Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing

  • Hande Guney-DenizEmail author
  • Gulcan Harput
  • Defne Kaya
  • John Nyland
  • Mahmut Nedim Doral



To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender-matched healthy control group, subjects who were post-ACL reconstruction would display impaired active joint position sense, knee extensor and flexor strength symmetry and knee function at 1 year post-surgery. A secondary hypothesis was that differences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups.


Sixty-seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee flexion. International Knee Documentation Committee (IKDC) subjective score and one-leg hop test were used to assess the functional status of the patients.


The JPS detection was different at the 15° target angle between groups (F3.86 = 24.56, p < 0.001). A significantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p < 0.0001). The quadriceps index was lower in patients compared to healthy individuals (p < 0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.).


Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over-estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group.

Level of evidence



Anterior cruciate ligament Quadriceps tendon autograft Hamstring tendon autograft Tibialis anterior tendon allograft Proprioception 


Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest with respect to the data collected and procedures used within this study.


Authors declare that they have no sponsor in the study design, in the collection, analysis and interpretation of data; in writing of the manuscript; and in the decision to submit the manuscript for publication.

Ethical approval

The authors confirm this study meets the guidelines of the Declaration of Helsinki. Ethical approval for the study was received, and written informed consent was provided from all subjects (GO 18/504-41).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Faculty of Physical Therapy and RehabilitationHacettepe UniversityAnkaraTurkey
  2. 2.Faculty of Health Sciences Physiotherapy and Rehabilitation DepartmentUskudar UniversityIstanbulTurkey
  3. 3.Kosair Charities College of Health and Natural SciencesSpalding UniversityLouisvilleUSA
  4. 4.Faculty of Medicine Orthopedics and Traumatology DepartmentUfuk UniversityAnkaraTurkey

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