{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:56:24Z","timestamp":1792634184544,"version":"4.5.0"},"reference-count":87,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1190882"],"award-info":[{"award-number":["GNT1190882"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2008523"],"award-info":[{"award-number":["GNT2008523"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2024,2,28]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review with meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and SportDiscus to 28 February 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Primary ACL injury with mean age 18\u201340 years at time of injury. Studies had to measure hip and\/or lower-leg muscle strength quantitatively (eg, dynamometer) and report muscle strength for the ACL-injured limb compared with: (i) an uninjured control group and\/or (ii) the uninjured contralateral limb. Risk of bias was assessed according to Cochrane Collaboration domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-eight studies were included (n=23 measured strength \u226412 months post-ACL reconstruction). Most examined hip abduction (16 studies), hip extension (12 studies) and hip external rotation (7 studies) strength. We found no meaningful difference in muscle strength between people or between limbs for hip abduction, extension, internal rotation, flexion or ankle plantarflexion, dorsiflexion (estimates ranged from \u22129% to +9% of comparator). The only non-zero differences identified were in hip adduction (24% stronger on ACL limb (95% CI 8% to 42%)) and hip external rotation strength (12% deficit on ACL limb (95% CI 6% to 18%)) compared with uninjured controls at follow-ups &gt;12 months, however both results stemmed from only two studies. Certainty of evidence was very low for all outcomes and comparisons, and drawn primarily from the first year post-ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results do not show widespread or substantial muscle weakness of the hip and lower-leg muscles after ACL injury, contrasting deficits of 10%\u201320%\u2009commonly reported for knee extensors and flexors. As it is unclear if deficits in hip and lower-leg muscle strength resolve with appropriate rehabilitation or no postinjury or postoperative weakness occurs, individualised assessment should guide training of hip and lower-leg strength following ACL injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42020216793.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjsports-2023-107536","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T13:20:24Z","timestamp":1711545624000},"page":"500-510","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury"],"prefix":"10.1136","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6477-7263","authenticated-orcid":false,"given":"Michael","family":"Girdwood","sequence":"first","affiliation":[{"name":"La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9491-0264","authenticated-orcid":false,"given":"Adam G","family":"Culvenor","sequence":"additional","affiliation":[{"name":"La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6570-5429","authenticated-orcid":false,"given":"Brooke","family":"Patterson","sequence":"additional","affiliation":[{"name":"Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6366-0896","authenticated-orcid":false,"given":"Melissa","family":"Haberfield","sequence":"additional","affiliation":[{"name":"La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebonie Kendra","family":"Rio","sequence":"additional","affiliation":[{"name":"La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia"},{"name":"The Victorian Institute of Sport, Melbourne, Victoria, Australia"},{"name":"The Australian Ballet, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hedger","sequence":"additional","affiliation":[{"name":"La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5892-129X","authenticated-orcid":false,"given":"Kay M","family":"Crossley","sequence":"additional","affiliation":[{"name":"La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,27]]},"reference":[{"key":"2025080112553298000_58.9.500.1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s40279-020-01386-6","article-title":"Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? 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