Desempenho muscular após reconstrução do LCA com enxertos do tendão do Reto Femoral versus tendões dos Músculos Isquiotibiais

• Ano de defesa: 2025
• Autor(a) principal: Barros, Alef Cavalcanti Matias de
• Orientador(a): Brasileiro, Jamilson Simões
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Rio Grande do Norte
• Programa de Pós-Graduação: PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA
• País: BR
• Palavras-chave em Português: Reconstrução do ligamento cruzado anterior; Lesões do ligamento cruzado anterior; Ligamento cruzado anterior
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
• Link de acesso: https://repositorio.ufrn.br/handle/123456789/69777

Introduction: Anterior cruciate ligament (ACL) injury represents one of the most disabling injuries in sports traumatology. Surgicalreconstruction is the gold standard treatment, with success dependenton graft quality and appropriate rehabilitation. The rectus femoris (RF)tendon emerges as a promising alternative to the patellar tendon(BPTB) and hamstring tendon (HT). However, significant gaps remainin the evidence regarding functional performance in the postoperativeperiod, particularly concerning recovery of muscular strength.Objectives: Study I = To evaluate bilateral isokinetic performancesymmetry of knee extensors and flexors six months after ACLreconstruction using rectus femoris autograft. Study II = To compareisokinetic knee muscle performance six months after ACLreconstruction using autologous rectus femoris (RF) versus hamstringtendon (HT) grafts.Methods: Study I = This retrospective case series included patientsrecruited consecutively at a single tertiary sports medicine centerbetween January 2023 and July 2024. Inclusion criteria requiredprimary ACL reconstruction with rectus femoris autograft, absence ofprevious knee surgery, and minimum follow-up of 6 months. Patientsundergoing revision surgery or multiligamentous procedures wereexcluded. Isokinetic testing was performed at six monthspostoperatively using a computerized dynamometer. The unaffectedlimb was tested first, followed by the operative limb. Patientsperformed five maximal effort attempts at 60°/s for both extension andflexion. Measured outcomes included peak torque (PT), peak torquenormalized to body weight (PT/BW), angle at peak torque (aPT), totalwork (TW), and mean power (MP) for knee extensors and flexors.Paired t-tests compared limbs, with statistical significance set at p ≤0.05.Study II = In this cross-sectional study, 75 male patients undergoingprimary ACL reconstruction with autologous RF (n = 31) or HT (n =44) grafts were evaluated approximately 6 months postoperatively.Bilateral isokinetic testing at angular velocity of 60°/s measured peaktorque (PT), peak torque normalized to body weight (PT/BW), angle atpeak torque (aPT), total work (TW), and mean power (MP) of kneeflexor and extensor groups.Results: Study I = Thirty-one male patients (mean age 26.3 ± 4.7years) were included with mean follow-up of 6.2 ± 0.4 months. Theoperative limb achieved 71% of contralateral extensor peak torque and75% of mean power, with significant deficits in extension PT (p <0.001), PT/BW (p < 0.001), TW (p < 0.001), and MP (p = 0.002). Nosignificant difference was found for aPT (p = 0.457). Flexorperformance demonstrated near-complete recovery, with the operativelimb achieving 93% of contralateral peak torque and 90% of total work,with p = 0.355, 0.340, 0.902, 0.153, and 0.316 for PT, PT/BW, aPT,TW, and MP, respectively.Study II = No statistically significant differences were observedbetween RF and HT groups in any isokinetic performance variables ofknee extensors (p > 0.05). The RF group demonstrated higher kneeflexor performance values compared to the HT group, except for angleat peak torque (p = 0.300). Conclusions: Study I = After six months, ACL reconstruction withrectus femoris autograft was associated with complete recovery of kneeflexor function but with persistent deficits in extensor function.Study II = Anterior cruciate ligament (ACL) reconstruction techniqueusing rectus femoris (RF) graft did not result in significant strengthdeficit in knee extensors compared to hamstring tendon (HT)technique. The RF group demonstrated superior knee flexorperformance, suggesting that this technique preserves functionality offlexor muscles.