Quadriceps Strength Research Articles

INFLUENCE OF POPLITEUS MUSCLE MANIPULATION AND QUADRICEPS STRENGTHENING ON ANTERIOR KNEE PAIN IN RUNNERS

Background: Anterior knee pain is prevalent among young athletes, with sports-related injuries accounting for 25–30% of cases. Patellofemoral pain syndrome (PFPS) contributes to up to 40% of knee disorders, with annual prevalence rates reported at 22.7% in the general population and 28.9% in adolescents. Among runners, the incidence of PFPS ranges from 37% to 56%. Objective: The popliteus muscle is primarily associated with anterior knee pain but may also influence posterior knee discomfort. This study aims to investigate the effects of soft tissue manipulation of the popliteus muscle combined with quadriceps strengthening exercises on anterior knee pain in athletic runners, addressing a gap in the literature regarding the interaction between these muscle groups. Methods: In this experimental study, 30 subjects with non-traumatic anterior knee pain were recruited. Baseline assessments included quadriceps strength and pain levels. Participants then underwent six sessions of popliteus manipulation alongside quadriceps strengthening exercises. Post-intervention, all parameters were reassessed. Results: A significant reduction in knee pain (P < 0.005) was observed after the six-week intervention, with more pronounced improvements in Group A compared to Group B. Conclusion: The results suggest that incorporating popliteus soft tissue manipulation can effectively reduce anterior knee pain while strengthening the quadriceps enhances muscle function. These findings support the integration of popliteus manipulation into treatment protocols for athletes experiencing anterior knee pain.

Hamstring-to-Quadriceps Strength Ratios in Women Team Sport Athletes: A Systematic Review

ABSTRACT Women experience a higher rate of anterior cruciate ligament (ACL) injuries than men. Muscle imbalance, in particular hamstring-to-quadriceps (H:Q) strength ratio, is considered a risk factor for ACL injury. The purpose of this systematic review was to identify isokinetic H:Q strength ratios in women team sport athletes and determine whether cutoff values, determined from research with predominantly males, of >0.6 for conventional ratio (Hamstringconcentric:Quadricepsconcentric [CR]) and >1.0 for functional ratio (Hamstringeccentric:Quadricepsconcentric [FR]) were met. The CR (0.6) was not met for team ([mean ± SD: 0.56 ± 0.08]), field (0.57 ± 0.08), and court (0.56 ± 0.08) sports. Handball presented the highest (0.58 ± 0.07), and softball presented the lowest CRs (0.47 ± 0.06). The FR (1.0) was not met for team (0.69 ± 0.14), field (0.85 ± 0.14), and court (0.65 ± 0.14) sports. Soccer presented the highest (0.85 ± 0.14) and handball the lowest (0.66 ± 0.13) FRs. When assessing hamstring and quadriceps strength balance, women team sport athletes did not meet CR or FR values, which may contribute to increased ACL injury risk. H:Q ratios below cutoff values may indicate compromised hamstring strength. It is recommended practitioners implement strength exercises aimed to improve H:Q ratios.

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis

BackgroundPrevious research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses. ObjectiveTo identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors. MethodsPeople with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis. ResultsTwo hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables. ConclusionsPhenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain. Database registrationThe protocol is registered at ClinicalTrials.gov (NCT05380648).

Vascular occlusion for optimising the functional improvement in patients with knee osteoarthritis: a randomised controlled trial.

Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes. The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680). The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups. Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period. NCT04996680.

The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study

BackgroundThis study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.Questions/purposesThe aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS).MethodsEighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery.ResultsNo significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks (p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels (p = 0.02) and higher estimated perioperative blood loss (p < 0.001) in the no tourniquet group than the torniquet group.ConclusionsOur study indicates that tourniquet use during TKA causes no significant differences in FJS-12 at 8 weeks, significantly reduces bleeding and postoperative Hb loss, and improves quadriceps strength at 8 weeks.Trial registrationClinicaltrails.gov. Registry Number: NCT03666598. Registered 30 August 2018.

Effect of periarticular cocktail of analgesia on immediate post-operative clinical outcomes after bilateral simultaneous total knee arthroplasty: a randomized placebo controlled, split-body superiority trial

IntroductionTotal knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration. MethodologySixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients’ visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively. ResultsThe cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up. ConclusionUse of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation. Level of evidenceI, Randomized Controlled Trial.

Comparing the subvastus and medial parapatellar approaches in total knee replacement

Background: This study aimed to compare the outcomes of the subvastus and medial parapatellar approaches in total knee replacement (TKR), focusing on postoperative pain, knee function recovery, quadriceps strength, hospital stay, complications, and patient satisfaction. Methods: This prospective comparative clinical trial was conducted over 18 months at a tertiary care hospital. A total of 120 patients, aged 50-75 years with knee osteoarthritis, were divided into two groups, group A (subvastus approach) and group B (medial parapatellar approach). Pain, range of motion (ROM), quadriceps strength, length of hospital stay, complications, and patient satisfaction were evaluated postoperatively at 1, 3, 6, and 12 months. Data were analyzed using SPSS, with significance set at p&lt;0.05. Results: Group A showed significantly lower pain at 1 and 3 months, with VAS scores of 4.1 and 2.8, respectively (p&lt;0.05). ROM was significantly greater in Group A at 1 and 3 months (105.2° and 120.8°, p&lt;0.05). Quadriceps strength improved faster in group A at 3 months (MMT score: 4.0, p=0.04). Group A also had a shorter hospital stay (4.5 vs 5.8 days, p=0.01). Complications and long-term satisfaction were similar across both groups. Conclusion: The subvastus approach offers advantages in early recovery, including reduced pain, quicker ROM recovery, and shorter hospital stays. However, long-term outcomes are comparable between both approaches.

Quadriceps Strength Testing Practices & Barriers During Return to Sport from ACL Reconstruction: A Survey of Collegiate Athletic Trainers.

Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after ACL reconstruction (ACLR) surgery. 1) Describe the quadriceps strength testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. 2)Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings. Cross-sectional. Online survey. 243 full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past five years (age: 34.8±10.7, years of AT practice: 11.7±9.3, NCAA division I setting: 56%). Our survey included four sections: Demographics, General ACLR rehabilitation practices, Quadriceps strength testing methods & criteria, and Quadriceps strength testing barriers. Knee muscle strength was the most common (98%) outcome collegiate ATs use when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing (MMT) was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition max (RM) testing (35%) and handheld dynamometry (HHD) (22%). Most ATs (63-64%) used >90% side-to-side symmetry as their return to sport-specific activities criteria. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold-standard testing method. Compared to ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used MMT (47% vs 70%). While almost all college ATs considered knee muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps strength testing practices were highly variable among ATs and may be impacted by access to necessary resources.

Effect of serum 25-hydroxyvitamin D level on quadriceps strength: a systematic review and meta-analysis

BackgroundVitamin D deficiency has been linked to poor muscle function, cartilage degeneration, and the development of knee osteoarthritis. However, the impact of serum 25-hydroxyvitamin D [25(OH)D] level on quadriceps muscle strength remains inconclusive, largely due to variations in study designs, differences in study populations, and the influence of confounding factors such as co-supplementation with other vitamins. The existing literature presents mixed findings, highlighting the need for a comprehensive evaluation of the available evidence.PurposeThis systematic review and meta-analysis aim to summarise.Study designSystematic review; Level of evidence, 4.MethodsSearches were conducted using Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and SPORTDiscus (EBSCOhost), which aimed to summarise recent (published after 2000 and before March 1st, 2024) studies reporting the effects of serum 25(OH)D levels on quadriceps strength. Appraisal tool for Cross-Sectional Studies (AXIS) for cross-sectional studies and Quality in Prognosis Studies (QUIPS) for longitudinal studies. Results from the AXIS and QUIPS tools were used for GRADE quality assessment. The review was carried out using PRIMSA guidelines and registered in PROSPERO (ID: CRD42022313240).ResultsFour hundred studies were screened and 28 studies with 5752 participants were included. 28 published studies (24 cross-sectional and 4 longitudinal) were identified. Key results supported the significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength at 180°/s in elderly and athletic populations with a correlation coefficient of 0.245 (95%CI: 0.078–0.398, p = 0.004). However, no significant correlation was found with isometric quadriceps strength or isokinetic strength at 60°/s (r = 0.190, p = 0.085). There was only a weak negative correlation with MVC.ConclusionThis review found a statistically significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength. This has important clinical implications, especially in the elderly cohort, with higher 25(OH)D levels being associated with a reduced incidence of falls and fragility fractures.

Comparison of quadriceps and hamstring muscle strength ratios between dominant and non-dominant legs in Saudi under-17 and under-19 premier league football players: A cross-sectional study

Football’s global popularity is often overshadowed by frequent lower limb injuries, particularly hamstring strains, which are linked to imbalances in the strength ratio of hamstring-to-quadriceps (H/Q). Research on these factors among Saudi Premier League players, specifically in Madinah City, is limited. Our study is a cross-sectional study that assessed 42 male professional football players from Ohoud Football Club, divided into Underage 17 (UD- 17) and Under age 19 (UD-19) of age groups. The Strength of muscle for hamstrings and quadriceps, as well as the H/Q ratio, was measured using handheld dynamometers (HDD), and demographic data were analyzed using SPSSv26. Results showed that UD-19 players had significantly greater quadriceps strength on both dominants (dominant and non-dominant) sides compared to UD-17 players, with no significant differences in strength of hamstring. The ratio of hamstring to quadriceps was significantly higher in UD-17 players on the dominant side compared to UD-19 players, but statistically significant differences were not found on the non-dominant side. These results suggest that quadriceps strength develops with age and training, potentially reducing injury risk, while the strength of hamstring stabilizes earlier. Tailored training programs focusing on quadriceps strength and balanced hamstring development are recommended for improving injury prevention and performance. Future research involving larger and more diverse samples could further validate these findings and provide a deeper understanding of muscle dynamics in young football players.

Which technique provides more benefits in return to sports and clinical outcomes after anterior cruciate ligament reconstruction: Double-bundle or single-bundle? A randomized controlled study.

The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR). A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS. DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2=19.57, P<0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS (χ2=17.08, P<0.05). The RTS rate was influenced by SNQs of the graft's tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test (χ2=13.49, P<0.01), objective IKDC-2000 (χ2=27.02, P=0.002), and anterior instability test (χ2=9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57±7.72, CASBR: 83.00±12.71, ASBR: 83.21±11.95; F=10.452, P<0.01) and IKDC-2000score (DBR: 90.95±7.00, CASBR: 84.64±12.68, ASBR: 83.63±11.41; F=11.78, P<0.01). For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS. ClinicalTrials.gov (NCT05400460).

Patellar Tendon Reconstruction Using Quadriceps, Semitendinosus, and Gracilis Autografts With Ultra-high Molecular Weight Polyethylene Tape Augmentation: A Novel Technique

Background: Chronic patellar tendon ruptures are challenging injuries to treat and can be debilitating to patients. Optimal treatment of these extensor mechanism injuries occurs in the acute postinjury period. When these injuries become chronic, they are increasingly difficult to treat effectively. Purpose: We present a case of chronic patellar tendon rupture in a young athletic male who was treated with quadriceps, semitendinosus, and gracilis autograft. To our knowledge, there have been no other reports of using a quadriceps autograft with a bone plug to reconstruct a chronic patellar tendon injury. Patients and Methods: A healthy male under the age of 18 presented in a delayed manner to our clinic with complaints of left knee pain and inability to straighten the knee. His imaging and clinical exam found that he had a patellar tendon rupture, ∼15-degree extensor lag, flexion to 140 degrees, and was unable to straight leg raise or perform any active extension of the knee. He had significant atrophy of his vastus musculature at the knee. The rupture was treated with quadriceps, semitendinosus, and gracilis autograft. Results: At 6 months follow-up, our patient had achieved full extension, flexion to 135 degrees, and 4 of 5 quadriceps strength. He returned to routine physical activity and was satisfied with his results to date. At 1 year’s follow-up, the patient had full extension and flexion to 140 degrees and had resumed playing recreational soccer. Conclusion: Treating chronic patellar tendon rupture with quadriceps, semitendinosus, and gracilis autograft resulted in a positive outcome for this difficult-to-treat injury.

Quadriceps Muscle Geometry and Strength Throughout Maturation in National-Level Male Soccer Players: A Cross-Sectional Study.

Adolescent soccer players experience distinct physiological changes due to chronological and biological maturation, impacting their soccer performance. Here, we explored age-related variations and associations between quadriceps geometry and strength in male national-level adolescent soccer players. We used ultrasonography to examine the regional architecture and morphology of the rectus femoris (RF) and vastus lateralis (VL) muscles, and we assessed knee extension strength by isometric and isokinetic dynamometry. Players were categorized into four age groups: under (U) 15 (n=18, age=13.7±0.5 years), U16 (n=15, age=14.7±0.5), U17 (n=19, age=15.7±0.5), U18 (n=18, age=16.7±0.5) and U21 (n=25, age=18.5±0.5). The absolute and relative strengths were higher in the U16 compared to U15 by 12-15% and 6-8%, 11-12% and 6-7% in the U17 compared to U16, 5-7% and -1-2% in the U18 compared to U17 and 0-15% and -1-11% in the U21 compared to U18 age groups, respectively. VL architecture did not change relevantly between the age groups. The muscle anatomical cross-sectional area (ACSA) of the VL and RF differed non-uniformly and muscle region-specific by 10-36%, with highest values in the U21 age group. Moderate correlations between the VL architecture and knee extension strength in both legs were observed only in the U16 age group. The quadriceps ACSA showed age-specific correlations with knee extension strength. Our findings highlight non-uniform differences in quadriceps muscle morphology and absolute and relative strength among male national-level adolescent soccer players in different age groups. The correlations observed between muscle morphology or architecture and strength were muscle, muscle region, leg and age dependent.

Residual Performance and Biomechanical Asymmetries During Jumping Tasks in Female Athletes at 9 Months After Anterior Cruciate Ligament Reconstruction.

Biomechanics and anterior cruciate ligament injury mechanisms differ in males and females. There is a need for more data on between-limb biomechanical differences after anterior cruciate ligament reconstruction (ACLR) in females. To explore biomechanical asymmetries throughout the kinetic chain during the single-legged (SL) and double-legged (DL) countermovement jump (CMJ) and drop jump (DJ) in female athletes after ACLR. Descriptive laboratory study. Kinematic and kinetic between-limb differences were analyzed during the SL and DL CMJ and DJ in 67 female athletes 9 months after ACLR. Biomechanical and performance asymmetries between limbs during the jumps and isokinetic strength testing were analyzed with statistical parametric mapping. The entire stance phase was used for the paired t tests of the biomechanical variables, with Cohen d effect sizes of significant portions of the stance phase (reported as % of stance) calculated in a point-by-point manner. Decreased vertical ground-reaction force, internal knee abduction moment, knee internal rotation angle, hip external rotation angle, internal ankle eversion, and external rotation moments were seen in the ACLR limb during all 4 vertical jump tests. The greatest number and highest value of differences were found during the DLDJ, with asymmetries having medium to large effect sizes. They tended to appear more frequently in the concentric phase (50% to 100% of stance) during the SLCMJ and DLCMJ and in the eccentric (0% to 49% of stance) and concentric (50% to 100% of stance) phase during the SLDJ and DLDJ. For the SLCMJ, SLDJ, and quadriceps strength, performance asymmetries of >15% were detected but not for change of direction. The findings suggest that return-to-play testing in female athletes should examine the entire stance phase and include assessments of kinetic and kinematic variables throughout the kinetic chain. Greater deficits were highlighted in the DJ than in the CMJ, and greater performance asymmetries were evident in the SL tasks, with greater kinetic and kinematic and compensatory strategies evident in the DL tests. Biomechanical analysis focusing on contralateral compensation strategies and sex-specific interventions are necessary before return to play.

A majority of the patient achieved both patient-acceptable symptom state and minimal clinically important difference of International Knee Documentation Committee Subjective Knee Form score at one year after anatomical double-bundle anterior cruciate ligament reconstruction

ObjectivesThere is a paucity of data about clinical outcomes after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the concepts of patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID). The aim of the present study was to evaluate the one-year clinical outcomes of patients who underwent DB-ACLR using PASS and MCID. MethodsAchievement of PASS and MCID were retrospectively evaluated for 298 (mean age 26.9 years; 145 men/153 women) and 214 patients (mean age 23.9 years; 114 males/100 females), respectively, who underwent primary DB-ACLR using a hamstring autograft. For patients who achieved PASS or MCID, demographics, preoperative, and postoperative data were statistically analyzed. ResultsOf 298 patients, 254 (85.2 %) achieved International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) PASS, and 191 out of 214 patients (88.8 %) achieved MCID. The dichotomous logistic regression analyses to assess the achievement of PASS showed that younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93–0.99; P = 0.013), male sex (OR, 2.2; 95% CI, 1.08-4.83; P = 0.030), and better one-year quadriceps strength symmetry (OR, 1.05; 95% CI, 1.03-1.07; P < 0.001) were independent predictors of PASS achievement. For MCID, preoperative IKDC-SKF score below the 50th percentile (OR, 14.39; 95% CI, 2.90-71.25; P = 0.001) and better one-year quadriceps strength symmetry (OR, 1.035; 95% CI, 1.007-1.064; P = 0.014) were independent predictors for MCID achievement. ConclusionsMore than 85 % of the patients achieved PASS and MCID for the IKDC-SKF score one year after undergoing DB-ACLR with hamstring tendon autograft. Better quadriceps strength symmetry at one year contributed to the achievement of both PASS and MCID. Rehabilitation dedicated to quadriceps strength recovery may be important for achieving good clinical outcomes after DB-ACLR. Level of evidenceIV, retrospective cohort.

Autograft Choice and Jumping Performance After Anterior Cruciate Ligament Reconstruction: A Comparative Study on Professional Athletes.

The extensor apparatus of the knee is of paramount importance in generating the torque needed for a countermovement jump (CMJ), especially in jumping athletes. In anterior cruciate ligament reconstruction (ACLR) procedures, graft harvesting from the extensor apparatus may dramatically affect extensor strength and jumping performance. The focused jump training of professional jumping athletes would increase the likelihood of restoring jumping performance after ACLR, despite the graft choice (autologous bone-patellar tendon-bone [BPTB] or hamstring [HS] tendon). Cohort study; Level of evidence, 3. A retrospective evaluation of prospectively collected data was carried out. Only professional athletes were included, and all surgical procedures were performed by a single experienced surgeon. Data collection considered the type of surgery, sports activity, and functional evaluation at 3 months after surgery. From the functional evaluation, data on single-leg hop (SLH) test, triple hop (TH) test, and CMJ were extracted. Limb symmetry index (LSI) for maximal voluntary isometric contraction of the quadriceps and for each of the jumping tests was calculated. Multiple analysis of covariance (ANCOVA) models were used to assess mean differences among groups for the LSI in CMJ, SLH, and TH and estimate the effect of confounders. From a subsequent series of 208 athletes, 44 professional athletes were included for data collection. Of these, 26 were male and 18 were female. A jumping sport (basketball, volleyball) was played by 17 athletes, while a running sport (soccer, judo, rugby, tennis, ski) was performed by 27 athletes. The mean time from injury to surgery was 17.8 ± 14.5 days. At 90 days from surgery, the overall mean LSI for CMJ was 85.3% ± 8.9%, for SLH was 92.2% ± 6.4%, and for TH was 90.8% ± 6.1%. When ANCOVA was fitted using the interaction term with BPTB autograft and jumping sport, a nonsignificant effect on LSI for CMJ (P = .56), SLH (P = .72), and TH (P = .98) was observed. The results of the present investigation on professional athletes showed that no difference occurred within the study cohort in overall jumping performance between jumping and running athletes undergoing ACLR either with BPTB or with HS tendon grafts. Although some evidence suggests that quadriceps strength may be dramatically affected by the harvesting of BPTB, the overall performance of the jump was not compromised.

Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft.

To investigate sex-based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft. This study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12- and 24-month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type. Males reported significantly higher Tegner scores at 12 (p = 0.029) and 24 (p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 (p = 0.009) and 24 (p = 0.010) months, and a significantly higher lateral hop LSI at 12 (p = 0.045) months, knee extensor torque LSI at 12 (p = 0.020) months, and knee flexor torque LSI at 12 (p = 0.001) and 24 (p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 (p = 0.006) months, a lower lateral hop LSI at 12 (p = 0.038) months, and a lower medial hop LSI at 12 (p = 0.042) months. Females reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation. Level IV.

Association of the COVID-19 Pandemic With Outcomes After Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study Examining Changes in Health Care Access, Delivery, and Functional Outcomes.

Structured rehabilitation optimizes outcomes and reduces reinjury risk after anterior cruciate ligament reconstruction (ACLR). The coronavirus 2019 (COVID-19) pandemic interrupted standard rehabilitation, possibly affecting ACLR outcomes. To characterize changes to ACLR functional outcomes related to the COVID-19 pandemic. Cohort study; Level of evidence, 3. Patients who underwent ACLR between June 11, 2019, and March 11, 2020, (postpandemic group) were compared retrospectively with those who underwent ACLR the year before (June 11, 2018, to March 11, 2019). A mixed-effects linear regression model was used to estimate group differences in isokinetic quadriceps testing. A Kaplan-Meier analysis assessed the probability of achieving >90% limb symmetry index (LSI) for isokinetic quadriceps strength at 60 deg/s and passing all return-to-sport functional outcomes at 1 year postoperatively. A total of 176 patients (80 in the control group and 96 in the postpandemic group) were included. The rate of achieving >90% LSI in isokinetic strength at 60 deg/s at 1 year postoperatively was 39% (95% CI, 27%-49%) for the control group versus 22% (95% CI, 13%-30%) for the postpandemic group (P = .01). Similarly, the rate of achieving >90% LSI in all functional tests at 1 year postoperatively was 15% (95% CI, 7%-22%) for the control group versus 7% (95% CI, 2%-12%) for the postpandemic group (P = .04). The number of in-person physical therapy visits per patient was 25.8 ± 6.8 in the control group versus 24.4 ± 7.5 in the postpandemic group (P = .23). Only the postpandemic group accessed physical therapy using remote telemedicine. Each additional telehealth rehabilitation visit was associated with a 1-week delay in achieving >90% LSI in isokinetic quadriceps strength for the postpandemic group. The COVID-19 pandemic was associated with a decrease in lower extremity strength and a lower probability of achieving limb symmetry and passing the criteria for return to sport at 1 year postoperatively. These results were not due to lack of access to physical therapy.

Low-intensity blood flow restriction (LI-BFR) and moderate-intensity improves quadriceps strength and thigh circumference in older women

Background and objectives. Weakness and atrophy in the quadriceps femoris lead to decreased functional capacity, heightened fall risk, and increased mortality among older women. While moderate-intensity strength training is generally recommended for the elderly, higher-intensity exercises carry a greater risk of injury. Low-intensity exercises with blood flow restriction offer an alternative, providing comparable benefits to high-intensity training. This study aims to evaluate the effects of moderate-intensity and low-intensity blood flow restriction exercises on quadriceps femoris strength and thigh circumference in healthy elderly women. Materials and methods. The sample size was of 88 subjects equally randomized into a moderate-intensity group and a blood-flow restriction group. The moderate-intensity group performed strengthening exercises with a load of ≥40–60% of 1RM, 3 sets, 36 repetitions. The blood-flow restriction group conducted exercises at 20–30% of 1RM, completing 75 repetitions across 4 sets, using a pressure cuff applied to the upper thigh at 50 mmHg or 40% of the Arterial Occlusion Pressure (AOP). Both groups exercised twice a week over a 6-week period. Muscle strength (assessed via dynamometer and 1RM) and thigh circumference were recorded before and after the intervention. Results. After six weeks of intervention, both groups showed a significant increase in muscle strength and thigh circumference (p &lt;0.001). However, no notable differences were observed between the moderate intensity group and the blood flow restriction group regarding quadriceps strength (dynamometer), quadriceps 1RM strength, or thigh circumference (p &gt;0.05). Muscle soreness was reported in 18% of participants in the moderate intensity group. Conclusion. Low-intensity resistance exercises with blood flow restriction in older women can promote strength gains and muscle hypertrophy comparable to moderate-intensity training, while offering a safer alternative.

Simple Mobility Tests Predict Use of Assistive Devices in Older Adults.

Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.