Isokinetic quadriceps symmetry helps in the decision to return to running after anterior cruciate ligament reconstruction

Abstract

Background: After anterior cruciate ligament reconstruction (ACLR), the decision to allow a return to running is empirical, and the post-operative delay is the most-used criterion. The Quadriceps isokinetic-strength Limb Symmetry Index (Quadriceps LSI), with a cutoff of 60%, could be a useful criterion.

Objective: To determine the association between a Quadriceps LSI≥60% and return to running after ACLR.

Methods: Over a 10-year period, we retrospectively included 470 patients who underwent ACLR. Four months after ACLR, participants performed an isokinetic test; quadriceps concentric peak torque was used to calculate the Quadriceps LSI at 60̊/s. With a Quadriceps LSI≥60%, a return to running was suggested. At 6 months after ACLR, participants were clinically evaluated for a return to sport and post-operative middle-term complications. A multivariable predictive model was built to assess the efficiency diagnosis of this cutoff in order to consider cofounding factors. Quadriceps LSI cutoff≥60% was assessed with sensitivity, specificity and the area under the receiver operating characteristic curve (AUC).

Results: According to our decision-making process with the 60% Quadriceps LSI cutoff at 60̊/s, 285 patients were authorized to return to running at 4 months after ACLR and 185 were not, but 21% (n=59) and 24% (n=45), respectively, were not compliant with the recommendation. No iterative autograft rupture or meniscus pathology occurred at 6 months of follow-up. On multivariable logistic regression analysis, a return to running by using the 60% Quadriceps LSI cutoff was associated with undergoing the hamstring strand procedure (odds ratio 2.60, 95% confidence interval [CI] 1.75-3.84; P<0.0001) and the absence of knee complications (1.18, 1.07-1.29; P=0.001) at 4 months. The sensitivity and specificity of the 60% Quadriceps LSI cutoff were 83% and 70%, respectively. The AUC was 0.840 (95% CI 0.803-0.877).

Conclusions: Using the 60% cutoff of the isokinetic Quadriceps LSI at 4 months after ACLR could help in the decision to allow a return to running.

Keywords: Anterior cruciate ligament reconstruction; Isokinetic; Limb symmetry index; Prediction; Quadriceps; Running.