Testing the Posterior Chain: Diagnostic Accuracy of the Bunkie Test versus the Isokinetic Hamstrings/Quadriceps Measurement in Patients with Self-Reported Knee Pain and Healthy Controls

(1) Background: The isokinetic measurement (IM) of the leg muscles is well established but costly, whereas the Bunkie Test (BT) is a rarely investigated but easy-to-conduct functional test to evaluate the total posterior chain. Although the tests differ in aim and test structures, both have their justification in the assessment process. Therefore, this study evaluated the diagnostic accuracy of the BT and the IM. (2) Methods: 21 participants (9 female, 12 male; age, 26.2 +/- 5.26 years; weight 73.8 +/- 14.6 kg; height 176.0 +/- 9.91 cm) and 21 patients (9 female, 12 male; age, 26.5 +/- 5.56 years; weight, 72.6 +/- 16.9 kg; height 177.0 +/- 10.1 cm) with self-reported pain in the knee performed the IM and the BT. For IM, we calculated the ratio of the knee mean flexor/extensor peak torque (H/Q ratio) for 60 degrees/s and 120 degrees/s, and BT performance was measured in seconds. We classified the IM (<0.6 H/Q ratio) and the BT (leg difference >= 4 s) as binary results according to the literature. We calculated the sensitivity and specificity, which we compared with the Chi-Square test, and the 95% confidence intervals (CI). A p-value of <= 0.05 is considered significant. (3) Results: The sensitivity for the BT was 0.89, 95% CI [0.67, 0.99], and the specificity was 0.52 [0.30, 0.74]. For the IM, the sensitivity was 0.14 [0.03, 0.36] for 60 degrees/s and 0.05 [0.00, 0.24] for 120 degrees/s, and the specificity was 0.70 [0.46, 0.88] for 60 degrees/s and 0.90 [0.68, 0.99] for 120 degrees/s. The results of the Chi-Square tests were significant for the BT (chi(2) (1) = 6.17, p = 0.01) but not for the IM (60 degrees/s: chi(2) (1) = 0.70, p = 0.40; 120 degrees/s: chi(2) (1) = 0.00, p = 0.97). (4) Conclusions: Patients were more likely to obtain a positive test result for the BT but not for the IM.