Natalia Urban

Background: Normalized strength outcomes and limb symmetry indices (LSIs) are widely used but poorly characterized across testing conditions, and it is unclear if these vary by sex. This study aimed, first, to investigate sex-related differences in normalized knee flexor strength and LSI values across multiple strength-testing conditions in healthy recreational athletes, and, second, to descriptively examine associations among strength outcomes obtained under different testing conditions within female and male participants. Methods: In this cross-sectional study, 52 healthy, recreationally active adults (26 females and 26 males) underwent bilateral knee flexor strength testing using three force plate-based isometric assessments, one static dynamometer-based isometric assessment, and three isokinetic dynamometer-based assessments. Differences were analyzed with a mixed analysis of variance (ANOVA), and associations were assessed using Pearson correlations. Results: Males showed higher normalized knee flexor strength than females across all testing conditions (main effect of sex: p < 0.001; partial η² = 0.334–0.371), with the magnitude of these sex-related differences varying across testing conditions (sex-by-testing condition interaction: p < 0.001; partial η² = 0.215–0.230). LSI values did not differ by sex (p = 0.896) and remained consistent across testing conditions (p = 0.385). Correlations were generally stronger within force plate-based and isokinetic dynamometer-based assessments (r = 0.528–0.922) than between different testing conditions. Conclusions: Sex-related differences were observed for normalized knee flexor strength but not for LSI values. Strength outcomes obtained under different testing conditions should not be considered directly interchangeable.

Background/Objectives: Restoring lower-limb strength and symmetry is crucial after ACL injury and reconstruction. The limb symmetry index (LSI) is often used to assess strength symmetry for return-to-sport decisions, but various assessment methods can influence outcomes. This study aimed to compare LSI across common knee flexor testing methods in healthy male athletes and to examine associations between absolute strength outcomes, thereby establishing baseline reference values for LSI in a healthy population. Methods: Twenty-two healthy recreationally active males participated in this prospective cross-sectional study. Knee flexor strength was assessed bilaterally using three force plate isometric tests, a static dynamometer-based test (isometric), and isokinetic dynamometer-based tests. Absolute strength values were normalized to body mass. LSI values were calculated for each testing condition. Differences in LSI across modalities were analyzed with repeated-measures ANOVA, and associations between normalized strength outcomes were assessed using Pearson correlation coefficients. Results: LSI values ranged from 96.69 to 101.83 across the testing conditions, with no significant differences observed between measures. Normalized absolute strength outcomes demonstrated very strong correlations within the same measurement category (r = 0.86–0.94 for force plate tests and r = 0.88–0.96 for isokinetic tests). In contrast, correlations between isometric and isokinetic strength outcomes were moderate (r = 0.41–0.67). Conclusions: LSI values were consistent across knee flexor strength testing modalities, suggesting that symmetry assessment was relatively consistent across different measurement methods in the studied group. In contrast, normalized absolute strength outcomes showed only moderate and variable associations across modalities, indicating that different testing approaches assess related but not interchangeable aspects of muscle strength.