Isokinetic hamstring and quadriceps strength interpretation guideline for football (soccer) players with ACL reconstruction: a Delphi consensus study in the Netherlands

2022 ◽  
Author(s):  
Nick van der Horst ◽  
Remy Denderen
Keyword(s):  
The Netherlands ◽  
Acl Reconstruction ◽  
Quadriceps Strength ◽  
Soccer Players ◽  
Delphi Consensus

scholarly journals The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
J. Taradaj ◽  
T. Halski ◽  
M. Kucharzewski ◽  
K. Walewicz ◽  
A. Smykla ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Acl Reconstruction ◽  
Neuromuscular Electrical Stimulation ◽  
Exercise Program ◽  
Return To Sport ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Knee Function ◽  
Soccer Players ◽  
Professional Soccer

The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials RegistryACTRN12613001168741.

scholarly journals Knee Muscle Strength Recovery in the Early Period After ACL Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Gulcan Harput ◽  
Hasan Erkan Kılınc ◽  
Hamza Özer ◽  
Gül Baltacı ◽  
Carl G. Mattacola
Keyword(s):  
Acl Reconstruction ◽  
Early Period ◽  
Quadriceps Strength ◽  
Isometric Strength ◽  
Time Points ◽  
Hamstring Muscles ◽  
Significant Difference ◽  
Isometric Torque ◽  
Over Time ◽  
Time Point

Objectives: The aim of this study was to investigate quadriceps and hamstrings isometric strength at 4, 8 and 12 week time points following ACL Reconstruction (ACLR) and to document the strength changes of these muscles over time. The primary hypothesis was that there would be significant increases in quadriceps and hamstring muscle strengths between the 4th, 8th and 12th weeks following ACLR. The secondary hypothesis was that the quadriceps index would be higher than hamstring index at 12th week after ACLR. Methods: Thirty patients (Mean ± SD [age, 29.1±2.3yrs; weight, 77.3±13.2kg; height, 172.1±7.1cm; BMI, 21.2±3.5kg/m2, time to surgery: 7.1±7.2 months]) who underwent ACLR with Hamstring Tendon Autograft (HTG) were enrolled in this study. The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at 60° knee flexion angle at 4th, 8th and 12th weeks after surgery. The recovery of quadriceps and hamstring muscles strength following rehabilitation was expressed as a Quadriceps Index (QI) and Hamstring Index (HI) and calculated with the following formula:[(maximum voluntary isometric torque of the involved limb / maximum voluntary isometric torque by uninvolved limb) × 100]. Torque output of the involved and uninvolved limbs and quadriceps and hamstring indexes were used for the statistical analysis. A repeated measures of ANOVA was used to determine the strength changes of quadriceps and hamstrings over time. Results: Quadriceps and Hamstrings strengths significantly increased over time for both involved (Quadriceps: F (2,46)=58.3, p<0.001, Hamstring: F (2,46)=35.7, p<0.001) and uninvolved limb (Quadriceps: F(2,46)=17.9, p<0.001, Hamstring: F(2,46)=56.9, p=0.001 ). Quadriceps strength was higher at 12th week when compared to the 8 and 4 week time points for the involved limb (p<0.001), and it was higher at 8th week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb, quadriceps strength was also higher at 12th week when compared to the 8 (p=0.02) and 4 week time point (p<0.001), and higher at 8 week when compared to the 4 week time point (p=0.02). Hamstring strength was higher at 12 week when compared to the 8 and 4 week time points (p<0.001) and it was higher at 8 week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb hamstring strength was also higher at 12 week when compared to 4 week time point (p=0.01). There was no significant difference between the 4 and 8 week time points (p>0.05) or between the 8 and 12 week time points (p=0.07). Quadriceps and hamstring indexes significantly changed from 4th weeks (QI:57.9, HI:54.4 ) to 8th weeks (QI:78.8, HI:69.9 ) and from 8th weeks to 12th weeks (QI:82, HI:75.7 ) (p<0.001); however, there was no difference between indexes at the 12-week time point (p=0.17). Conclusion: Isometric strength of quadriceps and hamstring muscles for the involved and uninvolved limb increased during the early period of ACLR. The results of this study could be a baseline for clinicians while prescribing a rehabilitation protocol for ACLR patients with HTG to better appreciate expected strength changes of the muscles in the early phase.

scholarly journals Blood Flow Restriction Training Does Not Improve Quadriceps Strength After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Michael Curran ◽  
Asheesh Bedi ◽  
Christopher Mendias ◽  
Edward M. Wojtys ◽  
Megan Kujawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Blood Flow Restriction ◽  
Effect Sizes ◽  
Leg Press ◽  
Symmetry Index ◽  
Flow Restriction ◽  
Anterior Cruciate

Objectives: Blood flow restriction training (BFRT) involves obstruction of venous outflow of working muscles during exercise and may lead to more substantial recovery of quadriceps strength after anterior cruciate ligament (ACL) reconstruction. The purpose of this study is to examine the effects of BFRT in ACL reconstruction patients before and after exposure to BFRT. Methods: This study was a randomized controlled trial in which 36 patients who had torn their ACL and were scheduled to undergo ACL reconstructive surgery (ACLR) with an autograft were randomized to receive exercise with BFRT (N=18) or exercise without BFRT (N=18). Participants in both groups performed the same exercise, but either did or did not have blood flow restricted. The exercise component of the intervention consisted of all subjects performing a single-leg isokinetic leg press, at an intensity of 70% of the subjects’ one-repetition maximum, for four sets of ten repetitions two times per week for 8 weeks beginning at 8 weeks post-operatively. Patients randomized to the BFRT group performed the leg-press exercise with a blood flow restriction cuff applied to the thigh and set to a limb occlusion pressure of 80 percent. All participants were concurrently undergoing standard ACL rehabilitation at the same physical therapy clinic. Bilateral isometric (recorded at a knee angle of 90°) and isokinetic (60°/second) quadriceps strength were recorded using a Biodex dynamometer (System 4, Shirley, NY) prior to ACLR and after the conclusion of the 8-week intervention. Peak isometric and isokinetic quadriceps strength were utilized to generate isometric and isokinetic quadriceps symmetry indices ((ACLR limb strength/Healthy limb strength) x100). Change from baseline symmetry scores were then generated using the following equation: (post-intervention symmetry - pre-intervention symmetry)/pre-intervention symmetry in order to account for possible differences in strength between groups prior to intervention delivery. Change from baseline isometric and isokinetic quadriceps symmetry scores were then compared between groups (exercise with BFRT, exercise without BFRT) using one-way analysis of variance tests with an a priori α set to P≤ 0.05. Effect sizes (Cohen’s d) and 95% confidence intervals were also computed. Results: No significant differences were found for change from baseline isokinetic quadriceps symmetry index (P=0.39, BFRT mean=-0.05, Control mean=-0.19) or change from baseline isometric quadriceps symmetry index (P=0.62, BFRT mean=-0.04, control mean=-0.10). The effect sizes for isokinetic quadriceps symmetry index (d=0.28, 95% CI= -0.37, 0.93) and isometric quadriceps symmetry (d=0.16, 95% CI= -0.49, 0.80) were small with confidence intervals that crossed zero. Conclusion: An 8-week blood flow resistance training + exercise intervention did not increase quadriceps muscle strength in patients who had undergone ACL reconstruction. Based on our findings, application of blood flow restriction training in ACL reconstruction patients to improve quadriceps strength may not be warranted. Future studies may benefit from a longer follow-up and larger sample size.

scholarly journals No Relationship Between Preoperative and Early Postoperative Strength After ACL Reconstruction

2020 ◽  
Vol 29 (5) ◽  
pp. 583-587
Author(s):  
Pier Paolo Mariani ◽  
Luca Laudani ◽  
Jacopo E. Rocchi ◽  
Arrigo Giombini ◽  
Andrea Macaluso
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Strength ◽  
Maximal Voluntary Isometric Contraction ◽  
Extensor Muscles ◽  
Flexor Muscles ◽  
Anterior Cruciate ◽  
Tendon Autograft ◽  
Knee Extensor Muscles

Context: All rehabilitative programs before anterior cruciate ligament (ACL) reconstructive surgery, which are focused on recovery of proprioception and muscular strength, are defined as prehabilitation. While it has shown that prehabilitation positively affects the overall outcome after ACL reconstruction, it is still controversial whether preoperatively enhancing quadriceps strength has some beneficial effect on postoperative strength, mainly during the first period. Objective: To determine whether there is any relationship between preoperative and early postoperative quadriceps strength. Design: Case control. Setting: University research laboratory. Participants: Fifty-nine males (18–33 y; age: 23.69 [0.71] y) who underwent ACL reconstruction with patellar-tendon autograft were examined the day before surgery, and at 60 and 90 days after surgery. Main Outcome Measures: The limb symmetry index (LSI) was quantified for maximal voluntary isometric contraction of the knee extensor muscles and of the knee flexor muscles at 90° joint angle. A k-means analysis was performed on either quadriceps or hamstrings LSI before surgery to classify the patients in high and low preoperative LSI clusters. Differences in postoperative LSI were then evaluated between the high and low preoperative LSI clusters. Results: Following surgery, there were no differences in the quadriceps LSI between patients with high and low preoperative quadriceps LSI. Sixty days after surgery, the hamstrings LSI was higher in patients with high than low preoperative hamstrings LSI (84.0 [13.0]% vs 75.4 [15.9]%; P < .05). Conclusions: Findings suggest that quadriceps strength deficit is related to the ACL injury and increases further after the reconstruction without any correlation between the preoperative and postoperative values. Therefore, it appears that there is no need to delay surgery in order to increase the preoperative quadriceps strength before surgery.

scholarly journals THE EFFECT OF AGE AND CONCOMITANT SURGERY ON STRENGTH IN ADOLESCENT ATHLETES WITH PRIMARY QUADRICEPS TENDON ACL RECONSTRUCTION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Sarah E. Reinking ◽  
Kaitlyn A. Flynn ◽  
Alexia G. Gagliardi ◽  
Cassidy J. Hallagin ◽  
Melissa N. Randall ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Steady Increase ◽  
Isokinetic Testing ◽  
Concomitant Surgery ◽  
Effect Of Age ◽  
Meniscus Surgery

Background: Knee extensor strength deficits occur after ACL reconstruction (ACLR). Prior studies have reported that age affects quadriceps strength after ACLR, however strength deficits in relation to age have not been assessed among adolescents. Isokinetic dynamometric strength testing is a tool frequently used to assess strength post-operatively in order to identify these deficits. Purposes: 1) To examine the effect of age on isokinetic extensor and flexor deficits among adolescents who were 5-10 months post-ACLR. We hypothesized that age would be inversely related to extensor strength deficit. 2) To determine if extensor or flexor strength deficits exist between adolescents post-ACLR with and without concomitant meniscus surgery. We hypothesized that those with concomitant meniscus surgery would demonstrate greater deficits in flexor and extensor strength. Methods: Study participants completed isokinetic testing within 5-10 months after primary quadriceps tendon ACLR, but before return to sport. The protocol consisted of assessing peak torque at 60, 180, and 300 degrees/s, through a limited range of knee extension and flexion. Our primary outcome variables were peak torque percent deficit of involved leg compared to uninvolved leg for flexion and extension. To address purpose 1, we constructed a series of multivariable regression models, where age was the independent variable, peak torque flexor/extensor deficits at each testing speed was the dependent variable, and sex and weight were covariates. To address purpose 2, we compared peak torque extensor and flexor deficits between those with and without concomitant meniscus surgery using independent samples t-tests. Results: A total of 44 completed the study protocol. There were no significant demographic differences between those with and without concomitant meniscus surgery (Table 1). The relationship between age at surgery and peak torque extensor deficits at 300d/s demonstrated a linear but non-significant association (Table 2; Figure 1). For every year increase in age, the expected deficit at 300d/s increased by approximately 3%. Patients who underwent isolated ACLR demonstrated significantly greater flexor deficits than those who underwent ACLR with concomitant meniscus surgery when tested at 180d/s and 300d/s (Table 3). Conclusion: Contrary to our first hypothesis, extensor deficits at 300d/s demonstrated an apparent association with older age. We observed a steady increase in strength deficit at 300d/s associated with increasing age. Contrary to our second hypothesis, no significant differences were found in extensor strength between those with and without meniscus surgery. Additionally, those with concomitant meniscus surgery demonstrated significantly less flexor deficit than those without meniscus surgery. [Table: see text][Table: see text][Figure: see text][Table: see text]

Is Pre-operative Quadriceps Strength a Predictive Factor for the Outcomes of Anterior Cruciate Ligament Reconstructions

2020 ◽  
Vol 41 (13) ◽  
pp. 912-920
Author(s):  
Jihong Qiu ◽  
Xin He ◽  
Sai-Chuen Fu ◽  
Michael Tim-Yun Ong ◽  
Hio Teng Leong ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Predictive Value ◽  
Cruciate Ligament ◽  
Positive Association ◽  
Quadriceps Strength ◽  
Treatment Protocols ◽  
Strength Assessment ◽  
Operative Outcomes ◽  
Anterior Cruciate

AbstractPersistent quadriceps weakness prevents patients from returning to sports after ACL reconstruction. Pre-operative quadriceps strength was indicated as an important factor for the outcomes of ACL reconstruction. However, the existing evidence is controversial. Therefore, this systematic review was conducted to summarize and evaluate the relationship between pre-operative quadriceps strength and the outcomes following ACL reconstruction, and to summarize the predictive value of pre-operative quadriceps strength for satisfactory post-operative outcomes. Pubmed, WOS, Embase, CINAHL and SportDiscus were searched to identify eligible studies according to PRISMA guidelines. Relevant data was extracted regarding quadriceps strength assessment methods, pre-operative quadriceps strength, participants treatment protocols, post-operative outcomes, follow-up time points and the relevant results of each individual study. Twelve cohort studies (Coleman methodology score: 62±10.4; from 44–78) with 1773 participants included. Follow-up period ranged from 3 months to 2 years. Moderate evidence supports the positive association between pre-operative quadriceps strength and post-operative quadriceps strength; weak evidence supports the positive association between pre-operative quadriceps strength and post-operative functional outcomes. By now, there is no consensus on the predictive value of pre-operative quadriceps strength for achieving satisfactory quadriceps strength after ACLR. To conclude, pre-operative quadriceps strength should be taken into consideration when predict patient recovery of ACLR.

scholarly journals Changes in Muscle Strength in U19 Soccer Players During an Annual Training Cycle

2014 ◽  
Vol 42 (1) ◽  
pp. 175-185 ◽  
Author(s):  
Michal Lehnert ◽  
Zuzana Xaverová ◽  
Mark De Ste Croix
Keyword(s):  
Peak Torque ◽  
Quadriceps Strength ◽  
Soccer Players ◽  
Muscle Action ◽  
Strength Assessment ◽  
Training Cycle ◽  
Competitive Season ◽  
Post Hoc ◽  
Testing Range ◽  
Knee Flexors

Abstract The aim of the study was to investigate the seasonal variation in isokinetic strength of the knee flexors and extensors, and conventional (H/QCONV) and functional (H/QFUNC) hamstring to quadriceps strength ratios in highly trained adolescent soccer players. The players (n=11; age 17.8±0.3) were measured at the end of the competitive season (autumn), at the beginning and the end of pre-season (winter) and during the sixth week of a new competitive season. Isokinetic peak torque (concentric and eccentric) was measured at 60°•s-1 in a sitting position with the hip flexed at 100°. The testing range of motion was set from 10 - 90° of knee flexion. The players performed a set of five maximum repetitions for both the dominant and non-dominant leg. Statistically significant differences (p<0.001) between the four seasonal measurements were noted for peak torque of the dominant leg knee flexors in concentric muscle action only. A post hoc analysis revealed a statistically significant increase in peak torque from the 1st to the 4th measurement (p<0.001; d=0.692) and from the 2nd to the 4th (p<0.01; d=0.564). The differences in the changes of peak torque of the knee flexors and extensors depending on type of muscle action and tendencies found in the H/Q ratios throughout the annual training cycle indicate that strength assessment of the knee flexors and extensors and their balance throughout the annual training cycle could be beneficial for elite male adolescent soccer players both in terms of performance and risk of injury.

The Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength after ACL Reconstruction (SS-13)

2013 ◽  
Vol 29 (6) ◽  
pp. e6-e7
Author(s):  
Scott Kuzma ◽  
Grigoriy Arutyunyan ◽  
Aaron Krych ◽  
Bruce A. Levy ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Acl Reconstruction ◽  
Femoral Nerve ◽  
Quadriceps Strength ◽  
Nerve Blockade
Sign in / Sign up

Export Citation Format

Share Document