Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction

Fischer, Felix; Fink, Christian; Herbst, Elmar; Hoser, Christian; Hepperger, Caroline; Blank, Cornelia; Gföller, Peter

doi:10.1007/s00167-017-4522-x

Cited by 80 publications

(107 citation statements)

References 47 publications

Supporting

Mentioning

103

Contrasting

Order By: Relevance

“…Further results that warrant discussion are the differences in the performance level of patients treated with different grafts. In agreement with previous studies reporting higher hamstrings-to-quadriceps strength ratios, when reconstruction was performed with either QT or patellar tendon as compared to SGT autografts [13][14][15], we found larger knee extensor but lower knee flexor strength deficits in patients with QT autografts. In contrast, performance in the more complex BIA tests was not significantly different between grafts.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, the interpretation of test results is complicated, as the rehabilitation progress may be influenced by graft selection as well as the patients' age, sex, and physical activity level. Although several cross-sectional studies have analyzed thigh muscle strength deficits in patients treated with different grafts [13][14][15], detailed comparisons of physical performance profiles of different populations of patients recovering from ACLR are missing.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Csapo

Pointner²,

Hoser

et al. 2020

Sports

Self Cite

View full text Add to dashboard Cite

Functional tests are used to facilitate return-to-sports decisions after anterior cruciate ligament reconstruction (ACLR). This study presents comprehensive physical fitness test data acquired in highly active patients within the first year after ACLR, for comparison between different grafts, age groups, and sexes. The outcomes from a specific seven-item test battery and isokinetic strength test data were extracted from a patient database. Results were compared to normative data from age-and sex-matched controls and between subgroups of patients. A total of 245 patients (94 women, 23.8 ± 8.4 years, pre-injury Tegner 7.4 ± 1.6) were tested 185 ± 44 days after surgery. In 116 patients (47.3%), one or more test results were classified as "poor" or "very poor" after comparison with normative data, with failures being most frequent during single-leg squat jump and plyometric strength tests. Test failures were more prevalent in adults than in adolescents <19 years (61.4%-62.2% vs. 24.5%, p < 0.001) and in men (61.6% vs. 24.5%, p < 0.001), but no differences were found between grafts. Isokinetic knee extensor strength was lower by 24.1% on the injured side. Six months after ACLR, nearly 50% of highly active patients presented with strength and functional fitness deficits. These deficits are particularly prevalent in older patients and men.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Csapo

Pointner²,

Hoser

et al. 2020

Sports

Self Cite

View full text Add to dashboard Cite

show abstract

“…The mean follow-up time between studies was 27.4 months (ranging from 12 months to 48 months). There was no significant difference between the cohorts in terms of age, sex, concomitant cartilage injuries or other characteristics in most of the studies included with the exception of Fischer et al, 25 in which there was a higher proportion of male patients undergoing reconstruction with HT. The characteristics of the studies and demographic data are described in Table 1.…”

Section: Resultsmentioning

confidence: 80%

“…It is possible to find similar clinical outcome and rate of complications between the two groups, with the advantage of lower donor site morbidity in the QT group. [16][17][18][19][20] Regarding studies comparing HT and QT, data in the literature are scarce, [21][22][23][24][25][26] particularly on comparative studies. The aim of this study is to perform a literature review comparing the clinical outcomes of patients undergoing anterior cruciate ligament reconstruction with QT versus HT.…”

Section: Introductionmentioning

confidence: 99%

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Salas

Oliveira

Lima

et al. 2020

Rev Bras Med Esporte

View full text Add to dashboard Cite

Introduction: Anterior cruciate ligament injury is one of the most prevalent musculoskeletal injuries. Therefore, several surgical techniques and graft types have been described for its reconstruction. Autologous hamstring tendon graft is one of the most frequently used, but use of the quadriceps tendon graft has gained prominence in recent years. Objective: To review the literature to compare the outcomes of patients undergoing anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft versus hamstring tendon (HT) autograft. Methods: A literature review was conducted through PubMed to locate studies (Level of evidence I-III) comparing the outcomes of the QT autograft vs. the HT autograft in patients undergoing primary ACL reconstruction. Patients were assessed on the basis of re-rupture rate, ligament instability, patient-reported outcome scores, previous pain, and isokinetic tests. Results: Six studies were selected according to inclusion criteria. A total of 481 patients were evaluated, 243 in the QT group and 238 in the HT group. The total re-rupture rate was 1.6% (8 of 481), with 6 in the HT group and 2 in the QT group, but with no statistical difference between groups. One study found increased ligament instability in the HT group and another study found greater instability in the QT group, both with statistical significance. Regarding the patient-reported functional scores, only 01 study found statistical difference, with better results in the QT group. There was no difference in previous pain between groups in the selected studies. Regarding the isokinetic test, one study found a difference in flexor force in the HT group (p <0.01), with no difference in extensor force, while another two studies found an increased extensor force deficit in the QT group within up to 01 year of follow-up. The flexor/ extensor muscle strength ratio was higher in the QT group in both studies. Conclusion: ACL reconstruction with QT graft presents re-rupture rates, ligament instability, functional scores and donor site morbidity that are similar to the HT graft, in addition to preserving greater flexor force in proportion to extensor force. Level of evidence: IV; Review study.

show abstract

“…Conversely, the HS autograft group demonstrated significantly diminished knee flexor strength at 2 years postoperative relative to the contralateral lower extremity 11. A similar analysis focused on the differential muscle strength ratio (Hamstring/Quadriceps ratio (H/Q)) observed in the affected lower extremity, as HS weakness in the setting of preserved quadriceps strength may be a risk factor for ACL rupture in females 41. While significant differences between groups were observed in quadriceps strength, those patients with QT autograft ACLR demonstrated higher H/Q ratios, which the authors hypothesised may be protective against graft rerupture in the first year after surgery.…”

Section: Clinical Resultsmentioning

confidence: 99%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

Self Cite

View full text Add to dashboard Cite

Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.

show abstract

Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction

Abstract: III.

Cited by 80 publications

References 47 publications

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Contact Info

Product

Resources

About