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Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations
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A Positive Quadriceps Active Test, without the Quadriceps Being Active.

D C Kieser1, E Savage1, P Sharplin1

  • 1Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.

Case Reports in Orthopedics
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Summary

A positive quadriceps active test in a patient with a posterior cruciate ligament (PCL) injury can indicate posterior tibial subluxation. Hamstring and gastrocnemius muscle actions can influence tibial translation, impacting knee stability.

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Biomechanics

Background:

  • Posterior cruciate ligament (PCL) injuries can lead to chronic knee instability.
  • The quadriceps active test is used to assess PCL integrity, but its interpretation can be complex in chronic injuries.

Observation:

  • A 55-year-old male with a chronic, isolated grade 3 PCL injury presented with a positive quadriceps active test.
  • Crucially, the patient could not actively contract his quadriceps musculature during the test.

Findings:

  • Gravity and hamstring contraction contribute to posterior tibial translation, causing subluxation.
  • Gastrocnemius contraction in knee flexion can lead to anterior tibial translation due to its mass, the "bowstring" effect, and its anatomical origin relative to the tibia.

Implications:

  • This case highlights the complex interplay of muscle forces and tibial translation in PCL-deficient knees.
  • Understanding these biomechanical principles is crucial for accurate diagnosis and effective management of chronic PCL injuries.