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Quadriceps Femoris and Hamstring Muscle Function in a Person With an Unstable Knee

ME Maitland, PhD, PT, is Associate Professor and Physical Therapist, Sport Medicine Centre, University of Calgary, 2500 University Dr NW, Calgary, Alberta, Canada T2N 1N4 (maitland{at}acs.ucalgary.ca). Address all correspondence to Dr Maitland
SV Ajemian, is Customer Service Engineer, Motion Analysis Corp. Mr Ajemian was a student at the McCaig Centre for Joint Injury and Arthritis Research, University of Calgary, when this case report was written
E Suter, PhD, is Adjunct Assistant Professor, Human Performance Laboratory, University of Calgary

Background and Purpose. The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency. Case Description. The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait. Outcomes. Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed. Discussion. Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.

Key Words: Anterior cruciate ligament • Electromyography • Gait analysis • Rehabilitation

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