Table 4.
Postoperative Quadriceps Volume and Strength After ACLR Stratified by Intervention Typea
| Study Author (Year) | Primary or Revision ACLR | Target Intervention | ACLR Graft Type | Outcome Measure | Follow-up Period After ACLR | Difference in Results |
|---|---|---|---|---|---|---|
| Perioperative femoral nerve block | ||||||
| Abdallah1 (2016) | Primary | Perioperative FNB vs ACB | BTB, n = 29 STG, n = 71 |
24-hour analgesic consumption, VAS scores, MVIC | 1 day | FNB group had significantly lower MVIC and a significantly larger percentage reduction at 45 minutes after block; no patients reported persistent weakness at 1 week. |
| Magnussen24 (2017) | Not indicated | Perioperative FNB vs no nerve block | STG all patients | KOOS, isokinetic quadriceps strength testing | 6 months | KOOS and quadriceps strength (limb symmetry) were lower for the FNB group at 6 weeks only. |
| Okoroha27 (2018) | Primary | Perioperative FNB vs liposomal bupivacaine | BTB, n = 31 STG, n = 12 |
Isokinetic quadriceps strength, functional testing | 9 months | No significant differences were seen between the block and control groups; 13% of the FNB patients had persistent motor/sensory complications at follow-up. |
| Runner30 (2018) | Primary | Perioperative FNB vs ACB | QTB, n = 58 BTB, n = 3 TAA, n = 10 QTA, n = 2 |
Analgesic consumption, time to straight-leg raise, isokinetic strength testing | 6 months | No significant differences were seen between the FNB and ACB groups for any measures. |
| Intraoperative tourniquet use | ||||||
| Kokki17 (2000) | Not indicated | 250 mm Hg vs 350 mm Hg tourniquet during ACLR | BTB all patients | Peroneal nerve MCV and SCV; EMG of vastus medialis | 3 weeks | No significant difference was observed between groups; both groups had significant, detrimental EMG/NCS changes postoperatively. |
| Appell2 (1993) | Not indicated | 400 mm Hg tourniquet during ACLR | STG all patients | Alterations in muscle structure of vastus lateralis biopsies | 1 day | Identifiable muscle damage was present at 15 minutes after tourniquet inflation and continued to worsen during surgery. |
| Nicholas25 (2001) | Primary | Tourniquet (300 mm Hg) vs no tourniquet during ACLR | BTB all patients | Thigh and calf circumference, isometric plantarflexion and dorsiflexion strength | 6 months | Significantly greater decrease in thigh girth occurred in the tourniquet group. |
| Faggal11 (2015) | Primary | Tourniquet (350 mm Hg) vs no tourniquet during ACLR | STG all patients | Pain; hemarthrosis; drainage; isokinetic hamstring and quadriceps strength; thigh and calf circumference | 6 months | Experimental group had significantly greater drainage, hemarthrosis, early pain, and smaller calf and thigh girth at 2 weeks. |
| Arciero3 (1996) | Primary | Tourniquet (269 mm Hg) vs no tourniquet for ACLR | BTB all patients | Thigh and calf girth, EMG, creatine phosphate levels, arthrometry, single-leg hop, Lysholm knee score, quadriceps and hamstring isokinetic testing | 1 year | No significant differences were noted. |
| Postoperative supplement use | ||||||
| Tyler33 (2004) | Not indicated | Creatine supplements after ACLR | BTB all patients | Isokinetic strength of quadriceps, hamstring, hip flexor, abductors, and adductors; isokinetic power of quadriceps, hamstring | 6 months | No significant differences were observed. |
| Laboute19 (2013) | Not indicated | Leucine supplements during 2- to 3-week period 200 days after ACLR | STG, n = 39 BTB, n = 5 |
Thigh perimeter, flexor and extensor isokinetic strength, single-leg testing, body fat percentage | 2-3 weeks (all patients 6-7 months after ACLR) | Experimental group had significantly larger thigh circumference 10 cm proximal to the patella. |
| Barker6 (2009) | Not indicated | Vitamin E and C supplements preoperatively until after ACLR | STG, n = 19 BTB, n = 1 |
Antioxidant levels, thigh circumference, muscle fiber circumference, muscle cytokine levels, single-leg power, single-leg isometric force | 3 months | Experimental group had no significant difference in outcome measures; patients with higher baseline vitamin C levels had significant positive correlation with muscle strength recovery. |
| Postoperative blood flow restriction training | ||||||
| Takarada31 (2000) | Not indicated | Blood flow restriction after ACLR | Not indicated | Knee extensor and flexor CSA on MRI | 2 weeks | Significantly less extensor CSA loss was observed in experimental group at POD 14. |
| Iverson15 (2016) | Primary | Blood flow restriction during exercises after ACLR | STG all patients | Quadriceps CSA on MRI | 2 weeks | No significant difference was observed at POD 14. |
| Ohta26 (2003) | Not indicated | Blood flow restriction during exercises after ACLR | STG all patients | Knee extensor and flexor torque; extensor, flexor, and adductor CSA on MRI; muscle fiber diameter | 4 months | Experimental group had significant increase in strength, larger extensor CSA. |
aACB, adductor canal block; ACLR, anterior cruciate ligament reconstruction; BTB, bone-tendon-bone graft; CSA, cross-sectional area; EMG, electromyography; FNB, femoral nerve block; KOOS, Knee injury and Osteoarthritis Outcome Score; MCV, motor conduction velocity; MRI, magnetic resonance imaging; MVIC, maximal voluntary isometric quadriceps contraction; NCS, nerve conduction study; POD, postoperative day; QTA, quadriceps tendon allograft; QTB, quadriceps tendon autograft; SCV, sensory conduction velocity; STG, semitendinosus and gracilis graft (hamstring graft); TAA, tibialis anterior allograft; VAS, visual analog scale.