Correlation among Knee Muscle Strength and Self-Reported Outcomes Score, Anterior Tibial Displacement, and Time Post-Injury in Non-Coper Anterior Cruciate Ligament Deficient Patients: A Cross-Sectional Study

Little attention has been paid to knee muscle strength after ACL rupture and its effect on prognostic outcomes and treatment decisions. We studied hamstrings (H) and quadriceps (Q) strength correlation with a patient-reported outcome measures score (International Knee Documentation Committee, IKDC), anterior tibial translation (ATT), and time post-injury in 194 anterior cruciate ligament deficient patients (ACLD) who required surgery after a failed rehabilitation program (non-copers). The correlation between knee muscle strength and ATT was also studied in 53 non-injured controls. ACLD patients showed decreased knee muscle strength of both the injured and non-injured limbs. The median (interquartile range) values of the H/Q ratio were 0.61 (0.52–0.81) for patients’ injured side and 0.65 (0.57–0.8) for the non-injured side (p = 0.010). The median H/Q ratio for the controls was 0.52 (0.45–0.66) on both knees (p < 0.001, compared with the non-injured side of patients). The H/Q, ATT, and time post-injury were not significantly correlated with the IKDC score. ATT was significantly correlated with the H/Q of the injured and non-injured knees of patients, but not in the knees of the controls. Quadriceps strength and H/Q ratio were significantly correlated with ATT for both limbs of the patients. IKDC score correlated significantly with the quadriceps and hamstrings strengths of the injured limb but not with the H/Q ratio, ATT or time passed after injury.

Intra- and Inter-Rater Reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque Measurements in a Concentric Test in Athletes

This study aimed to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed-2000 dynamometer for knee flexion and extension peak torque (PT) measurements in a concentric test in athletes. Two IsoMed-2000 isokinetic dynamometers were used, an old one that was well-used and a new one that was less-used. Thirty-seven weight-lifting athletes (12 female, 25 male) were included in this study. Both legs of each athlete were tested twice on each isokinetic dynamometer at 60°/s and 180°/s. The Intraclass Correlation Coefficients (ICC), Standard Error Measurement (SEM), Smallest Detectable Change (SDC), SDC% and 95% limits of agreement were calculated to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed 2000 dynamometer for knee flexion and extension peak torque in athletes. Intra-rater reliability was moderate to excellent (ICCs: 0.516–0.928) for knee muscle strength parameters, and the highest SDC and SEM values were 0.76 N/kg and 0.28 N/kg, respectively. Inter-rater reliability was moderate to excellent (ICCs: 0.519–915) for knee muscle strength parameters, and the highest SDC and SEM values were 0.81 N/kg and 0.29 N/kg, respectively. At least 89.2% of the obtained values of parameters fell within the 95% limits of agreement. Our findings demonstrate the intra and inter-rater reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque in Athletes.

Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction

Background: To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. Hypothesis: The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. Study Design: Retrospective cohort study. Level of Evidence: Level 2. Methods: A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. Results: Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. Conclusion: The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. Clinical Relevance: Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.

Effects of Whole-Body Vibration Training on Knee Muscle Strength After Anterior Cruciate Ligament Reconstruction: A Critically Appraised Topic

Clinical Scenario: Knee muscle strength weakness after anterior cruciate ligament (ACL) reconstruction is the most commonly seen impairment. Whole-body vibration (WBV) training has been shown to improve muscle strength in both healthy and injured individuals. However, it is not clear yet if WBV training has a beneficial effect in knee muscle strength recovery after ACL reconstruction. Clinical Question: Is adding WBV training to conventional rehabilitation more effective than conventional rehabilitation at improving quadriceps and hamstring muscles strength in individuals who have undergone ACL reconstruction? Summary of Key Findings: After the literature was reviewed, 4 randomized controlled trials met the inclusion criteria and were included in this critically appraised topic. Clinical Bottom Line: There is moderate- to high-quality evidence to support that adding WBV to conventional rehabilitation programs can result in better improvement in knee muscle strength after ACL reconstruction. Strength of Recommendation: Findings from 4 randomized controlled trials indicate that there is level B evidence supporting that WBV is effective for knee muscle strength recovery in patients who had undergone ACL reconstruction.

Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial

Background: Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings. Hypothesis: Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population. Study Design: Prospective randomized controlled trial. Level of Evidence: Level 2. Methods: A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS). Results: There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups ( P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS). Conclusion: In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises. Clinical Relevance: Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.