Abstract:Background
Knee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compa… Show more
“…There is also concern of inaccuracy when testing large muscle groups such as the knee extensors using HHD 1 88. This finding is consistent with systematic reviews on healthy and injured individuals13 and applies also for knee flexor strength tests 95…”
ObjectivesCritically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist.DesignSystematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality.Data sourcesMedline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022.Eligibility criteria for selecting studiesStudies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in individuals with ACL and/or meniscus injuries with a mean injury age of ≤30 years.ResultsThirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in individuals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality).ConclusionKnee extensor and flexor strength tests of individuals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.
“…There is also concern of inaccuracy when testing large muscle groups such as the knee extensors using HHD 1 88. This finding is consistent with systematic reviews on healthy and injured individuals13 and applies also for knee flexor strength tests 95…”
ObjectivesCritically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist.DesignSystematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality.Data sourcesMedline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022.Eligibility criteria for selecting studiesStudies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in individuals with ACL and/or meniscus injuries with a mean injury age of ≤30 years.ResultsThirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in individuals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality).ConclusionKnee extensor and flexor strength tests of individuals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.
“…Previous studies have reported that isometric and concentric knee flexion torque was significantly greater with the ankle dorsiflexed position than the plantarflexed position (Ogborn et al, 2021;Marchetti et al, 2019;Miller et al, 1996;Croce et al, 2000). Since the gastrocnemius is a biarticular muscle, it is thought that ankle dorsiflexion stretches the gastrocnemius and brings it closer to its optimal length, which contributes to knee flexion strength and knee joint stability, thereby enabling greater muscle force (Miller et al, 1996;Croce et al, 2000) In NHE strength testing, it was thought that the ankle dorsiflexed position was suitable for exerting greater peak eccentric force than the plantarflexed position; but, our results differed from the hypothesis.…”
Section: Discussionmentioning
confidence: 93%
“…Hamstring strength may be affected by ankle position, as a previous study reported that isometric knee flexion torque was 14-22% greater with the ankle dorsiflexed position than the plantarflexed position (Ogborn et al, 2021;Marchetti et al, 2019). Similarly, concentric knee flexion torque (angular velocity of 60°/s) was 7-13% greater with the ankle dorsiflexed position than the plantarflexed position (Miller et al, 1996;Croce and Miller, 2000).…”
Peak eccentric force during the Nordic hamstring exercise (NHE) is recognized as a predictive factor for hamstring strain injury (HSI). During the NHE, the knee flexor muscles are eccentrically contracting to resist the knee joint extension. Therefore, it is thought that the action of the gastrocnemius muscle, and thus the ankle position, influences peak eccentric force during the NHE. However, the effect of ankle position on peak eccentric force during the NHE remains unclear. Therefore, we investigated the effect of ankle position on peak eccentric force during the NHE in a cohort of 50 healthy young male rugby players (mean age, 18.7 ± 1.2 years; mean body mass, 81.7 ± 15.2 kg; height, 1.72 ± 0.06 m) with no history of HSI. Each participant performed NHE strength testing with the ankle dorsiflexed or plantarflexed position and was instructed to fall forward as far as possible within 3 s. Peak eccentric force, reported relative to body mass (N/kg), of both legs was recorded, and the mean values of both legs were compared in both ankle positions. The mean peak eccentric force was significantly greater with the ankle plantarflexed position than the dorsiflexed position (3.8 ± 1.1 vs. 3.5 ± 1.1 N/kg, respectively, p = 0.049). These results indicate that ankle position should be carefully considered when measuring peak eccentric force during the NHE and performing NHE training.
“…Maximal voluntary isometric contraction (MVIC) of the knee extensors and knee flexors was measured pre, immediately post intervention and at 3 months follow-up, with the unaffected contralateral limb tested prior to the KOA limb at each assessment. The participants were seated with their knees flexed at 60 degrees (−30 degrees from full knee extension) and the hip joint at 85 degrees on an isokinetic dynamometer (Biodex System 4 Pro, Biodex Medical Systems, Shirley, NY, USA), which has an intraclass correlation coefficient (ICC) of 0.93 for knee extension and an ICC of 0.89 for knee flexion [ 27 ]. Knee flexion of 60 degrees was selected to ensure consistency between testing sessions and participants; 60 degrees of knee flexion results in the greatest force output following and bypassing any potential restriction in movement due to KOA.…”
Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p < 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p < 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention.
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