Longitudinal Quadriceps Strength Recovery After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: Patients Stratified by Preoperative Quadriceps Strength Deficit

Ueda, Yuya; Matsushita, Takehiko; Shibata, Yohei; Takiguchi, Kohei; Kida, Akihiro; Araki, Daisuke; Kanzaki, Noriyuki; Hoshino, Yuichi; Ono, Rei; Sakai, Yoshitada; Kuroda, Ryosuke

doi:10.1123/jsr.2018-0236

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…Previous studies have reported that the preoperative LSI of IKE affects the recovery of IKE postoperatively. 47 In the future, we need to measure the data prospectively and conduct a multivariate analysis, which includes other variables to examine the impact of each variable.…”

Section: Discussionmentioning

confidence: 99%

Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction

Mitomo

Aizawa

Hirohata

et al. 2023

Journal of Sport Rehabilitation

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Context: Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6 months after anterior cruciate ligament reconstruction. Design: Retrospective study. Methods: Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3 months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6 months postoperatively as the dependent variable and the LSI of IKE at 3 months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6 months postoperatively as the dependent variable; LSI of IKE at 3 months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. Results: The correlation analysis revealed that the LSIs of IKE at 3 and 6 months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3 months postoperatively was significantly associated with that at 6 months postoperatively, even when other variables were included as covariates (R2 = .349, P = .004). Conclusion: Asymmetry of knee extension strength at 3 months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction

Mitomo

Aizawa

Hirohata

et al. 2023

Journal of Sport Rehabilitation

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“…Additionally, we recognize that preoperative quadriceps strength correlates with postoperative quadriceps strength and single-leg hop performance. 33 Given the retrospective nature of the data, we were unable to compare preoperative strength between the sexes. Finally, we recognize the potential for sampling bias, as patients were selected from those who participated in functional testing at our injury prevention center 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

Recovery After ACL Reconstruction in Male Versus Female Adolescents: A Matched, Sex-Based Cohort Analysis of 543 Patients

Maguire

Sugimoto

Micheli

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between men and women have been demonstrated in the adult population. Sex-based differences have been incompletely investigated in adolescents, which represent the subpopulation most affected by ACL injury. Purpose/Hypothesis: The purpose of this study was to compare the 6-month postoperative functional recovery after ACLR between adolescent boys and girls. It was hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes. Study Design: Cohort study; Level of evidence, 3. Methods: Included in this study were athletes aged 12 to 19 years with closed or closing growth plates who underwent ACLR with hamstring autograft between May 2014 and May 2018 at a single institution. All athletes had undergone strength and functional testing between 5 and 8 months postoperatively. Exclusion criteria were previous knee surgery (contralateral or ipsilateral knee), concomitant injury/surgery other than meniscal tear/repair, allograft supplementation, and incomplete medical records. The limb symmetry index (LSI) for strength (measured with handheld dynamometer), as well as dynamic Y-balance and functional hop test performance, was compared between groups. To account for differences in physical characteristics between the sexes, 1-way between-group multivariate analysis of covariance was used to analyze the data. Results: Overall, 543 patients (211 boys, 332 girls) were included. There was no significant difference in age, body mass index, incidence of concomitant meniscal pathology, use of regional anesthesia, or time to functional testing between cohorts. Female athletes demonstrated a statistically significantly greater deficit in quadriceps strength LSI compared with male athletes (boys, +3.4%; girls, –2.3%; P = .011). Both male and female athletes demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing. Conclusion: Female athletes demonstrated greater quadriceps strength deficits than male athletes at 6 months after ACLR with hamstring autograft. Severe hamstring strength deficits persisted in both male and female patients at this time point. The correlation of such deficits to risk of ACL retear warrants continued study in the adolescent population and may support a delay in return to sports, which has been suggested in the more recent literature.

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“…Considering the potential influence of bilateral AMI after unilateral ACLR, 14,15 the goal of restoring RFD ability to the level of the uninjured contralateral limb using a LSI may underestimate the true recovery from ACLR surgery. 56 Thus, pre-injury testing, 112 pre-surgery testing, 113,114 comparison to matched uninjured controls, 56,58,65 and/or a comparison to normative values 33 should be considered alongside a LSI when evaluating RFD and maximal strength capacity (MVC) after ACLR.…”

Section: Aclr and Intrinsic Muscular Factors Affecting Rfd Between-mentioning

confidence: 99%

“…Interestingly, high pre-operative quadriceps strength LSI (>80%) has been positively associated with accelerated quadriceps LSI recovery when compared to lower pre-operative LSI. 113 ACLR surgical procedures including the use of autograft or allograft techniques and their effect on knee extensor and flexor RFD should also be examined. Of importance is evaluating the co-morbidity effects from the use of autografts (eg, bone-patellar tendon-bone or semitendinosus autograft) compared to allografts.…”

Section: Study Limitationsmentioning

confidence: 99%

Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis

Turpeinen

Freitas

Rubio-Arias

et al. 2020

Scandinavian Med Sci Sports

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Study design Comprehensive review and meta‐analysis. Background The recovery in rapid force production measured as the rate of force development (RFD) is not clear after anterior cruciate ligament reconstruction (ACLR). Objectives To evaluate (a) time‐course change of between‐limb asymmetries in isometric knee extension/flexion RFD in individuals post‐ACLR and (b) differences in RFD between individuals post‐ACLR and healthy controls. Methods A literature search of Web of Science, SPORTDiscus, PubMed‐MEDLINE, and ScienceDirect identified 10 eligible studies (n = 246) assessing RFD after ACLR. Results Standard mean difference (SMD) for early‐phase (<100 ms) knee extensor RFD was −1.07 (95% CI: −1.46, −0.68) when comparing ACLR vs uninjured limb, while SMD for late‐phase (≥100 ms) RFD was −0.85 (95 CI%: −1.27, −0.42). SMD for early‐ and late‐phase knee flexor RFD was −0.74 (95% CI: −1.19, −0.29) and −0.79 (95% CI: −1.19, −0.39), respectively. Comparing ACLR limbs to uninjured controls, knee extensor SMD for early‐ and late‐phase RFD was −1.42 (95% CI: −2.10, −0.73) and 1.09 (95% CI: −1.81, −0.38). For the knee flexors, SMD for early‐ and late‐phase RFD was −0.78 (95% CI: −1.96, −0.39) and −1.14 (95% CI: −1.60, −0.67). Conclusions Anterior cruciate ligament reconstruction limbs demonstrated sustained post‐surgical suppression in RFD capacity for the knee extensors/flexors compared to the contralateral limb as well as to healthy controls. Monitoring of RFD should be considered throughout rehabilitation and return to sport (RTS) after ACLR to assess the effectiveness of post‐operative rehabilitation. Post‐surgical ACLR rehabilitation should include training interventions to enhance RFD.

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Longitudinal Quadriceps Strength Recovery After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: Patients Stratified by Preoperative Quadriceps Strength Deficit

Cited by 7 publications

References 32 publications

Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction

Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction

Recovery After ACL Reconstruction in Male Versus Female Adolescents: A Matched, Sex-Based Cohort Analysis of 543 Patients

Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis

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