ArticleSports medicine - open2024
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.
Article in Sports medicine - open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 7 citations in OpenAlex.
- Sex-Specific Analysis of Quadriceps and Hamstring Strength Following Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair.Journal of functional morphology and kinesiology · 2026Article
- Hamstring-to-quadriceps ratio across menstrual cycle phases in physically active women: a repeated-measures study.European journal of applied physiology · 2026Article
- Pass Rates of Return to Sport Test Batteries Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.Sports (Basel, Switzerland) · 2026Review
- Physiological and Psychological Predictors of Functional Performance Related to Injury Risk in Female Athletes: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2026Article
- Age is not a primary risk factor for anterior cruciate ligament injury-A comprehensive review of anterior cruciate ligament injury and reinjury risk factors confounded by young patient age.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Review
- Current concepts and future perspective of muscle function tests to inform return to sport decision-making after ACLR: A narrative review.Journal of experimental orthopaedics · 2026Review
- Lower limb muscle synergies during deceleration at different change of direction angles.Scientific reports · 2025Article
- Interpretable Machine Learning on Simulation-Derived Biomechanical Features for Hamstrings-Quadriceps Imbalance Detection in Running.Sports (Basel, Switzerland) · 2025Article
- Neurosciences and Sports Rehabilitation in ACLR: A Narrative Review on Winning Alliance Strategies and Connecting the Dots.Journal of functional morphology and kinesiology · 2025Review
- Higher Unilateral Muscle Imbalance at the Contralateral Knee 6 Months after Anterior Cruciate Ligament Reconstruction.Sports (Basel, Switzerland) · 2024Article
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe stress on the anterior cruciate ligament (ACL) induced by the quadriceps can be attenuated by activation of the hamstrings by exerting an opposing torque to the anterior translation of tibia. 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 years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL reconstruction.
methodsPatients who had undergone primary ACL reconstruction 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 years 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.
resultsA total of 574 patients (50.0% female) with a mean age of 24.0 ± 9.4 years at primary ACL reconstruction 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 0.95-1.00], p = 0.025). 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 0.95-1.01], p = 0.16). 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%], p = 0.0002 and 3.3% [95% CI 4.6; 2.1], p < 0.001, respectively).
conclusionThe HQ-ratio did not significantly affect the odds for sustaining a second ACL injury upon return to preinjury sports level after primary ACL reconstruction. Females had a significant higher HQ-ratio than males for both the ACL reconstructed and uninjured side.
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