Abstract
Despite extensive research of ACL reconstruction surgery (ACLR) and rehabilitation, mobility and functional issues often persist, leading to complications beyond the initial injury. This case study presents exercises employed to overcome negative consequences following ACLR. Participant (23yo, F, 163cm, 52kg) underwent ACLR in 2019 after a complete left ACL tear. After 7 months of PT following surgery, the participant was cleared to return to sport and continued consistent activity until 4 years post ACLR. At this time, the participant presented with knee pain, edema exacerbated by activity, 20% loss of range of motion (ROM), and extensive atrophy of the quadriceps (Q) and hamstrings (H). We observed left Q and H strength, and volume was profoundly decreased compared to right. PURPOSE: We aimed to increase ROM, muscle volume, and strength despite edema-related neuromuscular inhibition using an eccentric-focused exercise protocol to target Q and H muscles. METHODS: We measured initial muscle volume and strength of R/L legs. Muscle volume was assessed via MRI using Osirix MD. Isometric Q and H peak torque was measured with Biodex. We measured max force of H with Nordbord. Participant performed a progressive, customized body weight eccentric exercise protocol (3x/week) for 25 weeks, adapted to ability. Volume and strength data were recorded monthly. RESULTS: At 45°, left Q was initially 65% the strength of right Q. After 25 weeks, left Q decreased to 49% of right; right Q got stronger (+11%) while left Q weakened (-16%). Initially, left H was 70% the strength of right. After 25 weeks, left H was 75% of right. Both H increased in strength (R +10%, L +19%). H muscle volume increased in both legs (R +3.6%, L +3.7%) but Q volume only increased in right leg (R +2%, L +0.2%). Left leg stayed 70% the muscle volume of right leg (Quad 60% of right, H 77% of right). ROM was unaffected. Pain and edema with decreased function continued to be reported. CONCLUSION: Edema, from a foreign body reaction, resulted in neuromuscular inhibition of Q, preventing Q muscle growth/maintenance. After this intervention, under direction of an orthopedic surgeon, participant elected to remove all foreign bodies potentially contributing to persistent inhibition and replace the ACL. We expect to follow the progression of participant through surgeries and recovery.
Recommended Citation
Anderson, Melody F.; Hinkle, Lee J; Allen, Steven P.; and Johnson, Aaron W.
(2024)
"Case Study: Can Quadriceps Muscle Growth Be Achieved in ACLR Patient with Neuromuscular Inhibition?,"
International Journal of Exercise Science: Conference Proceedings: Vol. 14:
Iss.
4, Article 32.
Available at:
https://digitalcommons.wku.edu/ijesab/vol14/iss4/32
Included in
Health and Physical Education Commons, Medical Education Commons, Sports Sciences Commons