Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts

Abstract

Existing clinical studies have not proven which graft is to be preferred in anterior cruciate ligament (ACL) reconstruction. In recent years, bone-patellar tendon-bone and hamstring tendons have been the most frequently used graft types. Muscle strength deficit is one of the consequences after ACL reconstruction. The aim of this study was to evaluate possible differences in hamstring and quadriceps muscle strength and knee function 5 years after ACL reconstruction between the BPTB and the STG groups. The study group consisted of 288 patients (132 women, 156 men) with a unilateral ACL rupture who had received a BPTB (175 patients) or STG (113 patients) ACL reconstruction. Lower extremity concentric isokinetic peak extension and flexion torques were assessed at the angular velocities of 60 degrees /s and 180 degrees /s. The International Knee Documentation Committee (IKDC), the Tegner activity level, the Lysholm knee and the Kujala patellofemoral scores were also collected. Isokinetic quadriceps peak torque (percentage of the contralateral side) was 3.9% higher in the STG group than in the BPTB group at the velocity of 60 degrees /s and 3.2% higher at the velocity of 180 degrees /s and the isokinetic hamstring peak torque 2% higher in the BPTB group than in the STG group at the velocity of 60 degrees /s and 2.5% higher at the velocity of 180 degrees /s. In both groups the subjects had weaker quadriceps and hamstring muscle strength in the injured extremity compared with the uninjured one. In the single-leg hop test (according to the IKDC recommendations) there was a statistically significant difference (P = 0.040) between the groups. In the STG group, 68% of the patients had the single-leg hop ratio (injured vs. uninjured extremity) > or =90%, 31% of the patients 75-89% and 1% of the patients <75%, while in the BPTB group the corresponding percentages were 72, 21 and 7%. However, no statistically significant differences in clinical outcome were found between the groups as determined by the IKDC, Tegner activity level, Lysholm knee and Kujala patellofemoral scores.

Comparison of Strength and Endurance between Open and Closed Kinematic Chain Exercises after Anterior Cruciate Ligament Reconstruction: Randomized Control Trial

“…In the long term, continuous performance of OKC exercises after the end of therapy may be helpful for increasing endurance in activities such as long distance walking and stair climbing. Approximately 1 year after ACL reconstruction, even without special rehabilitation, the strength of the knee flexors increases, followed by an increase in ADL performance, whereas the strength of the knee extensor dose not increase 15,16) . Thus, rehabilitation is critical for increase of the strength and endurance of the quadriceps.…”

All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients

“…This may improve the postoperative lower extremity knee flexor and internal rotator strength as compared with harvesting both the semitendinosus and gracilis tendons, which can be deficient even at 2 years postoperatively. [46][47][48][49][50][51][52][53][54][55][56][57][58] This technique is less anatomy distorting than the iliotibial band reconstruction technique, with lower postoperative morbidity. The sockets used with this technique are all epiphyseal and blind ended with a cortical bone bridge of at least 7 mm.…”

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

“…Despite these reports, clinically assessing and detecting quadriceps dysfunction during the terminal phases of rehabilitation remains difficult due to the often subtle reductions in strength and activation. 10,15 The importance of quadriceps function after ACLR cannot be overstated because reduced quadriceps function consistently has been related to long-term quadriceps weakness 10,14 and physical performance 3,16,17 and has been hypothesized to increase the risk for knee-joint osteoarthritis. 7 Assessment and comparison of range of motion and strength are common clinical tools used to track progress throughout the rehabilitation process.…”