Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices

Alli Gokeler, Marsha Bisschop, Anne Benjaminse, Gregory Myer, Bert Otten

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: To determine the most effective practices for quadriceps strengthening after ACL reconstruction. Methods: An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist. Results: From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group. Conclusions: The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements. Level of evidence: II. © 2013 Springer-Verlag Berlin Heidelberg.

Keywords

  • muscle strength
  • rehabilitation

Cite this

@article{4f814d4c41594f0e929af96c23e1a850,
title = "Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices",
abstract = "Purpose: To determine the most effective practices for quadriceps strengthening after ACL reconstruction. Methods: An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist. Results: From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group. Conclusions: The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements. Level of evidence: II. {\circledC} 2013 Springer-Verlag Berlin Heidelberg.",
keywords = "muscle strength, rehabilitation, spierkracht, rehabilitatie",
author = "Alli Gokeler and Marsha Bisschop and Anne Benjaminse and Gregory Myer and Bert Otten",
year = "2014",
doi = "10.1007/s00167-013-2577-x",
language = "English",
volume = "22",
pages = "1163--1174",
journal = "Knee surgery, sports traumatology, arthroscopy : official journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy",
issn = "1433-7347",
publisher = "Springer",
number = "5",

}

Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices. / Gokeler, Alli; Bisschop, Marsha ; Benjaminse, Anne; Myer, Gregory; Otten, Bert.

In: Knee surgery, sports traumatology, arthroscopy : official journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, Vol. 22, No. 5, 2014, p. 1163-1174.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices

AU - Gokeler, Alli

AU - Bisschop, Marsha

AU - Benjaminse, Anne

AU - Myer, Gregory

AU - Otten, Bert

PY - 2014

Y1 - 2014

N2 - Purpose: To determine the most effective practices for quadriceps strengthening after ACL reconstruction. Methods: An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist. Results: From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group. Conclusions: The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements. Level of evidence: II. © 2013 Springer-Verlag Berlin Heidelberg.

AB - Purpose: To determine the most effective practices for quadriceps strengthening after ACL reconstruction. Methods: An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist. Results: From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group. Conclusions: The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements. Level of evidence: II. © 2013 Springer-Verlag Berlin Heidelberg.

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