Article Text

Download PDFPDF

110 Pronounced quadriceps weakness with quadriceps tendon graft compared to patellar or hamstrings tendon graft for anterior cruciate ligament reconstruction
  1. David Holmgren1,2,
  2. Shiba Noory1,
  3. Eva Moström1,2,
  4. Hege Grindem1,3,
  5. Anders Stålman1,2,
  6. Tobias Wörner1,2,4
  1. 1Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Sweden
  2. 2Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, Sweden
  3. 3Oslo Sport Trauma Research Center, Norway
  4. 4Department of Health Sciences, Lund University, Sweden


Introduction Impaired quadriceps muscle function following ACL reconstruction (ACLR) is associated with worse clinical outcomes and risk of re-injury. Yet, we know very little about quadriceps muscle function in patients reconstructed with quadriceps tendons (QT), a graft with increasing popularity worldwide. The purpose of this study was to describe and compare isokinetic quadriceps strength in patients undergoing ACLR with QT, hamstrings tendon (HT) or patellar tendon (BPTB) autograft.

Materials and Methods In this cross-sectional study we included QT-patients (n=104) and matched them to BPTB - (n=104) and HT-patients (n=104) according to age, gender, and associated meniscus surgeries (Mean time from ACLR [SD]: 7 months [1]). Data were collected through clinical follow up routines and the Swedish ACL registry. Isokinetic strength was measured at 90°/seconds and expressed through leg symmetry index (LSI). Group differences were assessed by analysis of variance with post-hoc pair wise comparison.

Results QT patients had significantly lower peak knee extension torque than BPTB- (Mean LSI difference [95%CI]: -6,9% [-11,2 to -2,7], p = <0.01) and HT-patients (Mean LSI difference [95%CI],: -17,4% [-21,7 to -13,2], p = <0.01). None of the graft groups reached a mean LSI in peak knee extension torque of >90% [Mean LSI [95%CI]: QT = 67,5% [64.8–70.1]; BPTB = 74,4% [72–76.9)]; HT = 84,9% [82.4–87.4].

Conclusion Seven months following ACLR, patients operated with QT-grafts present with significantly worse isokinetic quadriceps strength than patients operated with BPTB- and HT grafts. None of the three groups reached an LSI of >90% in quadriceps strength.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.