Research paper on acl tear
This study aimed to 1 compare recovery of knee extensor muscle quadriceps and flexor muscle hamstring strength in primary versus revision ACLR surgery, and 2 compare clinical functional and stability outcomes in primary versus revision ACLR surgery.
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There were 80 male participants included in this study. The median laxity was 2. AP laxity between involved and healthy limb was also recorded. For the revision group.
Box-and-whisker plot for anteroposterior laxity in the primary and the revision ACL reconstruction groups. The revision ACLR group had greater instability comparing with primary group. AP anteroposterior. Deficits in knee extensor strength were not significantly different between primary and revision ACL reconstruction groups, showing The knee extensor also showed Moreover, there were no differences in knee flexor strength between primary and revision ACLR groups, showing 9. For primary reconstruction, the median IKDC subject score was For the revision reconstruction group, the median IKDC subject score was The principal findings of this study are patients with revision ACL reconstructed knees had a higher AP translation and a higher percentage of instability than those with primary ACLR surgery.
However, after planned rehabilitation, patients in revision groups can have non-inferior results in the isokinetic knee strength and knee functional outcomes compared to those with primary ACLR surgery. However, it is unclear that whether the poor clinical outcomes are from knee joint instability or other factors such as muscle strength. Gifstad et al. Meanwhile, several studies showed loss of knee flexion strength only 17 , 18 , 19 , 20 or both flexion and extension muscle power in patients with the revision ACLR surgery but not in those with the primary ACLR surgery In the current study, though with higher degrees of joint instability, patients in the revision ACLR group still had similar performance in the knee flexion and extension muscle power, and had similar clinical outcomes when compared with those in the primary ACLR group.
The ideal graft for ACLR surgery remains controversial. Nevertheless, the degree of joint instability is reported to be associated with graft laxity, whereas allografts can theoretically trigger immune responses and show relatively slower postoperative reformation 21 , In contrast, there was no difference in laxity between the revision group and primary group when only autologous hamstring tendon was used as the graft material Accordingly, in this study, we used double-looped semitendinosus and gracilis autografts for primary ACLR compared to tibialis anterior tendon allografts for revision ACLR.
As such, we found a statistically significant difference in the joint laxity between two groups. To sum up, this difference between the two groups may possibly attribute to the different graft materials used. Muscle strength is a factor greatly influencing knee function. Therefore, it is important to accurately determine the level of muscular strength during postoperative recovery. The quadriceps muscle plays a key role in maintaining dynamic stability of the knee joint, whereas hamstring muscles act as an agonist to the ACL preventing anterior dislocation of the knee Atrophy of these two muscles causes more functional instability and impairment.
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Although isokinetic equipment is widely used for accurate and objective assessment of muscle strength in the knee joint 1 , 10 , 11 , evidence on revision ACLR surgery using isokinetic equipment to assess muscle strength is lacking. In this study, we used isokinetic equipment to assess the degree of muscle strength recovery in the knee joint between the two groups at the same time point of 1 year postoperatively. The two groups had similar outcomes in isokinetic muscle strengths, which corresponded to similar results in functional scores.
Uribe et al. However, we observed similar results in extensor and flexor muscle defect rates between primary and revision ACLR groups. Moreover, there were also no differences in functional knee scores IKDC and Lysholm score between the two groups. That is, after planned training and rehabilitation, patients with revision ACR still can have good results in knee strength and functions. Our study had four limitations.
First, there is the small number of revision ACLR cases, and all patients are males. The findings of our study cannot apply to the female patients.
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Further studies on females are needed. Second, the fixation methods of tendon graft were not identical with and between two groups, which cause inherent bias of this study. Third, the pre-injury status of each patient was hardly recorded, which might make the interpretation of findings difficult, especially muscle strength. However, we presented the data of isokinetic muscle strength deficit by comparing the healthy limb, which could minimize this potential bias.
Fourth, we cannot address the impact of potential covariates including commitment meniscus injury and critical physical findings status due to incomplete recording and limited sample size. Further study with a large sample will validate the findings of comparison after adjustment of potential covariates. In conclusion, patients with revision ACLR surgery had significantly higher AP laxity than those with primary ACLR surgery but can have similar results in knee strength and functions after rehabilitation. More intensive rehabilitation is suggested for patients with revision ACLR surgery.
This is a cross-sectional study with 80 male patients with arthroscopic ACL reconstruction surgery 40 primaries and 40 revisions recruited from Samsung Medical Center between April and May Hamstring semitendinosus-gracilis tendon autografts were used in the primary ACL reconstruction group, while tibialis anterior tendon allografts were used in revision ACL reconstruction group. The same postoperative rehabilitation program was used for primary and revision groups.
At the first week right after the operation, the general light intensity of isometric exercises and range of motion ROM exercises were performed. The patients subjected to partial weight bearing for 4—6 weeks postoperatively and progressively switched to full weight-bearing.
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By the 6—12 weeks, the patient would achieve combined strength, endurance and balance exercise without pain. At six months, light running was allowed. By nine month after surgery, the patient could receive sports-related training if there were no problems such as effusion, pain, or knee instability. The measurements were done three times, and a mean value was calculated.
These examinations were done by the same personnel who have several years of arthrometry experience to minimize the errors of measurements. Side-to-side AP laxity difference between injured and noninjured knee was also recorded. While doing the sessions, patients were encouraged to perform with the maximum effort by the examiner.
Sports Medicine research on ACL injuries published in national journals
Isokinetic concentric measurements of quadriceps and hamstring strength demonstrated excellent reliability Both injured and non-injured side were measured for three times, and a mean difference was calculated as. The IKDC knee scale quantifies symptoms, sports activities, and function The Lysholm knee scale quantifies pain, instability, locking, swelling, stair-climbing, squatting abilities, and need for support All data statistical analysis was performed using SPSS version All data were reported with median and interquartile range IQR.
The datasets generated during and analysed during the current study are not publicly available due to policy of the Sungkyunkwan University School of Medicine Clinical Research Ethics Board but are available from the corresponding author on reasonable request.
Biau, D. ACL reconstruction: a meta-analysis of functional scores. Kamath, G. Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 39 , — Brown, C. Revision Anterior Cruciate Ligament Surgery. Clin Sports Med 18 , — Bach, B. Revision anterior cruciate ligament surgery.
Arthroscopy 19 , 14—29 Diamantopoulos, A. Anterior cruciate ligament revision reconstruction: results in patients.
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Am J Sports Med 36 , — Muneta, T. Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon. Arthroscopy 26 , — Wolf, R. Revision anterior cruciate ligament reconstruction surgery. Journal of the Southern Orthopaedic Association 11 , 25—32 Group, M. Am J Sports Med 38 , — Busfield, B.
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