Strength does not influence knee function in the ACL-deficient knee but is a correlate of knee function in the and ACL-reconstructed knee

Hohmann, Erik; Bryant, Adam; Tetsworth, Kevin

doi:10.1007/s00402-015-2392-6

Cited by 20 publications

(27 citation statements)

References 39 publications

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“…In this study, quadriceps and hamstrings strengths and the H/Q ratio were significantly higher on the non-injured side than on the injured side of patients; the H/Q ratio was significantly higher and quadriceps strength was significantly lower on the non-injured side of patients compared with the average H/Q ratio and quadriceps strength on both legs of the controls. This finding has also been observed by other authors [ 5 , 6 , 10 , 17 ] and justified by factors such as bilateral arthrogenic muscle inhibition and atrophy due to a decrease in physical activity after injury.…”

Section: Discussionsupporting

confidence: 88%

“…The H/Q values of both legs of patients and controls in our study were within the range of 0.5 to 0.75, which are considered normal [ 10 , 18 , 19 ]. However, the average H/Q ratio was higher in both legs of the patients than in those of the controls, suggesting a bilateral decrease in quadriceps activity in patients with ACLD [ 5 , 10 , 17 , 20 , 21 ]. In a meta-analysis, Kim et al [ 8 ] found that the reduction in quadriceps muscle strength was about three times greater than the reduction in hamstrings muscle strength.…”

Section: Discussionmentioning

confidence: 96%

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Correlation among Knee Muscle Strength and Self-Reported Outcomes Score, Anterior Tibial Displacement, and Time Post-Injury in Non-Coper Anterior Cruciate Ligament Deficient Patients: A Cross-Sectional Study

Manchado

Álvarez

Motta

et al. 2021

IJERPH

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Little attention has been paid to knee muscle strength after ACL rupture and its effect on prognostic outcomes and treatment decisions. We studied hamstrings (H) and quadriceps (Q) strength correlation with a patient-reported outcome measures score (International Knee Documentation Committee, IKDC), anterior tibial translation (ATT), and time post-injury in 194 anterior cruciate ligament deficient patients (ACLD) who required surgery after a failed rehabilitation program (non-copers). The correlation between knee muscle strength and ATT was also studied in 53 non-injured controls. ACLD patients showed decreased knee muscle strength of both the injured and non-injured limbs. The median (interquartile range) values of the H/Q ratio were 0.61 (0.52–0.81) for patients’ injured side and 0.65 (0.57–0.8) for the non-injured side (p = 0.010). The median H/Q ratio for the controls was 0.52 (0.45–0.66) on both knees (p < 0.001, compared with the non-injured side of patients). The H/Q, ATT, and time post-injury were not significantly correlated with the IKDC score. ATT was significantly correlated with the H/Q of the injured and non-injured knees of patients, but not in the knees of the controls. Quadriceps strength and H/Q ratio were significantly correlated with ATT for both limbs of the patients. IKDC score correlated significantly with the quadriceps and hamstrings strengths of the injured limb but not with the H/Q ratio, ATT or time passed after injury.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Correlation among Knee Muscle Strength and Self-Reported Outcomes Score, Anterior Tibial Displacement, and Time Post-Injury in Non-Coper Anterior Cruciate Ligament Deficient Patients: A Cross-Sectional Study

Manchado

Álvarez

Motta

et al. 2021

IJERPH

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“…ACL-deficient non-copers have deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, and greater quadriceps/hamstring co-contraction, and these variables may need longer to recover. [8][9][10][11] The included group was quite heterogeneous: 73% had a meniscus injury or surgery, 89% had chondral lesions, the age ranged from 50 to 67 years, and the follow-up interval was wide, ranging from 25 to 58 months. Shortand midterm follow-up studies generally report satisfactory outcomes after ACL reconstruction, but after 10 to 20 years approximately 50% have osteoarthritis with associated pain and functional impairment.…”

Section: See Related Article On Page 558mentioning

confidence: 99%

Editorial Commentary: Fifty Is the New 30? Do Patients in Their 50s Deserve an Anterior Cruciate Ligament Reconstruction?

Hohmann¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Evidence suggests that anterior cruciate ligament reconstruction in patients older than 50 years of age has similar outcomes when compared with younger patients. However, poorer results are associated with advanced degenerative intra-articular chondral changes. The caveat here is that these conclusions are mainly based on retrospective level IV case series. The question is whether functionally unstable patients 50 years and older, whether active or not, benefit from surgical reconstruction and the answer is clearly yes. It provides restoration of function and should be considered in active older patients with subjective instability who have not responded to nonoperative treatment.

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“…Interestingly, involved-limb quadriceps strength and not symmetry has been related to knee function at an average of 2 years. 19 In contrast, both involved-limb and symmetric quadriceps strength and central activation have been associated with knee function at 2.6 13 and 3.1 5 years after surgery, yet involved-limb function has been consistently described as a better indicator of subjective knee function during this time. Although the clinical utility of time from surgery remains in question, these data appear to show that the relationships between specific metrics of objective performance and subjective function are in part mediated by time, with 2 years postsurgery being a possible inflection point.…”

mentioning

confidence: 96%

“…Quadriceps weakness is well documented at the time of return to activity and is often evaluated by metrics of single-limb and side-to-side limb symmetry indices. Previous authors 5,13,19,20 have examined the utility of both involved-limb and symmetric quadriceps function as markers of good subjective knee function after ACLR, which provide unique insight into time as a mediator of such relationships. Both metrics have been reported 20 to explain a significant amount of the variance in knee function at an average of 8.2 months, slightly in favor of quadriceps strength symmetry (13% versus 8%).…”

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confidence: 99%

Quadriceps Function and Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With or Without Knee Osteoarthritis

Norte

Hertel

Saliba

et al. 2018

Journal of Athletic Training

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Context: Relationships between quadriceps function and patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) are variable and may be confounded by including patients at widely different time points after surgery. Understanding these relationships during the clinically relevant phases of recovery may improve our knowledge of specific factors that influence clinical outcomes.Objective: To identify the relationships between quadriceps function and patient-reported outcomes in patients ,2 years (early) and .2 years (late) after ACLR, including those with posttraumatic knee osteoarthritis.Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 72 patients after ACLR: early (n ¼ 34, time from surgery ¼ 9.0 6 4.3 months), late (n ¼ 30, time from surgery ¼ 70.5 6 41.6 months), or osteoarthritis (n ¼ 8, time from surgery ¼ 115.9 6 110.0 months).Main Outcome Measure(s): The total Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) were used to quantify knee function and global health. Predictors of patient-reported outcomes were involved-limb and symmetry indices of quadriceps function (isokinetic strength [peak torque, total work, average power], maximum voluntary isometric contraction torque, fatigue index, central activation ratio, Hoffmann reflex, active motor threshold) and demographics (age, activity level, pain, kinesiophobia, time since surgery). Multiple linear regression analyses were used to predict KOOS and VR-12 scores in each group.Results: In the early patients, knee-extensor work, active motor threshold symmetry, pain, and activity level explained 67.8% of the variance in the KOOS score (P , .001); kneeextensor work, activity level, and pain explained 53.0% of the variance in the VR-12 score (P , .001). In the late patients, age and isokinetic torque symmetry explained 28.9% of the variance in the KOOS score (P ¼ .004). In the osteoarthritis patients, kinesiophobia and isokinetic torque explained 77.8% of the variance in the KOOS score (P ¼ .010); activity level explained 86.4% of the variance in the VR-12 score (P ¼ .001).Conclusions: Factors of muscle function and demographics that explain patient-reported outcomes were different in patients early and late after ACLR and in those with knee osteoarthritis.Factors of quadriceps function that explained patient-reported outcomes were different in patients early and late after anterior cruciate ligament reconstruction and in those with osteoarthritis. Patient-reported outcomes were best explained in patients early after reconstruction and in those with osteoarthritis, suggesting the need for early identification of impairments. Objective measures of quadriceps function and subjective patient-related factors (pain, activity level, kinesiophobia) should be included when assessing patient-reported outcomes after anterior cruciate ligament reconstruction.

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Strength does not influence knee function in the ACL-deficient knee but is a correlate of knee function in the and ACL-reconstructed knee

Cited by 20 publications

References 39 publications

Correlation among Knee Muscle Strength and Self-Reported Outcomes Score, Anterior Tibial Displacement, and Time Post-Injury in Non-Coper Anterior Cruciate Ligament Deficient Patients: A Cross-Sectional Study

Correlation among Knee Muscle Strength and Self-Reported Outcomes Score, Anterior Tibial Displacement, and Time Post-Injury in Non-Coper Anterior Cruciate Ligament Deficient Patients: A Cross-Sectional Study

Editorial Commentary: Fifty Is the New 30? Do Patients in Their 50s Deserve an Anterior Cruciate Ligament Reconstruction?

Quadriceps Function and Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With or Without Knee Osteoarthritis

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