Association Between Knee Extension Strength at 3 and 6 Months After Anterior Cruciate Ligament Reconstruction

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Sho Mitomo Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Junya Aizawa Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
Faculty of Health Science, Department of Physical Therapy, Juntendo University, Tokyo, Japan

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Kenji Hirohata Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Shunsuke Ohji Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Takehiro Ohmi Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Toshiyuki Ohara Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Hideyuki Koga Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

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Kazuyoshi Yagishita Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

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Context: Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6 months after anterior cruciate ligament reconstruction. Design: Retrospective study. Methods: Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3 months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6 months postoperatively as the dependent variable and the LSI of IKE at 3 months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6 months postoperatively as the dependent variable; LSI of IKE at 3 months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. Results: The correlation analysis revealed that the LSIs of IKE at 3 and 6 months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3 months postoperatively was significantly associated with that at 6 months postoperatively, even when other variables were included as covariates (R2 = .349, P = .004). Conclusion: Asymmetry of knee extension strength at 3 months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6 months postoperatively.

Mitomo (mitomo.spt@tmd.ac.jp) is corresponding author.

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  • 1.

    Burland JP, Kostyun RO, Kostyun KJ, et al. Clinical outcome measures and return-to-sport timing in adolescent athletes after anterior cruciate ligament reconstruction. J Athl Train. 2018;53(5):442451. PubMed ID: 29847160 doi:10.4085/1062-6050-302-16

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Barfod KW, Feller JA, Hartwig T, Devitt BM, Webster KE. Knee extensor strength and hop test performance following anterior cruciate ligament reconstruction. Knee. 2019;26(1):149154. PubMed ID: 30554909 doi:10.1016/j.knee.2018.11.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Lentz TA, Zeppieri G Jr, George SZ, et al. Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. Am J Sports Med. 2015;43(2):345353. PubMed ID: 25480833 doi:10.1177/0363546514559707

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804808. PubMed ID: 27162233 doi:10.1136/bjsports-2016-096031

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946951. PubMed ID: 27215935 doi:10.1136/bjsports-2015-095908

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Tourville TW, Jarrell KM, Naud S, et al. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42(2):302311. PubMed ID: 24275860 doi:10.1177/0363546513510672

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Arhos EK, Thoma LM, Grindem H, et al. Association of quadriceps strength symmetry and surgical status with clinical osteoarthritis 5 years after anterior cruciate ligament rupture. Arthritis Care Res. 2022;74(3):386391. doi:10.1002/acr.24479

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Oiestad BE, Holm I, Engebretsen L, Risberg MA. The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction. Br J Sports Med. 2011;45(7):583588. PubMed ID: 20647299 doi:10.1136/bjsm.2010.073130

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Nawasreh Z, Logerstedt D, Cummer K, et al. Do patients failing return-to-activity criteria at 6 months after anterior cruciate ligament reconstruction continue demonstrating deficits at 2 years? Am J Sports Med. 2017;45(5):10371048. PubMed ID: 28125899 doi:10.1177/0363546516680619

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Xergia SA, McClelland JA, Kvist J, Vasiliadis HS, Georgoulis AD. The influence of graft choice on isokinetic muscle strength 4–24 months after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):768780. PubMed ID: 21234542 doi:10.1007/s00167-010-1357-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg. 2014;134(10):14171428. PubMed ID: 25091127 doi:10.1007/s00402-014-1992-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):16971705. PubMed ID: 22137326 doi:10.1016/j.arthro.2011.09.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Welling W, Benjaminse A, Seil R, et al. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):36363644. PubMed ID: 29574548 doi:10.1007/s00167-018-4916-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Abrams GD, Harris JD, Gupta AK, et al. Functional performance testing after anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med. 2014;2(1):2325967113518305. PubMed ID: 26535266 doi:10.1177/2325967113518305

    • Search Google Scholar
    • Export Citation
  • 15.

    Cristiani R, Forssblad M, Edman G, Eriksson K, Stålman A. Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):41544162. PubMed ID: 33661322 doi:10.1007/s00167-021-06517-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Hallagin C, Garrison JC, Creed K, et al. The relationship between pre-operative and twelve-week post-operative y-balance and quadriceps strength in athletes with an anterior cruciate ligament tear. Int J Sports Phys Ther. 2017;12(6):986993. PubMed ID: 29158959 doi:10.26603/ijspt20170986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Ueda Y, Matsushita T, Araki D, et al. Factors affecting quadriceps strength recovery after anterior cruciate ligament reconstruction with hamstring autografts in athletes. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):32133219. PubMed ID: 27553297 doi:10.1007/s00167-016-4296-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Hannon JP, Wang-Price S, Goto S, et al. Twelve-week quadriceps strength as a predictor of quadriceps strength at time of return to sport testing following bone-patellar tendon-bone autograft anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2021;16(3):681688. PubMed ID: 34123520 doi:10.26603/001c.23421

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601614. PubMed ID: 22402434 doi:10.2519/jospt.2012.3871

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley TJ. Rehabilitation practice patterns following anterior cruciate ligament reconstruction: a survey of physical therapists. J Orthop Sports Phys Ther. 2018;48(10):801811. PubMed ID: 29787697 doi:10.2519/jospt.2018.8264

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Fältström A, Hägglund M, Kvist J. Patient-reported knee function, quality of life, and activity level after bilateral anterior cruciate ligament injuries. Am J Sports Med. 2013;41(12):28052813. PubMed ID: 24007758 doi:10.1177/0363546513502309

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Katakura M, Horie M, Watanabe T, et al. Effect of meniscus repair on pivot-shift during anterior cruciate ligament reconstruction: objective evaluation using triaxial accelerometer. Knee. 2019;26(1):124131. PubMed ID: 30554908 doi:10.1016/j.knee.2018.11.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Nakamura T, Linde MA, Marshall BD, et al. Arthroscopic centralization restores residual knee laxity in ACL-reconstructed knee with a lateral meniscus defect. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):36993704. PubMed ID: 30955073 doi:10.1007/s00167-019-05406-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Aizawa J, Hirohata K, Ohji S, et al. Correlations between isokinetic knee torques and single-leg hop distances in three directions in patients after ACL reconstruction. BMC Sports Sci Med Rehabil. 2021;13(1):38. PubMed ID: 33836820 doi:10.1186/s13102-021-00265-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Ohji S, Aizawa J, Hirohata K, et al. The psychological readiness to return to sports of patients with anterior cruciate ligament reconstruction preoperatively and 6 months postoperatively. Phys Ther Sport. 2021;50:114120. PubMed ID: 33971578 doi:10.1016/j.ptsp.2021.04.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Koga H, Muneta T, Watanabe T, et al. Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy. 2016;32(10):20002008. PubMed ID: 27132775 doi:10.1016/j.arthro.2016.01.052

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Koga H, Watanabe T, Horie M, et al. Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech. 2017;6(4):e1335e1339. PubMed ID: 29354437 doi:10.1016/j.eats.2017.05.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Kubota R, Koga H, Ozeki N, et al. The effect of a centralization procedure for extruded lateral meniscus on load distribution in porcine knee joints at different flexion angles. BMC Musculoskelet Disord. 2020;21(1):205. PubMed ID: 32245447 doi:10.1186/s12891-020-03197-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Montalvo AM, Schneider DK, Webster KE, et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train. 2019;54(5):472482. PubMed ID: 31009238 doi:10.4085/1062-6050-407-16

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Sturgill LP, Snyder-Mackler L, Manal TJ, Axe MJ. Interrater reliability of a clinical scale to assess knee joint effusion. J Orthop Sports Phys Ther. 2009;39(12):845849. PubMed ID: 20032559 doi:10.2519/jospt.2009.3143

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Schlegel TF, Boublik M, Hawkins RJ, Steadman JR. Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med. 2002;30(4):479482. PubMed ID: 12130400 doi:10.1177/03635465020300040501

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Lepley LK, Palmieri-Smith RM. Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sports Phys Ther. 2015;45(12):10171025. PubMed ID: 26471854 doi:10.2519/jospt.2015.5753

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Cohen J. A power primer. Psychol Bull. 1992;112(1):155159. PubMed ID: 19565683 doi:10.1037/0033-2909.112.1.155

  • 34.

    Lesevic M, Kew ME, Bodkin SG, et al. The affect of patient sex and graft type on postoperative functional outcomes after primary ACL reconstruction. Orthop J Sports Med. 2020;8(6):2325967120926052. PubMed ID: 32637429 doi:10.1177/2325967120926052

    • Search Google Scholar
    • Export Citation
  • 35.

    Harput G, Guney-Deniz H, Ozer H, Baltaci G, Mattacola C. Higher body mass index adversely affects knee function after anterior cruciate ligament reconstruction in individuals who are recreationally active. Clin J Sport Med. 2020;30:e194e200. PubMed ID: 30339632 doi:10.1097/jsm.0000000000000669

    • Search Google Scholar
    • Export Citation
  • 36.

    Cristiani R, Mikkelsen C, Forssblad M, Engström B, Stålman A. Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):34613470. PubMed ID: 30778627 doi:10.1007/s00167-019-05396-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med. 2001;29(6):722728. PubMed ID: 11734484 doi:10.1177/03635465010290060901

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Hunnicutt JL, Xerogeanes JW, Tsai LC, et al. Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):30853095. PubMed ID: 33175281 doi:10.1007/s00167-020-06351-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y balance test anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2015;10(5):602611. PubMed ID: 26491610

    • Search Google Scholar
    • Export Citation
  • 40.

    Myers H, Christopherson Z, Butler RJ. Relationship between the lower quarter y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. Int J Sports Phys Ther. 2018;13(2):152159. PubMed ID: 30090673 doi:10.26603/ijspt20180152

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Noll S, Garrison JC, Bothwell J, Conway JE. Knee extension range of motion at 4 weeks is related to knee extension loss at 12 weeks after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2015;3(5):2325967115583632. PubMed ID: 26675061 doi:10.1177/2325967115583632

    • Search Google Scholar
    • Export Citation
  • 42.

    Grapar Žargi T, Drobnič M, Vauhnik R, Koder J, Kacin A. Factors predicting quadriceps femoris muscle atrophy during the first 12 weeks following anterior cruciate ligament reconstruction. Knee. 2017;24(2):319328. PubMed ID: 27923622 doi:10.1016/j.knee.2016.11.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Garrison JC, Hannon J, Goto S, et al. Knee loading after ACL-R is related to quadriceps strength and knee extension differences across the continuum of care. Orthop J Sports Med. 2019;7(10):2325967119870155 PubMed ID: 31632992 doi:10.1177/2325967119870155

    • Search Google Scholar
    • Export Citation
  • 44.

    Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech. 2007;22(5):543550. doi:10.1016/j.clinbiomech.2007.01.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Urbach D, Awiszus F. Impaired ability of voluntary quadriceps activation bilaterally interferes with function testing after knee injuries. A twitch interpolation study. Int J Sports Med. 2002;23(4):231236. PubMed ID: 12015621 doi:10.1055/s-2002-29074

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Wellsandt E, Failla MJ, Snyder-Mackler L. Limb symmetry indexes can overestimate knee function after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2017;47(5):334338. PubMed ID: 28355978 doi:10.2519/jospt.2017.7285

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Ueda Y, Matsushita T, Shibata Y, et al. Longitudinal quadriceps strength recovery after anterior cruciate ligament reconstruction with hamstring autograft: patients stratified by preoperative quadriceps strength deficit. J Sport Rehabil. 2019;29(5):602607. PubMed ID: 31094615 doi:10.1123/jsr.2018-0236

    • Crossref
    • Search Google Scholar
    • Export Citation
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