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Consequently, considering the ratio between strength of the hamstrings-to-quadriceps (HQ-ratio) may be of value to reduce the odds of second ACL injuries. The objective was therefore to evaluate (1) the association between HQ-ratio and the occurrence of a second ACL injury in patients after ACL-reconstruction within 2\u00a0years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL\u00a0reconstruction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients who had undergone primary ACL\u00a0reconstruction and participated in knee-strenuous activity preinjury were included. Demographics, the occurrence of a second ACL injury, and muscle strength test results before returning to preinjury sport level were extracted from a rehabilitation registry. The endpoint was set at a second ACL injury or 2\u00a0years after return to preinjury sport level. A multivariable logistic regression was used to analyze the association between the HQ-ratio and a second ACL injury.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 574 patients (50.0% female) with a mean age of 24.0\u2009\u00b1\u20099.4\u00a0years at primary ACL\u00a0reconstruction were included. In the univariable logistic regression analysis, the odds of sustaining a second ACL injury decreased by 3% for every 1% increase in the HQ-ratio (OR 0.97 [95% CI 0.95\u20131.00], <jats:italic>p<\/jats:italic>\u2009=\u20090.025). After adjusting for the time from reconstruction to return to preinjury sport level, sex, preinjury sport level, graft choice, age, and body mass index, the results were no longer significant (OR 0.98 [95% CI 0.95\u20131.01], <jats:italic>p<\/jats:italic>\u2009=\u20090.16). Females had a higher HQ-ratio compared with males for both the ACL-reconstructed and uninjured side (3.7% [95% CI 5.7; 1.8%], <jats:italic>p<\/jats:italic>\u2009=\u20090.0002 and 3.3% [95% CI 4.6; 2.1], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, respectively).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The HQ-ratio did not significantly affect the odds for sustaining a second ACL injury upon return to preinjury sports level after primary ACL\u00a0reconstruction. Females had a significant higher HQ-ratio than males for both the ACL\u00a0reconstructed and uninjured side.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40798-023-00670-9","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T03:02:11Z","timestamp":1705028531000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["No Association Between Hamstrings-to-Quadriceps Strength Ratio and Second ACL Injuries After Accounting for Prognostic Factors: A Cohort Study of 574 Patients After ACL-Reconstruction"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7852-5603","authenticated-orcid":false,"given":"Johan","family":"H\u00f6gberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramana","family":"Piussi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Wernbom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Della Villa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Simonsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Samuelsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Thome\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Hamrin","family":"Hamrin Senorski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"issue":"5","key":"670_CR1","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1136\/bjsports-2013-092299","volume":"49","author":"AD Lynch","year":"2015","unstructured":"Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, et al. 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The study was approved by the Swedish Ethical Review Authority (DNR 2020-02501).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval and Consent to Participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"KS is a board member of Getinge AB. The remaining authors have no competing interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"7"}}