Midterm Quadriceps Strength Outcomes of Revision ACL Reconstructions Comparing Ipsilateral Extensor Mechanism...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Science

Background:

• Primary anterior cruciate ligament reconstructions (ACLRs) using extensor mechanism autografts (bone-patellar tendon-bone [BTB] or quadriceps tendon [QT]) are linked to reduced quadriceps strength symmetry 6 months post-surgery compared to hamstring tendon (HT) autografts.
• The impact of using an extensor mechanism autograft again for revision ACLR on quadriceps strength recovery remains unclear.

Purpose of the Study:

• To evaluate how the choice of autograft in ipsilateral revision ACLR influences the recovery of quadriceps limb symmetry index (Q-LSI) at 6 months post-revision.

Main Methods:

• A cohort of 53 patients undergoing revision ACLR were categorized into three groups based on their primary and revision autograft: hamstring to extensor (HT/Ext), extensor to hamstring (Ext/HT), and extensor to extensor (Ext/Ext).
• Quadriceps strength was assessed 6 months post-revision ACLR using an isokinetic dynamometer to calculate Q-LSI and quadriceps peak torque relative to body weight.
• Statistical analysis involved analyses of covariance within a multivariable linear regression framework, controlling for age, sex, body mass index, and time since surgery.

Main Results:

• Patients in the Ext/HT group demonstrated significantly higher Q-LSI (88%) at 6 months compared to the Ext/Ext (69%, P = .028) and HT/Ext (70%, P = .005) groups.
• No significant difference in Q-LSI was found between the Ext/Ext (69%) and HT/Ext (70%) groups at the 6-month follow-up (P = .99).

Conclusions:

• Revision ACLR utilizing an ipsilateral bone-patellar tendon-bone or quadriceps tendon autograft is associated with significantly lower quadriceps limb symmetry index values at 6 months postoperatively.
• These findings suggest that hamstring tendon autografts may offer superior quadriceps strength recovery in revision ACLR compared to extensor mechanism autografts, irrespective of the graft used in the primary surgery.