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Quadriceps and Hamstring Muscle Strength Recovery After a Multiligament Knee Injury: A Long-term Follow-up
Ingrid Trøan1,2, Inger Holm3, Gilbert Moatshe1,2,3
1Orthopaedic Division, Oslo University Hospital, Oslo, Norway.
The American Journal of Sports Medicine
|August 12, 2026
Summary
Multiligament knee injury (MLKI) surgery often results in persistent quadriceps and hamstring strength deficits, impacting functional recovery. Bicruciate injuries show worse outcomes than single cruciate injuries years after surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Rehabilitation Science
Background:
- Multiligament knee injuries (MLKIs) are severe and diverse, frequently causing long-term functional impairments.
- Limited research exists on objective muscle strength and functional recovery post-MLKI surgical treatment.
Purpose of the Study:
- To assess long-term quadriceps and hamstring muscle strength and functional recovery after MLKI surgical treatment.
- To compare postoperative outcomes between single cruciate MLKI and bicruciate MLKIs.
Main Methods:
- A cross-sectional study (Level 3 evidence) included patients surgically treated for MLKI.
- Isokinetic strength testing (Biodex) and hop tests (single-leg, triple hop, crossover hop, 6-m timed hop) were used to calculate limb symmetry index (LSI).
Main Results:
- At a mean 7-year follow-up, 54% lacked full quadriceps strength (LSI <90%) and 46% had hamstring deficits.
- Mean quadriceps LSI was 88% (60 deg/s) and 90% (240 deg/s); hamstring LSI was 93% (60 deg/s) and 97% (240 deg/s).
- Bicruciate injuries showed significantly lower 6-m timed hop scores and quadriceps strength compared to single cruciate injuries.
Conclusions:
- Persistent quadriceps and hamstring strength deficits are common 7 years post-MLKI surgery, with many patients not achieving full functional symmetry.
- Bicruciate MLKIs result in more significant muscle strength and hop performance deficits compared to single cruciate injuries.
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