{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:26:04Z","timestamp":1786969564969,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Funct. Morphol. Kinesiol.","JFMK"],"abstract":"<jats:p>Background and Objectives: Strength deficits are extremely common following anterior cruciate ligament reconstruction (ACLR). These deficits may be further impacted by concomitant meniscus repair during ACLR. However, there remains limited evidence investigating the effect of meniscus repair on lower-limb strength after ACLR, and particularly if there are between-sex differences in strength after ACLR with and without meniscus repair. Therefore, the purpose of this study was to investigate sex-specific differences in meniscus repair during ACLR on quadriceps and hamstring isometric strength. Methods: Eighty-five (37 females; 19.0 \u00b1 6.6 years old) patient charts were retrospectively evaluated after undergoing ACLR. Variables documented included meniscal status, maximal isometric quadriceps and hamstring strength of the operative (OP) and non-operative (NOP) legs. Three separate 3-way [leg (OP vs. NOP) \u00d7 sex (males vs. females) \u00d7 meniscus repair status (yes vs. no)] mixed-factorial analyses of variance (ANOVA) assessed differences in quadriceps and hamstring strength, and the hamstring-to-quadriceps strength ratio (H:Q), at an alpha level of p \u2264 0.05. Results: For H:Q there was a sex by meniscus repair status interaction (p = 0.007). Females who underwent meniscus repair had lower H:Q (18.2%) than those without. Females without meniscus repair had a 20.3% greater H:Q than males without meniscus repair. Males had greater quadriceps strength than females (mean difference \u00b1 standard error; 0.58 \u00b1 0.28 N\u2219kg\u22121) and the NOP leg was stronger than OP for quadriceps (0.34 \u00b1 0.08 N\u2219kg\u22121) and hamstring (0.14 \u00b1 0.04 N\u2219kg\u22121) strength across sex. Conclusions: These findings suggest that the H:Q ratio differed according to sex and meniscus repair status. Further, there was a between-limb difference for strength in the quadriceps and hamstrings along with sex-related differences in strength. However, meniscus repair status did not influence raw strength values.<\/jats:p>","DOI":"10.3390\/jfmk11030318","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:00:05Z","timestamp":1786964405000},"page":"318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-Specific Analysis of Quadriceps and Hamstring Strength Following Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8218","authenticated-orcid":false,"given":"Christopher J.","family":"Cleary","sequence":"first","affiliation":[{"name":"Department of Health and Kinesiology, Bridgewater State University, Bridgewater, MA 02325, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Federico","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3815-3327","authenticated-orcid":false,"given":"Lexy N.","family":"Farrington","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S.","family":"Dombrowski","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5862-6243","authenticated-orcid":false,"given":"Zachary D.","family":"Denton","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan G.","family":"Vopat","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6184-2055","authenticated-orcid":false,"given":"Ashley A.","family":"Herda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA"},{"name":"Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1123\/jsr.2014-0226","article-title":"The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament-Reconstructed Individuals","volume":"25","author":"Sugimoto","year":"2016","journal-title":"J. Sport Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.17161\/kjm.vol16.18617","article-title":"Return to Sport After Primary Anterior Cruciate Ligament (ACL) Reconstruction: A Survey of The American Orthopaedic Society for Sports Medicine","volume":"16","author":"Xu","year":"2023","journal-title":"Kans. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1177\/0363546514542796","article-title":"Incidence and Trends of Anterior Cruciate Ligament Reconstruction in the United States","volume":"42","author":"Mall","year":"2014","journal-title":"Am. J. Sports Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1177\/0363546516658026","article-title":"Anterior Cruciate Ligament Injuries Alter the Kinematics of Knees with or Without Meniscal Deficiency","volume":"44","author":"Zhang","year":"2016","journal-title":"Am. J. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/1941738118803616","article-title":"Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002\u20132014","volume":"10","author":"Herzog","year":"2018","journal-title":"Sports Health"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Partan, M.J., Iturriaga, C.R., and Cohn, R.M. (2021). Recent Trends in Concomitant Meniscal Procedures During Anterior Cruciate Ligament Reconstruction. Orthop. J. Sports Med., 9.","DOI":"10.1177\/2325967120984138"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1177\/03635465231194624","article-title":"Effect of Concomitant Lateral Meniscal Management on ACL Reconstruction Revision Rate and Secondary Meniscal and Cartilaginous Injuries","volume":"51","author":"Persson","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00402-020-03347-0","article-title":"The Effect of Meniscal Repair on Strength Deficits 6 Months after ACL Reconstruction","volume":"140","author":"Wenning","year":"2020","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.knee.2021.11.007","article-title":"Isometric Dynamometry, Dependent on Knee Angle, Is a Suitable Alternative to Isokinetic Dynamometry When Evaluating Quadriceps Strength Symmetry in Patients Following Anterior Cruciate Ligament Reconstruction","volume":"34","author":"Beere","year":"2022","journal-title":"Knee"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e20330","DOI":"10.7717\/peerj.20330","article-title":"Comparison of Quadriceps and Hamstring Muscle Size and Strength between Young Athletes Following Knee Surgery and Healthy Controls","volume":"13","author":"Cleary","year":"2025","journal-title":"PeerJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/0363546516664705","article-title":"Hamstring Strength Asymmetry at 3 Years after Anterior Cruciate Ligament Reconstruction Alters Knee Mechanics during Gait and Jogging","volume":"45","author":"Abourezk","year":"2017","journal-title":"Am. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1177\/1941738118822739","article-title":"Quadriceps Strength and Volitional Activation after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis","volume":"11","author":"Lisee","year":"2019","journal-title":"Sports Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"434","DOI":"10.26603\/001c.32378","article-title":"Quadriceps Strength Following Anterior Cruciate Ligament Reconstruction: Normative Values Based on Sex, Graft Type and Meniscal Status at 3, 6 & 9 Months","volume":"17","author":"Schwery","year":"2022","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s00167-017-4522-x","article-title":"Higher Hamstring-to-Quadriceps Isokinetic Strength Ratio during the First Post-Operative Months in Patients with Quadriceps Tendon Compared to Hamstring Tendon Graft Following ACL Reconstruction","volume":"26","author":"Fischer","year":"2018","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1123\/jsr.2020-0479","article-title":"Mechanisms of Arthrogenic Muscle Inhibition","volume":"31","author":"Lepley","year":"2022","journal-title":"J. Sport Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2106\/JBJS.16.00035","article-title":"Cellular and Morphological Alterations in the Vastus Lateralis Muscle as the Result of ACL Injury and Reconstruction","volume":"98","author":"Noehren","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5103","DOI":"10.1113\/JP282014","article-title":"Deficit in Knee Extension Strength Following Anterior Cruciate Ligament Reconstruction Is Explained by a Reduced Neural Drive to the Vasti Muscles","volume":"599","author":"Nuccio","year":"2021","journal-title":"J. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1080\/17461391.2014.911354","article-title":"Where Are All the Female Participants in Sports and Exercise Medicine Research?","volume":"14","author":"Costello","year":"2014","journal-title":"Eur. J. Sport Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3214","DOI":"10.1016\/j.arthro.2024.10.051","article-title":"Female Athletes Are Underrepresented in Anterior Cruciate Ligament Reconstruction Rehabilitation Studies: A Systematic Review","volume":"41","author":"Crowell","year":"2025","journal-title":"Arthroscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s11332-023-01083-7","article-title":"Sex-Based Comparison of Trunk Flexors and Extensors Functional and Contractile Characteristics in Young Gymnasts","volume":"20","author":"Deodato","year":"2024","journal-title":"Sport Sci. Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Comfort, P., McMahon, J.J., Lake, J.P., Ripley, N.J., Triplett, N.T., and Haff, G.G. (2024). Relative Strength Explains the Differences in Multi-Joint Rapid Force Production between Sexes. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0296877"},{"key":"ref_22","first-page":"101","article-title":"Comparison of Quadriceps and Hamstring Muscle Activity during an Isometric Squat between Strength-Matched Men and Women","volume":"18","author":"Nimphius","year":"2019","journal-title":"J. Sports Sci. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1113\/EP088548","article-title":"Physiological Sex Differences Affect the Integrative Response to Exercise: Acute and Chronic Implications","volume":"105","author":"Ansdell","year":"2020","journal-title":"Exp. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ptsp.2019.04.008","article-title":"Sex Differences in Quadriceps Rate of Torque Development within 1 year of ACL Reconstruction","volume":"38","author":"Kuenze","year":"2019","journal-title":"Phys. Ther. Sport"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Maguire, K., Sugimoto, D., Micheli, L.J., Kocher, M.S., and Heyworth, B.E. (2021). Recovery After ACL Reconstruction in Male Versus Female Adolescents: A Matched, Sex-Based Cohort Analysis of 543 Patients. Orthop. J. Sports Med., 9.","DOI":"10.1177\/23259671211054804"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1123\/ijspp.2019-0703","article-title":"Exercise and Sport Science Failing by Design in Understanding Female Athletes","volume":"14","author":"Nimphius","year":"2019","journal-title":"Int. J. Sports Physiol. Perform."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Brown, C., Marinko, L., LaValley, M.P., and Kumar, D. (2021). Quadriceps Strength after Anterior Cruciate Ligament Reconstruction Compared with Uninjured Matched Controls: A Systematic Review and Meta-Analysis. Orthop. J. Sports Med., 9.","DOI":"10.1177\/2325967121991534"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1123\/jsr.2019-0271","article-title":"Quadriceps and Hamstring Strength Symmetry After Anterior Cruciate Ligament Reconstruction: A Prospective Study","volume":"30","author":"Harput","year":"2020","journal-title":"J. Sport Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/1941738115578112","article-title":"Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity after ACL Reconstruction: A Review of the Current Literature","volume":"7","author":"Lepley","year":"2015","journal-title":"Sports Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.knee.2013.06.002","article-title":"Concurrent Assessments of Lower Limb Loading Patterns, Mechanical Muscle Strength and Functional Performance in ACL-Patients\u2014A Cross-Sectional Study","volume":"21","author":"Jensen","year":"2014","journal-title":"Knee"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1111\/sms.12314","article-title":"Lower Limb Asymmetry in Mechanical Muscle Function: A Comparison between Ski Racers with and without ACL Reconstruction","volume":"25","author":"Jordan","year":"2015","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.knee.2014.07.021","article-title":"Asymmetries in Explosive Strength Following Anterior Cruciate Ligament Reconstruction","volume":"21","author":"Knezevic","year":"2014","journal-title":"Knee"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"246","DOI":"10.4085\/1062-6050-38-19","article-title":"Quadriceps Muscle Size, Quality, and Strength and Self-Reported Function in Individuals with Anterior Cruciate Ligament Reconstruction","volume":"55","author":"Garcia","year":"2020","journal-title":"J. Athl. Train."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/19417381241230612","article-title":"Sex Differences in Quadriceps Atrophy After Anterior Cruciate Ligament Tear","volume":"17","author":"Owen","year":"2025","journal-title":"Sports Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1177\/0363546513489284","article-title":"Psychological Responses Matter in Returning to Preinjury Level of Sport after Anterior Cruciate Ligament Reconstruction Surgery","volume":"41","author":"Ardern","year":"2013","journal-title":"Am. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e16261","DOI":"10.7717\/peerj.16261","article-title":"Neural Drive and Motor Unit Characteristics after Anterior Cruciate Ligament Reconstruction: Implications for Quadriceps Weakness","volume":"11","author":"Sherman","year":"2023","journal-title":"PeerJ"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Casp, A.J., Bodkin, S.G., Gwathmey, F.W., Werner, B.C., Miller, M.D., Diduch, D.R., Brockmeier, S.F., and Hart, J.M. (2021). Effect of Meniscal Treatment on Functional Outcomes 6 Months after Anterior Cruciate Ligament Reconstruction. Orthop. J. Sports Med., 9.","DOI":"10.1177\/23259671211031281"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1177\/03635465231177626","article-title":"The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction","volume":"51","author":"Weaver","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40798-023-00670-9","article-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","volume":"10","author":"Piussi","year":"2024","journal-title":"Sports Med.-Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jsams.2014.12.009","article-title":"Muscle Atrophy Contributes to Quadriceps Weakness after Anterior Cruciate Ligament Reconstruction","volume":"19","author":"Thomas","year":"2016","journal-title":"J. Sci. Med. Sport."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s40279-021-01431-y","article-title":"Hamstrings Muscle Morphology after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis","volume":"51","author":"Sherman","year":"2021","journal-title":"Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1123\/jsr.2017-0132","article-title":"Effect of Sex and Level of Activity on Lower-Extremity Strength, Functional Performance, and Limb Symmetry","volume":"28","author":"Lisee","year":"2019","journal-title":"J. Sport Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13293-019-0257-3","article-title":"Muscle Metabolism and Atrophy: Let\u2019s Talk about Sex","volume":"10","author":"Greene","year":"2019","journal-title":"Biol. Sex Differ."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Behan, F.P., Maden-Wilkinson, T.M., Pain, M.T.G., and Folland, J.P. (2018). Sex Differences in Muscle Morphology of the Knee Flexors and Knee Extensors. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0190903"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e13151","DOI":"10.1111\/apha.13151","article-title":"Sex-Related Differences in Muscle Size Explained by Amplitudes of Higher-Threshold Motor Unit Action Potentials and Muscle Fibre Typing","volume":"225","author":"Trevino","year":"2019","journal-title":"Acta Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s00221-020-05759-1","article-title":"Sex-Related Differences in Motor Unit Firing Rates and Action Potential Amplitudes of the First Dorsal Interosseous during High-, but Not Low-Intensity Contractions","volume":"238","author":"Parra","year":"2020","journal-title":"Exp. Brain Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1123\/ijsnem.2021-0257","article-title":"Methodology Review: A Protocol to Audit the Representation of Female Athletes in Sports Science and Sports Medicine Research","volume":"32","author":"Smith","year":"2022","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Gans, I., Retzky, J.S., Jones, L.C., and Tanaka, M.J. (2018). Epidemiology of Recurrent Anterior Cruciate Ligament Injuries in National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2004\u20132014. Orthop. J. Sports Med., 6.","DOI":"10.1177\/2325967118777823"}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/3\/318\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:40:18Z","timestamp":1786966818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/3\/318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,15]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jfmk11030318"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11030318","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,15]]}}}