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

Abstract

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.

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

“…The seven systematic reviews we conducted to synthesise the evidence (table 1), incorporated the findings of approximately 230 studies containing data from >133 000 persons with traumatic knee injuries 17 29 30 35–38. Of the seven systematic reviews, four performed quantitative syntheses, and all seven performed semi-quantitative or narrative syntheses.…”

“…Research recommendations: the 6 research recommendations address priorities for knee injury and PTOA research, study design considerations and what outcomes to monitor. One additional draft recommendation (how to interpret outcome changes) was removed after the consensus meeting, because there was insufficient evidence available to inform a recommendation 36–38. Instead, guidance on interpreting changes in recommended PROs, muscle function and functional performance tests is provided in online supplemental file 4, and recommendation on thresholds for minimal important change, patient acceptable symptom state and treatment failure are summarised in the PROs systematic review 36.…”

“…While we have a sense of what evidence-based care is for ACL tears, we are unclear if these approaches are appropriate for other injury types (eg, meniscal tears) or if they mitigate PTOA risk 30 35. We also do not understand which outcomes are the most useful to monitor across the timespan from injury to PTOA and what constitutes a meaningful change in an outcome 36–38. These knowledge gaps represent important targets for future research and should be pursued alongside patient partners using existing study design and reporting guidelines to ensure higher levels of certainty of evidence and facilitate data synthesis (eg, PROGRESS 2,18 CONSORT, CERT47 and COSMIN) 48…”

“…One additional draft recommendation (how to interpret outcome changes) was removed after the consensus meeting, because there was insufficient evidence available to inform a recommendation. [36][37][38] on November Primary: synthesise evidence on physical activity, work limitations, health/economic costs, disease burden, and HRQoL outcomes ≥2 years after traumatic ACL and/or meniscal injury Secondary: determine the burden of living with knee symptoms and OA after traumatic ACL and/or meniscal injury…”

“…RoB: COSMIN checklist 48 56 Certainty: GRADE approach for PROs 57 Measurement properties of muscle strength tests following traumatic ACL or meniscal tear 37 Primary: synthesise and critically appraise the measurement properties of knee extensor and flexor strength in individuals following ACL and/or meniscal tear…”