{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:25:09Z","timestamp":1793496309570,"version":"4.5.0"},"reference-count":51,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone\u2013patellar tendon\u2013bone (BPTB) graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Randomized controlled trial; Level of evidence, 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb ( P &lt; .001 for all), and the improvements were significantly greater in the control group regarding peak torque and single-leg hop test in the reconstructed limb ( P &lt; .001 for both). Comparison between the groups showed significantly increased symmetry regarding peak torque, H:Q ratio, and single-leg hop test in the intervention group compared with the control group ( P &lt; .001), with large effect sizes (&gt;0.80) except for the H:Q ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>Brazilian Registry of Clinical Trials (number RBR-22rnjh).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671221088830","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T11:30:14Z","timestamp":1650281414000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone\u2013Patellar Tendon\u2013Bone Graft: A Randomized Controlled Trial"],"prefix":"10.1177","volume":"10","author":[{"given":"Marcio","family":"Oliveira","sequence":"first","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."},{"name":"Health Evidence-Based Graduate Program, Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Lobo","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Mizusaki","family":"Imoto","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00e1cio","family":"Santos","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Humberto Souza","family":"Borges","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Nunes","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabr\u00edcio Reichert","family":"Barin","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meire","family":"Damando","sequence":"additional","affiliation":[{"name":"Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine\/FIFA Medical Centre of Excellence (IPE\/HOME), Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Stella","family":"Peccin","sequence":"additional","affiliation":[{"name":"Health Evidence-Based Graduate Program, Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"bibr1-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181915670"},{"key":"bibr2-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/0363546505280214"},{"key":"bibr3-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-095475"},{"key":"bibr4-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093398"},{"key":"bibr5-23259671221088830","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2000.01.621"},{"issue":"1","key":"bibr6-23259671221088830","first-page":"19","volume":"11","author":"Ataides G","year":"2013","journal-title":"Universitas: Ci\u00eancias da Sa\u00fade"},{"key":"bibr7-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/1941738118811337"},{"key":"bibr8-23259671221088830","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00569"},{"issue":"1","key":"bibr9-23259671221088830","first-page":"2","volume":"4","author":"Biggs A","year":"2009","journal-title":"N Am J Sports Phys Ther"},{"key":"bibr10-23259671221088830","unstructured":"Biodex Medical Systems. Instructions for use. Published 1998. Accessed July 1, 2020. https:\/\/www.biodex.com\/physical-medicine\/products\/dynamometers\/system-4-pro"},{"issue":"6","key":"bibr11-23259671221088830","doi-asserted-by":"crossref","first-page":"749","DOI":"10.5007\/1980-0037.2012v14n6p749","volume":"14","author":"Botton CE","year":"2012","journal-title":"Rev Bras Cineantropom Desempenho Hum"},{"key":"bibr12-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0000000000001125"},{"key":"bibr13-23259671221088830","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J","year":"1988","edition":"2"},{"key":"bibr14-23259671221088830","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2012.3768"},{"key":"bibr15-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1037\/a0024338"},{"key":"bibr16-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508314428"},{"key":"bibr17-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e318213fefb"},{"key":"bibr18-23259671221088830","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20070189"},{"key":"bibr19-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1123\/ijspp.2014-0612"},{"key":"bibr20-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093891"},{"key":"bibr21-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096031"},{"key":"bibr22-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"bibr23-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097071"},{"key":"bibr24-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/036354658301100411"},{"key":"bibr25-23259671221088830","first-page":"2017","volume":"4721548","author":"Jewiss D","year":"2017","journal-title":"J Sports Med (Hindawi Publ Corp)"},{"key":"bibr26-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4060-y"},{"key":"bibr27-23259671221088830","volume-title":"Optimizing Strength Training: Designing Nonlinear Periodization Workouts. Human Kinetics","author":"Kraemer WJ","year":"2007"},{"key":"bibr28-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2010.079376"},{"key":"bibr29-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096836"},{"key":"bibr30-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1590\/1413-785220182602185594"},{"key":"bibr31-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1590\/1517-869220162204159074"},{"key":"bibr32-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514542796"},{"key":"bibr33-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097232"},{"key":"bibr34-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.15.1987"},{"key":"bibr35-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.10.008"},{"issue":"1","key":"bibr36-23259671221088830","first-page":"29","volume":"12","author":"Oliveira MP","year":"2014","journal-title":"Universitas: Ci\u00eancias da Sa\u00fade"},{"key":"bibr37-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/53A.6.B425"},{"key":"bibr38-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515578252"},{"key":"bibr39-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-78522006000500008"},{"key":"bibr40-23259671221088830","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2018.7656"},{"key":"bibr41-23259671221088830","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20060041"},{"issue":"4","key":"bibr42-23259671221088830","first-page":"378","volume":"36","author":"Rosene JM","year":"2001","journal-title":"J Athl Train"},{"key":"bibr43-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/036354659602400625"},{"key":"bibr44-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500610"},{"key":"bibr45-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-006-1007-z"},{"key":"bibr46-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514560877"},{"key":"bibr47-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096651"},{"key":"bibr48-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1177\/03635465010290011801"},{"key":"bibr49-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(05)70048-9"},{"key":"bibr50-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-095952"},{"key":"bibr51-23259671221088830","doi-asserted-by":"publisher","DOI":"10.1016\/j.ptsp.2019.08.004"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671221088830","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671221088830","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671221088830","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:08:19Z","timestamp":1777594099000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671221088830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":51,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4,1]]}},"alternative-id":["10.1177\/23259671221088830"],"URL":"https:\/\/doi.org\/10.1177\/23259671221088830","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,1]]},"article-number":"23259671221088830"}}