Differences in Psychological Readiness and Quadriceps Strength Symmetry Based on Anterior Cruciate Ligament Reconstruction Graft Type in Military Academy Cadets

Introduction The success of anterior cruciate ligament reconstruction (ACLR) is influenced by factors such as time since surgery, psychological readiness, neuromuscular asymmetries, and ACLR graft type. The purpose of this study was to examine differences in psychological readiness and quadriceps strength symmetry after ACLR based on graft type in military academy cadets. Materials and Methods This was a cross-sectional cohort study. Participants were included if they had a history of a unilateral ACLR within 10-24 months and were cleared by a medical provider to perform jump, hop, and strength testing. The Anterior Cruciate Ligament—Return to Sport after Injury scale (ACL-RSI) assessed psychological readiness. Quadriceps peak torque limb symmetry index (QuadPT LSI) assessed neuromuscular asymmetry. Independent t-tests determined differences in ACL-RSI scores and QuadPT LSI based on graft type. Results There were 22 participants with a bone-patellar tendon-bone (BPTB) graft and 26 participants with quadriceps tendon (QT) graft. Participants with BPTB grafts had significantly greater ACL-RSI scores than those with QT grafts (t = 2.39, P = .02; mean difference 13.7 [95% CI, 2.1-25.3]). Participants with BPTB grafts also had significantly greater QuadPT LSI than those with QT grafts (t = 3.04, P < .01; mean difference 19.0% [95% CI, 6.4-31.6]). Conclusions Military academy cadets who had an ACLR using a QT graft demonstrated lower psychological readiness and quadriceps strength symmetry compared to those with a BPTB graft and were less likely to meet strength symmetry criteria upon return to sport and duty. Rehabilitation professionals may consider closer monitoring of quadriceps strength for patients with QT grafts.