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Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices

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

Abstract

Purpose

To determine the most effective practices for quadriceps strengthening after ACL reconstruction.

Methods

An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist.

Results

From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group.

Conclusions

The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements.

Level of evidence

II.

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Author information

Authors and Affiliations

  1. Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Alli Gokeler & Egbert Otten

  2. School for Physiotherapy, Saxion University Applied Science, Enschede, The Netherlands

    Marsha Bisschop

  3. Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Marsha Bisschop, Anne Benjaminse & Egbert Otten

  4. SportsFieldLab Groningen, School of Sports Studies, Hanze University Applied Science, Groningen, The Netherlands

    Anne Benjaminse

  5. Division of Sports Medicine, Department of Pediatrics and Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Greg D. Myer

  6. FC Groningen Soccer Club, Groningen, The Netherlands

    Peter Eppinga

  7. FLYTTA Sports Physical Therapy, Groningen, The Netherlands

    Peter Eppinga

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  1. Alli Gokeler
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  2. Marsha Bisschop
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  3. Anne Benjaminse
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  4. Greg D. Myer
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  6. Egbert Otten
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Correspondence to Alli Gokeler.

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Gokeler, A., Bisschop, M., Benjaminse, A. et al. Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices. Knee Surg Sports Traumatol Arthrosc 22, 1163–1174 (2014). https://doi.org/10.1007/s00167-013-2577-x

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  • DOI: https://doi.org/10.1007/s00167-013-2577-x

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