Ascertaining Maximal Voluntary Effort Production During Isokinetic Knee Strength Testing of Anterior Cruciate Ligament-Reconstructed Patients

Objective: The aim of this study was to assess the performance of prediction rules meant for declaration of efforts as being maximal or not during isokinetic strength testing in a cohort that underwent anterior cruciate ligament reconstruction. Design: Thirty-six individuals performed four sets of six reciprocal concentric knee extension/flexion repetitions at a testing speed of 60 degrees per second through a 60-degree range of motion. The sets consisted of a maximal voluntary effort, two nonmaximal sincere efforts at 50% and 75% of self-perceived maximum, and a set attempting to feign or exaggerate thigh muscle strength deficiencies. Strength curve derived set internal consistency measures, namely, cross-correlation and percent root mean square difference scores, were inputted into the prediction rules, whose performance is reported as specificity and sensitivity percentages. Results: Dependent on the prediction rule used and when expressed on an individual participant basis, the corresponding specificity and sensitivity values ranged from 66.6% to 97.2% and 97.2% to 94.4%, respectively. Conclusions: Using the prediction rules presented in this investigation, clinicians may be able to ascertain maximal effort production during isokinetic testing in those who have undergone surgical reconstruction of their anterior cruciate ligament.