Summary

A retrospective chart review of differences in maximal and reactive strength between injured and uninjured limbs of athletes who underwent isolated ACLR and those who underwent ACLR-LEAT.

Abstract

Background

Recently there has been a resurgence of interest in lateral, extra-articular ITB tenodesis (LEAT) to augment ACLR in an attempt to reduce the residual laxity that may be present post isolated ACLR and subsequently improve surgical outcomes. Adding a LEAT procedure to an isolated ACLR surgery adds to the surgical morbidity and raises the concern of decreasing maximal quadriceps strength and may lead to a significant reduction in lower limb reactive strength and hence plyometric ability ahead of returning to play (RTP).

Objectives: The objective of our study was to identify differences in maximal quadriceps strength and reactive strength, with isokinetic and biomechanical 3D Laboratory testing at 6-8 months post-operatively, between athletes who undergo isolated ACLR and those who had ACLR-LEAT surgery.

Methods

This is a single surgeon, retrospective chart review of 68 athletes, matched for gender, age and activity level, who underwent isolated ACLR or ACLR-LEAT. All athletes completed their isokinetic and 3D motion capture assessments between 6 and 8 months post-operatively in our Biomechanical Laboratory. Each athlete’s isokinetic scores alongside their double leg drop jump (DLDJ) and bilateral single leg drop jump (SLDJ) results were documented and analysed.

Results

There was no statistically significant difference between the two groups for maximal quadriceps strength (P = 0.86; ) or for LSI for either muscle group (P=0.95,) . Reactive strength was significantly higher for DLDJ and bilateral SLDJ in the ACLR group (P = 0.018; P=0.009; P= 0.014).

Conclusions

In our isokinetic and biomechanical analysis we observed no statistically significant difference in the maximal strength between uninjured and injured limbs for isolated ACLR athletes and ACLR-LEAT athletes. Between 6-8 months, reactive strength was significantly higher in the isolated ACLR athletes. This is of clinical relevance for surgical decision making regarding augmenting ACLR with LEAT, as well as, prescription of plyometric end stage rehabilitation and RTP timelines.