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Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology.

Methods

The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18–40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°–50°, 50°–40°, 40°–30°, 30°–20°, 20°–10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression.

Results

In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°–50° and 50°–40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume.

Conclusion

Higher quadriceps strength at knee flexion angles of 60°–40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

AMI:

Arthrogenic muscle inhibition

BMI:

Body mass index

ICRS:

International Cartilage Repair Society

KOOS:

Knee injury and osteoarthritis outcome score

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

PFJ:

Patellofemoral joint

STGT:

Semitendinosus and gracilis tendon

TFJ:

Tibiofemoral joint

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Acknowledgements

We thank Karine Fortin for her contributions to the acquisition and analysis of data.

Funding

This work was supported by the National Health and Medical Research Council (NHMRC, project grant #628850). The funding source had no role in the: study design; collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia

    Anthony Hipsley, Michelle Hall, Kim L. Bennell, Xinyang Wang & Adam L. Bryant

  2. School of Allied Health Sciences, Griffith University, Gold Coast, Australia

    David J. Saxby

  3. Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Gold Coast, Australia

    David J. Saxby

  4. Gold Coast Orthopaedic Research and Education Alliance, Gold Coast, Australia

    David J. Saxby

  5. Department of Orthopaedic Surgery, Beijing Chao-Yang Hospital, Beijing, China

    Xinyang Wang

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  1. Anthony Hipsley
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  4. Kim L. Bennell
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  6. Adam L. Bryant
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Contributions

All authors were involved in revising it critically for intellectual content. Study conception and design: AH, DJS, KLB, ALB. Acquisition of the data: KF, XW, ALB. Analysis and interpretation of data: AH, MH, KF, ALB. Draft of the paper: AH, MH, DJS, KLB, ALB. Obtaining of funding: ALB, KLB. All authors read and approved the final manuscript.

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Correspondence to Anthony Hipsley.

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All research studies have been performed according to the rules of the University of Melbourne Human Research Ethics Committee (0932864.3).

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Hipsley, A., Hall, M., Saxby, D.J. et al. Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume. Knee Surg Sports Traumatol Arthrosc 30, 1949–1957 (2022). https://doi.org/10.1007/s00167-021-06853-9

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