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

Abstract

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.

Measurement properties for muscle strength tests following anterior cruciate ligament and/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus

“…Twenty-eight studies included ACL-reconstructed individuals,48–75 three assessed ACL-injured individuals,76–78 four79–82 involved individuals before and after ACL reconstruction and one study83 assessed individuals with an isolated partial meniscectomy. Further details about the included studies and strength tests are provided in table 2.…”

“…Isokinetic concentric and eccentric strength were consistently assessed by computerised dynamometry at five different speeds. Isometric strength was assessed at five different angles, either tested manually with HHD48 74 78 or by computerised dynamometry 51 52 55 60 62 66 79. Isotonic strength was either tested during one-repetition maximum (1RM) on leg extension or prone leg curl machines70 or in a leg press machine testing 70% of 1RM 69.…”

“…Isotonic strength was either tested during one-repetition maximum (1RM) on leg extension or prone leg curl machines70 or in a leg press machine testing 70% of 1RM 69. All strength tests but two74 78 were performed in a seated position. An overview of the modes, equipment and variables reported of the strength tests is provided in online supplemental appendix 4.…”

“…The included studies investigated four measurement properties: reliability,48 62 71 74 measurement error,48 62 71 construct validity (hypothesis testing)49–61 63 64 66–69 71–73 75–84 and criterion (concurrent) validity 48 69 70 74. None of the included studies investigated responsiveness or interpretability.…”

“…Thirty-two studies assessed hypothesis testing, including ACL-reconstructed or ACL-injured individuals or individuals after isolated meniscectomy (one study). All but one78 study exploring construct validity assessed strength using computerised dynamometry. Correlation coefficients for isokinetic concentric and isometric strength tests were quantitatively pooled.…”