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Knee Surgery, Sports Traumatology, Arthroscopy

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01-02-2018 | Knee

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

Authors: Matthew P. Ithurburn, Alex R. Altenburger, Staci Thomas, Timothy E. Hewett, Mark V. Paterno, Laura C. Schmitt

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2018

Abstract

Purpose

Quadriceps femoris (QF) strength deficits at return-to-sport (RTS) after ACL reconstruction (ACLR) contribute to decreased knee function at the same time point. However, the impact of QF strength at RTS on longitudinal function has not been examined. The purpose of this study was to test the hypothesis that young athletes after ACLR with QF strength asymmetry at RTS would demonstrate decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS compared to young athletes following ACLR with nearly symmetric QF strength at RTS.

Methods

Participants included 76 young athletes (74% female; mean age at RTS = 17.3 years) after primary, unilateral ACLR, cleared to RTS, and followed for 1 year after RTS. At the time of RTS, QF strength was quantified on an isokinetic dynamometer and a Limb Symmetry Index (LSI) was calculated [(involved/uninvolved) × 100%]. The cohort was subdivided into two groups based on RTS QF LSI: high quadriceps (HQ; LSI ≥ 90%; n = 36) and low quadriceps (LQ; LSI < 85%; n = 36). The cohort was followed for 1 year post-RTS, and knee-related function was assessed using the International Knee Documentation Committee subjective form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and LSI of single-leg hop tests. Functional recovery at 1 year post-RTS was defined as KOOS scores above literature-reported cut-offs.

Results

While the HQ group demonstrated higher symmetry on all 1 year post-RTS hop tests, only the triple-hop test (p = 0.020) was found to be statistically different. Similarly, while the HQ group scored higher on all 1 year post-RTS self-reported knee function measures, only differences on the KOOS-Sport/Rec score (p = 0.039) and IKDC score (p = 0.011) were statistically different. Additionally, the HQ group demonstrated higher proportions of functional recovery at 1 year post-RTS than the LQ group on the KOOS-Symptoms (HQ: 88.9%, LQ: 69.4%; p = 0.040) and KOOS-Sport/Rec (HQ: 91.7%, LQ: 69.4%; p = 0.017).

Conclusions

Young athletes after ACLR with QF strength asymmetry at RTS demonstrated decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS. However, group differences did not exceed reported minimal clinically important difference values. Further study is warranted to understand factors that contribute to longitudinal knee function after ACLR. Clinicians should focus on restoring symmetric QF strength at RTS after ACLR, which may promote higher longitudinal knee function.

Level of evidence

Level II, Prospective cohort study.

Ageberg E, Forssblad M, Herbertsson P, Roos EM (2010) Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sport Med 38:1334–1342CrossRef

Ardern CL, Webster KE (2009) Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review. Orthop Rev 1:e12CrossRef

Ardern CL, Webster KE, Taylor NF, Feller JA (2010) Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 26:462–469CrossRefPubMed

Barenius B, Forssblad M, Engstrom B, Eriksson K (2013) Functional recovery after anterior cruciate ligament reconstruction, a study of health-related quality of life based on the Swedish National Knee Ligament Register. Knee Surg Sport Traumatol Arthrosc 21:914–927CrossRef

Bell DR, Trigsted SM, Post EG, Walden CE (2016) Hip strength in patients with quadriceps strength deficits after ACL reconstruction. Med Sci Sport Exerc 48:1886–1892CrossRef

Bolgla LA, Keskula DR (1997) Reliability of lower extremity functional performance tests. J Orthop Sport Phys Ther 26:138–142CrossRef

Brosky JA Jr, Nitz AJ, Malone TR, Caborn DN, Rayens MK (1999) Intrarater reliability of selected clinical outcome measures following anterior cruciate ligament reconstruction. J Orthop Sport Phys Ther 29:39–48CrossRef

Bush-Joseph CA, Hurwitz DE, Patel RR, Bahrani Y, Garretson R, Bach BR Jr, Andriacchi TP (2001) Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon. Am J Sport Med 29:36–41CrossRef

Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, Wright RW, Kaeding CC, Marx RG, Amendola A, McCarty EC, Spindler KP, Wolf BR, Harrell FE (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42:1058–1067CrossRefPubMedPubMedCentral

10.

Frank CB, Jackson DW (1997) The science of reconstruction of the anterior cruciate ligament. J Bone Jt Surg Am 79:1556–1576CrossRef

11.

Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150CrossRefPubMed

12.

Ingelsrud LH, Granan LP, Terwee CB, Engebretsen L, Roos EM (2015) Proportion of patients reporting acceptable symptoms or treatment failure and their associated KOOS values at 6 to 24 months after anterior cruciate ligament reconstruction: a study from the norwegian knee ligament registry. Am J Sport Med 43:1902–1907CrossRef

13.

Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sport Med 29:600–613CrossRef

14.

Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC, Shelbourne KD, International Knee Documentation C (2006) Responsiveness of the international knee documentation committee subjective knee form. Am J Sport Med 34:1567–1573CrossRef

15.

Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD (1998) Development of a patient-reported measure of function of the knee. J Bone Jt Surg Am 80:1132–1145CrossRef

16.

Ithurburn MP, Paterno MV, Ford KR, Hewett TE, Schmitt LC (2015) Young athletes with quadriceps femoris strength asymmetry at return to sport after anterior cruciate ligament reconstruction demonstrate asymmetric single-leg drop-landing mechanics. Am J Sports Med 43:2727–2737CrossRefPubMed

17.

Kuenze C, Hertel J, Saliba S, Diduch DR, Weltman A, Hart JM (2015) Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction. J Sport Rehabil 24:36–46CrossRefPubMed

18.

Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sport Med 34:269–280CrossRef

19.

Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sport Traumatol Arthrosc 16:1009–1016CrossRef

20.

Lentz TA, Tillman SM, Indelicato PA, Moser MW, George SZ, Chmielewski TL (2009) Factors associated with function after anterior cruciate ligament reconstruction. Sports Health 1:47–53CrossRefPubMedPubMedCentral

21.

Lentz TA, Zeppieri G Jr, Tillman SM, Indelicato PA, Moser MW, George SZ, Chmielewski TL (2012) Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures. J Orthop Sport Phys Ther 42:893–901CrossRef

22.

Lepley AS, Ericksen HM, Sohn DH, Pietrosimone BG (2014) Contributions of neural excitability and voluntary activation to quadriceps muscle strength following anterior cruciate ligament reconstruction. Knee 21:736–742CrossRefPubMed

23.

Lepley LK, Palmieri-Smith RM (2015) Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sport Phys Ther 45:1017–1025CrossRef

24.

Lewek M, Rudolph K, Axe M, Snyder-Mackler L (2002) The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 17:56–63CrossRef

25.

Lorentzon R, Elmqvist LG, Sjostrom M, Fagerlund M, Fuglmeyer AR (1989) Thigh musculature in relation to chronic anterior cruciate ligament tear: muscle size, morphology, and mechanical output before reconstruction. Am J Sport Med 17:423–429CrossRef

26.

Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L (2015) Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sport Med 49:335–342CrossRef

27.

Mattacola CG, Perrin DH, Gansneder BM, Gieck JH, Saliba EN, McCue FC 3rd (2002) Strength, functional outcome, and postural stability after anterior cruciate ligament reconstruction. J Athl Train 37:262–268PubMedPubMedCentral

28.

McHugh MP, Tyler TF, Nicholas SJ, Browne MG, Gleim GW (2001) Electromyographic analysis of quadriceps fatigue after anterior cruciate ligament reconstruction. J Orthop Sport Phys Ther 31:25–32CrossRef

29.

Mikkelsen C, Werner S, Eriksson E (2000) Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study. Knee Surg Sport Traumatol Arthrosc 8:337–342CrossRef

30.

Noll S, Garrison JC, Bothwell J, Conway JE (2015) Knee extension range of motion at 4 weeks is related to knee extension loss at 12 weeks after anterior cruciate ligament reconstruction. Orthop J Sport Med 3:2325967115583632CrossRef

31.

Osteras H, Augestad LB, Tondel S (1998) Isokinetic muscle strength after anterior cruciate ligament reconstruction. Scand J Med Sci Sport 8:279–282CrossRef

32.

Palmieri-Smith RM, Lepley LK (2015) Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sport Med 43:1662–1669CrossRef

33.

Pietrosimone BG, Lepley AS, Ericksen HM, Clements A, Sohn DH, Gribble PA (2015) Neural excitability alterations after anterior cruciate ligament reconstruction. J Athl Train 50:665–674CrossRefPubMedPubMedCentral

34.

Pietrosimone BG, Lepley AS, Ericksen HM, Gribble PA, Levine J (2013) Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil 22:1–6CrossRefPubMed

35.

Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (2007) A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 23(1320–1325):e6

36.

Quelard B, Sonnery-Cottet B, Zayni R, Ogassawara R, Prost T, Chambat P (2010) Preoperative factors correlating with prolonged range of motion deficit after anterior cruciate ligament reconstruction. Am J Sport Med 38:2034–2039CrossRef

37.

Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR (2007) Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87:337–349CrossRefPubMed

38.

Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and Osteoarthritis Outcome Score (KOOS)-validation of a Swedish version. Scand J Med Sci Sport 8:439–448CrossRef

39.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sport Phys Ther 28:88–96CrossRef

40.

Salavati M, Akhbari B, Mohammadi F, Mazaheri M, Khorrami M (2011) Knee injury and Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive athletes after anterior cruciate ligament reconstruction. Osteoarthr Cartil 19:406–410CrossRefPubMed

41.

Sapega AA (1990) Muscle performance evaluation in orthopaedic practice. J Bone Jt Surg Am 72:1562–1574CrossRef

42.

Schmitt LC, Paterno MV, Ford KR, Myer GD, Hewett TE (2015) Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sport Exerc 47:1426–1434CrossRef

43.

Schmitt LC, Paterno MV, Hewett TE (2012) The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sport Phys Ther 42:750–759CrossRef

44.

Shelbourne KD, Urch SE, Gray T, Freeman H (2012) Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med 40:108–113CrossRefPubMed

45.

Thomee R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E (2011) Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sport Traumatol Arthrosc 19:1798–1805CrossRef

46.

Xergia SA, McClelland JA, Kvist J, Vasiliadis HS, Georgoulis AD (2011) The influence of graft choice on isokinetic muscle strength 4-24 months after anterior cruciate ligament reconstruction. Knee Surg Sport Traumatol Arthrosc 19:768–780CrossRef

47.

Xergia SA, Pappas E, Zampeli F, Georgiou S, Georgoulis AD (2013) Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction. J Orthop Sport Phys Ther 43:154–162CrossRef

Title: Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later
Authors: Matthew P. Ithurburn
Alex R. Altenburger
Staci Thomas
Timothy E. Hewett
Mark V. Paterno
Laura C. Schmitt
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4678-4

2024 ASCO Annual Meeting

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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