Great post from Dr. E on using knee extensions during ACL rehab. Are all clinicians doing this now? Are we past the point where clinicians are no longer scared and using the best evidence?

original post here: http://www.themanualtherapist.com/2016/08/why-you-should-be-using-knee-extensions.html

What does the research say about quad strength in ACLR patients?

While there are many impairments in ACLR patients, the most commonly reported/researched impairment is a significant decrease in quad strength (from early on to years later).  There are so many studies to choose from that have reported this finding, so here are just a few of them & what they found:

  • Quad strength was a good predictor of function & performance on hop tests.  More specifically, patients with <85% quad strength demonstrated decreased function and poor performance on hop tests.  Important to note, these findings were the same regardless of graft type, presence of meniscal injury, and knee pain/symptoms (Schmitt LC 2012).
  • Physical function at the time of return to sport following ACLR was largely influenced by the recovery of quadriceps strength (Lepley LK 2015)
  • Greater than 80% quad strength after ACLR is associated with less severe patellar cartilage damage at short-term follow-up (Wang HG 2015).
  • ACLR patients with weaker quads showed more asymmetry in their landing mechanics (Schmitt LC 2015).
  • To show how important quad strength is with regards to functional outcomes, here are two studies looking at a different patient population:
    • Quad strength is a major determinant of both performance-based and self-reported physical function in patients with knee osteoarthritis (Maly MR 2006).
    • After total knee arthroplasty (TKA), quadriceps strength was the most highly correlated impairment with functional performance (Mizner RL 2005).

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