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 EARLY OUTCOMES AFTER SUTURE TAPE REINFORCEMENT OF QUADRICEPS TENDON AUTOGRAFT ACL RECONSTRUCTION IN ADOLESCENT ATHLETES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Michael Saper
Keyword(s):  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Activity Level ◽  
Adolescent Athletes ◽  
Patient Reported ◽  
Adolescent Patients ◽  
The Mean ◽  
Tendon Autograft ◽  
Suture Tape

Background: Recently, anterior cruciate ligament reconstruction (ACLR) with suture-tape reinforcement has been popularized for protection of the graft during the revascularization and remodeling phase of incorporation. To date, there are limited short-term data regarding the outcomes of suture tape reinforcement to ACLR. Furthermore, its use with quadriceps tendon autograft (QT) ACLR is limited. Purpose: The purpose of this study was to review the early, preliminary results of ACLR in adolescent patients using QT autograft with suture tape reinforcement (QT-SR). Methods: A retrospective review was performed of skeletally mature adolescent patients who underwent primary ACLR with all-soft tissue QT-SR since 2018. Surgeries were performed by a single surgeon using an all-inside technique. All patients followed the same standardized rehabilitation protocol. Twelve-month patient-reported outcome measures (PROMs) and complications were analyzed. PROMs included the Pediatric International knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, and the Tegner activity level scale. Psychological readiness was assessed with the ACL-Return to Sport after Injury (ACL-RSI) scale. Results: 39 patients (24 girls, 15 boys) were identified. The mean age at the time of surgery was 15.7 ± 1.3 years (range, 13-18 years). 82% of patients were high school athletes. Soccer was the primary sport for 48.7% of patients. The mean graft diameter was 9.5 ± 0.4 mm. 51.3% of patients had concomitant meniscus repairs. The mean time to return-to-sport clearance was 10.1 ± 1.4 months. At 12 months, the mean postoperative Pedi-IKDC was 95.6 ± 4.0, the mean Lysholm score was 97.6 ± 3.9, and the mean Tegner score was 8.8 ± 0.9. All PROMs improved significantly compared to the preoperative scores (Pedi-IKDC: p = 0.003, Lysholm: p = 0.006, Tegner: p = 0.003). The mean ACL-RSI was 93.4 ± 4.7. Complications included return to surgery due to postoperative stiffness in two patients. There were no cases of postoperative instability, graft rupture, or contralateral ACL injury. Conclusion: QT-SR ACLR results in excellent clinical and patient-reported outcomes in adolescent athletes at 12 months follow-up. The long-term effect of QT-SR remains to be investigated.

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]

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Alexia G. Gagliardi ◽  
Patrick M. Carry ◽  
Harin B. Parikh ◽  
Jay C. Albright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

scholarly journals Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

2020 ◽  
pp. 036354652098007
Author(s):  
Elanna K. Arhos ◽  
Jacob J. Capin ◽  
Thomas S. Buchanan ◽  
Lynn Snyder-Mackler
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Sport Training ◽  
Gait Biomechanics ◽  
Peak Knee

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

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.

scholarly journals Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110566
Author(s):  
Soroush Baghdadi ◽  
David P. VanEenenaam ◽  
Brendan A. Williams ◽  
J. Todd R. Lawrence ◽  
Kathleen J. Maguire ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Quadriceps Tendon ◽  
Graft Size ◽  
Operative Notes ◽  
Tendon Autograft ◽  
Graft Diameter ◽  
Mri Measurements

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

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