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Objective: Our aim was to investigate the effect of body mass index (BMI) levels on quadriceps and hamstring strength and functional outcomes up to 6 months after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft (HTG)., Design: Prospective, controlled study., Setting: University clinical laboratory., Patients: Ninety-one participants who had undergone unilateral ACLR with HTG were divided into 2 groups according to their BMI. The participants whose BMI were between 18.5 and 24.9 kg/m were included in group 1 (n = 50, age: 27.2 ± 6.7 years, BMI: 22.3 ± 1.6 kg/m) and those whose BMI > 24.9 kg/m were included in group 2 (n = 41, age: 30.2 ± 6.9 years, BMI: 28.0 ± 2.4 kg/m)., Interventions: Quadriceps and hamstring strength, functional performance including hop, jump, and balance performance, and IKDC score., Main Outcome Measures: Maximum voluntary isometric contraction of the quadriceps and hamstring muscles and the body mass were measured at 1, 3, and 6 months after surgery. Absolute peak torques and normalized peak torques to body weight for both limbs were recorded. Functional outcomes were evaluated at 6 months after surgery., Results: Normalized quadriceps strength improvement was lower in group 2 when compared with group 1 (F(2,178) = 6.23, P = 0.003). Group 2 also demonstrated lower scores in functional performance (P < 0.05). Normalized hamstring and absolute quadriceps and hamstring strength improvement was not affected by higher BMI level (P > 0.05)., Conclusions: Higher BMI levels adversely affect quadriceps strength capacity and performance in patients who have undergone ACLR with HTG. Clinicians should consider BMI levels of patients when assessing and targeting muscle recovery because it could negatively affect the success of the ACLR rehabilitation.

The purposes of this study were to analyse (a) if "angle-specific" (AS) flexor and extensor torques were different between ACL-reconstructed and uninvolved limbs, (b) the difference in peak torque occurrence angles for concentric and eccentric knee flexor and extensor torques between involved and uninvolved limbs and (c) if AS concentric and eccentric knee flexor and extensor torques are determinants of performance in the "single-leg hop test" (SLHT) and "vertical jump and reach test" (VJRT) in ACL-reconstructed legs. Twenty-seven male ACL-reconstructed volunteers were included in the study. Isokinetic knee muscle strength, SLHT and VJRT were performed 6 months after ACL reconstruction. No difference was found in extremity and knee joint angle interaction for concentric and eccentric flexor and extensor torques (p > 0.05). Peak torque occurrence angles were not different between involved and uninvolved limbs (p > 0.05). In involved extremities, concentric knee extensor strength at 90° was a determinant of SLHT performance (R 2  = 0.403, p < 0.05), and concentric knee extensor strength at 60° was a determinant of VJRT (R 2  = 0.224, p < 0.05). Assessment of AS concentric knee extensor strength at 60° and 90° might be important, because these were determinants of functional test performance.

Background: The aim of this study was to investigate the relationship between self-reported knee outcomes and limb symmetry indices (LSIs) for hip and knee strength, postural control and single-leg hop distance in individuals who had undergone an anterior cruciate ligament (ACL) reconstruction via hamstring tendon autograft (HTG)., Methods: A total of 72 participants with a history of unilateral ACL reconstruction via HTG (mean ± standard deviation (SD) age: 28.0 ± 7.6 years; height: 178.4 ± 6.7 cm; mass 76.9 ± 14.9 kg) were included. International Knee Documentation Committee 2000 Subjective Knee Form (IKDC), Lysholm, Knee Osteoarthritis Outcomes Scores (KOOS) and Tampa scores were used to evaluate self-reported outcomes. Concentric and eccentric knee extensor and flexor, and hip strength, postural control and single leg hop distance were evaluated for performance-based outcomes. The relationships between the LSI scores and the performance measures were explored using the Pearson correlation coefficient., Results: The IKDC, Lysholm and KOOS scores were positively correlated with knee extensor and flexor strength LSIs (P < 0.05, r = 0.34 to r = 0.50), and the Tampa score was negatively correlated with eccentric extensor LSI (P = 0.02, r = -0.34). Single-leg hop distance LSI was correlated with IKDC and Lysholm scores (P = 0.003, r = 0.50; P = 0.04, r = 0.29) respectively, while postural control was only correlated with the KOOS scores (P < 0.001, r = 0.51 to r = 0.52)., Conclusions: Compared to Lysholm and Tampa scores, KOOS and IKDC scores were more likely to be correlated with performance-based outcomes. Therefore, KOOS and IKDC scores may help clinicians in return to sport decision making when there is a limited time to perform extensive evaluations or access equipment., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The objectives of this study were to investigate the effects of knee brace (KB) and kinesiotaping (KT) on functional performance and self-reported function in individuals six months post-ACLR who desired to return to their pre-injury activity levels but felt unable to do so due to kinesiophobia., Methods: This was a cross-sectional study involving 30 individuals six months post-ACLR with Tampa Kinesiophobia Scores >37. Individuals were tested under three conditions: no intervention, KB and KT in a randomized order. Isokinetic concentric quadriceps and hamstring strength tests, one leg hop test, star excursion balance test and global rating scale were assessed under the three conditions., Results: The involved side showed that KT and KB significantly increased the hop distance (P=0.01, P=0.04) and improved balance (P=0.01, P=0.04), respectively, but only KB was found to increase the quadriceps and hamstring peak torques compared to no intervention (P<0.05). Individuals reported having better knee function with KB when compared to no intervention (P<0.001) and KT (P=0.03)., Conclusions: Both KB and KT have positive effects in individuals post-ACLR which may assist in reducing kinesiophobia when returning to their pre-injury activity levels, with the KB appearing to offer the participants better knee function compared to KT., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Context: There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG)., Objective: To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time., Design: Longitudinal study., Participants: 24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft., Main Outcome Measures: The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery., Results: Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F2,46 = 58.3, P < .001; hamstring F2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F2,46 = 17.9, P < .001; hamstring F2,46 =56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17)., Conclusions: The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

Objective: The purpose of this study was to investigate the relationship of postural stability and lower extremity performance with core stability, knee laxity, and muscle strength in patients with anterior cruciate ligament reconstruction., Design: Twenty-eight anterior cruciate ligament-reconstructed subjects were included in the study. Anterior knee laxity tests, isokinetic knee muscle strength tests, and core stability tests were performed. Single-limb postural stability was assessed in both eyes-open and eyes-closed positions on a static surface and an eyes-open condition on a foam surface. A single-legged hop test was performed to assess lower extremity performance. To detect differences between the operated and healthy leg, a Mann-Whitney U test was performed, and a correlation analysis was performed using the Spearman correlation coefficient., Results: Knee muscle strength and laxity were different between the operated and healthy legs (P < 0.05). Postural stability scores correlated with core stability tests (P < 0.05) in both the operated and healthy legs. In the operated leg, knee laxity and muscle strength correlated with the mediolateral sway index on a foam surface (P < 0.05). Knee flexor and extensor muscle strength correlated with the single-legged hop for both legs (P < 0.05)., Conclusions: Decreased core stability, decreased knee muscle strength, and increased knee laxity correlated with single-limb postural stability. Better hop performance was demonstrated with better knee flexor and extensor muscle strength and was independent from core stability.

Purpose: The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction., Methods: Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 ± 7 years) or conventional rehabilitation (n = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine., Results: There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation., Conclusion: Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual-perceptual processing, coordination, proprioception and functional mobility.

Objective: In this study, we aimed to evaluate and compare the functional performance and muscle strength of cases of ACL reconstruction using bone-patellar tendon-bone graft followed by rehabilitation with those of healthy subjects., Methods: This study included fifteen patients (range: 20 to 35 years) who underwent ACL reconstruction 18 to 24 months previously and a control group of 15 healthy volunteers with similar characteristics. Cases were evaluated with physical examinations, functional tests, subjective scales (Lysholm, Hospital for Special Surgery Knee Score (HSSS), and Tegner activity scale) and isokinetic test. Differences between the reconstruction group and control group were analyzed., Results: Significant differences were found in the activity level of the reconstruction group (p<0.05) and in the clinical findings of the subjects with involved and uninvolved legs (p<0.05). When the reconstructed and control groups were compared according to the limb symmetry index, there were significant differences in single-leg hop test, timed hop test, shuttle run and stair hop test (p<0.05). The study also revealed a significant correlation between the vertical hop and quadriceps strength in the isokinetic test (r=0.56). When the operated knees were compared to the healthy side, mean limb symmetry index was over 92% (with two cases at 88%). When the dominant leg was compared to the non-dominant leg in the control group, the mean limb symmetry index was over 95%., Conclusion: Functional outcomes similar to those of healthy legs can be achieved following ACL reconstruction with bone-patellar tendon-bone grafting and rehabilitation. The similar functional test results of the operated and healthy subjects prove the effectiveness of the rehabilitation program.

Purpose: To evaluate muscle torque, lower extremity coordination, and knee laxity after ACL reconstruction comparing patients operated on with semitendinosus graft (ST) and patients with combined semitendinosus and gracilis (STGR) grafts., Methods: Forty-six subjects who underwent ST (n = 23) or STGR harvest (n = 23) ACL reconstruction participated in this study. Quadriceps and hamstring torque were recorded using an isokinetic dynamometer. The anterior tibial translation was measured using the Kneelax 3 Arthrometer. The eccentric and concentric motor coordination was tested by multi-joint lower-limb tracking-trajectory test. All measurements were taken 12 months after surgery. Side-to-side differences were determined for all subjects., Results: Side-to-side differences in extensor peak torque at 180°/s and 60°/s did not differ between semitendinosus (ST) and semitendinosus + gracilis (STGR) groups (n.s.). However, side-to-side differences in flexor peak torque were significantly higher at 60°/s for the STGR group than the ST group (P = 0.002). Side-to-side differences in eccentric and concentric parts of tracking-trajectory test and anterior tibial translation did not differ between the STGR and the ST groups (n.s.)., Conclusion: The outcomes of this study suggested that additional harvest of gracilis did not influence lower extremity motor control, quadriceps muscle torque, and anterior tibial translation; however, it affected knee flexion isokinetic torque negatively at low angular velocity. This finding could be important for functional activity or sports with high demands on hamstring muscle strength. It is recommended that gracilis muscle should be preserved as possible during ACL reconstruction., Level of Evidence: Prospective comparative study, Level II.