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Knee strength deficits following anterior cruciate ligament reconstruction differ between quadriceps and hamstring tendon autografts

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare patient reported outcomes and functional knee recovery following anterior cruciate ligament (ACL) reconstruction using either a quadriceps tendon (QT) or hamstring tendon (HT) autograft.

Methods

Thirty-five QT patients (age 20; range 15–34 years) participated in this study and were matched for gender, age and pre-injury activity level to 70 HT (age 20; range 15–32 years) patients. The following assessments were performed at 6 and 12 months post-operatively; standardized patient-reported outcome measures (IKDC, KOOS-QOL, ACL-RSI, Marx activity, anterior knee pain), knee range of motion (passive and active), anterior knee laxity, hop tests (single and triple crossover hop for distance), and isokinetic strength of the knee extensors and flexors. All dependent variables were analysed using a two-way mixed ANOVA model, with within (Time; 6 and 12 months) and between-subject (Graft; QT and HT) factors.

Results

Patient reported outcome measures and hop performance improved between 6 and 12 months (p < 0.001), however no significant differences in either patient-reported outcomes or hop performance were found between the two grafts. Isokinetic strength testing showed both groups improved their peak knee extensor strength in the operated limb between 6 and 12 months (p < 0.001), but the QT group had significantly lower knee extensor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.001) and 180 deg/s (p < 0.01). In contrast, the QT group had significantly greater knee flexor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.01) and 180 deg/s (p = 0.01), but knee flexor strength limb symmetry did not significantly improve over time in either group.

Conclusion

Recovery of knee function following either QT or HT ACL reconstruction continues between 6 and 12 months after surgery. However, knee extensor strength deficits in the QT group and knee flexor strength deficits in the HT persisted at 12 months. This may have implications for decisions regarding return to sport.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

ACL-RSI:

Anterior cruciate ligament-return to sport after injury scale

HT:

Hamstring tendon

IKDC:

International knee documentation committee-subjective knee evaluation form

KOOS-QOL:

Knee injury and osteoarthritis outcome score-knee-related quality of life subscale

LSI:

Limb symmetry index

Marx:

Marx activity rating scale

PEP:

Prevent injury and enhance performance

PT:

Patellar tendon

QT:

Quadriceps tendon

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Acknowledgements

This work was supported by an Australian Government Research Training Program Scholarship. Data collection for this study was completed by the research team at OrthoSport Victoria.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

Authors

Contributions

KW, JF, & JM conceived of the study. PJ participated in the data analysis and performed statistical analysis and drafted the manuscript. All authors participated in critically revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kate E. Webster.

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The authors listed on this manuscript certify none declared.

Ethical approval

Ethics approval was obtained from the relevant institutions (La Trobe University: HEC19003; Epworth Healthcare: HREC57012).

Informed consent

All participants were recruited from an existing longitudinal ACL reconstruction study, in which all participants had provided informed consent.

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Johnston, P.T., Feller, J.A., McClelland, J.A. et al. Knee strength deficits following anterior cruciate ligament reconstruction differ between quadriceps and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 30, 1300–1310 (2022). https://doi.org/10.1007/s00167-021-06565-0

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