{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:09:58Z","timestamp":1789718998646,"version":"4.0.1"},"reference-count":19,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"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":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Although quadriceps weakness after ACL reconstruction (ACLR) is well documented, the magnitude of reported weakness varies considerably. Such variation raises the possibility that certain patients may be more susceptible to quadriceps weakness after ACLR. This meta\u2010analysis identified factors explaining between\u2010study variability in quadriceps weakness post\u2010ACLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Studies between 2010 and 2020 were screened for the following criteria: human subjects, unilateral ACLR, and strength reported both for the ACLR leg and the uninjured or healthy\u2010control leg. 122 studies met the criteria, resulting in 303 and 152 Cohen\u2019s <jats:italic>d<\/jats:italic> effect sizes (ESs) comparing ACLR legs to uninjured legs (a total of 4135 ACLR subjects) and to healthy controls (a total of 1,507 ACLR subjects vs. 1\u2010193 healthy controls), respectively. Factors (time, graft, sex, activity, mass\/height, geographic area, concomitant injury, and type of strength testing) that may affect study ES were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Meta\u2010regressions indicated an association between time post\u2010ACLR and study ESs (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and predicted full recovery (ES\u2009=\u20090) to occur at 54\u201359\u00a0months post\u2010ACLR. When compared to uninjured legs, patients with patellar tendon autografts had greater deficits than studies using hamstring tendon autografts (<jats:italic>P<\/jats:italic>\u2009=\u20090.023). When compared to uninjured legs, studies including only males reported greater deficits than studies combining males and females (<jats:italic>P<\/jats:italic>\u2009=\u20090.045); whereas when compared to healthy controls, studies combining males and females reported greater deficits than studies with males (<jats:italic>P<\/jats:italic>\u2009=\u20090.013). When compared to controls, studies from USA reported greater deficits than studies from Europe (<jats:italic>P<\/jats:italic>\u2009=\u20090.003). Increased isokinetic\u2010testing speed was associated with smaller deficits (<jats:italic>P<\/jats:italic>\u2009\u2264\u20090.025). Less than 25% of patients achieved a between\u2010limb symmetry in quadriceps strength\u2009&gt;\u200990% between 6 and 12\u00a0months post\u2010ACLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Time post\u2010surgery, graft, sex, geographic location, and isokinetic speed influenced the magnitude of post\u2010ACLR quadriceps weakness. Patients with patellar tendon autografts demonstrated greater between\u2010limb asymmetry in quadriceps strength, while female strength deficits were underestimated to a greater extent. A slower isokinetic speed provided a more sensitive assessment of quadriceps strength post\u2010ACLR. The overwhelming majority of patients were returning to sport with significantly impaired quadriceps strength.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06906-7","type":"journal-article","created":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T12:02:22Z","timestamp":1645963342000},"page":"3367-3376","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Time, graft, sex, geographic location, and isokinetic speed influence the degree of quadriceps weakness after anterior cruciate ligament reconstruction: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5109-3655","authenticated-orcid":false,"given":"Liang\u2010Ching","family":"Tsai","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Georgia State University 140 Decatur Street Suite 1271 30303 Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Jeanfreau","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Georgia State University 140 Decatur Street Suite 1271 30303 Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Hamblin","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Georgia State University 140 Decatur Street Suite 1271 30303 Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John M.","family":"Popovich","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Michigan State University East Lansing MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Lyle","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel F.","family":"Cottmeyer","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Georgia State University 140 Decatur Street Suite 1271 30303 Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon L.","family":"Warren","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Georgia State University 140 Decatur Street Suite 1271 30303 Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,27]]},"reference":[{"key":"e_1_2_9_2_2","unstructured":"ArhosEK ThomaLM GrindemH LogerstedtD RisbergMA Snyder\u2010MacklerLAssociation of quadriceps strength symmetry and surgical status with clinical osteoarthritis 5 years after anterior cruciate ligament rupture.Arthritis Care Res (Hoboken)(2020)10.1002\/acr.24479"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102018\u2010099982"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40279\u2010020\u201001419\u20100"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518810750"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005739\u20101"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102016\u2010096031"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2019.01.011"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738115578112"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20103060\u2010z"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/2046\u20104053\u20104\u20101"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00035"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102017\u2010098674"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010015\u20103588\u20106"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006121\u20102"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2020.9111"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104517\u20107"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40279\u2010020\u201001386\u20106"},{"key":"e_1_2_9_20_2","doi-asserted-by":"crossref","unstructured":"TourvilleTW VoigtTB ChoquetteRH FaillaMJ EndresNK SlauterbeckJRet al. Skeletal muscle cellular contractile dysfunction after anterior cruciate ligament reconstruction contributes to quadriceps weakness at 6\u2010month follow\u2010up.J Orthop Res(2021)10.1002\/jor.2506534288090","DOI":"10.1002\/jor.25065"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-022-06906-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-022-06906-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-022-06906-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-022-06906-7","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T12:34:01Z","timestamp":1760877241000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-022-06906-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,27]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1007\/s00167-022-06906-7"],"URL":"https:\/\/doi.org\/10.1007\/s00167-022-06906-7","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,27]]},"assertion":[{"value":"24 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors have no conflict of interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"N\/A (meta-analysis).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"N\/A (meta-analysis).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}