun Lu, MD^* and Robert Sellards, MD^*

From the ^* Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, and the Department of Human Movement and Sport Sciences, Exercise Physiology Laboratory, Istituto Universitario di Scienze Motorie, Rome, Italy

Address correspondence to Moshe Solomonow, PhD, MD(Hon), Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, Suite 400, New Orleans, LA 70112 (e-mail: msolom{at}lsuhsc.edu).

Background: Cyclic load applied to various joints during occupational and sports activities is epidemiologically linked to higher risk of neuromuscular disorder development.

Hypothesis: Passive cyclic loading of the knee will develop laxity and creep in the anterior cruciate ligament, and these may elicit a neuromuscular disorder in the quadriceps and hamstrings. Women may be more susceptible to the disorder.

Study Design: Controlled laboratory study.

Methods: Male and female groups were subjected to 10 minutes of passive cyclic loading (0.1 Hz) of the knee at a mild load (150–200 N) and at 35° and 90° flexion. Anterior tibial displacement and electromyogram from the quadriceps and hamstrings were monitored during cyclic loading. Maximal voluntary contraction of knee extension and flexion was assessed before and after cyclic loading. The effect of gender and angle on maximal voluntary contraction and quadriceps/hamstrings electromyogram was tested by a 2-way analysis of variance. Differences between the preload and postload data were tested by a paired t test.

Results: At a knee angle of 90°, after cyclic loading, a decrease in maximal voluntary contraction during extension was present in men and women, with an associated decrease in quadriceps electromyogram activity. At 35°, a decrease in maximal voluntary contraction in extension was noted in women and men. Electromyogram spasms were present in the quadriceps and hamstrings during the 10-minute cyclic loading in 51.7% of subjects. Analysis of variance demonstrated that ligament creep was significantly greater in women than in men at both knee angles.

Conclusions: Even a mild cyclic loading of the anterior cruciate ligament, for a relatively short period, can elicit substantial creep, laxity, and a neuromuscular disorder. The disorder is composed of spasms and attenuated muscular function that may together create a condition that exposes the knee to injury. Women seem to be more susceptible than men.

Clinical Relevance: Cyclic actions performed at high frequencies and high-load magnitudes may lead to the occurrence of increased knee laxity and changes in neuromuscular function that, together with fatigue and changes in proprioception, may increase the risk of injury.

Key Words: knee • anterior cruciate ligament (ACL) • cyclic • electromyogram (EMG) • disorder