Quadriceps and Hamstring Strength Recovery During Early Neuromuscular Rehabilitation After ACL Hamstring-Tendon Autograft Reconstruction

in Journal of Sport Rehabilitation
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There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG).


To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time.


Longitudinal study.


24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft.

Main Outcome Measures:

The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery.


Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F 2,46 = 58.3, P < .001; hamstring F 2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F 2,46 = 17.9, P < .001; hamstring F 2,46 = 56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17).


The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

Harput, Kilinc, and Baltaci are with the Dept of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey. Ozer is with the Dept of Orthopedics and Traumatology, Gazi University, Ankara, Turkey. Mattacola is with the Dept of Rehabilitation Sciences, University of Kentucky, Lexington, KY.

Address author correspondence to Gulcan Harput at gulcan.aktas@hacettepe.edu.tr.