Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow‐up

Abstract

Computed tomography (CT) was used to explore if changes in muscle cross-sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16-54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus-gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right-leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.

Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study

“…In a previous study we have shown that females had worse subjective as well as functional hop test outcomes one year after surgery, and some lack of muscular development after surgery compared to males [15]. The present study confirms the lower subjective score ratings for females (KoSp subscale score).…”

“…Post-operative bracing neither prevented joint effusion measured at three-months post-operatively nor one-year functional and subjective outcome parameters. The results from the present study confirm our previous study findings regarding clinical, functional, subjective and muscle morphologic parameters [15]. We may thus conclude that post-operative bracing has no role after ACLR with a ST/G graft.…”

“…Details of the power analysis have been described previously [15]. The initial primary effect variable was muscular cross-sectional area before and after ACL injury and surgery.…”

“…The KOOS subscales were interpreted with the reference of 100 indicating no symptoms and 0 indicating severe symptoms. All tests were recorded by three experienced physical therapists and have been described in detail previously [15].…”

“…The aim was to add further depth to the vast literature on post-operative bracing after BPTB graft. In a previous study we have found that a three-weeks post-operative brace does not affect laxity, range of motion, subjective or functional test results or muscular cross-sectional area one year after surgery with ST/G graft [15].…”