Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing

Abstract

Purpose To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender‐matched healthy control group, subjects who were post‐ACL reconstruction would display impaired active joint position sense, knee extensor and flexor strength symmetry and knee function at 1 year post‐surgery. A secondary hypothesis was that differences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups. Methods Sixty‐seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee flexion. International Knee Documentation Committee (IKDC) subjective score and one‐leg hop test were used to assess the functional status of the patients. Results The JPS detection was different at the 15° target angle between groups (F3.86 = 24.56, p < 0.001). A significantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p < 0.0001). The quadriceps index was lower in patients compared to healthy individuals (p < 0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.). Conclusion Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post‐ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over‐estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group. Level of evidence III.

Alterations in sensorimotor function after ACL reconstruction during active joint position sense testing. A systematic review

“…The physical activity was not consistently described. Three studies reported a Tegner Score [ 20 , 21 , 24 ] and one stated that the participant groups had the same Tegner Score without the actual number [ 23 ]. Two studies included elite athletes [ 17 , 18 ] and one study nonprofessional athletes [ 25 ].…”

“…Three studies did not reported the activity level of the participants [ 7 , 19 , 22 ]. The most reported surgery type was bone patellar tendon bone autograft [ 7 , 18 , 20 – 22 , 25 ], followed by hamstring tendon autograft [ 7 , 18 , 23 – 25 ]. Further, it should be noted that different surgery types in the same or in multiple study populations were reported.…”

“…The JPS test design and results of all included studies are presented in Table 2 . The starting angle of the JPS test was mostly full knee extension (0°) [ 7 , 17 , 18 , 20 , 21 , 23 , 25 ] or 90° knee flexion [ 18 , 19 , 24 ]. One study reported a second starting angle of 60° knee flexion and another study let the angles be self-selected by the participants [ 21 , 22 ].…”

“…Two studies reported two practice trials prior to the testing [ 7 , 20 ] and one study let the participants familiarize themselves with visual feedback during five movements before each measurement trial [ 24 ]. A self-selected movement velocity was described in two studies [ 23 , 24 ], while the rest did not provide details about the movement velocity. Further, one study reported which leg was first examined (if applicable) during the testing [ 24 ].…”

Anterior Cruciate Reconstruction with Quadriceps Autograft using QuadLink Anterior Cruciate Ligament FiberTag TightRope Implant

“…This technique is not without limitations. Guney-Deniz et al 15 demonstrated that a patient who received ACLR with an autograft quadriceps tendon is less likely to correctly identify joint position at 15 of flexion compared to hamstrings or tibialis anterior autografts (P < .0001). When a quadriceps tendon harvest is performed, there is a risk of violating the suprapatellar pouch; however, it should be noted that a disruption of the suprapatellar FiberTag suture is then pierced using the teeth of the GraftClamp.…”