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1ComparisonofKneeStability,StrengthDeficits,andFunctionalScoreinPrimaryandRevisionAnteriorCruciateLigamentReconstructedKneesDoKyungKim1,GeonPark1,KamarulzamanBinHajiM.
S.
Kadir2,Liang-TsengKuo3&WonHahPark1Comparingtoprimarysurgery,revisionACLreconstructionismoretechnicallydemandingandhasahigherfailurerate.
Theoretically,rehabilitationcanimprovekneefunctionafterACLreconstructionsurgery.
Thisstudyaimedtocomparekneestability,strength,andfunctionbetweenprimaryandrevisionACLreconstructedknees.
40primaryand40revisionACLreconstructionsurgerieswereincludedbetweenApril2013andMay2016.
Patientswithrevisionsurgeryhadahigheranteroposteriortranslationcomparingthosewithprimaryreconstruction(medianlaxity,2.
0mmvs.
3.
0mm,p=0.
0022).
Nodifferenceswerenotedinkneeextensorat60°/secor180°/sec(p=0.
308,p=0.
931,respectively)orinflexormusclestrengthat60°/secor180°/secbetweenprimaryandrevisionACLreconstructionknees(p=0.
091,p=0.
343,respectively).
TherewerealsonosignificantdifferencesbetweenfunctionalscoresincludingIKDCscoreandLysholmscoreinprimaryversusrevisionsurgeriesat12thmonthsafterindexoperation(p=0.
154,p=0.
324,respectively).
Inconclusion,despitehavinghigheranteroposteriorinstability,patientswithrevisionACLreconstructioncanhavenon-inferioroutcomesinisokinetickneestrengthandfunctioncomparedtothosewithprimaryACLreconstructionafterproperrehabilitation.
Anteriorcruciateligamentreconstruction(ACLR)surgeryisacommonproceduretoimprovefunctionalstabilityafterananteriorcruciateligament(ACL)injury.
ThesuccessfulrateofprimaryACLRisapproximatedtobe75%to97%amongpatients1,2.
Thismeansthatalmostone-fourthofprimaryACLRsurgeriesboundtofaildespiteimprovedsurgicalmethods3.
ThecausesassociatedwithfailedACLRsurgeryaresurgicalfactorsandrepetitiveinjurytotheknee4,5.
Amongthesepatients,approximately2.
9to8.
9%underwentthefollowingrevisionACLRsurgery6,7.
ComparedtoprimaryACLRsurgery,revisionsurgeryismoretechnicallydemanding.
Inrevisionsurgery,accessibilitytooriginaltunnelsisakeyfactorofsuccesssincetheremovalofhardwareisoftenrequiredandbonegraftingislikelytobenecessary8.
Thiscontributestoanestimated35%failurerateofrevisionACLRsurgery,whichtranslatedtoapproximately54%ofpatientsreturningtopre-injurylevels9.
Therefore,withthesetechnicaldifficulties,thesuccessrateofrevisionACLRsurgeryiscommonlylesscomparedtoprimaryACLRsurgery10.
Inadditiontoregainthejointstability,thegoalofACLRsurgeryisalsotorecoverthefunctionofthekneejointandmusclestrength10.
Tomaximizetheoutcomesofsurgeryandenhancethefunctionalrecovery,anappro-priaterehabilitationprogramisincorporatedintotheroutinepostoperativecare.
TheimpairedkneefunctionsassociatedwithACLinjuryincludeinstabilityindynamicmovementandquadricepsweakness.
Asbeingcriticaltodynamicjointstability,thequadricepsmuscleweaknesseventuallyleadstodecreasedkneefunction,andpoor1DepartmentofSportsMedicine,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,Seoul,Korea.
2DepartmentofOrthopaedicSurgery,HospitalTengkuAmpuanRahimahKlang,MinistryofHealth,Selangor,Malaysia.
3DepartmentofOrthopaedicSurgeryandSportsMedicineCenter,ChangGungMemorialHospital,Chiayi,Taiwan.
Liang-TsengKuoandWonHahParkcontributedequallytothiswork.
CorrespondenceandrequestsformaterialsshouldbeaddressedtoL.
-T.
K.
(email:light71829@gmail.
com)orW.
H.
P.
(email:pk90007@naver.
com)Received:11January2018Accepted:1June2018Published:xxxxxxxxOPEN2exerciseperformance,andmaycontributeearlyonsetofosteoarthritis11–13.
Thus,thestrengthofmusclearoundthekneejoint,especiallythequadricepsmuscle,wasthemaintargetoftrainingandkeepindicatorformonitor-ingthefunctionalrecoveryafterACLRsurgery13.
Thus,toevaluatethesuccessofprimaryACLRsurgery,jointstability,musclestrengthandkneefunctionwerecommonoutcomesreportedinpreviousstudies1,10,11.
However,therewerelimitedstudieswhichhaveassessedmusclestrengthrecoveryfollowingrevisionACLRsurgery.
Thus,weperformedthisstudytoassessthestabilityandfunctionalrecoveryafterprimaryandrevisionACLRsurgeryunderthescheduledrehabilitationprogram.
Thisstudyaimedto(1)comparerecoveryofkneeextensormuscle(quadriceps)andflexormuscle(hamstring)strengthinprimaryversusrevisionACLRsurgery,and(2)compareclinicalfunctionalandstabilityoutcomesinprimaryversusrevisionACLRsurgery.
ResultsDemographics.
Therewere80maleparticipantsincludedinthisstudy.
Therewerenostatisticallysignificantdifferencesinage,heightandbodyweightbetweenprimaryandrevisiongroups(p=0.
538,p=0.
105,p=0.
969respectively)(Table1).
Ligamentstability.
TheAPlaxitybetweengroupswasstatisticallydifferent(p=0.
0022)(Fig.
1).
Themedianlaxitywas2.
0mm(IQR,1.
0mm–2.
5mm)inprimarygroupand3.
0mm(IQR,2.
0mm–3.
25mm)inrevi-siongroup.
APlaxitybetweeninvolvedandhealthylimbwasalsorecorded.
Fortheprimarygroup,thedifferencewas5mminnoneofthecases.
Fortherevisiongroup.
Thediffer-encewas5mmin5cases.
Thedegreeofside-to-sidelaxitydifferencewassignificantlydifferentbetweentwogroups(X2test,p5mm0(0%)5(12.
5%)Table2.
Anteroposteriorligamentlaxity.
Resultsareshownasnumberwithpercentage.
Chi-Squaredtest:p0.
80atanalphalevelequalto0.
05wasusedtodeterminethatasamplesizeof35foreachgroupwasnecessarytodetermineinKT-2000arthrometryvalue32.
AlldatastatisticalanalysiswasperformedusingSPSSversion13.
0(SPSSInc.
,Chicago,IL,USA).
Chi-SquaredtestandMann-WhitneyUtestwereusedthroughouttocomparevariablesbetweentwogroups,withpPaessler,H.
H.
Anteriorcruciateligamentrevisionreconstruction:resultsin107patients.
AmJSportsMed36,851–860(2008).
6.
Muneta,T.
etal.
Revisionanteriorcruciateligamentreconstructionbydouble-bundletechniqueusingmulti-strandsemitendinosustendon.
Arthroscopy26,769–781(2010).
7.
Wolf,R.
S.
&Lemak,L.
J.
Revisionanteriorcruciateligamentreconstructionsurgery.
JournaloftheSouthernOrthopaedicAssociation11,25–32(2002).
8.
Group,M.
etal.
DescriptiveepidemiologyoftheMulticenterACLRevisionStudy(MARS)cohort.
AmJSportsMed38,1979–1986(2010).
9.
Busfield,B.
T.
,Safran,M.
R.
&Cannon,W.
D.
ExtensorMechanismDisruptionAfterContralateralMiddleThirdPatellarTendonHarvestforAnteriorCruciateLigamentRevisionReconstruction.
Arthroscopy21,1268(2005).
10.
Gifstad,T.
,Drogset,J.
O.
,Viset,A.
,Grontvedt,T.
&Hortemo,G.
S.
InferiorresultsafterrevisionACLreconstructions:acomparisonwithprimaryACLreconstructions.
KneeSurgSportsTraumatolArthrosc21,2011–2018(2013).
11.
Kim,D.
K.
,Hwang,J.
H.
&Park,W.
H.
Effectsof4weekspreoperativeexerciseonkneeextensorstrengthafteranteriorcruciateligamentreconstruction.
JPhysTherSci27,2693–2696(2015).
12.
Muaidi,Q.
I.
,Nicholson,L.
L.
,Refshauge,K.
M.
,Herbert,R.
D.
&Maher,C.
G.
Prognosisofconservativelymanagedanteriorcruciateligamentinjury:asystematicreview.
SportsMed37,703–716(2007).
13.
Slemenda,C.
etal.
Quadricepsweaknessandosteoarthritisoftheknee.
AnnInternMed127,97–104(1997).
14.
Thomas,N.
P.
,Kankate,R.
,Wandless,F.
&Pandit,H.
Revisionanteriorcruciateligamentreconstructionusinga2-stagetechniquewithbonegraftingofthetibialtunnel.
AmJSportsMed33,1701–1709(2005).
15.
Wright,R.
etal.
RevisionACLreconstructionoutcomes:MOONcohort.
JKneeSurg24,289–294(2011).
16.
Wright,R.
W.
etal.
Outcomeofrevisionanteriorcruciateligamentreconstruction:asystematicreview.
JBoneJointSurgAm94,531–536(2012).
17.
Aune,A.
K.
,Holm,I.
,Risberg,M.
A.
,Jensen,H.
K.
&Steen,H.
Four-strandhamstringtendonautograftcomparedwithpatellartendon-boneautograftforanteriorcruciateligamentreconstruction.
AmJSportsMed29,722–728(2001).
18.
Drogset,J.
O.
etal.
Autologouspatellartendonandquadrupledhamstringgraftsinanteriorcruciateligamentreconstruction:aprospectiverandomizedmulticenterreviewofdifferentfixationmethods.
KneeSurgSportsTraumatolArthrosc18(8),1085–1093(2010).
19.
Matsumoto,A.
etal.
Acomparisonofbone-patellartendon-boneandbone-hamstringtendon-boneautograftsforanteriorcruciateligamentreconstruction.
AmJSportsMed34(2),213–219(2006).
20.
Mohtadi,N.
G.
,Chan,D.
S.
,Dainty,K.
N.
&Whelan,D.
B.
Patellartendonversushamstringtendonautograftforanteriorcruciateligamentruptureinadults.
CochraneDatabaseSystRev9,CD005960,https://doi.
org/10.
1002/14651858.
CD005960.
pub2(2011).
21.
Ahn,J.
H.
&Choi,H.
J.
Arthroscopicanteriorcruciateligamentreconstructionusingbone-patellartendon-boneautograft.
JournaloftheKoreanOrthopaedicAssociation35,375–380(2000).
22.
Harner,C.
D.
etal.
Allograftversusautograftanteriorcruciateligamentreconstruction:3-to5-yearoutcome.
Clin.
Orthop.
Relat.
Res.
324,134–144(1996).
23.
Tibor,L.
M.
etal.
Clinicaloutcomesafteranteriorcruciateligamentreconstruction:ameta-analysisofautograftversusallografttissue.
SportsHealth2,56–72(2010).
24.
Weiler,A.
,Schmeling,A.
,Stohr,I.
,Kaab,M.
J.
&Wagner,M.
Primaryversussingle-stagerevisionanteriorcruciateligamentreconstructionusingautologoushamstringtendongrafts:aprospectivematched-groupanalysis.
AmJSportsMed35,1643–1652(2007).
25.
Battaglia,M.
J.
etal.
Resultsofrevisionanteriorcruciateligamentsurgery.
AmJSportsMed35,2057–2066(2007).
26.
Denti,M.
etal.
Revisionanteriorcruciateligamentreconstruction:causesoffailure,surgicaltechnique,andclinicalresults.
AmJSportsMed36,1896–1902(2008).
27.
Keays,S.
L.
,Bullock-Saxton,J.
E.
,Newcombe,P.
&Bullock,M.
I.
Theeffectivenessofapre-operativehome-basedphysiotherapyprogrammeforchronicanteriorcruciateligamentdeficiency.
PhysiotherResInt11,204–218(2006).
28.
Uribe,J.
W.
,Hechtman,K.
S.
,Zvijac,J.
E.
&Tjin-A-Tsoi,E.
W.
Revisionanteriorcruciateligamentsurgery:experiencefromMiami.
Clin.
Orthop.
Relat.
Res.
325,91–99(1996).
29.
Myer,G.
D.
etal.
Therelationshipofhamstringsandquadricepsstrengthtoanteriorcruciateligamentinjuryinfemaleathletes.
ClinJSportMed19,3–8(2009).
30.
Peters,G.
,Wirth,C.
&Kohn,D.
Comparisonofkneeligamentscoresandratingsystems.
ZOrthopundIhreGrenzgeb135,63–69(1997).
31.
Lysholm,J.
&Gillquist,J.
Evaluationofkneeligamentsurgeryresultswithspecialemphasisonuseofascoringscale.
AmJSportsMed10,150–154(1982).
32.
Anderson,A.
F.
,Snyder,R.
B.
&Lipscomb,A.
B.
Anteriorcruciateligamentreconstruction.
Aprospectiverandomizedstudyofthreesurgicalmethods.
AmJSportsMed29,272–9(2001).
AuthorContributionsD.
K.
K.
andW.
H.
P.
designedthestudyanddirectedtheproject.
D.
K.
K.
andG.
P.
performedthetestandrecordedthedata.
D.
K.
K.
andL.
T.
K.
analyzedthedataandpreparedthetablesandfigures.
D.
K.
K.
,G.
P.
andK.
B.
H.
M.
K.
wrotethepaper.
D.
K.
K.
,G.
P.
andL.
T.
K.
contributedtointerpretationoftheresults.
Allauthorsprovidedcriticalfeedbackandhelpedshapetheresearch,analysisandmanuscript.
AdditionalInformationCompetingInterests:Theauthorsdeclarenocompetinginterests.
Publisher'snote:SpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
6OpenAccessThisarticleislicensedunderaCreativeCommonsAttribution4.
0InternationalLicense,whichpermitsuse,sharing,adaptation,distributionandreproductioninanymediumorformat,aslongasyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCre-ativeCommonslicense,andindicateifchangesweremade.
Theimagesorotherthirdpartymaterialinthisarticleareincludedinthearticle'sCreativeCommonslicense,unlessindicatedotherwiseinacreditlinetothematerial.
Ifmaterialisnotincludedinthearticle'sCreativeCommonslicenseandyourintendeduseisnotper-mittedbystatutoryregulationorexceedsthepermitteduse,youwillneedtoobtainpermissiondirectlyfromthecopyrightholder.
Toviewacopyofthislicense,visithttp://creativecommons.
org/licenses/by/4.
0/.
TheAuthor(s)2018
S.
Kadir2,Liang-TsengKuo3&WonHahPark1Comparingtoprimarysurgery,revisionACLreconstructionismoretechnicallydemandingandhasahigherfailurerate.
Theoretically,rehabilitationcanimprovekneefunctionafterACLreconstructionsurgery.
Thisstudyaimedtocomparekneestability,strength,andfunctionbetweenprimaryandrevisionACLreconstructedknees.
40primaryand40revisionACLreconstructionsurgerieswereincludedbetweenApril2013andMay2016.
Patientswithrevisionsurgeryhadahigheranteroposteriortranslationcomparingthosewithprimaryreconstruction(medianlaxity,2.
0mmvs.
3.
0mm,p=0.
0022).
Nodifferenceswerenotedinkneeextensorat60°/secor180°/sec(p=0.
308,p=0.
931,respectively)orinflexormusclestrengthat60°/secor180°/secbetweenprimaryandrevisionACLreconstructionknees(p=0.
091,p=0.
343,respectively).
TherewerealsonosignificantdifferencesbetweenfunctionalscoresincludingIKDCscoreandLysholmscoreinprimaryversusrevisionsurgeriesat12thmonthsafterindexoperation(p=0.
154,p=0.
324,respectively).
Inconclusion,despitehavinghigheranteroposteriorinstability,patientswithrevisionACLreconstructioncanhavenon-inferioroutcomesinisokinetickneestrengthandfunctioncomparedtothosewithprimaryACLreconstructionafterproperrehabilitation.
Anteriorcruciateligamentreconstruction(ACLR)surgeryisacommonproceduretoimprovefunctionalstabilityafterananteriorcruciateligament(ACL)injury.
ThesuccessfulrateofprimaryACLRisapproximatedtobe75%to97%amongpatients1,2.
Thismeansthatalmostone-fourthofprimaryACLRsurgeriesboundtofaildespiteimprovedsurgicalmethods3.
ThecausesassociatedwithfailedACLRsurgeryaresurgicalfactorsandrepetitiveinjurytotheknee4,5.
Amongthesepatients,approximately2.
9to8.
9%underwentthefollowingrevisionACLRsurgery6,7.
ComparedtoprimaryACLRsurgery,revisionsurgeryismoretechnicallydemanding.
Inrevisionsurgery,accessibilitytooriginaltunnelsisakeyfactorofsuccesssincetheremovalofhardwareisoftenrequiredandbonegraftingislikelytobenecessary8.
Thiscontributestoanestimated35%failurerateofrevisionACLRsurgery,whichtranslatedtoapproximately54%ofpatientsreturningtopre-injurylevels9.
Therefore,withthesetechnicaldifficulties,thesuccessrateofrevisionACLRsurgeryiscommonlylesscomparedtoprimaryACLRsurgery10.
Inadditiontoregainthejointstability,thegoalofACLRsurgeryisalsotorecoverthefunctionofthekneejointandmusclestrength10.
Tomaximizetheoutcomesofsurgeryandenhancethefunctionalrecovery,anappro-priaterehabilitationprogramisincorporatedintotheroutinepostoperativecare.
TheimpairedkneefunctionsassociatedwithACLinjuryincludeinstabilityindynamicmovementandquadricepsweakness.
Asbeingcriticaltodynamicjointstability,thequadricepsmuscleweaknesseventuallyleadstodecreasedkneefunction,andpoor1DepartmentofSportsMedicine,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,Seoul,Korea.
2DepartmentofOrthopaedicSurgery,HospitalTengkuAmpuanRahimahKlang,MinistryofHealth,Selangor,Malaysia.
3DepartmentofOrthopaedicSurgeryandSportsMedicineCenter,ChangGungMemorialHospital,Chiayi,Taiwan.
Liang-TsengKuoandWonHahParkcontributedequallytothiswork.
CorrespondenceandrequestsformaterialsshouldbeaddressedtoL.
-T.
K.
(email:light71829@gmail.
com)orW.
H.
P.
(email:pk90007@naver.
com)Received:11January2018Accepted:1June2018Published:xxxxxxxxOPEN2exerciseperformance,andmaycontributeearlyonsetofosteoarthritis11–13.
Thus,thestrengthofmusclearoundthekneejoint,especiallythequadricepsmuscle,wasthemaintargetoftrainingandkeepindicatorformonitor-ingthefunctionalrecoveryafterACLRsurgery13.
Thus,toevaluatethesuccessofprimaryACLRsurgery,jointstability,musclestrengthandkneefunctionwerecommonoutcomesreportedinpreviousstudies1,10,11.
However,therewerelimitedstudieswhichhaveassessedmusclestrengthrecoveryfollowingrevisionACLRsurgery.
Thus,weperformedthisstudytoassessthestabilityandfunctionalrecoveryafterprimaryandrevisionACLRsurgeryunderthescheduledrehabilitationprogram.
Thisstudyaimedto(1)comparerecoveryofkneeextensormuscle(quadriceps)andflexormuscle(hamstring)strengthinprimaryversusrevisionACLRsurgery,and(2)compareclinicalfunctionalandstabilityoutcomesinprimaryversusrevisionACLRsurgery.
ResultsDemographics.
Therewere80maleparticipantsincludedinthisstudy.
Therewerenostatisticallysignificantdifferencesinage,heightandbodyweightbetweenprimaryandrevisiongroups(p=0.
538,p=0.
105,p=0.
969respectively)(Table1).
Ligamentstability.
TheAPlaxitybetweengroupswasstatisticallydifferent(p=0.
0022)(Fig.
1).
Themedianlaxitywas2.
0mm(IQR,1.
0mm–2.
5mm)inprimarygroupand3.
0mm(IQR,2.
0mm–3.
25mm)inrevi-siongroup.
APlaxitybetweeninvolvedandhealthylimbwasalsorecorded.
Fortheprimarygroup,thedifferencewas5mminnoneofthecases.
Fortherevisiongroup.
Thediffer-encewas5mmin5cases.
Thedegreeofside-to-sidelaxitydifferencewassignificantlydifferentbetweentwogroups(X2test,p5mm0(0%)5(12.
5%)Table2.
Anteroposteriorligamentlaxity.
Resultsareshownasnumberwithpercentage.
Chi-Squaredtest:p0.
80atanalphalevelequalto0.
05wasusedtodeterminethatasamplesizeof35foreachgroupwasnecessarytodetermineinKT-2000arthrometryvalue32.
AlldatastatisticalanalysiswasperformedusingSPSSversion13.
0(SPSSInc.
,Chicago,IL,USA).
Chi-SquaredtestandMann-WhitneyUtestwereusedthroughouttocomparevariablesbetweentwogroups,withpPaessler,H.
H.
Anteriorcruciateligamentrevisionreconstruction:resultsin107patients.
AmJSportsMed36,851–860(2008).
6.
Muneta,T.
etal.
Revisionanteriorcruciateligamentreconstructionbydouble-bundletechniqueusingmulti-strandsemitendinosustendon.
Arthroscopy26,769–781(2010).
7.
Wolf,R.
S.
&Lemak,L.
J.
Revisionanteriorcruciateligamentreconstructionsurgery.
JournaloftheSouthernOrthopaedicAssociation11,25–32(2002).
8.
Group,M.
etal.
DescriptiveepidemiologyoftheMulticenterACLRevisionStudy(MARS)cohort.
AmJSportsMed38,1979–1986(2010).
9.
Busfield,B.
T.
,Safran,M.
R.
&Cannon,W.
D.
ExtensorMechanismDisruptionAfterContralateralMiddleThirdPatellarTendonHarvestforAnteriorCruciateLigamentRevisionReconstruction.
Arthroscopy21,1268(2005).
10.
Gifstad,T.
,Drogset,J.
O.
,Viset,A.
,Grontvedt,T.
&Hortemo,G.
S.
InferiorresultsafterrevisionACLreconstructions:acomparisonwithprimaryACLreconstructions.
KneeSurgSportsTraumatolArthrosc21,2011–2018(2013).
11.
Kim,D.
K.
,Hwang,J.
H.
&Park,W.
H.
Effectsof4weekspreoperativeexerciseonkneeextensorstrengthafteranteriorcruciateligamentreconstruction.
JPhysTherSci27,2693–2696(2015).
12.
Muaidi,Q.
I.
,Nicholson,L.
L.
,Refshauge,K.
M.
,Herbert,R.
D.
&Maher,C.
G.
Prognosisofconservativelymanagedanteriorcruciateligamentinjury:asystematicreview.
SportsMed37,703–716(2007).
13.
Slemenda,C.
etal.
Quadricepsweaknessandosteoarthritisoftheknee.
AnnInternMed127,97–104(1997).
14.
Thomas,N.
P.
,Kankate,R.
,Wandless,F.
&Pandit,H.
Revisionanteriorcruciateligamentreconstructionusinga2-stagetechniquewithbonegraftingofthetibialtunnel.
AmJSportsMed33,1701–1709(2005).
15.
Wright,R.
etal.
RevisionACLreconstructionoutcomes:MOONcohort.
JKneeSurg24,289–294(2011).
16.
Wright,R.
W.
etal.
Outcomeofrevisionanteriorcruciateligamentreconstruction:asystematicreview.
JBoneJointSurgAm94,531–536(2012).
17.
Aune,A.
K.
,Holm,I.
,Risberg,M.
A.
,Jensen,H.
K.
&Steen,H.
Four-strandhamstringtendonautograftcomparedwithpatellartendon-boneautograftforanteriorcruciateligamentreconstruction.
AmJSportsMed29,722–728(2001).
18.
Drogset,J.
O.
etal.
Autologouspatellartendonandquadrupledhamstringgraftsinanteriorcruciateligamentreconstruction:aprospectiverandomizedmulticenterreviewofdifferentfixationmethods.
KneeSurgSportsTraumatolArthrosc18(8),1085–1093(2010).
19.
Matsumoto,A.
etal.
Acomparisonofbone-patellartendon-boneandbone-hamstringtendon-boneautograftsforanteriorcruciateligamentreconstruction.
AmJSportsMed34(2),213–219(2006).
20.
Mohtadi,N.
G.
,Chan,D.
S.
,Dainty,K.
N.
&Whelan,D.
B.
Patellartendonversushamstringtendonautograftforanteriorcruciateligamentruptureinadults.
CochraneDatabaseSystRev9,CD005960,https://doi.
org/10.
1002/14651858.
CD005960.
pub2(2011).
21.
Ahn,J.
H.
&Choi,H.
J.
Arthroscopicanteriorcruciateligamentreconstructionusingbone-patellartendon-boneautograft.
JournaloftheKoreanOrthopaedicAssociation35,375–380(2000).
22.
Harner,C.
D.
etal.
Allograftversusautograftanteriorcruciateligamentreconstruction:3-to5-yearoutcome.
Clin.
Orthop.
Relat.
Res.
324,134–144(1996).
23.
Tibor,L.
M.
etal.
Clinicaloutcomesafteranteriorcruciateligamentreconstruction:ameta-analysisofautograftversusallografttissue.
SportsHealth2,56–72(2010).
24.
Weiler,A.
,Schmeling,A.
,Stohr,I.
,Kaab,M.
J.
&Wagner,M.
Primaryversussingle-stagerevisionanteriorcruciateligamentreconstructionusingautologoushamstringtendongrafts:aprospectivematched-groupanalysis.
AmJSportsMed35,1643–1652(2007).
25.
Battaglia,M.
J.
etal.
Resultsofrevisionanteriorcruciateligamentsurgery.
AmJSportsMed35,2057–2066(2007).
26.
Denti,M.
etal.
Revisionanteriorcruciateligamentreconstruction:causesoffailure,surgicaltechnique,andclinicalresults.
AmJSportsMed36,1896–1902(2008).
27.
Keays,S.
L.
,Bullock-Saxton,J.
E.
,Newcombe,P.
&Bullock,M.
I.
Theeffectivenessofapre-operativehome-basedphysiotherapyprogrammeforchronicanteriorcruciateligamentdeficiency.
PhysiotherResInt11,204–218(2006).
28.
Uribe,J.
W.
,Hechtman,K.
S.
,Zvijac,J.
E.
&Tjin-A-Tsoi,E.
W.
Revisionanteriorcruciateligamentsurgery:experiencefromMiami.
Clin.
Orthop.
Relat.
Res.
325,91–99(1996).
29.
Myer,G.
D.
etal.
Therelationshipofhamstringsandquadricepsstrengthtoanteriorcruciateligamentinjuryinfemaleathletes.
ClinJSportMed19,3–8(2009).
30.
Peters,G.
,Wirth,C.
&Kohn,D.
Comparisonofkneeligamentscoresandratingsystems.
ZOrthopundIhreGrenzgeb135,63–69(1997).
31.
Lysholm,J.
&Gillquist,J.
Evaluationofkneeligamentsurgeryresultswithspecialemphasisonuseofascoringscale.
AmJSportsMed10,150–154(1982).
32.
Anderson,A.
F.
,Snyder,R.
B.
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Anteriorcruciateligamentreconstruction.
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AmJSportsMed29,272–9(2001).
AuthorContributionsD.
K.
K.
andW.
H.
P.
designedthestudyanddirectedtheproject.
D.
K.
K.
andG.
P.
performedthetestandrecordedthedata.
D.
K.
K.
andL.
T.
K.
analyzedthedataandpreparedthetablesandfigures.
D.
K.
K.
,G.
P.
andK.
B.
H.
M.
K.
wrotethepaper.
D.
K.
K.
,G.
P.
andL.
T.
K.
contributedtointerpretationoftheresults.
Allauthorsprovidedcriticalfeedbackandhelpedshapetheresearch,analysisandmanuscript.
AdditionalInformationCompetingInterests:Theauthorsdeclarenocompetinginterests.
Publisher'snote:SpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
6OpenAccessThisarticleislicensedunderaCreativeCommonsAttribution4.
0InternationalLicense,whichpermitsuse,sharing,adaptation,distributionandreproductioninanymediumorformat,aslongasyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCre-ativeCommonslicense,andindicateifchangesweremade.
Theimagesorotherthirdpartymaterialinthisarticleareincludedinthearticle'sCreativeCommonslicense,unlessindicatedotherwiseinacreditlinetothematerial.
Ifmaterialisnotincludedinthearticle'sCreativeCommonslicenseandyourintendeduseisnotper-mittedbystatutoryregulationorexceedsthepermitteduse,youwillneedtoobtainpermissiondirectlyfromthecopyrightholder.
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