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Observational Study
. 2019 Feb 5;14(2):e0211825.
doi: 10.1371/journal.pone.0211825. eCollection 2019.

Peak torque angle of anterior cruciate ligament-reconstructed knee flexor muscles in patients with semitendinosus and gracilis autograft is shifted towards extension regardless of the postoperative duration of supervised physiotherapy

Aleksandra Królikowska  1 , Paweł Reichert  2 , Andrzej Czamara  1 , Katarzyna Krzemińska  3
Affiliations
Observational Study

Peak torque angle of anterior cruciate ligament-reconstructed knee flexor muscles in patients with semitendinosus and gracilis autograft is shifted towards extension regardless of the postoperative duration of supervised physiotherapy

Aleksandra Królikowska et al. PLoS One. .

Abstract

Background: The observational cohort study investigated whether the flexor muscles peak torque (PT) angle shifting towards extension observed in the involved knee in patients after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STGR) autograft is associated with the postoperative physiotherapy supervision duration.

Methods: From 230 ACL-reconstructed males, we identified patients after ACLR utilizing STGR autograft and divided them into those who completed supervised physiotherapy <6 months (Group I; n = 77) and those who completed supervised physiotherapy ≥6 months (Group II; n = 66). The mean follow-up time was 6.84 ± 1.47 months. The ACL-reconstructed patients were compared to 98 controls (Group III). Bilateral knee flexor muscle PT measurements were performed. The relative PT at 180°/s (RPT), PT angle at 180°/s, and range of motion at 180°/s were analysed. The RPT limb symmetry index (LSI) was calculated. Tests for dependent samples, one-way analysis of variance, post hoc test, and linear Pearson's correlation coefficient (r) calculations were performed.

Results: The shift towards extension was noted when comparing the ACL-reconstructed limb to the uninvolved limb (Group I, p ≤ 0.001; Group II, p ≤ 0.001) and to Group III (p ≤ 0.001), but it was not correlated with physiotherapy supervision duration (r = -0.037, p = 0.662). In ACL-reconstructed patients, there was a moderate association of supervision duration and knee flexor LSI (r = 0.587, p < 0.001).

Conclusions: The ACL-reconstructed knee flexors PT angle shift towards extension was observed regardless of the duration of postoperative physiotherapy supervision. However, the analysis revealed that the duration of supervised physiotherapy positively influenced the RPT and LSI in patients after the ACLR.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Anatomical zero as the starting position for the knee flexor muscle PT measurements.
Fig 2
Fig 2. Maximal flexion of the examined limb as the final position for the knee flexor muscle PT measurements.
Fig 3
Fig 3. The ROM reflected the range of motion through which knee flexor muscle strength was assessed with dynamometer axis set according to the examined knee axis.
The starting position from which the ROM was measured was the position of the extension of zero degrees (no hyperextension).
Fig 4
Fig 4. A significant but small positive correlation indicated that higher involved limb knee flexor muscle relative PT value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) is associated with longer duration of supervised postoperative physiotherapy.
Fig 5
Fig 5. Lack of association of uninvolved limb knee flexor muscle relative PT value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) with duration of supervised postoperative physiotherapy.
Fig 6
Fig 6. Significant positive moderate correlation indicating that higher knee flexor muscle LSI value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) is associated with longer duration of supervised postoperative physiotherapy.
Fig 7
Fig 7. Lack of association of involved limb knee flexor muscle PT angle value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) with duration of supervised postoperative physiotherapy.
Fig 8
Fig 8. Lack of association of uninvolved limb knee flexor muscle PT angle value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) with duration of supervised postoperative physiotherapy.
Fig 9
Fig 9. Lack of association of knee flexor muscle PT angle absolute side-to-side difference value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) with duration of supervised postoperative physiotherapy.
Fig 10
Fig 10. Lack of association of knee flexor muscle ROM absolute side-to-side difference value at 180°/s in ACL-reconstructed patients (Group I and Group II, n = 143) with duration of supervised postoperative physiotherapy.
Fig 11
Fig 11. Knee flexor muscle limb symmetry index distribution among patients in Group I.
Fig 12
Fig 12. Knee flexor muscle limb symmetry index distribution among patients in Group I.
Fig 13
Fig 13. Knee flexor muscle limb symmetry index distribution among participants in Group III.
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