Measurement properties for muscle strength tests following anterior cruciate ligament and/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus

Urhausen, AP; Berg, B; Øiestad, BE; Whittaker, JL; Culvenor, Adam; Crossley, Kay; Juhl, CB; Risberg, MA

doi:10.1136/bjsports-2022-105498

Measurement properties for muscle strength tests following anterior cruciate ligament and/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus

journal contribution

posted on 2025-01-20, 06:21 authored by AP Urhausen, B Berg, BE Øiestad, JL Whittaker, Adam CulvenorAdam Culvenor, Kay CrossleyKay Crossley, CB Juhl, MA Risberg

Objectives: Critically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist.

Design: Systematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality.

Data sources: Medline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022.

Eligibility criteria for selecting studies: Studies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in individuals with ACL and/or meniscus injuries with a mean injury age of ≤30 years.

Results: Thirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in individuals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality).

Conclusion: Knee extensor and flexor strength tests of individuals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.

Funding

This systematic review is part of the OPTIKNEE consensus (https://bit.ly/OPTIKNEE), which has received funding from the Canadian Institutes of Health Research (OPTIKNEE principal investigator JLW #161821). APU and MAR are recipients of the National Institutes of Health grant R37HD37985. AGC is a recipient of a National Health and Medical Research Council (NHMRC) of Australia Investigator Grant (GNT2008523). The funders had no role in any part of the study or in any decision about publication.

History

Publication Date

2022-09-16

Journal

British Journal of Sports Medicine

Volume

56

Issue

24

Pagination

11p. (p. 1422-1431)

Publisher

BMJ Publishing Group Ltd.

ISSN

0306-3674

Rights Statement

© The Authors 2022. This article has been accepted for publication in British Journal of Sports Medicine, 2022 following peer review, and the Version of Record can be accessed online at: doi.org/10.1136/bjsports-2022-105498 Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0): https://creativecommons.org/licenses/by-nc/4.0/