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Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Quadriceps femoris (QF) strength deficits at return-to-sport (RTS) after ACL reconstruction (ACLR) contribute to decreased knee function at the same time point. However, the impact of QF strength at RTS on longitudinal function has not been examined. The purpose of this study was to test the hypothesis that young athletes after ACLR with QF strength asymmetry at RTS would demonstrate decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS compared to young athletes following ACLR with nearly symmetric QF strength at RTS.

Methods

Participants included 76 young athletes (74% female; mean age at RTS = 17.3 years) after primary, unilateral ACLR, cleared to RTS, and followed for 1 year after RTS. At the time of RTS, QF strength was quantified on an isokinetic dynamometer and a Limb Symmetry Index (LSI) was calculated [(involved/uninvolved) × 100%]. The cohort was subdivided into two groups based on RTS QF LSI: high quadriceps (HQ; LSI ≥ 90%; n = 36) and low quadriceps (LQ; LSI < 85%; n = 36). The cohort was followed for 1 year post-RTS, and knee-related function was assessed using the International Knee Documentation Committee subjective form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and LSI of single-leg hop tests. Functional recovery at 1 year post-RTS was defined as KOOS scores above literature-reported cut-offs.

Results

While the HQ group demonstrated higher symmetry on all 1 year post-RTS hop tests, only the triple-hop test (p = 0.020) was found to be statistically different. Similarly, while the HQ group scored higher on all 1 year post-RTS self-reported knee function measures, only differences on the KOOS-Sport/Rec score (p = 0.039) and IKDC score (p = 0.011) were statistically different. Additionally, the HQ group demonstrated higher proportions of functional recovery at 1 year post-RTS than the LQ group on the KOOS-Symptoms (HQ: 88.9%, LQ: 69.4%; p = 0.040) and KOOS-Sport/Rec (HQ: 91.7%, LQ: 69.4%; p = 0.017).

Conclusions

Young athletes after ACLR with QF strength asymmetry at RTS demonstrated decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS. However, group differences did not exceed reported minimal clinically important difference values. Further study is warranted to understand factors that contribute to longitudinal knee function after ACLR. Clinicians should focus on restoring symmetric QF strength at RTS after ACLR, which may promote higher longitudinal knee function.

Level of evidence

Level II, Prospective cohort study.

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Acknowledgements

The authors thank the staff at the Sports Medicine Biodynamics Center and the Sports and Orthopaedic Team in the Division of Occupational and Physical Therapy at Cincinnati Children’s Hospital Medical Center for their contribution to this work.

Authors’ contributions

LCS, MVP, TEH, and MPI performed study conception and study design. LCS, MVP, MPI, and ST carried out data acquisition and analysis. LCS, MVP, MPI, TEH, ARA, and ST interpreted the data, drafted the work, or revised it critically.

Author information

Authors and Affiliations

  1. Movement Analysis and Performance Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, 2050 Kenny Road, Columbus, OH, USA

    Matthew P. Ithurburn & Laura C. Schmitt

  2. OSU Sports Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA

    Matthew P. Ithurburn

  3. Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Matthew P. Ithurburn & Laura C. Schmitt

  4. Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA

    Alex R. Altenburger & Laura C. Schmitt

  5. Divisions of Occupational and Physical Therapy and Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, USA

    Staci Thomas & Mark V. Paterno

  6. Biomechanics Laboratories and Sports Medicine, Departments of Orthopaedic Surgery, Physical Medicine and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, RO_GU_01_22, Rochester, MN, USA

    Timothy E. Hewett

  7. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Mark V. Paterno

Authors
  1. Matthew P. Ithurburn
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  2. Alex R. Altenburger
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  3. Staci Thomas
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  4. Timothy E. Hewett
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  6. Laura C. Schmitt
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Corresponding author

Correspondence to Laura C. Schmitt.

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Conflict of interest

The authors declare that they have no competing interests.

Funding

This work was funded by support from the National Institutes of Health grant F32-AR055844, the National Football League Charities Medical Research Grants 2007, 2008, 2009, 2011, and the Foundation for Physical Therapy Promotion of Doctoral Studies (PODS) II scholarship.

Ethical approval

Institutional Review Board approval provided by the Cincinnati Children's Hospital Medical CenteOr IRB (2008-0514).

Authors’ information

MPI is a Graduate Research Associate at The Ohio State University and a physical therapist at Ohio State Sports Medicine. ARA is a physical therapy graduate student at The Ohio State University. TEH is the Director of the Biomechanics Laboratories and Professor of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Physiology, and Biomedical Engineering at Mayo Clinic. MVP is Coordinator and Professor in the Division of Occupational and Physical Therapy and Sports Medicine at Cincinnati Children’s Hospital Medical Center. LCS is an Associate Professor in the Division of Physical Therapy and Co-Director of the Movement Analysis and Performance Laboratory at The Ohio State University.

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Ithurburn, M.P., Altenburger, A.R., Thomas, S. et al. Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later. Knee Surg Sports Traumatol Arthrosc 26, 426–433 (2018). https://doi.org/10.1007/s00167-017-4678-4

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