Strength assessment after proximal hamstring rupture: A critical review and analysis

Menu, Pierre; Mesland, Olivier; Dauty, Marc

doi:10.1016/j.clinbiomech.2019.11.016

Cited by 7 publications

(9 citation statements)

References 49 publications

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“…Furthermore, these isometric protocols only assessed the knee extensors and never the knee flexors. Isometric testing is usually not adjustable for gravity, which can bias results 19 . On the contrary, isokinetic testing is widely considered as a method of reference in the evaluation of muscular knee strength, 20,21 including patients with haemophilia 22 .…”

Section: Introductionmentioning

confidence: 99%

Isokinetic knee strength deficit in patients with moderate haemophilia

Maugars

Trossaërt²,

Rannou

et al. 2021

Haemophilia

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Introduction: Knee joint bleedings are responsible for quadriceps atrophy and strength deficit in patients with severe haemophilia. Little is known about patients with moderate haemophilia (PWMH). Aim:To evaluate isokinetic quadriceps and hamstrings strength in PWMH and to assess correlation with radiological and clinical parameter.Methods: 18 PWMH aged 37.1 ± 11.4 and 18 healthy age-, weight-and heightmatched controls performed a knee isokinetic test at 180°/s to assess quadriceps and hamstrings strength. In the PWMH group, knee Pettersson's score was pursued and Haemophilia Joint Health Score 2.1 (HJHS) was performed to determine unaffected knees (knee HJHS = 0) and affected ones (knee HJHS >0).Results: Affected knees had a decrease of quadriceps strength compared to controls, 1.26 ± 0.47 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.60 ± 0.29 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). Unaffected knees also had a decrease of quadriceps strength compared to controls, 1.36 ± 0.31 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.69 ± 0.18 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). The conventional hamstring-to-quadriceps ratio was significantly decreased in affected knees compared to controls, 0.46 ± 0.15 vs 0.64 ± 0.13 (P < 0.001) but also in unaffected knees, 0.53 ± 0.16 vs 0.64 ± 0.13 (P = 0.02).No correlation was found between strength and HJHS or Pettersson's score. Conclusion:PWMH have a significant knee strength deficit, both on the quadriceps and the hamstrings, which is responsible for an important muscle imbalance.

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Section: Introductionmentioning

confidence: 99%

Isokinetic knee strength deficit in patients with moderate haemophilia

Maugars

Trossaërt²,

Rannou

et al. 2021

Haemophilia

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“…The results showed a subjectively estimated residual strength of more or equal to 75% [ 19 , 44 ], which must be considered unsatisfactory. In other words, the patients may subjectively estimate a muscle strength deficit of up to 25%, even though the previously reported objectively measured strength deficit may be only around 15% at 12 months after surgery [ 13 , 26 , 49 ]. This discrepancy emphasizes the need for an objective, quantitative, and, most importantly, comparable assessment of postoperative hamstring muscle strength between studies, as recommended by Reza et al [ 50 ] and Fouasson-Chailloux et al [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…In other words, the patients may subjectively estimate a muscle strength deficit of up to 25%, even though the previously reported objectively measured strength deficit may be only around 15% at 12 months after surgery [ 13 , 26 , 49 ]. This discrepancy emphasizes the need for an objective, quantitative, and, most importantly, comparable assessment of postoperative hamstring muscle strength between studies, as recommended by Reza et al [ 50 ] and Fouasson-Chailloux et al [ 49 ]. The overall deficit of peak flexor strength in the affected leg achieved in our patients (3.5%) is well below the 15% reported in the review by Fouasson-Chailloux et al [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength

Chocholáč

Bühl

Nüesch

et al. 2023

Arch Orthop Trauma Surg

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Introduction After conventional surgical refixation of the hamstrings after proximal hamstring rupture, patients frequently experience pain while sitting and deficits in hamstring muscle strength of the operated side. To improve these outcomes, we have modified the surgical anchor placement and have carried out a thorough follow-up examination. Materials and methods Thirteen older patients (8 female, 5 males) with a median age of 64.2 (range, 52.1–80.4) years were surgically treated for acute proximal hamstring rupture using modified anchor placement and participated in a follow-up assessment at a median of 46.2 (11.2–75.0) months after surgery. Patients completed the Perth Hamstring Assessment Tool (PHAT), quality of life questionnaire (EQ-5D-5L) and the Lower Extremity Functional Scale (LEFS), and rated their satisfaction level on a scale from 0 to 100%. Local tenderness on the ischial tuberosity and maximum passive hip flexion were measured on both limbs. Maximum isokinetic knee flexor muscle strength was measured bilaterally using a dynamometer. Results The median (range) PHAT, EQ-5D-5L and LEFS score were 78.8/100 (54.6–99.8), 0.94/1 (0.83–1) and 88.75/100 (61.25–100). The median satisfaction was 100% (90–100%). Only one patient felt discomfort when the ischial tuberosity was palpated. Neither maximum passive hip flexion nor maximum isokinetic flexor muscle strength differed between the operated and non-operated side (P > 0.58). Clinical scores did not correlate with the leg symmetry index of knee flexor muscle strength (Spearman’s rho < 0.448, P > 0.125). There were no tendon re-ruptures, or postoperative sciatic radiculopathy, at the time of follow-up. Conclusions The modified extra-anatomical anchor placement resulted in good clinical and functional outcome of surgical repair of acute proximal hamstring rupture. Especially the absence of postoperative pain while sitting and the comparable muscle strength to the contralateral side is promising. Clinical trial registration ClinicalTrials.gov Identifier: NCT04867746, registered.

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“…At 4 months post-surgery, the H-LSI is related to the recovery of hamstring strength [ 39 ]. This recovery can sometimes be late due to posterior knee pain or arthrofibrosis and is rarely complete at 12 months post-surgery (H-LSI: 83 to 95%) due to the regeneration of the hamstring tendons [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Relevant Strength Parameters to Allow Return to Running after Primary Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

Grondin

Crenn

Gernigon

et al. 2022

IJERPH

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After anterior cruciate ligament reconstruction (ACLR), a progressive process is followed from rehabilitation to the return to sport including a crucial step known as the return to running. Return to running (RTR) can be predicted by an isokinetic knee strength assessment at 4 months post-surgery. All patients who had primarily undergone ACLR with a hamstring autograft procedure between 2010 and 2020 were included in this study. Four months after surgery, patients were evaluated using an isokinetic knee strength test. Patients were monitored until the 6th month post-surgery to see if they had returned to running. Comparisons were carried out between the two groups—the RTR and the no-RTR. A multivariate logistic regression analysis was used to predict the RTR status from explicative parameters. Receiver Operating Characteristic (ROC) curves were established to identify cutoffs with their characteristics. A total of 413 patients were included and 63.2% returned to running at 4 months post-surgery. The mean Lysholm score, knee complication rate, and isokinetic parameters were statistically different between both groups. Using a multivariate logistic regression model and ROC curves, the best isokinetic parameter to assist with the decision to allow an RTR was the quadriceps limb symmetry index at 60°/s with a cutoff of 65%. The hamstring LSI at 180°/s could be added (cutoff of 80%) to slightly increase the prediction of an RTR. Quadriceps strength normalized to body weight at 60°/s is a useful parameter (cutoff: 1.60 Nm/kg) but measurements on both sides are necessary. Isokinetic parameters are objective parameters to allow a return to running at 4 months after ACLR with a hamstring procedure.

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Strength assessment after proximal hamstring rupture: A critical review and analysis

Cited by 7 publications

References 49 publications

Isokinetic knee strength deficit in patients with moderate haemophilia

Isokinetic knee strength deficit in patients with moderate haemophilia

Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength

Relevant Strength Parameters to Allow Return to Running after Primary Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

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