Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 45 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Eivind Inderhaug ◽  
Joanna M. Stephen ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Acl Reconstruction ◽  
Repeated Measures ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Optical Tracking ◽  
Iliotibial Band ◽  
Anterior Cruciate

Background: Anterolateral soft tissue structures of the knee have a role in controlling anterolateral rotational laxity, and they may be damaged at the time of anterior cruciate ligament (ACL) ruptures. Purpose: To compare the kinematic effects of anterolateral operative procedures in combination with intra-articular ACL reconstruction for combined ACL plus anterolateral–injured knees. Study Design: Controlled laboratory study. Methods: Twelve cadaveric knees were tested in a 6 degrees of freedom rig using an optical tracking system to record the kinematics through 0° to 90° of knee flexion with no load, anterior drawer, internal rotation, and combined loading. Testing was first performed in ACL-intact, ACL-deficient, and combined ACL plus anterolateral–injured (distal deep insertions of the iliotibial band and the anterolateral ligament [ALL] and capsule cut) states. Thereafter, ACL reconstruction was performed alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and ALL reconstruction. Anterolateral grafts were fixed at 30° of knee flexion with both 20 and 40 N of tension. Statistical analysis used repeated-measures analyses of variance and paired t tests with Bonferroni adjustments. Results: ACL reconstruction alone failed to restore native knee kinematics in combined ACL plus anterolateral–injured knees ( P < .05 for all). All combined reconstructions with 20 N of tension, except for ALL reconstruction ( P = .002-.01), restored anterior translation. With 40 N of tension, the superficial Lemaire and MacIntosh procedures overconstrained the anterior laxity in deep flexion. Only the deep Lemaire and MacIntosh procedures—with 20 N of tension—restored rotational kinematics to the intact state ( P > .05 for all), while the ALL underconstrained and the superficial Lemaire overconstrained internal rotation. The same procedures with 40 N of tension led to similar findings. Conclusion: In a combined ACL plus anterolateral–injured knee, ACL reconstruction alone failed to restore intact knee kinematics. The addition of either the deep Lemaire or MacIntosh tenodesis tensioned with 20 N, however, restored native knee kinematics. Clinical Relevance: The current study indicates that unaddressed anterolateral injuries, in the presence of an ACL deficiency, result in abnormal knee kinematics that is not restored if only treated with intra-articular ACL reconstruction. Both the modified MacIntosh and modified deep Lemaire tenodeses (with 20 N of tension) restored native knee kinematics at time zero.

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

2019 ◽  
Vol 47 (13) ◽  
pp. 3203-3211
Author(s):  
Alberto Grassi ◽  
Stefano Di Paolo ◽  
Gian Andrea Lucidi ◽  
Luca Macchiarola ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Anatomic Acl Reconstruction ◽  
Medial Meniscectomy ◽  
Lateral Meniscectomy ◽  
Anterior Cruciate

Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

There Are No Kinematic Differences Between Inframeniscal and Suprameniscal Anterolateral Ligament Injury in the Anterior Cruciate Ligament–Deficient Knee

2018 ◽  
Vol 46 (14) ◽  
pp. 3391-3399 ◽  
Author(s):  
Timothy A. Burkhart ◽  
Manoj Matthew ◽  
W. Scott McGuffin ◽  
Alexandra Blokker ◽  
David Holdsworth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterolateral Ligament ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

Background: Previous research demonstrated that the attachment of the anterolateral ligament (ALL) to the lateral meniscus is stiffer and stronger in its tibial attachment than its femoral attachment. How this relates to anterolateral knee stability and lateral meniscal function is unknown. Hypothesis/Purpose: The hypothesis was that the ALL acts as a peripheral anchor to the lateral meniscus, aiding in anterolateral rotatory stability, and that the inframeniscal fibers of the ALL will provide greater anterolateral rotatory stability because of their greater tensile properties. The purpose was therefore to compare the difference in kinematics of the anterior cruciate ligament (ACL)–deficient knee between the infra- and suprameniscal ALL-sectioned states. Study Design: Controlled laboratory study. Methods: Eight paired fresh-frozen cadaveric knees were tested in a 5–degree of freedom loading jig under the following loading conditions: 5-N·m internal rotation at 15° incremental angles of flexion and combined 5-N·m internal rotation moment, 10-N·m valgus moment, and 88-N anterior translation force representing a pivot shift test at 0°, 15°, and 30° of flexion. The knees were tested under intact, ACL-deficient, and ACL-/ALL-deficient conditions, with the pairs of knees being randomized to either supra- or inframeniscal ALL sectioning. Resultant joint kinematics and tibiofemoral translations were measured and compared with a 2-way mixed repeated measures analysis of variance. Results: Internal rotation increased by 3° after sectioning of the ACL at 0° of knee flexion ( P = .035). At 45° of knee flexion, internal rotation increased significantly by 2° between the ACL-deficient and the ACL-/ALL-deficient conditions ( P = .049). Secondary kinematics of valgus and anterior translation were observed in response to the 5-N·m load after ACL and ALL sectioning. Analysis of the pivot shift showed increases in tibiofemoral translation after sectioning of the ACL, with further translations after sectioning of the ALL. No differences were observed between supra- and inframeniscal ALL sectioning under any of the loading conditions. Conclusion: An injury to the ALL, coexisting with ACL deficiency, results in only minor increases in knee joint patholaxity. No differences in pivot-shift kinematics or tibiofemoral rotations were observed between the supra- and inframeniscal sectioning of the ALL in the ACL-deficient knee Clinical Relevance: Tears of the midbody and/or posterior root attachment of the lateral meniscus are often observed at the time of ACL reconstruction. Increased anterolateral rotatory laxity has been observed in both lateral meniscus– and ALL-deficient states in combination with an ACL injury. While no significant functional relationship was found between the ALL and lateral meniscus, ALL sectioning did result in increased knee joint patholaxity, as demonstrated by composite tibiofemoral rotations.

A Preclinical Model to Study the Influence of Graft Force on the Healing of the Anterior Cruciate Ligament Graft

2018 ◽  
Vol 32 (05) ◽  
pp. 441-447
Author(s):  
Richard Ma ◽  
Mark Stasiak ◽  
Xiang-Hua Deng ◽  
Scott Rodeo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Tunnel Position ◽  
Anterior Cruciate Ligament Graft ◽  
Acl Graft ◽  
Anterior Cruciate ◽  
Femoral Graft

AbstractThe purpose of this study is to establish a small animal anterior cruciate ligament (ACL) reconstruction research model where ACL graft force can be varied to create different graft force patterns with controlled knee motion. Cadaveric (n = 10) and in vivo (n = 10) rat knees underwent ACL resection followed by reconstruction using a soft tissue autograft. Five cadaveric and five in vivo knees received a nonisometric, high-force femoral graft tunnel position. Five cadaveric and five in vivo knees received a more isometric, low-force graft tunnel position. ACL graft force (N) was then recorded as the knee was ranged from extension to 90 degrees using a custom knee flexion device. Our results demonstrate that distinct ACL graft force patterns were generated for the high-force and low-force femoral graft tunnels. For high-force ACL grafts, ACL graft forces increased as the knee was flexed both in cadaveric and in vivo knees. At 90 degrees of knee flexion, high-force ACL grafts had significantly greater mean graft force when compared with baseline (cadaver: 7.76 ± 0.54 N at 90 degrees vs. 4.94 ± 0.14 N at 0 degree, p = 0.004; in vivo: 7.29 ± 0.42 N at 90 degrees vs. 4.74 ± 0.13 N at 0 degree, p = 0.007). In contrast, the graft forces for low-force ACL grafts did not change with knee flexion (cadaver: 4.94 ± 0.11 N at 90 degrees vs. 4.72 ± 0.14 N at 0 degree, p = 0.41; in vivo: 4.78 ± 0.26 N at 90 degrees vs. 4.77 ± 0.06 N at 0 degree, p = 1). Compared with nonisometric ACL grafts, the graft force for grafts placed in an isometric position had significantly lower ACL graft forces at 15, 30, 45, 60, 70, and 90 degrees in both cadaveric and in vivo knees. In conclusion, we have developed a novel ACL reconstruction model that can reproducibly produce two ACL graft force patterns. This model would permit further research on how ACL graft forces may affect subsequent graft healing, maturation, and function.

scholarly journals Biomechanical Difference between Conventional Transtibial Single-Bundle and Anatomical Transportal Double-Bundle Anterior Cruciate Ligament Reconstruction Using Three-Dimensional Finite Element Model Analysis

2021 ◽  
Vol 10 (8) ◽  
pp. 1625
Author(s):  
Jae Gyoon Kim ◽  
Kyoung Tak Kang ◽  
Joon Ho Wang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Element Model ◽  
Double Bundle ◽  
Contact Stresses ◽  
Single Bundle ◽  
Anterior Cruciate

The purpose of our study was to analyze the graft contact stress at the tunnel after transtibial single-bundle (SB) and transportal double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. After transtibial SB (20 cases) and transportal DB (29 cases) ACL reconstruction, the three-dimensional image of each patient made by postoperative computed tomography was adjusted to the validation model of a normal knee and simulated SB and DB ACL reconstructions were created based on the average tunnel position and direction of each group. We also measured graft and contact stresses at the tunnel after a 134 N anterior load from 0° to 90° flexion. The graft and contact stresses became the greatest at 30° and 0° flexion, respectively. The total graft and contact stresses after DB ACL reconstruction were greater than those after SB ACL reconstruction from 0° to 30° and 0° to 90° knee flexion, respectively. However, the graft and contact stresses of each graft after DB ACL reconstruction were less than those after SB ACL reconstruction. In conclusion, the total graft and total contact stresses after DB ACL reconstruction are higher than those after SB ACL reconstruction from 0° to 30° and 0° to 90° knee flexion, respectively. However, the stresses of each graft after DB ACL reconstruction are about half of those after SB ACL reconstruction.

scholarly journals Single-Leg Squat After Anterior Cruciate Ligament Reconstruction: An Analysis of the Knee Valgus Angle at 6 and 12 Months

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094632
Author(s):  
Lachlan M. Batty ◽  
Julian A. Feller ◽  
Iswadi Damasena ◽  
Gerrit Behrens ◽  
Brian M. Devitt ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Effect Size ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Valgus ◽  
Contralateral Limb ◽  
Valgus Angle ◽  
Anterior Cruciate ◽  
Operative Limb

Background: Deficits in neuromuscular control are common after anterior cruciate ligament (ACL) reconstruction and may be associated with further knee injury. The knee valgus angle during a single-leg squat (SLS) is one measure of neuromuscular performance. Purpose: To determine whether the knee valgus angle during SLS changes between 6 and 12 months after ACL reconstruction and to assess how the operative knee valgus angle compares with that of the contralateral side. Study Design: Case series; Level of evidence, 4. Methods: A cohort of 100 patients with uninjured contralateral knees were assessed at 6 and 12 months after primary hamstring autograft ACL reconstruction. Participants performed the SLS on each leg, and the knee valgus angle was measured via frame-by-frame video analysis at 30° of flexion and at each patient’s maximum knee flexion angle. Results: For the operative limb at 30° of flexion, a small but statistically significant reduction was noted in the valgus angle between 6 and 12 months (5.46° vs 4.44°; P = .002; effect size = 0.24). At 6 months, a slightly higher valgus angle was seen in the operative limb compared with the nonoperative limb (5.46° vs 4.29°; P = .008; effect size = 0.27). At maximum flexion, no difference was seen between limbs in the valgus angle at either 6 or 12 months, and no change was seen in the operative limb between 6 and 12 months. At 6 months and 30° of knee flexion, 13 patients had a valgus angle greater than 10°. This group also had a higher mean valgus angle in the contralateral limb compared with the contralateral limb in the other 87 patients (8.5° vs 3.65°; P < .001). Conclusion: During a controlled SLS, the knee valgus angle remained essentially constant, and minimal limb asymmetries were present over the 6- to 12-month postoperative period, a time when athletes typically increase their activity levels. Whether changes or asymmetries will be seen with more dynamically challenging tasks remains to be determined. When present, high valgus angles were commonly bilateral.

scholarly journals The effect of anterolateral ligament integrity on the tibia displacement and reaction forces of anterior cruciate ligament

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Adem Aydın ◽  
Levent Uğur ◽  
Halil Atmaca
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Knee Flexion Angle ◽  
Anterior Drawer ◽  
Reaction Forces ◽  
Anterior Cruciate

Objective: Recent studies focused on rotational instability and remained positive pivot test in patients with anterior cruciate ligament (ACL) reconstruction. Clinical, radiological and biomechanical studies showed the importance of the anterolateral ligament (ALL) integrity. ALL is one of the stabilization structures against the internal rotation of the tibia under forces which was associated with Segond fracture previously. Even some authors claimed that ACL failure and risk of re-rupture increased if only ACL reconstruction performed in patients with simultaneous ALL injury. The aim of the study is to evaluate the importance of ALL on knee biomechanics during anterior drawer test and internal rotation forces with different flexion angles in terms of reaction forces on ACL and the amount of tibia displacement via finite element analysis. Methods: Three dimensional (3D) solid model of knee joint and ALL injured models were constructed based on DICOM formatted computed tomography (CT) images. 0°, 15°,30°,45°,60°,75° and 90° flexion angles were applied respectively to reference models. Then varied anterior drawer and internal rotational forces were used to investigate the effect of ALL. ANSYS ®Version 17 was used in analyses and same boundary conditions were used in all models. Results: In critical analyzing the all results; medial displacement and the amount of anterior drawer distance were increased in all ALL injured models when compared with references. Therewithal the rotational displacements were increased by increasing the knee flexion angle and rotational torque. But, it was not a significant change in the amount of displacement between the models with respect to anteroposterior displacement when the anterior drawer force was increased. Conclusion: ALL particular has an important role in the stability of the internal rotation occurs against the force and with increased contribution rate to the knee joint stability by increasing the knee flexion angle. But the reaction forces were not affected by ALL integrity. So this study do not support the previous studies which suggest simultaneously reconstruction of both ligaments to avoid re rupture of ACL in cases with ALL injured.

scholarly journals Effect of knee angle on quadriceps strength and activation after anterior cruciate ligament reconstruction

2015 ◽  
Vol 119 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Chandramouli Krishnan ◽  
Paul Theuerkauf
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Contractile Property ◽  
Knee Angle ◽  
Peripheral Muscle ◽  
Anterior Cruciate

Quadriceps strength and activation deficits after anterior cruciate ligament (ACL) injury or surgery are typically evaluated at joint positions that are biomechanically advantageous to the quadriceps muscle. However, the effect of knee joint position and the associated changes in muscle length on strength and activation is currently unknown in this population. Here, we examined the effect of knee angle on quadriceps strength, activation, and electrically evoked torque in individuals with ACL reconstruction. Furthermore, we evaluated whether knee angle mediated the relationship between quadriceps weakness and functional performance after ACL reconstruction. Knee strength and activation were tested bilaterally at 90° and 45° of knee flexion in 11 subjects with ACL reconstruction using an interpolated triplet technique. The magnitude of electrically evoked torque at rest was used to quantify peripheral muscle contractile property changes, and the single-leg hop for distance test was used to evaluate functional performance. The results indicated that although quadriceps strength deficits were similar between knee angles, voluntary activation deficits were significantly higher in the reconstructed leg at 45° of knee flexion. On the contrary, the side-to-side evoked torque at rest ratio [i.e., (reconstructed/nonreconstructed) × 100] was significantly lower at 90° than at 45° of knee flexion. The association between quadriceps strength and functional performance was stronger at 45° of knee flexion. The results provide novel evidence that quadriceps activation is selectively affected at 45° of knee flexion and emphasize the importance of assessing quadriceps strength and activation at this position when feasible because it better captures activation deficits.

Effect of Tunnel-Graft Length on the Biomechanics of Anterior Cruciate Ligament-Reconstructed Knees

2008 ◽  
Vol 36 (11) ◽  
pp. 2158-2166 ◽  
Author(s):  
Thore Zantop ◽  
Mario Ferretti ◽  
Kevin M. Bell ◽  
Peter U. Brucker ◽  
Lars Gilbertson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Structural Properties ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Bone Tunnel ◽  
Anterior Cruciate ◽  
Graft Length

Background In anterior cruciate ligament (ACL) reconstruction using hamstring grafts, the graft can be looped, resulting in an increased graft diameter but reducing graft length within the tunnels. Hypothesis After 6 and 12 weeks, structural properties and knee kinematics after soft tissue ACL reconstruction with 15 mm within the femoral tunnel will be significantly inferior when compared with the properties of ACL reconstruction with 25 mm in the tunnel. Study Design Controlled laboratory study. Methods In an intra-articular goat model, 36 ACL reconstructions using an Achilles tendon split graft were performed with 15-mm (18 knees) and 25-mm (18 knees) graft length in the femoral tunnel. Animals were sacrificed 6 weeks and 12 weeks after surgery and knee kinematics was tested. In situ forces as well as the structural properties were determined and compared with those in an intact control group. Histologic analyses were performed in 2 animals in each group 6 and 12 weeks postoperatively. Statistical analysis was performed using a 2-factor analysis of variance test. Results Anterior cruciate ligament reconstructions with 15 mm resulted in significantly less anterior tibial translation after 6 weeks ( P < .05) but not after 12 weeks. Kinematics after 12 weeks and in situ forces of the replacement grafts at both time points showed no statistically significant differences. Stiffness, ultimate failure load, and ultimate stress revealed no statistically significant differences between the 15-mm group and the 25-mm group. Conclusion The results suggest that there is no negative correlation between short graft length (15 mm) in the femoral tunnel and the resulting knee kinematics and structural properties. Clinical Relevance Various clinical scenarios exist in which the length of available graft that could be pulled into the bone tunnel (femoral or tibial) could be in question. To address this concern, this study showed that reducing the tendon graft length in the femoral bone tunnel from 25 mm to 15 mm did not have adverse affects in a goat model.

scholarly journals Force Production and Reactive Strength Capabilities After Anterior Cruciate Ligament Reconstruction

2008 ◽  
Vol 43 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Eamonn P. Flanagan ◽  
Lorcan Galvin ◽  
Andrew J. Harrison
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Repeated Measures ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Force Production ◽  
Limiting Factors ◽  
Normative Values ◽  
Control Group ◽  
Anterior Cruciate

Abstract Context: Ambiguity exists in the literature regarding whether individuals can restore function to 100% after anterior cruciate ligament (ACL) reconstruction. The response of force production and reactive strength in stretch-shortening cycle activities after surgery has not been established. Objective: To compare reactive strength and force production capabilities between the involved and uninvolved legs of participants who had undergone ACL reconstruction and rehabilitation with the reactive strength and force production capabilities of a control group. Design: Repeated measures, cross-sectional. Setting: Research laboratory. Patients or Other Participants: Ten participants with ACL reconstructions who had returned to their chosen sports and 10 age-matched and activity-matched control subjects. Intervention(s): We screened the ACL group with the International Knee Documentation Committee Subjective Knee Evaluation Form and functional performance tests to measure a basic level of function. We assessed force production capabilities and reactive strength using squat, countermovement, drop, and rebound jump protocols on a force sledge apparatus. Main Outcome Measure(s): The dependent variables were flight time, peak vertical ground reaction force, leg spring stiffness, and reactive strength index. Results: No participant in the ACL group exhibited functional deficits in comparison with normative values or the control group. Using the force sledge apparatus, we found no notable differences in force production capabilities and reactive strength in the ACL group when comparing the involved with uninvolved legs or the degree of difference between legs with the control group. Conclusions: After ACL reconstruction, rehabilitated participants did not exhibit deficits in force production or reactive strength capabilities. Our results suggest that force production and reactive strength capabilities can be restored to levels comparable with the uninjured control limb and may not be limiting factors in ACL recovery.

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