Dataset Information

Adolescent Patients Exhibit Significant Improvements in Strength and Functional Performance From 6 to 9 Months After ACL Reconstruction With Quadriceps Autograft.

ABSTRACT:

Purpose

To investigate differences between the 6-month and 9-month return to sport (RTS) assessments in adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft.

Methods

A retrospective review was performed of consecutive adolescent patients who underwent ACLR between June 2017 and October 2019. Patients completed a structured RTS test 6 and 9 months after surgery consisting of isometric and isokinetic strength testing, the Lower Quarter Y-Balance Test, 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 2 RTS test time points.

Results

In total, 27 patients (16 female, 11 male) were identified with a mean age of 15 years (range, 13-17 years). There were statistically significant improvements in isometric quadriceps strength (LSI, 85.0 ± 17.2 vs 92.5 ± 11.3; P = .04) and hamstring strength (LSI, 87.9 ± 11.2 vs 99.0 ± 10.5; P < .01). There were improvements in isokinetic knee extension at both 60°/s (LSI, 75.2 ± 16.7 vs 83.3 ± 13.8) and 180°/s (LSI, 79.9 ± 15.4 vs 83.4 ± 11.2), but the differences were only statistically significant at 60°/s (P = .02 and P = .17, respectively). There were no significant differences in isokinetic testing of knee flexion at either 60°/s or 180°/s. There were no statistically significant differences in the anterior reach component of the Lower Quarter Y-Balance Test at 6 and 9 months. Patients demonstrated statistically significant improvements on single- legged hop testing with mean LSIs >95% for each of the 4 tests at 9 months postop.

Conclusions

Adolescent patients undergoing ACLR with quadriceps tendon autograft demonstrated significant improvements in quadriceps strength between 6 and 9 months postoperatively.

Level of evidence

Level IV, therapeutic case series.

SUBMITTER: Saper M

PROVIDER: S-EPMC8220612 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeQuadriceps activation failure is considered to contribute to the weakness that lingers following anterior cruciate ligament (ACL) reconstruction. Importantly, the impact of pre-operative quadriceps activation on post-operative quadriceps function is unknown. Understanding this relationship is clinically important; as the counteractive approach clinicians should employ pre-operatively to mitigate post-operative quadriceps weakness is unclear. Accordingly, the primary purpose of this study was to investigate the relationship between pre-operative quadriceps activation and post-operative quadriceps strength and activation.MethodsFifty-four individuals post-ACL injury reported for testing on two occasions: prior to surgery and post-surgery once they returned to activity. Quadriceps activation was assessed using the burst superimposition technique and quantified using the central activation ratio. Quadriceps strength was assessed using isometric contractions that were performed at 90° of knee flexion. Multiple linear regressions were utilized to detect the relationships between pre-operative activation and strength and post-operative activation and strength.ResultsPre-operative activation was not associated with post-operative strength (R(2) = 0.064, P = 0.186). Pre-operative quadriceps activation and strength were associated with post-operative activation (R(2) = 0.383, P ≤ 0.001) and strength (R(2) = 0.465, P ≤ 0.001), respectively.ConclusionsIndividuals with better pre-operative quadriceps activation demonstrated greater post-operative activation. Similarly, individuals with better pre-operative strength demonstrated better post-operative strength. Pre-operative quadriceps activation was not a predictor of post-operative strength. From a clinical perspective, our work indicates that clinicians should utilize therapies targeting both quadriceps activation and strength prior to ACL reconstruction in order to maximize these factors post-ACL reconstruction, as pre-operative activation and strength are related to post-operative activation and strength, respectively at return-to-activity.

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