Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts

2020 ◽  
Author(s):  
Jennifer L. Hunnicutt ◽  
John W. Xerogeanes ◽  
Liang-Ching Tsai ◽  
Peter A. Sprague ◽  
Michael Newsome ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Knee Extension ◽  
Quadriceps Strength ◽  
Extension Deficit ◽  
Female Sex

scholarly journals THE EFFECT OF AGE AND CONCOMITANT SURGERY ON STRENGTH IN ADOLESCENT ATHLETES WITH PRIMARY QUADRICEPS TENDON ACL RECONSTRUCTION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Sarah E. Reinking ◽  
Kaitlyn A. Flynn ◽  
Alexia G. Gagliardi ◽  
Cassidy J. Hallagin ◽  
Melissa N. Randall ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Steady Increase ◽  
Isokinetic Testing ◽  
Concomitant Surgery ◽  
Effect Of Age ◽  
Meniscus Surgery

Background: Knee extensor strength deficits occur after ACL reconstruction (ACLR). Prior studies have reported that age affects quadriceps strength after ACLR, however strength deficits in relation to age have not been assessed among adolescents. Isokinetic dynamometric strength testing is a tool frequently used to assess strength post-operatively in order to identify these deficits. Purposes: 1) To examine the effect of age on isokinetic extensor and flexor deficits among adolescents who were 5-10 months post-ACLR. We hypothesized that age would be inversely related to extensor strength deficit. 2) To determine if extensor or flexor strength deficits exist between adolescents post-ACLR with and without concomitant meniscus surgery. We hypothesized that those with concomitant meniscus surgery would demonstrate greater deficits in flexor and extensor strength. Methods: Study participants completed isokinetic testing within 5-10 months after primary quadriceps tendon ACLR, but before return to sport. The protocol consisted of assessing peak torque at 60, 180, and 300 degrees/s, through a limited range of knee extension and flexion. Our primary outcome variables were peak torque percent deficit of involved leg compared to uninvolved leg for flexion and extension. To address purpose 1, we constructed a series of multivariable regression models, where age was the independent variable, peak torque flexor/extensor deficits at each testing speed was the dependent variable, and sex and weight were covariates. To address purpose 2, we compared peak torque extensor and flexor deficits between those with and without concomitant meniscus surgery using independent samples t-tests. Results: A total of 44 completed the study protocol. There were no significant demographic differences between those with and without concomitant meniscus surgery (Table 1). The relationship between age at surgery and peak torque extensor deficits at 300d/s demonstrated a linear but non-significant association (Table 2; Figure 1). For every year increase in age, the expected deficit at 300d/s increased by approximately 3%. Patients who underwent isolated ACLR demonstrated significantly greater flexor deficits than those who underwent ACLR with concomitant meniscus surgery when tested at 180d/s and 300d/s (Table 3). Conclusion: Contrary to our first hypothesis, extensor deficits at 300d/s demonstrated an apparent association with older age. We observed a steady increase in strength deficit at 300d/s associated with increasing age. Contrary to our second hypothesis, no significant differences were found in extensor strength between those with and without meniscus surgery. Additionally, those with concomitant meniscus surgery demonstrated significantly less flexor deficit than those without meniscus surgery. [Table: see text][Table: see text][Figure: see text][Table: see text]

scholarly journals The significance of post-operative bracing in preventing knee arthrofibrosis after ACL reconstruction

2021 ◽  
Author(s):  
Valeri Akhalkatsi ◽  
Marine Matiashvili ◽  
Lela Maskhulia ◽  
George Obgaidze ◽  
Levan Chikvatia
Keyword(s):  
Acl Reconstruction ◽  
Sports Medicine ◽  
Quadriceps Muscle ◽  
High Energy ◽  
Knee Extension ◽  
Negative Influence ◽  
Knee Brace ◽  
Extension Deficit ◽  
Reconstruction Surgery ◽  
Post Operative Period

High-energy injuries of the knee joint can cause ligament damage which may have complications in 4-6% of all cases in the form of movement limitation and arthrofibrosis (5,9,14). There are several intra- and extraarticular factors that could be closely connected with formation of arthrofibrosis. One of the most important factors is the utilization of a knee brace as the means of immobilization during the post-operative period (7,8). There are various opinions on the matter of using a knee brace after an ACL reconstruction surgery. For instance, 85% of members of the American Orthopedic Society for Sports Medicine (AOSSM) support and utilize this method (6). Despite the fact that movement limitations in the affected joint are rare after the aforementioned surgical procedure, the issue of preventing and eliminating knee extension deficit during the post-operative period is still relevant. The following research is based on the evaluation of the findings in 22 patients with extension deficits 2 weeks after arthroscopic ACL reconstruction surgery and it studies the effectiveness of knee brace in eliminating extension limitation during a 3-week rehabilitation period. The results of the abovementioned research showed that utilization of knee brace in the rehabilitation process during 3 weeks is significantly effective method (P<0.008) for eliminating knee extension deficit in a way that the negative influence on the function of the quadriceps muscle of the affected limb stays negligible.

scholarly journals 6- VS 9-MONTH RETURN TO SPORT TESTING RESULTS AFTER ACL RECONSTRUCTION WITH QUADRICEPS AUTOGRAFT IN ADOLESCENT PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Michael Saper
Keyword(s):  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Knee Extension ◽  
Quadriceps Strength ◽  
Balance Test ◽  
Isokinetic Testing ◽  
Adolescent Patients ◽  
Isokinetic Strength Testing ◽  
Tendon Autograft

Background: Recently, anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft has gained in popularity, particularly in adolescent patients. Studies are lacking that evaluate return to sport (RTS) testing after ACLR with quadriceps tendon autograft (QT). Hypothesis/Purpose: To investigate differences between the 6-month and 9-month RTS assessment in adolescent patients undergoing ACLR with QT. Methods: A retrospective review of adolescent patients who underwent primary ACLR with all soft-tissue QT identified 18 patients with formal RTS testing data at 6 and 9 months. Surgeries were performed between June 2017 and October 2018 by single surgeon using an all-inside technique. Concomitant meniscus repairs were performed in 38.9% of patients. All patients followed the same standardized rehabilitation protocol and completed a structured RTS test 6 and 9 months after surgery. The RTS test consisted of isometric and isokinetic strength testing, the Lower Quarter Y-Balance Test (YBT-LQ), and single-legged hop testing. The recovery of muscle strength, assessed via isometric/isokinetic and hop testing, was defined by a limb symmetry index (LSI) ≥ 90%. Differences were compared between the two RTS time points. Results: The mean age at the time of surgery was 15.2 years (range, 13-17 years). There were statistically significant improvements in the Pedi-IKDC (92.1 ± 8.4 vs. 82.9 ± 8.7; P = 0.001) and Tegner activity scale (7.1 ± 2 vs. 5.1 ± 2; P = 0.001). There were statistically significant improvements in isometric quadriceps strength (LSI, 82.6 ± 16.8 vs. 93.1 ± 11; P = 0.03) and hamstring strength (LSI, 86.4 ± 11.3 vs. 98.2 ± 9.6; P = 0.001). There were improvements in isokinetic knee extension at both 60 deg/sec (LSI, 75 ± 16.9 vs. 82.8 ± 13.9) and 180 deg/sec (LSI, 79.1 ± 14.8 vs. 84.6 ± 10.9), but the differences were not statistically significant ( P = 0.08 and P = 0.11, respectively). There were no significant differences in isokinetic testing of knee flexion at either 60 deg/sec or 180 deg/sec. There were no statistically significant differences in the anterior reach component of the YBT-LQ at 6 and 9 months. Patients demonstrated statistically significant improvements on single-legged hop testing with mean LSIs > 95% for each of the four tests at 9 months postop. Conclusion: Adolescent patients undergoing ACLR with QT demonstrated significant improvements in subjective function and quadriceps strength between 6 and 9 months postop. This data supports delaying RTS beyond 9 months in this at-risk population. [Table: see text]

scholarly journals Clinical Outcomes of All Soft Tissue Quadriceps Tendon Autograft in ACL Reconstruction

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0031
Author(s):  
John W. Xerogeanes ◽  
William Godfrey ◽  
Aaron Gebrelul ◽  
Ajay Premkumar ◽  
Danielle Mignemi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Tendon Autograft

scholarly journals DIFFERENCES IN ACUTE POSTOPERATIVE PAIN AFTER ACL RECONSTRUCTION IN ADOLESCENT PATIENTS: ALL SOFT-TISSUE QUADRICEPS VERSUS HAMSTRING AUTOGRAFT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0014
Author(s):  
Brandon Levy ◽  
Erica Holland ◽  
Viviana Bompadre ◽  
Gregory A. Schmale ◽  
Michael Saper
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Management Plan ◽  
Hamstring Autograft ◽  
Acute Postoperative Pain ◽  
Pain Scores ◽  
Adolescent Patients ◽  
Tendon Autograft

Background: Postoperative pain after anterior cruciate ligament (ACL) reconstruction is a subjective experience that contributes significantly to patient satisfaction and subjective outcomes. As such, it is important for surgeons to counsel their patients and set appropriate expectations following surgery. ACL reconstruction with hamstring (HS) tendon autograft remains the most popular graft choice in adolescent patients with open physes, yet recently, reconstruction using all soft-tissue quadriceps tendon autograft has gained in popularity. However, studies are lacking that evaluate acute postoperative pain after quadriceps autograft. Hypothesis/Purpose: To investigate differences in acute postoperative pain between adolescent patients undergoing ACL reconstruction with all soft-tissue quadriceps versus HS autograft. Methods: A retrospective review was performed of 65 patients that underwent primary ACL reconstruction using either quadriceps (n = 33) or HS (n = 32) autografts between October 2017 and April 2019. All patients received ultrasound-guided adductor canal catheters and single-shot sciatic nerve blocks preoperatively and followed a standard postoperative multi-modal pain management plan. Intraoperative and postoperative intravenous (IV) morphine equivalents (MEQ), post-anesthesia care unit (PACU) length of stay (LOS), and PACU pain scores (numeric rating scale, 0-10) were recorded. Pain scores and supplemental oxycodone use were recorded on postoperative days (POD) 1-3. Differences were compared between the two groups. Results: The mean age at the time of surgery was 15.2 ± 1.5 years. There were no statistically significant differences in age ( p = 0.62), sex ( p = 0.72), BMI ( p = 0.18), concomitant meniscus repairs ( p = 0.71), or surgical time ( p = 0.52) between the two groups. There were no statistically significant differences in intraoperative IV MEQs ( p = 0.44), PACU IV MEQ ( p = 0.43), or PACU LOS ( p = 0.47) between the two groups. Patients treated with quadriceps autograft has lower max PACU pain scores (3.2 ± 3.2 vs 4.1 ± 3.1; p = 0.27) and required less supplemental oxycodone doses on POD 1 (1.1 ± 1.2 vs 1.8 ± 1.6; p = 0.07) but the differences were not statistically significant. Max pain scores (at rest and with movement) on POD 1-3 and oxycodone use on both POD 2 and POD 3 were similar between groups. Conclusion: In the setting of a multi-modal pain management plan including regional anesthesia, adolescent patients undergoing ACL reconstruction with quadriceps tendon autograft and hamstring autograft have similar pain levels and opioid use in the acute postoperative period.

scholarly journals 6-MONTH RETURN TO SPORTS TESTING FOLLOWING ACL RECONSTRUCTION IN ADOLESCENTS WITH QUADRICEPS TENDON AUTOGRAFT VERSUS HAMSTRING AUTOGRAFT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Elizabeth S. Liotta ◽  
Dai Sugimoto ◽  
Kathleen J. Maguire ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Quadriceps Strength ◽  
Control Group ◽  
Return To Sports ◽  
Care Hospital ◽  
Hamstring Autograft ◽  
Muscle Testing ◽  
Operative Limb ◽  
Tendon Autograft

Background: Quadriceps tendon autograft represents an increasingly popular graft option for ACL reconstruction (ACLR). However, there is a paucity of literature regarding the early post-operative effects of this graft technique on functional recovery, particularly in adolescents. Purpose/Hypothesis: To quantify post-operative strength, dynamic balance, and functional hop test performance in adolescents 6 months following ACLR with a quadriceps tendon autograft (ACLR-Q) and compare to an adolescent control group who underwent ACLR with hamstring autograft (ACLR-HS). Methods: Patients 12-19 years-old who underwent primary ACLR-Q from 2017-2019 by a single surgeon at a pediatric tertiary care hospital and performed return to sports (RTS) assessments between 5-9 months post-operatively were included. Exclusion criteria were prior ipsilateral or contralateral ACLR and concomitant procedures other than meniscal repair or meniscectomy. RTS tests included manual muscle testing of strength (hamstring, quadriceps, hip abductor), dynamic-Y-balance, and functional hop tests (single-hop, triple-hop, crossover, 6-meter timed hop). Limb Symmetry Index (LSI) was calculated for all measures and each was compared with an ACLR-HS control group using T-tests. One-way between-group multivariate analysis of covariance (MANCOVA) was utilized to control for any baseline differences. Results: There were no significant differences in age, BMI, sex, or rates of meniscal procedures between cohorts (Table 1). The small difference in time of RTS testing was controlled by MANCOVA model. ACLR-Q patients demonstrated a significantly smaller hamstring strength deficit (-3.6%) than the ACLR-HS group (-35.8%, p<0.001, Table 2). The ACLR-Q group showed a significantly greater deficit in quadriceps strength (-11.9% vs. 0.9%, p<0.001). Hamstring-to-quadriceps strength ratios (HS:Q) were lower in the ACLR-HS (operative limb: 0.34 +/- 0.13, non-operative limb: 0.52 +/- 0.01) than the ACLR-Q group (operative limb: 0.61 +/- 0.16, non-operative limb: 0.56 +/- 0.12). Deficits in anterior reach, composite Y-balance score, cross-over hop, timed hop, and single hop were significantly greater in the ACLR-Q group. The deficit in 6-meter timed hop was significantly greater in the ACLR-HS group. Conclusion: Quadriceps strength deficits were greater in adolescents undergoing ACLR-Q (LSI of approximately -12%), while hamstring strength deficits were greater in adolescents undergoing ACLR-HS (LSI of approximately -33%). Hamstring-to-quad ratios were greater in the ACLR-Q patients’ operative knees than their nonoperative knees, while they were significantly lower in the ACLR-HS patients’ operative knee than their nonoperative knees. Hop testing performance was mixed between the 2 graft cohorts. The degree to which these performance metrics influence eventual athletic performance and graft-retear remains a critical area of continued investigation. [Table: see text][Table: see text]

scholarly journals Patient-Reported Knee Outcome Scores With Soft Tissue Quadriceps Tendon Autograft Are Similar to Bone–Patellar Tendon–Bone Autograft at Minimum 2-Year Follow-up: A Retrospective Single-Center Cohort Study in Primary Anterior Cruciate Ligament Reconstruction Surgery

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989006
Author(s):  
Jose R. Perez ◽  
Christopher P. Emerson ◽  
Carlos M. Barrera ◽  
Dylan N. Greif ◽  
William H. Cade ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Patient Reported ◽  
Outcome Scores ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Bone Patellar Tendon

Background: Quadriceps tendon (QT)–bone autografts used during anterior cruciate ligament (ACL) reconstruction have provided comparable outcomes and decreased donor-site morbidity when compared with bone–patellar tendon–bone (BPTB) autografts. No study has directly compared the outcomes of the all–soft tissue QT autograft with that of the BPTB autograft. Hypothesis: Patient-reported knee outcome scores and rates of postoperative complication after primary ACL reconstruction with QT autografts are no different from BPTB autografts at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 75 patients who underwent primary autograft ACL reconstruction with QT or BPTB autografts between January 1, 2015, and March 31, 2016, at a single hospital center were contacted by telephone and asked to complete the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, Tegner activity level scale, and Lysholm knee scoring scale. Information about the subsequent surgeries performed on the operative knee was also collected. Statistical analysis was performed using the Kruskal-Wallis test and the Fisher exact test for categorical data. Results: Fifty patients (28 QT, 22 BPTB) completed the surveys at a mean follow-up of 33.04 months (range, 24-44 months). For the QT versus the BPTB group respectively, the median IKDC scores were 94.83 (interquartile range [IQR], 7.61) versus 94.83 (IQR, 10.92) ( P = .47), the median Tegner scores were 6 (IQR, 2.5) versus 6 (IQR, 2.75) ( P = .48), and the median Lysholm scores were 95 (IQR, 9) versus 95 (IQR, 13) ( P = .27). Additionally, 2 QT patients and 3 BPTB patients required follow-up arthroscopy for arthrolysis ( P = .64). There was 1 graft failure in the QT group requiring revision surgery. Conclusion: There was no statistical difference in patient-reported knee outcomes or graft complication rates between the QT and BPTB autograft groups at a minimum 2-year follow-up after primary ACL reconstruction. This study highlights that the all–soft tissue QT autograft may be a suitable graft choice for primary ACL reconstruction.

PHYSIOTHERAPY AFTER SURGICALLY STABILIZED PROXIMAL TIBIA FRACTURE

2020 ◽  
Vol 18 (2) ◽  
pp. 156-160
Author(s):  
R. Tasheva
Keyword(s):  
Proximal Tibia ◽  
Weight Bearing ◽  
Lateral Compartment ◽  
Recovery Phase ◽  
Knee Extension ◽  
Tibia Fracture ◽  
Extension Deficit ◽  
Proximal Tibia Fracture ◽  
Ao Classification ◽  
Correct Function

THE AIM OF THIS STUDY is to present the physiotherapy for overcoming the substitution movements and to restore the correct function in the phase of relative protection after surgical stabilized proximal tibia fracture. Material and method Seven patients after fracture in the proximal lateral compartment of the tibia (type b1 in AO classification) with an average age of 42, 9 years were treated. After surgery, an average of 30 days of the brace was used for relative protection. The aim of the physiotherapy was to overcome muscle imbalance to achieve proper movement in the respective planes. Emphasis on recovery was the proper weight bearing on the operated lower limb. RESULTS The results of the first recovery phase demonstrated very limited knee flexion in range of 22, 7º, and knee extension deficit in the range of -15º. After two weeks the results progressed to 115, 5º flexion and full restoration of the extension. Control of edema and hypotrophy of the thigh were proven by circumference. CONCLUSION The adequate physiotherapy provides overcoming of the substitution movements and to restore the correct knee function in the phase of relative protection after surgical stabilized fracture in the proximal tibia.

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