Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction

Rosalia L Parrino; Will Adams; Michael I Letter; Zachary Ripic; Michael G Baraga; Lee D Kaplan; Tanner Harrah; Julien Tremblay; Dylan Luxenburg; Joseph Conti; Thomas M Best; Joseph F Signorile

doi:10.1177/23259671231201832

Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction

Orthop J Sports Med. 2023 Oct 13;11(10):23259671231201832. doi: 10.1177/23259671231201832. eCollection 2023 Oct.

Authors

Affiliations

¹ Max Orovitz Laboratory, University of Miami, Coral Gables, Florida, USA.
² University of Miami Health System Sports Medicine Institute, Coral Gables, Florida, USA.
³ Valley Orthopedic Associates, San Dimas, California, USA.
⁴ Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA.

Abstract

Background: Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR).

Purpose: To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR.

Study design: Controlled laboratory study.

Methods: A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables.

Results: A significant speed×depth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P < .001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, -57.0 ± 10.5 N·m, P < .001; 180 deg/s, -26.0 ± 10.2 N·m, P = .020; 300 deg/s, -20.3 ± 8.9 N·m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD_0-25 (0-25% of the range of motion), -131.3 ± 50.9 N·m/s, P = .018; RTD_25-50, -197.0 ± 72.5 N·m/s, P = .014; RTD_50-75, -113.3 ± 39.8 N·m/s, P = .013; RTD_75-100, -149.4 ± 35.9 N·m/s, P < .001).

Conclusion: Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds.

Clinical relevance: The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.

Keywords: ACLR; electromechanical delay; electromyography; knee.