title: Comparison of knee flexion isokinetic deficits between seated and prone positions after ACL reconstruction with hamstrings graft: Implications for rehabilitation and return to sports decisions.
abstract: OBJECTIVE
  Hamstrings grafts are commonly used in ACL reconstruction, however, the effect of graft harvesting on knee flexion strength has not been longitudinally evaluated in functional positions. We hypothesized that greater deficits in knee flexion strength exist in the prone compared to the seated position and these deficits remain as rehabilitation progresses.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Forty-two consecutive patients who underwent ACL reconstruction with a hamstrings graft were followed prospectively for 9 months. Isokinetic knee flexion strength at a slow and a fast speed were collected at 3, 4, 6, and 9 months in two different positions: conventional (seated) and functional (0° of hip flexion).
  
  
  RESULTS
  Peak torque knee flexion deficits were higher in the prone position compared to the seated position by an average of 6.5% at 60°/s and 9.1% at 180°/s (p<0.001).
  
  
  CONCLUSIONS
  Measuring knee flexion strength in prone demonstrates higher deficits than in the conventional seated position. Most athletes would not be cleared to return to sports even at 9 months after surgery with this method.
authors.affiliation: Physical Therapy, Technological Education Institute of Thessaloniki, Greece. Electronic address: kutrasg@otenet.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Koutras
authors.affiliation: Klinik Sanssouci Potsdam-Berlin, Department of Orthopaedic Surgery, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Bernard
authors.affiliation: Ippokration General Hospital, Greece.
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Terzidis
authors.affiliation: Orthopaedics, General Hospital Papanikolaou, Aristotle University of Thessaloniki, Greece. Electronic address: perpap@otenet.gr.
authors.forename: Pericles
authors.initials: P
authors.lastname: Papadopoulos
authors.affiliation: Orthopaedic and Sports Medicine Center, Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Georgoulis
authors.affiliation: Orthopaedic and Sports Medicine Center, Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, Greece; Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia. Electronic address: Evangelos.pappas@sydney.edu.au.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Pappas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D001265:Athletic Injuries / Q000534:rehabilitation*; D005260:Female; D000070632:Hamstring Tendons / Q000637:transplantation; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D016684:Prone Position / Q000502:physiology; D011446:Prospective Studies; D016059:Range of Motion, Articular; D000068958:Return to Sport; D019415:Torque; D055815:Young Adult
keywords: Graft harvesting; Isokinetics; Return to sports; Strength