Establishing normal variances and expectations for quadriceps limb symmetry index benchmarks based on time from surgery after anterior cruciate ligament reconstruction

Review written by Dr Teddy Willsey info

Key Points

  1. Patients undergoing anterior cruciate ligament reconstruction (ACLR) with a bone-tendon-bone (BTB) autograft are estimated to achieve 70% limb symmetry index at 4.1 months, 80% at 7.1 months, and 90% at 10.2 months.
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BACKGROUND & OBJECTIVE

There are conflicting findings regarding the relationship between passing return to sport (RTS) tests and the risk of second anterior cruciate ligament (ACL) injury (1,2). Although RTS testing is not a panacea, experts agree utilizing a criterion-based approach with a multitude of tests is critical for optimizing outcomes (3). A 2019 paper on athletes’ expectations post ACLR showed 88% of first-time patients (n = 675) expected to return to their pre-injury level. Notably, only 24% of these patients had reached their pre-injury level at one year, and 15% had already decided to give up sport (4). There appears to be a mismatch between expectations and reality.

Recent data suggests only 65% of post ACLR athletes are returning to their preinjury level of sport while over 75% of the patients who are attempting to RTS are doing so prematurely (5,6).

The purpose of this investigation was to evaluate quadriceps strength percentage and functional benchmarks at various post op time intervals in patients undergoing ACLR.

Experts agree utilizing a criterion-based approach with a multitude of tests is critical for optimizing return to sport outcomes.
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Individual therapists need to utilize dynamometry testing and familiarize their patients with the sobering normative data on anterior cruciate ligament reconstruction return to sport.

METHODS

  • The authors used a REDCap database to collect demographic and outcomes data on 164 patients (98 female, 66 male) with an average age of 31.
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