Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 12;13(5):23259671251334143.
doi: 10.1177/23259671251334143. eCollection 2025 May.

Isokinetic Knee Strength and Patient-Reported Outcomes Differ Between Graft Types in Adolescents After Anterior Cruciate Ligament Reconstruction: A Multicenter Study

Adam P Weaver  1 , Christopher M Kuenze  2 , Dylan Roman  1 , Nicholas Giampetruzzi  1 , Meredith Link  3 , Alexa Martinez  4 , Kylee Rucinski  5 , Natalie Kupperman  2 , Lucy Phan  6 , Victor V Prati  6 , Cody Walker  6 , Taylor Douthit  7 , Dhalston Cage  7 , John Abt  7 , Elliot Greenberg  3 , Theodore Ganley  3 , Stephen LaPlante  7 , Lee Pace  7 , Brooke Farmer  8 , Terry L Grindstaff  8 , Lauren Butler  9 , Edward Chang  10 , Rachel Cherelstein  10 , Corey D Grozier  11 , Matthew Harkey  11 , Arjun Parmar  11 , Jacob Landers  12 , Sophia Ulman  12 , Chelsea Harrison  5 , Steven DeFroda  5 , Richard Ma  5 , Elaine Reiche  13 , Caitlin Brinkman  13 , Tom Birchmeier  13 , Shelby Baez  13 , Joseph M Hart  13 , Michelle Walaszek  2 , Kevin Cross  2 , Xavier Thompson  14   15
Affiliations

Isokinetic Knee Strength and Patient-Reported Outcomes Differ Between Graft Types in Adolescents After Anterior Cruciate Ligament Reconstruction: A Multicenter Study

Adam P Weaver et al. Orthop J Sports Med. .

Abstract

Background: Graft selection can influence strength and patient-reported outcomes (PROs) in adults undergoing anterior cruciate ligament reconstruction (ACLR). Yet, there is a lack of high-quality evidence comparing these results in adolescents.

Purpose/hypothesis: The purpose of this study was to determine differences in quadriceps and hamstring strength and PROs between adolescents with bone-patellar tendon-bone (BPTB), quadriceps tendon (QT), and hamstring tendon (HT) autografts. It was hypothesized that patients with QT and BPTB grafts would have greater impairments in knee extension, patients with HT grafts would have greater impairments in knee flexion, but PROs would be similar between graft types.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 522 adolescents (mean age, 16.8 ± 1.8 years; 55% female) completed isokinetic knee strength testing at 60 deg/s, the International Knee Documentation Committee (IKDC) subjective knee form, the pediatric IKDC (Pedi-IKDC) subjective knee form, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale at 7.8 ± 1.5 months after ACLR. Weight-normalized strength was compared via linear mixed-effects models, and PROs were compared between graft types with the Kruskal-Wallis test.

Results: After controlling for age, sex, time since surgery, and assessment site, patients with BPTB grafts had 10.8% less quadriceps strength in the ACLR limb (P = .05) than patients with QT grafts and 20.4% less quadriceps strength (P < .001) than patients with HT grafts, while patients with HT grafts had 9.6% more quadriceps strength (P = .01) than patients with QT grafts. Patients with BPTB grafts had 3.1% more hamstring strength (P < .01) than patients with QT grafts and 7.0% more hamstring strength (P < .001) than patients with HT grafts. Patients with HT grafts had 10.8% less hamstring strength (P < .01) than patients with QT grafts. Patients with QT grafts had lower IKDC scores (-7.2%; P < .001) than patients with HT grafts and higher KOOS Sports scores (+4.5%; P < .001) than patients with BPTB grafts. Patients with HT grafts had higher IKDC scores (+5.4%; P < .001) and higher KOOS Sports scores (+5.1%; P < .01) than patients with BPTB grafts. There were no differences in ACL-RSI scores (P = .37).

Conclusion: At 6 to 12 months after ACLR, patients with QT or BPTB grafts had worse normalized quadriceps strength but greater hamstring strength than patients with HT grafts. PROs were mixed, with no differences seen in ACL-RSI scores, but patients with HT grafts displayed greater self-reported function and a greater ability to participate in sport.

Keywords: anterior cruciate ligament; functional testing; muscle strength; return to play.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: C.M.K. has received grants from Inova Health System and Nike. E.C. has received consulting fees from Avanos Medical and research support from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the University of Virginia (HSR230335).

Figures

Figure 1.
Figure 1.
Between-group comparison of normalized isokinetic knee extension and knee flexion strength (N·m/kg).
Figure 2.
Figure 2.
Between-group comparison of limb symmetry index (LSI; %) for knee extension and knee flexion strength.
See this image and copyright information in PMC

References

    1. Alderman EM, Breuner CC, Committee on Adolescence. Unique needs of the adolescent. Pediatrics. 2019;144(6):e20193150. - PubMed
    1. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549-1558. - PubMed
    1. Ardern CL, Webster KE, Taylor NF, Feller JA. Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy. 2010;26(4):462-469. - PubMed
    1. Beischer S, Hamrin Senorski E, Thomeé C, Samuelsson K, Thomeé R. How is psychological outcome related to knee function and return to sport among adolescent athletes after anterior cruciate ligament reconstruction? Am J Sports Med. 2019;47(7):1567-1575. - PubMed
    1. Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J. Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med. 2017;45(6):1326-1332. - PubMed

LinkOut - more resources