Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care

J. Craig Garrison, Joseph Hannon, Shiho Goto, Victor Kosmopoulos, Subhash Aryal, Curtis Bush, James M. Bothwell, Steven B. Singleton

Research output: Contribution to journalArticle

Abstract

Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. Study Design: Case series; Level of evidence, 4. Methods: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P <.05. Results: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P =.0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P <.0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P <.0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P <.0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P <.0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P <.0001). Preoperatively, QUADS for both the surgical (P <.0003) and nonsurgical (P =.0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P <.0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P =.0201) of surgical limb knee EAC, explaining 12.92% of the variance. Conclusion: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.

Original languageEnglish
JournalOrthopaedic Journal of Sports Medicine
Volume7
Issue number10
DOIs
StatePublished - 1 Jan 2019

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Continuity of Patient Care
Anterior Cruciate Ligament
Knee
Extremities
Anterior Cruciate Ligament Reconstruction
Return to Sport

Keywords

  • ACL
  • continuum of care
  • double-limb squat
  • energy absorption contribution
  • quadriceps strength

Cite this

Garrison, J. Craig ; Hannon, Joseph ; Goto, Shiho ; Kosmopoulos, Victor ; Aryal, Subhash ; Bush, Curtis ; Bothwell, James M. ; Singleton, Steven B. / Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care. In: Orthopaedic Journal of Sports Medicine. 2019 ; Vol. 7, No. 10.
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abstract = "Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. Study Design: Case series; Level of evidence, 4. Methods: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P <.05. Results: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P =.0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P <.0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P <.0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P <.0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98{\%} ± 13.73{\%} vs 47.50{\%} ± 12.04{\%}; P <.0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P <.0001). Preoperatively, QUADS for both the surgical (P <.0003) and nonsurgical (P =.0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99{\%} of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P <.0051) of surgical limb knee EAC, explaining 18.83{\%} of the variance. At RTS, ExtDiff was a significant predictor (P =.0201) of surgical limb knee EAC, explaining 12.92{\%} of the variance. Conclusion: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.",
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Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care. / Garrison, J. Craig; Hannon, Joseph; Goto, Shiho; Kosmopoulos, Victor; Aryal, Subhash; Bush, Curtis; Bothwell, James M.; Singleton, Steven B.

In: Orthopaedic Journal of Sports Medicine, Vol. 7, No. 10, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Knee Loading After ACL-R Is Related to Quadriceps Strength and Knee Extension Differences Across the Continuum of Care

AU - Garrison, J. Craig

AU - Hannon, Joseph

AU - Goto, Shiho

AU - Kosmopoulos, Victor

AU - Aryal, Subhash

AU - Bush, Curtis

AU - Bothwell, James M.

AU - Singleton, Steven B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. Study Design: Case series; Level of evidence, 4. Methods: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P <.05. Results: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P =.0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P <.0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P <.0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P <.0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P <.0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P <.0001). Preoperatively, QUADS for both the surgical (P <.0003) and nonsurgical (P =.0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P <.0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P =.0201) of surgical limb knee EAC, explaining 12.92% of the variance. Conclusion: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.

AB - Background: Quadriceps strength and knee extension are believed to be important in the ability to effectively load the knee after anterior cruciate ligament (ACL) reconstruction (ACL-R). Purpose: To compare quadriceps strength (QUADS), side-to-side knee extension difference (ExtDiff), and knee energy absorption contribution (EAC) in patients preoperatively, 12 weeks postoperatively, and at return to sport (RTS). A secondary aim was to determine how the factors of QUADS and ExtDiff contributed to the ability to load the knee (knee EAC) at each of the 3 time points. Study Design: Case series; Level of evidence, 4. Methods: Overall, 41 individuals (mean ± SD age, 15.95 ± 1.63 years) were enrolled in this study. QUADS, ExtDiff, and knee EAC during a double-limb squat were collected preoperatively, 12 weeks postoperatively, and at RTS. Isokinetic QUADS was collected at 60 deg/s, normalized to body mass, and averaged across 5 trials. Knee extension was measured with a goniometer, and ExtDiff was calculated for analyses. Knee EAC was measured during double-limb squat descent and was calculated as a percentage of total energy absorption for the limb. Observations were obtained from both the surgical and nonsurgical limbs at the 3 time points. A mixed regression model with random intercept to compare change over the 3 time points was used, and a model selection was conducted with Akaike information criteria. Significance was set at P <.05. Results: Surgical limb QUADS was significantly lower preoperatively (mean ± SD, 1.37 ± 0.49 N·m/kg; P =.0023) and at 12 weeks (1.11 ± 0.38 N·m/kg; P <.0001) than at RTS (1.58 ± 0.47 N·m/kg). Nonsurgical limb QUADS was also significantly lower preoperatively (2.01 ± 0.54 N·m/kg; P <.0256) and at 12 weeks (2.03 ± 0.48 N·m/kg; P <.0233) than at RTS (2.18 ± 0.54 N·m/kg). Knee EAC for the surgical limb was significantly lower at 12 weeks than at RTS (40.98% ± 13.73% vs 47.50% ± 12.04%; P <.0032), and ExtDiff was significantly greater preoperatively than at RTS (–2.68° ± 3.19° vs –0.63° ± 1.43°; P <.0001). Preoperatively, QUADS for both the surgical (P <.0003) and nonsurgical (P =.0023) limbs was a significant predictor of surgical limb knee EAC, explaining 33.99% of the variance. At 12 weeks, surgical limb QUADS was a significant predictor (P <.0051) of surgical limb knee EAC, explaining 18.83% of the variance. At RTS, ExtDiff was a significant predictor (P =.0201) of surgical limb knee EAC, explaining 12.92% of the variance. Conclusion: The ability to load the knee after ACL injury changes across the continuum of care and is related to QUADS and ExtDiff. These results provide clinicians with insight into potential contributing factors that may limit knee loading during the rehabilitation process.

KW - ACL

KW - continuum of care

KW - double-limb squat

KW - energy absorption contribution

KW - quadriceps strength

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DO - 10.1177/2325967119870155

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