The Clinical Utility of Strength Measures in Predicting Patient Progression Following ACLR
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Prognostic indicators of lack of strength progression or poor self-reported function may alter rehabilitation decision-making following anterior cruciate ligament reconstruction (ACLR). The torque-velocity relationship is a noninvasive measure of muscle function that is altered following ACLR, but its prognostic value has not been explored. Purpose: To compare the torque-velocity relationship of knee extensors (quadriceps) and flexors (hamstrings) between the ACLR and uninvolved limbs and to determine whether the torque-velocity relationship was prognostic of subsequent achievement of satisfactory strength. Study Design: Cohort study; Level of evidence, 3. Methods: Participants following ACLR with bone–patellar tendon–bone or hamstring autografts completed isokinetic knee extension and flexion at 90°/s and 180°/s bilaterally, the International Knee Documentation Committee (IKDC) form, and Knee injury and Osteoarthritis Outcome Score (KOOS) at approximately 5.5 and 8.3 months post-ACLR. The torque-velocity relationship was defined as the difference in torque production across velocities, and relationships were analyzed using 2 × 2 analyses of variance. Binomial logistic regressions were used to determine the association between the torque-velocity relationship, age, sex, and time postsurgery with satisfactory knee extension strength, IKDC, and KOOS at visit 2. Results: This study included 189 participants (22.4 ± 9.3 years; 55.0% female). There were significant increases in the quadriceps torque-velocity relationship from visit 1 (0.22 Nm/kg) to visit 2 (0.34 Nm/kg, P < .001) but no differences in the uninvolved limb ( P = .46) or for the hamstrings ( P = .20). When controlling for sex, age, and graft type, higher visit 1 quadriceps torque-velocity relationships were predictive of a higher likelihood of achieving satisfactory knee extension strength (≥1.23 Nm/kg; odds ratio [OR], 1.05; P = .04). The model was associated with an acceptable IKDC score (≥75.9, P = .01), but the only significant individual predictor was age (OR, 0.94; P < .01). The model was not associated with KOOS Sport score at visit 2 ( P = .24). Conclusion: Quadriceps torque-velocity relationships of the ACLR limbs increased across time but remained less than uninvolved limbs. Hamstrings torque-velocity relationships remained similar between limbs and across time. These findings indicate that the torque-velocity relationship of the quadriceps changed over time and was predictive of future satisfactory strength. Clinical Relevance: Clinicians may use a greater quadriceps torque-velocity relationship as a positive indication of a patient's ability to achieve satisfactory strength later in rehabilitation.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
Funders: Europäischer Sozialfonds, American Foundation for Suicide Prevention, Patient-Centered Outcomes Research Institute, Takeda Science Foundation, Deutsche Bundesstiftung Umwelt, Helsingin Yliopisto, Suomen Lääketieteen Säätiö, Uehara Memorial Foundation, Education Department of Hunan Province, Japan Agency for Medical Research and Development, Yrjö Jahnssonin Säätiö, Fondation Pour l'Audition, European Commission, Agency for Science, Technology and Research, University College Dublin, Deutsche Forschungsgemeinschaft, Ministry of Education, Culture, Sports, Science and Technology, University of Sydney, Fundação de Amparo à Pesquisa do Estado de São Paulo, National Natural Science Foundation of China, Fundacja na rzecz Nauki Polskiej, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Kela, China Postdoctoral Science Foundation, Fondation pour la Recherche Médicale, Suomen Kulttuurirahasto, Ministero della Salute, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, Science and Technology Commission of Shanghai Municipality, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão, Juho Vainion Säätiö, Karolinska Institutet, Knut och Alice Wallenbergs Stiftelse, Vetenskapsrådet, Tabriz University of Medical Sciences, Thüringer Aufbaubank, Riksbankens Jubileumsfond, Ministerstwo Edukacji i Nauki, Österreichische Forschungsförderungsgesellschaft, Sydäntutkimussäätiö, Vedecká Grantová Agentúra MŠVVaŠ SR a SAV, Natural Science Foundation of Tianjin City, Russian Science Foundation, Natural Science Foundation of Shandong Province, Paulon Säätiö, UBS Optimus Foundation, Paavo Nurmen Säätiö, Novo Nordisk Fonden, Liga Portuguesa Contra o Cancro, Diabetestutkimussäätiö, Sabzevar University of Medical Sciences, Gemeinsame Bundesausschuss, Universitas Padjadjaran, BioTechMed-Graz, Korea Research Environment Open Network, Gandel Foundation, National Institutes of Health, National Nuclear Security Administration, Engineering and Physical Sciences Research Council, Biotechnology and Biological Sciences Research Council, Economic and Social Research Council, National Health and Medical Research Council, Cancer Council Victoria, European Regional Development Fund, National Key Research and Development Program of China, Fundamental Research Funds for the Central Universities, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Biomedical Imaging and Bioengineering, Uniwersytet Gdański
OpenAlex ID: W7119037017