Abstract
Long-term muscle weakness may increase the risk of knee reinjury after anterior cruciate ligament reconstruction (ACLR) and of osteoarthritis. The incidence of secondary injuries after ACLR and the predictive value of preoperative and postoperative limb symmetry index (LSI) and estimated preinjury capacity (EPIC) index were studied for predicting the risk of reinjury in a retrospective study. Sixty-three recreational and professional athletes after ACLR with hamstring autograft were followed for secondary injury in the period from 2012 to 2014, 5 years after ACLR. Peak torque values of knee extensor and flexor muscle strength of the involved and uninvolved limb were measured with an isokinetic dynamometer at 60 degrees per second before ACLR and 6 months after ACLR and were used to calculate LSI and EPIC index. The results suggest that the preoperative LSI and EPIC indexes predict a secondary ACL injury better than the postoperative LSI for extensor muscles which is often used as a criterion to determine the time for returning to normal sports activities. Individuals with secondary ACL injuries suffer greater loss of knee extensor muscle strength of the uninvolved limb between preoperative and postoperative ACLR testing compared to the individuals without secondary injury.
Highlights
All these variables are influenced by other factors such as sex, age, previous injury, the amount of time elapsed since Anterior cruciate ligament (ACL) reconstruction (ACLR), and increased exposure to sports precipitation, unanticipated environmental events, and higher training load [7,8]
This demonstrates that knee extension strength at 6 months after the initial ACLR does not guarantee that pre-injury strength levels of the uninvolved limb have been met and can inflate the limb symmetry index (LSI)
Our study provides additional data to support the existing body of literature, which emphasizes the importance of preoperative rehabilitation to achieve a better preoperative LSI before ACLR
Summary
Main physical factors are based on impairments found in patients after ACLR They include poor neuromuscular control and poor biomechanics known to contribute to secondary ACL injuries, such as greater knee abduction moment, smaller knee flexion angle during landing with compensatory hip flexion, patterns of favoring the uninjured contralateral limb, decreased quadriceps limb symmetry index (LSI) below 90%, decreased rate of force development and hop test LSI below 90% [8,9,10,11,12].
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