|dc.description.abstract||Anterior cruciate ligament (ACL) injury is a common knee injury with an incidence
of between 32 and 80 cases per 100,000 inhabitants every year worldwide.
Reconstruction of the ACL is the standard surgical method that aims to repair
knee stability, improve both clinical and functional outcomes, achieve a rapid
return to sport (RTS) and reduce the potential risk of knee osteoarthritis.
Quadriceps tendon autografts (QTA) have become more popular in the last 20
years because of their advantages over knee stability and muscle strength
recovery . Patellar tendon autografts (PTA) and hamstring tendon autografts
(HTA) are the most commonly used autografts. Therefore, choosing ACL
reconstruction autografts remains controversial because of their advantages and
Consequently, a series of objective were proposed , divided into four objectives:
The first phase of this doctoral thesis mainly aimed 1) To review the literature
and compare isokinetic strength tests, functional outcomes, and knee
anteroposterior laxity between QTA and HTA or PTA after ACL reconstruction.
And the second phase aimed, 2)To analyse the sociodemographic and clinical
characteristics of patients with injured ACLs before reconstruction surgeries. 3)
To compare the difference of PROM, CROM and FROM between patients
following ACL reconstruction with BQTB, QTA, or HTA at three evaluation periods
(Pre – 3 months, Pre – 6 months, and Pre – 12 months) after rehabilitation
protocol. 4) To compare the difference of CROM and FROM between the injured
side and non-injured side of all ACL reconstruction patients at 12 months of
follow up. To achieve the objectives of the both phases, two methodology were
caried: A systematic review and meta-analysis for the first phase and
Randomized Control Trail for the second phase of the doctoral thesis.
The results of this doctoral thesis were; 1) The first phase of the thesis adds further quantitative data analysis to
previously published systematic reviews. The QTA showed better and significant
results in knee flexion strength compared with HTA and similar results to PTA at
3-, 6-, and 12- months. HTA showed better and significant results in knee
extension strength at 6 months and similar results at 12 months compared to
QTA. 2) The BQTA showed the major disadvantage in terms of surgery failure
due to intraoperative patella fracture and therefore the delay of rehabilitation
process and return to sport. 3)All of the three groups (BQTA, QTA, and HTA)
showed a similar result in terms of PROM during all of the evaluation times.
However, all patients showed massive improvement between pre-surgery and
the final follow-up. 4)All of the three groups (BQTA, QTA, and HTA) showed a
similar result in terms of knee anteroposterior laxity, sonographic measurements,
PPT, and VAS. However, the HTA group showed better improvement of thigh
girth measurement during the 3 - and 6-months follow-up test. Moreover, all
patients showed huge improvement between 3 - and 12-months follow-up.
5)The HTA group showed better improvement of knee extension muscle
strength during the first 6 months. The three groups showed similar knee
extensions muscle strength results at 12 months follow-up. A similar result was
found for all groups in terms of knee flexion muscle strength and SLHT. The RTS
criteria was in favour of HTA at 6 months and similar between all groups at 12
months. Furthermore, both sides showed an improvement regarding the FROM.
6)The side-to-side comparison showed similar results regarding knee
anteroposterior laxity, sonographic measurements, PPT, and VAS. However, the
non-injured side had better results in terms of thigh girths measurements and
knee flexion and extension isokinetic test.||es_ES