The Influence of Quadriceps Strength Asymmetry on Patient-Reported Function at Time of Return to Sport after Anterior Cruciate Ligament Reconstruction

Christin Zwolski, Laura C. Schmitt, Catherine Quatman-Yates, Staci Thomas, Timothy Hewett, Mark V. Paterno

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Background: An objective assessment of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is an important clinical measure to determine readiness to return to sport (RTS). Not all clinicians are equipped with the means to objectively quantify quadriceps strength limb symmetry indices (Q-LSIs) via lower extremity isokinetic dynamometers, as recommended by previous studies. Purpose/Hypothesis: The purpose of this study was to determine whether the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC) score at time of RTS was a predictor of quadriceps strength in a young, athletic population after ACLR. Two hypotheses were tested: (1) Individuals with higher self-reports of function would demonstrate better quadriceps strength of the involved limb than individuals with lower self-reports of function at the time of RTS, and (2) individuals with higher self-reports of function would have normal quadriceps strength limb symmetry. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: At time of RTS, 139 subjects who had undergone ACLR completed the IKDC. In addition, an isometric quadriceps strength test (Biodex dynamometer) was performed on both lower extremities. Peak torques were calculated, as was the Q-LSI, determined by the formula (involved limb peak torque/uninvolved limb peak torque) × 100%. Participants were dichotomized based on IKDC scores: high IKDC (IKDC ‰90) and low IKDC (IKDC <90). Two-way analysis of variance was used to determine the effect of limb (involved vs uninvolved) and group (high vs low IKDC) on isometric quadriceps strength. Chi-square and logistic regression analyses were then performed to determine whether IKDC scores could predict Q-LSI. Results: At time of RTS, a significant correlation between IKDC scores and (1) peak isometric torque (r = 0.282, P <.001) and (2) Q-LSI (r = 0.357, P <.001) was observed. Individuals with IKDC scores ‰90 were 3 times (OR = 3.4; 95% CI, 1.71-6.93) more likely to demonstrate higher Q-LSI (‰90%). An IKDC score ‰94.8 predicted Q-LSI ‰90% with high sensitivity (0.813) and moderate specificity (0.493). Conclusion: Participants with higher IKDC scores demonstrated an increased likelihood of presenting with greater involved limb quadriceps strength and better Q-LSI. Based on the results of this study, a patient-reported outcome measure, such as the IKDC, may be able to serve as a valuable screening tool for the identification of quadriceps strength deficits in this population; however, it should not be considered an accurate surrogate for isokinetic dynamometry. Furthermore, a score of ‰94.8 on the IKDC is likely to indicate that a patients quadriceps strength is at an acceptable RTS level.

Original languageEnglish (US)
Pages (from-to)2242-2249
Number of pages8
JournalAmerican Journal of Sports Medicine
Issue number9
StatePublished - Sep 3 2015
Externally publishedYes


  • ACL reconstruction
  • IKDC
  • patient-reported outcomes
  • quadriceps strength
  • return to sport

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)


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