Lower Extremities Strength Differences in Female Volleyball Players With Stage 1 Patellar Tendinopathy

There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders

BACKGROUND

Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.

METHODS

Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created.

RESULTS

Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.

CONCLUSION

Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.

Maximal Lower Limb Strength in Patellar Tendinopathy: A Systematic Review With Meta-Analysis

OBJECTIVE

To investigate whether lower limb strength is reduced in people with patellar tendinopathy (PT) compared with asymptomatic control individuals or the asymptomatic contralateral limb.

DATA SOURCES

MEDLINE, PubMed, Scopus, and Web of Science.

STUDY SELECTION

To be included in the systematic review and meta-analysis, studies were required to be peer reviewed, published in the English language, and case control investigations; include participants with a clinical diagnosis of PT and an asymptomatic control or contralateral limb group; and include an objective measure of lower limb maximal strength.

DATA EXTRACTION

We extracted descriptive statistics for maximal strength for the symptomatic and asymptomatic limbs of individuals with PT and the limb(s) of the asymptomatic control group, inferential statistics for between-groups differences, participant characteristics, and details of the strength-testing protocol. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for analytical cross-sectional studies.

DATA SYNTHESIS

Of the 23 included studies, 21 reported knee strength, 3 reported hip strength, and 1 reported ankle strength. Random-effects models (Hedges g) were used to calculate the pooled effect sizes (ESs) of muscle strength according to the direction of joint movement and type of contraction. The pooled ESs (95% CI) for maximal voluntary isometric contraction knee-extension strength, concentric knee-extension strength, and concentric knee-flexion strength were 0.54 (0.27, 0.80), 0.78 (0.30, 1.33), and 0.41 (0.04, 0.78), respectively, with all favoring greater strength in the asymptomatic control group. Researchers of 2 studies described maximal eccentric knee-extensor strength with no differences between the PT and asymptomatic control groups. In 3 studies, researchers measured maximal hip strength (abduction, extension, and external rotation), and all within-study ESs favored greater strength in the asymptomatic control group.

CONCLUSIONS

Isometric and concentric knee-extensor strength are reduced in people with PT compared with asymptomatic control individuals. In contrast, evidence for reduced eccentric knee-extension strength in people with PT compared with asymptomatic control individuals is limited and inconsistent. Although evidence is emerging that both knee-flexion and hip strength may be reduced in people with PT, more examination is needed to confirm this observation.

Variability of unilateral and bilateral isometric muscle strength of lower extremities extensors in young females and males

BACKGROUND

The muscle strength of the lower extremity extensors can be evaluated in the closed kinetic chain (CKC) during unilateral or bilateral conditions. Factors such as the mass and length of the muscle, joint angle, type of contraction, and gender influence the magnitude of the muscle strength. The aim of this study was to compare the isometric strength of lower extremity extensors between the different knee extension angles (KEs) as well as between bilateral and unilateral conditions.

METHODS

Nineteen female students (age: 20.2 ± 0.6 years) and nineteen male students (age: 20.3 ± 0.7 years) participated in the study. The muscle strength was evaluated in CKC using the strain gauge dynamometer. The analysis included values of the maximum muscle strength normalized to body mass (MS/BM) for the six KEs of 80°, 70°, 60°, 50°, 40° and 30°.

RESULTS

A significant main effect in the MS/BM values for the angle factor (p < 0.001) and condition factor (p < 0.001) was found. Moreover, there was a non-significant interaction effect between the angle factor and gender factor (p = 0.476) as well as between the condition factor and gender factor (p = 0.770). Comparisons showed significant differences in the MS/BM values between the six KEs (p < 0.001). Furthermore, significantly lower MS/BM values for bilateral conditions than unilateral conditions at the 30° KE were observed (p < 0.001).

CONCLUSION

The decrease in KE by 10° significantly increased the muscle strength of the lower extremity extensors. Gender did not affect the change in MS/BM values with the change in KE and conditions. Findings also revealed significant bilateral deficit, i.e., significantly a lower summed muscle strength during bilateral conditions than unilateral conditions. The study emphasized the importance of selecting the 30° KE as the optimal angle to assess the maximum strength developed in CKC.

Impact of Patellar Tendinopathy on Isokinetic Knee Strength and Jumps in Professional Basketball Players

Patellar tendinopathy is characterized by tendon pain which may reduce the level of performance. This study's main aim was to compare isokinetic knee strength and jump performances at the start of the sport season between players with patellar tendinopathy and those without. Secondary aims were to assess the relationship between knee strength and jump function. Sixty-two professional basketball players were enrolled (mean age: 25.0 ± 4.0). All players performed knee isokinetic measurements, single leg countermovement jumps, and one leg hop tests. Correlations between knee strength and jump performances were examined. Twenty-four players declared a patellar tendinopathy and were compared to the 38 players without tendinopathy. The isokinetic quadriceps strength was lower in cases of patellar tendinopathy, and a camel's back curve was observed in 58% of the cases of patellar tendinopathy. However, jump performances were preserved. No link was found between quadriceps and hamstring limb symmetry indexes at 60 and 180°/s with jumps. This preseason screening enabled us to identify the absence of consequences of patellar tendinopathy in professional basketball players. Jump performances were not altered, possibly due to compensatory strategies.