Recommendations for Hamstring Function Recovery After ACL Reconstruction

Abstract

It is important to optimise the functional recovery process in order to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor strength after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR. Key Points• A knee flexor strength deficit after ACL reconstruction is a strong risk factor for ACL re-injury • Overcoming deficits in hamstring function after ACL reconstruction is essential for optimal outcomes, satisfactory return to sport and re-injury risk reduction • Most of the information concerning the hamstrings is devoted to hamstring injury prevention and hamstring muscle injury rehabilitation, with a lack of information on hamstring rehabilitation after ACL reconstruction • Most training recommendations are focused on un-injured athletes and so needs to be adapted for the injured athlete • Understanding hamstring training considerations and applying this to the ACL reconstruction patient as part of the ACL functional recovery process is essential

Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction

“…Previous studies have emphasized the importance of hamstring muscle function recovery in patients who underwent ACLR, as it is associated with the occurrence of knee osteoarthritis and reinjury upon returning to sports. 5 Our results emphasize the role of quadriceps and hamstring muscle strength in achieving better subjective outcomes in patients undergoing ACLR.…”

Bilateral Alterations in Isokinetic Strength and Knee Biomechanics During Side-Cutting 1 Year After Unilateral ACL Reconstruction

“…In addition, previous studies have shown that the reconstructed leg demonstrates lower strength than the contralateral leg, emphasizing the importance of quadriceps and hamstring strength for knee movement control and functional performance. 2,3,27,37 Quadriceps symmetry has also been used as a prerequisite for a successful return to sports after ACLR. 8 These studies used the contralateral leg as a reference and did not analyze whether the contralateral muscle strength was normal.…”

Finding the needle in the haystack of isokinetic knee data: Random Forest modelling improves return-to-sport information

“…Thus, a focus should be put on improving hamstring strength in the rehabilitation process post ACL reconstruction which is in line with current approaches. [37] In addition, hamstring muscle loading has been demonstrated to reduce loading of the ACL. [38][39][40] For the male athletes, six out of the ten most impactful features are differences between advantageous and disadvantageous leg including both quadriceps and hamstrings.…”