scholarly journals QUADRICEPS STRENGTH CHANGES ACROSS THE CONTINUUM OF CARE FOLLOWING ANTERIOR CRUCIATE LIGAMENT INJURY IN ADOLESCENT MALES AND FEMALES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Shiho Goto ◽  
Joseph Hannon ◽  
Angellyn Grondin ◽  
James C. Garrison ◽  
Sharon Wang ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Continuum Of Care ◽  
Quadriceps Strength ◽  
Adolescent Females ◽  
Adolescent Males ◽  
Time Points ◽  
Males And Females ◽  
Anterior Cruciate ◽  
Time Point ◽  
The Continuum

Background: Deficits in quadriceps strength have consistently been observed following anterior cruciate ligament reconstruction (ACL-R) and this deficit is frequently accompanied by altered lower extremity biomechanics that could increase risk of a second ACL injury. Regaining strength is a major focus for rehabilitation; however, it is unclear how quadriceps strength of both the involved (INV) and uninvolved (UnINV) limbs change across the continuum of care. Therefore, the purpose of this study was to examine quadriceps strength from the pre-operative time point until time of return to sport (RTS) in adolescent males and females. Methods: Cohort study design was used. A total of 60 adolescents participated (Males: N = 26, Age = 15.96? 1.23 yr, Ht = 177.14? 8.13 cm, Mass = 76.23? 1.23Kg; Females: N = 34, Age = 15.32? 1.12 yr, Ht = 163.11? 6.30 cm, Mass = 61.39? 7.38Kg) in the study. Participants were included in the study if they: 1) had a primary ACL-R, 2) participated in organized high-risk sports with an intention to return to sports, 3) completed assessments at the pre-operative timepoint (Pre), 12-weeks after surgery (12wk), and at time of RTS, and 4) completed the post-operative rehabilitation program. Five isokinetic repetitions of quadriceps strength (QUADS) of the INV and UnINV limbs were assessed at Pre, 12wk, and RTS, using a Biodex dynamometer (60?/sec). Peak strength was normalized to body weight (BW-1) and averaged across 5 trials. Separate 2 (limb – INV, UnINV) X 3 (time – Pre, 12wk, RTS) repeated measures of ANOVA were performed. With significant interaction, paired t-tests were performed to compare strength between each time point in each limb and between INV and UnINV limbs at each time point. Results: There were significant side by time interactions in adolescent females (F = 6.49, p = 0.002) and males (F=16.57, p < 0.001). Post hoc tests revealed that adolescent females had greater INV RTS QUADS than INV PRE QUADS (p= 0.001) and INV 12wk QUADS (p < 0.001), but no significant differences were observed between any time points in the UnINV limb. Adolescent males demonstrated decreased INV 12wk QUADS compared with INV Pre QUADS (p = 0.032), greater INV RTS QUADS than INV 12wk QUADS (p < 0.001). UnINV 12wk QUADS was lower than UnINV Pre QUADS (p < 0.037) and UnINV RTS QUADS was greater than UnINV Pre QUADS (p < 0.002). In both female and male participants, INV QUADS was significantly less than UnINV QUADS at Pre, 12wk, and RTS time points (Females: p < 0.001, p=0.007, p < 0.001, respectively; Males: p < 0.001, p < 0.001, p < 0.001, respectively). Conclusion/Significance: Quadriceps strength changes differently in adolescent females and males in both the INV and UnINV limbs across the continuum of care following ACL injury. While no changes were observed in UnINV QUADS over time, adolescent females improved INV QUADS from 12wk to RTS without changes in QUADS from Pre to 12wk. Although INV RTS QUADS was greater than INV Pre QUADS, INV RTS QUADS was 27% lower than RTS UnINV QUADS. Since UnINV QUADS is expected to be decreased due to reduced activity compared to that of pre-injury, strengthening the UnINV limb in addition to the INV limb appears to be a priority during rehabilitation. For adolescent males, INV QUADS decreased from Pre to 12wk and returned near to baseline at time of RTS, but not enough to surpass the Pre QUADS. Perhaps, minimizing the reduction of QUADS between the Pre and 12wk time points through an increase of exercise load during the early stages of rehabilitation may help to improve these deficits. Unlike female adolescents, adolescent males improved UnINV strength over time. This improvement may be a compensation of the decreased QUADS of the INV limb as significant deficits of QUADS were present at each time point. [Table: see text][Table: see text]

scholarly journals Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987015 ◽  
Author(s):  
J. Craig Garrison ◽  
Joseph Hannon ◽  
Shiho Goto ◽  
Victor Kosmopoulos ◽  
Subhash Aryal ◽  
...  
Keyword(s):  
Energy Absorption ◽  
Cruciate Ligament ◽  
Case Series ◽  
Continuum Of Care ◽  
Knee Extension ◽  
Quadriceps Strength ◽  
Information Criteria ◽  
Time Points ◽  
Knee Loading ◽  
The Continuum

Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. Study Design: Case series; Level of evidence, 4. Methods: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P < .05. Results: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P = .0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P < .0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P < .0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P < .0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P < .0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P < .0001). Preoperatively, QUADS for both the surgical ( P < .0003) and nonsurgical ( P = .0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor ( P < .0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor ( P = .0201) of surgical limb knee EAC, explaining 12.92% of the variance. Conclusion: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.

Quadriceps and Hamstring Strength Symmetry After Anterior Cruciate Ligament Reconstruction: A Prospective Study

2021 ◽  
Vol 30 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Gulcan Harput ◽  
Volga B. Tunay ◽  
Matthew P. Ithurburn
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Repeated Measures ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Analysis Of Covariance ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Time Point

Objectives: To evaluate change in involved and uninvolved quadriceps and hamstring strength and limb symmetry indices (LSI) in regular intervals over the first 6 months following anterior cruciate ligament reconstruction (ACLR). Design: Prospective cohort study. Participants: Thirty-eight male participants (mean age: 24.2 [6.4] y, mean body mass index: 23.6 [4.2] kg/m2), who underwent ACLR were included. Main Outcome Measures: Isometric strength testing of the quadriceps and hamstring muscles was performed at 1, 2, 3, and 6 months after ACLR. Quadriceps and hamstring peak torques for each limb and LSI were calculated. Repeated-measures analysis of covariance and paired t tests were used to evaluate changes in strength over time and between limbs, respectively. Results: Quadriceps and hamstring peak torques of the involved limb consistently increased between each time point from 1 to 6 months (P < .001 and P = .01, respectively), whereas the uninvolved limb values did not change after ACLR (P > .05). In addition, uninvolved limb peak torque values were higher than involved limb values at each time point after ACLR for both the quadriceps and hamstrings (all P < .01). At 6 months after ACLR, 28.9% of participants demonstrated LSI greater than 90% for quadriceps strength, 36.8% demonstrated LSI greater than 90% for hamstring strength, and 15.8% of participants demonstrated greater than 90% LSI for both quadriceps and hamstring strength. Conclusions: Participants demonstrated a consistent increase in quadriceps and hamstring strength of the involved limb, with no notable change in uninvolved limb strength over the 6 months after ACLR. However, at 6 months after ACLR, only approximately 16% of participants demonstrated both quadriceps and hamstring strength LSI greater than 90%, the typically recommended cutoff value for return to sport.

scholarly journals Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Jiang ◽  
Lei Zhang ◽  
Rui-Ying Zhang ◽  
Qiu-Jian Zheng ◽  
Meng-Yuan Li
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Anatomical Reconstruction ◽  
Single Bundle ◽  
Knee Stability ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Reconstruction Group

Abstract Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusions Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.

scholarly journals STRONGER THAN EVER! ADOLESCENT ATHLETES SHOW STRENGTH GAINS WITHIN THE UNINJURED LEG AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Elliot Greenberg ◽  
Joshua Bram ◽  
Theodore Ganley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cohort Analysis ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Strength Assessment ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes. Purpose: To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test. Results: Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%). Conclusions: Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts.

scholarly journals Knee Muscle Strength Recovery in the Early Period After ACL Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Gulcan Harput ◽  
Hasan Erkan Kılınc ◽  
Hamza Özer ◽  
Gül Baltacı ◽  
Carl G. Mattacola
Keyword(s):  
Acl Reconstruction ◽  
Early Period ◽  
Quadriceps Strength ◽  
Isometric Strength ◽  
Time Points ◽  
Hamstring Muscles ◽  
Significant Difference ◽  
Isometric Torque ◽  
Over Time ◽  
Time Point

Objectives: The aim of this study was to investigate quadriceps and hamstrings isometric strength at 4, 8 and 12 week time points following ACL Reconstruction (ACLR) and to document the strength changes of these muscles over time. The primary hypothesis was that there would be significant increases in quadriceps and hamstring muscle strengths between the 4th, 8th and 12th weeks following ACLR. The secondary hypothesis was that the quadriceps index would be higher than hamstring index at 12th week after ACLR. Methods: Thirty patients (Mean ± SD [age, 29.1±2.3yrs; weight, 77.3±13.2kg; height, 172.1±7.1cm; BMI, 21.2±3.5kg/m2, time to surgery: 7.1±7.2 months]) who underwent ACLR with Hamstring Tendon Autograft (HTG) were enrolled in this study. The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at 60° knee flexion angle at 4th, 8th and 12th weeks after surgery. The recovery of quadriceps and hamstring muscles strength following rehabilitation was expressed as a Quadriceps Index (QI) and Hamstring Index (HI) and calculated with the following formula:[(maximum voluntary isometric torque of the involved limb / maximum voluntary isometric torque by uninvolved limb) × 100]. Torque output of the involved and uninvolved limbs and quadriceps and hamstring indexes were used for the statistical analysis. A repeated measures of ANOVA was used to determine the strength changes of quadriceps and hamstrings over time. Results: Quadriceps and Hamstrings strengths significantly increased over time for both involved (Quadriceps: F (2,46)=58.3, p<0.001, Hamstring: F (2,46)=35.7, p<0.001) and uninvolved limb (Quadriceps: F(2,46)=17.9, p<0.001, Hamstring: F(2,46)=56.9, p=0.001 ). Quadriceps strength was higher at 12th week when compared to the 8 and 4 week time points for the involved limb (p<0.001), and it was higher at 8th week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb, quadriceps strength was also higher at 12th week when compared to the 8 (p=0.02) and 4 week time point (p<0.001), and higher at 8 week when compared to the 4 week time point (p=0.02). Hamstring strength was higher at 12 week when compared to the 8 and 4 week time points (p<0.001) and it was higher at 8 week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb hamstring strength was also higher at 12 week when compared to 4 week time point (p=0.01). There was no significant difference between the 4 and 8 week time points (p>0.05) or between the 8 and 12 week time points (p=0.07). Quadriceps and hamstring indexes significantly changed from 4th weeks (QI:57.9, HI:54.4 ) to 8th weeks (QI:78.8, HI:69.9 ) and from 8th weeks to 12th weeks (QI:82, HI:75.7 ) (p<0.001); however, there was no difference between indexes at the 12-week time point (p=0.17). Conclusion: Isometric strength of quadriceps and hamstring muscles for the involved and uninvolved limb increased during the early period of ACLR. The results of this study could be a baseline for clinicians while prescribing a rehabilitation protocol for ACLR patients with HTG to better appreciate expected strength changes of the muscles in the early phase.

scholarly journals The hybrid anterior cruciate ligament reconstruction surgical technique does permit an accelerated early functional recovery and return to sport.

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Peter Annear ◽  
Ebert Jay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Hamstring Graft ◽  
Cruciate Ligament Reconstruction ◽  
Hop Tests ◽  
Anterior Cruciate ◽  
Tegner Score

Objectives: A major reason for undergoing anterior cruciate ligament reconstruction (ACLR) for patients is to return to high demand activity and sport. Published literature supports a return to sport (RTS) at 6-12 months, though the recovery of lower limb strength and functional symmetry is critical and is linked with a patient’s ability to RTS, as well as reducing the incidence of secondary re-tear. This study aimed to compare clinical outcomes and RTS between patients undergoing ACLR utilizing a hamstring graft and those undergoing a hybrid technique which augments the hamstring graft with a synthetic LARS ligament. Methods: A non-randomized study design was used to compare clinical outcomes at 10-12 months post-surgery, in 82 patients undergoing conventional ACLR via a hamstring graft (HG) and 35 patients undergoing a hybrid hamstring/LARS graft (HLG). All patients were assessed using a range of patient-reported outcome (PRO) scores (IKDC, KOOS, Cinncinati, Lysholm, SF-36, Tegner, Noyes, Global Rating of Change – GRC). Limb symmetry indices (LSIs) presenting the operated limb as a percentage of the unaffected limb were calculated for several strength/functional assessments (peak isokinetic quadriceps and hamstring strength, the single, triple and triple crossover hop for distance, and the 6 m timed hop). Results: There were no group differences (p>0.05) in patient demographics and the majority of PROs. The HLG group perceived themselves to be significantly ‘more recovered’ (p=0.046) on the GRC scale (HLG = 3.2, HG = 2.2), and also reported a significantly greater (p=0.004) Tegner score (HLG = 7.2, HG = 5.9). For the HG group, 62% of patients had returned to Noyes Level 1 or 2 activities, versus 80% of the HLG group. For the Tegner score, 57% of patients reported a score >6, versus 77% of the HLG group. There were no significant differences (p>0.05) in LSIs between groups for the strength and functional hop tests. However, the HLG group demonstrated a mean LSI above 90% for all four hop tests, while all four were below 90% in the HG group. Both groups demonstrated mean hamstring strength LSIs above 90%, while the quadriceps strength LSI was 81.9% and 85.8% for the HG and HLG groups, respectively. Conclusion: Patients in the HLG group perceived themselves to be more recovered, and had returned to a higher level of activity/sport, compared with the HG group. While not significant, the HLG group did demonstrate more favorable functional hop and quadriceps strength LSIs, which has been linked with the ability to RTS and the incidence of ACL re-tear. A larger patient cohort and follow-up is required to observe long-term outcomes.

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