A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts

Abstract

Background: This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology. Methods: Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used. Results: In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction. Conclusions: The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.

Evaluating the quality of systematic reviews of comparative studies in autograft‐based anterior cruciate ligament reconstruction using the AMSTAR‐2 tool: A systematic umbrella review

“…Of the 2598 studies initially identified from the search strategy, a total of 50 systematic reviews (36 systematic reviews with meta‐analyses, 14 systematic reviews alone) were included in the final quality assessment (Figure 1) [1‐7, 10‐13, 16, 19, 21‐23, 25‐29, 31‐33, 35, 38‐42, 44, 46, 48, 52, 54, 58‐60, 65‐69, 71‐75, 77]. Cohen's κ Scores were 0.73, 0.75 and 0.74 at the title/abstract, full‐text screening and AMSTAR‐2 assessment stages, respectively, indicating substantial agreement at all phases of the review.…”

Quadriceps tendon autograft has similar clinical outcomes when compared to hamstring tendon and bone–patellar tendon–bone autografts for revision ACL reconstruction: a systematic review and meta‐analysis

“…In addition, incidence of post‐operative septic arthritis after RACLR has been found to be lower with QT compared to HT [55]. Previously described extensor mechanism strength deficits associated with QT harvest appear less pronounced than originally thought; and while extensor strength is inferior to HT at 6 months, strength measurements are equivalent at 1 year [23, 29]. While concerns exist regarding a double hit to the extensor mechanism when using a BTB graft followed by a QT graft or vice versa, multiple studies have demonstrated there is no appreciable difference in extension strength with or without a use of a second extensor mechanism graft in RACLR [26, 56].…”

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

“…The goal is to ensure safe return to sport and work, as inadequate strength has been associated with poorer function, altered biomechanics, and an increased risk of further knee injury [ 38 , 116 , 138 ]. Isokinetic strength testing is considered the “gold-standard” for postoperative strength testing, however varied testing protocols limit the comparability of studies [ 43 ]. When comparing different graft options, recent systematic reviews and meta-analyses demonstrate different outcomes [ 56 ].…”