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148 Muscle strength tests in individuals following an anterior cruciate ligament or meniscus injury: a systematic review of measurement properties (OPTIKNEE)
  1. Anouk Urhausen1,
  2. Bjørnar Berg2,3,
  3. Britt Elin Øiestad4,
  4. Jackie Whittaker5,6,
  5. Adam G Culvenor7,
  6. Ewa Roos8,
  7. Kay Crossley7,
  8. Carsten Juhl8,
  9. May Arna Risberg1,2
  1. 1Department of Sports Medicine, Norwegian School of Sport Sciences, Norway
  2. 2Division of Orthopedic Surgery, Oslo University Hospital, Norway
  3. 3Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Norway
  4. 4Department of Physiotherapy, Oslo Metropolitan University, Norway
  5. 5Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver Canada, Canada
  6. 6Arthritis Research Canada, Canada
  7. 7La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia
  8. 8Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Denmark


Introduction There is a lack of consensus on the most relevant and clinically applicable tests to evaluate knee muscle strength following a knee injury. This systematic review aimed to critically appraise and summarize the measurement properties of knee muscle strength tests in young individuals with anterior cruciate ligament (ACL) or meniscus injury.

Materials and Methods Studies evaluating at least one measurement property of a knee extensor or flexor strength test in individuals with an ACL or meniscus injury with a mean injury age of ≤30 years were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist was used to assess methodological quality. A modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessed evidence quality.

Results Thirty-four studies evaluating 30 muscle strength tests following an ACL or meniscal injury were included. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=25) and criterion validity (n=7). Concentric extensor and flexor strength tests showed sufficient ratings for two measurement properties, namely for intra-rater reliability (very low quality of evidence) and construct validity (moderate quality of evidence). Isotonic extensor and flexor strength tests displayed sufficient criterion validity (high quality of evidence).

Conclusion This review highlights an important lack of evidence on measurement properties of strength tests following ACL tear and meniscus injury. Concentric strength tests are currently the most promising tests following an ACL injury. High-quality studies on measurement properties are needed to recommend muscle strength tests in research and clinical practice.

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