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STRENGTH RECOVERY AND FUNCTIONAL OUTCOMES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON VERSUS HAMSTRING TENDON AUTOGRAFTS IN SOCCER PLAYERS: A RANDOMIZED CONTROL TRIAL
ESSKA Academy. MARTIN ALGUACIL J. May 11, 2018; 218187
José Luis MARTIN ALGUACIL
José Luis MARTIN ALGUACIL
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Abstract
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Objectives: To prospectively compare strength recovery and functional outcomes of anatomic single bundle reconstruction (ACLR) with hamstrings (HT) and Quadriceps (QT) autografts in competitive soccer players.The main hypothesis of this study is that ACLR with HT and QT yield similar knee stability, functional results and extension muscle strength recovery with a significant deficit in isokinetic hamstring muscle strength in patients who had an ACLR with a HT compared to patients who had ACLR with QT.

Methods: 56 participants were enrolled in this randomized controlled trial and placed into two groups: HT or QT. Both groups followed the same staged rehabilitation protocol, performed by the same team of physiotherapists. Patients were evaluated previous to surgery and 3,6 and 12 months after surgery for isokinetic testing , anteroposterior laxity and functional assessment (Lyshom knee scoring scale) which was also evaluated at 24 months after the surgery. Hamstring/quadriceps (H/Q) ratio was the primary end-point measured with a Genu 3 dynamometer. Peak torque (at 60, 180 and 300 degrees/second), and anteroposterior laxity (KT-2000 TM arthrometer) were also assessed.Intention-to-treat analysis was performed.

Results: The results of the H/Q ratio analysis of the participants over time revealed significant differences at 60, 180 and 300 deg/s at 3,6 and 12 months of follow-up (60deg/s: F= 5,3, p= 0,005; 180 deg/s: F= 5,5, p= 0,004; 300 deg/s: F= 5,1, p= 0,005) and revealed significant differences at 60 deg/s, 180 deg/s, and 300 deg/s in the participants over time for peak torque in extensor muscle strength at 3 and 6 months of follow-up, with higher values in the quadriceps tendon group but not at 12 months follow-up. There were no significant differences in functional endpoints or arthrometer assessments.

Conclusions: ACLR with QT graft showed similar functional results at 24 months follow up with a better isokinetic H/Q ratio at 3,6 and 12 months compared to ACLR with HT in soccer players. This higher H/Q ratio observed with QT could be an advantage of this graft over HT for ACLR.

Keywords:
ACL, QUADRICEPS, HAMSTRINGS, ISOKINETIC,GRAFT
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