Correlation of muscle strength and reported knee function after Anterior Cruciate Ligament (ACL) graft, unrepaired ACL injury, and healthy knees
DOI:
https://doi.org/10.33448/rsd-v13i1.44755Keywords:
Muscle strength; Knee; Anterior cruciate ligament; Questionnaires.Abstract
Introduction: Many tools can be used for functional assessment following an Anterior Cruciate Ligament (ACL) injury or reconstruction. These include the assessment of stability, the assessment of neuromuscular factors such as strength, and the patient's perception of knee function. The manual dynamometer (MD) is a strength assessment tool that can be used in environments where isokinetic assessment is not feasible. The Lyshom questionnaire, Tegner scale, and the International Knee Documentation Committee (IKDC) scale are validated instruments for subjective functional assessment. Objective: To evaluate the correlation between muscle strength and reported knee function after ACL grafting, unrepaired ACL injury, and healthy knees. Methods: 95 male subjects were evaluated, 36 with ACL reconstruction, 23 with unrepaired ACL injury, and 36 without knee injuries. All were evaluated with the Lysholm questionnaire, Tegner, and IKDC scales. Muscle strength was assessed with the MD, and the limb symmetry index (LSI) was used to correlate with the reported function. Results: The lowest scores on the Lysholm questionnaires and Tegner and IKDC scales occurred in subjects with unrepaired injuries, with significance between groups (p=0.000–0.001). The association involving the ISL with the Lysholm questionnaire and IKDC scale was observed in the ISL of 10% and 15% only for the extension (p<0.01). Conclusion: The Lysholm questionnaire and the Tegner and IKDC scales indicated the level of function according to the clinical condition, and the association of LSI with reported function occurred only for extension. The association of strength tests, functional tests, and questionnaires should be considered for functional assessment of the knee. The MD should be a tool to be considered in the absence of an isokinetic dynamometer, and because it is superior to manual muscle strength testing (MMT).
References
Abernethy, P., Wilson, G., & Logan, P. (1995). Strength and power assessment. Issues, controversies and challenges. Sports medicine (Auckland, N.Z.), 19(6), 401–417. https://doi.org/10.2165/00007256-199519060-00004
Almeida, G. P. L., Albano, T. R., & Melo, A. K. P. (2019). Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA, 27(8), 2494–2501. https://doi.org/10.1007/s00167-018-5245-3
Benfica, P. D. A., Aguiar, L. T., Brito, S. A. F., Bernardino, L. H. N., Teixeira-Salmela, L. F., & Faria, C. D. C. M. (2018). Reference values for muscle strength: a systematic review with a descriptive meta-analysis. Brazilian journal of physical therapy, 22(5), 355–369. https://doi.org/10.1016/j.bjpt.2018.02.006
Bittencourt, N. F., Santos, T. R., Gonçalves, G. G., Coelho, A. P., Gomes, B. G., Mendonça, L.deM., & Fonseca, S. T. (2016). Reference values of hip abductor torque among youth athletes: Influence of age, sex and sports. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 21, 1–6. https://doi.org/10.1016/j.ptsp.2015.12.005
Bohannon, R. W. (2012). Hand-held dynamometry: A practicable alternative for obtaining objective measures of muscle strength. Isokinetics and Exercise Science, 20(4), 301-315. https://doi.org/10.3233/IES-2012-0476
Bohannon R. W. (1986). Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Physical therapy, 66(2), 206–209. https://doi.org/10.1093/ptj/66.2.206
Chamorro, C., Armijo-Olivo, S., De la Fuente, C., Fuentes, J., & Javier Chirosa, L. (2017). Absolute Reliability and Concurrent Validity of Hand Held Dynamometry and Isokinetic Dynamometry in the Hip, Knee and Ankle Joint: Systematic Review and Meta-analysis. Open medicine (Warsaw, Poland), 12, 359–375. https://doi.org/10.1515/med-2017-0052
Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., & Roos, E. M. (2011). Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis care & research, 63 Suppl 11(0 11), S208–S228. https://doi.org/10.1002/acr.20632
Contador, J. L., & Senne, E. L. F. (2016). Testes não paramétricos para pequenas amostras de variáveis não categorizadas: um estudo. Gestão & Produção, 23(3), 588–599. https://doi.org/10.1590/0104-530X357-15
Davies, G. J., McCarty, E., Provencher, M., & Manske, R. C. (2017). ACL Return to Sport Guidelines and Criteria. Current reviews in musculoskeletal medicine, 10(3), 307–314. https://doi.org/10.1007/s12178-017-9420-9
Dawson, A. G., Hutchison, J. D., & Sutherland, A. G. (2016). Is Anterior Cruciate Reconstruction Superior to Conservative Treatment?. The journal of knee surgery, 29(1), 74–79. https://doi.org/10.1055/s-0034-1396017
Fitzgerald, G. K., Axe, M. J., & Snyder-Mackler, L. (2000). A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 8(2), 76–82. https://doi.org/10.1007/s001670050190
Florencio, L. L., Martins, J., da Silva, M. R. B., da Silva, J. R., Bellizzi, G. L., & Bevilaqua-Grossi, D. (2019). Knee and hip strength measurements obtained by a hand-held dynamometer stabilized by a belt and an examiner demonstrate parallel reliability but not agreement. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 38, 115–122. https://doi.org/10.1016/j.ptsp.2019.04.011
Fulcher, M. L., Hanna, C. M., & Raina Elley, C. (2010). Reliability of handheld dynamometry in assessment of hip strength in adult male football players. Journal of science and medicine in sport, 13(1), 80–84. https://doi.org/10.1016/j.jsams.2008.11.007
Gaines, J. M., & Talbot, L. A. (1999). Isokinetic strength testing in research and practice. Biological research for nursing, 1(1), 57–64. https://doi.org/10.1177/109980049900100108
Gonçalves, C. C. K., Peccin, M. S., Almeida, G. J. d. M., & Cohen, M. (2007). Tradução, validação e adaptação cultural da escala de atividade esportiva. Acta Ortopédica Brasileira, 15(5), 246-250. https://doi.org/10.1590/S1413-78522007000500002
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British journal of sports medicine, 50(13), 804–808. https://doi.org/10.1136/bjsports-2016-096031
Hansen, E. M., McCartney, C. N., Sweeney, R. S., Palimenio, M. R., & Grindstaff, T. L. (2015). Hand-held Dynamometer Positioning Impacts Discomfort During Quadriceps Strength Testing: A Validity and Reliability Study. International journal of sports physical therapy, 10(1), 62–68.
Herrington, L., Hatcher, J., Hatcher, A., & McNicholas, M. (2009). A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. The Knee, 16(2), 149–152. https://doi.org/10.1016/j.knee.2008.10.004
Imoto, A. M., Peccin, M. S., & Trevisani, V. F. (2012). Quadriceps strengthening exercises are effective in improving pain, function and quality of life in patients with osteoarthritis of the knee. Acta ortopedica brasileira, 20(3), 174–179. https://doi.org/10.1590/S1413-78522012000300008
Irrgang, J. J., Anderson, A. F., Boland, A. L., Harner, C. D., Kurosaka, M., Neyret, P., Richmond, J. C., & Shelborne, K. D. (2001). Development and validation of the international knee documentation committee subjective knee form. The American journal of sports medicine, 29(5), 600–613. https://doi.org/10.1177/03635465010290051301
Jackson, S. M., Cheng, M. S., Smith, A. R., Jr, & Kolber, M. J. (2017). Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device. Musculoskeletal science & practice, 27, 137–141. https://doi.org/10.1016/j.math.2016.07.010
Jang, S. H., Kim, J. G., Ha, J. K., Wang, B. G., & Yang, S. J. (2014). Functional performance tests as indicators of returning to sports after anterior cruciate ligament reconstruction. The Knee, 21(1), 95–101. https://doi.org/10.1016/j.knee.2013.08.017
Katoh, M., & Yamasaki, H. (2009). Comparison of Reliability of Isometric Leg Muscle Strength Measurements Made Using a Hand-Held Dynamometer with and without a Restraining Belt. Journal of Physical Therapy Science, 21, 37-42.
Katoh, M., Hiiragi, Y., & Uchida, M. (2011). Validity of Isometric Muscle Strength Measurements of the Lower Limbs Using a Hand-held Dynamometer and Belt: a Comparison with an Isokinetic Dynamometer. Journal of Physical Therapy Science, 23(4), 553-557. https://doi.org/10.1589/jpts.23.553
Katoh, M., & Isozaki, K. (2014). Reliability of Isometric Knee Extension Muscle Strength Measurements of Healthy Elderly Subjects Made with a Hand-held Dynamometer and a Belt. Journal of physical therapy science, 26(12), 1855–1859. https://doi.org/10.1589/jpts.26.1855
Kelln, B. M., McKeon, P. O., Gontkof, L. M., & Hertel, J. (2008). Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active,young adults. Journal of sport rehabilitation, 17(2), 160–170. https://doi.org/10.1123/jsr.17.2.160
Koblbauer, I. F., Lambrecht, Y., van der Hulst, M. L., Neeter, C., Engelbert, R. H., Poolman, R. W., & Scholtes, V. A. (2011). Reliability of maximal isometric knee strength testing with modified hand-held dynamometry in patients awaiting total knee arthroplasty: useful in research and individual patient settings? A reliability study. BMC musculoskeletal disorders, 12, 249. https://doi.org/10.1186/1471-2474-12-249
Kvist J. (2004). Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports medicine (Auckland, N.Z.), 34(4), 269–280. https://doi.org/10.2165/00007256-200434040-00006
Lesnak, J., Anderson, D., Farmer, B., Katsavelis, D., & Grindstaff, T. L. (2019). Validity of hand-held dynamometry in measuring quadriceps strength and rate of torque development. International journal of sports physical therapy, 14(2), 180–187.
Lienhard, K., Lauermann, S. P., Schneider, D., Item-Glatthorn, J. F., Casartelli, N. C., & Maffiuletti, N. A. (2013). Validity and reliability of isometric, isokinetic and isoinertial modalities for the assessment of quadriceps muscle strength in patients with total knee arthroplasty. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 23(6), 1283–1288. https://doi.org/10.1016/j.jelekin.2013.09.004
Luzo, M. V. M., Franciozi, C. E. d. S., Rezende, F. C., Gracitelli, G. C., Debieux, P., & Cohen, M. (2016). Anterior Cruciate Ligament - updating article. Revista Brasileira de Ortopedia, 51(4), 385-395. https://doi.org/10.1016/j.rboe.2016.05.001
Magalhães, E., Fukuda, T. Y., Sacramento, S. N., Forgas, A., Cohen, M., & Abdalla, R. J. (2010). A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome. The Journal of orthopaedic and sports physical therapy, 40(10), 641–647. https://doi.org/10.2519/jospt.2010.3120
Malempati, C., Jurjans, J., Noehren, B., Ireland, M. L., & Johnson, D. L. (2015). Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes. Orthopedics, 38(11), 689–696. https://doi.org/10.3928/01477447-20151016-07
Marcondes, F. B., Rosa, S. G., Vasconcelos, R. A. d., Basta, A., Freitas, D. G., & Fukuda, T. Y. (2011). Força do manguito rotador em indivíduos com síndrome do impacto comparado ao lado assintomático. Acta Ortopédica Brasileira, 19, 333-337.
Mentiplay, B. F., Perraton, L. G., Bower, K. J., Adair, B., Pua, Y. H., Williams, G. P., McGaw, R., & Clark, R. A. (2015). Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study. PloS one, 10(10), e0140822. https://doi.org/10.1371/journal.pone.0140822
Mentiplay, B. F., Tan, D., Williams, G., Adair, B., Pua, Y. H., Bower, K. J., & Clark, R. A. (2018). Assessment of isometric muscle strength and rate of torque development with hand-held dynamometry: Test-retest reliability and relationship with gait velocity after stroke. Journal of biomechanics, 75, 171–175. https://doi.org/10.1016/j.jbiomech.2018.04.032
Metsavaht, L., Leporace, G., Riberto, M., de Mello Sposito, M. M., & Batista, L. A. (2010). Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. The American journal of sports medicine, 38(9), 1894–1899. https://doi.org/10.1177/0363546510365314
Muff, G., Dufour, S., Meyer, A., Severac, F., Favret, F., Geny, B., Lecocq, J., & Isner-Horobeti, M. E. (2016). Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer. Journal of physical therapy science, 28(9), 2445–2451. https://doi.org/10.1589/jpts.28.2445
Nascimento, L. R., Teixeira-Salmela, L. F., Souza, R. B., & Resende, R. A. (2018). Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. The Journal of orthopaedic and sports physical therapy, 48(1), 19–31. https://doi.org/10.2519/jospt.2018.7365
Noyes, F. R., Barber, S. D., & Mangine, R. E. (1991). Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. The American journal of sports medicine, 19(5), 513–518. https://doi.org/10.1177/036354659101900518
Nunn, K. D., & Mayhew, J. L. (1988). Comparison of three methods of assessing strength imbalances at the knee. The Journal of orthopaedic and sports physical therapy, 10(4), 134–137. https://doi.org/10.2519/jospt.1988.10.4.134
O'Malley, E., Richter, C., King, E., Strike, S., Moran, K., Franklyn-Miller, A., & Moran, R. (2018). Countermovement Jump and Isokinetic Dynamometry as Measures of Rehabilitation Status After Anterior Cruciate Ligament Reconstruction. Journal of athletic training, 53(7), 687–695. https://doi.org/10.4085/1062-6050-480-16
Pagano M. & Gauvreau K. (2004) Princípios de Bioestatística. São Paulo: Thomson.
Peccin, M. S., Ciconelli, R., & Cohen, M.. (2006). Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa. Acta Ortopédica Brasileira, 14(5), 268–272. https://doi.org/10.1590/S1413-78522006000500008
Plisky, P. J., Gorman, P. P., Butler, R. J., Kiesel, K. B., Underwood, F. B., & Elkins, B. (2009). The reliability of an instrumented device for measuring components of the star excursion balance test. North American journal of sports physical therapy : NAJSPT, 4(2), 92–99.
Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. The Journal of orthopaedic and sports physical therapy, 36(12), 911–919. https://doi.org/10.2519/jospt.2006.2244 Siqueira, D. A., Baraúna, M. A., & Dionísio, V. C. (2012). Avaliação funcional do joelho em portadores da síndrome da dor femoropatelar (SDFP): comparação entre as escalas KOS e IKDC. Revista Brasileira de Medicina do Esporte, 18, 400-403.
Shinzato G.T., Vasconcelos J.C.P, Ogawa C.T., Sampaio I.C.S.P., Gonçalves A. & Neves E.M. (1996). Protocolo de avaliação funcional de joelho em patologias ortopédicas. http://www.revistas.usp.br/actafisiatrica/article/view/101991, 3(1), 30-36. https://doi:10.11606/issn.2317-0190.v3i1a101991.
Suzuki T. (2015). Reliability of measurements of knee extensor muscle strength using a pull-type hand-held dynamometer. Journal of physical therapy science, 27(3), 967–971. https://doi.org/10.1589/jpts.27.967
Tegner, Y., & Lysholm, J. (1985). Rating systems in the evaluation of knee ligament injuries. Clinical orthopaedics and related research, (198), 43–49.
Trudelle-Jackson, E., Jackson, A. W., Frankowski, C. M., Long, K. M., & Meske, N. B. (1994). Interdevice reliability and validity assessment of the Nicholas Hand-Held Dynamometer. The Journal of orthopaedic and sports physical therapy, 20(6), 302–306. https://doi.org/10.2519/jospt.1994.20.6.302
Vasconcelos, R. A. d., Bevilaqua-Grossi, D., Shimano, A. C., Paccola, C. A. J., Salvini, T. F., Prado, C. L., & Mello Junior, W. A. (2009). Análise da correlação entre pico de torque, desempenho funcional e frouxidão ligamentar em indivíduos normais e com reconstrução do ligamento cruzado anterior. Revista Brasileira de Ortopedia, 44, 134-142.
Wang, C. Y., Olson, S. L., & Protas, E. J. (2002). Test-retest strength reliability: hand-held dynamometry in community-dwelling elderly fallers. Archives of physical medicine and rehabilitation, 83(6), 811–815. https://doi.org/10.1053/apmr.2002.32743
Xergia, S. A., Pappas, E., Zampeli, F., Georgiou, S., & Georgoulis, A. D. (2013). Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction. The Journal of orthopaedic and sports physical therapy, 43(3), 154–162. https://doi.org/10.2519/jospt.2013.3967
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