Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction

Eitzen, Ingrid; Holm, Inger; Risberg, May Arna

doi:10.1136/bjsm.2008.057059

Cited by 315 publications

(304 citation statements)

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“…Early symptoms predict postsurgical outcomes years after an ACL reconstruction. [24][25][26] Future longitudinal studies that assess whether baseline traumatic BML size can predict patient-reported outcomes years after surgery or that evaluate whether changes in traumatic BML size relate to changes in knee pain will help build on these findings. Second, it remains unclear if the associations presented here were confounded by inflammation or concurrent injuries (eg, meniscal injury or chondral lesions) that could have contributed to the development of both traumatic BML volumes and knee pain.…”

Section: Discussionmentioning

confidence: 99%

“…24 Furthermore, preoperative knee and body pain are important predictors of postsurgical outcomes 1 or 2 years after an ACL reconstruction. 25,26 Thus, enhancing our understanding of the factors involved in posttraumatic pain may be important in improving long-term results for the ACL-injured population. To further clarify the relationships between traumatic BMLs and knee pain and symptoms, we explored the cross-sectional associations between posttraumatic BML volume and self-reported knee pain and symptoms within the first 4 weeks after an ACL injury.…”

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confidence: 99%

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Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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Context: After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.Objective: To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.Design: Cross-sectional exploratory analysis of a randomized clinical trial.Setting: Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants: As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age ¼ 26 6 5 years, height ¼ 1.8 6 0.1 m, weight ¼ 76 6 13 kg) with an ACL tear were studied.Main Outcome Measure(s): The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.Results: Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (b ¼ À0.09, P ¼ .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (b ¼ -0.46, P ¼ .02), whereas no association was found for those with a depression fracture (b ¼ 0.0, P ¼ .96). Larger medial (b ¼ -0.48, P ¼ .02) but not lateral (b ¼ -0.03, P ¼ .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.Conclusions: We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.Key Words: knee injuries, magnetic resonance imaging, sprains, trauma, patient-reported outcomes Key PointsWithin 4 weeks of anterior cruciate ligament injury, total-knee bone marrow lesion volume and self-reported pain and symptoms were not associated. More pain was weakly related to greater medial compartment and greater total-knee bone marrow lesion volume and to greater bone marrow lesion volume among participants without a depression fracture.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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“…Extensive research demonstrates quadriceps deficits can be present at six months and even up to and exceeding one year. [1][2][3][4][5] Quadriceps strength has recently been shown to help predict reinjury rate. Grindem et al 20 found that individuals following ACL-R with a quadriceps strength deficit of greater than 10% are significantly more likely to reinjure their ipsilateral ACL.…”

Section: Discussionmentioning

confidence: 99%

“…Greater quadriceps strength pre-operatively has been correlated to increased quadriceps strength post-operatively. However, it is well documented that quadriceps strength deficits may remain for two years and beyond, following ACL-R. [1][2][3][4][5] Multiple authors have shown that those individuals with greater quadriceps strength pre-operatively have significantly greater quadriceps strength at RTS, and those with lower quadriceps strength pre-operatively have lower functional scores on single and triple hop tests (time and distance) at time of RTS and may take longer to RTS after ACL-R. 1, 2,6 Quadriceps strength is important as it relates to outcomes and performance at time of RTS. 2,7 Recently, researchers have found that decreased quadriceps strength, and larger asymmetries between limbs, lead to shorter distances on hop tests.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Pre-Operative and Twelve-Week Post-Operative Y-Balance and Quadriceps Strength in Athletes With an Anterior Cruciate Ligament Tear

Hallagin

Garrison

Creed

et al. 2017

Intl J Sports Phys Ther

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Background: Pre-operative quadriceps strength may have a positive influence on post-operative function and outcomes at time of return to sport. Little consideration has been given to quadriceps strength during the early post-operative timeframes. Twelveweek post-operative anterior cruciate ligament reconstruction (ACL-R) is considered a critical time point for progression in the rehabilitation process. There is currently limited research looking at the relationship between clinical measurements pre-operatively and at 12-weeks following ACL-R. Purpose/Hypothesis:The primary purpose of this study was to examine the differences between Y-Balance Test Lower Quarter (YBT-LQ) and isokinetic quadriceps strength tested pre-operatively and post-operatively following ACL-R (12-weeks). Study Design: Within subject, repeated measuresMethods: Thirty-nine participants (15.6±1.5 y/o) were diagnosed with an ACL tear and were undergoing rehabilitation to return to a sport requiring cutting and pivoting were included. YBT-LQ and isokinetic quadriceps strength were assessed pre-operatively and at 12-weeks after ACL-R. YBT-LQ composite scores were calculated bilaterally and isokinetic quadriceps strength was tested using the Biodex Multi-Joint Testing and Rehabilitation System. Paired T-tests were used to determine mean group differences between YBT-LQ and isokinetic quadriceps strength scores pre-operatively and at 12-weeks post-operative. A Pearson Correlation was performed to determine relationships between variables at both time points.Results: There was a significant improvement in YBT-LQ composite scores from pre-operative to 12-weeks post-operative on both the involved p<0.001) limbs. Quadriceps strength decreased significantly from pre-operative to 12-weeks on the involved limb (Pre-operative: 82.3 ftlbs ± 38.6; 12-weeks: 67.9 ftlbs±27.4, p<0.01), but no differences were found on the uninvolved limb (Pre-operative: 117.3ftlbs ± 42.0; 12-weeks: 121.7ftlbs ± 41.5, p = 0.226). Conclusions:Involved limb quadriceps strength decreases from time of pre-operative to 12-weeks following ACL-R. Level of Evidence: 3

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“…The concept was initially coined in the 1980s for professional athletes as a process to prevent unnecessary atrophy of muscle in order to prevent future injuries [101]. Preoperative quadriceps strength is an important predictor of the functional outcome of the knee joint after ACLR [102]. This paper focuses on exerciserelated prehabilitation in preoperative ACL patients.…”

Section: Exercise Before Aclr and The Role Of Prehabilitationmentioning

confidence: 99%

Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

Shaarani

Moyna

Moran

et al. 2012

ISRN Rehabilitation

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The rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction requires symmetry in bilateral quadriceps strength and adequate proprioception capabilities prior to return to preoperative level of activity or sport. This is the limiting factor and can delay the time that patients can return to play. There is little literature on pre-operative physiotherapy or prehabilitation of patient with ACL injury. This paper discusses the anatomy, biomechanics, surgical decision making, and the current knowledge of preoperative training or "prehabilitation" in patients awaiting ACL reconstruction.

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Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction

Cited by 315 publications

References 61 publications

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

The Relationship Between Pre-Operative and Twelve-Week Post-Operative Y-Balance and Quadriceps Strength in Athletes With an Anterior Cruciate Ligament Tear

Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

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