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 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 Effect of Isometric and Isotonic Exercise Program on Increased Strength of Quardriceps Muscles in Osteoarthritis Patients in Singgasana Rama Physiotherapy Clinic Blitar

2021 ◽  
Vol 5 (1) ◽  
pp. 42-48
Author(s):  
Irwan Syahputra ◽  
Nurwijayanti Nurwijayanti
Keyword(s):  
Muscle Strength ◽  
Exercise Program ◽  
Quadriceps Strength ◽  
Manual Muscle Testing ◽  
Moderate Intensity ◽  
Rank Test ◽  
Control Group ◽  
Isometric Training ◽  
Muscle Testing ◽  
Isotonic Exercise

Background: Osteoarthritis is a disease of the joints that can cause disability and is progressive in the joints which cause changes in the water content, proteoglycin content, and collagen in the joints. One of the ways to improve functional ability in osteoarthritis cases is to use isotonic and isometric training exercise. Pain is a clinical symptom of knee osteoarthritis, limiting movement due to pain over time will cause rehabilitation problems such as impaired flexibility and stability, reduction of muscle mass (atrophy). Mild and moderate intensity quadriceps strength training is effective at achieving optimal muscle strength and function without causing significant muscle damage. Destination: The purpose of this study was to analyze the effect of isotonic and isometric exercises on muscle strength. Research methods: This study uses a pre-experimental research type using "One Group Pre - test and Post - Test". This research has carried out the first observation (pretest) so that researchers can test the changes that occur after the treatment, and the control group. Result: with the Wilcoxon signed rank test test the isometric and isotonic groups had p = 0.000 while the control group had a significance value of p = 1,000; and the 3 groups test has different values, namely: isotonic exercise has a value of 27.67; isometric; 28.60; and control 12.73. The conclusion that can be concluded that the value of isometric training has the highest value, namely 28.60 which means it is the most effective exercise to increase the value of Manual Muscle Testing. Conclusion: There is an effect of giving isometric and isotonic exercises in strengthening the quadriceps muscles.

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.

scholarly journals No Relationship Between Preoperative and Early Postoperative Strength After ACL Reconstruction

2020 ◽  
Vol 29 (5) ◽  
pp. 583-587
Author(s):  
Pier Paolo Mariani ◽  
Luca Laudani ◽  
Jacopo E. Rocchi ◽  
Arrigo Giombini ◽  
Andrea Macaluso
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Strength ◽  
Maximal Voluntary Isometric Contraction ◽  
Extensor Muscles ◽  
Flexor Muscles ◽  
Anterior Cruciate ◽  
Tendon Autograft ◽  
Knee Extensor Muscles

Context: All rehabilitative programs before anterior cruciate ligament (ACL) reconstructive surgery, which are focused on recovery of proprioception and muscular strength, are defined as prehabilitation. While it has shown that prehabilitation positively affects the overall outcome after ACL reconstruction, it is still controversial whether preoperatively enhancing quadriceps strength has some beneficial effect on postoperative strength, mainly during the first period. Objective: To determine whether there is any relationship between preoperative and early postoperative quadriceps strength. Design: Case control. Setting: University research laboratory. Participants: Fifty-nine males (18–33 y; age: 23.69 [0.71] y) who underwent ACL reconstruction with patellar-tendon autograft were examined the day before surgery, and at 60 and 90 days after surgery. Main Outcome Measures: The limb symmetry index (LSI) was quantified for maximal voluntary isometric contraction of the knee extensor muscles and of the knee flexor muscles at 90° joint angle. A k-means analysis was performed on either quadriceps or hamstrings LSI before surgery to classify the patients in high and low preoperative LSI clusters. Differences in postoperative LSI were then evaluated between the high and low preoperative LSI clusters. Results: Following surgery, there were no differences in the quadriceps LSI between patients with high and low preoperative quadriceps LSI. Sixty days after surgery, the hamstrings LSI was higher in patients with high than low preoperative hamstrings LSI (84.0 [13.0]% vs 75.4 [15.9]%; P < .05). Conclusions: Findings suggest that quadriceps strength deficit is related to the ACL injury and increases further after the reconstruction without any correlation between the preoperative and postoperative values. Therefore, it appears that there is no need to delay surgery in order to increase the preoperative quadriceps strength before surgery.

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]

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

2020 ◽  
Author(s):  
Reinhold Ortmaier ◽  
Christian Fink ◽  
Wolfgang Schobersberger ◽  
Harald Kindermann ◽  
Iris Leister ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Well Being ◽  
Matched Pair ◽  
Return To Sports ◽  
Acl Repair ◽  
Sports Activity ◽  
Matched Pair Analysis ◽  
Internal Brace

Abstract Purpose The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. Methods Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. Results Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. Conclusion At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. Level of Evidence: Level III Retrospective comparative study.

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