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      Comparison of the Clinical Effects of Open and Closed Chain Exercises after Medial Patellofemoral Ligament Reconstruction

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          Abstract

          [Purpose] To compare the effects of open-chain exercise (OCE) and closed-chain exercise (CCE) for patients after medial patellofemoral ligament (MPFL) reconstruction. [Subjects and Methods] Forty patients after MPFL reconstruction were randomly divided into an OCE group and a CCE group. All the patients were evaluated at four different time points. [Results] The mean change of thigh circumference decrease in the CCE group was lower than that in the OCE group at both the 3rd and 6th month after surgery. The Lysholm score of the CCE group was higher than that of the OCE group at both the 3rd and 6th month. At the 3rd month after surgery, the visual analog scale score of the CCE group was lower than that of the OCE group. [Conclusion] CCE is better than OCE for both short and long term outcomes of patients after MPFL reconstruction.

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          Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises.

          G Fleisig, Kevin Wilk, J. E. Andrews … (1998)
          Although closed (CKCE) and open (OKCE) kinetic chain exercises are used in athletic training and clinical environments, few studies have compared knee joint biomechanics while these exercises are performed dynamically. The purpose of this study was to quantify knee forces and muscle activity in CKCE (squat and leg press) and OKCE (knee extension). Ten male subjects performed three repetitions of each exercise at their 12-repetition maximum. Kinematic, kinetic, and electromyographic data were calculated using video cameras (60 Hz), force transducers (960 Hz), and EMG (960 Hz). Mathematical muscle modeling and optimization techniques were employed to estimate internal muscle forces. Overall, the squat generated approximately twice as much hamstring activity as the leg press and knee extensions. Quadriceps muscle activity was greatest in CKCE when the knee was near full flexion and in OKCE when the knee was near full extension. OKCE produced more rectus femoris activity while CKCE produced more vasti muscle activity. Tibiofemoral compressive force was greatest in CKCE near full flexion and in OKCE near full extension. Peak tension in the posterior cruciate ligament was approximately twice as great in CKCE, and increased with knee flexion. Tension in the anterior cruciate ligament was present only in OKCE, and occurred near full extension. Patellofemoral compressive force was greatest in CKCE near full flexion and in the mid-range of the knee extending phase in OKCE. An understanding of these results can help in choosing appropriate exercises for rehabilitation and training.
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            Soft tissue restraints to lateral patellar translation in the human knee.

            S Desio, R Burks, K N Bachus (2015)
            The purpose of this investigation was to identify and quantify the soft tissue restraints, both medially and laterally, to lateral patellar translation. These restraints to lateral patellar translation at 20 degrees of knee flexion were tested biomechanically on a universal testing instrument in nine fresh-frozen cadaveric knees. After preconditioning the tissues, the patella of each intact knee was translated laterally to a distance at which a force of 200 N was recorded. This distance was used to translate the patella for the remaining structures to be sectioned. The contribution of each structure to the total restraining force was determined as the percent of the force to restrain the intact specimen by sectioning the restraints in a predetermined order. The contribution of each structure to the restraining force was defined as the difference between the restraining force before and after its sectioning. The medial patellofemoral ligament was found to be the primary restraint to lateral patellar translation at 20 degrees of flexion, contributing 60% of the total restraining force. The medial patellomeniscal ligament contributed 13% of the total force, and the lateral retinaculum contributed 10%. The medial patellotibial ligament and superficial fibers of the medial retinaculum were not functionally important in preventing lateral translation. The previously unrecognized contribution of the lateral retinaculum as a restraint to lateral patellar translation may shed new light on the failures of isolated lateral release for acute lateral dislocation of the patella.
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              Acute dislocation of the patella. A correlative pathoanatomic study.

              P Sallay, J Poggi, K P Speer … (2015)
              The objective of our study was to elucidate the characteristic pathoanatomy associated with patellar dislocation and report the preliminary results of early surgical repair. Twenty-three patients with documented patellar dislocation had standard radiographs and a magnetic resonance imaging scan. Intraarticular lesions were evaluated and treated arthroscopically followed by an open exploration of the medial aspect of the knee in 16 patients. Twelve patients were observed for a minimum of 2 years after surgical repair (average, 34 months). Eleven patients returned for a follow-up examination. Magnetic resonance imaging revealed effusion (100%), tears of the femoral insertion of the medial patellofemoral ligament (87%), increased signal in the vastus medialis muscle (78%), and lateral femoral condyle (87%) and medial patellar (30%) bone bruises. Arthroscopic examination revealed osteochondral lesions involving the patella and the lateral femoral condyle in 68% of cases. Open surgical exploration revealed tears of the medial patellofemoral ligament off the femur in 15 of 16 patients (94%). After medial patellofemoral ligament repair, none of the patients experienced recurrent dislocation. Overall 58% of the results were considered to be good or excellent and 42% were fair. Fifty-eight percent of the group returned to their previous sport with no or minor limitations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Phys Ther Sci
                Journal ID (iso-abbrev): J Phys Ther Sci
                Journal ID (publisher-id): JPTS
                Title: Journal of Physical Therapy Science
                Publisher: The Society of Physical Therapy Science
                ISSN (Print): 0915-5287
                ISSN (Electronic): 2187-5626
                Publication date (Electronic): 28 October 2014
                Publication date (Print): October 2014
                Volume: 26
                Issue: 10
                Pages: 1557-1560
                Affiliations
                [1) ] Department of Rehabilitation Medicine, Third Hospital of Hebei Medical University, China
                [2) ] Depatrtment of Orthopedics, Cangzhou Central Hospital, China
                [3) ] Department of Joint Surgery, Third Hospital of Hebei Medical University, China
                [4) ] Hebei Provincial Orthopedic Biomechanics Key Laboratory, China
                Author notes
                [* ]Corresponding author. Fei Wang, Department of Joint Surgery, Third Hospital of Hebei Medical University: No. 139 Ziqiang Road, 050051 Shijiazhuang, Hebei, China. (E-mail: doctorwangfei@ 123456126.com )
                Article
                Publisher ID: jpts-2014-152
                DOI: 10.1589/jpts.26.1557
                PMC ID: 4210397
                SO-VID: 38cf1ebc-5991-4629-bd60-b770dfb65969
                Copyright © 2014©by the Society of Physical Therapy Science
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                Date received : 11 March 2014
                Date accepted : 12 April 2014
                Categories
                Subject: Original Article

                Keywords: medial patellofemoral ligament reconstruction,open-chain exercise,closed-chain exercise
                Data availability:
                Keywords: medial patellofemoral ligament reconstruction, open-chain exercise, closed-chain exercise

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