Effect of Meniscal Repair on Joint Loading in Athletes With Anterior Cruciate Ligament Reconstruction at 3 Months Following Surgery.

CONTEXT: Joint loading following anterior cruciate ligament reconstruction (ACL-R) is thought to influence long-term outcomes. However, our understanding of the role of meniscus repair at the time of ACL-R on early joint loading is limited. OBJECTIVE: To assess if differences in total energy absorption and energy absorption contribution of the hip, knee, and ankle exist in the early stages of rehabilitation between patients who received an isolated ACL-R and those with concomitant meniscal repairs. DESIGN: Cross-sectional. SETTING: Clinical laboratory. PATIENTS: Fifty-nine human subjects, including 27 who underwent ACL-R and 32 who underwent ACL-R with concomitant meniscal repairs. MAIN OUTCOME MEASURE: The total energy absorption and the energy absorption contribution of each joint of both the involved and uninvolved limbs during a double-limb squat task. RESULTS: There were significant differences in energy absorption contribution between groups at the knee joint (P = .01) and the hip joint (P = .04), but not at the ankle joint (P = .48) of the involved limb. Post hoc analysis indicates that preoperative hip and knee loading differences exist and when you control for preoperative loading (analysis of covariance), the postsurgery difference was not significant. CONCLUSIONS: The results of the study suggest that the additional surgical procedure of MR may not have had negative effects on joint loading during squatting at 12 weeks.

Quadriceps strength changes across the continuum of care in adolescent male and female athletes with anterior cruciate ligament injury and reconstruction.

OBJECTIVES: To examine the quadriceps strength (QUADS) on the surgical (SURG) and non-surgical (Non-SURG) limbs in adolescent male and female athletes at pre-operative (PRE), 12 weeks post-operative (12WK), and return to sport (RTS) time points following ACL injury and reconstruction. DESIGN: Prospective cohort study design. SETTING: Clinical Research Laboratory. PARTICIPANTS: 66 adolescent athletes. MAIN OUTCOME MEASURES: Isokinetic QUADS of the SURG and Non-SURG limbs at the PRE, 12WK, and RTS time points were assessed and compared between each time point. RESULTS: Both male and female participants had significantly lower 12 WK QUADS in the SURG limb than the PRE QUADS, but the RTS QUADS was significantly greater than the 12WK QUAD (p < 0.05). However, only female participants had greater RTS QUADS as compared to the PRE QUADS (p < 0.001). For the Non-SURG limb, only male participants had a significant improvement over time (PRE vs RTS; p < 0.001). CONCLUSION: Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.

Energy Absorption Contribution and Strength in Female Athletes at Return to Sport After Anterior Cruciate Ligament Reconstruction: Comparison With Healthy Controls.

BACKGROUND: Female patients are more likely to suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) compared with healthy female controls. Few studies have examined the energy absorption contribution (EAC) that could lead to this subsequent injury. HYPOTHESIS: The ACLR group would demonstrate an altered EAC between joints (hip, knee, and ankle) but no difference in quadriceps, hip abduction, or hip external rotation (ER) strength at the time of RTS. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 34 female participants (ACLR: n = 17; control: n = 17) were enrolled in the study and matched for age and activity level. Jump landing performance for the initial 50 milliseconds of landing of a lateral-vertical jump was assessed using a 10-camera 3-dimensional motion capture system and 2 force plates. Isokinetic quadriceps strength was measured using a Biodex machine, and hip abduction and ER isometric strength were measured using a handheld dynamometer. All values were normalized to the participant's height and weight. A 1-way multivariate analysis of variance was used to assess between-group differences in the EAC at the hip, knee, and ankle. Two 1-way analyses of variance were used to independently examine quadriceps, hip abduction, and hip ER strength between the groups. RESULTS: Significant differences in the EAC were found between the groups for the involved hip (P = .002), uninvolved hip (P = .005), and involved ankle (P = .023). There were no between-group differences in the EAC for the involved or uninvolved knee or the uninvolved ankle. Patients who underwent ACLR demonstrated significantly decreased quadriceps strength on the involved limb (P = .02) and decreased hip ER strength on both the involved (P = .005) and uninvolved limbs (P = .002). No significant strength differences were found between the groups for the uninvolved quadriceps or for involved or uninvolved hip abduction. CONCLUSION: At RTS, patients who underwent ACLR utilized a greater hip EAC bilaterally and a decreased involved ankle EAC during a lateral-vertical jump. Furthermore, quadriceps strength on the involved limb and hip ER strength of bilateral lower extremities remained decreased. This could place greater stress on the ACL graft and ultimately lead to an increased injury risk.