Strength and function recovery after multiple-ligament reconstruction of the knee

The advent of modern arthroscopic techniques has lead to widespread surgical repair of multiligament injuries of the knee. Although functional outcomes may be linked to the recovery of strength and range of movement, studies have failed to report objective measures of strength recovery. The primary aim of this study was to describe the recovery of isokinetic quadriceps and hamstrings' strength. The secondary aims were to describe the recovery of movement and function.

Isokinetic muscle dynamomentry was performed by a research physiotherapist. Range-of-movement and patient-reported outcome measures (International Knee Documentation Committee (IKDC), Short Musculoskeletal Function Questionnaire (SMFA) and Knee injury and Osteoarthritis Outcome Score (KOOS)) were also evaluated.

At 2 years, quadriceps peak torque had recovered to 85% of the uninjured side and hamstrings were 90%. Hamstring recovery was faster than quadriceps, but at final recovery there were no overall differences between muscle group recovery (p=0.194). Patients obtained a mean 135° of flexion. The KOOSs showed that sporting and quality of life factors recovered more slowly. Although 95% of patients returned to work, 20% had to change types of employment. Median time to return to work was 8 weeks. Nearly one-third (30%) of patients returned to their original level of sport at 2 years.

Muscle strength improves after multiple ligament reconstruction. There is no difference in outcomes for different muscle groups at 2 years. Deficits persist in comparison with the uninjured limb. A proportion of patients will be unable to return to the pre-injury occupation or sporting ability.