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Reliability of Heel-Height Measurement for Documenting Knee Extension Deficits

Theodore F. Schlegel, MD^,, Martin Boublik, MD, Richard J. Hawkins, MD^, and J. Richard Steadman, MD^,

Steadman Hawkins Denver Clinics, Denver and Vail, Colorado
Steadman Hawkins Sports Medicine Foundation, Vail, Colorado

Presented at the 21st annual meeting of the AOSSM, Toronto, Ontario, Canada, July 1995.

Address correspondence and reprint requests to Theodore F. Schlegel, MD, Steadman Hawkins Denver Clinic, 8200 East Belleview, Suite 615, Englewood, CO 80111

Background: Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated.

Hypothesis: Differences in thigh circumference measurements and whether the patient’s patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture.

Study Design: Prospective cohort study.

Methods: Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction.

Results: A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture.

Conclusion: Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10°.

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