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Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery. Twenty subjects with PT and 16 subjects with HT grafts (mean age at follow up 30 years, range 20–39, 25% women), who were all included in a prospective study and followed the same goal-based rehabilitation protocol for at least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2–5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100) value, were used for comparisons between the groups (analysis of variance). The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power (–21.3 vs. 7.7 W, p = 0.001). Patients with HT graft had lower H:Q ratio in the injured leg than the patients with PT graft (0.63 vs. 0.77, p = 0.012). They also had lower LSI for knee flexion power than those in the PT group (88 vs. 106%, p < 0.001). No differences were found between the groups for knee extension power. The lower hamstring muscle power, and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years (range 2–5) after ACL reconstruction, reflect imbalance of knee muscles after reconstruction with HT graft that may have a negative effect on dynamic knee-joint stabilization.

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References

  1. Ageberg E (2002) Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation-using the anterior cruciate ligament-injured knee as model. J Electromyogr Kinesiol 12:205–212

    Article  PubMed  Google Scholar 

  2. Ageberg E, Thomeé R, Neeter C, Grävare Silbernagel K, Roos E (2008) Muscle strength and functional performance in patients with ACL injury treated with training and surgical reconstruction or training only: a 2 to 5-year follow-up. Arthritis Care Res Accepted for publication

  3. Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, Renstrom P (2002) Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 84-A:1503–1513

    PubMed  Google Scholar 

  4. Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. Br Med J 332:995–1001

    Article  Google Scholar 

  5. Dauty M, Tortellier L, Rochcongar P (2005) Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature. Int J Sports Med 26:599–606

    Article  PubMed  CAS  Google Scholar 

  6. Eriksson E (2008) Does harvesting the hamstrings for ACL reconstruction impair the muscular function of the knee joint? Knee Surg Sports Traumatol Arthrosc 16:1

    Article  PubMed  Google Scholar 

  7. Frobell RB, Lohmander LS, Roos EM (2007) The challenge of recruiting patients with anterior cruciate ligament injury of the knee into a randomized clinical trial comparing surgical and non-surgical treatment. Contemp Clin Trials 28:295–302

    Article  PubMed  Google Scholar 

  8. Gobbi A, Domzalski M, Pascual J (2004) Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts. Knee Surg Sports Traumatol Arthrosc 12:534–539

    Article  PubMed  Google Scholar 

  9. Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, Dick RW, Engebretsen L, Garrett WE Jr, Hannafin JA, Hewett TE, Huston LJ, Ireland ML, Johnson RJ, Lephart S, Mandelbaum BR, Mann BJ, Marks PH, Marshall SW, Myklebust G, Noyes FR, Powers C, Shields C Jr, Shultz SJ, Silvers H, Slauterbeck J, Taylor DC, Teitz CC, Wojtys EM, Yu B (2006) Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med 34:1512–1532

    Article  PubMed  Google Scholar 

  10. Herrington L, Wrapson C, Matthews M, Matthews H (2005) Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee 12:41–50

    Article  PubMed  Google Scholar 

  11. Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2004) Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects. Clin J Sport Med 14:274–280

    Article  PubMed  Google Scholar 

  12. Holcomb WR, Rubley MD, Lee HJ, Guadagnoli MA (2007) Effect of hamstring-emphasized resistance training on hamstring:quadriceps strength ratios. J Strength Cond Res 21:41–47

    Article  PubMed  Google Scholar 

  13. Ikeda H, Kurosawa H, Takazawa S, Kim S-G, Nakagawa T, Nozawa M, Takazawa Y (2004) Comparison of gender distinction in postoperative stability after anterior cruciate ligament reconstruction using multiple-looped semitendinosus tendon. Eur J Orthop Surg Traumatol 14:112–115

    Article  Google Scholar 

  14. Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft. Am J Sports Med 35:729–739

    Article  PubMed  Google Scholar 

  15. Kim SG, Kurosawa H, Sakuraba K, Ikeda H, Takazawa S, Seto H, Ishijima M (2005) Analysis of the risk factors regarding anterior cruciate ligament reconstruction using multiple-looped semitendinosus tendon. Knee 12:366–369

    Article  PubMed  Google Scholar 

  16. Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, Fleck SJ, Franklin B, Fry AC, Hoffman JR, Newton RU, Potteiger J, Stone MH, Ratamess NA, Triplett-McBride T (2002) American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 34:364–380

    Article  PubMed  Google Scholar 

  17. Li RC, Maffulli N, Hsu YC, Chan KM (1996) Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. Br J Sports Med 30:161–164

    Article  PubMed  CAS  Google Scholar 

  18. Moisala AS, Jarvela T, Kannus P, Jarvinen M (2007) Muscle strength evaluations after ACL reconstruction. Int J Sports Med 28:868–872

    Article  PubMed  Google Scholar 

  19. Neeter C, Gustavsson A, Thomee P, Augustsson J, Thomee R, Karlsson J (2006) Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 14:571–580

    Article  PubMed  Google Scholar 

  20. Noojin FK, Barrett GR, Hartzog CW, Nash CR (2000) Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 28:783–789

    PubMed  CAS  Google Scholar 

  21. Pincivero DM, Lephart SM, Karunakara RG (1997) Relation between open and closed kinematic chain assessment of knee strength and functional performance. Clin J Sport Med 7:11–16

    Article  PubMed  CAS  Google Scholar 

  22. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  23. Risberg M, Lewek M, Snyder-Mackler L (2004) A systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type? Phys Ther Sports 5:125–145

    Article  Google Scholar 

  24. Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS)—validation of a Swedish version. Scand J Med Sci Sports 8:439–448

    PubMed  CAS  Google Scholar 

  25. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    PubMed  CAS  Google Scholar 

  26. Segawa H, Omori G, Koga Y, Kameo T, Iida S, Tanaka M (2002) Rotational muscle strength of the limb after anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon. Arthroscopy 18:177–182

    Article  PubMed  Google Scholar 

  27. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone–tendon–bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    Article  PubMed  Google Scholar 

  28. Stergiou N, Ristanis S, Moraiti C, Georgoulis AD (2007) Tibial rotation in anterior cruciate ligament (ACL)-deficient and ACL-reconstructed knees: a theoretical proposition for the development of osteoarthritis. Sports Med 37:601–613

    Article  PubMed  Google Scholar 

  29. Torry MR, Decker MJ, Jockel JR, Viola R, Sterett WI, Steadman JR (2004) Comparison of tibial rotation strength in patients’ status after anterior cruciate ligament reconstruction with hamstring versus patellar tendon autografts. Clin J Sport Med 14:325–331

    Article  PubMed  Google Scholar 

  30. Tsepis E, Vagenas G, Giakas G, Georgoulis A (2004) Hamstring weakness as an indicator of poor knee function in deficient patients. Knee Surg Sports Traumatol Arthrosc 12:22–29

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by the Swedish National Centre for Research in Sports, the Swedish Research Council, the Swedish Rheumatism Association, Region Skåne, and the Faculty of Medicine, Lund University. The original KANON study, from which the patients were included, was in addition financially supported by Pfizer Global Research, Thelma Zoegas Fund, the Swedish National Centre for Research in Sports, Stig & Ragna Gorthon Research fund.

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Authors and Affiliations

  1. Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund University Hospital, 221 85, Lund, Sweden

    Eva Ageberg, Harald P. Roos & Ewa M. Roos

  2. Lundberg Laboratory of Orthopaedic Research, Department of Orthopaedics, Göteborg University, Göteborg, Sweden

    Karin Grävare Silbernagel & Roland Thomeé

  3. Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Ewa M. Roos

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  1. Eva Ageberg
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Correspondence to Eva Ageberg.

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Ageberg, E., Roos, H.P., Silbernagel, K.G. et al. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17, 162–169 (2009). https://doi.org/10.1007/s00167-008-0645-4

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