Early clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after anterior cruciate ligament reconstruction

Stropnik, Domen; Sajovic, Matjaž; Kacin, Alan; Pavlič-Založnik, Simona; Drobnič, Matej

doi:10.1007/s00402-020-03436-0

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…3 The IKDC score in patients with quadriceps tendon-patellar bone autograft (= QTB group) and with bone-patellar tendon-bone autograft (= BPTB group) showed no significant difference between the groups 10 years postoperatively (N = 43, p = 0.653) Fig. 4 The KT-1000 arthrometer measurement in patients with quadriceps tendon-patellar bone autograft (= QTB group) and with bone-patellar tendonbone autograft (= BPTB group) showed no significant difference between the groups at following three points in time: after the injury and before surgery (N = 60, p = 0.834), 1 year postoperatively (N = 56, p = 0.518) and 10 years postoperatively (N = 43, p = 0.235) A recent meta-analysis reported BPTB autografts to provide superior rotational knee stability in comparison with hamstring autografts, albeit with higher donor site complication rate in the form of anterior knee pain, especially during kneeling [27,28]. This pain during kneeling after BPTB ACL reconstruction is recurrently reported in the medical literature and can lead to patient dissatisfaction [29,30].…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis reported BPTB autografts to provide superior rotational knee stability in comparison with hamstring autografts, albeit with higher donor site complication rate in the form of anterior knee pain, especially during kneeling [ 27 , 28 ]. This pain during kneeling after BPTB ACL reconstruction is recurrently reported in the medical literature and can lead to patient dissatisfaction [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years

Barié

Sprinckstub²,

Huber³

et al. 2020

Arch Orthop Trauma Surg

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Introduction The use of quadriceps tendon–patellar bone (QTB) autograft for anterior cruciate ligament (ACL) reconstruction is gaining momentum. Yet, long-term results that compare this procedure with established methods are lacking. The aim of this study was to report and compare long-term results of ACL reconstruction using QTB autografts versus bone–patellar tendon–bone (BPTB) autografts, both anchored using a hardware-free press-fit fixation technique. Materials and methods 60 athletes (Tegner score ≥6) with primary ACL rupture were prospectively randomized into two groups. 56 patients were evaluated after a mean duration of 12.2 ± 1.9 months (range 10–14) and 43 patients after 10.3 ± 0.2 years (range 10–11). Results On final follow-up, 90% of patients scored very good and good results in the functional Lysholm score (mean 99 ± 7.1, range 74–100 points). Normal or almost normal IKDC score was reported by 84% of the patients (mean 97 ± 9.5, range 60–100 points). The activity level decreased in the Tegner score from median of 7 before injury to 6 after 10 years. The KT-1000 arthrometer showed a difference in the anterior translation of less than 3 mm (mean 1.0 ± 1.2, range − 1 to 5 mm) in 91% of the patients. Significant degeneration was radiologically detected in one patient per group. No tunnel widening was seen in any patient. Up to 97% of all patients were satisfied with the operative procedure. No significant differences were found in the mentioned parameters between the two groups and also in comparison with the 1-year results. The only significant difference was in the donor site morbidity. Significantly more patients in the BPTB group had complaints during kneeling both at 1 (p < 0.001) and 10 years (p = 0.019). Squatting was also subjectively more problematic in the BPTB group than in the QTB group both after 1 (p = 0.003) and 10 years (p = 0.046). Conclusions This study shows equally good functional, clinical and radiological long-term results for both hardware-free methods of ACL reconstruction. These results clinically confirm the safety of press-fit anchoring after 10 years. The failure rate in this study was very low, with only one re-rupture in 10 years. The increased donor site morbidity when using the BPTB autograft compared to the QTB autograft supports already reported data. It was also seen in this study for the implant-free press-fit techniques. Study design Prospective and randomized, level of evidence 2.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years

Barié

Sprinckstub²,

Huber³

et al. 2020

Arch Orthop Trauma Surg

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“…Weakness of the quadriceps femoris (QF) muscle typically develops after injury of the anterior cruciate ligament (ACL) and is strongly correlated with poor knee function after otherwise successful ACL reconstruction 1 . The combination of QF weakness and increased activity of knee flexors is considered as a natural protective mechanism against anterior subluxation that may cause aggravation of pain and further damage to the joint 2 .…”

Section: Introductionmentioning

confidence: 99%

Functional and molecular adaptations of quadriceps and hamstring muscles to blood flow restricted training in patients with ACL rupture

Kacin

Drobnič

Marš

et al. 2021

Scandinavian Med Sci Sports

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Effects of low‐load blood flow restricted (LL‐BFR) training remain unexplored in patients with ACL rupture. Our hypothesis was that LL‐BFR training triggers augmented gains in knee muscle strength and size, which are paralleled with transcriptional responses of hypoxia‐regulated genes and myokines. Eighteen volunteers (age 37.5 ± 9 years) planned for ACL reconstruction, participated in the study. Twelve were divided between BFR group, performing 9 sessions of LL‐BFR exercise, and SHAM‐BFR group performing equal training with sham vascular occlusion. Six subjects served as a control for muscle biopsy analysis. Cross‐sectional area (CSA) and isokinetic strength of knee muscles were assessed before and after the training. Change in CSAquad was significantly (p < 0.01) larger in BFR (4.9%) compared with SHAM‐BFR (1.3%). Similarly, change in peak torque of knee extensors was significantly (p < 0.05) larger in BFR (14%) compared with SHAM‐BFR (−1%). The decrease in fatigue index of knee extensors (6%) was larger (p < 0.01) in BFR than in SHAM‐BFR (2%). mRNA expression of HIF‐1α in the vastus lateralis was reduced (p < 0.05) in SHAM‐BFR, while VEGF‐A mRNA tended to be higher in BFR. The mRNA expression of myostatin and its receptor were reduced (p < 0.05) in the semitendinosus after both types of training. Expression of IL‐6, its receptors IL‐6Rα and gp130, as well as musclin were similar in control and training groups. In conclusion, our results show augmented strength and endurance of knee extensors but less of the flexors. LL‐BFR training is especially effective for conditioning of knee extensors in this population.

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“…Similarly, the significant difference of mean age between the two groups could as well have biased results [ 36 , 39 ]. The height should not have an impact on the overall outcome, particularly as the BMI did not differ significantly [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial

Horstmann

Petri

Tegtbur

et al. 2021

Arch Orthop Trauma Surg

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Introduction Comparable data of functional outcomes of anterior cruciate ligament reconstruction using either hamstring- or quadriceps tendon grafts is controversial. This prospective, randomized controlled trial aims to provide data comparing both grafts regarding the functional outcome. Materials and methods A two centre trial involving symptomatic patients 18 years of age or older with an anterior cruciate ligament tear was conducted. We randomly assigned 27 patients to quadruple hamstring tendon reconstruction and 24 to quadriceps tendon reconstruction. The patients were evaluated preoperatively, at 3, 6, 12 and 24 months post-surgery. The primary outcome parameter was the side-to-side knee laxity measured with an arthrometer. Secondary outcomes included results in the International Knee Documentation Committee (IKDC) and Lysholm Scores and isokinetic testing of strength in knee extension and flexion. Results Forty-four patients (86%) completed the 2-year follow-up. There was significantly improved knee stability at all time intervals with no difference between the two study groups. The manual side-to-side displacement improved by 4.7 ± 3.0 mm in patients with hamstring tendon reconstruction and 5.5 ± 2.9 mm in patients with quadriceps tendon reconstruction. In addition, muscle strength and outcome scores (IKDC and Lysholm Score) did not show any differences between the hamstring tendon group and the quadriceps tendon group. Patients in the hamstring tendon group returned to their pre-injury activity level after 95.2 ± 45.5 days while patients in the quadriceps tendon group needed 82.1 ± 45.6 days. Conclusion Quadriceps and hamstring tendon autografts yield comparably good results in primary anterior cruciate ligament reconstruction.

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Early clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after anterior cruciate ligament reconstruction

Cited by 7 publications

References 39 publications

Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years

Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years

Functional and molecular adaptations of quadriceps and hamstring muscles to blood flow restricted training in patients with ACL rupture

Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial

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