Pottkotter Kristy A, Di Stasi Stephanie L, Schmitt Laura C, Magnussen Robert A, Paterno Mark V, Flanigan David C, Kaeding Christopher C, Hewett Timothy E
Sports Medicine Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Orthop J Sports Med. 2018 Nov 28;6(11):2325967118807459. doi: 10.1177/2325967118807459. eCollection 2018 Nov.
The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR.
Cohort study; Level of evidence, 2.
Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength were calculated at each time point. The Friedman and Wilcoxon signed-rank tests were used to analyze changes in KOOS values over time. Spearman rank-order correlations were used to test the relationship between changes in strength and KOOS values between each time point.
Hamstring and quadriceps limb symmetry significantly increased with time ( ≤ .03). Fair correlations were observed between changes in the hamstring index and changes in the KOOS Symptoms subscore from before surgery to 12 weeks postoperatively ( = 0.48; ≤ .05). Changes in the quadriceps index (QI) were moderately correlated with changes in the KOOS Sport/Recreation subscore ( = 0.60; = .001), and fair correlations were seen between the QI and the KOOS Quality of Life subscore ( = 0.39; ≤ .04) from preoperatively to 12 weeks after surgery. Moderate correlations were seen between the QI and the KOOS Sport/Recreation subscore ( = 0.57; = .005) from 12 to 24 weeks after surgery.
Improvements in quadriceps and hamstring strength symmetry were modestly associated with improvements in athletes' perceived function in the first 6 months after ACLR. Specifically, improvements in hamstring symmetry were associated with improvements in knee symptoms within the first 12 weeks postoperatively, while improvements in quadriceps symmetry were associated with improvements in self-reported sport function throughout the first 6 months after ACLR. The restoration of strength symmetry within the first 6 months may be a critical component of rehabilitation aimed at maximizing function after ACLR. Further investigation is warranted to comprehensively evaluate whether the timing of strength gains predicts future function, including those who successfully return to their preinjury activity level after ACLR.
前交叉韧带重建术（ACLR）后股四头肌力量与功能结果之间的关联是当前研究的重点，尽管经常使用腘绳肌自体移植物，但对腘绳肌力量的评估却很有限。
目的/假设：本研究的目的是确定ACLR术前以及术后12周和24周时股四头肌和腘绳肌力量对称性变化与自我报告结果之间的关系。我们假设，ACLR术后前6个月内，股四头肌和腘绳肌力量对称性的改善将与自我报告结果测量指标的改善相关。
队列研究；证据等级，2级。
纳入30例行腘绳肌自体移植物ACLR的患者。在ACLR术前以及术后12周和24周评估股四头肌和腘绳肌力量以及膝关节损伤和骨关节炎疗效评分（KOOS）值；计算每个时间点的力量肢体对称指数。采用Friedman检验和Wilcoxon符号秩检验分析KOOS值随时间的变化。使用Spearman等级相关分析每个时间点之间力量变化与KOOS值之间的关系。
腘绳肌和股四头肌的肢体对称性随时间显著增加（P≤0.03）。术前至术后12周，腘绳肌指数变化与KOOS症状子评分变化之间存在中等程度的相关性（r = 0.48；P≤0.05）。股四头肌指数（QI）变化与KOOS运动/娱乐子评分变化中度相关（r = 0.60；P = 0.001），术前至术后12周，QI与KOOS生活质量子评分之间存在中等程度的相关性（r = 0.39；P≤0.04）。术后12至24周，QI与KOOS运动/娱乐子评分之间存在中等程度的相关性（r = 0.57；P = 0.005）。
ACLR术后前6个月内，股四头肌和腘绳肌力量对称性的改善与运动员自我感知功能的改善适度相关。具体而言，腘绳肌对称性的改善与术后前12周内膝关节症状的改善相关，而股四头肌对称性的改善与ACLR术后前6个月内自我报告的运动功能改善相关。前6个月内力量对称性的恢复可能是旨在使ACLR后功能最大化的康复的关键组成部分。有必要进行进一步研究，以全面评估力量增加的时间是否能预测未来功能，包括那些ACLR后成功恢复到伤前活动水平的患者。
