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Isokinetic Evaluation of Internal/External Tibial Rotation Strength After the Use of Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

Tanya Armour, PhD^*,, Lorie Forwell, MSc, PT, Robert Litchfield, MD, FRCSC, Alexandra Kirkley, MD, FRCSC, Ned Amendola, MD, FRCSC and Peter J. Fowler, MD, FRCSC

From the Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada, and the University of Iowa, Iowa City, Iowa

^* Address correspondence to Tanya Armour, PhD, 2858 Woodcock Blvd., Koger Office Center, Atlanta, GA 30341.

Background: Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to internal tibial rotation weakness.

Hypothesis: Internal tibial rotation strength may be affected by the semitendinosus and gracilis harvest after anterior cruciate ligament reconstruction.

Study Design: Prospective evaluation of internal and external tibial rotation strength.

Methods: Inclusion criteria for subjects (N = 30): unilateral anterior cruciate ligament reconstruction at least 2 years previously, a stable anterior cruciate ligament (<5-mm side-to-side difference) at time of testing confirmed by surgeon and KT-1000 arthrometer, no history of knee problems after initial knee reconstruction, a normal contralateral knee, and the ability to comply with the testing protocol. In an attempt to minimize unwanted subtalar joint motion, subjects were immobilized using an ankle brace and tested at angular velocities of 60°/s, 120°/s, and 180°/s at a knee flexion angle of 90°.

Results: The mean peak torque measurements for internal rotation strength of the operative limb (60°/s, 17.4 ± 4.5 ft-lb; 120°/s, 13.9 ± 3.3 ft-lb; 180°/s, 11.6 ± 3.0 ft-lb) were statistically different compared to the nonoperated limb (60°/s, 20.5 ± 4.7 ft-lb; 120°/s, 15.9 ± 3.8 ft-lb; 180°/s, 13.4 ± 3.8 ft-lb) at 60°/s (P = .012), 120°/s (P = .036), and 180°/s (P = .045). The nonoperative limb demonstrated greater strength at all speeds. The mean torque measurements for external rotation were statistically similar when compared to the nonoperated limb at all angular velocities.

Conclusions: We have shown through our study that patients who undergo surgical intervention to repair a torn anterior cruciate ligament with the use of autogenous hamstring tendons demonstrate with weaker internal tibial rotation postoperatively at 2 years when compared to the contralateral limb.

Key Words: anterior cruciate ligament (ACL) • internal tibial rotation • isokinetic evaluation • strength

This article has been cited by other articles:

				R. T. Ruland, C. J. Hogan, C. J. Randall, A. Richards, and S. M. Belkoff Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques Am. J. Sports Med., August 1, 2008; 36(8): 1565 - 1570. [Abstract] [Full Text] [PDF]