Clinical Thresholds for Quadriceps Assessment After Anterior Cruciate Ligament Reconstruction

Context: Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear. Objective: To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR. Design: Descriptive laboratory study. Setting: Laboratory. Patients: 22 (10 female, 12 male; age = 22.5 5.0 y, height = 172.9 +/- 7.1 cm, mass = 74.1 +/- 15.5 kg, months since surgery = 31.5 +/- 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 +/- 3.6 y, height = 168.0 +/- 8.8 cm, mass = 69.3 +/- 13.6 kg) recreationally active healthy participants. Main Outcome Measures: Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function. Results: Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes. Conclusions: Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.