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. 2020 Oct 30;12(1):68.
doi: 10.1186/s13102-020-00215-7.

Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft

J Riesterer  1 , M Mauch  1 , J Paul  1 , D Gehring  2 , R Ritzmann  1 , M Wenning  3   4   5
Affiliations

Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft

J Riesterer et al. BMC Sports Sci Med Rehabil. .

Abstract

Background: Anterior cruciate ligament (ACL) ruptures are of major concern in sports. As mostly young and active individuals are affected there is an emphasis on the rapid and safe return to sports (RTS). Strengthening the ventral and dorsal thigh muscles is a prerequisite for a successful RTS after ACL reconstruction (ACLR), as persistent muscle weakness may increase the incidence for secondary injuries and impair performance. Aiming to increase evidence on the importance of preoperative muscle strength and the coaching of patients, the purpose of this study is to compare thigh muscle strength pre- and post-operatively after ACLR.

Methods: We performed a retrospective analysis of 80 patients with primary, isolated ACLR using a four-stranded hamstring autograft. We performed bilateral isokinetic concentric strength measurement (60°/s) before and six months after ACLR. Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q ratio) and the corresponding limb symmetry indices (LSI). Pearson correlations were calculated for pre- and post-surgical values.

Results: The operated as well as the unaffected leg increased maximal knee extension (+ 18% ± 7% p < 0.05; + 11% ± 5% p < 0.05) and flexion torque (+ 9% ± 5% p < 0.05, + 10% ± 6% p < 0.05) throughout the 6 months of rehabilitation. The H/Q ratio remained unaffected (- 2% ± 3% p = 0.93; - 4% ± 4% p = 0.27). LSI of knee extension strength increased significantly (6% ± 3% p < 0.05), while flexion strength remained unaffected (+ 2% ± 4% p = 0.27). Positive correlations underline the interrelationship between the strength pre- and post-surgery for the knee extension (r = 0.788 p < 0.05) and knee flexion strength (r = 0.637 p < 0.05) after ACLR.

Conclusions: Preoperative leg extension and flexion strength normalized to body mass are strongly correlated to postoperative strength performance after ACLR. Therefore, pre-operative quadriceps and hamstring muscle strength deficits may have a significant negative impact on functional performance following ACLR. This emphasizes the need for intensive preoperative screening and subsequent treatment to achieve the best possible preoperative leg strength before ACLR.

Trial registration: DRKS00020210 .

Keywords: ACL reconstruction; Isokinetic strength measurements; Pre-habilitation; Return to sport.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart diagram – description of the study population, inclusion and exclusion criteria
Fig. 2
Fig. 2
Isokinetic strength measurements of the knee extensors and flexors. a Body position, axis of rotation and the amplitude of the active ROM for both movement directions established in a concentric test setting. b Knee extension and c knee flexion joint torque with reference to the knee angle displayed for the ACL injured and not injured leg pre (−---) and post (− − - -) surgery of one subject of the random sample
Fig. 3
Fig. 3
Descriptive distribution of pre- and postoperative LSI
Fig. 4
Fig. 4
The graph illustrates the scatter plot, regression line and regression equation for the relationship between the dependent variables maximal isokinetic knee extension (left) and flexion torques (right) normalized to body mass of the injured leg obtained before (abscissa) and after (ordinate) ACL reconstruction. R2 linear is the coefficient of determination; the fitted regression line is described by the equitation y
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