Deficit in Quadriceps Voluntary Activation After Anterior Cruciate Ligament Reconstruction: Roles of the Learned Non-use Paradigm and the Interhemispheric Inhibition

Status: Recruiting
Location: See all (2) locations...
Intervention Type: Diagnostic test
Study Type: Observational
SUMMARY

Anterior cruciate ligament (ACL) tear is mainly caused by sport injuries. 40% of injuries are attributed to noncontact mechanisms involving pivoting. Regaining quadriceps strength is a primary focus of patients pursuing a rehabilitation program after ACL reconstruction (ACLR). Unfortunately, despite rehabilitation programs aimed at reversing this muscle weakness, quadriceps strength deficits may persist for years. Moreover, this deficit leads to increased risk of sustaining another knee injury, and increased risk for developing posttraumatic osteoarthritis. At present, neither the optimal rehabilitative program nor the clinical and instrumental parameters to take into account at the time of return to activity have reached a consensus among clinicians. The investigators hypothesize that: * a persistent deficit in voluntary activation, that is an inability to achieve complete activation of a muscle, is present after ACLR. * this deficit in voluntary activation is associated with a phenomenon of learned/acquired non-use both in balance and during gait. This phenomenon will be demonstrated by investigating asymmetries in the recruitment of the injured lower limb in balance tests and during gait. * the learned/acquired non-use paradigm is associated to asymmetries in the hemispheric cortical activity. This phenomenon will be investigated through transcranial magnetic stimulation. The primary endpoint is the demonstration that the quadriceps muscle weakness after ACLR may represent a case of learned non-use. This behaviour looks automatic and unconscious, so that the adjective acquired seems preferable to learned. It consists of the under recruitment of the impaired side, once healed, as a form of unconscious protection, which is adopted when the contralateral side may carry out the function. The secondary outcome is the investigation of the correlation among the deficits in voluntary activation, in balance tests, during gait, and in the neurophysiologic trials, with the clinical conditions of the patients. It is expected that the injured lower limb show a deficit in the activation of the quadriceps muscle with respect to the contralateral one and with respect to normative data. The impaired limb will present lower recruitment in balance tests and a deficit in power production during gait. The contralesional hemisphere will demonstrate higher interhemispheric inhibition, lower short-interval intracortical inhibition (SICI) and higher short-interval intracortical facilitation (SICF) with respect to the ipsilesional hemisphere. The evidence for an asymmetry between the two lower limbs would support the hypothesis that the acquired non-use paradigm has a role in the deficits following ACL lesions and that it is unspecific across asymmetric impairments, and independent of the underlying disease. Results from the present study will allow: * the identification of clinical and instrumental criteria to guide the return-to-sport decision following ACLR. * the estimate of the sample size for future experimental protocols and new rehabilitative programs.

Eligibility
Participation Requirements
Sex: Male
Minimum Age: 18
Maximum Age: 35
Healthy Volunteers: f
View:

• anterior cruciate ligament tear with arthroscopic reconstruction, between 6 and 18 months before the tests;

• Tegner activity level \> 5;

• Body Mass Index between 18 and 25;

• voluntary knee extension of at least 70°;

• ability to understand the instructions;

• ability to wittingly sign the informed consent form.

Locations
Other Locations
Italy
ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Presidio Ospedaliero Gaetano Pini
NOT_YET_RECRUITING
Milan
Istituto Auxologico Italiano
RECRUITING
Milan
Contact Information
Primary
Luigi Tesio, MD, Full Professor
l.tesio@auxologico.it
+39 02 58218151
Backup
Stefano Scarano, MD, Research Fellow
s.scarano@auxologico.it
+39 02 58218717
Time Frame
Start Date: 2021-07-14
Estimated Completion Date: 2024-12-31
Participants
Target number of participants: 10
Treatments
Pathologic group
At least 10 male participants who underwent anterior cruciate ligament arthroscopic reconstruction using semitendinosus and gracilis tendons graft, between 6 and 18 months before the tests
Related Therapeutic Areas
Sponsors
Leads: Istituto Auxologico Italiano
Collaborators: ASST Gaetano Pini-CTO

This content was sourced from clinicaltrials.gov