Effect of knee joint angle on side-to-side strength ratios.

Isometric knee extensor and flexor strength are typically tested at different joint angles due to the differences in length-tension relationships of the quadriceps and hamstring muscles. The efficiency of strength testing can be improved if the same angle can be used to test both the knee extensor and flexor muscle groups. The aim of this study was to determine an optimal angle for isometric knee strength testing by examining the effect of knee angle on side-to-side peak torque ratios. Eighteen active young people (9 males and 9 females) participated in this study. Knee extensor and knee flexor strength were tested on both sides at 30°, 60°, and 90° of knee flexion. The effect of knee flexion angle on side-to-side peak torque ratios, raw torque values, and side-to-side flexor-to-extensor torque ratios were assessed. Side-to-side knee extensor peak torque ratios and knee flexor-to-extensor torque ratios differed significantly by knee flexion angle (p = 0.024 and p = 0.011, respectively), but side-to-side knee flexor peak torque ratios did not differ significantly (p = 0.311). When considering both side-to-side peak torque ratios and flexor-to-extensor torque ratios, the values were more symmetrical (i.e., closer to 100%) only at 60° of knee flexion. Our results indicate that both the knee flexors and the knee extensors can be tested clinically at 60° of knee flexion. Our results also indicate that the hamstrings can be tested at any of the 3 angles if the examiner is interested in side-to-side ratios rather than raw torque values. These results may facilitate more efficient and flexible clinical knee strength testing.