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The hamstring/quadriceps ratio is an indicator of function in ACL-deficient, but not in ACL-reconstructed knees

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to investigate the isokinetic, eccentric and isometric hamstring/quadriceps (HQ) ratios in patients before and after ACL reconstruction (ACLR) using bone–patellar tendon grafts and to establish the relationships between HQ ratio and knee function.

Methods

Forty-four patients (mean age of 26.6 years) underwent isokinetic testing of quadriceps and hamstring muscles before and after ACLR and HQ ratios were calculated. Lysholm, IKDC and Cincinnati Scores were used to assess function. Isokinetic concentric and eccentric peak torque (Nm/kg) was measured at three different speeds: 60, 120, and 180°/s. Isometric strength was tested at 30° and 60° of knee flexion.

Results

For the isometric tests, the HQ ratio between the involved and non-involved limb was not different for the ACLD knee (p = 0.28) at 30° knee flexion, but significant at the 60° flexion angle (p = 0.02) and for the ACLR knees at 30° and 60° (p = 0.02). For the isokinetic tests, the ratio between involved and non-involved limb was significant for ACL-deficient knees at both 60 (p = 0.039) and 120°/s (p = 0.05). There were significant differences between limbs for all speeds in ACLR knees (p = 0.0003–0.01). For the eccentric tests, the HQ ratio between the involved and non-involved limbs was not significant for both the ACLD (p = 0.19) and ACLR knees (p = 0.29) at the speed of 60°/s. At 120 and 180°/s, there were significant differences between limbs for both the ACLD (p = 0.02) and ACLR knees (p = 0.003). Linear regression did not reveal significant relationships between Cincinnati, Lysholm, and IKDC scores and HQ ratios in the ACLD (R2 = 0.35, p = 0.58; R2 = 0.34, p = 0.63; R2 = 0.38, p = 0.49). In contrast, there were significant correlations between the Lysholm and IKDC scores and HQ ratios in the ACLR knees (R2 = 0.84, p = 0.002; R2 = 0.86, p = 0.001).

Conclusions

The findings of this study suggest that the HQ ratio in ACLD patients was not a predictor, but an indicator of patient-perceived knee function following ACLR.

Level of evidence

Level IV, case series.

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Authors and Affiliations

  1. Medical School, University of Queensland, Brisbane, Australia

    Erik Hohmann

  2. Medical School, Faculty of Health, University of Pretoria, Pretoria, South Africa

    Erik Hohmann

  3. Valiant Clinic/Houston Methodist Group, PO Box 414296, Dubai, United Arab Emirates

    Erik Hohmann

  4. Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia

    Kevin Tetsworth

  5. Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia

    Kevin Tetsworth

  6. University of Texas Health Science Center, San Antonio, TX, USA

    Vaida Glatt

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Correspondence to Erik Hohmann.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hohmann, E., Tetsworth, K. & Glatt, V. The hamstring/quadriceps ratio is an indicator of function in ACL-deficient, but not in ACL-reconstructed knees. Arch Orthop Trauma Surg 139, 91–98 (2019). https://doi.org/10.1007/s00402-018-3000-3

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