Is Pre-operative Quadriceps Strength a Predictive Factor for the Outcomes of Anterior Cruciate Ligament Reconstructions

Abstract

Persistent quadriceps weakness prevents patients from returning to sports after ACL reconstruction. Pre-operative quadriceps strength was indicated as an important factor for the outcomes of ACL reconstruction. However, the existing evidence is controversial. Therefore, this systematic review was conducted to summarize and evaluate the relationship between pre-operative quadriceps strength and the outcomes following ACL reconstruction, and to summarize the predictive value of pre-operative quadriceps strength for satisfactory post-operative outcomes. Pubmed, WOS, Embase, CINAHL and SportDiscus were searched to identify eligible studies according to PRISMA guidelines. Relevant data was extracted regarding quadriceps strength assessment methods, pre-operative quadriceps strength, participants treatment protocols, post-operative outcomes, follow-up time points and the relevant results of each individual study. Twelve cohort studies (Coleman methodology score: 62±10.4; from 44–78) with 1773 participants included. Follow-up period ranged from 3 months to 2 years. Moderate evidence supports the positive association between pre-operative quadriceps strength and post-operative quadriceps strength; weak evidence supports the positive association between pre-operative quadriceps strength and post-operative functional outcomes. By now, there is no consensus on the predictive value of pre-operative quadriceps strength for achieving satisfactory quadriceps strength after ACLR. To conclude, pre-operative quadriceps strength should be taken into consideration when predict patient recovery of ACLR.

Bilateral impairments of quadriceps neuromuscular function occur early after anterior cruciate ligament injury

“…Since pre-operative quadriceps strength is an independent predictor for postoperative outcomes of ACLR, bilateral quadriceps strengthening exercises should be included in pre-operative rehabilitation protocol (Qiu et al, 2020).…”

“…It has been reported that pre-operative quadriceps neuromuscular function is a predictor of good functional outcomes and successful return to sports after ACLR. More specifically, previous studies found that pre-operative strength, quadriceps activation failure (QAF) and median frequency of electromyography of quadriceps were related to post-operative quadriceps neuromuscular function, functional performance, and patients-reported outcomes(L. K. Lepley & Palmieri-Smith, 2016;McHugh et al, 2002;Qiu et al, 2020). Thus, restoring quadriceps neuromuscular function is a key objective during pre-operative rehabilitation for ACL injury.…”

Combining age, sex, body mass index, sport level, and preoperative quadriceps strength improves the predictive ability of quadriceps strength recovery after anterior cruciate ligament reconstruction

“…Factors that affect poor quadriceps strength recovery reportedly include older age [13, 16, 29], female sex [9, 19, 29], high body mass index (BMI) [11], low preinjury sports level [25, 26], delayed ACL reconstruction [32], use of a bone‐patellar tendon bone (BTB) graft [27, 33], concomitant cartilage injury [8], and low preoperative quadriceps strength [7, 24, 30]. While there have been many reports on these relationships, only a few studies have examined the predictive ability of these factors.…”

Weaker Quadriceps Muscle Strength With a Quadriceps Tendon Graft Compared With a Patellar or Hamstring Tendon Graft: Letter to the Editor

“…Preoperative muscle strength and preoperative rehabilitation of patients affect the postoperative muscle strength values. 3,4 Although it may be assumed that these criteria are random and will not affect the results for all patients, I believe that the potential differences in this study, which is conducted using a 1:1 matched method and relatively early follow-up period of 7 months postoperatively, may influence the results.…”