Symmetries in Muscle Torque and Landing Kinematics Are Associated With Maintenance of Sports Participation at 5 to 10 Years After ACL Reconstruction in Young Men

Abstract

Background: Long-term maintenance of sports participation is important for young men undergoing anterior cruciate ligament (ACL) reconstruction. Identifying biomechanical characteristics in patients who achieve this goal can assist in elaborating rehabilitation programs and in identifying successful recovery, but this has rarely been investigated. Purpose: To test the association between maintenance of sports participation at 5 to 10 years after ACL reconstruction and measures of force production and landing biomechanics in men. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 30 men who underwent isolated ACL reconstruction were examined. At 5- to 10-year follow-up, associations were tested between reported outcomes of sports maintenance and objective biomechanical measures. The biomechanical tests included isokinetic knee torque and lower limb kinetics and kinematics during landing tasks. Measurements for each limb were conducted separately, and side-to-side symmetry indices (SI) were calculated. Subgroups included SI greater than +10% (ie, extreme positive), SI lower than –10% (ie, extreme negative), and SI between –10% and +10% (ie, symmetric). Results: At follow-up, concentric knee torque in the operated limb correlated with Tegner and Marx scores ( r = 0.42-0.47; P ≤ .05). Regarding the SI of knee torque, the highest Tegner, Marx, and KOOS (Knee injury and Osteoarthritis Outcome Score) results were associated with symmetry, as opposed to patients with extreme positive or extreme negative SIs ( P < .05). As for landing kinematics, Tegner score negatively correlated with knee range of motion (ROM) in the operated limb ( r = –0.38; P ≤ .05). With regard to SI, hip and knee ROM correlated with Tegner, IKDC, and KOOS scores ( r = 0.41-0.51; P ≤ .05). Specifically, the highest sports participation levels were associated with achieving symmetric hip and knee ROM but also with extreme positive SIs, as opposed to patients with extreme negative SIs ( P < .03), indicating substantially higher ROM in the uninjured limb as compared with the operated limb. Conclusion: At 5 to 10 years after ACL reconstruction, maintenance of sports participation was associated with symmetric side-to-side concentric knee torque and with producing greater attenuation of hip and knee ROM during the drop jump landing in the operated limb. Therefore, eccentric load programs that can improve attenuation-phase kinematics during landing tasks may be valuable in addition to concentric training and may facilitate enhanced long-term outcomes.

No significant improvement in neuromuscular proprioception and increased reliance on visual compensation 6 months after ACL reconstruction

“…Absolute and side-to-side difference of anteroposterior laxity were recorded using the GnRB device (Genourob, Laval, France), at a force of 200 N [ 7 , 18 ]. Isokinetic testing was performed at 180°/s during 3 repetitions to assess muscle strength deficit at peak torque between the ipsilateral and contralateral leg [ 17 ].…”

Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play

“…Adequate preparation was done at submaximal intensity to familiarize patients, in concentric mode, to gain appreciation of the speeds and verify the patients’ understanding of the exercise. The first test was performed assessing the hamstrings and quadriceps muscle groups both in concentric and eccentric mode at an amplitude of 20°-90° of flexion completing 3 repetitions at 90°/s and 15 repetitions at 240°/s [ 20 ]. Between every test there was a rest period of 90 s. The second test was performed assessing the hamstrings at an amplitude of 90°-20° of flexion completing 3 repetitions at 30°/s in eccentric mode to evaluate recovery of the hamstring tendons.…”

Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft

“…106 However, only 65% of individuals may return to their preinjury level of sports participation, 107 with knee re-injury rates between 20-30% within higher-risk cohorts. [108][109][110] Equally troubling is the unclear association between return-to-activity testing batteries and the subsequent risk of knee re-injury within various cohorts, [111][112][113][114][115][116][117] and although the restoration of limb function on objective performance tests appears to improve return-to-sport rates, [118][119][120] the use of performance testing cut-points as strict, medicallyrequired, return-to-activity criteria remains controversial. 112,[121][122][123] Recent literature has highlighted the importance of shared decision-making after ACLR, 124,125 to which the use of a decision-making framework may improve the return-to-activity decision-making process.…”