A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Study Eligibility
2.3. Literature Search
2.4. Study Selection and Data Abstraction
2.5. Risk of Bias Assessment
2.6. Data Analysis
3. Results
3.1. General Overview
3.2. Risk of Bias
3.3. Combined Outcomes
3.3.1. Three Months
3.3.2. Six Months
3.3.3. Twelve Months
3.3.4. Twenty-Four Months
3.4. Return to Sport and Rehabilitation Protocols
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author (Year) Study Design | Objective | Participants | Rehabilitation Procedures (Duration) | Outcomes Measures | Evaluation Follow-Up | Participants Gender n (%) | Principal Findings |
---|---|---|---|---|---|---|---|
Cavaignac, E., et al., 2017 [48] Cohort study | To compare isokinetic strength test of HTA and QTA, stability, functional outcomes scores, anterior knee pain and reoperation rate. | 95 patients QTA; n = 45; 32.1 ± 8 years HTA; n = 41; 30.9 ± 9 years. | – | Functional outcome (KOOS, Tegner and IKDC), Joint stability KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. | 6 and 43 months post-surgery | QTA: 55% male HTA: 58% male | The use of a QTA graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HTA graft, without affecting morbidity. |
Csapo, R., et al., 2019 [41] Retrospective cohort study | To assess the fitness of elite alpine skiers during recovery from ACL reconstruction and changes in performance level after return to competition. | 46 athletes; QTA; n = 21; HTA; n = 25. | – | Isokinetic dynamometry, back in action test battery (knee function after ACL recovery), VAS Functional outcome (Lysholm score, Tegner activity scale) | 15 days, 6, 12, and 24 months post-surgery | 20 male vs. 26 female | The rate of recovery of knee extensor muscle function may be slower following ACL reconstruction using QTA. On overage, athletes returned to competition within one year after surgery and succeeded in surpassing their baseline performance level within the first year after return to competition. |
Fischer, F., et al., 2018 [42] Randomized Controlled Study | To compare isokinetic strength test for Quadriceps in who received either QTA or HTA autografts at two-time intervals within the first year after surgery. | 124 patients QTA; n = 61; 21.7 ± 7.4 years, HTA; n =63; 21.5 ± 6.9 years. | Isometric and closed chain exercises, bicycling running and sport-specific exercises post-operatively. | Isokinetic strength test. | 5.5- and 7.6-months post-surgery | QTA: male 34 (55.7). HTA: male 47 (74.6) | ACL reconstruction with a QTA autograft have a significantly higher H/Q ratio within one year after surgery compared to the HTA group. |
Guney-Deniz, H., et al., 2020 [45] Cross-sectional, case–control study | To compare isokinetic strength test, the active joint position sense and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with QTA, HTA, TAA and healthy individuals. | 67 subjects QTA; n = 22; 27.8 ± 2.8 years, HTA; n = 24; 26.7 ± 4.6 years, ATT; n = 21 26.4 ± 5.5 years, Control; n = 20 28.7 ± 3.1 years. | Post-operative protocol includes progressive quadriceps femoris strengthening with neuromuscular electrical stimulation, and neuromuscular control exercise training. | Isokinetic strength test and active joint position sense assessments | 13.5 months post-surgery | – | Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. QTA group may be more likely to actively over-estimate knee position near terminal extension. |
Han, H.S., et al., 2008 [43] Retrospective comparative study | To compare the clinical outcomes of anterior cruciate ligament reconstructions using QTA and PTA autografts. | 144 patients QTA; n = 72; 27.8 (15–51) * years, PTA; n = 72; 27.8 (15–51) * years | – | knee stability (KT-1000), Functional outcome (Lysholm and IKDC) and Isokinetic strength test. | Pre-surgery, 6, 12 and 24 months | QTA: 68 male vs PTA: 68 male. | QTA group showed clinical outcomes comparable to PTA group with anterior knee pain beingless severe in the former. The data indicate the quadriceps tendon can be a good alternative graft choice. |
Hunnicut, J.K., et al., 2019 [49] Cohort Study | To compare quadriceps recovery and functional outcomes in patients with QTA versus PTA autografts. | 30 patients QTA; n = 15; 25.0 (14.0–41.0) years PTA; n = 15; 18.0 (15.0–32.0) years | – | Isometric and isokinetic strength testcentral Activation, MRI, Spatiotemporal Gait Hop Test and Functional outcome (IKDC, Lysholm, and KOOS) | 8 months post-surgery | QTA: male 12 vs. PTA: male 7 | Patients with QTA autografts demonstrated similar short-term quadriceps recovery and postsurgical outcomes compared with patients with PTA autografts. |
Lee, J.K., et al., 2016 [15] Cohort study | To compare functional outcomes and knee joint stability of anatomic ACL reconstruction with double-bundle hamstring tendon and bone–quadriceps tendon autografts | 96 patients QTA; n = 48; 31.1 (17–57) * years, HTA; n = 48; 29.9 (17–58) * years | Post-operative protocol includes quadriceps-strengthening, continuous passive motion, open kinetic chain exercise and kinetic exercises. (6 months) | Knee stability (Manual laxity test, KT-2000) Functional outcome (IKDC, Tegner activity score, modified Lysholm score), anterior knee pain questionnaire, Isokinetic strength test and tunnel position evaluation by quadrant method. | Pre-surgery and 6 weeks, 3, 12 and 24 months post-surgery | QTA: male 44. PTA: male 44 | QTA group showed similar knee stability and functional outcomes when compared with the HTA autograft. Better flexor muscle strength recovery was found in the QTA, indicating a potential advantage of the QTA autograft in ACL reconstruction. |
Martín-Alguacil, J.L., et al., 2018 [44] Randomized Controlled Study | To compare the strength recovery and functional outcomes of an anatomic single bundle reconstruction with QTA and HTA autografts in competitive soccer players. | 51 participants QTA; n = 26; 18.7 ± 3.6 years, HTA; n = 25; 19.2 ± 3.6 years. | Both groups followed the same pre-and-post rehabilitation protocol based on muscular strength, endurance and neuromuscular control. (24 weeks) | Isokinetic strength test Function outcome (Lysholm knee score and Cincinnati Knee Rating System) and knee stability with KT-2000. | Pre-surgery and 3, 6, 12 and 24 months post-surgery | QTA: male 23 (88.5). HTA: male 16 (54.0) | QTA group showed similar functional outcome results with a better isokinetic H/Q ratio compared to HTA group at 12 months of follow-up in soccer players. |
Pigozzi E., et al., 2004 [14] Prospective randomized study | To compare the isokinetic recovery of thigh strength after ACL reconstruction by using patellar or quadriceps tendon as a graft. | 48 patients QTA; n = 24; 33 (21–47) years PTA; n = 24 35 (23–41) * years | Post rehabilitation program: continuous passive motion, walking, swimming, cycling and running at the end of 6 months. (6 months) | Counter movement jump, leg press, knee stability (KT-1000) and isokinetic strength tests. | Pre-surgery and 6 months post-surgery. | QTA: 17 male vs. PTA: 19 male | Significant improvement of the lower limb strength deficit using QTA compared to PTA that could encourage the use of QTA in order to achieve an easier rehabilitation and a faster Return to sport. |
Sinding, K.S., et al., 2020 [47] Prospective randomized controlled clinical trial | To investigate the effects of QTA vs. HTA on thigh muscle strength and functional capacity, and a patient-reported outcome 1 year after ACL-R, and to compare the results to healthy controls. | 150 patients QTA; n = 50; 128.7 ± 6.4 years, HTA; n = 50; 28.3 ± 6.2 years, CON; n = 50; 28.3 ± 6.2 years | Post rehabilitation program: days 1–14: full support to pain threshold, free movement, no bandages; weeks 3–12: frequent movement exercises supervised by a physiotherapist, bicycle ergometer, full weight bearing; months 4–9: running allowed; months 10–12: contact sports. allowed. (12 months) | Isokinetic strength test, one leg hop test and Functional outcome with IKDC | 12.5 months post-surgery | QTA: male 25 (60%) HTA: male 23 (53%) vs. CON: male 27 (54%) | HTA leading to impairments of knee extensor and knee flexor muscle strength, while QTA results in more pronounced impairments of knee extensor only. Functional capacity and functional outcome was unaffected by autograft type, with the former showing impairment compared to healthy controls. |
D1 | D2 | D3 | D4 | D5 | D6 | D7 | Overall Judgement | |
---|---|---|---|---|---|---|---|---|
Cavaignac E., et al., 2017 [48] | Serious | Low | Low | Low | Serious | Low | Low | Serious |
Csapo R., et al., 2019 [41] | Moderate | Moderate | Low | Low | Low | Low | Serious | Serious |
Fischer F., et al., 2018 [42] | Moderate | Low | Low | Low | Low | Low | Low | Moderate |
Han H.S., et al., 2008 [43] | Serious | Low | Low | Low | Critical | Low | Moderate | Critical |
Guney-Deniz H., et al., 2020 [45] | Serious | Low | Low | Low | Low | Low | Low | Serious |
Hunnicutt J.L., et al., 2019 [49] | Serious | Low | Low | Low | Low | Low | Moderate | Serious |
Lee J.K., et al., 2016 [15] | Serious | Moderate | Low | Low | Low | Low | Moderate | Serious |
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Herbawi, F.; Lozano-Lozano, M.; Lopez-Garzon, M.; Postigo-Martin, P.; Ortiz-Comino, L.; Martin-Alguacil, J.L.; Arroyo-Morales, M.; Fernandez-Lao, C. A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts. Int. J. Environ. Res. Public Health 2022, 19, 6764. https://doi.org/10.3390/ijerph19116764
Herbawi F, Lozano-Lozano M, Lopez-Garzon M, Postigo-Martin P, Ortiz-Comino L, Martin-Alguacil JL, Arroyo-Morales M, Fernandez-Lao C. A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts. International Journal of Environmental Research and Public Health. 2022; 19(11):6764. https://doi.org/10.3390/ijerph19116764
Chicago/Turabian StyleHerbawi, Fahed, Mario Lozano-Lozano, Maria Lopez-Garzon, Paula Postigo-Martin, Lucia Ortiz-Comino, Jose Luis Martin-Alguacil, Manuel Arroyo-Morales, and Carolina Fernandez-Lao. 2022. "A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts" International Journal of Environmental Research and Public Health 19, no. 11: 6764. https://doi.org/10.3390/ijerph19116764