Evidence map›Paper›PMID 28916871›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018

Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction.

Jay R Ebert, Peter Edwards, Luke Yi, Brendan Joss, Timothy Ackland, Richard Carey-Smith, Jens-Ulrich Buelow, Ben Hewitt

Abstract read
PubMed Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 5 pooled it
10.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 5 syntheses or guidelines pooled it, 146 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Trial
  9. Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Validity of the Uninjured Limb as a Control for Preoperative Assessment in Anterior Cruciate Ligament Reconstruction.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2025
    Observational
  19. Article
  20. Article

7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Jay R EbertSchool of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. jay.ebert@uwa.edu.au.
Peter EdwardsSchool of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Luke YiSchool of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Brendan JossHFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
Timothy AcklandSchool of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Richard Carey-SmithPerth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia.
Jens-Ulrich BuelowPerth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia.
Ben HewittOrthology, Suite 1, 48 Outram Street, West Perth, WA, 6005, Australia.
University of Western Australia · AUNorth Sydney Orthopaedic and Sports Medicine Centre · AUSir Charles Gairdner Hospital · AU

Funding

Hollywood Private Hospital Research Foundation RF070
6 · The paper itself

Abstract

purposeTo investigate strength and functional symmetry during common tests in patients after anterior cruciate ligament reconstruction (ACLR), and its association with post-operative rehabilitation.

methodsAt a median 11.0 months post-surgery (range 10-14), 111 ACLR patients were assessed. A rehabilitation grading tool was employed to evaluate the duration and supervision of rehabilitation, as well as whether structured jumping, landing and agility exercises were undertaken. Patients completed the Noyes Activity Score (NSARS), maximal isokinetic knee extensor and flexor strength assessment, and a 4-hop test battery. Limb Symmetry Indices (LSIs) were calculated, presented for the entire group and also stratified by activity level. ANOVA evaluated differences between the operated and unaffected limbs across all tests. Correlations were undertaken to assess the relationship between post-operative rehabilitation and objective test LSIs.

resultsThe unaffected limb was significantly better (p < 0.0001) than the operated limb for all tests. Only 52-61 patients (47-55%) demonstrated LSIs ≥ 90% for each of the hop tests. Only 34 (30.6%) and 61 (55.0%) patients were ≥ 90% LSI for peak quadriceps and hamstring strength, respectively. Specifically in patients actively participating in jumping, pivoting, cutting, twisting and/or turning sports, 21 patients (36.8%) still demonstrated an LSI < 90% for the single hop for distance, with 37 patients (65.0%) at < 90% for peak knee extension strength. Rehabilitation was significantly associated with the LSIs for all tests.

conclusionRehabilitation was significantly correlated with limb symmetry, and lower limb symmetry was below recommended criterion for many community-level ACLR patients, including those already engaging in riskier activities. It is clear that many patients are not undertaking the rehabilitation required to address post-operative strength and functional deficits, and are being cleared to return to sport (or are returning on their own accord) without appropriate evaluation and further guidance. LEVEL OF EVIDENCE: IV.

Indexed as

Muscle StrengthAdolescentAdultAnterior Cruciate Ligament InjuriesAnterior Cruciate Ligament ReconstructionExerciseFemaleFollow-Up StudiesHamstring MusclesHumansKneeKnee JointLower ExtremityMaleMiddle AgedQuadriceps MuscleAnterior cruciate ligament injuryLimb symmetry indexLower limb strengthRehabilitationSingle leg hop test

Identifiers

PMID28916871
OpenAlexW2754082086

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.