Objectives: The aim of the study was to compare the Hamstring: Quadriceps (H:Q ) ratio between operated and non-operated limbs in three subject groups: isolated ACL reconstruction, ACL reconstruction and meniscectomy, and ACL reconstruction and meniscal repair.
Method: Ethical approval was obtained from the Galway Clinic Ethics Committee. Data was retrospectively analysed from patients who underwent an ACL reconstruction using a hamstring tendon graft and had isokinetic testing carried out 5 months post-operatively. H:Q ratio at the 60°/second speed was measured using an Isokinetic machine.
Results: Retrospective data from 133 patients was included in the study. 41 subjects had an isolated ACL reconstruction (30 male, 11 female, mean age 26.5 years), 45 patients had an ACL reconstruction and menisectomy (36 male, 9 female, mean age 27.5 years), and 47 patients had ACL reconstruction and meniscal repair (11 female, 36 male, mean age 26.5 years).
SPSS statistics package was used for data analysis. One-way ANOVA was used for comparison across the three subject groups (significance p<0.05). In group 1, p=0.01, indicating significant difference, with the non-operated limb showing a lower H:Q ratio than the operated limb. There was no significant difference in the other groups (p=.302 and p=.157). When comparing H:Q ratio of each subject group to the normative value of 60%, the patients who had an isolated ACL reconstruction had the closest mean H:Q ratio to normal (56.89%).
Discussion: The results show that patients who underwent isolated ACL reconstruction surgery had a better H: Q ratio 5 months post surgery than patients who underwent ACL reconstruction and menisectomy or meniscal repair respectively. The H:Q ratios of the non-operated limb were lower than the operated limb in the three subject groups.
Conclusions: This study suggests that patients who have ACL reconstruction without associated meniscal surgery tend to have better H: Q ratio 5 months post-operatively. Poor H: Q ratio may indicate an imbalance of opposing muscle groups, thus predisposing the knee joint to potential poor technique and injury. This study also found that the operated limb tended to have better H:Q ratios than non-operated limb, indicating that rehabilitation needs to focus on both lower limbs post-operatively.
References: 1Frobell, R., Roos, H., Roos, E., Roemer., Ranstam, J., Lohmander, L., (2013) ‘Treatment for aute anterior cruciate ligament tear: five year outcome of randomised trial’, BMJ 2013;346:f232.
2Lee, D., Lee, J., Jeong, H., Lee, S., (2015) ‘Serial changes in knee muscle strength after anterior cruciate ligament reconstruction using hamstring tendon autografts’, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 31 (5), 890-895.
3Kim, D., and Hong, J., (2011) ‘Hamstring to quadriceps strength ratio and noncontact leg injuries: A prospective study during one season’, Isokinetics and Exercise Science, 19, 1-6.
Ethical Approval: Ethical approval was obtained from the Galway Clinic Ethics Committee.
