title: Hamstring stretch reflex: could it be a reproducible objective measure of functional knee stability?".
abstract: BACKGROUND
  The anterior cruciate ligament (ACL) plays an important role in anterior knee stability by preventing anterior translation of the tibia on the femur. Rapid translation of the tibia with respect to the femur produces an ACL-hamstring stretch reflex which may provide an object measure of neuromuscular function following ACL injury or reconstruction. The aim of this study was to determine if the ACL-hamstring stretch reflex could be reliably and consistently obtained using the KT-2000 arthrometer.
  
  
  METHODS
  A KT-2000 arthrometer was used to translate the tibia on the femur while recording the electromyography over the biceps femoris muscle in 20 participants, all with intact ACLs. In addition, a sub-group comprising 4 patients undergoing a knee arthroscopy for meniscal pathology, were tested before and after anaesthetic and with direct traction on the ACL during arthroscopy. The remaining 16 participants underwent testing to elicit the reflex using the KT-2000 only.
  
  
  RESULTS
  A total number of 182 trials were performed from which 70 trials elicited stretch reflex (38.5 %). The mean onset latency of the hamstring stretch reflexes was 58.9 ± 17.9 ms. The average pull force was 195 ± 47 N, stretch velocity 48 ± 35 mm/s and rate of force 19.7 ± 6.4 N/s.
  
  
  CONCLUSIONS
  Based on these results, we concluded that the response rate of the anterior cruciate ligament-hamstring reflex is too low for it to be reliably used in a clinical setting, and thus would have limited value in assessing the return of neuromuscular function following ACL injuries.
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston Campus, Birmingham, West Midlands, B15 2TT, UK. jxa263@bham.ac.uk.
authors.forename: Jawad F
authors.initials: JF
authors.lastname: Abulhasan
authors.affiliation: The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd South, Birmingham, West Midlands, B31 2AP, UK. cam_anley@yahoo.com.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Anley
authors.affiliation: The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd South, Birmingham, West Midlands, B31 2AP, UK. snowmartyn@gmail.com.
authors.forename: Martyn D
authors.initials: MD
authors.lastname: Snow
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston Campus, Birmingham, West Midlands, B15 2TT, UK. m.j.grey@bham.ac.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Grey
keywords: Anterior Cruciate Ligament ACL; Hamstring Activity; Instability; Short-latency response