Prediction of quadriceps strength recovery after anterior cruciate ligament reconstruction with a hamstring autograft: Decision tree analysis

Shibata, Yohei; Matsushita, Takehiko; Araki, Daisuke; Kida, Akihiro; Takiguchi, Kohei; Ueda, Yuya; Ono, Kumiko; Matsumoto, Tomoyuki; Niikura, Takahiro; Sakai, Yoshitada; Kuroda, Ryosuke

doi:10.1016/j.jos.2018.10.007

Cited by 10 publications

(19 citation statements)

References 28 publications

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“…The score of quality assessment ranged from 44-78, with a mean of 62 ± 10.4. There were nine studies of moderate quality [11][12][13][14][22][23][24][25][26]] and 3 studies were low quality [27][28][29][30][31][32][33][34][35][36][37][38][39]. The scores of each individual study are shown in ▶Table 1.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Of the included studies, 6 studies recorded pre-injury activity level of participants. Among the 12 studies, participants from 6 studies were reconstructed with bone patellar tendon bone (BPTB) autograft [11,12,[25][26][27]29], 4 studies with hamstring autograft or allograft [13,14,22,23], and another 2 studies reconstructed with either BPTB or hamstring autograft [24,28]. Nine studies provided their own postoperative rehabilitation protocols with the duration ranging from 7…”

Section: Study Characteristicsmentioning

confidence: 99%

“…weeks to 1 year. All of the reported rehabilitation protocols included muscle strengthening exercises, proprioception and balance training as well as plyometric training [11][12][13][14][22][23][24][25][26][27][28][29]. The treatment protocols of each individual study are listed in ▶Table 3.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies assessed quadriceps strength through maximum voluntary isometric test (MVIC) [11,13,22,26,29], and the other 7 studies assessed through isokinetic test at different speeds [12, 14, 23-25, 27, 28]. For the units of quadriceps strength, 8 studies [12, 13, 23-26, 28, 29] used quadriceps strength symmetry index (QSI) which was calculated as the quadriceps peak torque on the injured side divided by the quadriceps peak torque on the uninjured side, three studies [11,22,27] used normalized strength (peak torque/body weight) and one study used both QSI and normalized strength [14]. The duration of follow-up ranged from 3 months to 2 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Pre-operative quadriceps strength has been proposed to be a significant predictor for the outcomes of ACLR [11][12][13]. It has been reported that severe quadriceps strength deficit pre-operatively is a factor for the persistent quadriceps weakness after reconstruction [12,14]. Quadriceps weakness is a common phenomenon before ACLR due to injury-induced neuromuscular dysfunction and decreased activity level during the period from injury to surgery [15,16].…”

Section: Introductionmentioning

confidence: 99%

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

Qiu

et al. 2020

Int J Sports Med

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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.

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Section: Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Qiu

et al. 2020

Int J Sports Med

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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

Ueda

Matsushita

Shibata

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose This study compared the predictive ability of each independent predictor with that of a combination of predictors for quadriceps strength recovery one year after anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent primary ACL reconstruction using hamstring autografts were enrolled. Quadriceps strength, hamstring strength, and anterior tibial translation were measured, and the limb symmetry index (LSI) of the quadriceps and the hamstrings was calculated preoperatively and one year after surgery. Patients were classified into two groups according to the LSI of the quadriceps strength at one year postoperatively (≥ 80% or < 80%). Multivariate logistic regression analysis identified the independent predictors of quadriceps strength recovery, and the cut-off value was calculated using the receiver operating characteristic curve. A model assessing predictive ability of the combination of independent predictors was created, and the area under the curve (AUC) for each independent predictor was calculated by using the receiver-operating characteristic curves and the DeLong method. Results Of the 646 patients, 414 (64.1%) had an LSI of at least 80% for quadriceps strength one year after surgery, and 232 patients (35.9%) had an LSI of < 80%. Age, sex, body mass index (BMI), preinjury sport level, and LSI of preoperative quadriceps strength were independently associated with quadriceps strength recovery one year after ACL reconstruction. The cut-off values were age: 22.5 years; sex: female; BMI: 24.3 kg/m2; preinjury sport level: no sport; and LSI of preoperative quadriceps strength: 63.3%. The AUC of the model assessing the predictive ability of the combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength was significantly higher (0.73) than that of similar factors of preoperative quadriceps strength (AUC: 0.63, 0.53, 0.56, 0.61, and 0.68, p < 0.01, respectively). Conclusion The combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength had a superior predictive ability for quadriceps strength recovery at one year after ACL reconstruction than these predictors alone. Multiple factors, including patient characteristics and preoperative quadriceps strength, should be considered when planning rehabilitation programs to improve quadriceps strength recovery after ACL reconstruction. Level of evidence III.

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Limited preoperative knee extension in anterior cruciate ligament reconstruction using a hamstring tendon affects improvement of postoperative knee extensor strength

Sengoku,

Nakase,

Mizuno

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose This study aimed to determine the factors affecting knee extensor strength 6 months after anterior cruciate ligament (ACL) reconstruction using autograft hamstring tendon. Methods 144 patients who could undergo regular follow-up after ACL reconstruction were divided into 2 groups: those with greater than 90% (Group A: n = 95) and less than 85% (Group B: n = 49) isokinetic knee contraction at 60°/s 6 months post-ACL reconstruction. Basic information, injury status, limited preoperative knee extension, and knee extensor strength at 3 and 6 months postoperatively were compared between the groups. Multivariate logistic analysis was performed and included variables that showed statistically significant differences between the groups in the univariate analysis. In addition, the cut-off value for the limb symmetry index (LSI) at 3 months postoperatively needed to exceed an LSI of 90% at 6 months postoperatively was calculated using the receiver operating characteristics curve. Results Age, preoperative waiting period, limited preoperative knee extension, and knee extensor strength at 3 months postoperatively were significantly different between the two groups. The multivariate logistic analysis showed that all the variables affected the improvement in knee extensor strength at 6 months postoperatively. Limited preoperative knee extension was the most significant factor (odds ratio: 15.1, 95% confidence interval: 2.57-118.56, p < 0.01). The LSI cut-off value at 3 months postoperatively was 72.0%. Conclusion Key factors in achieving the necessary knee extensor strength criteria for return to sports at 6 months post-ACL reconstruction include addressing limited preoperative knee extension and achieving an LSI ≥ 72% in knee extensor strength at 3 months postoperatively. Level of evidenceLevel III. Keywords Anterior cruciate ligament reconstruction • Knee extensor strength • Limited preoperative knee extension Abbreviations LSI Limb strength index ACL Anterior cruciate ligament HT Hamstring tendon BW Body weight TAS Tegner activity level scale ROM Range of motion * Junsuke Nakase

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Prediction of quadriceps strength recovery after anterior cruciate ligament reconstruction with a hamstring autograft: Decision tree analysis

Cited by 10 publications

References 28 publications

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

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

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

Limited preoperative knee extension in anterior cruciate ligament reconstruction using a hamstring tendon affects improvement of postoperative knee extensor strength

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