Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and
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KNEE
Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and meta‑analysis Peta T. Johnston1 · Jodie A. McClelland1 · Julian A. Feller1,2 · Kate E. Webster1 Received: 30 June 2020 / Accepted: 28 September 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Restoration of knee muscle strength is associated with better outcomes following anterior cruciate ligament (ACL) reconstruction, but little is known about the outcome of strength following quadriceps tendon autograft (QT) ACL reconstruction in relation to other graft types. The aim of this review was to evaluate strength outcomes of the knee extensors and knee flexors following QT ACL reconstruction compared to (1) the non-reconstructed contralateral limb and (2) alternative ACL graft types. Methods Four electronic databases were searched up until 21st February 2020. Summary meta-analyses were performed comparing knee strength outcomes following QT ACL reconstruction to the contralateral limb by way of limb symmetry index (LSI). Comparative meta-analyses were performed comparing QT ACL reconstruction to alternative ACL grafts for the two most frequently reported strength outcome measures which were peak knee extensor torque LSI, and peak knee flexor torque LSI at the following post-operative periods: 3, 5–8, 9–15, 24, 36–60 months. Results In total, 18 studies met the inclusion criteria. Knee strength outcomes of 952 QT ACL reconstructions were included and compared to either the contralateral limb or 1 of 4 alternative ACL graft types; 245 hamstring tendon autograft (HT), 143 patellar tendon autograft (PT), 45 quadriceps tendon allograft, and 21 tibialis anterior allograft. Knee extensor strength LSI following QT ACL reconstruction did not reach 90% even at 24 months post-operatively. Conversely, knee flexor strength LSI following QT ACL reconstruction exceeded 90% at the 9–15 months post-operative period. Knee extensor strength at 5–8 months following QT ACL reconstruction appears similar to PT but weaker than HT ACL reconstruction. In addition, peak knee flexor LSI was significantly greater at 5–8 months in QT ACL reconstruction patients compared to HT patients. Conclusion The decision to utilize a QT graft for ACL reconstruction should include consideration of strength outcomes. Knee extensor strength recovery following QT ACL reconstruction appears not to be restored before 24 months. Level of evidence Level IV. Keywords Knee · Strength · ACL reconstruction · Quadriceps tendon autograft Abbreviations ACL Anterior cruciate ligament ACLR Anterior cruciate ligament reconstruction HT Hamstring tendon
LSI Limb symmetry index PT Patellar tendon QT Quadricep tendon SD Standard deviation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-06311-y) contains supplementary material, which is available to authorized users.
Introduction
* Peta T. Johnston [email protected]
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