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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins and Jonathan W. Hartman

Context: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. Objective: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Design: Case control. Setting: Laboratory. Participants: A total of 20 post-ACLR and 40 healthy control participants. Main Outcome Measures: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. Results: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Conclusions: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.

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Gabriel Andrade Paz, Marianna de Freitas Maia, Haroldo Gualter Santana, Humberto Miranda, Vicente Lima and John D. Willson

reason for the disparity in the number of serious knee injuries, such as ACL rupture, between male and female athletes. 11 , 15 Greater knee valgus angles and interlimb hip and knee joint sagittal and frontal plane kinematic asymmetries are reported to be more common in females compared with males. 5

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Aaron Derouin and Jim R. Potvin

, by way of a visual display of knee angle. Surface EMG was measured from 8 of the 13 muscles that cross the knee joint with disposable bipolar Ag–AgCl surface electrodes (Medi-Trace disposable electrodes; Graphic Controls, Gananoque, Canada). Vastus intermedius activity was estimated from EMG values

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Danilo de Oliveira Silva, Ronaldo Briani, Marcella Pazzinatto, Deisi Ferrari, Fernando Aragão and Fábio de Azevedo

Individuals with patellofemoral pain (PFP) use different motor strategies during unipodal support in stair climbing activities, which may be assessed by vertical ground reaction force parameters. Thus, the aims of this study were to investigate possible differences in first peak, valley, second peak, and loading rate between recreational female athletes with PFP and pain-free athletes during stair climbing in order to determine the association and prediction capability between these parameters, pain level, and functional status in females with PFP. Thirty-one recreational female athletes with PFP and 31 pain-free recreational female athletes were evaluated with three-dimensional kinetics while performing stair climbing to obtain vertical ground reaction force parameters. A visual analog scale was used to evaluate the usual knee pain. The anterior knee pain scale was used to evaluate knee functional score. First peak and loading rate were associated with pain (r = .46, P = .008; r = .56, P = .001, respectively) and functional limitation (r = .31, P = .049; r = −.36, P = .032, respectively). Forced entry regression revealed the first peak was a significant predictor of pain (36.5%) and functional limitation (28.7%). Our findings suggest that rehabilitation strategies aimed at correcting altered vertical ground reaction force may improve usual knee pain level and self-reported knee function in females with PFP.

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Dusa Marn-Vukadinovic and Helena Jamnik


Valid patient-based outcome instruments are necessary for comprehensive patient care that focuses on all aspects of health, from impairments to participation restrictions.


To validate the Slovenian translation of Medical Outcome Survey (MOS) Short Form Health Survey (SF-36) and to assess relations among various knee measurements, activity tested with Oxford Knee Score (OKS) and health-related quality of life as estimated with SF-36 domains.


Descriptive validation study.


Isokinetic laboratory in outpatient rehabilitation unit.


101 subjects after unilateral sport knee injury.


All subjects completed the SF-36 and OKS, and isokinetic knee-muscle strength output at 60°/s was determined in 78 participants. Within a 3-d period, 43 subjects completed the SF-36 and OKS questionnaires again.

Main Outcome Measures:

Reliability testing included internal consistency and test–retest reliability. Correlations between SF-36 subscales and OKS were calculated to assess construct validity, and correlation between SF-36 subscales and muscle strength was calculated to assess concurrent validity.


Chronbach α was above .78 for all SF-36 subscales. ICCs ranged from .80 to .93. The correlation between OKS and the physical-functioning subscale, showing convergent construct validity, was higher (r = .83, P < .01) than between OKS and mental health (r = .50, P < .01), showing divergent construct validity. Knee-extensor weakness negatively correlated with physical-functioning (r = −.59, P < .01) and social-functioning (r = −.43, P < .01) subscales.


The Slovenian translation of the SF-36 is a reliable and valuable tool. The relationships between knee-muscle strength and activity and between knee-muscle strength and SF-36 subscales in patients after sport knee injury were established.

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Takuma Hoshiba, Hiroki Nakata, Yasuaki Saho, Kazuyuki Kanosue and Toru Fukubayashi

importance of mechanoreceptors for knee proprioception. 4 , 5 Therefore, the ACL acts as not only a mechanical stabilizer of the knee joint but also a sensory organ. 6 Deficits in sensory signals from mechanoreceptors following unilateral ACL injury and/or reconstruction may impair knee proprioception. It

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Scott R. Brown, Matt Brughelli, Peter C. Griffiths and John B. Cronin


While several studies have documented isokinetic knee strength in junior and senior rugby league players, investigations of isokinetic knee and hip strength in professional rugby union players are limited. The purpose of this study was to provide lower-extremity strength profiles and compare isokinetic knee and hip strength of professional rugby league and rugby union players.


32 professional rugby league and 25 professional rugby union players.


Cross-sectional analysis. Isokinetic dynamometry was used to evaluate peak torque and strength ratios of the dominant and nondominant legs during seated knee-extension/flexion and supine hip-extension/flexion actions at 60°/s.


Forwards from both codes were taller and heavier and had a higher body-mass index than the backs of each code. Rugby union forwards produced significantly (P < .05) greater peak torque during knee flexion in the dominant and nondominant legs (ES = 1.81 and 2.02) compared with rugby league forwards. Rugby league backs produced significantly greater hip-extension peak torque in the dominant and nondominant legs (ES = 0.83 and 0.77) compared with rugby union backs. There were no significant differences in hamstring-to-quadriceps ratios between code, position, or leg. Rugby union forwards and backs produced significantly greater knee-flexion-to-hip-extension ratios in the dominant and nondominant legs (ES = 1.49–2.26) than rugby union players.


It seems that the joint torque profiles of players from rugby league and union codes differ, which may be attributed to the different demands of each code.

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Ty B. Palmer, Jose G. Pineda and Rachel M. Durham

reliable strength values for this type of testing is critical. The isometric squat has been examined at knee joint angles ranging from 90 to 150° (180° fully extended). 2 , 3 , 9 , 11 – 15 Recently, many studies have found that the isometric squat is a reliable assessment for examining maximal strength

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Sarah C. Moudy, Neale A. Tillin, Amy R. Sibley and Siobhán Strike

flexion at all lower limb joints when landing from a jump, which could aid in reducing knee joint loading. 17 , 18 Substantial deficits in quadriceps muscle strength of 30% to 39% have previously been reported in the intact limb of ITTAs compared with able-bodied individuals 13 , 19 ; however, it is

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Seiichiro Takei, Kuniaki Hirayama and Junichi Okada

performed to determine the bar kinematics data and knee joint angle during the receiving phase of HPC. Bar displacement data were filtered with a fourth Butterworth filter with a cutoff frequency of 6 Hz. The displacement data were then converted to the vertical acceleration and velocity of the bar using