The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries

This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 +/- 3.6 years; 175 +/- 4 cm; 77.3 +/- 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 +/- 3.7 years; 177 +/- 6 cm; 74.3 +/- 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 +/- 2.8 years; 178 +/- 6 cm; 75.8 +/- 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300 degrees/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.