{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T13:39:52Z","timestamp":1772717992372,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is widely performed to restore knee stability and facilitate return to activity. However, recovery of muscle strength, balance, functional performance, and patient-reported outcomes does not occur uniformly over time. The longitudinal recovery trajectory across various functional areas during the first year after ACLR remains insufficiently characterized. Materials and Methods: We included 107 patients who underwent isolated unilateral ACLR using a hamstring autograft. Isokinetic knee extensor and flexor strength, postural stability, Y-Balance Test (YBT) performance, and subjective knee function scores were assessed post-injury (approximately six weeks after ACL injury and prior to ACLR) and at 3, 6, and 12 months postoperatively. All patients followed a standardized postoperative rehabilitation protocol. Results: Knee extensor strength deficit worsened at 3 months and remained present at 12 months. In contrast, knee flexor strength deficit decreased progressively and reached near-symmetrical values by 12 months. Sway path length decreased significantly over time in both limbs. In the operated limb, improvements plateaued after 6 months, and limb symmetry indices approached symmetry by 12 months. YBT limb symmetry indices demonstrated a non-linear recovery pattern. Anterior, posterolateral, and composite scores decreased at 3 months, recovered to post-injury levels by 6 months, and showed significant improvement at 12 months. Posteromedial reach did not decline at 3 months and improved significantly only at 12 months. Subjective knee function scores (Lysholm and IKDC) did not differ significantly between post-injury and 3-month assessments, but improved significantly from 6 months onward. Tegner activity scores gradually increased and returned to pre-injury levels by 12 months. Conclusions: Recovery after ACLR is prolonged and non-synchronous. Quadricep strength remains incompletely restored at 12 months, whereas hamstring strength recovers more favorably. Balance, functional performance, and subjective outcomes improve mainly after 6 months. These findings support the need for prolonged rehabilitation and serial, multidimensional functional assessments beyond time-based criteria.<\/jats:p>","DOI":"10.3390\/medicina62030489","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T11:52:11Z","timestamp":1772711531000},"page":"489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serial Changes in Knee Muscle Strength and Functional Performance After Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study of 107 Patients"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7929-478X","authenticated-orcid":false,"given":"Seung Ik","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju Won","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngwook","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4157-3414","authenticated-orcid":false,"given":"Dhong Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byung Sun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Bin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9901-7624","authenticated-orcid":false,"given":"Hun-Young","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul 05029, Republic of Korea"},{"name":"Physical Activity and Performance Institute, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8435-3926","authenticated-orcid":false,"given":"Eunjoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul 05029, Republic of Korea"},{"name":"Physical Activity and Performance Institute, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Jin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Management, Tongwon University, 26 Gyeongchung-daero, Gonjiam-eup, Gwangju-si 12813, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-5714","authenticated-orcid":false,"given":"Joon Kyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Czaplicki, A., Jarocka, M., and Walawski, J. 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