{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T01:04:30Z","timestamp":1792285470256,"version":"4.4.0"},"reference-count":55,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The all\u2010soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex\u2010specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all\u2010soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6\u2010month quadriceps strength.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients 14\u201325 years who underwent primary, unilateral ACLR with all\u2010soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6 weeks, 3 and 6\u00a0months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6\u00a0months using isokinetic dynamometry at 60\u00b0\/s. Two\u2010way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6\u2010month quadriceps strength.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three\u2010hundred and twenty patients were included (18\u2009\u00b1\u20093 years; 156\u00a0males:164 females; BMI\u2009=\u200924\u2009\u00b1\u20094\u00a0kg\/m<jats:sup>2<\/jats:sup>) with no early graft failures within the study period. For strength, there were significant main effects of time (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and sex (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), indicating similar improvement from 3 to 6\u00a0months with males demonstrating greater quadriceps LSI (6\u00a0months: 72.1 vs 63.3%) and normalized strength (6\u00a0months: 2.0 vs 1.6\u00a0Nm\/kg). A significantly higher proportion of females had knee extension ROM deficits\u2009\u2265\u20095\u00b0 compared to males at 6 weeks (61 vs 39%; <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Female sex and 3\u2010month extension ROM deficits were identified as significant predictors of 6\u2010month quadriceps LSI (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.083; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Female sex, BMI, and 6\u2010week extension ROM deficits were identified as significant predictors of 6\u2010month normalized quadriceps strength (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.190; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6\u00a0months following ACLR using all\u2010soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6\u00a0months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06351-4","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T05:02:51Z","timestamp":1605070971000},"page":"3085-3095","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all\u2010soft tissue quadriceps tendon autografts"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7588-6676","authenticated-orcid":false,"given":"Jennifer 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July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. Xerogeanes declares conflict of interest (paid consultant for Arthrex and holds patent for device with Arthrex). Dr. Slone declares conflict of interest (editorial board for Am J Orthop and J Surg Orthop Advances).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Prior to the conduct of this study, the institutional review board of Emory University approved the protocol (IRB #: 00106812).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Prior to the conduct of this study, the institutional review board approved the protocol and provided a waiver of informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}