Role of the Triceps Surae Muscles in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Matched Case-Control Study

Abstract

A limited number of studies has investigated the gastrocnemius and soleus in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigated the muscle strength (Nm kg−1 × 100) and reaction time (acceleration time (AT), milliseconds) of thigh and calf muscles in patients undergoing ACLR. Thirty-two patients with ACLR and 32 normal control subjects were included. One year postoperatively, the strength of thigh muscles was significantly reduced after ACLR compared with that of controls (hamstring: 80 ± 31.3 vs. 142 ± 26.4, p < 0.001, quadriceps: 159 ± 63.7 vs. 238 ± 35.3, p < 0.001). However, the strength of calf muscles was not significantly different compared with that of controls (gastrocnemius: 77 ± 22.9 vs. 81 ± 22.5, p = 0.425, soleus: 54 ± 15.9 vs. 47 ± 16.1, p = 0.109). The AT of calf muscles was significantly faster after ACLR than that of controls (gastrocnemius: 26 ± 9.8 vs. 31 ± 9, p = 0.030, soleus: 18 ± 6.7 vs. 22 ± 8.5, p = 0.026). The AT of thigh muscles was significantly elongated after ACLR than that of controls (hamstring: 72 ± 18 vs. 55 ± 12.4, p < 0.001, quadriceps: 63 ± 17.6 vs. 47 ± 17, p < 0.000). The strength of thigh muscles was reduced, and the ATs of thigh muscles were slower one year after ACLR. However, the AT of the triceps surae was faster than that of controls. This may implicate a compensatory mechanism of the triceps surae for the weakness and delayed activation in hamstring and quadriceps muscles.

No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury

“…Isometric testing with a hand-held dynamometer was the most common method of strength assessment (16 studies). The remaining 12 studies measured slow speed concentric strength using computerised isokinetic dynamometers (≤120°/s),13 14 40 43–47 51–57 with 2 also measuring eccentric strength 46 54. Hip external and internal rotation strength were only measured with hand-held dynamometers.…”

“…55 59 60 Outcome measurement was reliably reported with detailed methodology and low risk of bias for all except four studies 50 52 53 58. Ten studies suffered from unclear selection bias 40 42–44 46 47 51 56 57 61. Of the intervention trials included, three out of six had high risk of bias in randomisation methods (sequence generation and concealment), and blinding methods, respectively 40 52 53.…”

“…One study measured ankle eversion and first ray plantarflexion strength (after use of peroneus longus autograft), and found no differences between limbs 58. Five studies measured strength pre-operatively,48 51 55–57 with findings summarised in online supplemental 10.…”

“…No difference was found between ACL and uninjured control groups (ACL n=67, control n=67, 3 studies, online supplemental figure 8.4), or between limbs in ACL-injured groups (n=175, 6 studies, online supplemental figure 8.4). Only one study measured plantarflexion strength in a knee flexed position (in addition to knee extended position included in meta-analysis), 56 finding no difference comparing with uninjured controls, but significantly greater strength (10%) on the ACL limb compared with the contralateral limb.…”

Addition of anterolateral ligament reconstruction to primary anterior cruciate ligament reconstruction could benefit recovery of functional outcomes

“…The LSI value is the ratio of the muscle strength of the opposing limbs and calculated as the mean score for the injured limb divided by the uninjured limb × 100% 36 . A previous study demonstrated that the intergroup differences in quadriceps muscle strength (> 10%) were clinically significant after ACLR 37 . A priori power analysis was calculated using repeated-measures analysis of variance (RM-ANOVA), indicated that a minimum 48 patients (effect size f (V): 0.516, P (η 2 ) = 0.210) would be needed to detect an intergroup difference in quadriceps muscle strength > 10% (α = 0.05, power = 0.8).…”