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Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To verify the validity and diagnostic accuracy of the hand-held dynamometer (HHD) with the isokinetic dynamometer for evaluating the quadriceps strength of subjects who have undergone ACL reconstruction (ACLR).

Methods

This validity and diagnostic accuracy study was conducted prospectively by examining 70 consecutive participants who had undergone ACLR at least 6 months previously. All participants performed strength evaluation of the quadriceps muscle using the HHD and isokinetic dynamometer.

Results

The HHD presented high test–retest reliability [intraclass correlation coefficient (ICC) = 0.98], moderate to good validity with the isokinetic dynamometer when compared for the quadriceps strength (r = 0.62), 100% perfect specificity [LR + infinity, 95% confidence interval (CI) 81.4%–100%] to identify those with LSI > 10%, and a sensitivity of 63.4% (48.9%–76.3%).

Conclusion

The HHD is an instrument valid and reliable of low cost and easy handling compared to the isokinetic dynamometer to evaluate the quadriceps torque and the limb symmetry index after the ACLR with high diagnostic accuracy.

Level of evidence

I.

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References

  1. Bodkin S, Goetschius J, Hertel J, Hart J (2017) Relationships of muscle function and subjective knee function in patients after ACL reconstruction. Orthop J Sport Med 5:1–7

    Article  Google Scholar 

  2. Dunn WR, Spindler KP, MOON Consortium (2010) Predictors of activity level 2 years after anterior cruciate ligament reconstruction (ACLR): a multicenter orthopaedic outcomes network (MOON) ACLR cohort study. Am J Sports Med 38:2040–2050

    Article  PubMed  PubMed Central  Google Scholar 

  3. Konishi Y, Oda T, Tsukazaki S, Kinugasa R, Fukubayashi T (2012) Relationship between quadriceps femoris muscle volume and muscle torque at least 18 months after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 22:791–796

    Article  CAS  PubMed  Google Scholar 

  4. Thomas AC, Villwock M, Wojtys EM, Palmieri-Smith RM (2013) Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. J Athl Train 48:610–620

    Article  PubMed  PubMed Central  Google Scholar 

  5. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA (2016) Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the delaware-Oslo ACL cohort study. Br J Sports Med 50:804–808

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schmitt LC, Paterno MV, Ford KR, Myer GD, Hewett TE (2015) Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc 47:1426–1434

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L (2015) Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med 49:335–342

    Article  PubMed  Google Scholar 

  8. Palmieri-Smith RM, Lepley LK (2015) Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med 43:1662–1669

    Article  PubMed  PubMed Central  Google Scholar 

  9. Almosnino S, Stevenson JM, Bardana DD, Diaconescu ED, Dvir Z (2012) Reproducibility of isokinetic knee eccentric and concentric strength indices in asymptomatic young adults. Phys Ther Sport 13:156–162

    Article  PubMed  Google Scholar 

  10. Aquino MDA, Leme LEG, Amatuzzi MM, Greve JMD, Terreri ASAP, Andrusaitis FR, Nardelli JC de C (2002) Isokinetic assessment of knee flexor/extensor muscular strength in elderly women. Rev Hosp Clin Fac Med Sao Paulo 57:131–134

    Article  Google Scholar 

  11. de Carvalho Froufe Andrade ACP, Caserotti P, de Carvalho P, de Azevedo Abade EA, da Eira Sampaio AJ (2013) Reliability of concentric, eccentric and isometric knee extension and flexion when using the REV9000 isokinetic dynamometer. J Hum Kinet 37:47–53

    Article  PubMed  PubMed Central  Google Scholar 

  12. Molczyk L, Thigpen LK, Eickhoff J, Goldgar D, Gallagher JC (1991) Reliability of testing the knee extensors and flexors in healthy adult women using a cybex II isokinetic dynamometer. J Orthop Sports Phys Ther 14:37–41

    Article  CAS  PubMed  Google Scholar 

  13. 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. J Phys Ther Sci 28:2445–2451

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim WK, Kim D-K, Seo KM, Kang SH (2014) Reliability and validity of isometric knee extensor strength test with hand-held dynamometer depending on its fixation: a pilot study. Ann Rehabil Med 38:84–93

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua Y-H, Williams GP, McGaw R, Clark RA (2015) Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One 10:e0140822

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Stark T, Walker B, Phillips JK, Fejer R, Beck R (2011) Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PMR 3:472–479

    Article  Google Scholar 

  17. Katoh M, Hiiragi Y, Uchida M (2016) Validity of isometric muscle strength measurements of the lower limbs using a hand- held dynamometer and belt: a comparison with an isokinetic dynamometer. J Phys Ther Sci 28:2123–2127

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bohannon RW (2012) Hand-held dynamometry: a practicable alternative for obtaining objective measures of muscle strength. Isokinet Exerc Sci 20:301–315

    Article  Google Scholar 

  19. Paul DJ, Nassis GP (2015) Testing strength and power in soccer players: the application of conventional and traditional methods of assessment. J Strength Cond Res 29:1748–1758

    Article  PubMed  Google Scholar 

  20. Robinson RL, Nee RJ (2007) Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther 37:232–238

    Article  PubMed  Google Scholar 

  21. Hansen EM, McCartney CN, Sweeney RS, Palimenio MR, Grindstaff TL (2015) Hand-held dynamometer positioning impacts discomfort during quadriceps strength testing: a validity and reliability study. Int J Sports Phys Ther 10:62–68

    PubMed  PubMed Central  Google Scholar 

  22. Martin HJ, Yule V, Syddall HE, Dennison EM, Cooper C, Aihie Sayer A (2006) Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry. Gerontology 52:154–159

    Article  CAS  PubMed  Google Scholar 

  23. Whiteley R, Jacobsen P, Prior S, Skazalski C, Otten R, Johnson A (2012) Correlation of isokinetic and novel hand-held dynamometry measures of knee flexion and extension strength testing. J Sci Med Sport 15:444–450

    Article  PubMed  Google Scholar 

  24. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HCW, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 61:h5527

    Article  Google Scholar 

  25. Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hroóbjartsson A, Roberts C, Shoukri M, Streiner DL (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. Int J Nurs Stud 48:661–671

    Article  PubMed  Google Scholar 

  26. Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E (2016) Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med 0:1–7

    Google Scholar 

  27. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2014) Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med 42:1567–1573

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schlumberger M, Schuster P, Schulz M, Immendörfer M, Mayer P, Bartholomä J, Richter J (2017) Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases. Knee Surg Sport Traumatol Arthrosc 25:1535–1541

    Article  Google Scholar 

  29. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606

    Article  PubMed  Google Scholar 

  30. van Grinsven S, van Cingel REH, Holla CJM, van Loon CJM (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sport Traumatol Arthrosc 18:1128–1144

    Article  Google Scholar 

  31. Harris JD, Abrams GD, Bach BR, Williams D, Heidloff D, Bush-Joseph CA, Verma NN, Forsythe B, Cole BJ (2014) Return to sport after acl reconstruction. Orthopedics 37:e103–e108

    Article  PubMed  Google Scholar 

  32. Müller U, Krüger-Franke M, Schmidt M, Rosemeyer B (2015) Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sport Traumatol Arthrosc 23:3623–3631

    Article  Google Scholar 

  33. Zwolski C, Schmitt LC, Quatman-Yates C, Thomas S, Hewett TE, Paterno MV (2015) The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med 43:2242–2249

    Article  PubMed  Google Scholar 

  34. Metsavaht L, Leporace G, Riberto M, de Mello Sposito M, Batista L (2010) Translation and cross-cultural adaptation of the Brazilian version of the international knee documentation committee subjective knee form: validity and reproducibility. Am J Sports Med 38:1894–1899

    Article  PubMed  Google Scholar 

  35. Silva LO, Mendes LMR, Lima PO, de P, Almeida GPL (2017) Translation, cross-adaptation and measurement properties of the Brazilian version of the ACL-RSI Scale and ACL-QoL Questionnaire in patients with anterior cruciate ligament reconstruction. Br J Phys Ther 22:127–134

    Article  Google Scholar 

  36. Martins J, da Silva JR, da Silva MRB, Bevilaqua-Grossi D (2017) Reliability and validity of the belt-stabilized handheld dynamometer in hip- and knee-strength tests. J Athl Train 52:809–819

    Article  PubMed  PubMed Central  Google Scholar 

  37. Terreri ASA, Greve JMD, Amatuzzi MM (2001) Avaliação isocinética no joelho do atleta. Rev Bras Med do Esporte 7:62–66

    Article  Google Scholar 

  38. De Ste Croix M, Deighan M, Armstrong N (2003) Assessment and interpretation of isokinetic muscle strength during growth and maturation. Sports Med 33:727–743

    Article  PubMed  Google Scholar 

  39. Pua YH, Bryant AL, Steele JR, Newton RU, Wrigley TV (2008) Isokinetic dynamometry in anterior cruciate ligament injury and reconstruction. Ann Acad Med Singapore 37:330–340

    PubMed  Google Scholar 

  40. 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

    Article  PubMed  PubMed Central  Google Scholar 

  41. Almeida GPL, das Rodrigues HL, de Freitas N, BW, Lima PO de P (2017) Reliability and validity of the hip stability isometric test (HipSIT): a new method to assess hip posterolateral muscle strength. J Orthop Sport Phys Ther 47:906–913

    Article  Google Scholar 

  42. Altman D, Bland J (1983) Measurement in medicine: the analysis of method comparison studies. Statistician 32:307–317

    Article  Google Scholar 

  43. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  44. Hajian-Tilaki K (2013) Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Casp J Intern Med Camb 4:1–30

    Google Scholar 

  45. Hulley S, Cummings S, Browner W, Grady D, Newman T (2013) Designing clinical research: an epidemiologic approach, 4th edn. Lippincott Williams & Wilkins, Philadelphia. Appendix 6C, page 79

    Google Scholar 

  46. Arnold CM, Warkentin KD, Chilibeck PD, Magnus CRA (2010) The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res 24:815–824

    Article  PubMed  Google Scholar 

  47. Deones VL, Wiley SC, Worrell T (1994) Assessment of quadriceps muscle performance by a hand-held dynamometer and an isokinetic dynamometer. J Orthop Sports Phys Ther 20:296–301

    Article  CAS  PubMed  Google Scholar 

  48. Reinking MF, Bockrath-Pugliese K, Worrell T, Kegerreis RL, Miller-Sayers K, Farr J (1996) Assessment of quadriceps muscle performance by hand-held, isometric, and isokinetic dynamometry in patients with knee dysfunction. J Orthop Sports Phys Ther 24:154–159

    Article  CAS  PubMed  Google Scholar 

  49. Sinacore JA, Evans AM, Lynch BN, Joreitz RE, Irrgang JJ, Lynch AD (2017) Diagnostic accuracy of handheld dynamometry and 1-repetition-maximum tests for identifying meaningful quadriceps strength asymmetries. J Orthop Sport Phys Ther 47:97–107

    Article  Google Scholar 

  50. Wellsandt E, Failla MJ, Snyder-Mackler L (2017) Limb Symmetry indexes can overestimate knee function after anterior cruciate ligament injury. J Orthop Sports Phys Ther 47:334–338

    Article  PubMed  PubMed Central  Google Scholar 

  51. Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W (2012) A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 132:1287–1297

    Article  PubMed  Google Scholar 

  52. Li YL, Ning GZ, Wu Q, Wu QL, Li Y, Hao Y, Feng SQ (2014) Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee Elsevier BV 21:28–37

    Article  Google Scholar 

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Physical Therapy Department, School of Medicine, Federal University of Ceará, Alexandre Baraúna Street, 949 – 1° andar – Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil

    Gabriel Peixoto Leão Almeida

  2. Knee Research Group, University of Ceará, Fortaleza, CE, Brazil

    Gabriel Peixoto Leão Almeida, Thamyla Rocha Albano & Antônio Kayro Pereira Melo

Authors
  1. Gabriel Peixoto Leão Almeida
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  2. Thamyla Rocha Albano
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  3. Antônio Kayro Pereira Melo
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Corresponding author

Correspondence to Gabriel Peixoto Leão Almeida.

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All authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Review Board (IRB) of Federal University of Ceará/PROPESQ (number 1.000.404).

Informed consent

Patients provided informed consent to take part in the study.

Additional information

This study was approved by the Ethics Committee at the Federal University of Ceará with protocol number 1.000.404.

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Almeida, G.P.L., Albano, T.R. & Melo, A.K.P. Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 2494–2501 (2019). https://doi.org/10.1007/s00167-018-5245-3

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  • DOI: https://doi.org/10.1007/s00167-018-5245-3

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