Category
Poster - Theoretical Proposal
Description
Context: Recently, research has investigated the phenomenon of cross-education to improve quadriceps strength deficits for injured athletes – specifically those post-ACL reconstruction surgery. The clinical question is: what is the effect of cross-education on quadriceps strength recovery as an adjunct to standard rehabilitation after ACL reconstruction surgery? Methods: To identify relevant studies, a computerized search was completed October 2023 using the electronic databases CINAHL, MEDLINE, SPORTDiscus, and PubMed. Key terms used in the search were cross-education, quadriceps strength or weakness, and ACL reconstruction. Inclusion criteria were studies limited to those including patients undergoing ACL reconstruction surgery, those with patient-reported outcomes, those using the cross-education technique, testing quadriceps strength, written in the English language, written in the last 10 years, and randomized control trials. In the first study done by Harput et al, quadriceps maximum voluntary isometric contractions (MVIC), single leg hop distance, and IKDC scores were assessed. Concentric and eccentric quadriceps contractions were also compared. In the second study done by Zult et al, self-reported knee function, maximal quadriceps torque, maximal hamstrings torque, and single leg hop distance were assessed. Lastly, quadriceps and hamstring peak force, rate of force development, IKDC scores, and hop distance were assessed by Minshull et al. Mean differences were used to summarize the extracted data. After assessing the quality of evidence using the PEDro scale, Harput et al met the criteria with 10/10, Zult et al with 9/10, and Minsull et al with 6/10. For Zult et al, the therapists that administered the treatment were not blinded, which could lead to bias or discrimination to the patients within the groups. Minshull et al did not have concealed allocation, and it was unclear as to whether the subjects and administers were blinded. Results: Six studies were retrieved from the search, and 3 studies were excluded either by title or relevance, leaving 3 relevant studies for eligibility. In the first study, quadriceps strength for both limbs was greater at 12 and 24 weeks (concentric CE and Eccentric CE vs control) p<0.001 and p=0.01. In the second study, adding cross-education did not accelerate or benefit ACL recovery. In the third study, cross-education attenuated decline of quadriceps weakness and PF of the reconstructed leg (16.6% decrease vs 32%) at 10 weeks compared to the control, but not at 24 weeks. No significant difference in IKDC, HOP, HPF, or RFD Conclusion: Based on the analysis of the results, implementing cross-education into a rehabilitation program may be beneficial in attenuating muscular weakness. Since there were different results found in the three studies, it is difficult to pinpoint exact effects on quadriceps weakness. Although, the maintenance of strength provides a promising outlook for reducing immobilization effects, as well as declining muscular strength loss in those post-surgery.
The Effects of Cross-education on Quadriceps Strength in Patients After ACL Reconstruction Surgery: A Critically Appraised Topic
Poster - Theoretical Proposal
Context: Recently, research has investigated the phenomenon of cross-education to improve quadriceps strength deficits for injured athletes – specifically those post-ACL reconstruction surgery. The clinical question is: what is the effect of cross-education on quadriceps strength recovery as an adjunct to standard rehabilitation after ACL reconstruction surgery? Methods: To identify relevant studies, a computerized search was completed October 2023 using the electronic databases CINAHL, MEDLINE, SPORTDiscus, and PubMed. Key terms used in the search were cross-education, quadriceps strength or weakness, and ACL reconstruction. Inclusion criteria were studies limited to those including patients undergoing ACL reconstruction surgery, those with patient-reported outcomes, those using the cross-education technique, testing quadriceps strength, written in the English language, written in the last 10 years, and randomized control trials. In the first study done by Harput et al, quadriceps maximum voluntary isometric contractions (MVIC), single leg hop distance, and IKDC scores were assessed. Concentric and eccentric quadriceps contractions were also compared. In the second study done by Zult et al, self-reported knee function, maximal quadriceps torque, maximal hamstrings torque, and single leg hop distance were assessed. Lastly, quadriceps and hamstring peak force, rate of force development, IKDC scores, and hop distance were assessed by Minshull et al. Mean differences were used to summarize the extracted data. After assessing the quality of evidence using the PEDro scale, Harput et al met the criteria with 10/10, Zult et al with 9/10, and Minsull et al with 6/10. For Zult et al, the therapists that administered the treatment were not blinded, which could lead to bias or discrimination to the patients within the groups. Minshull et al did not have concealed allocation, and it was unclear as to whether the subjects and administers were blinded. Results: Six studies were retrieved from the search, and 3 studies were excluded either by title or relevance, leaving 3 relevant studies for eligibility. In the first study, quadriceps strength for both limbs was greater at 12 and 24 weeks (concentric CE and Eccentric CE vs control) p<0.001 and p=0.01. In the second study, adding cross-education did not accelerate or benefit ACL recovery. In the third study, cross-education attenuated decline of quadriceps weakness and PF of the reconstructed leg (16.6% decrease vs 32%) at 10 weeks compared to the control, but not at 24 weeks. No significant difference in IKDC, HOP, HPF, or RFD Conclusion: Based on the analysis of the results, implementing cross-education into a rehabilitation program may be beneficial in attenuating muscular weakness. Since there were different results found in the three studies, it is difficult to pinpoint exact effects on quadriceps weakness. Although, the maintenance of strength provides a promising outlook for reducing immobilization effects, as well as declining muscular strength loss in those post-surgery.
Comments
Graduate