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Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim was to assess the consequences of quadriceps tendon (QT) harvest on knee extensor strength after anterior cruciate ligament reconstruction (ACL-R) compared to hamstring tendon (HT) autograft. Secondary objectives were to evaluate flexor strength recovery and search for correlation between strength status and functional outcome.

Methods

This a retrospective cohort of 44 patients who underwent ACL-R using either QT (25) or HT (19). Median age was 31.1 years. We assessed thigh muscle strength thanks to concentric iso kinetic evaluation (peak torque) at 60°.s−1, 180°.s−1, 240°.s−1 and eccentric at 30°.s−1, 7 months on average after surgery. Muscle strength values were compared to the uninjured leg in order to calculate a percentage of deficit as well as unilateral hamstring/quadriceps (H/Q) ratios. KOOS score was obtained at a mean follow-up of 18 months.

Results

Extensor strength deficit (concentric 60°.s−1) was one average 33.1% in the QT group and 28.2% in the HT group (p = 0.42). Difference of flexor strength deficit (concentric 60°.s−1) was close to be significant with 5% and 12% of deficit in the QT and HT group, respectively (p = 0.1), and statistically significant for high angular velocity (14% versus 3% at 240°.s−1, p = 0.04). H/Q ratios were comparable in both groups ranging from 0.62 to 0.78. Quadriceps muscle strength deficit was negatively correlated with the KOOS score (Pearson coefficient = −0.4; p = 0.005).

Conclusion

QT autograft harvest does not yield significant quadriceps muscle weakness after ACL-R, which appear to be a pejorative factor for functional outcome.

Level of evidence

IV, Retrospective study.

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Funding

No funding was needed for this study.

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Authors and Affiliations

Authors

Contributions

CH and BRD performed data extraction. MO, JC and RP designed the protocol. MO performed statistical analysis. AM performed the isokinetic tests. CH wrote the initial draft and edited the different versions of the draft. CH, BRD, AM, RP, JC and MO approved the submitted and final version.

Corresponding author

Correspondence to C. Horteur.

Ethics declarations

Conflict of interest

MO (Matthieu Ollivier) is an educational consultant for Stryker, New-clip and Arthrex. Other authors declare no conflict of interest.

Ethical approval

Study ethics approval was obtained on 19/05/2020 (CECIC Rhône-Alpes-Auvergne, IRB 5891).

Consent to participate

All patients included gave their informed consent. Data collection started after registration to the CNIL France (National commission for Data Protection and Liberties).

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Horteur, C., Rubens Duval, B., Merlin, A. et al. Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts. Eur J Orthop Surg Traumatol 32, 857–865 (2022). https://doi.org/10.1007/s00590-021-03062-5

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