Relationship Between Quadriceps Strength at 6 Months Postoperatively and Improvement in Patient-Reported Knee Function After Anterior Cruciate Ligament Reconstruction

Overview

Journal Orthop J Sports Med

Date 2025 Jan 27

PMID 39866956

Authors

Tomoya Ishida

Makoto Suzuki

Hisashi Matsumoto

Mina Samukawa

Satoru Kaneko

Chiharu Inoue

Yoshimitsu Aoki

Harukazu Tohyama

Affiliations

Soon will be listed here.

Abstract

Background: Understanding the factors associated with poor recovery over time after anterior cruciate ligament reconstruction (ACLR) helps clinicians identify patients who are at risk and targets for an intervention.

Purpose: To determine the factors associated with improvement in subjective knee function from 6 to 12 months after ACLR.

Study Design: Case-control study; Level of evidence, 3.

Methods: A total of 91 patients undergoing primary unilateral ACLR were included. Subjective knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at 6 and 12 months postoperatively. Isokinetic knee strength (quadriceps and hamstring) and Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale scores were also assessed. Patients were included in the poor recovery group if their improvement in the IKDC-SKF score from 6 to 12 months was <15.5 points (minimal detectable change) and their IKDC-SKF score at 12 months was <90 points (maximum, 100 points). The IKDC-SKF score, knee strength, and the ACL-RSI score were compared between the poor recovery and good recovery groups with and without propensity score matching. Matched variables included age, sex, and IKDC-SKF score at 6 months after ACLR. In addition, logistic regression analysis was performed to identify factors that discriminated between the poor recovery and good recovery groups.

Results: There were 32 participants (35%) allocated to the poor recovery group. Before propensity score matching, the poor recovery group had a significantly older age, lower IKDC-SKF scores at 6 and 12 months, and a lower limb symmetry index (LSI) for quadriceps strength at 6 months. After propensity score matching, the LSI for quadriceps strength at 6 months was significantly different between the poor recovery and good recovery groups (73.0 ± 17.4 vs 83.3 ± 18.2, respectively; = .039). Logistic regression analysis showed that a lower LSI for quadriceps strength at 6 months was significantly associated with poor recovery of the IKDC-SKF score (odds ratio, 0.96 [95% CI, 0.93-0.98]), and receiver operating characteristic curve analysis identified 80.9% as a cutoff value of the LSI for quadriceps strength with 75.0% sensitivity and 61.0% specificity.

Conclusion: A lower LSI for quadriceps strength at 6 months postoperatively was associated with poor recovery of the IKDC-SKF score from 6 to 12 months after ACLR, even after adjusting for confounders.

References

Harput G, Ozer H, Baltaci G, Richards J . Self-reported outcomes are associated with knee strength and functional symmetry in individuals who have undergone anterior cruciate ligament reconstruction with hamstring tendon autograft. Knee. 2018; 25(5):757-764. DOI: 10.1016/j.knee.2018.06.007. View

Ishida T, Samukawa M, Suzuki M, Matsumoto H, Ito Y, Sakashita M . Improvements in asymmetry in knee flexion motion during landing are associated with the postoperative period and quadriceps strength after anterior cruciate ligament reconstruction. Res Sports Med. 2021; 31(3):285-295. DOI: 10.1080/15438627.2021.1966010. View

Lentz T, Tillman S, Indelicato P, Moser M, George S, Chmielewski T . Factors associated with function after anterior cruciate ligament reconstruction. Sports Health. 2012; 1(1):47-53. PMC: 3445122. DOI: 10.1177/1941738108326700. View

Krosshaug T, Steffen K, Kristianslund E, Nilstad A, Mok K, Myklebust G . The Vertical Drop Jump Is a Poor Screening Test for ACL Injuries in Female Elite Soccer and Handball Players: A Prospective Cohort Study of 710 Athletes. Am J Sports Med. 2016; 44(4):874-83. DOI: 10.1177/0363546515625048. View

Muller B, Yabroudi M, Lynch A, Lai C, van Dijk C, Fu F . Defining Thresholds for the Patient Acceptable Symptom State for the IKDC Subjective Knee Form and KOOS for Patients Who Underwent ACL Reconstruction. Am J Sports Med. 2016; 44(11):2820-2826. DOI: 10.1177/0363546516652888. View

Ithurburn M, Thomas S, Paterno M, Schmitt L . Young athletes after ACL reconstruction with asymmetric quadriceps strength at the time of return-to-sport clearance demonstrate drop-landing asymmetries two years later. Knee. 2021; 29:520-529. PMC: 8127385. DOI: 10.1016/j.knee.2021.02.036. View

Lepley A, Pietrosimone B, Cormier M . Quadriceps Function, Knee Pain, and Self-Reported Outcomes in Patients With Anterior Cruciate Ligament Reconstruction. J Athl Train. 2018; 53(4):337-346. PMC: 5967275. DOI: 10.4085/1062-6050-245-16. View

Stropnik D, Sajovic M, Kacin A, Pavlic-Zaloznik S, Drobnic M . Early clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg. 2020; 140(9):1231-1239. DOI: 10.1007/s00402-020-03436-0. View

OConnor R, King E, Richter C, Webster K, Falvey E . No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2019; 48(1):78-84. DOI: 10.1177/0363546519887952. View

10.

Pedersen M, Grindem H, Berg B, Engebretsen L, Axe M, Snyder-Mackler L . Four Distinct 5-Year Trajectories of Knee Function Emerge in Patients Who Followed the Delaware-Oslo ACL Cohort Treatment Algorithm. Am J Sports Med. 2022; 50(11):2944-2952. PMC: 9442772. DOI: 10.1177/03635465221116313. View

11.

Pietrosimone B, Lepley A, Harkey M, Luc-Harkey B, Troy Blackburn J, Gribble P . Quadriceps Strength Predicts Self-reported Function Post-ACL Reconstruction. Med Sci Sports Exerc. 2016; 48(9):1671-7. DOI: 10.1249/MSS.0000000000000946. View

12.

Kostyun R, Burland J, Kostyun K, Milewski M, Nissen C . Male and Female Adolescent Athletes' Readiness to Return to Sport After Anterior Cruciate Ligament Injury and Reconstruction. Clin J Sport Med. 2019; 31(4):383-387. DOI: 10.1097/JSM.0000000000000751. View

13.

Suzuki M, Ishida T, Matsumoto H, Kaneko S, Inoue C, Aoki Y . Psychological readiness at 9 months after anterior cruciate ligament reconstruction -which factors affect?. Phys Ther Sport. 2022; 58:74-79. DOI: 10.1016/j.ptsp.2022.09.007. View

14.

Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H . Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy. 2004; 20(10):1015-25. DOI: 10.1016/j.arthro.2004.08.010. View

15.

Yasuda K, Kondo E, Kitamura N, Kawaguchi Y, Kai S, Tanabe Y . A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. Arthroscopy. 2011; 28(3):343-53. DOI: 10.1016/j.arthro.2011.08.305. View

16.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P . Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001; 29(5):600-13. DOI: 10.1177/03635465010290051301. View

17.

Webster K, Nagelli C, Hewett T, Feller J . Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med. 2018; 46(7):1545-1550. PMC: 6598700. DOI: 10.1177/0363546518773757. View

18.

Schmitt L, Paterno M, Ford K, Myer G, Hewett T . Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc. 2014; 47(7):1426-34. PMC: 4418954. DOI: 10.1249/MSS.0000000000000560. View

19.

Greco N, Anderson A, Mann B, Cole B, Farr J, Nissen C . Responsiveness of the International Knee Documentation Committee Subjective Knee Form in comparison to the Western Ontario and McMaster Universities Osteoarthritis Index, modified Cincinnati Knee Rating System, and Short Form 36 in patients with.... Am J Sports Med. 2010; 38(5):891-902. DOI: 10.1177/0363546509354163. View

20.

Bodkin S, Rutherford M, Diduch D, Brockmeier S, Hart J . How Much Time Is Needed Between Serial "Return to Play" Assessments to Achieve Clinically Important Strength Gains in Patients Recovering From Anterior Cruciate Ligament Reconstruction?. Am J Sports Med. 2019; 48(1):70-77. DOI: 10.1177/0363546519886291. View