Relationships Among Isokinetic Knee Flexion and Extension Parameters, Three Functional Tests

85 Pages·2017·1.97 MB·English

GGrraanndd VVaalllleeyy SSttaattee UUnniivveerrssiittyy
SScchhoollaarrWWoorrkkss@@GGVVSSUU
Masters Theses Graduate Research and Creative Practice
1996
RReellaattiioonnsshhiippss AAmmoonngg IIssookkiinneettiicc KKnneeee FFlleexxiioonn aanndd EExxtteennssiioonn
PPaarraammeetteerrss,, TThhrreeee FFuunnccttiioonnaall TTeessttss,, aanndd SSuubbjjeeccttiivvee KKnneeee SSccoorreess
iinn AACCLL RReeccoonnssttrruucctteedd PPaattiieennttss
Laura Call
Grand Valley State University
Sheryl Chandler
Grand Valley State University
Follow this and additional works at: https://scholarworks.gvsu.edu/theses
Part of the Physical Therapy Commons
SScchhoollaarrWWoorrkkss CCiittaattiioonn
Call, Laura and Chandler, Sheryl, "Relationships Among Isokinetic Knee Flexion and Extension Parameters,
Three Functional Tests, and Subjective Knee Scores in ACL Reconstructed Patients" (1996). Masters
Theses. 266.
https://scholarworks.gvsu.edu/theses/266
This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at
ScholarWorks@GVSU. It has been accepted for inclusion in Masters Theses by an authorized administrator of
ScholarWorks@GVSU. For more information, please contact [email protected].
Relationships Among Isokinetic Knee Flexion and Extension
Parameters, Three Functional Tests, and
Subjective Knee Scores in ACL Reconstructed Patients
By
Laura Call
Sheryl Chandler
THESIS
Submitted to the Department of Physical Therapy
at Grand Valley State University
Allendale, Michigan
in partial fulfillment of the requirements
for the degree of
MASTER OF SCIENCE IN PHYSICAL THERAPY
1996
THESIS COMMITTEE APPROVAL:
CHAIR: Gg^n^erinK, M.S., P.T. Date
MEI\/50ER:‘3olene Bennett, MA., P.T., A.T.C. Date
1
.k y \k ( /In Pt N 3W4
MEMBER: Alma Mulder. M.P.T. Date
Relationships Among Isokinetic Knee Flexion and Extension
Parameters, Three Functional Tests, and
Subjective Knee Scores in ACL Reconstructed Patients
Abstract
The purposes of this study were: (1) to investigate the relationships
between isokinetically tested quadriceps femoris and hamstring strength, the
subjects' self-assessment of knee function, and three functional tests, and (2) to
determine the strength and functional differences between the surgical and non-
surgical limbs. Subjects included 18 males and 27 females aged 18 to 45 years
who had undergone anterior cruciate ligament reconstruction. Knee strength
was measured at 180, 300, and 450°/second and normalized to body weight,
while functional hop data were normalized to height. Significant differences
existed between limbs for the single, triple, and cross-over hops, and all, but one,
isokinetic extension variable. Moderate to good correlations were found between
knee extension values and the single, triple, and cross-over hops. Fair
correlations were noted between knee flexors and the triple and cross-over hops.
Results suggest clinicians should use both strength and functional measures to
determine return to activity.
ACKNOWLEDGEMENTS
The investigators would like to extend their thanks and appreciation to
commitee members; Gordon Alderink, Jolene Bennett, and Alma Mulder, for all
of their time and assistance in completing this study. They give special thanks to
Gordon Alderink for all his help in the writing of this paper. The investigators
would also like to express their gratitude to Jolene Bennett, Angie Miedzielec,
and the staff of Butterworth Rehabilitation Center for the long hours of planning
and assistance in carrying out this project.
TABLE OF CONTENTS
Page
ABSTRACT......................................................................................... i
ACKNOWLEDGEMENTS................................................................... ii
GLOSSARY OF TERMS..................................................................... v
LIST OF TABLES................................................................................. vl
LIST OF APPENDICES...................................................................... vii
CHAPTER
1. INTRODUCTION............................................................... 1
2. LITERATURE REVIEW.................................................... 3
Anterior Cruciate Ligament.......................................... 3
Surgical Procedure....................................................... 4
Traditional vs. Accelerated ACL Rehabilitation.............6
Open vs. Closed Kinetic Chain.................................... 7
Isokinetic Exercise........................................................ 8
Stabilization and Positioning...........................................9
Gravity Correction......................................................... 10
Warm-up and Rest Intervals...........................................11
Isokinetic Testing.............................................................12
Subjective Knee Questionnaire......................................13
KT-1000© Knee Arthrometer..........................................15
Isokinetic vs. Functional Tests vs.
Subjective scores......................................16
3. METHODS AND MATERIALS.............................................20
Design............................................................................ 20
Subjects......................................................................... 20
Instrumentation............................................................. 22
Methods......................................................................... 23
Data Analysis................................................................. 25
4. RESULTS........................................................................... 27
111
IV
5. DISCUSSION AND IMPLICATIONS................................ 39
Interpretation of Statistical Outcomes......................... 39
Comparison of Results to Other Studies................... 44
Implications for Clinical Use........................................ 46
Limitations.................................................................... 47
Suggestions for Further Study.................................... 48
Conclusion.................................................................... 48
REFERENCES................................................................................... 50
APPENDICES...................................................................................... 57
A. Informed Consent.................................................. 57
B. Pretest Subjective Knee Questionnaire................ 61
C. Patient Screening Procedure................................ 64
D. Instructions for Functional Tests........................... 66
E. Data Collection Form............................................. 69
F. Instructions for Isokinetic Tests............................. 70
G. Isokinetic Data Collection Forms.......................... 73
H. Stretching Protocol................................................ 76
GLOSSARY OF TERMS
Average Power (Watts): the total work divided by the time required to perform
the work.
Average Power to Body Weight : a percentage expressing the ratio of average
power to body weight.
Mean or Average Torque ; the average torque calculated from the tension
produced over several consecutive torque curves.
Mean Torque to Body Weight : percentage expressing the ratio of mean torque
to body weight.
Peak Torque : refers to the single highest torque produced by a muscle group
action through a range of motion.
Torque Acceleration Energy (TAB) : energy needed to accelerate the limb to the
preset speed of the isokinetic machine.
Total Work : calculated by summing the area under the torque curves produced
during the exercise set.
Total Work to Body Weight ; a percentage expressing the ratio of the total work
to body weight.
LIST OF TABLES
Table Page
4.1) Demographic Descriptive Statistics - All Subjects................................30
4.2) Demographic Descriptive Statistics - Males, Females.........................30
4.3) Descriptive Statistics of the Hop Test Indices - All Subjects...............31
4.4) Descriptive Statistics of the Isokinetic Strength Values - All................32
Subjects
4.5) Paired T-tests for Mean Differences Between Surgical and.................33
and Non-surgical Data
4.6) Pearson Product Moment Correlations Between the Single................33
Hop Indices and the Isokinetic Strength Values
4.7) Pearson Product Moment Correlations Between the Triple.................35
Hop Indices and the Isokinetic Strength Values
4.8) Pearson Product Moment Correlations Between the Cross-................36
Over Hop Indices and the Isokinetic Strength Values
4.9) Spearman Rank Correlations Between the Subjective Knee...............37
Rating Scale (additive score), the Hop Indices, and the
Isokinetic Strength Values
4.10) Spearman Rank Correlations Between the Subjective........................38
Composite Scores (0-100), the Hop Indices, and the
Isokinetic Strength Values
VI
LIST OF APPENDICES
Appendix Page
A. Informed Consent............................................................ 57
B. Pretest Subjective Knee Questionnaire......................... 61
0. Patient Screening Procedure.......................................... 64
D. Instructions for Functional Tests..................................... 66
E. Functional Data Collection Form..................................... 69
F. Instructions for Isokinetic Tests........................................ 70
G. Isokinetic Data Collection Form....................................... 73
H. Stretching Protocol........................................................... 76
vn
Chapter 1
Introduction
The anterior cruciate ligament (ACL) is a key structure for controlling static
and dynamic knee stability. A partial or complete rupture of this ligament is one
of the most commonly treated knee injuries (Podesta & Podesta, 1994). Injury to
the ACL leads to abnormal arthrokinematics within the tibiofemoral joint (Irrgang,
1993). If untreated, the knee joint may become vulnerable to recurrent pain,
progressive instability, meniscal tears, articular degeneration, arthritic changes
and significant functional losses (Seto, Orofino, Morrissey, Medeiros, & Mason,
1988; Irrgang, 1993; Tovin, Tovin, & Tovin, 1992). Most individuals who wish to
return to athletics or other demanding activities require surgical reconstruction of
the ACL in order to avoid repeated episodes of the knee "giving way" during
activity (Podesta & Podesta, 1994).
Rehabilitation following ACL reconstruction continues to be one of the
most discussed topics in sports medicine. Current trends are geared towards a
more aggressive accelerated approach in treating these post-surgical patients.
The more rapid approaches return patients to activity within approximately 4 to 6
months, whereas the more traditional conservative approaches do not return
patients to full activity until 9 to 12 months post-surgery (Blair & Wills, 1991; Fu,
Woo, & Irrgang, 1992; Wilk & Andrews, 1992; DeCarlo, Shelbourne, McCarroll, &
Rettig, 1992; Irrgang, 1993; Paulos, Noyes, G rood, & Butler, 1991).
Isokinetic dynamometers are commonly used to assess muscular strength
and endurance of the knee flexors and extensors as patients progress through
rehabilitation. In the last stage of treatment physicians commonly utilize
isokinetic test results as one of the important prerequisites to determine the