Advertisement

Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review

      Purpose

      To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR).

      Methods

      A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations.

      Results

      A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period.

      Conclusions

      Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols.

      Level of Evidence

      II, a systematic review of level I-II studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Phillips S.M.
        Current concepts and unresolved questions in dietary protein requirements and supplements in adults.
        Front Nutr. 2017; 4: 13
        • Ji H.M.
        • Han J.
        • Jin D.S.
        • Suh H.
        • Chung Y.S.
        • Won Y.Y.
        Sarcopenia and sarcopenic obesity in patients undergoing orthopedic surgery.
        Clin Orthop Surg. 2016; 8: 194-202
        • Holm B.
        • Thorborg K.
        • Husted H.
        • Kehlet H.
        • Bandholm T.
        Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty: A prospective cohort study.
        PLoS One. 2013; 8e62109
        • Moon Y.W.
        • Kim H.J.
        • Ahn H.S.
        • Lee D.H.
        Serial changes of quadriceps and hamstring muscle strength following total knee arthroplasty: A meta-analysis.
        PLoS One. 2016; 11e0148193
        • Meier W.
        • Mizner R.L.
        • Marcus R.L.
        • Dibble L.E.
        • Peters C.
        • Lastayo P.C.
        Total knee arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches.
        J Orthop Sports Phys Ther. 2008; 38: 246-256
        • Raines B.T.
        • Naclerio E.
        • Sherman S.L.
        Management of anterior cruciate ligament injury: What's in and what's out?.
        Indian J Orthop. 2017; 51: 563-575
        • Burgess L.C.
        • Phillips S.M.
        • Wainwright T.W.
        What is the role of nutritional supplements in support of total hip replacement and total knee replacement surgeries? A systematic review.
        Nutrients. 2018; 10 (:820.)
        • Dreyer H.C.
        • Owen E.C.
        • Strycker L.A.
        • et al.
        Essential amino acid supplementation mitigates muscle atrophy after total knee arthroplasty: A randomized, double-blind, placebo-controlled trial.
        JB JS Open Access. 2018; 3e0006
        • Nishizaki K.
        • Ikegami H.
        • Tanaka Y.
        • Imai R.
        • Matsumura H.
        Effects of supplementation with a combination of beta-hydroxy-beta-methyl butyrate, L-arginine, and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee arthroplasty.
        Asia Pac J Clin Nutr. 2015; 24: 412-420
        • Perez-Baos S.
        • Prieto-Potin I.
        • Roman-Blas J.A.
        • Sanchez-Pernaute O.
        • Largo R.
        • Herrero-Beaumont G.
        Mediators and patterns of muscle loss in chronic systemic inflammation.
        Front Physiol. 2018; 9: 409
        • Londhe P.
        • Guttridge D.C.
        Inflammation induced loss of skeletal muscle.
        Bone. 2015; 80: 131-142
        • Hohmann E.
        • Feldman M.
        • Hunt T.J.
        • Cote M.P.
        • Brand J.C.
        Research pearls: How do we establish the level of evidence?.
        Arthroscopy. 2018; 34: 3271-3277
        • Holm L.
        • Esmarck B.
        • Mizuno M.
        • et al.
        The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients.
        J Orthop Res. 2006; 24: 2114-2123
        • Lopez-Vidriero E.
        • Olive-Vilas R.
        • Lopez-Capape D.
        • Varela-Sende L.
        • Lopez-Vidriero R.
        • Til-Perez L.
        Efficacy and tolerability of progen, a nutritional supplement based on innovative plasma proteins, in ACL reconstruction: A multicenter randomized controlled trial.
        Orthop J Sports Med. 2019; 7 (2325967119827237)
        • Eraslan A.
        • Ulkar B.
        Glucosamine supplementation after anterior cruciate ligament reconstruction in athletes: A randomized placebo-controlled trial.
        Res Sports Med. 2015; 23: 14-26
        • Laboute E.
        • France J.
        • Trouve P.
        • Puig P.L.
        • Boireau M.
        • Blanchard A.
        Rehabilitation and leucine supplementation as possible contributors to an athlete's muscle strength in the reathletization phase following anterior cruciate ligament surgery.
        Ann Phys Rehabil Med. 2013; 56: 102-112
        • Tyler T.F.
        • Nicholas S.J.
        • Hershman E.B.
        • Glace B.W.
        • Mullaney M.J.
        • McHugh M.P.
        The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: A randomized, placebo-controlled, double-blind trial.
        Am J Sports Med. 2004; 32: 383-388
        • Barker T.
        • Leonard S.W.
        • Hansen J.
        • et al.
        Vitamin E and C supplementation does not ameliorate muscle dysfunction after anterior cruciate ligament surgery.
        Free Radic Biol Med. 2009; 47: 1611-1618
        • Barker T.
        • Leonard S.W.
        • Trawick R.H.
        • Walker J.A.
        • Traber M.G.
        Antioxidant supplementation lowers circulating IGF-1 but not F(2)-isoprostanes immediately following anterior cruciate ligament surgery.
        Redox Rep. 2009; 14: 221-226
        • Barker T.
        • Leonard S.W.
        • Trawick R.H.
        • et al.
        Modulation of inflammation by vitamin E and C supplementation prior to anterior cruciate ligament surgery.
        Free Radic Biol Med. 2009; 46: 599-606
        • Barker T.
        • Henriksen V.T.
        • Rogers V.E.
        • Trawick R.H.
        Serum cytokines and muscle strength after anterior cruciate ligament surgery are not modulated by high-doses of vitamins E (alpha- and gamma-tocopherol's) and C.
        Cytokine. 2015; 74: 279-286
        • Wu B.
        • Lorezanza D.
        • Badash I.
        • et al.
        Perioperative testosterone supplementation increases lean mass in healthy men undergoing anterior cruciate ligament reconstruction: A randomized controlled trial.
        Orthop J Sports Med. 2017; 5 (2325967117722794)
        • Dreyer H.C.
        • Strycker L.A.
        • Senesac H.A.
        • et al.
        Essential amino acid supplementation in patients following total knee arthroplasty.
        J Clin Invest. 2013; 123: 4654-4666
        • Pujji O.
        • Keswani N.
        • Collier N.
        • Black M.
        • Doos L.
        Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: A systematic review.
        Orthop Rev (Pavia). 2017; 9: 6833
        • Jia Z.Y.
        • Zhang C.
        • Cao S.Q.
        • et al.
        Comparison of artificial graft versus autograft in anterior cruciate ligament reconstruction: A meta-analysis.
        BMC Musculoskelet Disord. 2017; 18: 309
        • Fleming B.C.
        • Spindler K.P.
        • Palmer M.P.
        • Magarian E.M.
        • Murray M.M.
        Collagen-platelet composites improve the biomechanical properties of healing anterior cruciate ligament grafts in a porcine model.
        Am J Sports Med. 2009; 37: 1554-1563
        • Terencio M.C.
        • Ferrandiz M.L.
        • Carceller M.C.
        • et al.
        Chondroprotective effects of the combination chondroitin sulfate-glucosamine in a model of osteoarthritis induced by anterior cruciate ligament transection in ovariectomised rats.
        Biomed Pharmacother. 2016; 79: 120-128
        • Okada Y.
        Histochemical study on the atrophy of the quadriceps femoris muscle caused by knee joint injuries of rats.
        Hiroshima J Med Sci. 1989; 38: 13-21
        • Biolo G.
        • Chinkes D.
        • Zhang X.J.
        • Wolfe R.R.
        • Harry M.
        A new model to determine in vivo the relationship between amino acid transmembrane transport and protein kinetics in muscle.
        JPEN J Parenter Enteral Nutr. 1992; 16: 305-315
        • Biolo G.
        • Maggi S.P.
        • Williams B.D.
        • Tipton K.D.
        • Wolfe R.R.
        Increased rates of muscle protein turnover and amino acid transport after resistance exercise in humans.
        Am J Physiol. 1995; 268: E514-E520
        • Hua J.
        • Sakamoto K.
        • Nagaoka I.
        Inhibitory actions of glucosamine, a therapeutic agent for osteoarthritis, on the functions of neutrophils.
        J Leukoc Biol. 2002; 71: 632-640
        • Durmus D.
        • Alayli G.
        • Aliyazicioglu Y.
        • Buyukakincak O.
        • Canturk F.
        Effects of glucosamine sulfate and exercise therapy on serum leptin levels in patients with knee osteoarthritis: Preliminary results of randomized controlled clinical trial.
        Rheumatol Int. 2013; 33: 593-599
        • Kawasaki T.
        • Kurosawa H.
        • Ikeda H.
        • et al.
        Additive effects of glucosamine or risedronate for the treatment of osteoarthritis of the knee combined with home exercise: A prospective randomized 18-month trial.
        J Bone Miner Metab. 2008; 26: 279-287
        • Messier S.P.
        • Mihalko S.
        • Loeser R.F.
        • et al.
        Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: A preliminary study.
        Osteoarthritis Cartilage. 2007; 15: 1256-1266
        • Williams G.N.
        • Buchanan T.S.
        • Barrance P.J.
        • Axe M.J.
        • Snyder-Mackler L.
        Quadriceps weakness, atrophy, and activation failure in predicted noncopers after anterior cruciate ligament injury.
        Am J Sports Med. 2005; 33: 402-407
        • Chilibeck P.D.
        • Kaviani M.
        • Candow D.G.
        • Zello G.A.
        Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: A meta-analysis.
        Open Access J Sports Med. 2017; 8: 213-226
        • Hespel P.
        • Op't Eijnde B.
        • Van Leemputte M.
        • et al.
        Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans.
        J Physiol. 2001; 536: 625-633
        • Backx E.M.P.
        • Hangelbroek R.
        • Snijders T.
        • et al.
        Creatine loading does not preserve muscle mass or strength during leg immobilization in healthy, young males: A randomized controlled trial.
        Sports Med. 2017; 47: 1661-1671
        • de Souza E.S.A.
        • Pertille A.
        • Reis Barbosa C.G.
        • et al.
        Effects of creatine supplementation on renal function: A systematic review and meta-analysis.
        J Ren Nutr. 2019; 29: 480-489
        • Servais S.
        • Letexier D.
        • Favier R.
        • Duchamp C.
        • Desplanches D.
        Prevention of unloading-induced atrophy by vitamin E supplementation: Links between oxidative stress and soleus muscle proteolysis?.
        Free Radic Biol Med. 2007; 42: 627-635
        • Coombes J.S.
        • Powers S.K.
        • Rowell B.
        • et al.
        Effects of vitamin E and alpha-lipoic acid on skeletal muscle contractile properties.
        J Appl Physiol (1985). 2001; 90: 1424-1430
        • Neto W.K.
        • Gama E.F.
        • Rocha L.Y.
        • et al.
        Effects of testosterone on lean mass gain in elderly men: Systematic review with meta-analysis of controlled and randomized studies.
        Age (Dordr). 2015; 37: 9742
        • Rue J.P.
        • Ferry A.T.
        • Lewis P.B.
        • Bach Jr., B.R.
        Oral corticosteroid use for loss of flexion after primary anterior cruciate ligament reconstruction.
        Arthroscopy. 2008; 24: 554-559.e1
        • Baverel L.
        • Cucurulo T.
        • Lutz C.
        • et al.
        Anesthesia and analgesia methods for outpatient anterior cruciate ligament reconstruction.
        Orthop Traumatol Surg Res. 2016; 102: S251-S255
        • Lattermann C.
        • Jacobs C.A.
        • Proffitt Bunnell M.
        • et al.
        A multicenter study of early anti-inflammatory treatment in patients with acute anterior cruciate ligament tear.
        Am J Sports Med. 2017; 45: 325-333
        • Baldissarro E.
        • Aquilani R.
        • Boschi F.
        • et al.
        The hip functional retrieval after elective surgery may be enhanced by supplemented essential amino acids.
        Biomed Res Int. 2016; 2016: 9318329