Background: The choice of graft for anterior cruciate ligament reconstruction is a matter of debate, with patellar and hamstring tendons being the two most popular autologous graft options. The objective of this study was to determine in a prospective, randomized clinical trial whether two grafts (bone-patellar tendon-bone or doubled hamstring tendons) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction.

Methods: One hundred and twenty patients with a chronic unilateral rupture of the anterior cruciate ligament underwent arthroscopically assisted reconstruction with use of either autologous bone-patellar tendon-bone or doubled hamstring tendon grafts, in a strictly alternating manner. Both groups were comparable with regard to demographic data, preoperative activity level, mechanism of injury, interval between the injury and the operation, and the amount of knee laxity present preoperatively. The same well-proven surgical technique and aggressive controlled rehabilitation was used. An independent observer, who was blinded with regard to the involved leg and the type of graft, performed the outcome assessment with use of a visual analog scale, the new International Knee Documentation Committee form, the Knee Injury and Osteoarthritis Outcome Score, the Functional Knee Score for Anterior Knee Pain, and an arthrometric and an isokinetic dynamometric evaluation. Radiographs were also made.

Results: At the two-year follow-up evaluation, no differences were found in terms of the visual analog score, the Knee Injury and Osteoarthritis Outcome Score, the new International Knee Documentation Committee subjective and objective evaluation scores, the KT-1000 side-to-side laxity measurements, the Functional Knee Score for Anterior Knee Pain, muscle strength recovery, or return to sports activities. In the bone-patellar tendon-bone group, we found a higher prevalence of postoperative kneeling discomfort (p < 0.01) and an increased area of decreased skin sensitivity (p < 0.001). In the hamstring tendon group, we recorded a higher prevalence of femoral tunnel widening (p < 0.01). In this group, a correlation was also found between medial meniscectomy and an increased prevalence of pivot-shift glide (p = 0.035).

Conclusions: We believe that, with use of accurate and proven surgical and rehabilitation techniques, both grafts are an equivalent option for anterior cruciate ligament reconstruction.

Level of Evidence: Therapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]). See Instructions to Authors for a complete description of levels of evidence.

Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial.

The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction. A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports. The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their knee-related quality of life. The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and non-injured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction. IV.

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Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction.

Neuromuscular consequences of anterior cruciate ligament injury.

The knee self-efficacy scale (K-SES) has been shown to have good reliability, validity and responsiveness during rehabilitation for patients’ perceived self-efficacy of knee function. Determinants of self-efficacy of knee function 1 year after ACL reconstruction have been found to be the patients’ internal locus of control and knee symptoms in sports and recreation. The predictive ability of perceived self-efficacy of knee function measured by the K-SES has not been studied in terms of patient outcome after an ACL reconstruction. The purpose of this study was to explore the potential for pre-operative self-efficacy of knee function measured by the K-SES to predict patient outcome in terms of physical activity, knee symptoms and muscle function 1 year after an ACL reconstruction. Thirty-eight patients were evaluated for outcome in terms of physical activity with the Tegner activity scale and the physical activity scale (PAS), knee symptoms with the Lysholm knee scoring scale and the knee injury and osteoarthritis outcome score (KOOS) and knee function with ability tests for muscle function 1 year after ACL reconstruction. Multiple regression and logistic multiple regression analysis were used to evaluate the K-SES as a possible predictor of outcome. The patients’ present perceived self-efficacy of knee function (K-SESPresent) pre-operatively was a significant predictor (P = 0.016) of the patients returning to their intensity and frequency of physical activity (PAS) 1 year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (TegnerPre-injury) (odds ratio = 2.1). The patients’ perceived future self-efficacy of knee function (K-SESFuture) pre-operatively was a significant predictor (P = 0.045) of their self-rated knee function in sports/recreational activities (KOOSSports/recreation) at the 1-year follow-up, when adjusted for age, gender and TegnerPre-injury (R2 =0.25). The pre-operative K-SESFuture was also a significant predictor (P = 0.023) of the patients’ knee-related quality of life (KOOSQol), at the 1-year follow-up, when adjusted for age, gender and TegnerPre-injury (R2 =0.23). The pre-operative K-SESFuture was furthermore a significant predictor of an acceptable outcome 1 year after surgery, on the Lysholm knee scoring scale (P = 0.003, odds ratio = 1.7), as well as on KOOSSports/recreation (P = 0.002, odds ratio = 1.6) and knee-related quality of life (KOOSQol) (P = 0.037, odds ratio = 1.4), when adjusted for age, gender and TegnerPre-injury. The pre-operative K-SESFuture was also a significant predictor (P = 0.04) of an acceptable outcome 1 year after surgery, on the one-leg hop for distance (odds ratio = 2.2), when adjusted for age, gender and TegnerPre-injury. In conclusion, this study indicates that patients’ perceived self-efficacy of knee function pre-operatively is of predictive value for their return to acceptable levels of physical activity, symptoms and muscle function 1 year after ACL reconstruction.

Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction

Purpose
There is a lack of consensus regarding appropriate criteria attesting patients’ unrestricted sports activities after ACL reconstruction. Purpose of this study was to perform a systematic review about strength deficits to find out if a strength test might be a return to play criterion.

Return to play following ACL reconstruction: a systematic review about strength deficits

We designed a prospective study to examine the influence of graft type (hamstring or patella tendon) on thigh muscle torque recovery after anterior cruciate ligament reconstruction. 60 patients undergoing ACL reconstruction, using a hamstring or patella tendon graft, were studied and 45 were followed up to 1 year. Concentric and eccentric quadriceps and hamstring torque were recorded, using an isokinetic dynamometer preoperatively, 6 and 12 months after ACL reconstruction. We found an improvement in all muscle functions in both the operated and unoperated legs during the recovery period. Graft type had no effect on recovery. During the first 6 months, torque was restored to preoperative levels and continued to improve in all muscles and actions between 6 months and 1 year.

https://www.tandfonline.com/doi/pdf/10.1080/000164702321022820

Changes in muscle torque following anterior cruciate ligament reconstruction: a comparison between hamstrings and patella tendon graft procedures on 45 patients.

Stephanie Davies

Papers

Changes in muscle torque following anterior cruciate ligament reconstruction: a comparison between hamstrings and patella tendon graft procedures on 45 patients.