Return-to-sport quadriceps strength symmetry impacts 5-year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis

Abstract

Quadriceps femoris strength asymmetry at the time of return to sports participation after anterior cruciate ligament (ACL) reconstruction contributes to worse function and asymmetric landing patterns, but the impact on longitudinal outcomes is not known. This study determined if young athletes after ACL reconstruction with quadriceps femoris strength asymmetry at a return to sports clearance would demonstrate markers of knee cartilage degeneration 5 years later compared to those with symmetric quadriceps femoris strength at return to sports. Participants (n = 27) were enrolled at the time of medical clearance for sports participation (baseline testing) and followed for 5 years. At baseline, quadriceps femoris strength was measured bilaterally and a limb symmetry index was used to divide the cohort into two groups: return to sport clearance with high quadriceps femoris strength (RTS-HQ; limb symmetry index ≥ 90%) and return to sport clearance with low quadriceps femoris strength (RTS-LQ; limb symmetry index < 85%). At 5 years post-baseline, quantitative magnetic resonance imaging (T2 relaxation times (ms): involved knee medial/lateral femoral condyle and tibial plateau) data were collected. Group differences were evaluated with independent samples t tests. At 5 years post-return to sports, the RTS-LQ strength group (n = 14) demonstrated elevated T2 relaxation times at the anterior region of the lateral femoral condyle compared to the RTS-HQ strength group (n = 13). Clinical Significance: Just over 50% of this cohort was cleared for sports participation with involved limb quadriceps femoris strength deficits that may contribute to early markers of knee cartilage degeneration within the subsequent 5 years.

Keywords: ACL reconstruction; MRI; osteoarthritis; quadriceps femoris.

Figure 1.. Representative 3D fast spin-echo image showing subcompartment definition for the lateral femoral condyle and tibia plateau.

The anterior regions (1, 4) are regions above and below the anterior horn of the meniscus, respectively; the posterior regions (3, 6) are regions above and below the posterior horn of the meniscus, respectively; the middle regions (2, 5) are between the anterior and posterior horns of the meniscus, respectively. 1, anterior femoral condyle; 2, middle femoral condyle; 3, posterior femoral condyle; 4, anterior tibial plateau; 5, middle tibial plateau; 6, posterior tibial plateau. Image with permission.