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Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation


Riccardo Cristiani, MD, PhD
SWEDEN

Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation

Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN

Capio Artro Clinic, Stockholm Sports Trauma Research Center, Karolinska Institute, FIFA Medical Centre of Excellence, Stockholm, SWEDEN

2021 Congress   Abstract Presentation   6 minutes   Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments Muscle

Ligaments

ACL

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Summary: Asymmetries in muscle strength and hop performance are persistent even 24 months after ACLR performed with either of the 2 grafts. Rehabilitation protocols should be implemented and more time needs to be spent on muscle strength rehabilitation. The choice between BPTB and HT grafts strongly affects the pattern of recovery of muscle strength.

Background

The most commonly used autografts for anterior cruciate ligament (ACLR) are the hamstring tendons (HT) and the bone-patellar tendon-bone (BPTB). However, questions remain about how patients with either an HT or a BPTB autograft recover knee muscle strength postoperatively. Contrasting results have been reported in randomized studies comparing the two autografts at postoperative follow-ups ranging from 3 to 24 months after ACLR. Moreover, there is a lack of studies comparing the effects on the recovery of muscle strength and hop performance of an accelerated or a standard rehabilitation protocol for both autografts at several follow-ups after ACLR.

Purpose

To evaluate and compare changes in quadriceps and hamstring strength and single-leg-hop (SLH) test performance over the first 24 postoperative months in patients who underwent ACLR with BPTB or HT autografts and followed either a standard or an accelerated rehabilitation protocol.

Methods

A total of 160 patients undergoing ACLR were randomized in 4 groups depending on the graft that was used and the rehabilitation protocol (40 BPTB/standard rehab, 40 BPTB/accelerated rehab, 40 HT/standard rehab, 40 HT/accelerated rehab). Isokinetic concentric quadriceps and hamstring strength at 90°/s and the SLH test performance were assessed preoperatively and 4,6,8,12 and 24 months postoperatively. The results were reported as the limb symmetry index (LSI) at the same time point. Linear mixed models were used to compare the groups at the different time points throughout the follow-up.

Results

An average quadriceps strength LSI of 78.4% was found preoperatively. After ACLR, the LSI first decreased at 4 months and then increased from 6 to 24 months, reaching an overall value of 92.7% at the latest follow-up. The BPTB group showed a significantly decreased LSI at 4, 6, 8 and 12 months compared with the HT group. No significant differences between the graft groups were found at 24 months.
An average hamstring strength LSI of 84.6% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months in the BTPB group. In the HT group, the LSI first decreased at 4 months and then increased from 6 to 24 months. An LSI of 97.1% and 89.1% was found at the latest follow-up for the BPTB and the HT group respectively. The HT group showed a significantly decreased LSI at all follow-ups (4, 6, 8, 12 and 24 months) compared with the BPTB group.
An average SLH test LSI of 81.0% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months, reaching 97.6% overall at the latest follow-up. The BPTB group showed a significantly decreased LSI at 4 months postoperatively compared with the HT group. No significant differences between the graft groups were found at the other time points.
No significant differences in any of the three tests were found between the standard and accelerated rehabilitation groups for either of the graft groups at any time point.

Conclusion

Muscle strength and SLH test performance recovered progressively after ACLR overall, but they did not all fully recover, as the injured leg performed on average less than 100% compared with the uninjured leg even 24 months postoperatively. After ACLR, inferior quadriceps strength and a poorer SLH test performance were found at 4 , 6, 8 and 12 months and at 4 months respectively for the BTPB group compared with the HT group. Persistent, inferior hamstring strength was found at all postoperative follow-ups in the HT group. Rehabilitation, standard or accelerated, had no significant impact on the recovery of muscle strength and SLH test performance after ACLR in any of the graft groups.

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