Isokinetic angle-specific moments and ratios characterizing hamstring and quadriceps strength in anterior cruciate ligament deficient knees

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.