Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 5, pp 1163–1174

Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices

  • Alli Gokeler
  • Marsha Bisschop
  • Anne Benjaminse
  • Greg D. Myer
  • Peter Eppinga
  • Egbert Otten
Knee

DOI: 10.1007/s00167-013-2577-x

Cite this article as:
Gokeler, A., Bisschop, M., Benjaminse, A. et al. Knee Surg Sports Traumatol Arthrosc (2014) 22: 1163. doi:10.1007/s00167-013-2577-x

Abstract

Purpose

To determine the most effective practices for quadriceps strengthening after ACL reconstruction.

Methods

An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist.

Results

From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group.

Conclusions

The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements.

Level of evidence

II.

Keywords

ACL Rehabilitation Knee surgery Quadriceps strength External focus 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Alli Gokeler
    • 1
  • Marsha Bisschop
    • 2
    • 3
  • Anne Benjaminse
    • 3
    • 4
  • Greg D. Myer
    • 5
  • Peter Eppinga
    • 6
    • 7
  • Egbert Otten
    • 1
    • 3
  1. 1.Center for RehabilitationUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
  2. 2.School for PhysiotherapySaxion University Applied ScienceEnschedeThe Netherlands
  3. 3.Center for Human Movement SciencesUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
  4. 4.SportsFieldLab Groningen, School of Sports StudiesHanze University Applied ScienceGroningenThe Netherlands
  5. 5.Division of Sports Medicine, Department of Pediatrics and Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, College of MedicineUniversity of CincinnatiCincinnatiUSA
  6. 6.FC Groningen Soccer ClubGroningenThe Netherlands
  7. 7.FLYTTA Sports Physical TherapyGroningenThe Netherlands