Muscle Strength and Functional Performance in Patients With Anterior Cruciate Ligament Injury Treated With Training and Surgical Reconstruction or Training Only: A Two to Five-Year Followup

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To study muscle strength and functional performance in patients with anterior cruciate ligament (ACL) injury with or without surgical reconstruction 2 to 5 years after injury. Good muscle function is important in preventing early-onset osteoarthritis (OA), but the role of reconstructive surgery in restoring muscle function is unclear.


Of 121 patients with ACL injury included in a randomized controlled trial on training and surgical reconstruction versus training only (the Knee, Anterior cruciate ligament, NON-surgical versus surgical treatment [KANON] study, ISRCTN: 84752559), 54 (mean age at followup 30 years, range 20–39, 28% women) were assessed a mean ± SD of 3 ± 0.9 years after injury with reliable, valid, and responsive test batteries for strength (knee extension, knee flexion, leg press) and hop performance (vertical jump, one-leg hop, side hop). The Limb Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) value and absolute values were used for comparisons between groups (analysis of variance). An LSI ≥90% was considered normal.


There were no differences between the surgical and nonsurgical treatment groups in muscle strength or functional performance. Between 44% and 89% of subjects had normal muscle function in the single tests, and between 44% and 56% had normal function in the test batteries.


The lack of differences between patients treated with training and surgical reconstruction or training only indicates that reconstructive surgery is not a prerequisite for restoring muscle function. Abnormal muscle function, found in approximately one-third or more of the patients, may be a predictor of future knee OA.

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