single-leg aerobic capacity, muscular strength, balance, and agility in healthy and surgically ...

113 Pages·2015·1.93 MB·English

by  Bagley, Morgan Cooper

SINGLE-LEG AEROBIC CAPACITY, MUSCULAR STRENGTH, BALANCE, AND
AGILITY IN HEALTHY AND SURGICALLY REPAIRED ANTERIOR CRUCIATE
LIGAMENT LEGS IN COLLEGE AGE STUDENTS

A dissertation submitted to the
Kent State University College
of Education, Health, and Human Services
in partial fulfillment of the requirements
for the degree of Doctor of Philosophy

By

Morgan Cooper Bagley

August 2015
A dissertation written by

Morgan Cooper Bagley

B.S., Mount Union College, 2003

M.A., Kent State University, 2005

Ph.D., Kent State University, 2015

Approved by

________________________, Co-director, Doctoral Dissertation Committee
Lisa Chinn

________________________, Co-director, Doctoral Dissertation Committee
John McDaniel

________________________, Member, Doctoral Dissertation Committee
Ellen Glickman

________________________, Member, Doctoral Dissertation Committee
Dianne Kerr

Accepted by

________________________, Director, School of Health Sciences
Lynne Rowan

________________________, Interim Dean, College of Education, Health, and Human
Mark Kretovics Services
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BAGLEY, MORGAN COOPER, Ph.D., August 2015 School of Health Sciences

SINGLE-LEG AEROBIC CAPACITY, MUSCULAR STRENGTH, BALANCE, AND
AGILITY IN HEALTHY AND SURGICALLY REPAIRED ANTERIOR CRUCIATE
LIGAMENT LEGS IN COLLEGE AGE STUDENTS (104 pp.)

Co- Directors of Dissertation: Lisa Chinn, Ph.D.
John McDaniel, Ph.D.

Following anterior cruciate ligament (ACL) surgery there is known inconsistency
of return to play criteria, which may explain why cleared athletes are at a greater risk for
re-injury of the surgical limb or injury of the bilateral limb. The purpose of this study was
to examine whether there are limb differences in single-leg aerobic capacity in subjects
who have undergone ACL surgery. Our goal was to compare single-leg aerobic capacity
to traditional return to play outcomes to determine if this novel outcome provides an
additional criteria for clinicians to consider. Our secondary purpose was to compare the
data from the ACL injured limb with a matched limb from a non-ACL surgery control.
Eight non-ACL surgery controls and eight subjects with ACL surgery (average time since
clearance 12.9 months) aged 18-29 completed two separate visits to determine strength,
agility, balance, and single-leg aerobic capacity for each limb. Although there were some
minor differences observed within the traditional return to play criteria, indices of aerobic
capacity were no different between the ACL and control groups or the uninjured or
injured limbs in the ACL group. Only minor differences were found in some of the more
traditional tests that evaluated strength, agility, and balance. Additional research needs to
be performed to determine the role of aerobic testing as a clinical measure following
ACL or other lower limb injuries.
ACKNOWLEDGEMENTS
I would like to express my sincere gratitude to the members of my dissertation
committee: Dr. Lisa Chinn, Dr. John McDaniel, Dr. Ellen Glickman, and Dr. Dianne Kerr
for their belief and support with this project. Thank you to Dr. Mark Lyberger for his
role as the graduate faculty representative and moderator of my dissertation defense.
Thank you to Eddie Bowden, Sara Harper, Scott Habowski, Jay Jonas, and Lauren Miller
who provided support and helped this project come to life and saw it through to fruition.
I would also like to take a moment to say thank you for the support and guidance
from the Kent State Exercise Physiology, Kent State Athletic Training, and the Mount
Union Administration, Athletic Training faculty and students. Your support, guidance,
and patience has made this dream come true. Dr. Glickman, you have been there for me
for the last 10 years, you have been there for me even when I didn’t know I needed you
and for that I am truly grateful, thank you for treating me as part of your extended family.
Dr. Chinn and Dr. McDaniel, a special thank you to each of you for taking the time to
direct me through this process near and far and also for your belief in this project and in
me.
A special thank you goes out to all my former athletes who served as subjects in
this study and for the current and past athletes at Kent State for taking the time to
participate. It was a fun ride.
Finally, to my family a true thank you for the support and everything that you
have done over the past five years. My husband, Shawn, has reminded me every day that
I could do it all by not only pursuing my degree but maintaining a successful career. I
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could have never done this without his unwavering love, support, and encouragement.
My parents and siblings were a sounding board and support system that I truly know not
everyone is as lucky to have.

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TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS ............................................................................................... iii
LIST OF TABLES ............................................................................................................ vii
CHAPTER
I. INTRODUCTION ...................................................................................................1
II. REVIEW OF LITERATURE.................................................................................6
ACL Injuries ...........................................................................................................6
ACL Surgery ..........................................................................................................8
Criteria to Return ....................................................................................................9
Leg Dominance ....................................................................................................10
Isokinetic Muscle Function ..................................................................................10
Balance .................................................................................................................11
Fatigue ..................................................................................................................12
Hop Tests ..............................................................................................................13
Aerobic Capacity ..................................................................................................14
Return to Play .......................................................................................................14
Risk of Re-injury ..................................................................................................15
III. METHODOLOGY .............................................................................................17

Subjects ................................................................................................................17
Procedures ............................................................................................................18
Statistics ................................................................................................................22
IV. MANUSCRIPT ..................................................................................................23

Introduction ..........................................................................................................23
Methods ................................................................................................................25
Statistics ................................................................................................................30
Results ..................................................................................................................31
Discussion ............................................................................................................43
V. GRANT PROPOSAL ..........................................................................................48
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Specific Aims .......................................................................................................48
Hypothesis ............................................................................................................48
Background and Significance ...............................................................................49
Experimental Design and Methods ......................................................................50
Budget ..................................................................................................................52
Goals .....................................................................................................................52

APPENDICES ...................................................................................................................53
APPENDIX A. Research Design ................................................................................54
APPENDIX B. Informed Consent Form ....................................................................56
APPENDIX C. Modified Tegner and IKDC Scale .....................................................61
APPENDIX D. Inclusion/Exclusion Sheet .................................................................66
APPENDIX E. Hop Test.............................................................................................68
APPENDIX F. Borg Role of Percieved Exertion Scale .............................................70
APPENDIX G. Data Collection Form 1 .....................................................................72
APPENDIX H. Data Collection Form 2 .....................................................................74
APPENDIX I. Recruitment Flyer ...............................................................................76
APPENDIX J. ACL Modified Tegner Activity Results ............................................78
APPENDIX K. ACL Graft Type ................................................................................80
APPENDIX L. Additional Results .............................................................................82

REFERENCES ..................................................................................................................89

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LIST OF TABLES

Table Page

1. Participant Physical Characteristics (N=16) ..................................................................32
2. Strength at 60 degrees/second Results ...........................................................................34
3. Strength at 180 degrees/second Results ........................................................................35
4. Strength at 300 degrees/second Results ........................................................................36
5. Agility Results ...............................................................................................................38
6. Balance Results ..............................................................................................................40
7. Single-leg Aerobic Capacity Results .............................................................................42
8. ACL Modified Tegner Activity Results ........................................................................79
9. ACL Graft Type .............................................................................................................81
10. Pre-cycling Force Plate Balance Time to Boundry Results .........................................84
11. Post-cycling Force Plate Balance Results ....................................................................86
12. Post-cycling Force Plate Balance Time to Boundry Results .......................................88

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CHAPTER I

INTRODUCTION

Anterior cruciate ligament (ACL) injuries are one of the most common knee
injuries to athletes. In the United States, ACL tears occur in 1 in 3,000 -3,500 individuals
each year (Baer & Harner, 2007; Kiapour & Murray, 2014). ACL surgery is commonly
performed in individuals who plan to return to athletics as well as normal activities of
daily living. People choose to have ACL surgery because the ACL is critical to stability
for the knee joint and plays an important role in dynamic tasks and in athletic activity. In
1996, there were 71,953 ACL reconstruction surgeries done in the United States and that
number increased to nearly 125,000 in 2006 (Kim, Bosque, Meehan, Jamali, & Marder,
2011). The increase in ACL surgery has brought an increase in the total number of failed
reconstructed ACLs and or complications in the opposite leg (Hewett, Torg, & Boden,
2009). This has led to almost 25% of patients having to undergo additional surgery
(Hewett, Di Stasi, & Myer, 2013). Barger-Westin and Noyes (2011) reported that the
rates of either re-injuring an ACL reconstructed knee or sustaining an ACL rupture to the
contralateral knee could be upwards of 49%. Although unknown, this high occurrence of
re-injury may be due to inconsistent criteria being applied to determine return to activity
status.
Barber-Westin and Noyes (2011) conducted a recent systematic review and
concluded that there is a lack of agreement regarding the appropriate criteria for return to
play for patients following ACL reconstruction. It has been reported that 40% of the
studies examined, failed to provide measures for return to sports after surgery.
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