Skip to main content

Documentation of strength training for research purposes after ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy volume 21, pages 1849–1855 (2013)Cite this article

Abstract

Purpose

The purpose of this systematic literature review was to evaluate strength training protocol documentation during rehabilitation after anterior cruciate ligament (ACL) reconstruction. The aim was further to present recommendations concerning what components (i.e. methods, principles and training variables) could be considered vital to document when it comes to strength training for research purposes after ACL reconstruction.

Methods

A search of the PUBMED/MEDLINE, CINAHL and SportDiscus databases was made of relevant literature relating to strength training after ACL reconstruction. The database search was based on relevant medical subject headings terms (strength/resistance/weight training, anterior cruciate ligament reconstruction/rehabilitation). The literature was reviewed regarding the way methods and variables were documented in strength training protocols during rehabilitation after ACL reconstruction in peer-reviewed original prospective articles.

Results

The systematic literature search identified 139 citations published between January 1983 and May 2012. Six studies contained a strength training programme-part of the rehabilitation protocol after ACL reconstruction that met the inclusion criteria. Basic information (i.e. training frequency, intensity, volume, progression or the duration of the training period) regarding the strength training protocols used during rehabilitation after ACL reconstruction was not documented in full in four of the studies.

Conclusion

The results clearly indicate the need of a more standardised and detailed way of documenting strength training for research purposes after ACL reconstruction in order to increase the value of future studies on this subject. This review gives recommendations on strength training protocol documentation after ACL reconstruction to facilitate this goal.

Level of evidence

IV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Adachi N, Ochi M, Uchio Y, Sakai Y, Kuriwaka M, Fujihara A (2003) Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance. Arch Orthop Trauma Surg 123:460–465

    Article  PubMed  Google Scholar 

  2. Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169

    Article  PubMed  Google Scholar 

  3. Andersen LL, Magnusson SP, Nielsen M, Haleem J, Poulsen K, Aagaard (2006) Neuromuscular activation in conventional therapeutic exercises and heavy resistance exercises: implications for rehabilitation. Phys Ther 86:683–697

    PubMed  Google Scholar 

  4. Anderson JL, Lamb SE, Barker KL, Davies S, Dodd CA, Beard DJ (2002) Changes in muscle torque following anterior cruciate ligament reconstruction: a comparison between hamstrings and patella tendon graft procedures on 45 patients. Acta Orthop Scand 73:546–552

    Article  PubMed  Google Scholar 

  5. Arangio GA, Chen C, Kalady M, Reed JF 3rd (1997) Thigh muscle size and strength after anterior cruciate ligament reconstruction and rehabilitation. J Orthop Sports Phys Ther 26:238–243

    PubMed  CAS  Google Scholar 

  6. Augustsson J, Thomeé R, Karlsson J (2004) Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:350–356

    Article  PubMed  Google Scholar 

  7. Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 27:1697–1705

    Article  PubMed  Google Scholar 

  8. Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110

    Article  PubMed  Google Scholar 

  9. Beynnon BD, Johnson RJ, Fleming BC (2002) The science of anterior cruciate ligament rehabilitation. Clin Orthop Relat Res 402:9–20

    Article  PubMed  Google Scholar 

  10. Beynnon BD, Uh BS, Johnson RJ, Abate JA, Nichols CE, Fleming BC, Poole AR, Roos H (2005) Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med 33:347–359

    Article  PubMed  Google Scholar 

  11. Carter T, Edinger S (1999) Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 15:169–172

    Article  PubMed  CAS  Google Scholar 

  12. Cooper RL, Taylor NF, Feller JA (2005) A randomised controlled trial of proprioceptive and balance training after surgical reconstruction of the anterior cruciate ligament. Res Sports Med 13:217–230

    Article  PubMed  CAS  Google Scholar 

  13. De Lorme TL (1946) Heavy resistance exercises. Arch Phys Med Rehabil 27:607–630

    Google Scholar 

  14. Eitzen I, Holm I, Risberg MA (2009) Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med 43:371–376

    Article  PubMed  CAS  Google Scholar 

  15. Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA (2010) A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther 40:705–721

    PubMed  Google Scholar 

  16. Ernst GP, Saliba E, Diduch DR, Hurwitz SR, Ball DW (2000) Lower extremity compensations following anterior cruciate ligament reconstruction. Phys Ther 80:251–260

    PubMed  CAS  Google Scholar 

  17. Gustavsson A, Neeter C, Thomeé P, Silbernagel KG, Augustsson J, Thomeé R, Karlsson J (2006) A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14:778–788

    Article  PubMed  Google Scholar 

  18. Hartigan EH, Axe MJ, Snyder-Mackler L (2010) Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 40:141–154

    PubMed  Google Scholar 

  19. Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2000) Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 32:1472–1479

    Article  PubMed  CAS  Google Scholar 

  20. Hoffman M, Koceja DM (2000) Hoffmann reflex profiles and strength ratios in postoperative anterior cruciate ligament reconstruction patients. Int J Neurosci 104:17–27

    Article  PubMed  CAS  Google Scholar 

  21. Hooper DM, Morrissey MC, Drechsler W, Morrissey D, King J (2001) Open and closed kinetic chain exercises in the early period after anterior cruciate ligament reconstruction. Improvements in level walking, stair ascent, and stair descent. Am J Sports Med 29:167–174

    PubMed  CAS  Google Scholar 

  22. Keays SL, Bullock-Saxton JE, Newcombe P, Keays AC (2003) The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res 21:231–237

    Article  PubMed  CAS  Google Scholar 

  23. Konishi Y, Ikeda K, Nishino A, Sunaga M, Aihara Y, Fukubayashi T (2007) Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament repair. Scand J Med Sci Sports 17:656–661

    Article  PubMed  CAS  Google Scholar 

  24. Kraemer WJ, Newton RU (2000) Training for muscular power. Phys Med Rehabil Clin N Am 11:341–368

    PubMed  CAS  Google Scholar 

  25. Kraemer WJ, Duncan ND, Volek JS (1998) Resistance training and elite athletes: adaptations and program considerations. J Orthop Sports Phys Ther 28:110–119

    PubMed  CAS  Google Scholar 

  26. Kraemer WJ, Ratamess NA, French DN (2002) Resistance training for health and performance. Curr Sports Med Rep 1:165–171

    PubMed  Google Scholar 

  27. Kristensen J, Franklyn-Miller A (2011) Resistance training in musculoskeletal rehabilitation: a literature review. Br J Sports Med. doi:10.1136/bjsm.2010.079376

  28. 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 Sports Traumatol Arthrosc 16:1009–1016

    Article  PubMed  Google Scholar 

  29. 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 17:56–63

    Article  Google Scholar 

  30. Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM (2003) The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial. Scand J Med Sci Sports 13:115–123

    Article  PubMed  CAS  Google Scholar 

  31. 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 Sports Traumatol Arthrosc 8:337–342

    Article  PubMed  CAS  Google Scholar 

  32. Morrissey MC, Drechsler WI, Morrissey D, Knight PR, Armstrong PW, McAuliffe TB (2002) Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction. Phys Ther 82:35–43

    PubMed  Google Scholar 

  33. Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE (2006) Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 36:385–402

    PubMed  Google Scholar 

  34. Myer GD, Paterno MV, Ford KR, Hewett TE (2008) Neuromuscular training techniques to target deficits before return to sport after anterior cruciate ligament reconstruction. J Strength Cond Res 22:987–1014

    Article  PubMed  Google Scholar 

  35. Neeter C, Gustavsson A, Thomeé P, Augustsson J, Thomeé R, Karlsson J (2006) Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 14:571–580

    Article  PubMed  Google Scholar 

  36. Øiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38:2201–2210

    Article  PubMed  Google Scholar 

  37. Peterson MD, Rhea MR, Alvar BA (2005) Applications of the dose-response for muscular strength development: a review of meta-analytic efficacy and reliability for designing training prescription. J Strength Cond Res 19:950–958

    PubMed  Google Scholar 

  38. Pfeifer K, Banzer W (1999) Motor performance in different dynamic tests in knee rehabilitation. Scand J Med Sci Sports 9:19–27

    Article  PubMed  CAS  Google Scholar 

  39. Ratamess NA, Alvar BA, Evetoch TK, Housh TJ, Kibler B, Kraemer WJ, Triplett NT (2009) American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 41:687–708

    Article  Google Scholar 

  40. Risberg MA, Holm I, Tjomsland O, Ljunggren E, Ekeland A (1999) Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 29:400–412

    PubMed  CAS  Google Scholar 

  41. Risberg MA, Holm I, Myklebust G, Engebretsen L (2007) Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial. Phys Ther 87:737–750

    Article  PubMed  Google Scholar 

  42. Sale D (1988) Neural adaptation to resistance training. Med Sci Sports Exerc 20:135–145

    Article  Google Scholar 

  43. Scarfe AC, Li FX, Reddin DB, Bridge MW (2011) A new progression scale for common lower-limb rehabilitation tasks. J Strength Cond Res 25:612–619

    PubMed  Google Scholar 

  44. Schoenfeld BJ (2010) The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res 24:2857–2872

    Article  PubMed  Google Scholar 

  45. Thomeé R, Neeter C, Gustavsson A, Thomeé P, Augustsson J, Eriksson B, Karlsson J (2012) Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(6): 1143–1151

    Article  PubMed  Google Scholar 

  46. Urbach D, Nebelung W, Becker R, Awiszus F (2001) Effects of reconstruction of the anterior cruciate ligament on voluntary activation of quadriceps femoris: a prospective twitch interpolation study. J Bone Joint Surg Br 83:1104–1110

    Article  PubMed  CAS  Google Scholar 

  47. Wernbom M, Augustsson J, Thomeé R (2007) The influence of frequency, intensity, volume and mode of strength training on whole muscle cross-sectional area in humans. Sports Med 37:225–264

    Article  PubMed  Google Scholar 

  48. Wojtys EM, Huston LJ (2000) Longitudinal effects of anterior cruciate ligament injury and patellar tendon autograft reconstruction on neuromuscular performance. Am J Sports Med 28:336–344

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Box 300, 405 30, Göteborg, Sweden

    Jesper Augustsson

  2. Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    Jesper Augustsson

Authors
  1. Jesper Augustsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jesper Augustsson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Augustsson, J. Documentation of strength training for research purposes after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 21, 1849–1855 (2013). https://doi.org/10.1007/s00167-012-2167-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2167-3

Keywords

  • Strength training protocol
  • Muscle strength
  • Systematic review
  • Physiotherapy
  • ACL rehabilitation
  • Reconstruction