A comparison of strength and power characteristics prior to anterior cruciate ligament rupture and at the end of rehabilitation in professional soccer players

Background: Strength and power is often reduced on the involved vs. contralateral limb and healthy controls following anterior cruciate ligament (ACL) reconstruction but no study has compared to pre-injury values at the time of return to sport (RTS).
Hypothesis: Divergent recovery patterns in strength and power characteristics will be present at RTS relative to pre-injury baseline data and healthy matched controls.
Study design: Cohort study
Level of evidence: Level 3
Methods: Isokinetic strength tests, bilateral and single leg countermovement jumps (CMJ; SLCMJ) were measured prior to ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow up testing prior to RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group pre-injury. Values recorded at RTS of the ACL group were compared to pre-injury. We also compared the uninjured and ACL groups at baseline and RTS.
Results: Compared to pre-injury, ACL normalised quadriceps peak torque of the involved limb (% difference = -7%), SLCMJ height (% difference = -12.08%) and Reactive Strength Index modified (RSImod) (% difference = -5.04%) were reduced following ACL reconstruction. No significant reductions in CMJ height, RSImod and relative peak power were indicated at RTS in the ACL group when compared to pre-injury values but deficits were present relative to controls. The uninvolved limb significantly improved quadriceps (% difference = 9.34%) and hamstring strength (% difference = 7.36%) from pre-injury to RTS. No significant differences from baseline were shown in SLCMJ height, power and reactive strength of the uninvolved limb following ACL reconstruction.
Conclusion: Strength and power in professional soccer players at RTS following ACL reconstruction were often reduced compared to preinjury values and matched healthy controls.
Clinical relevance: Deficits were more apparent in the SLCMJ suggesting dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.