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Zheng F, Jia R, Ye J, Li M, Zhang Y, Xu G, Zhang L. Prediction of specific structural damage to the knee joint using qualitative isokinetic analysis. BMC Musculoskelet Disord 2024; 25:382. [PMID: 38745166 PMCID: PMC11091992 DOI: 10.1186/s12891-024-07434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND An isokinetic moment curve (IMC) pattern-damaged structure prediction model may be of considerable value in assisting the diagnosis of knee injuries in clinical scenarios. This study aimed to explore the association between irregular IMC patterns and specific structural damages in the knee, including anterior cruciate ligament (ACL) rupture, meniscus (MS) injury, and patellofemoral joint (PFJ) lesions, and to develop an IMC pattern-damaged structure prediction model. METHODS A total of 94 subjects were enrolled in this study and underwent isokinetic testing of the knee joint (5 consecutive flexion-extension movements within the range of motion of 90°-10°, 60°/s). Qualitative analysis of the IMCs for all subjects was completed by two blinded examiners. A multinomial logistic regression analysis was used to investigate whether a specific abnormal curve pattern was associated with specific knee structural injuries and to test the predictive effectiveness of IMC patterns for specific structural damage in the knee. RESULTS The results of the multinomial logistic regression revealed a significant association between the irregular IMC patterns of the knee extensors and specific structural damages ("Valley" - ACL, PFJ, and ACL + MS, "Drop" - ACL, and ACL + MS, "Shaking" - ACL, MS, PFJ, and ACL + MS). The accuracy and Macro-averaged F1 score of the predicting model were 56.1% and 0.426, respectively. CONCLUSION The associations between irregular IMC patterns and specific knee structural injuries were identified. However, the accuracy and Macro-averaged F1 score of the established predictive model indicated its relatively low predictive efficacy. For the development of a more accurate predictive model, it may be essential to incorporate angle-specific and/or speed-specific analyses of qualitative and quantitative data in isokinetic testing. Furthermore, the utilization of artificial intelligence image recognition technology may prove beneficial for analyzing large datasets in the future.
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Affiliation(s)
- Feisheng Zheng
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Rui Jia
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jinqun Ye
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yunping Zhang
- Clinical Medical College of Acupuncture moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Lei Zhang
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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Parker J, Lundgren LE. Pedal to the Metal: Velocity and Power in High-Level Golfers. J Strength Cond Res 2021; 35:3425-3431. [PMID: 31490426 DOI: 10.1519/jsc.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Parker, J, and Lundgren, LE. Pedal to the metal: Velocity and power in high-level golfers. J Strength Cond Res 35(12): 3425-3431, 2021-In most rotational power assessments, discrete variables are used for subsequent examination; however, movements are continuous, and data can be collected in time series. The purpose of this investigation was to examine the velocity- and power-time series characteristics of a standing rotation test and identify relationships with golf performance. Thirty-one golfers performed a golf-specific rotation test (GSRT) with 3 different resistances (6, 10, and 14 kg) in a robotic engine system. Time series of velocity and power was calculated from the raw data, and each repetition was then normalized to 0-100%. Principal component analyses (PCAs) were performed on velocity and power waveforms. The PCA used an eigenvalue analysis of the data covariance matrix. The relationship between clubhead speed (CHS) and all principal components (PC) was examined using linear regression. Ten velocity parameters and 6 power parameters explained 80% of the variance in the data. For velocity, the first 2 PCs identified both magnitude and phase shift features while PCs 3-5 identified difference features. For power, the first 2 PCs identified both magnitude and phase shift features, the third PC identified a phase shift feature, and the fourth PC identified a difference feature. The highest relationship with CHS was shown for GSRT with 14 kg in PC2 for power (R2 = 0.48, p < 0.001). The PCA of the GSRT power test could distinguish intraindividual differences, external loads, and sex-based differences. Athletes should focus on accelerating smoothly through the movement, particularly with heavier loads, and not pulling aggressively at the beginning of the rotational movement to achieve maximum power.
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Affiliation(s)
- James Parker
- The Rydberg Laboratory for Applied Sciences, School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
- The Center for Sport and Health Research, School of Health and Welfare, Halmstad University, Halmstad, Sweden ; and
| | - Lina E Lundgren
- The Rydberg Laboratory for Applied Sciences, School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
- Center of Artificial Intelligence Research, School of Information Technology, Halmstad University, Sweden
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Diagnostic Validity of an Isokinetic Testing to Identify Partial Anterior Cruciate Ligament Injuries. J Sport Rehabil 2019; 29:1086-1092. [PMID: 31825887 DOI: 10.1123/jsr.2019-0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/18/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the diagnostic validity of an isokinetic testing to detect partial injuries on the anterior cruciate ligament (ACL). DESIGN Prospective diagnostic study. SETTINGS Orthopedic clinic, physiotherapy clinic, orthopedic hospital, and diagnostic/image clinic. PARTICIPANTS Consecutive patients (n = 29) with unilateral knee complaint submitted to physical examination, magnetic resonance images (MRIs), and isokinetic testing prior to surgery of ACL reconstruction. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The isokinetic torque curves data from extensor and flexor muscles were converted to frequency domain by fast Fourier transformation and compared with healthy contralateral limb. Differences were categorized as unstable knees and these conclusions were compared with patient's physical examinations (doctor's conclusion on ACL integrity) and MRIs (as the radiologist conclusions on ACL integrity). After surgery, all intraoperatively confirmed partial injured patient's data were collected. The diagnostic accuracy measures to compare the conclusions of all 3 professionals included sensitivity, specificity, positive predictive value, negative predictive value, disease prevalence, positive likelihood ratio, and accuracy-all using a confidence interval of 95%. RESULTS Compared with MRI, the sensitivity of isokinetic test for an ACL partial injury was 90.00%, specificity 83.33%, positive predictive value 52.94%, negative predictive value 97.56%, and accuracy 84.48%. Compared with physical examination, the sensitivity of isokinetic test for an ACL partial injury was 85.71%, specificity 78.43%, positive predictive value 35.29%, negative predictive value 97.56%, and accuracy 79.31%. CONCLUSIONS This method of isokinetic data analysis through fast Fourier transformation can be used to improve diagnostic accuracy of a difficult detection injury. Even present, a partial ACL injury can produce a stable knee during isokinetic testing and could be used to detect candidates for conservative treatment based on strengthening exercises, reducing surgery risks, and financial and social impact on patient's life.
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Detecting the presence of anterior cruciate ligament injury based on gait dynamics disparity and neural networks. Artif Intell Rev 2019. [DOI: 10.1007/s10462-019-09758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Detecting the presence of anterior cruciate ligament deficiency based on a double pendulum model, intrinsic time-scale decomposition (ITD) and neural networks. Artif Intell Rev 2019. [DOI: 10.1007/s10462-019-09761-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Classification of gait patterns in patients with unilateral anterior cruciate ligament deficiency based on phase space reconstruction, Euclidean distance and neural networks. Soft comput 2019. [DOI: 10.1007/s00500-019-04017-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zeng W, Ismail SA, Lim YP, Smith R, Pappas E. Classification of Gait Patterns Using Kinematic and Kinetic Features, Gait Dynamics and Neural Networks in Patients with Unilateral Anterior Cruciate Ligament Deficiency. Neural Process Lett 2018. [DOI: 10.1007/s11063-018-9965-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wu W, Zeng W, Ma L, Yuan C, Zhang Y. Modeling and classification of gait patterns between anterior cruciate ligament deficient and intact knees based on phase space reconstruction, Euclidean distance and neural networks. Biomed Eng Online 2018; 17:165. [PMID: 30382920 PMCID: PMC6211421 DOI: 10.1186/s12938-018-0594-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The anterior cruciate ligament (ACL) plays an important role in stabilizing translation and rotation of the tibia relative to the femur. ACL injury alters knee kinematics and usually links to the alternation of gait patterns. The aim of this study is to develop a new method to distinguish between gait patterns of patients with anterior cruciate ligament deficient (ACL-D) knees and healthy controls with ACL-intact (ACL-I) knees based on nonlinear features and neural networks. Therefore ACL injury will be automatically and objectively detected. METHODS First knee rotation and translation parameters are extracted and phase space reconstruction (PSR) is employed. The properties associated with the gait system dynamics are preserved in the reconstructed phase space. For the purpose of classification of ACL-D and ACL-I knee gait patterns, three-dimensional (3D) PSR together with Euclidean distance computation has been used. These measured parameters show significant difference in gait dynamics between the two groups and have been utilized to form a feature set. Neural networks are then constructed to identify gait dynamics and are utilized as the classifier to distinguish between ACL-D and ACL-I knee gait patterns based on the difference of gait dynamics between the two groups. RESULTS Experiments are carried out on a database containing 18 patients with ACL injury and 28 healthy controls to assess the effectiveness of the proposed method. By using the twofold and leave-one-subject-out cross-validation styles, the correct classification rates for ACL-D and ACL-I knees are reported to be 91.3[Formula: see text] and 95.65[Formula: see text], respectively. CONCLUSION Compared with other state-of-the-art methods, the results demonstrate that gait alterations in the presence of ACL deficiency can be detected with superior performance. The proposed method is a potential candidate for the automatic and non-invasive classification between patients with ACL deficiency and healthy subjects.
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Affiliation(s)
- Wenbao Wu
- Department of Acupuncture, Longyan First Hospital, Longyan, 364000, China
| | - Wei Zeng
- School of Physics and Mechanical & Electrical Engineering, Longyan University, Longyan, 364012, China.
| | - Limin Ma
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China
| | - Chengzhi Yuan
- Department of Mechanical, Industrial and Systems Engineering, University of Rhode Island, Kingston, RI, 02881, USA
| | - Yu Zhang
- Department of Orthopedics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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Burland JP, Kostyun RO, Kostyun KJ, Solomito M, Nissen C, Milewski MD. Clinical Outcome Measures and Return-to-Sport Timing in Adolescent Athletes After Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53:442-451. [PMID: 29847160 DOI: 10.4085/1062-6050-302-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Multiple factors are likely associated with an adolescent athlete's ability to return to play after anterior cruciate ligament (ACL) reconstruction (ACLR). OBJECTIVE To investigate the relationship between self-reported and functional outcome measures on return-to-play timing in an adolescent population, in athletes who returned and those who did not return to sport, and to identify a cutoff value for isometric quadriceps strength that could serve as a clinical target for maximizing the odds of returning to play after ACLR. DESIGN Cross-sectional study. SETTING Outpatient clinic. PATIENTS OR OTHER PARTICIPANTS Adolescent athletes who underwent ACLR and completed clinical measures at their 3- and 6-month follow-up appointments were included. MAIN OUTCOME MEASURE(S) Clinical measures included functional outcomes of isometric and isokinetic strength tests and the Anterior Cruciate Ligament Return to Sport After Injury scale and the pediatric version of the International Knee Documentation Committee subjective form. Physician clearance dates for return to play were obtained from patient records. RESULTS Higher strength measures were associated with better scores on the Anterior Cruciate Ligament Return to Sport After Injury and the pediatric version of the International Knee Documentation Committee instruments at each follow-up. Differences were found in isometric extension strength ( P = .001) and isokinetic extension strength at 180°/s ( P = .03) and 300°/s ( P = .002) between patients who returned to sports and those who did not. A 6-month isometric extension deficit (mean Limb Symmetry Index = 85.48 ± 23.15) displayed high accuracy (area under the curve = 0.82, 95% confidence interval = 0.68, 0.95) for identifying patients who returned to play after ACLR. CONCLUSIONS Higher strength measures at both 3 and 6 months after ACLR were associated with greater self-reported knee function and greater readiness to return to functional activities at 6 months and ultimately earlier return to sport in adolescent athletes. These results provide evidence that self-reported outcome scores should be used as an additional screening tool in conjunction with quadriceps strength testing to help provide realistic recovery timeframes for adolescent patients.
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Affiliation(s)
| | - Regina O Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Kyle J Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Matthew Solomito
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Carl Nissen
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Matthew D Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington.,Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, MA
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Huang H, Guo J, Yang J, Jiang Y, Yu Y, Müller S, Ren G, Ao Y. Isokinetic angle-specific moments and ratios characterizing hamstring and quadriceps strength in anterior cruciate ligament deficient knees. Sci Rep 2017; 7:7269. [PMID: 28779114 PMCID: PMC5544756 DOI: 10.1038/s41598-017-06601-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/14/2017] [Indexed: 11/23/2022] Open
Abstract
This study is intended to find more effective and robust clinical diagnostic indices to characterize muscle strength and coordination alternation following anterior cruciate ligament (ACL) rupture. To evaluate angle-specific moments and hamstring (H)/quadriceps (Q) ratios, 46 male subjects with unilateral chronic ACL-rupture performed isokinetic concentric (c), eccentric (e) quadriceps and hamstring muscle tests respectively at 60°/s. Normalized moments and H/Q ratios were calculated for peak moment (PM) and 30°, 40°, 50°, 60°, 70°, 80° knee flexion angles. Furthermore, we introduced single-to-arithmetic-mean (SAM) and single-to-root-mean-square (SRMS) muscle co-contraction ratios, calculating them for specific angles and different contraction repetitions. Normalized PM and 40° specific concentric quadriceps, concentric hamstring strength in the ACL-deficient knee were reduced significantly (P ≤ 0.05). Concentric angle-specific moments together with Qe/Qc ratios at 40° (d = 0.766 vs. d = 0.654) identify more obvious differences than peak values in ACL ruptured limbs. Furthermore, we found SRMS-QeQc deficits at 40° showed stronger effect than Qe/Qc ratios (d = 0.918 vs. d = 0.766), albeit other ratio differences remained basically the same effect size as the original H/Q ratios. All the newly defined SAM and SRMS indices could decrease variance. Overall, 40° knee moments and SAM/SRMS ratios might be new potential diagnosis indices for ACL rupture detection.
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Affiliation(s)
- Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Jianqiao Guo
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, China
| | - Jie Yang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yuanyuan Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Steffen Müller
- Departments of Sports Medicine and Orthopedics, University of Potsdam, Potsdam, 14469, Germany
| | - Gexue Ren
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, China.
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China.
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Clouthier AL, Bohm ER, Rudan JF, Shay BL, Rainbow MJ, Deluzio KJ. Correcting waveform bias using principal component analysis: Applications in multicentre motion analysis studies. Gait Posture 2017; 51:153-158. [PMID: 27770680 DOI: 10.1016/j.gaitpost.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/06/2016] [Accepted: 10/11/2016] [Indexed: 02/02/2023]
Abstract
Multicentre studies are rare in three dimensional motion analyses due to challenges associated with combining waveform data from different centres. Principal component analysis (PCA) is a statistical technique that can be used to quantify variability in waveform data and identify group differences. A correction technique based on PCA is proposed that can be used in post processing to remove nuisance variation introduced by the differences between centres. Using this technique, the waveform bias that exists between the two datasets is corrected such that the means agree. No information is lost in the individual datasets, but the overall variability in the combined data is reduced. The correction is demonstrated on gait kinematics with synthesized crosstalk and on gait data from knee arthroplasty patients collected in two centres. The induced crosstalk was successfully removed from the knee joint angle data. In the second example, the removal of the nuisance variation due to the multicentre data collection allowed significant differences in implant type to be identified. This PCA-based technique can be used to correct for differences between waveform datasets in post processing and has the potential to enable multicentre motion analysis studies.
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Affiliation(s)
- Allison L Clouthier
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
| | - Eric R Bohm
- Department of Surgery, University of Manitoba, 820 Sherbrook St., Winnipeg, Manitoba, Canada.
| | - John F Rudan
- Department of Surgery, Queen's University, 76 Stuart St., Kingston, ON, Canada.
| | - Barbara L Shay
- Department of Physical Therapy, University of Manitoba, 771 McDermot Ave., Winnipeg, Manitoba, Canada.
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
| | - Kevin J Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
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Almosnino S, Dvir Z, Bardana DD. Consistency of strength curves for determining maximal effort production during isokinetic knee testing of anterior cruciate ligament-deficient patients. Physiother Theory Pract 2016; 32:202-8. [PMID: 27043046 DOI: 10.3109/09593985.2015.1137092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this investigation was to attempt to establish decision rules for determining maximal effort production during isokinetic strength testing of unilateral anterior cruciate ligament-deficient patients based on the degree of strength curve consistency within a set. Thirty-three participants performed six bilateral knee extension and flexion exertions at maximal effort and at 80% of perceived maximum at testing velocities of 60 and 180°s(-1). Within-set consistency was quantified by computation of the variance ratio across strength curves. Tolerance interval-based cutoff scores covering 99% of the population were calculated for declaring efforts as being maximal or not at confidence levels of 90%, 95%, and 99%. The sensitivity percentages attained for the injured knee for both testing velocities ranged between 9.1% and 27.2%, while specificity percentages ranged between 84.8% and 100%. For the non-injured knee, sensitivity values for both testing velocities ranged between 21.2% and 45.0%, while specificity percentages ranged between 97.0% and 100%. The developed decision rules do not effectively discriminate on an individual patient basis between maximal and non-maximal isokinetic knee musculature efforts. Further research is needed for development of methods that would enable to ascertain maximal effort production in this patient population during knee muscle strength testing.
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Affiliation(s)
- Sivan Almosnino
- a Resource Environmental Associates, Ltd ., Markham , ON , Canada
| | - Zeevi Dvir
- b Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Davide D Bardana
- c Department of Orthopedic Surgery , Kingston General Hospital , Kingston , ON , Canada
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