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Factors affecting quadriceps strength recovery after anterior cruciate ligament reconstruction with hamstring autografts in athletes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patients typically return to sports activities 6–12 months after anterior cruciate ligament (ACL) reconstruction, and quadriceps strength has been used as one of the criteria to return to sports activities. The purpose of this study is to identify the factors that affect quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft 6 months after surgery.

Methods

Isokinetic quadriceps strength at 60°/s was measured preoperatively and 6 months after surgery in 193 athletes who underwent ACL reconstruction with a hamstring tendon autograft. The quadriceps strength index was calculated by normalizing the peak torque of the involved leg with the uninvolved leg. The subjects were divided into two groups according to the quadriceps strength index 6 months after surgery: at least 85 % (n = 84) or less than 85 % (n = 109). Multivariate logistic regression analysis and a receiver operating curve analysis were performed.

Results

The preoperative quadriceps strength index [odds ratio (OR) 1.02; 95 % confidence interval (CI) 1.01–1.03], age (OR 0.92; 95 % CI 0.86–0.98), sex (OR 2.45; 95 % CI 1.19–5.18), and knee pain (OR 0.17; 95 % CI 0.04–0.52) were independently associated with quadriceps strength recovery. The cut-off value of the preoperative quadriceps strength index was 70.2 % to obtain at least 85 % quadriceps strength index 6 months after surgery.

Conclusion

To achieve sufficient quadriceps strength recovery at the timing of return to sports activities following ACL reconstruction using a hamstring tendon autograft, preoperative quadriceps strength, age, sex, and knee pain should be considered.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

ROC:

Receiver operating curve

OR:

Odds ratio

CI:

Confidence interval

BPTB:

Bone–patellar-tendon–bone

SB:

Single-bundle

DB:

Double-bundle

AMB:

Anteromedial bundle

PMB:

Posterolateral bundle

GR group:

Good quadriceps strength recovery group

PR group:

Poor quadriceps strength recovery group

AUC:

Area under the curve

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Acknowledgments

We thank the staff of Kobe University Hospital for supporting the authors.

Authors’ contribution

Y. U was involved in the conception and design of the study, the acquisition, analysis and interpretation of the data, and writing the article. T. Matsushita was involved in the conception and design of the study, development of the research, and writing the article. D. A, Y. Shibata, and R. O were involved in the conception and design of the study. A. K, K. Takiguchi, Y. Shibata, and K. O were involved in the acquisition of the data. All of the authors were involved in the critical revisions of the article for its important intellectual content, and they all approved the final version of the article.

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Authors and Affiliations

  1. Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan

    Yuya Ueda, Akihiro Kida, Kohei Takiguchi & Yohei Shibata

  2. Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan

    Yuya Ueda, Kumiko Ono & Rei Ono

  3. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Takehiko Matsushita, Daisuke Araki, Tomoyuki Matsumoto, Koji Takayama, Masahiro Kurosaka & Ryosuke Kuroda

  4. Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshitada Sakai

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  1. Yuya Ueda
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Corresponding author

Correspondence to Takehiko Matsushita.

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The all authors declare that they have no conflict of interest associated with this study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required

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Informed consent was obtained from all individual participants included in the study.

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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 25, 3213–3219 (2017). https://doi.org/10.1007/s00167-016-4296-6

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  • DOI: https://doi.org/10.1007/s00167-016-4296-6

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