title: The evaluation of muscle recovery after anatomical single-bundle ACL reconstruction using a quadriceps autograft.
abstract: OBJECTIVE
  The purpose of this study was to reveal the degree of muscle recovery and report the clinical results of anatomical single-bundle ACL reconstruction using a quadriceps autograft.
  
  
  METHODS
  Twenty subjects undergoing anatomical single-bundle ACL reconstruction using a quadriceps autograft were included in this study. A 5-mm-wide, 8-cm-long graft, involving the entire layer of the quadriceps tendon, was harvested without bone block. The average graft diameter was 8.1 ± 1.4 mm. An initial tension of 30 N was applied. The femoral tunnel was created from the far-medial portal. Each femoral and tibial tunnel was created close to the antero-medial bundle insertion site. For the evaluation of muscle recovery (quadriceps and hamstring), a handheld dynamometer was used. The evaluation of muscle recovery was performed pre-operatively, and at 3, 6, 9, and 12 months after surgery. Muscle recovery data were calculated as a percentage of leg strength in the non-operated leg. Anterior tibial translation (ATT), pivot shift test, and IKDC score were evaluated.
  
  
  RESULTS
  The average quadriceps strength pre-operatively, and at 3, 6, 9, and 12 months after ACL reconstruction was 90.5 ± 19, 67.8 ± 21.4, 84 ± 17.5, and 85.1 ± 12.6 %, respectively. The average hamstring strength pre-operatively, and at 3, 6, 9, and 12 months after ACL reconstruction was 99.5 ± 13.7, 78.7 ± 11.4, 90.5 ± 19, and 96.7 ± 13.8 %, respectively. ATT pre-operatively and at 12 months after surgery was 5.4 ± 1.3 and 1.0 ± 0.8 mm, respectively. No subjects exhibited positive pivot shift after surgery. Within 6 months following surgery, quadriceps hypotrophy was observed in all subjects. However, the hypotrophy had recovered at 12 months following surgery. No subjects complained of donor site pain after surgery.
  
  
  CONCLUSIONS
  Anatomical single-bundle ACL reconstruction using a quadriceps autograft resulted in equivalent level of muscle recovery and knee stability when compared with previously reported ACL reconstruction using hamstrings tendon with no donor site complications.
  
  
  METHODS
  Case controlled study, Level III.
authors.affiliation: Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan. sekaiwoseisu@yahoo.co.jp.
authors.forename: Takanori
authors.initials: T
authors.lastname: Iriuchishima
authors.affiliation: Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
authors.forename: Keinosuke
authors.initials: K
authors.lastname: Ryu
authors.affiliation: Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan.
authors.forename: Tatsumasa
authors.initials: T
authors.lastname: Okano
authors.affiliation: Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suruga
authors.affiliation: Departments of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Aizawa
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburg, PA, USA.
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D064592:Autografts; D016022:Case-Control Studies; D005260:Female; D005269:Femur / Q000601:surgery; D000070633:Hamstring Muscles / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D052097:Quadriceps Muscle / Q000503:physiopathology* / Q000637:transplantation; D020127:Recovery of Function; D013710:Tendons / Q000637:transplantation; D013977:Tibia / Q000601:surgery; D014182:Transplantation, Autologous
keywords: Anatomical; Anterior cruciate ligament; Muscle recovery; Quadriceps tendon