Restricted accessResearch articleFirst published online 2010-3
Anterior Cruciate Ligament—Deficient Potential Copers and Noncopers Reveal Different Isokinetic Quadriceps Strength Profiles in the Early Stage After Injury
Background: Isokinetic muscle strength testing using the peak torque value is the most frequently included quadriceps muscle strength measurement for anterior cruciate ligament (ACL)—injured subjects.
Purpose and Hypotheses: The purpose of this study was to investigate quadriceps muscle performance during the whole isokinetic curve in subjects with ACL deficiency classified as potential copers or noncopers and to investigate whether these curve profiles were associated with single-legged hop performance. We hypothesized that quadriceps muscle torque at other knee flexion angles than peak torque would give more information about quadriceps muscle strength deficits. Furthermore, we hypothesized that there would be significant torque differences between potential copers and noncopers and a significant relationship between angle-specific torque values and single-legged hop performance.
Study Design: Cross-sectional study; Level of evidence, 3.
Methods: Seventy-six individuals with a complete unilateral ACL rupture within the last 3 months were included. The subjects were classified as potential copers and noncopers. Isokinetic quadriceps muscle tests were performed at 60 deg/s. Mean torque values were calculated for peak torque as well as for specific knee flexion angles. The 1-legged hop and the 6-m timed hop tests were included, and symmetry indices were used.
Results: The peak torque value did not identify the largest quadriceps muscle strength deficit. Rather, these were established at knee flexion angles of less than 40°. There were significant differences in angle-specific torque values between potential copers and noncopers (P < .05). Moderate to strong associations were disclosed between angle-specific torque values and single-legged hop performance, but only for noncopers (r ≥ .32-.58).
Conclusion: Angle-specific quadriceps muscle torque values of less than 40° of knee flexion provide more information on the quadriceps strength deficits after ACL injury than the commonly used peak torque values. Interpretation of the isokinetic curve profiles seems to be of clinical importance for the evaluation of quadriceps muscle performance after ACL injury.
Andrade MS, Cohen M., Picarro IC, Silva ACKnee performance after anterior cruciate ligament reconstruction. Isokinet Exerc Sci.2009;10:81-86.
2.
Ayalon M., Barak Y., Rubinstein M.Qualitative analysis of the isokinetic moment curve of the knee extensors . Isokinet Exerc Sci. 2002;10:145-151.
3.
Ayalon M., Rubinstein M., Barak Y., Dunsky A., Ben-Sira D.Identification of feigned strength test of the knee extensors and flexors based on the shape of the isokinetic torque curve. Isokinet Exerc Sci. 2001;9:45-50.
4.
Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W.Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res. 1990;255:204-214.
5.
Benjuya N., Plotqin D., Melzer I.Isokinetic profile of patient with anterior cruciate ligament tear . Isokinet Exerc Sci. 2000;8:229-232.
6.
Bryant AL, Creaby MW, Newton RU, Steele JRDynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 2008;89(12):2324-2331.
7.
Cohen J.Statistical PowerAnalysis for the Behavioural Sciences. 2nd ed. Mahwah, NJ: Lawrence Erlbaum ; 1988.
8.
Croisier JL, Malnati M., Reichard LB, Peretz C., Dvir Z.Quadriceps and hamstring isokinetic strength and electromyographic activity measured at different ranges of motion: a reproducibility study. J Electromyogr Kinesiol. 2007;17(4):484-492.
Eastlack ME , Axe MJ, Snyder-Mackler L.Laxity, instability, and functional outcome after ACL injury: copers versus noncopers. Med Sci Sports Exerc.1999;31(2):210-215.
11.
Eitzen I., Holm I., Risberg MAPreoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009;43(5):371-376.
12.
Fitzgerald GK, Axe MJ, Snyder-Mackler L.A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):76-82.
13.
Hamilton RT , Shultz SJ, Schmitz RJ, Perrin DHTriple-hop distance as a valid predictor of lower limb strength and power. J Athl Train. 2008;43(2):144-151.
14.
Hefti F., Muller W., Jakob RP, Staubli HUEvaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;(1)(3-4):226-234.
15.
Hole CD, Smit GH, Hammond J., Kumar A., Saxton J., Cochrane T.Dynamic control and conventional strength ratios of the quadriceps and hamstrings in subjects with anterior cruciate ligament deficiency. Ergonomics . 2000;43(10):1603-1609.
16.
Holm I.Quantification of Muscle Strength by Isokinetic Performance. Oslo: University of Oslo, Norway; 1996.
17.
Hurd WJ, Axe MJ, Snyder-Mackler L.A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury. Part 2: determinants of dynamic knee stability. Am J Sports Med. 2008;36(1):48-56.
18.
Ikeda H., Kurosawa H., Kim SGQuadriceps torque curve pattern in patients with anterior cruciate ligament injury. Int Orthop. 2002;26(6): 374-376.
19.
Impellizzeri FM, Bizzini M., Rampinini E., Cereda F., Maffiuletti NAReliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer . Clin Physiol Funct Imaging. 2008;28(2):113-119.
20.
Ingersoll CD , Grindstaff TL, Pietrosimone BG, Hart JMNeuromuscular consequences of anterior cruciate ligament injury. Clin Sports Med. 2008;27(3):383-404.
21.
Kannus P.Peak torque and total work relationship in the thigh muscles after anterior cruciate ligament injury. J Orthop Sports Phys Ther . 1988;10(3):97-101.
22.
Kannus P., Jarvinen M., Johnson R., et al. Function of the quadriceps and hamstrings muscles in knees with chronic partial deficiency of the anterior cruciate ligament: isometric and isokinetic evaluation. Am J Sports Med. 1992 ;20(2):162-168.
23.
Keays SL, Bullock-Saxton JE, Newcombe P., Keays ACThe relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res. 2003;21(2): 231-237.
24.
Konishi Y., Ikeda K., Nishino A., Sunaga M., Aihara Y., Fukubayashi T.Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament repair. Scand J Med Sci Sports.2007;17(6):656-661.
25.
Kotrlik JW, Williams HAThe incorporation of effect size in information technology, learning, and performance research. Inf Technol Learn Perform J. 2003;21(1):1-7.
26.
Kurdak SS, Özgünen K., Ümüt A., et al. Analysis of isokinetic knee extension/flexion in male elite adolescent wrestlers. J Sports Sci Med. 2005 ;4:489-498.
27.
Lephart SM, Kocher MS, Harner CD, Fu FHQuadriceps strength and functional capacity after anterior cruciate ligament reconstruction: patellar tendon autograft versus allograft. Am J Sports Med. 1993;21(5):738-743.
Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JLCombined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res.1995;13(6):930-935.
30.
Mattacola CG , Perrin DH, Gansneder BM, Gieck JH, Saliba EN, McCue FC III.Strength, functional outcome, and postural stability after anterior cruciate ligament reconstruction. J Athl Train. 2002 ; 37(3):262-268.
31.
Natri A., Jarvinen M., Latvala K., Kannus P.Isokinetic muscle performance after anterior cruciate ligament surgery: long-term results and outcome predicting factors after primary surgery and late-phase reconstruction. Int J Sports Med. 1996;17(3):223-228.
32.
Noyes FR, Barber SD, Mangine REAbnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19(5):513-518.
33.
Nyberg B., Granhed H., Peterson K., Piros C., Svantesson U.Muscle strength and jumping distance during 10 years post ACL reconstruction . Isokinet Exerc Sci. 2006;14:363-370.
34.
O’Donnell S., Thomas SG, Marks P.Improving the sensitivity of the hop index in patients with an ACL deficient knee by transforming the hop distance scores . BMC Musculoskelet Disord.2006;7:9.
35.
Ostenberg A. , Roos E., Ekdahl C., Roos H.Isokinetic knee extensor strength and functional performance in healthy female soccer players . Scand J Med Sci Sports. 1998;8(5 Pt 1):257-264.
36.
Palmieri-Smith RM, Thomas AC, Wojtys EMMaximizing quadriceps strength after ACL reconstruction . Clin Sports Med.2008;27(3): 405-424.
37.
Petersen W. , Zantop T.Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res. 2007;454:35-47.
38.
Petschnig R. , Baron R., Albrecht M.The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 1998;28(1):23-31.
39.
Pincivero DM , Heller BM, Hou SIThe effects of ACL injury on quadriceps and hamstring torque, work and power. J Sports Sci. 2002; 20(9):689-696.
40.
Probst MM, Fletcher R., Seelig DSA comparison of lower-body flexibility, strength, and knee stability between karate athletes and active controls. J Strength Cond Res. 2007;21(2):451-455.
41.
Pua YH, Bryant AL, Steele JR, Newton RU, Wrigley TVIsokinetic dynamometry in anterior cruciate ligament injury and reconstruction . Ann Acad Med Singapore. 2008;37(4):330-340.
42.
Reichard LB , Croisier JL, Malnati M., Katz-Leurer M., Dvir Z.Testing knee extension and flexion strength at different ranges of motion: an isokinetic and electromyographic study. Eur J Appl Physiol. 2005;95(4):371-376.
43.
Reid A., Birmingham TB, Stratford PW, Alcock GK, Giffin JRHop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther . 2007;87(3):337-349.
44.
Ross MD, Irrgang JJ, Denegar CR, McCloy CM, Unangst ETThe relationship between participation restrictions and selected clinical measures following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2002;10(1):10-19.
45.
Rudolph KS, Axe MJ, Snyder-Mackler L.Dynamic stability after ACL injury: who can hop?Knee Surg Sports Traumatol Arthrosc.2000; 8(5):262-269.
Shirakura K. , Kato K., Udagawa E.Characteristics of the isokinetic performance of patients with injured cruciate ligaments. Am J Sports Med . 1992;20(6):754-760.
48.
Siqueira CM , Pelegrini FR, Fontana MF, Greve JMIsokinetic dynamometry of knee flexors and extensors: comparative study among non-athletes, jumper athletes and runner athletes. Rev Hosp Clin Fac Med Sao Paulo . 2002;57(1):19-24.
49.
Slocker de Arce A., Sanchez JC, Camacho FJF, de Arriba CC, Pellico LGIsokinetic evaluation of the healthy knee: position of the joint at the peak torque. Isokinet Exerc Sci.2001;9:151-154.
50.
Snyder-Mackler L., Fitzgerald GK, Bartolozzi AR III, Ciccotti MGThe relationship between passive joint laxity and functional outcome after anterior cruciate ligament injury. Am J Sports Med. 1997;25(2): 191-195.
51.
Sole G., Hamren J., Milosavljevic S., Nicholson H., Sullivan SJTestretest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil. 2007;88(5):626-631.
52.
Sørensen H., Zacho M., Simonsen EB, Dyhre-Poulsen P., Klausen K.Joint angle errors in the use of isokinetic dynamometers. Isokinet Exerc Sci. 1998;7:129-133.
53.
Tsepis E., Giakas G., Vagenas G., Georgoulis A.Frequency content asymmetry of the isokinetic curve between ACL deficient and healthy knee. J Biomech. 2004;37(6):857-864.
54.
Wilk KE, Romaniello WT, Soscia SM, Arrigo CA, Andrews JRThe relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. J Orthop Sports Phys Ther. 1994;20(2):60-73.
55.
Williams GN , Chmielewski T., Rudolph K., Buchanan TS, Snyder-Mackler L.Dynamic knee stability: current theory and implications for clinicians and scientists . J Orthop Sports Phys Ther. 2001; 31(10):546-566.
56.
Wroble RR, Van Ginkel LA, Grood ES, Noyes FR, Shaffer BLRepeatability of the KT-1000 arthrometer in a normal population. Am J Sports Med. 1990;18(4):396-399.
57.
Yasuda K., Ichiyama H., Kondo E., Miyatake S., Inoue M., Tanabe Y.An in vivo biomechanical study on the tension-versus-knee flexion angle curves of 2 grafts in anatomic double-bundle anterior cruciate ligament reconstruction: effects of initial tension and internal tibial rotation. Arthroscopy. 2008;24(3):276-284.
58.
Yasuda K., Ohkoshi Y., Tanabe Y., Kaneda K.Quantitative evaluation of knee instability and muscle strength after anterior cruciate ligament reconstruction using patellar and quadriceps tendon . Am J Sports Med. 1992;20(4):471-475.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
