Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft

Abstract

Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38). Conclusions ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb. Level of evidence Level: Level: 4.

Harvesting a second graft from the extensor mechanism for revision ACL reconstruction does not delay return of quadriceps function

“…Yet, such a delay was not seen. Overall, these results agree with previous reports on progression of quadriceps strength [9, 26, 28, 32]. Although not reported in the results section, no patellar fractures occurred in either cohort.…”

Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review

“…Patients with anterior cruciate ligament injuries received arthroscopic treatment in 10 studies. Bone-patellar tendon-bone grafts were used in 7 articles [ 22 – 25 , 27 , 31 , 32 ], and the hamstring tendon was used in 5 studies [ 26 , 28 – 30 , 33 ]. Primary surgery was performed in 7 studies [ 24 – 27 , 31 – 33 ], and revision surgery was performed in 2 studies [ 23 , 28 ].…”

“…Bone-patellar tendon-bone grafts were used in 7 articles [ 22 – 25 , 27 , 31 , 32 ], and the hamstring tendon was used in 5 studies [ 26 , 28 – 30 , 33 ]. Primary surgery was performed in 7 studies [ 24 – 27 , 31 – 33 ], and revision surgery was performed in 2 studies [ 23 , 28 ]. Postoperative rehabilitation was reported in all the studies except one [ 33 ] (Table 2 ).…”

“…In theory, this creates a good environment for the rehabilitation of the ipsilateral limb, because trauma was divided between the two knees. The inflammation, damage and soft tissues swelling of the injured limb should be reduced [ 31 , 41 ] However, in the early postoperative period, results showed no significant difference in muscle strength between the two techniques. This may be related to the simultaneous rehabilitation programs of both knees after the operation [ 32 ].…”

“…This may be related to the simultaneous rehabilitation programs of both knees after the operation [ 32 ]. Another reason may be that the recovery of muscle strength after ACLR depends only on the difference between the two limbs, not on which limb the graft was taken from [ 31 ]. Although some patients may be concerned that having surgery on both limbs will affect their ability to engage in sports, current evidence shows that the contralateral graft technique has comparable clinical and functional outcomes as the ipsilateral graft technique.…”