Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients.

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to evaluate the construct validity (known group), concurrent validity (criterion based) and test-retest (intra-rater) reliability of manual goniometers to measure passive hip range of motion (ROM) in femoroacetabular impingement patients and healthy controls.</p> <p>Methods</p> <p>Passive hip flexion, abduction, adduction, internal and external rotation ROMs were simultaneously measured with a conventional goniometer and an electromagnetic tracking system (ETS) on two different testing sessions. A total of 15 patients and 15 sex- and age-matched healthy controls participated in the study.</p> <p>Results</p> <p>The goniometer provided greater hip ROM values compared to the ETS (range 2.0-18.9 degrees; <it>P </it>< 0.001); good concurrent validity was only achieved for hip abduction and internal rotation, with intraclass correlation coefficients (ICC) of 0.94 and 0.88, respectively. Both devices detected lower hip abduction ROM in patients compared to controls (<it>P </it>< 0.01). Test-retest reliability was good with ICCs higher 0.90, except for hip adduction (0.82-0.84). Reliability estimates did not differ between the goniometer and the ETS.</p> <p>Conclusions</p> <p>The present study suggests that goniometer-based assessments considerably overestimate hip joint ROM by measuring intersegmental angles (e.g., thigh flexion on trunk for hip flexion) rather than true hip ROM. It is likely that uncontrolled pelvic rotation and tilt due to difficulties in placing the goniometer properly and in performing the anatomically correct ROM contribute to the overrating of the arc of these motions. Nevertheless, conventional manual goniometers can be used with confidence for longitudinal assessments in the clinic.</p

Comparison of quadriceps inactivation between nerve and muscle stimulation

We evaluated the use of direct muscle stimulation for quantifying quadriceps inactivation at different contraction levels as opposed to conventional twitch interpolation using nerve stimulation. Fourteen healthy volunteers were tested. Paired stimuli were delivered to the femoral nerve or to the quadriceps muscle belly during voluntary contractions ranging from 20% to 100% of maximum, and the amplitude of the superimposed doublet was quantified to investigate inactivation. Superimposed doublet for muscle and nerve stimulation, respectively between the range of 60% to 100% of maximum (e.g., at 100%, muscle stimulation was 14 ± 5 Nm and nerve stimulation was 15 ± 6 Nm). Despite higher current doses, muscle stimulation was associated with less discomfort than nerve stimulation (P < 0.05). Collectively, our data suggest that direct muscle stimulation could be used to assess quadriceps inactivation at maximal and quasi-maximal contraction levels as a valid alternative to motor nerve stimulation

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: Methodological issues

International audienceThe aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4-8 months after total knee arthroplasty (TKA, n = 29) and total hip arthroplasty (THA, n = 30), and in healthy controls (n = 19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P > 0.05), whereas a significant main effect of testing modality (P < 0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P = 0.06) and isoinertial 1-RM load (P = 0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4-8 months after surgery. (C) 2013 Elsevier Ltd. All rights reserved

Hip muscle strength recovery after hip arthroscopy in a series of patients with symptomatic femoroacetabular impingement

International audiencePurpose: The aim of the study was to prospectively evaluate hip muscle strength in a series of patients with symptomatic FAI after hip arthroscopy. Methods: Hip muscle strength of eight patients (age: 29 +/- 10 years) was evaluated preoperatively and 2.5 years after hip arthroscopy, and was compared to eight matched controls. Maximal voluntary contraction (MVC) strength was measured for all hip muscle groups. At follow-up, we used the symptom-specific well-being outcome to assess the acceptability of the health state related to the hip. Results: Patients showed MVC strength increases for all hip muscles (9-59%, P<.05). At follow-up, only hip flexor MVC strength was lower for patients than controls (-18%, P<.05). At follow-up, four patients (out of eight) were "neither satisfied nor dissatisfied" with the health state of their operated hip. Conclusions: Patients with symptomatic FAI recovered their hip muscle strength to normal levels 2.5 years after hip arthroscopy, except for hip flexors. Although all patients showed good hip muscle strength at follow-up, half of them were not completely satisfied with their health state related to the hip

Quadriceps Neuromuscular Impairments after Arthroscopic Knee Surgery: Comparison between Procedures

Quadriceps neuromuscular function remains impaired in the short- and long-term following knee arthroscopy for meniscal surgery and/or anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare quadriceps neuromuscular impairments in patients following meniscal surgery with and without ACL reconstruction. Thirty patients were tested six months after meniscal surgery with (n = 15) and without (n = 15) ACL reconstruction. We bilaterally assessed knee extension maximal voluntary contraction (MVC) torque using dynamometry, vastus lateralis thickness using ultrasound, quadriceps voluntary activation and evoked knee extension torque with transcutaneous electrical stimulation. Patient-reported outcomes were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Compared with meniscus patients, ACL patients demonstrated larger asymmetries in MVC torque (15% vs. 5%, p = 0.049) and vastus lateralis thickness (6% vs. 0%, p = 0.021). In ACL patients, asymmetries in MVC torque correlated with asymmetries in evoked torque (r = 0.622, p = 0.013). In meniscus patients, asymmetries in muscle activation correlated with KOOS quality of life (r = 0.619, p = 0.018). Patients demonstrated persistent quadriceps muscle weakness six months after ACL reconstruction, but not after isolated meniscal surgery. Quantitative and/or qualitative muscular changes likely underlie quadriceps muscle weakness in ACL patients, whereas activation failure is associated with poor quality of life in some meniscus patients.ISSN:2077-038