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Int J Sports Med 2007; 28(10): 868-872
DOI: 10.1055/s-2007-964912
Orthopedics & Biomechanics

© Georg Thieme Verlag KG Stuttgart · New York

Muscle Strength Evaluations after ACL Reconstruction

A.-S. Moisala1 , T. Järvelä2 , P. Kannus3 , M. Järvinen4
  • 1Medical School, Tampere University, Tampere, Finland
  • 2Department of Orthopaedics and Traumatology, Hatanpää Hospital, Tampere, Finland
  • 3UKK Institute, Accident and Trauma Research Center, Tampere University, Tampere, Finland
  • 4Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
Further Information

Publication History

accepted after revision August 25, 2006

Publication Date:
15 March 2007 (online)

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Abstract

The quadriceps and hamstring muscle strengths of 16 patients operated using a bone-patellar tendon-bone (BTB) autograft and 32 patients operated using a quadruple hamstring autograft for an arthroscopic anterior cruciate ligament (ACL) reconstruction were analyzed 4- to 7-years postoperatively. Standardized isokinetic testing, a clinical evaluation and instrumented assessment of knee laxity were done. The findings showed no significant strength deficits between the patients in the BTB and Hamstring groups and the deficits were, in general, small. The quadriceps and hamstring muscle strengths were better in patients with a longer than shorter follow-up and stable knees had less knee flexion torque deficit than unstable knees. Strength deficit was associated with lower Lysholm knee scores. The findings of this study showed that the muscle strengths of the operated limb had a positive association with the functional outcome of the knee in the long-term and support the use of active rehabilitation after ACL reconstruction.

Key words

ACL - BTB - hamstring - extension torque - flexion torque - HQ ratio

References

  • 1 Anderson J L, Lamb S E, Barker K L, Davies S, Dodd C A, Beard D J. Changes in muscle torque following anterior cruciate ligament reconstruction: a comparison between hamstrings and patella tendon graft procedures on 45 patients.  Acta Orthop Scand. 2002;  73 546-552
    Search in Google Scholar
  • 2 Aune A K, Holm I, Risberg M A, Jensen H K, 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;  29 722-728
    CrossrefPubMedSearch in Google Scholar
  • 3 Coombs R, Cochrane T. Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons.  Int J Sports Med. 2001;  22 618-622
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Eriksson K, Hamberg P, Jansson E, Larsson H, Shalabi A, Wredmark T. Semitendinosus muscle in anterior cruciate ligament surgery: Morphology and function.  Arthroscopy. 2001;  17 808-817
    PubMedSearch in Google Scholar
  • 5 Giove T P, Miller 3rd S J. Non-operative treatment of the torn anterior cruciate ligament.  J Bone Joint Surg Am. 1983;  65 184-192
    PubMedSearch in Google Scholar
  • 6 Gobbi A, Domzalski M, Pascual J, Zanazzo M. Hamstring anterior cruciate ligament reconstruction: Is it necessary to sacrifice the gracilis?.  Arthroscopy. 2005;  21 275-280
    CrossrefPubMedSearch in Google Scholar
  • 7 Hewett T E, Myer G D, Ford K R. Prevention of anterior cruciate ligament injuries.  Curr Womens Health Rep. 2001;  1 218-224
    PubMedSearch in Google Scholar
  • 8 Jarvela T, Kannus P, Latvala K, Jarvinen M. Simple measurements in assessing muscle performance after an ACL reconstruction.  Int J Sports Med. 2002;  23 196-201
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Kannus P, Järvinen M, Latvala K. Knee strength evaluations.  Scand J Sport Med. 1987;  9 9-13
    PubMedSearch in Google Scholar
  • 10 Kannus P. Ratio of hamstring to quadriceps femoris muscles' strength in the anterior cruciate ligament insufficient knee. Relationship to long-term recovery.  Phys Ther. 1988;  68 961-965
    PubMedSearch in Google Scholar
  • 11 Kim S G, Kurosawa H, Sakuraba K, Ikeda H, Takazawa S, Seto H, Ishijima M. Analysis of the risk factors regarding anterior cruciate ligament reconstruction using multiple-looped semitendinosus tendon.  Knee. 2005;  12 366-369
    CrossrefPubMedSearch in Google Scholar
  • 12 Kobayashi A, Higuchi H, Terauchi M, Kobayashi F, Kimura M, Takagishi K. Muscle performance after anterior cruciate ligament reconstruction.  Int Orthop. 2004;  28 48-51
    CrossrefPubMedSearch in Google Scholar
  • 13 Lephart S M, Kocher M S, Harner C D, Fu F H. Quadriceps strength and functional capacity after anterior cruciate ligament reconstruction. Patellar tendon autograft versus allograft.  Am J Sports Med. 1993;  21 738-743
    PubMedSearch in Google Scholar
  • 14 Li R C, Maffulli N, Hsu Y C, Chan K M. Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes.  Br J Sports Med. 1996;  30 161-164
    PubMedSearch in Google Scholar
  • 15 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.  Am J Sports Med. 1982;  10 150-154
    CrossrefPubMedSearch in Google Scholar
  • 16 Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K. Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction.  Scand J Med Sci Sports. 1998;  8 283-289
    PubMedSearch in Google Scholar
  • 17 Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K. Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons.  Arthroscopy. 2002;  18 598-602
    PubMedSearch in Google Scholar
  • 18 Natri A, Jarvinen M, Latvala K, Kannus P. Isokinetic muscle performance after anterior cruciate ligament surgery. Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction.  Int J Sports Med. 1996;  17 223-228
    PubMedSearch in Google Scholar
  • 19 Pinczewski L A, Deehan D J, Salmon L J, Russell V J, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament.  Am J Sports Med. 2002;  30 523-536
    PubMedSearch in Google Scholar
  • 20 Seto J L, Orofino A S, Morrissey M C, Medeiros J M, Mason W J. Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction.  Am J Sports Med. 1988;  16 170-180
    CrossrefPubMedSearch in Google Scholar
  • 21 Solomonow M, Baratta R, Zhou B H, Shoji H, Bose W, Beck C, D'Ambrosia R. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability.  Am J Sports Med. 1987;  15 207-213
    CrossrefPubMedSearch in Google Scholar
  • 22 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries.  Clin Orthop Relat Res. 1985;  198 43-49
    PubMedSearch in Google Scholar
  • 23 Tegner Y, Lysholm J, Lysholm M, Gillquist J. A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries.  Am J Sports Med. 1986;  14 156-159
    CrossrefPubMedSearch in Google Scholar
  • 24 Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K. Graft site morbidity with autogenous semitendinosus and gracilis tendons.  Am J Sports Med. 1995;  23 706-714
    PubMedSearch in Google Scholar
  • 25 Zhang L Q, Nuber G W, Bowen M K, Koh J L, Butler J P. Multiaxis muscle strength in ACL deficient and reconstructed knees: compensatory mechanism.  Med Sci Sports Exerc. 2002;  34 2-8
    PubMedSearch in Google Scholar

MD Anna-Stina Moisala

Tampere University
Medical School

Teiskontie 35

33014 University of Tampere

Finland

Email: anna-stina.moisala@uta.fi