scholarly journals Functional Recovery after Revision Anterior Cruciate Ligament Reconstruction with a Second Autograft: A Matched Cohort Analysis in Adolescent Patients (197)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Benjamin Wilson ◽  
Benton Heyworth ◽  
Ryan Coene ◽  
Dai Sugimoto ◽  
Lyle Micheli ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Knee Flexion ◽  
Graft Failure ◽  
Cohort Analysis ◽  
Knee Extension ◽  
Muscle Group ◽  
Iliotibial Band ◽  
Return To Sports ◽  
Knee Extension Strength ◽  
Flexion Strength

Objectives: Young patients are the highest risk demographic for ACL graft failure and revision surgery. Previous studies have shown higher rates of graft failure with the use of allograft tissue for ACL reconstruction (ACLR) in both primary and revision surgeries. However, questions remain regarding the functional consequence of harvesting a second autograft from the ipsilateral knee for revision ACLR. The purpose of this study was to evaluate 6-month functional testing in patients who underwent revision ACLR with use of a second autograft from the ispilateral knee, when compared to matched cohorts of primary ACLR patients. Methods: A retrospective review of prospectively collected data from patients aged 19 or younger who underwent revision ACLR with a second autograft of an opposite muscle group (either revision patellar tendon (BTB) following primary hamstring (HS) or revision HS following primary BTB) at the study institution was performed. Exclusion criteria were patients who underwent iliotibial band autograft ACLR, those with two autografts from synergistic muscle groups, grafts from the contralateral knee, debilitating injury or surgery to the contralateral lower extremity, and multi-ligamentous knee injury. All subjects underwent functional return to sports (RTS) testing 5-8 months after revision surgery, which included anthropometric measures, isometric strength, Y-Balance, and functional hop testing. Side-to-side deficits were then compared using standard limb symmetry index (LSI) metrics, after matching a cohort of primary ACLR patients based on age, sex, and body mass index (BMI). Multivariate analysis of variance (MANOVA) was used to compare RTS metrics, and if significance was detected, pairwise comparison was performed by Bonferroni post-hoc correction. Statistical significance of p<0.05 was applied. Results: The cohort of 37 revision ACLR patients were compared to cohorts of 62 primary HS and 47 BTB ACLR patients, respectively (Table 1). The revision cohort showed comparable knee extension strength deficits to the BTB cohort (-9.45±12.09% vs -8.81±13.83%, p=0.999), which were significantly greater than that of the HS cohort (-9.45±12.09% vs -0.99±12.00%, p<0.05). Greater knee flexion strength deficits were seen in the HS cohort than the revision cohort (-38.90±16.21% vs -28.13±23.22%, p=0.009), whose deficits were, in kind, significantly greater than that of the BTB cohort (-28.13±23.22% vs -1.17±12.41%, p=0.001). The HS cohort also showed greater triple hop deficit (-21.08±25.99%) than the other two cohorts (-21.08±25.99% vs -10.75±12.85 vs -6.84±23.81, p=0.024), which were not significantly different from each other. Conclusions: After revision ACLR with a second autograft from the opposing muscle group of the ipsilateral knee, adolescents show similar knee extension strength deficits compared to primary ACLR patients with BTB grafts, but improved knee flexion strength deficits compared to primary ACLR patients with HS grafts.

scholarly journals FUNCTIONAL RECOVERY AFTER REVISION ACL RECONSTRUCTION WITH A SECOND AUTOGRAFT: A MATCHED COHORT ANALYSIS IN ADOLESCENT PATIENTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Benjamin R. Wilson ◽  
Benton E. Heyworth ◽  
Ryan P. Coene ◽  
Dai Sugimoto ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Revision Surgery ◽  
Knee Flexion ◽  
Graft Failure ◽  
Knee Extension ◽  
Iliotibial Band ◽  
Functional Testing ◽  
Knee Extension Strength ◽  
Flexion Strength

Background: Young patients are the highest risk demographic for ACL graft failure and revision surgery. Previous studies have shown higher rates of graft failure with the use of allograft tissue for ACL reconstruction (ACLR) in both primary and revision surgeries. However, questions remain regarding the functional consequence of taking a second autograft from the same knee for revision ACLR. Purpose: The purpose of this study was to evaluate 6-month functional testing in patients who underwent revision ACLR with a second autograft from the same knee compared to matched cohorts of primary ACL patients. Methods: We retrospectively reviewed prospectively collected data from patients aged 19 or younger who had revision ACLR with a second autograft at our institution. We excluded patients with iliotibial band autografts, two autografts from a synergistic muscle groups, or grafts from the contralateral knee. Patients with previous significant injury or surgery to the contralateral leg, and those with multiligamentous knee injuries were excluded. Patients underwent functional testing 5-8 months after revision surgery including anthropometric measures, isometric strength, Y-Balance, and hop testing. Side-to-side deficits were then compared to age, sex, and BMI matched cohorts of primary ACLR patients, with hamstring or patellar tendon autografts. Multivariate analysis of variance (MANOVA) was used, and if significance was detected, pairwise comparison was performed by Bonferroni post-hoc correction. Statistical significance of p<0.05 was applied. Results: Thirty-seven adolescents underwent functional testing at 6.25±0.56 months after revision ACLR with a second autograft. These patients were matched to 62 patients who underwent primary ACLR with hamstring autograft, and 47 who underwent ACLR with patellar tendon autograft (Table 1). Revision ACLR patients showed comparable knee extension strength deficits to the patellar tendon group (-9.45±12.09% vs -8.81±13.83%, p=0.999) which were significantly greater than hamstring group (-9.45±12.09% vs -0.99±12.00%, p<0.05). Greater strength deficits were seen in knee flexion strength in the hamstring group than the revision group (-38.90±16.21% vs -28.13±23.22%, p=0.009) which had significantly greater knee flexion strength deficits than the patellar tendon group (-28.13±23.22% vs -1.17±12.41%, p=0.001). The hamstring primary group also showed greater triple hop deficit (-21.08±25.99%) than the other two groups (-21.08±25.99% vs -10.75±12.85 vs -6.84±23.81, p=0.024), which were similar. Conclusions: After revision ACLR with a second autograft from the same knee, adolescents show similar knee extension strength deficits compared to primary ACL patients with patellar tendon grafts, but improved knee flexion strength deficits compared to primary ACL patients with hamstring grafts. Tables/Figures: [Table: see text]

scholarly journals Military Protein Intake Related to Strength and Fat Mass Independent of Energy Intake

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1671-e1678
Author(s):  
Jeremy A Ross ◽  
D Travis Thomas ◽  
Joshua D Winters ◽  
Scott D Royer ◽  
Christopher J Halagarda ◽  
...  
Keyword(s):  
Energy Intake ◽  
Body Mass ◽  
Knee Flexion ◽  
Protein Intake ◽  
Performance Metrics ◽  
Knee Extension ◽  
Special Operations ◽  
Knee Extension Strength ◽  
Peak Knee ◽  
Flexion Strength

ABSTRACT Introduction Kinetic military units operate in austere training environments and deprivation not commonly experienced by competitive athletes. Nutritional strategies to protect against decrements in performance and potential injury risk may differ for these two groups. A cross sectional analysis was conducted to determine energy and macronutrient characteristics associated with performance metrics. Materials and Methods 78 male subjects (age: 28.4 ± 6.0 years, height: 178.3 ± 6.7 cm, mass: 84.3 ± 9.4 kg, 8.5 ± 5.8 years of service) assigned to Marine Corps Forces Special Operations Command completed a 1-day performance assessment. Body mass, lean body mass, fat mass (FM), aerobic capacity (VO2max), lactate inflection point (LT), anaerobic power, anaerobic capacity, knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength outcome values were recorded. Dietary intake was collected using automated self-administered 24-hour dietary recall (ASA24). Performance assessment scores were compared with macronutrient intake and controlled for energy intake using analysis of covariance. Results Differences in knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength were significant across low (LPRO), medium (MPRO), and high (HPRO) protein intake groups (p &lt; 0.05) with LPRO performance metrics significantly lower than both MPRO and HPRO and MPRO significantly lower than HPRO. FM was significantly higher in LPRO than MPRO or HPRO (p &lt; 0.05). Low carbohydrate intake (LCHO) was associated with greater body mass and FM compared with high (HCHO) (p &lt; 0.05). There was no association between fat intake and any variable. Conclusions Increases in protein intake may have beneficial performance effects independent of total energy intake, while moderate increases in carbohydrate intake may not be sufficient to enhance physical performance in a special operations population.

scholarly journals LOWER QUARTER Y-BALANCE TEST SCORES ARE ASSOCIATED WITH ISOKINETIC KNEE STRENGTH

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0015
Author(s):  
Ashley L. Erdman ◽  
Charles W. Wyatt ◽  
Kirsten Tulchin-Francis ◽  
Sophia M. Ulman
Keyword(s):  
Knee Flexion ◽  
Knee Extension ◽  
Composite Score ◽  
Balance Test ◽  
Knee Extension Strength ◽  
Knee Strength ◽  
The Right ◽  
Composite Scores ◽  
Flexion Strength ◽  
Component Scores

Background: Lower extremity asymmetry has been shown to be associated with increased risk of anterior cruciate ligament injury. Return-to-sport screens commonly involve assessing the restoration of symmetrical strength and balance. Therefore, it is important to understand how these measures are related. Hypothesis/Purpose: To determine if relationships exist between the Lower Quarter Y-Balance Test (LQ-YBT) component scores, composite scores, and isokinetic knee strength in healthy, female athletes. Methods: Female adolescent athletes completed the LQ-YBT and isokinetic knee strength as a part of a comprehensive evaluation in competitive level athletes (Tegner activity scale≥7). LQ-YBT anterior, posteromedial, and posterolateral component scores for the each leg were normalized to leg length, and composite scores for each leg were calculated for each participant. Knee flexion/extension strength was collected at 120°/second using a Biodex System 4. Peak torque was normalized by body weight, and paired t-tests were used to compare legs ( α<0.05). Spearman correlation coefficients were calculated to test whether any LQ-YBT measures were associated to knee strength. Results: A total of 106 participants (age 13.8±2.4 years; BMI 20.2±3.0) were tested, and all were right leg dominant. No differences were found between LQ-YBT right and left component (Table 1), or composite scores (right 97.9 vs left 98.2, p=0.29). Flexion and extension strength were significantly increased on the right side ( p=0.02, <0.01 respectively). There were significant, weak to moderate correlations between all LQ-YBT scores (components and composite) versus knee flexion strength (r=0.26 to 0.40) (Table 2). Left knee extension strength was weakly correlated to left anterior and posteromedial component scores (r=0.24, 0.34 respectively), as well as the left composite score (r=0.29). Right knee extension strength was only correlated to the right posteromedial component score (r=0.21) and the right composite score (r=0.22). Conclusion: Weak to moderate relationships exist between both component and composite LQ-YBT scores and knee strength. The strongest correlations were found between the LQ-YBT composite scores and knee flexion strength. LQ-YBT composite scores were relatively high, indicating a low chance of injury while differences were seen in knee strength between legs. Future injury prevention programs would benefit from utilizing both tools as the Y-Balance test evaluates motor control and isokinetic strength identifies muscular imbalance, both of which are important in reducing future injury risk. Tables/Figures: [Table: see text][Table: see text]

scholarly journals Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction

2019 ◽  
Vol 5 (1) ◽  
pp. e000504 ◽  
Author(s):  
Susanne Beischer ◽  
Eric Hamrin Senorski ◽  
Christoffer Thomeé ◽  
Kristian Samuelsson ◽  
Roland Thomeé
Keyword(s):  
Acl Reconstruction ◽  
Self Efficacy ◽  
Muscle Function ◽  
Knee Flexion ◽  
Early Stage ◽  
Knee Extension ◽  
Young Athletes ◽  
Patient Demographics ◽  
Patient Reported ◽  
Flexion Strength

ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1 year after ACL reconstruction.MethodsWe extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15–30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1 year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.ResultsIn all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function was associated with present self-efficacy, OR 1.28 (95% CI 1.04 to 1.58, p=0.011), knee-extension strength, OR 1.73 (95% CI 1.28 to 2.34), knee-flexion strength, OR 1.39 (95% CI 1.07 to 1.81), vertical hop, OR 1.77 (95% CI 1.27 to 2.45), single-leg hop for distance, OR 1.98 (95% CI 1.24 to 3.17) and side hop, OR 1.64 (95% CI 1.15 to 2.33).ConclusionSymmetrical knee-extension and knee-flexion strength, a more symmetrical hop performance and higher present self-efficacy at an early stage all increased the odds of achieving symmetrical muscle function in young athletes 1 year after ACL reconstruction.

scholarly journals Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
J. Riesterer ◽  
M. Mauch ◽  
J. Paul ◽  
D. Gehring ◽  
R. Ritzmann ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Acl Reconstruction ◽  
Negative Impact ◽  
Knee Extension ◽  
Thigh Muscle ◽  
Return To Sports ◽  
Hamstring Autograft ◽  
Leg Extension ◽  
Post Surgery ◽  
Flexion Strength

Abstract Background Anterior cruciate ligament (ACL) ruptures are of major concern in sports. As mostly young and active individuals are affected there is an emphasis on the rapid and safe return to sports (RTS). Strengthening the ventral and dorsal thigh muscles is a prerequisite for a successful RTS after ACL reconstruction (ACLR), as persistent muscle weakness may increase the incidence for secondary injuries and impair performance. Aiming to increase evidence on the importance of preoperative muscle strength and the coaching of patients, the purpose of this study is to compare thigh muscle strength pre- and post-operatively after ACLR. Methods We performed a retrospective analysis of 80 patients with primary, isolated ACLR using a four-stranded hamstring autograft. We performed bilateral isokinetic concentric strength measurement (60°/s) before and six months after ACLR. Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q ratio) and the corresponding limb symmetry indices (LSI). Pearson correlations were calculated for pre- and post-surgical values. Results The operated as well as the unaffected leg increased maximal knee extension (+ 18% ± 7% p < 0.05; + 11% ± 5% p < 0.05) and flexion torque (+ 9% ± 5% p < 0.05, + 10% ± 6% p < 0.05) throughout the 6 months of rehabilitation. The H/Q ratio remained unaffected (− 2% ± 3% p = 0.93; − 4% ± 4% p = 0.27). LSI of knee extension strength increased significantly (6% ± 3% p < 0.05), while flexion strength remained unaffected (+ 2% ± 4% p = 0.27). Positive correlations underline the interrelationship between the strength pre- and post-surgery for the knee extension (r = 0.788 p < 0.05) and knee flexion strength (r = 0.637 p < 0.05) after ACLR. Conclusions Preoperative leg extension and flexion strength normalized to body mass are strongly correlated to postoperative strength performance after ACLR. Therefore, pre-operative quadriceps and hamstring muscle strength deficits may have a significant negative impact on functional performance following ACLR. This emphasizes the need for intensive preoperative screening and subsequent treatment to achieve the best possible preoperative leg strength before ACLR. Trial registration DRKS00020210.

Heritability of maximal isometric muscle strength in older female twins

2004 ◽  
Vol 96 (1) ◽  
pp. 173-180 ◽  
Author(s):  
Kristina Tiainen ◽  
Sarianna Sipilä ◽  
Markku Alen ◽  
Eino Heikkinen ◽  
Jaakko Kaprio ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Confidence Interval ◽  
Environmental Effects ◽  
Plantar Flexion ◽  
Knee Extension ◽  
Genetic Component ◽  
Knee Extension Strength ◽  
Muscle Groups ◽  
Flexion Strength ◽  
Ankle Plantar Flexion

The purpose of the present study was to examine genetic and environmental effects on maximal isometric handgrip, knee extension, and ankle plantar flexion strength. In addition, we wanted to investigate whether the strength of these three muscle groups shares a genetic component or whether the genetic effect is specific for each muscle group. Muscle strength was measured as part of the Finnish Twin Study on Aging in 97 monozygotic (MZ) and 102 dizygotic (DZ) female twin pairs, aged 63-76 yr. The MZ and DZ individuals did not differ from each other in age, body height, weight, or self-related health. The age-adjusted pairwise (intraclass) correlations of the MZ and DZ twins were, respectively, 0.462 and 0.242 in knee extension, 0.435 and 0.345 in handgrip, and 0.512 and 0.435 in ankle plantar flexion strength. The multivariate genetic analysis showed that handgrip and knee extension strength shared a genetic component, which accounted for 14% (95% confidence interval: 4-28%) of the variance in handgrip strength and 31% (95% confidence interval: 18-45%) in knee extension strength. The influence of genetic effects on ankle plantar flexion strength was minor and not significant. Furthermore, these three muscle groups had a nongenetic familial effect in common and nonshared environmental effects in common. The results suggested that muscle strength is under a genetic regulation, but also environmental effects have a significant role in explaining the variability in the muscle strength.

scholarly journals Relationships Between Physical Function and Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Author(s):  
Junya Aizawa ◽  
Kenji Hirohata ◽  
Shunsuke Ohji ◽  
Takehiro Ohmi ◽  
Sho Mitomo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Physical Function ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Sports ◽  
Knee Strength ◽  
Physical Functions ◽  
Anterior Cruciate ◽  
Flexion Strength

Abstract Background: Information about specific factors of physical function that contribute to psychological readiness is needed to plan rehabilitation for a return to sports. The purpose of this study was to identify specific physical functions related to the psychological readiness of patients aiming to return to sports 6 months after reconstruction. We hypothesized that the knee strength is a factor related to the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) cutoff score for a return to sports at 2 years after reconstruction.Methods: Fifty-four patients who had undergone primary reconstruction using hamstring tendon participated in this study. Psychological readiness was measured using the ACL-RSI in patients at 6 months after reconstruction. To identify specific physical functions related to the ACL-RSI score, participants were divided into groups with ACL-RSI scores of ³60 or <60. Non-paired t-tests or the Mann-Whitney test were performed to analyze group differences in objective variables in physical function: 1) knee strength in both legs; 2) leg anterior reach distance on both sides; and 3) single-leg hop (SLH) distances in three directions for both legs.Results: Significant differences between groups were identified in knee flexion strength (60°/s) for the uninvolved limb, hamstring-to-quadriceps ratio (60°/s) for the uninvolved limb, knee flexion strength (180°/s) for the involved limb, limb symmetry index (LSI) of leg anterior reach distance, the ratio of the distance to the height of the patient and LSI of SLH distances in lateral and medial directions. Conclusion: This study revealed that at 6 months after reconstruction, increased knee flexion strength (Ratio of the peak torque measured to the body mass of the patient), hamstring-to-quadriceps ratio, leg anterior reach distance LSI, and lateral and medial SLH appear important to exceed the ACL-RSI cutoff for a return to sports at 2 years after reconstruction. The present results may be useful for planning post-operative rehabilitation for long-term return to sports after reconstruction.

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