The online version of this article (https://doi.org/10.1007/s11332-017-0410-5) contains supplementary material, which is available to authorized users.
There is sparse evidence for return to sport criteria after knee injury. Functional performance deficits, particularly in fatigued muscular condition, should be verified prior to the attempt to return to high-risk pivoting sports. The purpose of this study was to generate reference values for the limb symmetry index (LSI) of healthy subjects in fatigued and non-fatigued muscular condition in a newly designed test battery.
Forty-two healthy subjects [22 females, 20 males; mean (SD) age 30.4 (6.6) years] were evaluated using a test battery consisting of an isometric strength test, a series of five single-leg hop tests and an integrated fatigue protocol. Subjective physical activity was assessed with the Tegner Activity Scale (TAS). The cut-off values for healthy subjects were calculated considering the fifth percentile as the minimum reference value for the LSI and single-leg hop distance.
The mean (SD) overall LSI was 98.8% (4.6). No significant gender or age specific differences in limb symmetry were observed. The comparison of the non-fatigued LSI with the overall LSI revealed no clinically relevant change due to muscular fatigue. Repeated measures ANOVA revealed a significant within effect on fatigue/non-fatigue condition (F (1,38) = 18.000; p < 0.001, η 2 = 0.321) on absolute single-leg hop distance. Moreover, a significant between effect on the TAS-parameter (F (1,38) = 5.928; p = 0.020, η 2 = 0.135 between: TAS ≤ 5/TAS > 5) and on gender (F (1,38) = 23.956; p < 0.001, η 2 = 0.387) could be detected.
The absolute jumping distance in the single-leg hop for distance was significantly reduced due to fatigue. No clinically relevant effect of muscular fatigue was observed on limb symmetry in our study sample. Gender and physical activity are important factors to be considered when interpreting reference values.
Supplementary material 1 (DOCX 1705 kb)11332_2017_410_MOESM1_ESM.docx
Micheo W, Hernández L, Seda C (2010) Evaluation, management, rehabilitation, and prevention of anterior cruciate ligament injury: current concepts. PM&R 2:935–944. https://doi.org/10.1016/j.pmrj.2010.06.014 CrossRef
Ithurburn MP, Paterno MV, Ford KR et al (2015) Young athletes with quadriceps femoris strength asymmetry at return to sport after anterior cruciate ligament reconstruction demonstrate asymmetric single-leg drop-landing mechanics. Am J Sports Med 43:2727–2737. https://doi.org/10.1177/0363546515602016 CrossRefPubMed
Paterno MV, Schmitt LC, Ford KR et al (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38:1968–1978. https://doi.org/10.1177/0363546510376053 CrossRefPubMedPubMedCentral
Hildebrandt C, Müller L, Zisch B et al (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 23:1273–1281. https://doi.org/10.1007/s00167-015-3529-4 CrossRefPubMedPubMedCentral
Herbst E, Hoser C, Hildebrandt C et al (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc 23:1283–1291. https://doi.org/10.1007/s00167-015-3546-3 CrossRefPubMedPubMedCentral
Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg 27:1697–1705. https://doi.org/10.1016/j.arthro.2011.09.009 CrossRef
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 39:538–543. https://doi.org/10.1177/0363546510384798 CrossRefPubMed
Mizrahi J, Verbitsky O, Isakov E, Daily D (2000) Effect of fatigue on leg kinematics and impact acceleration in long distance running. Hum Mov Sci 19:139–151. https://doi.org/10.1016/S0167-9457(00)00013-0 CrossRef
Swanenburg J, Koch PP, Meier N, Wirth B (2014) Function and activity in patients with knee arthroplasty: validity and reliability of a German version of the Lysholm Score and the Tegner Activity Scale. Swiss Med Wkly 144:1–6. https://doi.org/10.4414/smw.2014.13976
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Budziareck MB, Duarte RRP, Barbosa-Silva MCG (2008) Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr 27:357–362. https://doi.org/10.1016/j.clnu.2008.03.008 CrossRefPubMed
Schmitt LC, Paterno MV, Hewett TE (2012) The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 42:750–759. https://doi.org/10.2519/jospt.2012.4194 CrossRefPubMedPubMedCentral
Schmitt LC, Paterno MV, Ford KR et al (2015) Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sport Exerc 47:229–262. https://doi.org/10.1007/978-1-4614-5915-6
Tesio L (2012) Outcome measurement in behavioural sciences: a view on how to shift attention from means to individuals and why. Int J Rehabil Res 35:1–12. https://doi.org/10.1097/MRR.0b013e32834fbe89 CrossRefPubMed
Tesio L, Rota V, Longo S, Grzeda MT (2013) Measuring standing balance in adults: reliability and minimal real difference of 14 instrumental measures. Int J Rehabil Res 36:362–374. https://doi.org/10.1097/MRR.0000000000000037 CrossRefPubMed
Hopper D, Goh S, Wentworth L et al (2002) Test-retest reliability of knee rating scales and functional hop tests one year following anterior cruciate ligament reconstruction. Physical Ther Sport 3:10–18 CrossRef
Ageberg E, Thomeé R, Neeter C et al (2008) Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. Arthritis Rheum 59:1773–1779. https://doi.org/10.1002/art.24066 CrossRefPubMed
Lautamies R, Harilainen A, Kettunen J et al (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 16:1009–1016. https://doi.org/10.1007/s00167-008-0598-7 CrossRefPubMed
- Reference values for fatigued versus non-fatigued limb symmetry index measured by a newly designed single-leg hop test battery in healthy subjects: a pilot study
Stefan Tino Kulnik
- Springer Milan
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II