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Using an electromyography (EMG) signal analysis technique coupled with a machine learning approach, we sought to: (1) identify whether ACLR muscle activity patterns differed from those of healthy controls, and (2) explore which combination of patient outcome measures (thigh muscle girth, knee laxity, hop distance, and activity level) predicted the extent of osteoarthritic changes via magnetic resonance imaging (MRI) in ACLR patients. Eleven ACLR patients 10\u201315 years post-surgery and 12 healthy controls performed a hop activity while lower limb muscle EMG was recorded bilaterally. Osteoarthritis was evaluated based on MRI. ACLR muscle activity patterns were bilaterally symmetrical and differed from those of healthy controls, suggesting the presence of a global adaptation strategy. Smaller ipsilateral thigh muscle girth was the strongest predictor of inferior MRI scores. The ability of our EMG analysis approach to detect meaningful neuromuscular differences that could ultimately be related to thigh muscle girth provides the foundation to further investigate a direct link between muscle activation patterns and PTOA risk.<\/jats:p>","DOI":"10.3390\/bioengineering10070812","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T02:37:29Z","timestamp":1688697449000},"page":"812","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Long-Term Bilateral Neuromuscular Function and Knee Osteoarthritis after Anterior Cruciate Ligament Reconstruction"],"prefix":"10.3390","volume":"10","author":[{"given":"Payam","family":"Zandiyeh","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren R.","family":"Parola","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meggin Q.","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalyn J.","family":"Hague","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Molino","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"},{"name":"Lifespan Biostatistics, Epidemiology, Research Design, & Informatics Core, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7841-425X","authenticated-orcid":false,"given":"Braden C.","family":"Fleming","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2821-1227","authenticated-orcid":false,"given":"Jillian E.","family":"Beveridge","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rhode Island Hospital\/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/1941738118803616","article-title":"Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014","volume":"10","author":"Herzog","year":"2018","journal-title":"Sport. 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