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
The Ohio State University Sports Medicine Center- Columbus, OH, USA.
Consultant at Hewett Global Consulting, Greater Minneapolis-St. Paul Area, MN, USA.
Int J Sports Phys Ther. 2020 Dec;15(6):995-1005. doi: 10.26603/ijspt20200995.
Quadriceps weakness is a predictor of long-term knee function and strength recovery can vary from months to years after anterior cruciate ligament reconstruction (ACLR). However, few studies evaluate quadriceps strength and self-reported function within the first several weeks after ACLR.
HYPOTHESIS/PURPOSE: To examine changes over time in quadriceps strength symmetry, quadriceps peak torque, and self-reported knee function prior to and at six, 12, and 24 weeks post-ACLR. The hypotheses were 1) quadriceps strength symmetry, bilateral quadriceps peak torque, and patient-reported function would improve over time from pre-ACLR to 24 weeks post-ACLR and 2) significant improvements in patient-reported function, but not strength symmetry, would occur between time points.
Prospective, cohort study.
Thirty participants completed four testing sessions: pre-surgery and six, 12, and 24 weeks post-ACLR. Isometric quadriceps strength testing was performed at six weeks and isokinetic quadriceps strength was measured at all other testing points. Quadriceps index was calculated to evaluate between limb quadriceps strength symmetry. The Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) were administered at each time point. A repeated-measures analysis of variance evaluated changes over time, with post-hoc comparisons to determine at which time-point significant changes occurred.
Quadriceps strength symmetry, involved limb quadriceps peak torque and all patient-reported outcome scores increased over time (p<0.02). Post-hoc tests showed that neither self-reported outcomes, nor quadriceps index improved between pre-surgery and six-weeks post-ACLR. From six to 12 weeks post-ACLR, scores on IKDC and KOOS Pain, Symptoms, Quality of Life, and Sport subscales improved (p≤0.003). From 12 to 24 weeks post-ACLR, quadriceps strength symmetry, involved limb quadriceps peak torque, KOOS-Symptoms, Quality of Life, and Sport subscales and the IKDC improved (p≤0.01). Uninvolved limb quadriceps peak torque did not change across any time point (p≥0.18).
Patient-reported knee function increased between six and 24 weeks post-ACLR, while increases in involved limb quadriceps strength and quadriceps strength symmetry were not noted until 12-24 weeks post-ACLR.
2b, individual cohort study.
股四头肌无力是长期膝关节功能的一个预测指标，且前交叉韧带重建术（ACLR）后力量恢复可能需要数月至数年时间。然而，很少有研究评估ACLR后最初几周内的股四头肌力量和自我报告的功能。
假设/目的：研究ACLR术前、术后6周、12周和24周时股四头肌力量对称性、股四头肌峰值扭矩以及自我报告的膝关节功能随时间的变化。假设为：1）从ACLR术前到术后24周，股四头肌力量对称性、双侧股四头肌峰值扭矩以及患者报告的功能会随时间改善；2）在各时间点之间，患者报告的功能会有显著改善，但力量对称性不会。
前瞻性队列研究。
30名参与者完成了四次测试：术前、ACLR术后6周、12周和24周。术后6周进行等长股四头肌力量测试，在所有其他测试点测量等速股四头肌力量。计算股四头肌指数以评估双侧股四头肌力量对称性。在每个时间点使用膝关节损伤和骨关节炎结果评分（KOOS）以及国际膝关节文献委员会主观膝关节评估表（IKDC）。采用重复测量方差分析评估随时间的变化，并进行事后比较以确定在哪个时间点发生了显著变化。
股四头肌力量对称性、患侧股四头肌峰值扭矩以及所有患者报告的结果评分均随时间增加（p<0.02）。事后检验表明，在ACLR术前和术后6周之间，自我报告的结果和股四头肌指数均未改善。在ACLR术后6至12周，IKDC和KOOS疼痛、症状、生活质量及运动亚量表的评分有所改善（p≤0.003）。在ACLR术后12至24周，股四头肌力量对称性、患侧股四头肌峰值扭矩、KOOS症状、生活质量及运动亚量表以及IKDC均有所改善（p≤0.01）。在任何时间点，健侧股四头肌峰值扭矩均未发生变化（p≥0.18）。
ACLR术后6至24周患者报告的膝关节功能有所增加，而患侧股四头肌力量和股四头肌力量对称性直到ACLR术后12 - 24周才出现增加。
2b级，个体队列研究。
