ISOKINETIC PERFORMANCE AND LIMB ASYMMETRY DIFFERENCES BETWEEN ADOLESCENT MALES AND FEMALES FOLLOWING QUADRICEPS TENDON – PATELLAR BONE AUTOGRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background: Accurate measurement of limb strength asymmetry differences between sexes may be important to consider when determining readiness to return to sport among adolescents following ACL reconstruction. Hypothesis/Purpose: The purpose was to compare isokinetic performance between females and males after ACL reconstruction but before return to sport clearance on isokinetic measures of limb strength asymmetry and flexor/extensor strength ratio. We hypothesized there would be no difference in limb strength asymmetry or flexor/extensor strength ratio between sexes measured by isokinetic testing. Methods: We retrospectively collected demographic, surgical, and injury information on patients aged 10 – 18 years at time of surgery. Patients completed isokinetic testing within 5-10 months after primary quadriceps tendon ACL reconstruction, and before return to sport clearance. Isokinetic testing assessed maximum torque at three speeds, 60, 180, and 300 degrees per second, through a limited range of knee extension and flexion. Maximum torque percent deficit of the involved leg compared to the uninvolved leg and flexor/extensor strength ratios were calculated. We compared peak torque extensor deficits and flexor deficits (the % difference between operative and non-operative sides) and flexor/extensor ratios at the three isokinetic test speeds within sexes and between sexes. Results: 80 subjects were tested during the study period, of which 44 subjects met inclusion criteria (female: n=29, 66%). Injury characteristics and time since surgery were similar between sexes (Table 1). Greater extensor deficits among males and females were observed at 60 degrees/s compared to 180 degree/s (p=0.003) and 300 degree/s (p<0.001), and at 180 degrees/s compared to 300 degrees/s (p=0.001) (Figure 1). Females demonstrated significantly greater peak torque flexor deficits at 300 degrees/s, compared to males (p=0.04, Figure 2). Within males, greater flexor deficits were observed at 60 degrees/s compared to 180 degrees/s (p<0.001) and 300 degrees/s (p=0.001) (Figure 2). Within females, greater flexor deficits were observed at 60 degrees/s compared to 180 degrees/s (p=0.02, Figure 2). There were no significant interactions or main effects of sex or speed for either the operative or the non-operative limb peak torque flexor/extensor ratio. Conclusion: The results demonstrate greater peak torque flexor deficits among females compared to males at the fastest testing speed in our protocol. Currently, our results indicate variability both within and between sex isokinetic performance at different speeds and suggest that isokinetic testing at slower speeds may be most effective in determining strength deficits between limbs. Tables and Figures: [Table: see text][Figure: see text][Figure: see text]

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00200 ◽

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]

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

The American Journal of Sports Medicine ◽

10.1177/0363546519885371 ◽

2019 ◽

Vol 48 (1) ◽

pp. 93-98 ◽

Cited By ~ 4

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.

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Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4678-4 ◽

2017 ◽

Vol 26 (2) ◽

pp. 426-433 ◽

Cited By ~ 22

Author(s):

Matthew P. Ithurburn ◽

Alex R. Altenburger ◽

Staci Thomas ◽

Timothy E. Hewett ◽

Mark V. Paterno ◽

...

Keyword(s):

Acl Reconstruction ◽

Return To Sport ◽

Quadriceps Strength ◽

Knee Function ◽

Young Athletes ◽

Strength Asymmetry

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Confidence varies more than time during a change-of-direction task in patients following unilateral ACL reconstruction (180)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00298 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0029

Author(s):

Daniel Ogborn ◽

Brittany Bruinooge ◽

Jarret Woodmass ◽

Devin Lemmex ◽

Gregory Stranges ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Dynamic Performance ◽

Return To Sport ◽

Quadriceps Tendon ◽

Change Of Direction ◽

Hop Tests ◽

Comparable Performance ◽

Anterior Cruciate ◽

Patient Confidence

Objectives: Psychological outcomes may be important for predicting readiness to return to sport and guiding appropriate treatment intervention during rehabilitation for patients following anterior cruciate ligament (ACL) reconstruction. Motor confidence can vary based on the context or task in which it is measured, and clinician perceptions of patient confidence may not accurately reflect patient confidence for a given athletic task. The purpose of this study was to: 1) determine how confidence varies between the affected and unaffected limb, 2) compare patient-rated confidence with a clinician’s perception of patient confidence during the completion of a change-of-direction (COD) test and 3) determine how performance varies between standard hop and change of direction tests completed at six months following ACL reconstruction. Methods: 46 patients (76.36 ± 11.82 kg, 176.2 ± 8.8 cm, 24.3 ± 7.2 yrs., 19/46 Female; Table 1) completed a functional assessment at six months following ACL reconstruction with a bone-patellar-tendon-bone (n=18), quadriceps tendon (n=13) or hamstring (n=15) graft. Functional testing included the single, triple and triple crossover hops for distance and the timed 505 change-of-direction (505) test. Patients rated their confidence during the 505 tests on a scale from “0”, representing no confidence, to “10”, or complete confidence in their ability to complete the task. A single clinician indicated their perception of the patient’s confidence on a 10 cm visual analog scale, with scores converted to a 0-10 scale for agreement analysis. Results: Patient (unaffected limb median 9 (range 6-10), affected limb median 7 (3-10), Z=-5.842, p<0.001,) and clinician-perceived confidence (unaffected median 8 (3-10), affected median 7 (3-9), Z=-3.52, p<0.001) were lower on the affected limb during the 505 task (Fig 2). There was no difference in median scores between clinician’s and patients rating the affected limb (Z=-0.681, p=0.496), whereas the clinician rated the unaffected limb lower (Z=-5.016, p<0.001; Fig 2). There was minimal to no agreement and correlation between patient and clinician-perceived confidence in either the affected (Κ = -0.090 (95%CI -0.196-0.016), p=0.170; Rs(44) = 0.173, p=0.251) or unaffected limb (Κ = -0.048 (95%CI -0.140-0.044), p=0.346; Rs(44) = 0.12, p=0.428) during the 505 test. Completion time did not differ whether the 180 pivot was performed on the affected or unaffected limb (3.2 ±0.5 s vs. 3.2 ±0.5 s, p=0.858), while large differences in performance in the single (138 ±39 cm vs. 103 ±42 cm, p<0.001), triple (451 ± 114 cm vs. 367 ± 116 cm, p<0.001) and triple crossover hop tests (403 ± 119 cm vs. 324 ± 116 cm, p<0.001) were observed (Fig 3A and B). Consequently there was a main effect of test (F(3,180) = 30.686, p<0.001) when comparing LSI indicating that the 505 LSI (100 ± 5%) was higher than for the three hop tests (73 ± 19%, p<0.001, 81 ± 13%, p<0.001, 80 ± 15%, p<0.001; Fig 4). Conclusions: Clinician’s perceptions of patient confidence may not accurately reflect patient confidence during the 505 test, although this requires validation with a larger population of clinicians over a greater variety of tasks. Both patients and a clinician report lower confidence in their reconstructed knee during the 505 test despite comparable performance between limbs. Measuring time alone during the 505 may not accurately reflect underlying performance impairments, and measures of confidence and consideration of movement strategies or compensations may be required, alongside additional tests of lower extremity dynamic performance. Further research is required to clarify the importance of task-specific motor confidence against measures of readiness (i.e., ACL-RSI) and in the context of facilitating safe return to sport following ACL reconstruction.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00176 ◽

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]

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Temporal Patterns of Knee-Extensor Isokinetic Torque Strength in Male and Female Athletes Following Comparison of Anterior Thigh and Knee Cooling Over a Rewarming Period

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0499 ◽

2020 ◽

Vol 29 (6) ◽

pp. 723-729

Author(s):

Jill Alexander ◽

David Rhodes

Keyword(s):

Muscle Strength ◽

Knee Extensor ◽

Peak Torque ◽

Local Cooling ◽

Isokinetic Testing ◽

Time Points ◽

Anterior Thigh ◽

Males And Females ◽

Main Effects ◽

To Receive

Context: The effect of local cooling on muscle strength presents conflicting debates, with literature undecided as to the potential implications for injury, when returning to play following cryotherapy application. Objective: To investigate concentric muscle strength following local cooling over the anterior thigh compared with the knee joint in males and females and the temporal pattern over a 30-minute rewarming period. Design: Repeated-measures crossover design. Method: Twelve healthy participants randomly assigned to receive cooling intervention on one location, directly over either the anterior thigh or the knee, returning 1 week later to receive the cooling intervention on opposite location. Muscle strength measured via an isokinetic dynamometer at multiple time points (immediately post, 10-, 20-, and 30-min post) coincided with measurement of skin surface temperature (Tsk) using a noninvasive infrared camera. Results: Significant main effects for time (P ≤ .001, η2 = .126) with preice application higher than all other time points (P ≤ .05) were demonstrated for both peak torque and average torque. There were also significant main effects for isokinetic testing speed, sex of the participant, and position of the ice application for both peak torque and average torque (P ≤ .05). Statistically significant decreases in Tsk were reported in both gender groups across all time points compared with preintervention Tsk for the anterior thigh and knee (P < .05). Conclusions: Reductions reported for concentric peak torque and average torque knee-extensor strength in males and females did not fully recover to baseline measures at 30-minute postcryotherapy interventions. Sports medicine practitioners should consider strength deficits of the quadriceps after wetted ice applications, regardless of cooling location (joint/muscle) or gender.

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PATIENT REPORTED OUTCOMES ARE ASSOCIATED WITH ISOMETRIC STRENGTH DEFICITS EARLY AFTER ACL RECONSTRUCTION IN ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00224 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0022

Author(s):

Adam Weaver ◽

Lauren Macmillan ◽

Danielle Suprenant ◽

Nicholas Giampetruzzi

Keyword(s):

Acl Reconstruction ◽

Patient Reported Outcomes ◽

Cruciate Ligament ◽

Pearson Correlation ◽

Return To Sport ◽

Peak Torque ◽

Isometric Strength ◽

Patient Reported ◽

Adolescent Patients ◽

The Relationship

Background: Quadriceps Femoris (QF) strength has been identified to impact patient reported function following ACL reconstruction (ACLR) at time of return to sport. Patients with higher subjective reports of knee function displayed greater QF symmetry. To our knowledge the relationship between patient reported outcomes and strength measurements have not been studied during the rehabilitation process in adolescent patients post ACLR. Hypothesis/Purpose: The purpose of this study was to examine the relationship of International Knee Documentation Committee subjective form (IKDC) and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scores to isometric QF strength at three months status post ACLR. Methods: A retrospective chart review was conducted on patients treated with ACLR between July 2017 and April 2019 at a single institution. Patients between 12 and 20 years of age that underwent ACLR and completed a three-month functional tests assessment were included in the study. Data was collected for IKDC and ACL-RSI scores, and isometric strength testing at 60° of knee flexion on the HUMAC isokinetic dynamometer (CSMI USA, Stoughton, MA). Pearson correlation was used to determine if there is an association between IKDC and isometric strength, and Spearman Correlation to determine if there is an association between ACL-RSI and isometric strength. Results: The cohort included 138 patients (68 females; 16.16±1.88) (97.31±16.12 post-op days) status post ACLR, with an average IKDC score of 69.73±13.19 and average ACL-RSI score of 60.08±24.19. Hamstring autografts were the most common reconstruction (n=80, 58%). The average QF peak torque was 71.30±28.98 ft-lbs and average isometric QF strength deficit was 31.07±23.85 percent. IKDC scores were positively associated with QF peak torque isometric strength (r=0.437, P=<.0001). ACL-RSI scores were also positively associated with peak torque QF isometric strength (r=0.284, P=.001) and negatively associated with QF strength deficit (r= -.279, P=<.002). Conclusion: IKDC and RSI were positively associated with QF isometric strength in adolescent patients three months status post ACLR. These finding suggest that QF strength impacts patients’ reported function and psychological readiness to return to sport at this time point. Possible impact on rehabilitation includes implementing strategies to progress QF strength from three months status post to time of return to sport.

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SEX-BASED DIFFERENCES IN THE OUTCOMES OF ACL RECONSTRUCTION WITH QUADRICEPS TENDON – PATELLAR AUTOGRAFT IN ADOLESCENT PATIENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00010 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0001

Author(s):

Alexia G. Gagliardi ◽

Patrick Carry ◽

Harin B. Parikh ◽

Jessica L. Traver ◽

Jay Albright

Keyword(s):

Acl Reconstruction ◽

Graft Failure ◽

Patient Reported Outcomes ◽

Female Athletes ◽

Quadriceps Tendon ◽

Male Athletes ◽

Acl Injuries ◽

Graft Choice ◽

Patient Reported ◽

Males And Females

Background: Female athletes suffer anterior cruciate ligament (ACL) injuries at a 2- to 10-fold greater rate than male athletes participating in the same sports. Previous research demonstrates worse patient reported outcomes and increased postoperative laxity in females with an HA autograft or BTB autograft compared to their male counterparts. Quadriceps tendon-patellar autograft has been established as a reliable graft choice for adolescent ACL reconstruction. The purpose of this study is to investigate sex-based differences in graft survival, patient reported outcomes, and joint laxity after ACL reconstruction with QPA among adolescent patients. Methods: All patients who underwent ACL reconstruction with QPA between November 2013 and November 2015 who were a minimum of 1-year post-operative were identified. Demographic data, surgical information, and graft failure was collected retrospectively. Subjects were then contacted by phone to administer International Knee Documentation Committee (IKDC) and Lysholm questionnaires. KT1000 arthrometer measurements were available for a subset of patients who attended a clinic follow-up appointment greater than 1 year postoperative. Results: The final cohort included 18 females and 20 males ages 10 to 18 years old. After adjusting for age and medial meniscus procedures, the hazard of graft failure among male athletes was 2.11 times [95% CI: 0.17 to 26.10, p = 0.5577] the hazard of failure among female athletes. No significant sex-based differences were found in time to return to sport, contralateral ACL injuries, or patient reported outcomes. KT 1000 joint laxity measurements were similar in male [median: 1 mm, IQR: 1 to 2 mm] and in female athletes [median: 1 mm, IQR: 1 to 2 mm]. After adjusting for BMI and medial meniscus procedures performed, KT1000 measurements were 8.74% higher [95% CI: 16.4% lower to 41.40% higher, p = 0.51999] in male athletes compared to female athletes. Conclusion/Significance: There were no differences between males and females in patient reported outcomes, post-operative laxity, or graft failure among subjects who underwent ACL reconstruction with QPA at a minimum of 1 year postoperative. The quadriceps tendon-patellar autograft is a reliable graft choice for both adolescent males and females. We will be completing further data collection in the next month and aim to consider subjects who are a minimum of 2 years postoperative.

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Return to Sport After ACL Reconstruction: Strength and Functionality Testing

Video Journal of Sports Medicine ◽

10.1177/26350254211040510 ◽

2021 ◽

Vol 1 (5) ◽

pp. 263502542110405

Author(s):

Simon J. Padanilam ◽

Steven R. Dayton ◽

Ryan Jarema ◽

Michael J. Boctor ◽

Vehniah K. Tjong

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Rehabilitation Program ◽

Isokinetic Testing ◽

Symmetry Index ◽

Limb Symmetry Index ◽

Rehabilitation Programs ◽

Increased Risk ◽

Hop Test

Background: Functionality testing following anterior cruciate ligament (ACL) reconstruction can benefit clinicians and patients in determining readiness for return to sport. While a component of a multifactorial decision, inability to perform well on these tests predicts increased risk of reinjury. As of 2013, only 41% of orthopaedic surgeons report using strength or functionality testing in evaluating patients for return to sport (RTS). Indications: In the intermediate to late stages of their rehabilitation program, patients may undergo these tests to determine readiness and safety to return to sport. Technique Description: The tests described in this video include the single and triple hop for distance, triple crossover hop, single and double vertical leg jump tasks, drop jump landing task, and isokinetic and isometric strength testing. Results: Clinicians who incorporate these tests into patient rehabilitation programs may reduce patient risk of ACL reinjury by 75% to 84%. The limb symmetry index (LSI) is a reliable calculated measure for these tests, with a strong reliability for the hop tests. The limb symmetry index can be calculated for each test and represents the ratio of measured performance of the involved, or post-ACL reconstruction, leg when compared against the uninvolved leg. The commonly used limb symmetry index threshold for passing each hop test is 90%. Patients who score 90% or greater on each of these tests are less likely to experience knee reinjury. Discussion/Conclusion: The ability of knee strength and functionality tests in determining RTS following ACL reconstruction has been highlighted as a tool in potentially reducing risk of knee reinjury. Other isometric and isokinetic testing can be used in addition to the described functionality tests but may not be possible in certain practices due to equipment and funding limitations. Usage of these strength and functionality tests, in conjunction with clinician evaluation, may lead to more optimal outcomes for patients and lower rates of reinjury. Psychological assessment may aid in evaluating patient readiness for return to sport. Importantly, further sport-specific testing is still recommended and will optimize patient outcomes.

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Quadriceps Tendon Autografts Have A Lower Early Graft Failure Rate Than Hamstring Tendon Autografts When Performing Transphyseal ACL Reconstructions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00294 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0029

Author(s):

Andrew T. Pennock ◽

Kristina Parvanta Johnson ◽

Henry G. Chambers ◽

Tracey P. Bastrom ◽

Raghav Badrinath ◽

...

Keyword(s):

Acl Reconstruction ◽

Return To Sport ◽

Quadriceps Tendon ◽

Hamstring Tendon ◽

Skeletally Immature ◽

Hamstring Tendon Autograft ◽

Early Graft ◽

Tendon Grafts ◽

Tendon Autograft

Objectives: It is unclear what the optimal graft choice is for performing a transphyseal ACL reconstruction in a skeletally immature patient. The purpose of the current study was to evaluate outcomes and complications of skeletally immature patients undergoing an ACL reconstruction with hamstring tendon autograft versus quadriceps tendon autograft. Methods: Between 2012 and 2016, 104 skeletally immature patients from a single institution underwent a primary transphyseal ACL reconstruction with either quadriceps tendon autograft or hamstring tendon autograft based on surgeon preference. Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included Lysholm score, SANE score, pain score, satisfaction, return to sport, and complications such as graft tears and physeal abnormalities. Results: Ninety patients (87%) including 62 hamstring tendon reconstructions and 28 quadriceps tendon reconstructions were available for a minimum follow-up of 2 years. The mean age of the patients was 14.8±1.3 years. No differences in chronologic age, bone age, gender, patient size, or mechanism of injury were noted between patient groups. There were no differences in surgical variables except the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 mm vs 7.8 mm; p<0.001). Patient outcomes at a mean follow-up of 2.8 years revealed no differences based graft type with a mean Lysholm score, SANE score, pain score, satisfaction, and Tegner score were 95, 91, 0.8, 9.3, and 6.9 respectively. While there were no physeal complications in either group, patients undergoing a hamstring tendon autograft reconstruction were more likely to tear their graft (19% vs 0%; p= 0.01). Conclusion: Skeletally immature patients undergoing an ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, relatively high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. Although a relatively new graft source for skeletally immature ACL reconstructions, the quadriceps tendon is not only a viable graft option, but it may be superior to the hamstrings tendon when it comes to early graft failures.

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