Straub Rachel K, Mandelbaum Bert, Powers Christopher M
Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA.
Cedars Sinai Kerlan Jobe Institute, Santa Monica, CA.
Med Sci Sports Exerc. 2022 Dec 1;54(12):2005-2010. doi: 10.1249/MSS.0000000000002995. Epub 2022 Jul 8.
The influence of graft type on the restoration of quadriceps strength symmetry after ACL reconstruction (ACLR) has been widely studied. However, an important consideration when evaluating quadriceps symmetry is the fact that this measure can be influenced by numerous factors beyond graft type. This study sought to determine if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration potentially influential factors (i.e., age, sex, body mass index, time post-ACLR).
We retrospectively reviewed quadriceps strength data from 434 patients (303 female patients and 131 male patients) who had previously undergone ACLR with an autograft (hamstring tendon, quadriceps tendon [QT], patellar tendon [PT]) or allograft. Chi-Squared Automatic Interaction Detection decision tree analysis was used to evaluate if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration age, sex, body mass index, and time post-ACLR.
The best predictor of quadriceps strength asymmetry was graft type. Specifically, three graft categories were identified: 1) allograft and hamstring tendon autograft, 2) PT autograft, and 3) QT autograft. The average quadriceps strength asymmetry for each of the three identified categories was 0.91, 0.87, and 0.81, respectively, and differed statistically from each other ( P < 0.001). The second-best predictor of quadriceps strength asymmetry was sex, albeit only in the PT and QT groups (with female patients having increased asymmetry). Female patients post-ACLR with a QT autograft were at highest risk for quadriceps strength asymmetry.
Graft type and sex are important predictors of quadriceps strength asymmetry after ACLR. Clinicians should take these factors into consideration when designing rehabilitation protocols to restore quadriceps strength symmetry during the postoperative period.
移植物类型对前交叉韧带重建（ACLR）后股四头肌力量对称性恢复的影响已得到广泛研究。然而，在评估股四头肌对称性时，一个重要的考虑因素是，这一指标可能受到移植物类型以外的众多因素影响。本研究旨在确定在考虑潜在影响因素（即年龄、性别、体重指数、ACLR术后时间）的情况下，移植物类型是否可预测ACLR术后12个月内的股四头肌力量不对称。
我们回顾性分析了434例患者（303例女性患者和131例男性患者）的股四头肌力量数据，这些患者之前接受了自体移植物（腘绳肌腱、股四头肌肌腱[QT]、髌腱[PT]）或同种异体移植物的ACLR。采用卡方自动交互检测决策树分析，在考虑年龄、性别、体重指数和ACLR术后时间的情况下，评估移植物类型是否可预测ACLR术后12个月内的股四头肌力量不对称。
股四头肌力量不对称的最佳预测因素是移植物类型。具体而言，确定了三类移植物：1）同种异体移植物和腘绳肌腱自体移植物，2）PT自体移植物和3）QT自体移植物。所确定的三类移植物中，每类的平均股四头肌力量不对称分别为0.91、0.87和0.81，且彼此之间存在统计学差异（P<0.001）。股四头肌力量不对称的第二大预测因素是性别，尽管仅在PT和QT组中如此（女性患者的不对称性增加）。ACLR术后接受QT自体移植物的女性患者股四头肌力量不对称的风险最高。
移植物类型和性别是ACLR后股四头肌力量不对称的重要预测因素。临床医生在设计康复方案以在术后恢复股四头肌力量对称性时应考虑这些因素。
