Simple Measurements in Assessing Muscle Performance After an ACL Reconstruction

 

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Abstract

The purpose of this study was to evaluate the validity of the simple measurements of the muscle performance of the lower extremity, one legged hop testing for distance and the measurement of the circumference of the thigh 15 cm proximal to the joint line, by comparing them to the isokinetic strength testing 5 to 9 years after an ACL reconstruction with a bone-patellar tendon-bone (BTB) autograft. The measurements were performed on 86 patients on average 7 years after the surgery. The clinical evaluation was performed using the standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) and the Lysholm and the Marshall knee scores. At seven years, the isokinetic mean strength deficit of knee extension at the 60° per second was 10 % in the operated limb as compared to the contralateral limb (NS). In the knee flexion, the differences were even smaller and statistically not significant either. The strength deficit of the knee extension at all knee angle velocities (p < 0.005), and flexion at 60 degrees per second (p < 0.05), correlated to the one legged hop testing, so that the patients with the greatest strength deficit also had the worst outcome in the one legged hop test. Also, the correlation between thigh atrophy and the deficit in the isokinetic strength test was significant in knee extension at all knee angle velocities (p < 0.001), and in knee flexion at 180° per second (p < 0.005). In the final evaluation of the IKDC, 21 patients were rated as “normal”, 51 as “nearly normal”, 13 as “abnormal”, and one as “severely abnormal”. The mean of the Lysholm score was 83, classified as good, and that of Marshall score 43, classified as good. In conclusion, the one legged hop testing, as a functional muscle strength testing after an anterior cruciate ligament reconstruction, seems to correlate well with the isokinetic strength testing of the knee, especially in the knee extension. Because the hop testing can be easily performed and without extra equipment, we recommend its use for the evaluation of the functional muscle performance after an anterior cruciate ligament reconstruction. The measurement of the thigh atrophy is also easy to perform, and should be used beside the one legged hop testing, especially if the isokinetic strength testing is not available.

References

• 1 Antonopolous J, Gillquist J. Anterior tibial translation related to isokinetic concentric quadriceps torques.  Isokinet Exer Sci. 1996;  6 145-151
  PubMedGoogle Scholar
• 2 Barber-Westin S D, Noyes F R, Andrews M. A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction.  Am J Sports Med. 1997;  25 514-526
  PubMedGoogle Scholar
• 3 Clancy W G Jr, Smith L. Arthroscopic anterior and posterior cruciate ligament reconstruction technique.  Ann Chir Gynaecol. 1991;  80 141-148
  PubMedGoogle Scholar
• 4 Daniel D M, Stone M L, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption.  Am J Sports Med. 1985;  13 401-407
  CrossrefPubMedGoogle Scholar
• 5 Donatelli R, Cole S P, Greenfield B, Wooden M, Wilkes J S, Lackey C. Open and closed kinetic chain strength training verse functional exercises to improve performance in patients with ACL reconstructed knees: a prospective study.  Isokin Exer Sci. 1996;  6 7-13
  PubMedGoogle Scholar
• 6 Feiring D C, Ellenbecker T S. Single versus multiple joint isokinetic testing with ACL reconstructed patients.  Isokin Exer Sci. 1996;  6 109-115
  PubMedGoogle Scholar
• 7 Fu F H, Bennett C H, Lattermann C, Ma C B. Current trends in anterior cruciate ligament reconstruction. Part I: Biology and biomechanics of reconstruction.  Am J Sports Med. 1999;  27 821-830
  PubMedGoogle Scholar
• 8 Hefti F, Drobny T, Hackenbusch W, Kipfer W C, Holzach P, Jakob R P, Muller W e, Staubli H U. Evaluation of knee ligament injuries: the OAK and IKDCformsIn: Jakob RP, Staubli H-U (eds).  The Knee and the Cruciate Ligament. Berlin, Heidelberg, New York; Springer 1990: 134-139
  Google Scholar
• 9 Hogervorst T, Brand R A. Mechanoreceptors in joint function. Current concepts review.  J Bone Joint Surg. 1998;  80 1365-1378
  PubMedGoogle Scholar
• 10 Holm I, Ludvigsen P, Steen H. Isokinetic hamstrings/quadriceps ratios: Normal values and reproducibility in sport students.  Isokin Exer Sci. 1994;  4 141-145
  PubMedGoogle Scholar
• 11 Holm I, Risberg M A, Aune A K, Tjomsland O, Steen H. Muscle strength recovery following anterior cruciate ligament reconstruction: A prospective study of 151 patients with a two-year follow-up.  Isokin Exer Sci. 2000;  8 57-63
  PubMedGoogle Scholar
• 12 Johnson R J, Beynnon B D, Nichols C E, Renström P AFH. The treatment of injuries of the anterior cruciate ligament. Current concepts review.  J Bone Joint Surg. 1992;  74 140-151
  PubMedGoogle Scholar
• 13 Juris P M, Phillips E M, Dalpe C, Edwards C, Gotlin R S, Kane D J. A dynamic test of lower extremity function following anterior cruciate ligament reconstruction and rehabilitation.  JOSPT. 1997;  26 184-191
  PubMedGoogle Scholar
• 14 Järvelä T, Kannus P, Järvinen M. Anterior knee pain 7 years after an anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft.  Scand J Med Sci Sports. 2000;  10 221-227
  CrossrefPubMedGoogle Scholar
• 15 Järvelä T, Paakkala T, Kannus P, Järvinen M. The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft.  Am J Sports Med. 2001;  29 18-24
  PubMedGoogle Scholar
• 16 Kannus P, Järvinen M, Latvala K. Knee strength evaluation: A standardized test protocol and scoring scale for isokinetic and isometric strength measurement of the knee joint for evaluation of long-term healing results of various knee problems and their treatment procedures.  Scand J Sports Sci. 1987;  9 9-13
  PubMedGoogle Scholar
• 17 Li C K, Chan K M, Hsu S YC, Chien P, Wong W N. A quantifiable approach in the comparison of isokinetic assessment data-new correlation equations for the Johnson antishear device and standard shin pad in the isokinetic assessment of the knee.  Br J Sports Med. 1995;  29 171-173
  PubMedGoogle Scholar
• 18 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of scoring scale.  Am J Sports Med. 1982;  10 150-154
  CrossrefPubMedGoogle Scholar
• 19 Marshall J L, Fetto J F, Botero B M. Knee ligament injuries. A standardized evaluation method.  Clin Orthop. 1977;  123 115-129
  PubMedGoogle Scholar
• 20 Moore K L. The knee joint. In: Moore KL (eds) Clinically Oriented Anatomy. Baltimore, London, Los Angeles, Sydney; Williams & Wilkins 1985 Second Edition: 523-41
  Google Scholar
• 21 Natri A, Järvinen 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;  17 223-238
  PubMedGoogle Scholar
• 22 Ohkoshi Y, Inoue C, Yamane S, Hashimoto T, Ishida R. Changes in muscle strength properties caused by harvesting of autogenous semitendinosus tendon for reconstruction of contralateral anterior cruciate ligament.  Arthroscopy. 1998;  14 580-584
  PubMedGoogle Scholar
• 23 Paterno M V, Greenberger H B. The test-retest reliability of a one legged hop for distance in young adults with and without ACL reconstruction.  Isokin Exer Sci. 1996;  6 1-6
  PubMedGoogle Scholar
• 24 Rosenberg T D, Franklin J L, Baldwin G N, Nelson K A. Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction.  Am J Sports Med. 1992;  20 519-525
  Google Scholar
• 25 Sachs R A, Daniel D M, Stone M L, Garfein R F. Patellofemoral problems after anterior cruciate ligament reconstruction.  Am J Sports Med. 1989;  17 760-765
  CrossrefPubMedGoogle Scholar
• 26 Sekiya I, Muneta T, Ogiuchi T, Yagishita K, Yamamoto H. Significance of the single-legged hop test to the anterior cruciate ligament-reconstructed knee in relation to muscle strength and anterior laxity.  Am J Sports Med. 1998;  26 384-388
  PubMedGoogle Scholar
• 27 Strauss G R, Bozikovic A J, Jones G L, Neale G C, Spittles M R, Boyle J JW. Knee extensor strength 12 and 18 weeks post anterior cruciate ligament reconstruction.  Isokin Exer Sci. 1998;  7 19-26
  PubMedGoogle Scholar
• 28 Österås H, Augestad L B, Töndel S. Isokinetic muscle strength after anterior cruciate ligament reconstruction.  Scand J Med Sci Sports. 1998;  8 279-282
  PubMedGoogle Scholar

MD T. Järvelä

Division of Orthopaedics · Department of Surgery · Tampere University Hospital

PO Box 2000 · 33521 Tampere · Finland ·

Phone: +358 (3) 2476072

Fax: +358 (3) 2474358

Email: timo.jarvela@sci.fi