Objectives: To evaluate change in involved and uninvolved quadriceps and hamstring strength and limb symmetry indices (LSI) in regular intervals over the first 6 months following anterior cruciate ligament reconstruction (ACLR). Design: Prospective cohort study. Participants: Thirty-eight male participants (mean age: 24.2 [6.4] y, mean body mass index: 23.6 [4.2] kg/m2), who underwent ACLR were included. Main Outcome Measures: Isometric strength testing of the quadriceps and hamstring muscles was performed at 1, 2, 3, and 6 months after ACLR. Quadriceps and hamstring peak torques for each limb and LSI were calculated. Repeated-measures analysis of covariance and paired t tests were used to evaluate changes in strength over time and between limbs, respectively. Results: Quadriceps and hamstring peak torques of the involved limb consistently increased between each time point from 1 to 6 months (P < .001 and P = .01, respectively), whereas the uninvolved limb values did not change after ACLR (P > .05). In addition, uninvolved limb peak torque values were higher than involved limb values at each time point after ACLR for both the quadriceps and hamstrings (all P < .01). At 6 months after ACLR, 28.9% of participants demonstrated LSI greater than 90% for quadriceps strength, 36.8% demonstrated LSI greater than 90% for hamstring strength, and 15.8% of participants demonstrated greater than 90% LSI for both quadriceps and hamstring strength. Conclusions: Participants demonstrated a consistent increase in quadriceps and hamstring strength of the involved limb, with no notable change in uninvolved limb strength over the 6 months after ACLR. However, at 6 months after ACLR, only approximately 16% of participants demonstrated both quadriceps and hamstring strength LSI greater than 90%, the typically recommended cutoff value for return to sport.
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Quadriceps and Hamstring Strength Symmetry After Anterior Cruciate Ligament Reconstruction: A Prospective Study
Gulcan Harput, Volga B. Tunay, and Matthew P. Ithurburn
Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction
Kyle Southall, Laura Vogtle, Harshvardhan Singh, Matthew P. Ithurburn, C. Scott Bickel, and Christopher P. Hurt
Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.
