Knee joint laxity affects muscle activation patterns in the healthy knee.

This study investigated the effects of anterior knee joint laxity on muscle activation patterns prior to and following a lower extremity perturbation. Participants were subjected to a forward and either internal (IR) or external (ER) rotation perturbation of the trunk and thigh on the weight-bearing shank. Pre-activity (%MVIC) before the perturbation, and reflex time (ms) and mean reflex amplitude (%MVIC) following the perturbation were recorded via surface electromyography (sEMG) in the medial and lateral gastrocnemius, hamstring and quadriceps muscles. Twenty-one NCAA DI intercollegiate female athletes with below average anterior knee laxity (3-5 mm) were compared to 21 with above average anterior knee laxity (7-14 mm) as measured by a standard knee arthrometer. Groups differed in reflex timing by muscle (P = 0.013), with females with above average knee laxity (KT((>7 mm))) demonstrating a 16 ms greater delay in biceps femoris reflex timing compared to females with below average knee laxity (KT((<5 mm))). Groups also differed in muscle activation amplitude by response, muscle and direction of rotation (i.e. a 4-way interaction; P = 0.027). The magnitude of change from pre to post perturbation was significantly less in KT((>7 mm)) vs. KT((<5 mm)) for the medial (MG) and lateral (LG) gastrocnemius muscles, primarily due to higher levels of muscle preactivity while awaiting the perturbation (MG = 20% vs. 12% MVIC, P = 0.05; LG = 33% vs. 21% MVIC, P = 0.11). Further, KT((>7 mm)) demonstrated higher activation levels in the biceps femoris than KT((<5 mm)) (47% vs. 27% MVIC; P = 0.025) regardless of response (pre vs. post perturbation) or direction of rotation. These findings suggest females with increased knee laxity may be less sensitive to joint displacement or loading (delayed reflex), and are more reliant on active control of the gastrocnemius and biceps femoris muscles to potentially compensate for reduced passive joint stability.     

Functional muscle synergies to support the knee against moment specific loads while weight bearing

ObjectiveExternally applied abduction and rotational loads are major contributors to the knee joint injury mechanism; yet, how muscles work together to stabilize the knee against these loads remains unclear. Our study sought to evaluate lower limb functional muscle synergies in healthy young adults such that muscle activation can be directly related to internal knee joint moments.MethodsConcatenated non-negative matrix factorization extracted muscle and moment synergies of 22 participants from electromyographic signals and joint moments elicited during a weight-bearing force matching protocol.ResultsTwo synergy sets were extracted: Set 1 included four synergies, each corresponding to a general anterior, posterior, medial, or lateral force direction. Frontal and transverse moments were coupled during medial and lateral force directions. Set 2 included six synergies, each corresponding to a moment type (extension/flexion, ab/adduction, internal/external rotation). Hamstrings and quadriceps dominated synergies associated with respective flexion and extension moments while quadriceps-hamstring co-activation was associated with knee abduction. Rotation moments were associated with notable contributions from hamstrings, quadriceps, gastrocnemius, and hip ab/adductors, corresponding to a general co-activation muscle synergy.ConclusionOur results highlight the importance of muscular co-activation of all muscles crossing the knee to support it during injury-inducing loading conditions such as externally applied knee abduction and rotation. Functional muscle synergies can provide new insight into the relationship between neuromuscular control and knee joint stability by directly associating biomechanical variables to muscle activation.     

Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle

There is some debate in the literature regarding the role of quadriceps-hamstrings co-contraction in the onset and progression of knee osteoarthritis. Does co-contraction during walking increase knee contact loads, thereby causing knee osteoarthritis, or might it be a compensatory mechanism to unload the medial tibial condyle? We used a detailed musculoskeletal model of the lower limb to test the hypothesis that selective activation of lateral hamstrings and quadriceps, in conjunction with inhibited medial gastrocnemius, can actually reduce the joint contact force on the medial compartment of the knee, independent of changes in kinematics or external forces. “Baseline” joint loads were computed for eight subjects with moderate medial knee osteoarthritis (OA) during level walking, using static optimization to resolve the system of muscle forces for each subject?s scaled model. Holding all external loads and kinematics constant, each subject?s model was then perturbed to represent non-optimal “OA-type” activation based on mean differences detected between electromyograms (EMG) of control and osteoarthritis subjects. Knee joint contact forces were greater for the “OA-type” than the “Baseline” distribution of muscle forces, particularly during early stance. The early-stance increase in medial contact load due to the “OA-type” perturbation could implicate this selective activation strategy as a cause of knee osteoarthritis. However, the largest increase in the contact load was found at the lateral condyle, and the “OA-type” lateral activation strategy did not increase the overall (greater of the first or second) medial peak contact load. While “OA-type” selective activation of lateral muscles does not appear to reduce the medial knee contact load, it could allow subjects to increase knee joint stiffness without any further increase to the peak medial contact load.     

Muscle activation patterns of selected lower extremity muscles during stepping and cutting tasks

Lower extremity muscle activations during crossover and side step cut tasks are hypothesized to play an important role in controlling knee motion, and therefore, impact the design of knee injury prevention and rehabilitation programs. However, the contribution of lower extremity muscles to frontal and transverse plane moments during cutting tasks is unclear. The purpose of this study was to compare the muscle activation patterns of selected lower extremity muscles (vastus lateralis, medial/lateral hamstrings and medial/lateral gastrocnemius) of subjects performing a stepping down and side step cut, a stepping down and crossover cut and an equivalent straight ahead task. Ground reaction force was used to determine the cut angle, stance time and compare the lower limb loading during each task. Electromyography data during all tasks were normalized to the average activation during the straight ahead tasks to determine relative changes in muscle activation between the straight ahead and different cut styles (crossover and side step). There were no differences in the pattern of muscle activation of the vastus lateralis, or lateral hamstring muscles when comparing the cutting tasks to the equivalent straight ahead task. However, the crossover cut task resulted in significantly higher muscle activation of the medial hamstrings and lateral gastrocnemius muscles relative to both the side step cut and straight ahead tasks. These results suggest the medial/lateral hamstrings and medial/lateral gastrocnemius play a role in transverse and frontal plane control during cut tasks.     

The effect of hamstring muscle compensation for anterior laxity in the ACL-deficient knee during gait

The hamstring muscles have been recognized as an important element in compensating for the loss of stability in the ACL-deficient knee, but it is still not clear whether the hamstring muscle force can completely compensate for the loss of ACL, and the consequences of increased hamstring muscle force. A two-dimensional anatomical knee model in the sagittal plane was developed to examine the effect of various levels of hamstring muscle activation on restraining anterior tibial translation in the ACL-deficient knee during level walking. The model included the tibiofemoral and patellofemoral joints, four major ligaments, the medial capsule, and five muscle units surrounding the knee. Simulations were conducted to determine anterior tibial translation and internal joint loading at a single selected position when the knee was under a peak external flexion moment during early stance phase of gait. Incremental hamstring muscle forces were applied to the modeled normal and the ACL-deficient knees. Results of simulations showed that the ACL injury increased the anterior tibial translation by 11.8mm, while 56% of the maximal hamstring muscle force could reduce the anterior translation of the tibia to a normal level during the stance phase of gait. The consequences of increased hamstring muscle force included increased quadriceps muscle force and joint contact force.     

Muscle and external load contribution to knee joint contact loads during normal gait

Large knee adduction moments during gait have been implicated as a mechanical factor related to the progression and severity of tibiofemoral osteoarthritis and it has been proposed that these moments increase the load on the medial compartment of the knee joint. However, this mechanism cannot be validated without taking into account the internal forces and moments generated by the muscles and ligaments, which cannot be easily measured. Previous musculoskeletal models suggest that the medial compartment of the tibiofemoral joint bears the majority of the tibiofemoral load, with the lateral compartment unloaded at times during stance. Yet these models did not utilise explicitly measured muscle activation patterns and measurements from an instrumented prosthesis which do not portray lateral compartment unloading. This paper utilised an EMG-driven model to estimate muscle forces and knee joint contact forces during healthy gait. Results indicate that while the medial compartment does bear the majority of the load during stance, muscles provide sufficient stability to counter the tendency of the external adduction moment to unload the lateral compartment. This stability was predominantly provided by the quadriceps, hamstrings, and gastrocnemii muscles, although the contribution from the tensor fascia latae was also significant. Lateral compartment unloading was not predicted by the EMG-driven model, suggesting that muscle activity patterns provide useful input to estimate muscle and joint contact forces.     

Changes in the medial–lateral hamstring activation ratio with foot rotation during lower limb exercise

This paper investigated whether the ratio of medial–lateral hamstring muscular activation could be altered with changes in foot rotation position (both internal and external rotation) during three standard lower limb exercises. It has been suggested that those with medial compartment knee OA activate the lateral hamstrings more than the medial to help unload the diseased compartment; therefore, preferential activation of this muscle during lower limb exercise may help to further decrease the stresses on the articular cartilage and be an effective intervention for knee OA and lateral hamstring injury. Thirteen healthy young adult subjects were tested and average medial and lateral hamstring EMG data during the full exercise, as well as the concentric and eccentric phases, were used to calculate the medial–lateral (M–L) hamstring activation ratio for each exercise and foot position. Results suggest that internal foot rotation increases the M–L hamstring activation ratio while external foot rotation decreases this ratio. Therefore, altering the position of the foot during standard lower limb exercise can help selectively activate the medial or lateral hamstring muscle groups. This selective activation may have implication in treating symptoms of knee osteoarthritis and hamstring injury; but, longitudinal intervention studies would be needed to determine clinical utility.     

Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects

PurposeTo compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.ScopeNine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.ResultsPerturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.ConclusionsHealthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.     

Changes in knee joint muscle activation patterns during walking associated with increased structural severity in knee osteoarthritis

PurposeTo determine whether alterations in knee joint muscle activation patterns during gait were related to structural severity determined by Kellgren–Lawrence (KL) radiographic grades, for those with a moderate knee OA classification.ScopeEighty-two individuals with knee OA, classified as moderate using a functional and clinical criterion were stratified on KL-grade (KL II, KL III and KL IV). Thirty-five asymptomatic individuals were matched for age and walking velocity. Lower limb motion and surface electromyograms from rectus femoris plus lateral and medial sites for the gastrocnemii, vastii and hamstring muscles were recorded during self-selected walking. Gait velocity and characteristics from sagittal plane knee angular displacement waveforms were calculated. Principal component analysis extracted amplitude and temporal features from electromyographic waveform. Analysis of variance models tested for main effects (group, muscle) and interactions (α = 0.05) for these features. No differences in anthropometrics, velocity, knee muscle strength and symptoms were found among the three OA groups (p > 0.05). Specific features from medial gastrocnemius, lateral hamstring and quadriceps amplitude and temporal patterns were significantly different among OA groups (p < 0.05).ConclusionsSystematic alterations in specific knee joint muscle activation patterns were associated with increasing structural severity based on KL-grades whereas other alterations were associated with the presence of OA.     

Reflex muscle contractions can be elicited by valgus positional perturbations of the human knee

Experimental evidence on the reflex responses of thigh muscles to valgus mechanical perturbations at the human knee are presented. Random step positional deflections, ranging from 5 degrees to 12 degrees at 60 degrees /s, were applied to the fully extended knees of seven healthy subjects. Subjects were instructed to maintain a constant background co-activation ( approximately 2-11% MVC) of the quadriceps and hamstring muscles prior to and during the mechanical stimulus. We found that the reflex response to sustained valgus joint deflection in the vasti muscles had longer onset latencies (range: 83-92ms) than did the stretch reflex in the same muscles (latencies: 29-31ms). This reflex EMG response consisted typically of a peak followed by sustained muscle activity throughout the step perturbation. The sustained EMG activity was dependent on the amplitude of the perturbing stimulus, but in a nonlinear manner. The long latency of the valgus response suggests that the reflex originates in nonmuscular sensory pathways, potentially from mechanoreceptors lying in periarticular tissues such as joint ligaments and capsule. Analysis of the spatial distribution of reflex responses showed an asymmetrical pattern with preferential activation of medial vs. lateral muscles of the knee. We assess whether these asymmetric reflex contractions could promote joint stability, either by inducing generalized joint stiffening, or by preferential activation of those muscles that are best suited to resist induced ligament strain.     

Muscle response times between shoe and no-shoe conditions following a weight-bearing rotary perturbation are similar in females

The purpose of this study was to compare the muscle response times (MRTs) of select lower extremity muscles following a weight bearing rotary perturbation in single-leg stance with and without shoes. Ten recreationally active females volunteered for this study. Each subject received a rotary perturbation in single-leg stance under two conditions: with shoes and without shoes. The outcomes measured were response times of the medial and lateral quadriceps, hamstrings and gastrocnemius. The results demonstrated that significant differences in MRTs were not apparent for either the medial or lateral perturbation between conditions. While a main effect for muscle was evident for both medial and lateral perturbations, a muscle by shoe interaction was not present for either the medial or lateral perturbation. Our findings suggest that wearing shoes does not alter MRTs during single-limb rotary perturbations. These data indicate that lower extremity perturbation device testing may be done with or without shoes and comparisons between works are permissible as response times are unaffected.     

The effect of anterior cruciate ligament rupture on the timing and amplitude of gastrocnemius muscle activation: a study of alterations in EMG measures and their relationship to knee joint stability

Changes in hamstring and quadriceps activity are well known in individuals with anterior cruciate ligament deficiency (ACLD) to potentially compensate for knee joint instability. However, few studies have explored gastrocnemius activity or its relationship to knee stability. The purpose of this study was therefore to examine the activation characteristics of medial gastrocnemius (MG) in ACLD subjects and relate any changes to knee joint laxity. Two subject cohorts were assessed: those with unilateral ACLD (n=15) and uninjured control subjects (n=11). Surface EMG of the left and right MG were recorded during a controlled single leg hop on each limb. Onset and offset of MG activation relative to take-off, during flight and landing were calculated as well as muscle activity (RMS). Passive antero-posterior knee laxity was measured with a KT1000 arthrometer during a maximal manual displacement test. Medial gastrocnemius activity on the injured side of ACLD participants demonstrated significantly prolonged activation in preparation to hop, minimal muscle inactivity prior to take-off, and increased duration of overall muscle activity when compared to the uninjured side and control subjects (p<0.05). Significant positive correlations were found between passive knee joint laxity and prolonged activation prior to knee bend. RMS of the muscle signal was not significantly different between limbs. Overall, MG on the ACLD side demonstrated longer activation, with minimal rest during the hop test, which may be an attempt to maintain knee stability. Furthermore, the strong relationship between knee laxity and prolonged muscle activation suggests that individuals with a loss of knee stability are more reliant on active control of the gastrocnemius muscle.     

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis

PurposeExternal knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle co-activation and external knee moments during walking in subjects with medial knee osteoarthritis.Methods19 controls (11 males, aged 56.6 ± 5, and BMI 25.2 ± 3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3 ± 5.3, and BMI 28.2 ± 4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups.FindingsSubjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments.InterpretationMuscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Diminished sub-maximal quadriceps force control in anterior cruciate ligament reconstructed patients is related to quadriceps and hamstring muscle dyskinesia

The aim of this study was to determine the effects of anterior cruciate ligament reconstruction (ACLR) on sub-maximal quadriceps force control with respect to quadriceps and hamstring muscle activity. Thirty ACLR individuals together with 30 healthy individuals participated. With real-time visual feedback of muscle force output and electromyographic electrodes attached to the quadriceps and hamstring muscles, subjects performed an isometric knee extension task where they increased and decreased their muscle force output at 0.128 Hz within a range of 5–30% maximum voluntary capacity. The ACLR group completed the task with more error and increased medial hamstring and vastus medialis activation (p < 0.05). Moderate negative correlations (p < 0.05) were observed between quadriceps force control and medial (Spearman’s rho = −0.448, p = 0.022) and lateral (Spearman’s rho = −0.401, p = 0.034) hamstring activation in the ACLR group. Diminished quadriceps sub-maximal force control in ACLR subjects was reflective of medial quadriceps and hamstring dyskinesia (i.e., altered muscle activity patterns and coordination deficits). Within the ACLR group however, augmented hamstring co-activation was associated with better quadriceps force control. Future studies should explore the convergent validity of quadriceps force control in ACLR patients.     

Characteristics of human knee muscle coordination during isometric contractions in a standing posture: The effect of limb task

Different functional roles for the hands have been demonstrated, however leg control is not as well understood. The purpose of the present study was to evaluate bilateral knee neuromuscular control to determine if the limb receiving greater attention would have more well-tuned control compared to an unattended limb. Surface electrodes were placed on seven muscles of each limb, before standing on two force platforms. Visual feedback was given of the forces and moments of the “focus limb,” but not the “unattended limb.” Static isometric forces were matched with their focus limb, requiring their unattended limb to push in the opposite direction, using a combination of forward–backward–medial–lateral shear forces while muscle activity was collected bilaterally. There was a significant main effect for limb task (p = 0.02), with the medial hamstrings being more specific (p = 0.001) while performing the unattended limb and the lateral hamstring being more well-tuned (p = 0.007) while performing the focus limb task. The focus limb’s medial and lateral gastrocnemius were principally active in the forwards direction, but only the unattended limb’s lateral gastrocnemius was active in the backwards direction. Findings suggest unique neuromuscular control strategies are used for the legs depending on limb task.     

Gender differences exist in neuromuscular control patterns during the pre-contact and early stance phase of an unanticipated side-cut and cross-cut maneuver in 15–18 years old adolescent soccer players

Non-contact ACL injuries generally occur as the foot contacts the ground during cutting or landing maneuvers and the non-contact ACL injury rate is 2–8 times greater in females compared to males. To provide insight into the gender bias of this injury, this study set out to identify gender differences in the neuromuscular response of the quadriceps, hamstrings and gastrocnemii muscles in elite adolescent soccer players during the pre-contact and early stance phases of an unanticipated side-cut and cross-cut. For the early stance phase of the two maneuvers, females demonstrated greater rectus femoris activity compared to males. Throughout the pre-contact phase of the maneuvers, a rectus femoris activation difference was identified with females having an earlier and more rapid rise in muscle activity as initial ground contact approached. Females demonstrated greater lateral and medial gastrocnemii activity for the pre-contact and early stance phases of the side-cut and greater lateral gastrocnemii activity during early stance of the cross-cut. Timing of hamstring activity also differed between genders prior to foot contact. The differences suggest that the activation patterns observed in females might not be providing adequate joint protection and stability, thereby possibly having a contributing role towards increased non-contact ACL injuries in females.     

Timing of neuromuscular activation of the quadriceps and hamstrings prior to landing in high school male athletes, female athletes, and female non-athletes.

There is a discrepancy between males and females in regards to lower extremity injury rates, particularly at the knee [Agel, J., Arendt, E.A., Bershadsky, B., 2005. Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer: a 13-year review. American Journal of Sports Medicine 33, (4) 524-530]. Gender differences in neuromuscular recruitment characteristics of the muscles that stabilize the knee are often implicated as a factor in this discrepancy. There is considerable research in the area of gender differences in regards to neuromuscular characteristics of the lower extremity in response to perturbation; however, most studies have been performed on the adult population only. Additionally, there is no consensus as to the gender differences that have been demonstrated. The purpose of this study was to compare muscular preactivation of selected lower extremity muscles (vastus medialis, rectus femoris, and medial/lateral hamstrings) in adolescent female basketball athletes, male basketball athletes, and female non-athletes in response to a drop landing. Subjects in the female non-athlete group recruited rectus femoris significantly slower than both the female athlete and male athlete groups (619.9=588.5>200.1ms prior to ground contact). The female non-athlete group also demonstrated a significantly slower vastus medialis compared to the female athlete group (127.1 vs 408.1ms), but not significantly slower than the male athlete group (127.1 vs 275.7ms). There were no differences between female athletes and male athletes for time to initial contraction of any muscle groups. No differences were found among the groups for medial or lateral hamstring activation. This study demonstrates that physical conditioning due to basketball participation appears to affect neuromuscular recruitment in adolescents and reveals a necessity to find alternate methods of training the hamstrings for improved neuromuscular capabilities to prevent injury.     

Antagonist muscle co-contraction during a double-leg landing maneuver at two heights

Background: Knee injuries are common during landing activities. Greater landing height increases peak ground reaction forces (GRFs) and loading at the knee joint. As major muscles to stabilize the knee joint, Quadriceps and Hamstring muscles provide internal forces to attenuate the excessive GRF. Despite the number of investigations on the importance of muscle function during landing, the role of landing height on these muscles forces using modeling during landing is not fully investigated. Methods: Participant-specific musculoskeletal models were developed using experimental motion analysis data consisting of anatomic joint motions and GRF from eight male participants performing double-leg drop landing from 30 and 60 cm. Muscle forces were calculated in OpenSim and their differences were analyzed at the instances of high risk during landing i.e. peak GRF for both heights. Results: The maximum knee flexion angle and moments were found significantly higher from a double-leg landing at 60 cm compared to 30 cm. The results showed elevated GRF, and mean muscle forces during landing. At peak GRF, only quadriceps showed significantly greater forces at 60 cm. Hamstring muscle forces did not significantly change at 60 cm compared to 30 cm. Conclusions: Quadriceps and hamstring muscle forces changed at different heights. Since hamstring forces were similar in both landing heights, this could lead to an imbalance between the antagonist muscles, potentially placing the knee at risk of injury if combined with small flexion angles that was not observed at peak GRF in our study. Thus, enhanced neuromuscular training programs strengthening the hamstrings may be required to address this imbalance. These findings may contribute to enhance neuromuscular training programs to prevent knee injuries during landing.     

Limb and sex-related differences in knee muscle co-contraction exist 3 months after anterior cruciate ligament reconstruction

Interlimb and sex-based differences in gait mechanics and neuromuscular control are common after anterior cruciate ligament reconstruction (ACLR). Following ACLR, individuals typically exhibit elevated co-contraction of knee muscles, which may accelerate knee osteoarthritis (OA) onset. While directed (medial/lateral) co-contractions influence tibiofemoral loading in healthy people, it is unknown if directed co-contractions are present early after ACLR and if they differ across limbs and sexes. The purpose of this study was to compare directed co-contraction indices (CCIs) of knee muscles in both limbs between men and women after ACLR. Forty-five participants (27 men) completed overground walking at a self-selected speed 3 months after ACLR during which quadriceps, hamstrings, and gastrocnemii muscle activities were collected bilaterally using surface electromyography. CCIs of six muscle pairs were calculated during the weight acceptance interval. The CCIs of the vastus lateralis/biceps femoris muscle pair (lateral musculature) was greater in the involved limb (vs uninvolved; p = 0.02). Compared to men, women exhibited greater CCIs in the vastus medialis/lateral gastrocnemius and vastus lateralis/lateral gastrocnemius muscle pairs (p < 0.01 and p = 0.01, respectively). Limb- and sex-based differences in knee muscle co-contractions are detectable 3 months after ACLR and may be responsible for altered gait mechanics.