Single-Leg Squat Performance and Its Relationship to Extensor Mechanism Strength After Anterior Cruciate Ligament Reconstruction

• Published in: The American journal of sports medicine Vol. 47; no. 14; p. 3423
• Main Authors: Batty, Lachlan M, Feller, Julian A, Hartwig, Taylor, Devitt, Brian M, Webster, Kate E
• Format: Journal Article
• Language: English
• Published: United States 01.12.2019
• Subjects: extensor strength; single-leg squat; rehabilitation; ACL
• DOI: 10.1177/0363546519878432

Performance in strength and functional testing is important when considering return to sport after anterior cruciate ligament (ACL) reconstruction. Both knee extensor strength and the single-leg squat (SLS) have been used in this context. To evaluate the relationship between knee extensor strength and SLS performance after primary ACL reconstruction. Cohort study (Diagnosis); Level of evidence, 3. A prospective cohort of 100 patients was assessed 6 and 12 months after primary ACL reconstruction with a hamstring tendon autograft. Knee extensor peak torque was measured. Three sequential SLSs were performed, and the maximum flexion angle identified from frame-by-frame video analysis was used as the measure of squat performance. A limb symmetry index (LSI) was calculated and satisfactory performance defined as ≥90%. Extensor mechanism strength deficits were seen in 75% of patients at 6 months and 57% at 12 months postoperatively. Mean extensor mechanism strength showed a large improvement between 6 and 12 months (123.6 vs 147.8 N·m, respectively; < .001; Cohen = 1.10), and while there was also a statistically significant improvement in the mean maximum flexion angle, the change was small (66.1° vs 68.1°, respectively; = .011; Cohen = 0.26). There was a weak positive correlation between knee extensor strength and the SLS maximum flexion angle at 6 months ( = 0.342; < .001) and 12 months ( = 0.245; = .014). An SLS LSI <90% was 80% specific and 35% sensitive for extensor mechanism weakness at 6 months and 79% specific and 18% sensitive at 12 months. Extensor mechanism strength deficits are common after ACL reconstruction but reduce between 6 and 12 months. The SLS maximum flexion angle has a weak linear relationship to knee extensor strength. SLS performance has high specificity but low sensitivity in identifying extensor mechanism strength deficits. The SLS maximum flexion angle is therefore a suboptimal surrogate test to identify extensor mechanism strength deficits as diagnosed by isokinetic dynamometric testing. However, unsatisfactory SLS performance indicates a very high chance of underlying extensor mechanism weakness.