Explosive hamstrings strength asymmetry persists despite maximal hamstring strength recovery following anterior cruciate ligament reconstruction using hamstring tendon autografts

Jose, Argell T. San; Maniar, Nirav; Timmins, Ryan G.; Beerworth, K.; Hampel, Chris; Tyson, Natalie; Williams, Morgan; Opar, David A.

doi:10.1007/s00167-022-07096-y

Cited by 6 publications

(2 citation statements)

References 41 publications

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“…Future work in the female population is still needed given the previously reported differences in lower limb strength and biomechanics between the sexes. 40 , 42 …”

Section: Discussionmentioning

confidence: 99%

Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Following Anterior Cruciate Ligament Reconstruction

et al. 2023

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Background: Low patellofemoral joint (PFJ) contact force has been associated with PFJ osteoarthritis. Quadriceps force and knee flexion angles, which are typically altered after an anterior cruciate ligament reconstruction (ACLR), primarily influence PFJ contact forces. It is still inconclusive whether differences in PFJ contact forces are present during high knee flexion tasks such as side-step cutting after clearance to return to sports (RTS) after ACLR. Purpose: To explore PFJ contact forces in the ACLR limb and compare them with those of the contralateral and control limbs during side-step cutting tasks after clearance to RTS. Study Design: Controlled laboratory study. Methods: A total of 26 male athletes with ACLR who were previously cleared to RTS were matched with 23 healthy men serving as the control group. Three-dimensional motion capture and force plate data were collected while both groups performed anticipated side-step cutting tasks. Joint kinematics, kinetics, muscle forces, and PFJ contact forces were calculated using musculoskeletal modeling. Results: Peak PFJ force was lower in the ACLR limbs compared with the contralateral limbs (mean difference [MD], 5.89 body weight [BW]; 95% CI, 4.7-7.1 BW; P < .001) and the control limbs (MD, 4.44 BW; 95% CI, 2.1-6.8 BW; P < .001). During peak PFJ force, knee flexion angle was lower in ACLR limbs compared with the contralateral (MD, 4.88°; 95% CI, 3.0°-6.7°; P < .001) and control (MD, 6.01°; 95% CI, 2.0°-10.0°; P < .002) limbs. A lower quadriceps force compared with the contralateral (MD, 4.14 BW; 95% CI, 3.4-4.9 BW; P < .001) and control (MD, 2.83 BW; 95% CI, 1.4-4.3 BW; P < .001) limbs was also found. Conclusion: Lower PFJ contact forces and a combination of quadriceps force deficits and smaller knee flexion angle were found in the ACLR compared with the contralateral and control limbs even after clearance to RTS. Clinical Relevance: Despite rehabilitation and subsequent clearance to RTS, differences in PFJ contact forces are present after ACLR. Current rehabilitation and RTS battery may not be effective and sensitive enough to identify and address these differences.

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“…Future work in the female population is still needed given the previously reported differences in lower limb strength and biomechanics between the sexes. 40 , 42 …”

Section: Discussionmentioning

confidence: 99%

Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Following Anterior Cruciate Ligament Reconstruction

et al. 2023

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“…Similar data, with no difference in extensor strength but decreased flexor strength when using HT, is also reported when comparing BPTB and HT [ 6 , 42 , 67 ]. Interestingly, a recent study showed that maximal hamstring strength, but not explosive hamstring strength improved over time following ACL-R using HT [ 114 ]. Comparing QT to BPTB, similar levels of quadriceps recovery have been observed in the short term [ 39 , 51 ].…”

Section: Introductionmentioning

confidence: 99%

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

et al. 2023

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Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.

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Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months

Sengoku,

Nakase,

Mizuno

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut‐off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively.MethodsOne hundred forty‐eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperatively and peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut‐off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively.ResultsMultiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut‐off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI.ConclusionThe LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon.Level of evidenceLevel III.

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Explosive hamstrings strength asymmetry persists despite maximal hamstring strength recovery following anterior cruciate ligament reconstruction using hamstring tendon autografts

Cited by 6 publications

References 41 publications

Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Following Anterior Cruciate Ligament Reconstruction

Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Following Anterior Cruciate Ligament Reconstruction

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months

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