Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance after ACL Reconstruction.

Background: Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR).Purpose: To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR.Study Design: Controlled laboratory study.Methods: A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] +/- SE) or interactions for all variables.Results: A significant speedxdepth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD +/- SE, 19.92 +/- 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD +/- SE, 19.11 +/- 3.95 ms; P < .001) and 300 deg/s (MD +/- SE, 16.43 +/- 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD +/- SE: 90 deg/s, -57.0 +/- 10.5 N.m, P < .001; 180 deg/s, -26.0 +/- 10.2 N.m, P = .020; 300 deg/s, -20.3 +/- 8.9 N.m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD +/- SD: RTD0-25 (0-25% of the range of motion), -131.3 +/- 50.9 N.m/s, P = .018; RTD25-50, -197.0 +/- 72.5 N.m/s, P = .014; RTD50-75, -113.3 +/- 39.8 N.m/s, P = .013; RTD75-100, -149.4 +/- 35.9 N.m/s, P < .001).Conclusion: Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds.Clinical Relevance: The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.