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Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus–gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus–gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90° flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 ± 11) and Group 2 (80.5 ± 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of −17.0 ± 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of −0.8 ± 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of −0.7 ± 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group × side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.

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References

  1. Adachi N, Ochi M, Uchio Y, Sakai Y, Kuriwaka M, Fujihara A (2003) Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance. Arch Orthop Trauma Surg 123:460–465

    Article  PubMed  Google Scholar 

  2. Ageberg E, Roos HP, Silbernagel KG, Thomee R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169

    Article  PubMed  Google Scholar 

  3. Aglietti P, Buzzi R, Zaccherrotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22:211–217

    Article  CAS  PubMed  Google Scholar 

  4. Anderson A, Snyder R, Lipscomb A (2001) Anterior cruciate ligament reconstruction. Am J Sports Med 29:272–279

    CAS  PubMed  Google Scholar 

  5. Armour T, Forwell L, Litchfield R, Kirkley A, Amendola N, Fowler PJ (2004) Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 32:1639–1643

    Article  PubMed  Google Scholar 

  6. Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602–609

    Article  PubMed  Google Scholar 

  7. Bizzini M, Gorelick M, Munzinger U, Drobny T (2006) Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts. Clin J Sports Med 16:4–9

    Article  Google Scholar 

  8. Centers for Disease Control, Prevention (CDC) (2001) Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts—Florida and Louisiana, 2000. MMWR 50:1081–1083

    Google Scholar 

  9. Chumanov ES, Heiderscheit BC, Thelen DG (2007) The effect of speed and influence of individual muscles on hamstring mechanics during the swing phase of sprinting. J Biomech 40:3555–3562

    Article  PubMed  Google Scholar 

  10. Crawford C, Nyland J, Landes S, Jackson R, Chang HC, Nawab A, Caborn DN (2007) Anatomic double bundle ACL reconstruction: a literature review. Knee Surg Sports Traumatol Arthrosc 15:946–964

    Article  PubMed  Google Scholar 

  11. Elmlinger B, Nyland J, Tillett E (2006) Knee flexor function 2 years after anterior cruciate ligament reconstruction with semitendinosus-gracilis autografts. Arthroscopy 22:650–655

    PubMed  Google Scholar 

  12. Feller J, Webster K, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9:260–266

    Article  CAS  PubMed  Google Scholar 

  13. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557

    CAS  PubMed  Google Scholar 

  14. Harner CD (2001) Specialty update: what’s new in sports medicine? J Bone Joint Surg Am 83:305–310

    PubMed  Google Scholar 

  15. Haut Donahue TL, Howell SM, Hull ML, Gregersen C (2002) A biomechanical evaluation of anterior and posterior tibialis tendons as suitable single-loop anterior cruciate ligament grafts. Arthroscopy 18:589–597

    Article  PubMed  Google Scholar 

  16. Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2000) Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 32:1472–1479

    Article  CAS  PubMed  Google Scholar 

  17. Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980

    Article  CAS  PubMed  Google Scholar 

  18. Lautamies R, Harlilainen A, Kettunen J, Sandelin J, Kujala UM (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 16:1009–1016

    Article  PubMed  Google Scholar 

  19. Mann RA, Hagy J (1980) Biomechanics of walking, running, and sprinting. Am J Sports Med 8:345–350

    Article  CAS  PubMed  Google Scholar 

  20. Marrale J, Morrisey M, Haddad F (2007) A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:690–704

    Article  PubMed  Google Scholar 

  21. Miller MD, Nichols T, Butler CA (1999) Patella fracture and proximal patellar tendon rupture following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 15:640–643

    CAS  PubMed  Google Scholar 

  22. Moebius UG, Georgoulis AD, Papageorgiou CD, Papadonikolakis A, Rossis J, Soucacos PN (2001) Alterations of the extensor apparatus after anterior cruciate ligament reconstruction using the medial third of the patellar tendon. Arthroscopy 17:953–959

    Article  CAS  PubMed  Google Scholar 

  23. Moisala AS, Jarvela T, Kannus P, Jarvinen M (2007) Muscle strength evaluations after ACL reconstruction. Int J Sports Med 28:868–872

    Article  PubMed  Google Scholar 

  24. Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M et al (2000) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  Google Scholar 

  25. Noojin FK, Barrett GR, Hartzog CW, Nash CR (2000) Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 28:783–789

    CAS  PubMed  Google Scholar 

  26. Nyland J, Caborn DNM, Rothbauer J, Kocabey Y, Couch J (2003) Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study. Knee Surg Sports Traumatol Arthrosc 11:212–218

    Article  CAS  PubMed  Google Scholar 

  27. AW Pearsall IV, Hollis JM, Russell GV Jr, Scheer Z (2003) A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee. Arthroscopy 19:1091–1096

    Google Scholar 

  28. Scheffler SU, Schmidt T, Gangey I, Dustmann M, Unterhauser F, Weiler A (2008) Fresh-frozen free-tendon allografts versus autografts in anterior cruciate ligament reconstruction: delayed remodeling and inferior mechanical function during long-term healing in sheep. Arthroscopy 24:448–458

    Article  PubMed  Google Scholar 

  29. Segawa H, Omori G, Koga Y, Kameo T, Iida S, Tanaka M (2002) Rotational muscle strength of the limb after anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon. Arthroscopy 18:177–182

    Article  PubMed  Google Scholar 

  30. Shaieb M, Kan D, Chang S, Marumoto J, Richardson A (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220

    PubMed  Google Scholar 

  31. Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N (1995) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single- and double-tendon harvest. Am J Sports Med 23:706–714

    Article  Google Scholar 

  32. Thelen DG, Chumanov ES, Hoerth DM, Best TM, Swanson SC, Li L, Young M, Heiderscheit BC (2005) Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc 37:108–114

    Article  PubMed  Google Scholar 

  33. Tillett E, Madsen R, Rogers R, Nyland J (2004) Localization of the semitendinosus-gracilis tendon bifurcation point relative to the tibial tuberosity: an aid to hamstring tendon harvest. Arthroscopy 20:51–54

    Article  PubMed  Google Scholar 

  34. Torry MR, Decker MJ, Jockel JR, Viola R, Sterett WI, Steadman JR (2004) Comparison of tibial rotation strength in patients’ status after anterior cruciate ligament reconstruction with hamstring versus patellar tendon autografts. Clin J Sports Med 14:325–331

    Article  Google Scholar 

  35. Vairo GL, Myers JB, Sell TC, Fu FH, Harner CD, Lephart SM (2008) Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:2–14

    Article  PubMed  Google Scholar 

  36. Viola RW, Sterett WI, Newfield D, Steadman JR, Torry MR (2000) Internal and external tibial rotation strength after anterior cruciate ligament reconstruction using ipsilateral semitendinosus and gracilis tendon autografts. Am J Sports Med 28:552–555

    CAS  PubMed  Google Scholar 

  37. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray St., Suite 1003, Louisville, KY, 40202, USA

    Sarah Landes, John Nyland, Brian Elmlinger, Ed Tillett & David Caborn

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  1. Sarah Landes
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  2. John Nyland
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  3. Brian Elmlinger
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  4. Ed Tillett
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  5. David Caborn
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Correspondence to John Nyland.

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Landes, S., Nyland, J., Elmlinger, B. et al. Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls. Knee Surg Sports Traumatol Arthrosc 18, 317–324 (2010). https://doi.org/10.1007/s00167-009-0931-9

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