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Christopher Kuenze, Jay Hertel, Susan Saliba, David R. Diduch, Arthur Weltman and Joseph M. Hart


Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear.


To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR.


Descriptive laboratory study.




22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants.

Main Outcome Measures:

Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function.


Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes.


Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.

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Wei-Cheng Chao, Jui-Chi Shih, Kuan-Chung Chen, Ching-Lin Wu, Nai-Yuan Wu and Chien-Sheng Lo

patients who underwent ACLR. In this randomized controlled study, a post-ACLR rehabilitation program integrating FMS, FMS-based functional exercise, and routine rehabilitation was designed, and the effect of FMS-based functional exercise was evaluated by comparing patients undertaking FMS-based functional

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Selvin Balki and Hanım Eda Göktas¸

Objective: Kinesio taping® (KT) is a widely used treatment method in musculoskeletal rehabilitation. Little is known about the KT treatment and hip strength in patients with anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the effectiveness of the KT treatment on hip muscle weakness in early rehabilitation of ACLR and the possible determinants of the ACLR-hip strength deficit (HSD). Design: Double-blind sham-controlled study. Setting: Rehabilitation department. Patients: A total of 26 male patients who underwent unilateral ACLR using hamstring autograft or allograft 4 days before. Interventions: The patients were randomized to receive the knee KT treatment (n = 13) with lymphatic correction plus muscle (biceps/rectus femoris) facilitation or sham KT (n = 13) for 10 days. In addition, the same ACLR rehabilitation program was applied to all the patients. Main Outcome Measures: The baseline data included demographic and clinical characteristics, postoperative swelling, knee motion loss and knee pain, and bilateral strength of the knee and hip muscle groups, except for rotator. Then, percentage values of hip HSD and knee strength limb symmetry index were calculated. The hip strength measurements in ACLR-operated leg were repeated on the 5th to 10th days of KT. Results: Changes in all hip strength values over time were significant in both groups (P < .01). In intergroup analysis of 5th and 10th days, improvements in the flexor (only 10th day), extensor, and adductor hip strength on operated leg were in favor of KT group (P < .05). In addition, the postoperative thigh swelling and knee strength limb symmetry index values were correlated with the HSD outcomes in baseline data (P < .05). Conclusions: ACLR-HSD can be caused by postoperative increased swelling and reduced knee strength. The KT treatment with lymphatic correction and muscle facilitation can be used in the treatment of postoperative hip muscle weakness after ACLR.

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Johanna M. Hoch, Megan N. Houston, Shelby E. Baez and Matthew C. Hoch

ACLR rehabilitation algorithms to address all of the patient’s needs and concerns that impact the patient after they have been cleared to RTS. Health-related quality of life (HRQL) is comprised of multiple domains including: physical, social, and psychological. 11 Generic patient-reported outcomes

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Kate N. Jochimsen, Margaret R. Pelton, Carl G. Mattacola, Laura J. Huston, Emily K. Reinke, Kurt P. Spindler, Christian Lattermann and Cale A. Jacobs

symptoms may not provide as much usefulness in terms of ACLR rehabilitation. Based on the current findings, we can conclude that preoperative PCS scores may have limited value in terms of their relationship with 6-month postoperative outcomes; however, it is yet to be determined if their usefulness may be

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Rosa M. Rodriguez, Ashley Marroquin and Nicole Cosby

on improving motion and strength of the knee joint, while reducing psychological distress has not been stressed as an important aspect in postoperative ACLR rehabilitation. 12 In efforts to address psychological factors affecting this population, the studies appraised have suggested that the fear of

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Kristin D. Morgan

, 16 Peak vGRF was selected to assess between-limb stability because asymmetric vGRF production remains years after ACLR and rehabilitation and reflects altered limb loading and elevated injury risk. 3 , 10 , 20 , 21 Given that a goal of post-ACLR rehabilitation is to track the restoration of

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Dai Sugimoto, Benton E. Heyworth, Jeff J. Brodeur, Dennis E. Kramer, Mininder S. Kocher and Lyle J. Micheli

/mobility tests. 6 , 10 , 11 Comparison of balance and hop abilities between involved and uninvolved lower-extremity was suggested as a part of criteria of ACLR rehabilitation and return to play. 12 Also, the limb symmetry index (LSI) was often employed to compare lower-extremity parameters between involved and

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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins and Jonathan W. Hartman

due to the limited available literature. 34 Therefore, clinicians should continue to integrate postural control and functional activities in post-ACLR rehabilitation. Limitations This study is not without limitations. First, we did not collect information regarding rehabilitation type, duration, or

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Ian J. Dempsey, Grant E. Norte, Matthew Hall, John Goetschius, Lindsay V. Slater, Jourdan M. Cancienne, Brian C. Werner, David R. Diduch and Joseph M. Hart

was not influenced by history of meniscectomy or meniscus repair. This is somewhat surprising regarding meniscus repair, as many surgeons modify postoperative weight bearing status after meniscal repair. In a review paper by Wilk et al 44 regarding ACLR rehabilitation, PT was reported to progress