Study Design: Randomized clinical trial, single-masked. Objectives: To determine the effectiveness of using a modified neuromuscular electrical stimulation (NMES) training program as an adjunct treatment for improving quadriceps strength and physical function in rehabilitation following anterior cruciate ligament reconstruction (ACLR). Background: NMES training for quadriceps strengthening has previously been shown to be an effective adjunct treatment following ACLR when performed against isometric resistance using a dynamometer with the knee positioned in flexion. We developed a modified version of published NMES protocol because some patients have difficulty tolerating the existing protocol and many clinics may not have instrumented dynamometers. There is a need to determine the effectiveness of this modified protocol. Methods and Measures: Forty-three subjects who had undergone ACLR were randomly assigned to either a group that received (NMES group) or did not receive (comparison group) the NMES treatment in conjunction with their rehabilitation. Group means for quadriceps strength and self-reported measures of knee function were compared after 12 and 16 weeks of rehabilitation. The proportion of subjects in each group achieving clinical criteria to initiate ambulation without crutches, treadmill running, and agility training at selected times during rehabilitation were also compared. Results: The NMES group demonstrated moderately greater quadriceps strength at 12 weeks (effect size, 0.48), and moderately higher levels of self-reported knee function at both 12 (effect size, 0.72) and 16 (effect size, 0.65) weeks of rehabilitation compared to the comparison group. A greater proportion of subjects in the NMES group achieved clinical criteria for advancing to agility training at 16 weeks. Conclusions: The modified NMES quadriceps training protocol can be a useful adjunct to ACLR rehabilitation programs, but the treatment effect is smaller than what has been reported in previous studies.

J Orthop Sports Phys Ther. 2003;33(9):492-501.

Key Words: ACL, clinical trial, knee, strengthening, training

Single leg hop tests are commonly used as physical performance measures of function and are also commonly used to evaluate progress in knee rehabilitation programs, particularly for individuals recovering from anterior cruciate ligament injury or reconstructive surgery. While there is some evidence that hop tests may show promise as a predictive measure for identifying individuals who are at risk for recurrent dynamic instability, further work is needed to clearly define the role of hop test measurements for this purpose. The purposes of this clinical commentary are to review the research that has been done to establish hop tests as a physical performance measure of function, to discuss neuromuscular and biomechanical considerations related to hop performance and dynamic knee stability, to discuss existing evidence that supports the potential for hop tests as a predictor of dynamic knee stability, and to discuss considerations for future studies that are designed to more clearly define the role of hop tests in predicting dynamic knee stability.

J Orthop Sports Phys Ther. 200l;31(10):588-597.

Key Words: anterior cruciate ligament, functional performance testing, hop tests

Nonoperative management of anterior cruciate ligament (ACL) rupture has not been a successful option for those who participate in high-level physical activity. However, there are instances when patients may want to attempt to return to physically demanding activities with nonoperative rehabilitation for an ACL injury. The purpose of this commentary is to describe guidelines for nonoperative management of physically active individuals with ACL injuries who wish to return to preinjury levels of physical activity. The guidelines are based on the results of 2 clinical studies that improved the overall success of nonoperative management of physically active individuals with ACL ruptures. A decision-making process for selecting appropriate candidates for nonoperative management (rehabilitation candidates) is described. Individuals are classified as rehabilitation candidates if they have no concomitant ligament or mensical damage associated with the ACL injury, have a unilateral ACL injury, and meet all 4 of the following criteria: (1) timed hop test score of 80% or more of the uninjured limb, (2) Knee Outcome Survey Activities of Daily Living Scale score of 80% or more, (3) global rating of knee function of 60% or more, and (4) no more than 1 episode of giving way since the incident injury to the time of testing. Individuals meeting the criteria of a rehabilitation candidate undergo an intensive rehabilitation program before returning to high-level activity. The rehabilitation program consisting of lower extremity muscle strength training, cardiovascular endurance training, agility and sport-specific skill training, and a training program using balance perturbations is described.

J Orthop Sports Phys Ther. 2000;30(4):194-203.

Key Words: anterior cruciate ligament, knee, rehabilitation

Study Design: Test-retest reliability study.
Objective: To determine interrater reliability of the modified scapular assistance test (SAT). The modified SAT is designed to assess the contribution of scapular motion to shoulder pain.
Background: Abnormal scapular motion has been implicated in different shoulder disorders. However, there is a lack of clinical evaluation tools to assess the scapular component of shoulder dysfunction.
Methods and Measures: Forty-six subjects who were referred to physical therapy for treatment of various shoulder pathologies were recruited for this study. The modified SAT was performed on each participant by 2 different examiners. Percent agreement and kappa coefficient were utilized to determine interrater reliability of the modified SAT.
Results: The kappa coefficient and percent agreement were 0.53 and 77%, respectively, when the test was performed in the scapular plane, and 0.62 and 91%, respectively, when the test was performed in the sagittal plane.
Conclusions: The modified SAT possesses acceptable interrater reliability for clinical use.

 J Orthop Sports Phys Ther. 2006;36(9):653-660. doi:10.2519/jospt.2006.2234

Key Words: measurement, scapula, shoulder