Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts

Hart, Luke, Izri, Erwan, King, Enda and Daniels, Katherine AJ (2022) Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts. Scandinavian Journal of Medicine and Science in Sports, 32 (12). pp. 1781-1790. ISSN 0905-7188

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Abstract

After anterior cruciate ligament reconstruction (ACLR) there are differences in the neuromuscular deficits observed in patients with bone-patellar tendon-bone (BPTB) and with hamstring tendon (HT) autografts. Differences in knee extensor and flexor strength are commonly reported, but analyses have largely focused on peak torque metrics despite the requirement to generate torque through range when returning to sport. The aim of this study was to investigate the angle-specific strength and strength asymmetry differences between BPTB and HT around the time of return to play after ACLR. A total of 357 male field sport athletes with either a BPTB (n=297) or an HT (n=60) autograft underwent concentric knee flexor and extensor isokinetic strength testing nine months post-ACLR. Angle-specific torques were compared between grafts and limbs using 1D Statistical Parametric Mapping and discrete-point variables. Inter-limb extensor torque asymmetry was greater in BTPB than HT at knee angles of >30° (p=0.001, peak d=5.53), with flexor torque asymmetry lower in BPTB than HT at flexion angles of >25° (p=0.001, peak d=2.68). Angle of maximum asymmetry and angle of operated limb peak torque differed in knee extension for BPTB (p<0.001, d=0.32) but not HT, whereas knee flexion angle of maximum asymmetry and operated limb peak torque differed in both BTPB (p<0.001, d=0.75) and HT (p<0.001, d=0.43). Graft type affected extensor torque at knee angles of 67-85° and flexor torque at knee angles of 27-85°. Angle-specific strength analysis may inform the rehabilitation process and improve rehabilitation and return-to-play decision making strategies in comparison to the use of peak torque values alone.

Item Type:	Article
Peer-reviewed:	Yes
Date Deposited:	09 Sep 2022 13:29
Publisher:	Wiley
Additional Information:	This is the peer reviewed version of the following article: Hart, L.M., Izri, E., King, E. and Daniels, K.A.J. (2022), Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts. Scand J Med Sci Sports., which has been published in final form at https://doi.org/10.1111/sms.14229. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Divisions:	Faculties > Science and Engineering
Subject terms:	Science & Technology, Life Sciences & Biomedicine, Sport Sciences, asymmetry, isokinetic dynamometry, statistical parametric mapping, torque, ANTERIOR CRUCIATE LIGAMENT, RETURN, SPORT, ASSOCIATION, RELIABILITY, ASYMMETRIES, EXTENSION, FLEXION, GRAFT, METAANALYSIS, Knee Joint, Humans, Male, Muscle Strength, Anterior Cruciate Ligament Reconstruction, Autografts, Anterior Cruciate Ligament Injuries, Hamstring Tendons, asymmetry, isokinetic dynamometry, statistical parametric mapping, torque, Humans, Male, Hamstring Tendons, Autografts, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Knee Joint, Muscle Strength, 1106 Human Movement and Sports Sciences, 1116 Medical Physiology, Sport Sciences
Data Access Statement:	The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
URI:	https://e-space.mmu.ac.uk/id/eprint/630372
DOI:	https://doi.org/10.1111/sms.14229
ISSN	0905-7188
e-ISSN	1600-0838

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