Skip to main content

Role of Isokinetic Testing and Training After ACL Injury and Reconstruction

  • Chapter
  • First Online:
ACL Injuries in the Female Athlete

Abstract

This chapter focuses on the role of isokinetics with regard to testing and training after ACL injury and reconstruction. This includes the use of isokinetics for screening, evaluation, treatment, rehabilitation, and criteria for discharge to return to sports. Specific considerations for testing after ACL reconstruction are detailed. Testing and training protocols are provided.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sugimoto D, LeBlanc JC, Wooley SE, Micheli LJ, Kramer DE (2016) The effectiveness of a functional knee brace on joint-position sense in anterior cruciate ligament-reconstructed individuals. J Sport Rehabil 25(2):190–194. https://doi.org/10.1123/jsr.2014-0226

    Article  PubMed  Google Scholar 

  2. Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS (2017) Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther 47(2):67–79. https://doi.org/10.2519/jospt.2017.7286

    Article  PubMed  Google Scholar 

  3. Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, Khan KM, Beck N, van Leeuwen J, Crossley KM (2015) Early knee osteoarthritis is evident one year following anterior cruciate ligament reconstruction: a magnetic resonance imaging evaluation. Arthritis Rheumatol 67(4):946–955. https://doi.org/10.1002/art.39005

    Article  PubMed  CAS  Google Scholar 

  4. Frobell RB, Le Graverand MP, Buck R, Roos EM, Roos HP, Tamez-Pena J, Totterman S, Lohmander LS (2009) The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year. Osteoarthritis Cartilage 17(2):161–167. https://doi.org/10.1016/j.joca.2008.06.020

    Article  PubMed  CAS  Google Scholar 

  5. Carpenter MR, Carpenter RL, Peel J, Zukley LM, Angelopoulou KM, Fischer I, Angelopoulos TJ, Rippe JM (2006) The reliability of isokinetic and isometric leg strength measures among individuals with symptoms of mild osteoarthritis. J Sports Med Phys Fitness 46(4):585–589

    PubMed  CAS  Google Scholar 

  6. Culvenor AG, Cook JL, Collins NJ, Crossley KM (2013) Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review. Br J Sports Med 47(2):66–70. https://doi.org/10.1136/bjsports-2012-091490

    Article  PubMed  Google Scholar 

  7. Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463. https://doi.org/10.1177/0363546509350914

    Article  PubMed  Google Scholar 

  8. Maerz T, Newton MD, Kurdziel MD, Altman P, Anderson K, Matthew HW, Baker KC (2016) Articular cartilage degeneration following anterior cruciate ligament injury: a comparison of surgical transection and noninvasive rupture as preclinical models of post-traumatic osteoarthritis. Osteoarthritis Cartilage 24(11):1918–1927. https://doi.org/10.1016/j.joca.2016.06.013

    Article  PubMed  CAS  Google Scholar 

  9. Risberg MA, Oiestad BE, Gunderson R, Aune AK, Engebretsen L, Culvenor A, Holm I (2016) Changes in knee osteoarthritis, symptoms, and function after anterior cruciate ligament reconstruction: a 20-year prospective follow-up study. Am J Sports Med 44:1215–1224. https://doi.org/10.1177/0363546515626539

    Article  PubMed  Google Scholar 

  10. Smith MV, Nepple JJ, Wright RW, Matava MJ, Brophy RH (2016) Knee osteoarthritis is associated with previous meniscus and anterior cruciate ligament surgery among Elite College American Football Athletes. Sports Health 9:247–251. https://doi.org/10.1177/1941738116683146

    Article  PubMed  PubMed Central  Google Scholar 

  11. Feucht MJ, Cotic M, Saier T, Minzlaff P, Plath JE, Imhoff AB, Hinterwimmer S (2016) Patient expectations of primary and revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24(1):201–207. https://doi.org/10.1007/s00167-014-3364-z

    Article  PubMed  Google Scholar 

  12. Filbay SR (2017) Longer-term quality of life following ACL injury and reconstruction. Br J Sports Med 52:208–209. https://doi.org/10.1136/bjsports-2017-097552

    Article  PubMed  Google Scholar 

  13. Lentz TA, Zeppieri G Jr, George SZ, Tillman SM, Moser MW, Farmer KW, Chmielewski TL (2015) Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. Am J Sports Med 43(2):345–353. https://doi.org/10.1177/0363546514559707

    Article  PubMed  Google Scholar 

  14. Lepley LK (2015) Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health 7(3):231–238. https://doi.org/10.1177/1941738115578112

    Article  PubMed  PubMed Central  Google Scholar 

  15. Roi GS, Creta D, Nanni G, Marcacci M, Zaffagnini S, Snyder-Mackler L (2005) Return to official Italian first division soccer games within 90 days after anterior cruciate ligament reconstruction: a case report. J Orthop Sports Phys Ther 35(2):52–66

    Article  PubMed  Google Scholar 

  16. Nagelli CV, Hewett TE (2017) Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? biological and functional considerations. Sports Med 47(2):221–232. https://doi.org/10.1007/s40279-016-0584-z

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48(21):1543–1552. https://doi.org/10.1136/bjsports-2013-093398

    Article  PubMed  Google Scholar 

  18. Hislop HJ, Perrine JJ (1967) The isokinetic concept of exercise. Phys Ther 47(2):114–117

    Article  CAS  PubMed  Google Scholar 

  19. Thistle HG, Hislop HJ, Moffroid M, Lowman EW (1967) Isokinetic contraction: a new concept of resistive exercise. Arch Phys Med Rehabil 48(6):279–282

    PubMed  CAS  Google Scholar 

  20. Davies GJ (1984) A compendium of isokinetics in clinical usage, 1st edn. S & S Publishers, LaCrosse, WI

    Google Scholar 

  21. Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L, Huston LJ, Spindler KP, Snyder-Mackler L (2016) Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? a comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med 44(10):2608–2614. https://doi.org/10.1177/0363546516652594

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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(13):804–808. https://doi.org/10.1136/bjsports-2016-096031

    Article  PubMed  Google Scholar 

  23. Kruse LM, Gray B, Wright RW (2012) Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 94(19):1737–1748. https://doi.org/10.2106/JBJS.K.01246

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Ellenbecker TS, Davies GJ (2001) Closed kinetic chain exercises: a comprehensive guide to multiple joint exercise. Human Kinetics, Champaign, IL

    Google Scholar 

  25. Bonazza NA, Smuin D, Onks CA, Silvis ML, Dhawan A (2017) Reliability, validity, and injury predictive value of the functional movement screen. Am J Sports Med 45(3):725–732. https://doi.org/10.1177/0363546516641937

    Article  PubMed  Google Scholar 

  26. Boyle MJ, Butler RJ, Queen RM (2016) Functional movement competency and dynamic balance after anterior cruciate ligament reconstruction in adolescent patients. J Pediatr Orthop 36(1):36–41. https://doi.org/10.1097/BPO.0000000000000402

    Article  PubMed  Google Scholar 

  27. Whittaker JL, Booysen N, de la Motte S, Dennett L, Lewis CL, Wilson D, McKay C, Warner M, Padua D, Emery CA, Stokes M (2017) Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review. Br J Sports Med 51(7):580–585. https://doi.org/10.1136/bjsports-2016-096760

    Article  PubMed  Google Scholar 

  28. 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(5):444–450. https://doi.org/10.1016/j.jsams.2012.01.003

    Article  PubMed  Google Scholar 

  29. Blackburn JR, Morrissey MC (1998) The relationship between open and closed kinetic chain strength of the lower limb and jumping performance. J Orthop Sports Phys Ther 27(6):430–435. https://doi.org/10.2519/jospt.1998.27.6.430

    Article  PubMed  CAS  Google Scholar 

  30. Iossifidou A, Baltzopoulos V, Giakas G (2005) Isokinetic knee extension and vertical jumping: are they related? J Sports Sci 23(10):1121–1127. https://doi.org/10.1080/02640410500128189

    Article  PubMed  Google Scholar 

  31. Ithurburn MP, Paterno MV, Ford KR, Hewett TE, Schmitt LC (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(11):2727–2737. https://doi.org/10.1177/0363546515602016

    Article  PubMed  Google Scholar 

  32. Newman MA, Tarpenning KM, Marino FE (2004) Relationships between isokinetic knee strength, single-sprint performance, and repeated-sprint ability in football players. J Strength Cond Res 18(4):867–872. https://doi.org/10.1519/13843.1

    Article  PubMed  Google Scholar 

  33. Rouis M, Coudrat L, Jaafar H, Filliard JR, Vandewalle H, Barthelemy Y, Driss T (2015) Assessment of isokinetic knee strength in elite young female basketball players: correlation with vertical jump. J Sports Med Phys Fitness 55(12):1502–1508

    PubMed  CAS  Google Scholar 

  34. Ucar M, Koca I, Eroglu M, Eroglu S, Sarp U, Arik HO, Yetisgin A (2014) Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J Phys Ther Sci 26(12):1875–1878. https://doi.org/10.1589/jpts.26.1875

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bell DR, Trigsted SM, Post EG, Walden CE (2016) Hip strength in patients with quadriceps strength deficits after ACL reconstruction. Med Sci Sports Exerc 48(10):1886–1892. https://doi.org/10.1249/MSS.0000000000000999

    Article  PubMed  Google Scholar 

  36. Brent JL, Myer GD, Ford KR, Paterno MV, Hewett TE (2013) The effect of sex and age on isokinetic hip-abduction torques. J Sport Rehabil 22(1):41–46

    Article  PubMed  Google Scholar 

  37. Hannon J, Wang-Price S, Goto S, Garrison JC, Bothwell JM (2017) Do muscle strength deficits of the uninvolved hip and knee exist in young athletes before anterior cruciate ligament reconstruction? Orthop J Sports Med 5(1):2325967116683941. https://doi.org/10.1177/2325967116683941

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nicholas JA, Strizak AM, Veras G (1976) A study of thigh muscle weakness in different pathological states of the lower extremity. Am J Sports Med 4(6):241–248. https://doi.org/10.1177/036354657600400602

    Article  PubMed  CAS  Google Scholar 

  39. Gleim GW, Nicholas JA, Webb JN (1978) Isokinetic evaluation following leg injuries. Phys Sportsmed 6(8):75–82. https://doi.org/10.1080/00913847.1978.11710743

    Article  PubMed  CAS  Google Scholar 

  40. Bolz S, Davies GJ (1984) Leg length differences and correlation with total leg strength. J Orthop Sports Phys Ther 6(2):123–129

    Article  CAS  PubMed  Google Scholar 

  41. Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33(4):492–501. https://doi.org/10.1177/0363546504269591

    Article  PubMed  Google Scholar 

  42. Hewett TE, Ford KR, Myer GD (2006) Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34(3):490–498. https://doi.org/10.1177/0363546505282619

    Article  PubMed  Google Scholar 

  43. Davies GJ (1994) A compendium of isokinetics in clinical usage, 4th edn. S & S Publishers, LaCrosse, WI

    Google Scholar 

  44. Wilk KE, Andrews JR (1993) The effects of pad placement and angular velocity on tibial displacement during isokinetic exercise. J Orthop Sports Phys Ther 17(1):24–30. https://doi.org/10.2519/jospt.1993.17.1.24

    Article  PubMed  CAS  Google Scholar 

  45. Karanikas K, Arampatzis A, Bruggemann GP (2009) Motor task and muscle strength followed different adaptation patterns after anterior cruciate ligament reconstruction. Eur J Phys Rehabil Med 45(1):37–45

    PubMed  CAS  Google Scholar 

  46. Patel RR, Hurwitz DE, Bush-Joseph CA, Bach BR Jr, Andriacchi TP (2003) Comparison of clinical and dynamic knee function in patients with anterior cruciate ligament deficiency. Am J Sports Med 31(1):68–74

    Article  PubMed  Google Scholar 

  47. Petschnig R, Baron R, Albrecht M (1998) The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 28(1):23–31

    Article  CAS  PubMed  Google Scholar 

  48. Wilk KE, Romaniello WT, Soscia SM, Arrigo CA, Andrews JR (1994) The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. J Orthop Sports Phys Ther 20(2):60–73

    Article  CAS  PubMed  Google Scholar 

  49. Angelozzi M, Madama M, Corsica C, Calvisi V, Properzi G, McCaw ST, Cacchio A (2012) Rate of force development as an adjunctive outcome measure for return-to-sport decisions after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 42(9):772–780. https://doi.org/10.2519/jospt.2012.3780

    Article  PubMed  Google Scholar 

  50. Flosadottir V, Roos EM, Ageberg E (2016) Muscle function is associated with future patient-reported outcomes in young adults with ACL injury. BMJ Open Sport Exerc Med 2(1):e000154. https://doi.org/10.1136/bmjsem-2016-000154

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kline PW, Morgan KD, Johnson DL, Ireland ML, Noehren B (2015) Impaired quadriceps rate of torque development and knee mechanics after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 43(10):2553–2558. https://doi.org/10.1177/0363546515595834

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kuenze C, Hertel J, Saliba S, Diduch DR, Weltman A, Hart JM (2015) Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction. J Sport Rehabil 24(1):36–46. https://doi.org/10.1123/jsr.2013-0110

    Article  PubMed  Google Scholar 

  53. Lepley AS, Gribble PA, Thomas AC, Tevald MA, Sohn DH, Pietrosimone BG (2015) Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: a 6-month longitudinal investigation. Scand J Med Sci Sports 25(6):828–839. https://doi.org/10.1111/sms.12435

    Article  PubMed  CAS  Google Scholar 

  54. Matheson JW, Kernozek TW, Fater D, Davies G (2001) Quadriceps activity applied load during knee extension exercises. Med Sci Sports Exerc 33:1713–1725

    Article  CAS  PubMed  Google Scholar 

  55. Pietrosimone B, Lepley AS, Harkey MS, Luc-Harkey BA, Blackburn JT, Gribble PA, Spang JT, Sohn DH (2016) Quadriceps strength predicts self-reported function post-ACL reconstruction. Med Sci Sports Exerc 48(9):1671–1677. https://doi.org/10.1249/MSS.0000000000000946

    Article  PubMed  Google Scholar 

  56. Davies GJ (2017) Individualizing the return to play decision after ACL reconstruction. Oper Tech Ortho 27:70–78

    Google Scholar 

  57. Davies GJ, McCarty E, Provencher MT, Manske R, Ellenbecker TS (2017) ACL return to sport guidelines and criteria. Current Rev Musculoskel Med 10(3):307–314

    Article  Google Scholar 

  58. Binder D, Schamus E, Brown-Cross D (2001) Peak torque, total work and power values when comparing individuals with Q-angle differences. Isok Exerc Sci 9:27–30

    Google Scholar 

  59. Bryant AL, Pua YH, Clark RA (2009) Morphology of knee extension torque-time curves following anterior cruciate ligament injury and reconstruction. J Bone Joint Surg Am 91(6):1424–1431. https://doi.org/10.2106/JBJS.H.01335

    Article  PubMed  Google Scholar 

  60. Czaplicki A, Jarocka M, Walawski J (2015) Isokinetic identification of knee joint torques before and after anterior cruciate ligament reconstruction. PLoS One 10(12):e0144283. https://doi.org/10.1371/journal.pone.0144283

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  61. Davies GJ, Heiderscheit BS, Brinks K (2000) Isokinetic test interpretation. In: Brown LE (ed) Isokinetics in human performance. Human Kinetics, Champaign, IL, pp 3–24

    Google Scholar 

  62. Davies GJ, Durall C, Matheson JW (2015) Isokinetic testing and exercise. In: Placzek JD, Boyce DA (eds) Orthopaedic physical therapy secrets, 3rd edn. Hanley & Belfus, Inc., Philadelphia

    Google Scholar 

  63. Eitzen I, Eitzen TJ, Holm I, Snyder-Mackler L, Risberg MA (2010) Anterior cruciate ligament-deficient potential copers and noncopers reveal different isokinetic quadriceps strength profiles in the early stage after injury. Am J Sports Med 38(3):586–593. https://doi.org/10.1177/0363546509349492

    Article  PubMed  PubMed Central  Google Scholar 

  64. Eitzen I, Grindem H, Nilstad A, Moksnes H, Risberg MA (2016) Quantifying quadriceps muscle strength in patients with ACL injury, focal cartilage lesions, and degenerative meniscus tears: differences and clinical implications. Orthop J Sports Med 4(10):2325967116667717. https://doi.org/10.1177/2325967116667717

    Article  PubMed  PubMed Central  Google Scholar 

  65. Jones PA, Bampouras TM (2010) A comparison of isokinetic and functional methods of assessing bilateral strength imbalance. J Strength Cond Res 24(6):1553–1558. https://doi.org/10.1519/JSC.0b013e3181dc4392

    Article  PubMed  Google Scholar 

  66. Ford KR, Myer GD, Hewett TE (2003) Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc 35(10):1745–1750. https://doi.org/10.1249/01.MSS.0000089346.85744.D9

    Article  PubMed  Google Scholar 

  67. Myer GD, Ford KR, Hewett TE (2004) Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes. J Athl Train 39(4):352–364

    PubMed  PubMed Central  Google Scholar 

  68. Kadija M, Knezevic OM, Milovanovic D, Nedeljkovic A, Mirkov DM (2016) The effect of anterior cruciate ligament reconstruction on hamstring and quadriceps muscle function outcome ratios in male athletes. Srp Arh Celok Lek 144(3–4):151–157

    Article  PubMed  Google Scholar 

  69. Kim HJ, Lee JH, Ahn SE, Park MJ, Lee DH (2016) Influence of anterior cruciate ligament tear on thigh muscle strength and hamstring-to-quadriceps ratio: a meta-analysis. PLoS One 11(1):e0146234. https://doi.org/10.1371/journal.pone.0146234

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Fischer F, Fink C, Herbst E, Hoser C, Hepperger C, Blank C, Gfoller P (2017) Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26:418–425. https://doi.org/10.1007/s00167-017-4522-x

    Article  PubMed  Google Scholar 

  71. Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2004) Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects. Clin J Sport Med 14(5):274–280

    Article  PubMed  Google Scholar 

  72. Ford KR, Myer GD, Schmitt LC, Uhl TL, Hewett TE (2011) Preferential quadriceps activation in female athletes with incremental increases in landing intensity. J Appl Biomech 27(3):215–222

    Article  PubMed  PubMed Central  Google Scholar 

  73. Myer GD, Ford KR, Barber Foss KD, Liu C, Nick TG, Hewett TE (2009) The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin J Sport Med 19(1):3–8. https://doi.org/10.1097/JSM.0b013e318190bddb

    Article  PubMed  Google Scholar 

  74. Nakamura T, Kurosawa H, Kawahara H, Watarai K, Miyashita H (1986) Muscle fiber atrophy in the quadriceps in knee-joint disorders. Histochemical studies on 112 cases. Arch Orthop Trauma Surg 105(3):163–169

    Article  CAS  PubMed  Google Scholar 

  75. Davies GJ (1988) Isokinetic rehabilitation of the knee. In: Mangine R (ed) Physical therapy and rehabilitation of the knee. Churchill-Livingstone, New York, pp 221–243

    Google Scholar 

  76. Davies GJ (1995) Descriptive study comparing OKC and CKC isokinetic testing of the lower extremity in 300 patients with selected knee pathologies. In: WCPT Proceedings, Washington, DC

    Google Scholar 

  77. Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA (2010) A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther 40(11):705–721. https://doi.org/10.2519/jospt.2010.3345

    Article  PubMed  PubMed Central  Google Scholar 

  78. Glass R, Waddell J, Hoogenboom B (2010) The effects of open versus closed kinetic chain exercises on patients with ACL deficient or reconstructed knees: a systematic review. N Am J Sports Phys Ther 5(2):74–84

    PubMed  PubMed Central  Google Scholar 

  79. Hooper DM, Morrissey MC, Drechsler W, Morrissey D, King J (2001) Open and closed kinetic chain exercises in the early period after anterior cruciate ligament reconstruction. Improvements in level walking, stair ascent, and stair descent. Am J Sports Med 29(2):167–174

    Article  CAS  PubMed  Google Scholar 

  80. Manske R, Davies GJ, Decario M (2009) Rehabilitation concepts following ACL reconstructions. In: Kibler B, Ellenbecker TS (eds) Orthopaedic knowledge update: sports medicine 4. American Academy of Orthopaedic Surgery, Rosemont, IL

    Google Scholar 

  81. Mikkelsen C, Werner S, Eriksson E (2000) Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study. Knee Surg Sports Traumatol Arthrosc 8(6):337–342

    Article  CAS  PubMed  Google Scholar 

  82. Morrissey MC, Drechsler WI, Morrissey D, Knight PR, Armstrong PW, McAuliffe TB (2002) Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction. Phys Ther 82(1):35–43

    Article  PubMed  Google Scholar 

  83. Morrissey MC, Hooper DM, Drechsler WI, Hill HJ (2004) Relationship of leg muscle strength and knee function in the early period after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 14(6):360–366. https://doi.org/10.1046/j.1600-0838.2003.366.x

    Article  PubMed  CAS  Google Scholar 

  84. Perry MC, Morrissey MC, King JB, Morrissey D, Earnshaw P (2005) Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13(5):357–369

    Article  PubMed  Google Scholar 

  85. Sekir U, Gur H, Akova B (2010) Early versus late start of isokinetic hamstring-strengthening exercise after anterior cruciate ligament reconstruction with patellar tendon graft. Am J Sports Med 38(3):492–500. https://doi.org/10.1177/0363546509349490

    Article  PubMed  Google Scholar 

  86. Tagesson S, Oberg B, Good L, Kvist J (2008) A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain exercise in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function. Am J Sports Med 36(2):298–307

    Article  PubMed  Google Scholar 

  87. Timm KE (1988) Postsurgical knee rehabilitation. A five year study of four methods and 5,381 patients. Am J Sports Med 16(5):463–468. https://doi.org/10.1177/036354658801600506

    Article  PubMed  CAS  Google Scholar 

  88. Wright RW, Preston E, Fleming BC, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Kaeding C, Kuhn JE, Marx RG, McCarty EC, Parker RC, Spindler KP, Wolcott M, Wolf BR, Williams GN (2008) A systematic review of anterior cruciate ligament reconstruction rehabilitation: part II: open versus closed kinetic chain exercises, neuromuscular electrical stimulation, accelerated rehabilitation, and miscellaneous topics. J Knee Surg 21(3):225–234

    Article  PubMed  PubMed Central  Google Scholar 

  89. Ariki PK, Davies GJ, Siewart M (1985) Optimum rest interval between isokinetic velocity spectrum rehabilitation sets. Phys Ther 65(5):733–734

    Google Scholar 

  90. Ariki PK, Davies GJ, Siewart M (1985) Optimum rest interval between isokinetic velocity spectrum rehabilitation speeds. Phys Ther 65(5):735–736

    Google Scholar 

  91. Mirkov D, Knezevic OM, Maffiuletti NA (2000) Velocity specificity in early training of the knee extensors after anterior cruciate ligament reconstruction. Eur J Appl Physiol 81(6):493–496

    Article  Google Scholar 

  92. Timm KE (1986) Validation of the Johnson anti-shear accessory as an accurate and effective clinical isokinetic instrument. J Orthop Sports Phys Ther 7(6):298–303

    Article  CAS  PubMed  Google Scholar 

  93. Davies GJ, Gould J, Halbach J (1984) Computerized Cybex testing of ACL reconstruction assessing quadriceps peak torque, TAE, total work, and average power. Med Sci Sports Exerc 16(2):204

    Article  Google Scholar 

  94. Ebert JR, Smith A, Edwards PK, Ackland TR (2014) The progression of isokinetic knee strength after matrix-induced autologous chondrocyte implantation: implications for rehabilitation and return to activity. J Sport Rehabil 23(3):244–258. https://doi.org/10.1123/JSR.2014-0159

    Article  PubMed  Google Scholar 

  95. Harkey MS, Luc-Harkey BA, Lepley AS, Grindstaff TL, Gribble P, Blackburn JT, Spang JT, Pietrosimone B (2016) Persistent muscle inhibition after anterior cruciate ligament reconstruction: role of reflex excitability. Med Sci Sports Exerc 48(12):2370–2377. https://doi.org/10.1249/MSS.0000000000001046

    Article  PubMed  Google Scholar 

  96. Harput G, Kilinc HE, Ozer H, Baltaci G, Mattacola CG (2015) Quadriceps and hamstring strength recovery during early neuromuscular rehabilitation after ACL hamstring-tendon autograft reconstruction. J Sport Rehabil 24(4):398–404. https://doi.org/10.1123/jsr.2014-0224

    Article  PubMed  Google Scholar 

  97. Kuenze CM, Blemker SS, Hart JM (2016) Quadriceps function relates to muscle size following ACL reconstruction. J Orthop Res 34(9):1656–1662. https://doi.org/10.1002/jor.23166

    Article  PubMed  Google Scholar 

  98. Oiestad BE, Holm I, Gunderson R, Myklebust G, Risberg MA (2010) Quadriceps muscle weakness after anterior cruciate ligament reconstruction: a risk factor for knee osteoarthritis? Arthritis Care Res (Hoboken) 62(12):1706–1714. https://doi.org/10.1002/acr.20299

    Article  Google Scholar 

  99. 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(7):1662–1669. https://doi.org/10.1177/0363546515578252

    Article  PubMed  PubMed Central  Google Scholar 

  100. Thomas AC, Wojtys EM, Brandon C, Palmieri-Smith RM (2016) Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. J Sci Med Sport 19(1):7–11. https://doi.org/10.1016/j.jsams.2014.12.009

    Article  PubMed  Google Scholar 

  101. 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(9):2242–2249. https://doi.org/10.1177/0363546515591258

    Article  PubMed  Google Scholar 

  102. Eitzen I, Holm I, Risberg MA (2009) Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med 43(5):371–376. https://doi.org/10.1136/bjsm.2008.057059

    Article  PubMed  CAS  Google Scholar 

  103. Davies GJ (1995) Open kinetic chain assessment and rehabilitation. Ath Train: Sports Health Care Per 1(4):347–370

    Google Scholar 

  104. Davies GJ, Ellenbecker TS (1992) Eccentric isokinetics. Orthop Phys Ther Clin North Am 1(2):297–336

    CAS  Google Scholar 

  105. Feiring DC, Ellenbecker TS, Derscheid GL (1990) Test-retest reliability of the biodex isokinetic dynamometer. J Orthop Sports Phys Ther 11(7):298–300

    Article  CAS  PubMed  Google Scholar 

  106. Ernst GP, Saliba E, Diduch DR, Hurwitz SR, Ball DW (2000) Lower extremity compensations following anterior cruciate ligament reconstruction. Phys Ther 80(3):251–260

    PubMed  CAS  Google Scholar 

  107. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, Nevitt M, Lewis CE (2010) Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage 18(6):769–775. https://doi.org/10.1016/j.joca.2010.02.002

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  108. van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MW (2016) Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 50(24):1506–1515. https://doi.org/10.1136/bjsports-2015-095898

    Article  PubMed  Google Scholar 

  109. Fujiya H, Kousa P, Fleming BC, Churchill DL, Beynnon BD (2011) Effect of muscle loads and torque applied to the tibia on the strain behavior of the anterior cruciate ligament: an in vitro investigation. Clin Biomech (Bristol, Avon) 26(10):1005–1011. https://doi.org/10.1016/j.clinbiomech.2011.06.006

    Article  Google Scholar 

  110. Heijne A, Fleming BC, Renstrom PA, Peura GD, Beynnon BD, Werner S (2004) Strain on the anterior cruciate ligament during closed kinetic chain exercises. Med Sci Sports Exerc 36(6):935–941

    Article  PubMed  Google Scholar 

  111. Luque-Seron JA, Medina-Porqueres I (2016) Anterior cruciate ligament strain in vivo: a systematic review. Sports Health 8(5):451–455. https://doi.org/10.1177/1941738116658006

    Article  PubMed  PubMed Central  Google Scholar 

  112. Beynnon BD, Johnson RJ, Fleming BC, Stankewich CJ, Renstrom PA, Nichols CE (1997) The strain behavior of the anterior cruciate ligament during squatting and active flexion-extension. A comparison of an open and a closed kinetic chain exercise. Am J Sports Med 25(6):823–829

    Article  CAS  PubMed  Google Scholar 

  113. Fleming BC, Beynnon BD (2004) In vivo measurement of ligament/tendon strains and forces: a review. Ann Biomed Eng 32(3):318–328

    Article  PubMed  Google Scholar 

  114. Fleming BC, Beynnon BD, Renstrom PA, Peura GD, Nichols CE, Johnson RJ (1998) The strain behavior of the anterior cruciate ligament during bicycling. An in vivo study. Am J Sports Med 26(1):109–118

    Article  CAS  PubMed  Google Scholar 

  115. Fleming BC, Ohlen G, Renstrom PA, Peura GD, Beynnon BD, Badger GJ (2003) The effects of compressive load and knee joint torque on peak anterior cruciate ligament strains. Am J Sports Med 31(5):701–707

    Article  PubMed  Google Scholar 

  116. Fleming BC, Oksendahl H, Beynnon BD (2005) Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction? Exerc Sport Sci Rev 33(3):134–140

    Article  PubMed  Google Scholar 

  117. Witvrouw E, Sneyers C, Lysens R, Victor J, Bellemans J (1996) Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome. J Orthop Sports Phys Ther 24(3):160–165. https://doi.org/10.2519/jospt.1996.24.3.160

    Article  PubMed  CAS  Google Scholar 

  118. Witvrouw E, Lysens R, Bellemans J, Peers K, Vanderstraeten G (2000) Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study. Am J Sports Med 28(5):687–694

    Article  CAS  PubMed  Google Scholar 

  119. Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D (2004) Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med 32(5):1122–1130. https://doi.org/10.1177/0363546503262187

    Article  PubMed  Google Scholar 

  120. Kline PW, Johnson DL, Ireland ML, Noehren B (2016) Clinical predictors of knee mechanics at return to sport after ACL reconstruction. Med Sci Sports Exerc 48(5):790–795. https://doi.org/10.1249/MSS.0000000000000856

    Article  PubMed  PubMed Central  Google Scholar 

  121. 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 50:946–951. https://doi.org/10.1136/bjsports-2015-095908

    Article  PubMed  Google Scholar 

  122. Larsen JB, Farup J, Lind M, Dalgas U (2015) Muscle strength and functional performance is markedly impaired at the recommended time point for sport return after anterior cruciate ligament reconstruction in recreational athletes. Hum Mov Sci 39:73–87. https://doi.org/10.1016/j.humov.2014.10.008

    Article  PubMed  Google Scholar 

  123. Narducci E, Waltz A, Gorski K, Leppla L, Donaldson M (2011) The clinical utility of functional performance tests within one-year post-acl reconstruction: a systematic review. Int J Sports Phys Ther 6(4):333–342

    PubMed  PubMed Central  Google Scholar 

  124. Rodriguez-Roiz JM, Caballero M, Ares O, Sastre S, Lozano L, Popescu D (2015) Return to recreational sports activity after anterior cruciate ligament reconstruction: a one- to six-year follow-up study. Arch Orthop Trauma Surg 135(8):1117–1122. https://doi.org/10.1007/s00402-015-2240-8

    Article  PubMed  Google Scholar 

  125. Shrier I (2015) Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med 49(20):1311–1315. https://doi.org/10.1136/bjsports-2014-094569

    Article  PubMed  Google Scholar 

  126. White K, Di Stasi SL, Smith AH, Snyder-Mackler L (2013) Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial. BMC Musculoskelet Disord 14:108. https://doi.org/10.1186/1471-2474-14-108

    Article  PubMed  PubMed Central  Google Scholar 

  127. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE (2016) Mechanisms, prediction, and prevention of ACL injuries: cut risk with three sharpened and validated tools. J Orthop Res 34(11):1843–1855. https://doi.org/10.1002/jor.23414

    Article  PubMed  PubMed Central  Google Scholar 

  128. Paterno MV (2015) Incidence and predictors of second anterior cruciate ligament injury after primary reconstruction and return to sport. J Athl Train 50(10):1097–1099. https://doi.org/10.4085/1062-6050-50.10.07

    Article  PubMed  PubMed Central  Google Scholar 

  129. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (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(10):1968–1978. https://doi.org/10.1177/0363546510376053

    Article  PubMed  PubMed Central  Google Scholar 

  130. 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(7):1567–1573. https://doi.org/10.1177/0363546514530088

    Article  PubMed  PubMed Central  Google Scholar 

  131. Paterno MV, Kiefer AW, Bonnette S, Riley MA, Schmitt LC, Ford KR, Myer GD, Shockley K, Hewett TE (2015) Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Clin Biomech (Bristol, Avon) 30(10):1094–1101. https://doi.org/10.1016/j.clinbiomech.2015.08.019

    Article  Google Scholar 

  132. Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39(3):100–110. https://doi.org/10.3810/psm.2011.09.1926

    Article  PubMed  Google Scholar 

  133. Cvjetkovic DD, Bijeljac S, Palija S, Talic G, Radulovic TN, Kosanovic MG, Manojlovic S (2015) Isokinetic testing in evaluation rehabilitation outcome after ACL reconstruction. Med Arch 69(1):21–23. https://doi.org/10.5455/medarh.2015.69.21-23

    Article  PubMed  PubMed Central  Google Scholar 

  134. Duncan KJ, Chopp-Hurley JN, Maly MR (2016) A systematic review to evaluate exercise for anterior cruciate ligament injuries: does this approach reduce the incidence of knee osteoarthritis? Open Access Rheumatol 8:1–16. https://doi.org/10.2147/OARRR.S81673

    Article  PubMed  PubMed Central  Google Scholar 

  135. Jacopetti M, Pasquini A, Costantino C (2016) Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study. Acta Biomed 87(1):76–80

    PubMed  Google Scholar 

  136. Labanca L, Laudani L, Menotti F, Rocchi J, Mariani PP, Giombini A, Pigozzi F, Macaluso A (2016) Asymmetrical lower extremity loading early after anterior cruciate ligament reconstruction is a significant predictor of asymmetrical loading at the time of return to sport. Am J Phys Med Rehabil 95(4):248–255. https://doi.org/10.1097/PHM.0000000000000369

    Article  PubMed  Google Scholar 

  137. Shaarani SR, O’Hare C, Quinn A, Moyna N, Moran R, O'Byrne JM (2013) Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med 41(9):2117–2127. https://doi.org/10.1177/0363546513493594

    Article  PubMed  Google Scholar 

  138. Ucay O, Renault A, Gleizes Cervera S, Gasq D (2016) How to evaluate precisely return to sport after anterior cruciate ligament tear with operative or conservative treatment on patients with moderate sport level? Ann Phys Rehabil Med 59S:e19. https://doi.org/10.1016/j.rehab.2016.07.046

    Article  Google Scholar 

  139. Undheim MB, Cosgrave C, King E, Strike S, Marshall B, Falvey E, Franklyn-Miller A (2015) Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation. Br J Sports Med 49(20):1305–1310. https://doi.org/10.1136/bjsports-2014-093962

    Article  PubMed  Google Scholar 

  140. Davies GJ, Zillmer DA (2000) Functional progression of a patient through a rehabilitation program. Ortho Phys Ther Clin North Am 9:103–118

    Google Scholar 

  141. Davies GJ, Clark MA, Hedierscheit BC (2000) Functional progression of exercise during rehabilitation. In: Ellenbecker TS (ed) Knee ligament rehabilitation. Churchill-Livingstone, New York, pp 345–360

    Google Scholar 

  142. Jang SH, Kim JG, Ha JK, Wang BG, Yang SJ (2014) Functional performance tests as indicators of returning to sports after anterior cruciate ligament reconstruction. Knee 21(1):95–101. https://doi.org/10.1016/j.knee.2013.08.017

    Article  PubMed  Google Scholar 

  143. Augustsson J, Thomee R, Linden C, Folkesson M, Tranberg R, Karlsson J (2006) Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis. Scand J Med Sci Sports 16(2):111–120. https://doi.org/10.1111/j.1600-0838.2005.00446.x

    Article  PubMed  CAS  Google Scholar 

  144. Barber-Westin SD, Noyes FR (2017) Effect of fatigue protocols on lower limb neuromuscular function and implications for ACL injury prevention training: a systematic review. Am J Sports Med 45:3388–3396. https://doi.org/10.1177/0363546517693846

    Article  PubMed  Google Scholar 

  145. DeNuccio DK, Davies GJ, Rowinski MJ (1991) Comparison of quadriceps isokinetic eccentric and concentric data using a standard fatigue protocol. Isok Exerc Sci 1(2):81–86

    Google Scholar 

  146. Creighton DW, Shrier I, Shultz R, Meeuwisse WH, Matheson GO (2010) Return-to-play in sport: a decision-based model. Clin J Sport Med 20(5):379–385. https://doi.org/10.1097/JSM.0b013e3181f3c0fe

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George J. Davies .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag GmbH Germany, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Davies, G.J., Riemann, B., Ellenbecker, T. (2018). Role of Isokinetic Testing and Training After ACL Injury and Reconstruction. In: Noyes, F., Barber-Westin, S. (eds) ACL Injuries in the Female Athlete. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-56558-2_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-56558-2_24

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-56557-5

  • Online ISBN: 978-3-662-56558-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics