Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects

Postural control during gait termination and prehension

BACKGROUND

Challenges to postural stability emerge in the transition from locomotion to a standing posture as during gait termination, often accompanied by another task (e.g., opening a door), which may complicate control. However, less is known about postural control during terminating gait while engaged in a secondary manual task.

RESEARCH QUESTION

What are the changes in postural control when terminating gait with and without a prehension task?

METHODS

In a cross-sectional design, 15 healthy young adults (M=8, F=7; 27±2 years; 69±13 kg; 171±8 cm) underwent both a single task gait termination (GTO) and dual task (gait termination plus reaching; GTR). Postural Time-to-Contact (TtC) was measured using Center of Pressure (CoP) and the sternum position in anterior-posterior (AP) and medial-lateral (ML) directions over two different phases: preparatory phase and stabilization phase. Five successful trials were recorded to obtain a mean TtC. For statistical analysis of TtC, a two-tailed paired t-test was used (p =.05) as normality was satisfied.

RESULTS

For the preparatory phase, there were no differences for the CoP, but TtC of the sternum position in AP was shorter in GTR than GTO (p =.001). Meanwhile, for the stabilization phase, TtCs of both the CoP and sternum position were longer in GTR in both AP and ML directions (p's <.001).

SIGNIFICANCE

We suggest that for the preparatory phase, the shorter TtC of the sternum position with intact TtC of the CoP in GTR indicates that healthy young individuals are flexible, in that they smoothly integrate CoP control with the upper body demands required to also perform the prehension task. Meanwhile, for the stabilization phase, the longer TtC in dual termination and prehension task indicates that the perturbation imposed by the prehension movement did not result in reduced stabilization when returning to an upright posture.

Neuromuscular control strategies of the lower limb during a typical Tai Chi brush knee and twist step in practitioners with and without knee pain: a pilot study

As a complex movement, Tai Chi (TC) could be challenging for knee control, and the compensatory changes in TC biomechanics of knee pain patients are unknown. The Brush Knee and Twist Step (BKTS) is a typical TC movement that involves basic leg motion repeated in the whole TC. This pilot study examined electromyography and retro-reflective marker trajectory data to investigate neuromuscular control strategies of the lower extremity during BKTS in TC practitioners with and without knee pain. Twelve experienced TC practitioners with (n = 6) and without knee pain (n = 6) participated. Our results revealed that knee pain practitioners presented muscle imbalance in the vastus medialis-vastus lateralis and vastus lateralis-biceps femoris, and poor alignment of the knee with the toes in TC lunge. Additionally, they adaptively developed rigid coordination strategies, showing higher levels of lower limb muscle co-contraction and activity compared to controls. Training programs for TC practitioners with knee pain should be designed to modify both abnormal muscle synergy patterns and incorrect lunge during TC, which may improve exercise safety.

A balance focused biometric does not predict rehabilitation needs and outcomes following total knee arthroplasty

BACKGROUND

Both length of hospital stay and discharge to a skilled nursing facility are key drivers of total knee arthroplasty (TKA)-associated spending. Identifying patients who require increased postoperative care may improve expectation setting, discharge planning, and cost reduction. Balance deficits affect patients undergoing TKA and are critical to recovery. We aimed to assess whether a device that measures preoperative balance predicts patients' rehabilitation needs and outcomes after TKA.

METHODS

40 patients indicated for primary TKA were prospectively enrolled and followed for 12 months. Demographics, KOOS-JR, and PROMIS data were collected at baseline, 3-months, and 12-months. Single-leg balance and sway velocity were assessed preoperatively with a force plate (Sparta Science, Menlo Park, CA). The primary outcome was patients' discharge facility (home versus skilled nursing facility). Secondary outcomes included length of hospital stay, KOOS-JR scores, and PROMIS scores.

RESULTS

The mean preoperative sway velocity for the operative leg was 5.7 ± 2.7 cm/s, which did not differ from that of the non-operative leg (5.7 ± 2.6 cm/s, p = 1.00). Five patients (13%) were discharged to a skilled nursing facility and the mean length of hospital stay was 2.8 ± 1.5 days. Sway velocity was not associated with discharge to a skilled nursing facility (odds ratio, OR = 0.82, 95% CI = 0.27-2.11, p = 0.690) or longer length of hospital stay (b = -0.03, SE = 0.10, p = 0.738). An increased sway velocity was associated with change in PROMIS items from baseline to 3 months for global07 ("How would you rate your pain on average?" b = 1.17, SE = 0.46, p = 0.015) and pain21 ("What is your level of pain right now?" b = 0.39, SE = 0.17, p = 0.025) at 3-months.

CONCLUSION

Preoperative balance deficits were associated with postoperative improvements in pain and function after TKA, but a balance focused biometric that measured single-leg sway preoperatively did not predict discharge to a skilled nursing facility or length of hospital stay after TKA making their routine measurement cost-ineffective.

Balance Control is Sequentially Correlated with Proprioception, Joint Range of Motion, Strength, Pain, and Plantar Tactile Sensation Among Older Adults with Knee Osteoarthritis

BACKGROUND

Patients with knee osteoarthritis (KOA) are at high risk for falls, which is attributed to their impaired balance control. Identifying factors associated with balance control facilitates the development of precise KOA rehabilitation programs. This study was to investigate the correlations of balance control with proprioception, plantar tactile sensation (PTS), pain, joint range of motion (ROM), and strength among older adults with and without KOA, as well as the magnitudes and sequence of correlation of these factors to balance control.

METHODS

A total of 240 older adults with (n = 124, female: 84, age: 68.8 ± 4.0 years) and without (n = 116, female: 64, age: 67.9 ± 3.5 years) KOA were recruited and assigned to the KOA and control groups. Their proprioception, PTS, pain, ROM, and strength were measured. Pearson or Spearman correlations were used to test whether they were significantly related to their Berg Balance Scale (BBS), and factor analysis and multivariate linear regression were used to determine the degrees of correlation between each factor and the BBS.

RESULTS

Compared to the control group, the KOA group had lower BBS score, larger proprioception and PTS thresholds, smaller ROM, and less strength (p: 0.008, < 0.001-0.016, < 0.001-0.005, < 0.001-0.014, and < 0.001-0.002, respectively). In the KOA group, the BBS was weakly to moderately correlated with proprioception, PTS, pain, ROM, and strength (r: 0.332-0.501, 0.197-0.291, 0.340, 0.212-0.508, and 0.236-0.336, respectively). While in the control group, the BBS was correlated with proprioception and strength (r: 0.207-0.379, and 0.212-0.410). In the KOA group, BBS = 54.41+ (0.668*strength) - (0.579*PTS) - (1.141*proprioception) + (1.054* ROM) - (0.339*pain). While in the control group, BBS = 53.85+ (0.441*strength) - (0.677*proprioception).

CONCLUSION

Worse proprioception and PTS, smaller ROM, and less strength were detected among older adults with KOA, and their proprioception, PTS, pain, ROM, and strength were all related to balance control. Proprioception had the strongest correlations, followed by ROM, strength, pain, and PTS. Precise KOA rehabilitation programs may be proposed following the sequence of improving the five factors.

Postural stability and its relation to knee flexor/extensor strength ratio in women with mild to moderate unilateral knee osteoarthritis: a case-control study

PURPOSE/AIM

Knee muscles strength is an important factor influencing postural stability in patients with knee osteoarthritis (KOA). However, there is no evidence regarding the relationship between the knee flexor/extensor strength ratio, which is suggested to be a good indicator of knee stability, and postural stability. We aimed to investigate postural stability and its relation to knee flexor and extensor strength and strength symmetry in women with KOA.

MATERIALS AND METHODS

Thirty-five women with unilateral KOA and thirty-five asymptomatic women were assessed with the Prokin system to collect the following parameters during quiet standing with eyes-open and eyes-closed: ellipse area, perimeter, forward-backward standard deviation, mediolateral standard deviation, the average centre of pressure displacement on the x- and y-axises (COPX and COPY), and the limit of stability (LoS) score. Higher scores mean better balance for LoS and poorer balance for other parameters. Knee flexor and extensor strength were assessed bilaterally with the Lafayette hand-held dynamometer.

RESULTS

The COPX during standing with eyes-closed was higher in women with KOA than controls and the LoS score was lower (p < 0.05, Cohens'd = 0.72 and 0.65). Postural stability was correlated with knee muscles strength and the flexor/extensor strength ratios in both groups (r = between 0.395 and 0.456 for LoS, r = between -0.335 and -0.639 for the others, p < 0.05).

CONCLUSIONS

Women with KOA had poorer postural stability in the mediolateral direction during standing with eyes-closed and a worse LoS score than controls. Postural stability was related to knee flexor and extensor strength and the flexor/extensor strength ratio in women.

Robotic-arm assisted versus manual total knee arthroplasty: Functional gait analysis from a randomised controlled trial

The primary aim of this study was to assess whether measures of functional gait assessment were improved with robotic total knee arthroplasty (rTKA) when compared to manual TKA (mTKA). Gait analysis was performed as part of a randomised controlled trial. Walking and relaxed standing assessments were performed using an instrumented mat system. Spatiotemporal variables included gait cycle parameters, anteroposterior and lateral sway, and plantar pressure ratios. Measurements were recorded at pre-operative baseline and 12 months post-operatively. 100 patients were randomised, 50 to each group. Complete gait cycle data were available for 26 rTKA and 23 mTKA patients. Cadence and walking velocity showed overall improvements following surgery, with no difference between the two groups. In the operated limb, overall step and stride times decreased, while step and stride lengths increased. Subgroup analysis showed reduced propulsion time with rTKA, and decreased foot flat and mid stance times with mTKA. Lateral sway was decreased in the rTKA group. Plantar pressure ratios showed an overall increase in hindfoot loading on the operated limb, with no difference between the two groups. No other significant differences were identified between rTKA and mTKA at 12 months, and limitations may include statistical error. A small sample of the study cohort was followed up; analysis may represent the results of satisfied patients with well-functioning TKA. Further study could incorporate proprioceptive and 3D gait analysis techniques to analyse knee kinetics and kinematics with robotic surgery. Pressure mapping could further subdivide the plantar surfaces to explore any nuances in differential loading.

Neuromuscular Responses and Perceptions of Health Status and Pain-Related Constructs in End-Stage Knee Osteoarthritis During Resistance Training With Blood Flow Restriction

ABSTRACT

Ogrezeanu, DC, López-Bueno, L, Sanchís-Sánchez, E, Carrasco, JJ, Cuenca-Martínez, F, Suso-Martí, L, López-Bueno, R, Cruz-Montecinos, C, Martinez-Valdes, E, Casaña, J, and Calatayud, J. Neuromuscular responses and perceptions of health status and pain-related constructs in end-stage knee osteoarthritis during resistance training with blood flow restriction. J Strength Cond Res 38(4): 762-772, 2024-We aimed to evaluate the neuromuscular responses and their relationship with health status, kinesiophobia, pain catastrophizing, and chronic pain self-efficacy in patients with end-stage knee osteoarthritis during acute resistance training with different levels of blood flow restriction (BFR). Seventeen patients with end-stage knee osteoarthritis participated in 3 experimental sessions separated by 3 days, performing 4 sets of knee extensions with low load and 3 levels of concurrent BFR performed in a random order: control (no BFR), BFR at 40% arterial occlusion pressure (AOP), and BFR at 80% AOP. Normalized root-mean-square (nRMS), nRMS spatial distribution (centroid displacement, modified entropy, and coefficient of variation), and normalized median frequency (nFmed) were calculated from the vastus medialis (VM) and lateralis (VL) using high-density surface electromyography. Subjects were asked to report adverse effects after the sessions. In the VM, nRMS was higher with 80% AOP than with 40% AOP ( p = 0.008) and control ( p < 0.001), whereas there were no differences between conditions in the VL. Normalized root-mean-square also showed an association with pain catastrophizing, chronic pain self-efficacy, and health status (VM: -0.50, 0.49, -0.42; VL: -0.39, 0.27, -0.33). Spatial distribution varied between conditions but mostly in the VL. Overall, nFmed did not vary, with only a slight increase in the VL with 40% AOP, between set 3 and 4. BFR during knee extensions at 80% AOP increases VM activity and VL amplitude distribution more than 40% AOP and control. Importantly, muscle activity increases are modulated by pain catastrophizing, chronic pain self-efficacy, and health status in these patients, and kinesiophobia seems to especially modulate entropy.

Individuals with knee osteoarthritis show few limitations in balance recovery responses after moderate gait perturbations

BACKGROUND

Knee osteoarthritis causes structural joint damage. The resultant symptoms can impair the ability to recover from unexpected gait perturbations. This study compared balance recovery responses to moderate gait perturbations between individuals with knee osteoarthritis and healthy individuals.

METHODS

Kinematic data of 35 individuals with end-stage knee osteoarthritis, and 32 healthy individuals in the same age range were obtained during perturbed walking on a treadmill at 1.0 m/s. Participants received anteroposterior (acceleration or deceleration) or mediolateral perturbations during the stance phase. Changes from baseline in margin of stability, step length, step time, and step width during the first two steps after perturbation were compared between groups using a linear regression model. Extrapolated center of mass excursion was descriptively analyzed.

FINDINGS

After all perturbation modes, extrapolated center of mass trajectories overlapped between individuals with knee osteoarthritis and healthy individuals. Participants predominantly responded to mediolateral perturbations by adjusting their step width, and to anteroposterior perturbations by adjusting step length and step time. None of the perturbation modes yielded between-group differences in changes in margin of stability and step width during the first two steps after perturbation. Small between-group differences were observed for step length (i.e. 2 cm) of the second step after mediolateral and anteroposterior perturbations, and for step time (i.e. 0.01-0.02 s) of first step after mediolateral perturbations and the second step after outward and belt acceleration perturbations.

INTERPRETATION

Despite considerable pain and damage to the knee joint, individuals with knee osteoarthritis showed comparable balance recovery responses after moderate gait perturbations to healthy participants.

Relationship Between Postural Stability and Proprioception, Pain, Quadriceps Strength, and Muscle Tightness in Athletes With Patellar Tendinopathy

BACKGROUND

Athletes with patellar tendinopathy (PT) have postural stability deficits; however, the underlying mechanisms and factors responsible remain unknown. The effect on postural stability in PT of decreased quadriceps strength, altered proprioception, lower-limb muscle tightness, and knee pain, which explain postural stability deficiency in other populations, is uninvestigated.

HYPOTHESIS

Proprioceptive acuity, muscle tightness, quadriceps strength, and pain predict postural stability in athletes with PT.

STUDY DESIGN

Cross-sectional comparative study.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 43 athletes with PT and 43 healthy athletes were enrolled. Static and dynamic postural stability, proprioceptive acuity, muscle tightness, quadriceps strength, and pain were evaluated using a force platform, Y-balance test (YBT), a weight discrimination protocol, a goniometer, an isometric dynamometer, and a valid questionnaire, respectively.

RESULTS

Athletes with PT had significantly worse static and dynamic postural stability in the affected limb (AL) compared with the nonaffected limb (NAL) (P < 0.01) and the control group (P < 0.01). Athletes suffering from PT revealed lower quadriceps strength (P < 0.01), proprioceptive acuity (P = 0.02), and higher muscle tightness in the AL compared with the NAL and controls. Quadriceps weakness of the AL and pain in athletes with PT explained the variance of dynamic postural stability impairment.

CONCLUSION

Athletes with PT have postural stability deficiency compared with healthy peers. Our results demonstrate that quadriceps muscle weakness and pain are the factors that explain postural stability impairment.

CLINICAL RELEVANCE

These results can assist clinicians in the design of therapeutic balance rehabilitation programs by acting not only on pain relief but also on quadriceps strengthening through resistance training to avoid subsequent injuries in athletes with PT.

Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study

Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.

Factors associated with meniscus volume in knees free of degenerative features

OBJECTIVES

To explore factors that were associated with meniscus volume in knees free of radiographic osteoarthritis (OA) features and symptoms of OA.

METHODS

In the third Rotterdam Study cohort, clinical, radiographic, and magnetic resonance data were obtained at baseline (BL) and after 5 years of follow-up. Meniscus volumes and their change over time were calculated after semi-automatic segmentation on Magnetic Resonance Imaging. Knees with radiographic OA features (Kellgren and Lawrence>0) or clinical diagnosis of OA (American College of Rheumatology) at BL were excluded. Ten OA risk factors were adjusted in the multivariable analysis (generalized estimating equations), treating two knees within subjects as repeated measurements.

RESULTS

From 1065 knees (570 subjects), the average (standard deviation) age and Body mass index (BMI) of included subjects were 54.3 (3.7) years and 26.5 (4.4) kg/m2. At BL, nine factors (varus alignment, higher BMI, meniscus pathologies, meniscus extrusion, cartilage lesions, injury, greater physical activity level, quadriceps muscle strength, and higher age) were significantly associated with greater meniscus volume. Five factors (injury, meniscus pathologies, meniscus extrusion, higher age, and change of BMI) were significantly associated with meniscus volume loss.

CONCLUSIONS

Modifiable factors (varus alignment, BMI, physical activity level, and quadriceps muscle strength) and non-modifiable factors (higher age, injury, meniscus pathologies, meniscus extrusion, and cartilage lesions) were all associated with meniscus volume or meniscus volume loss over time.

Quadriceps Strength, Postural Stability, and Pain Mediation in Bilateral Knee Osteoarthritis: A Comparative Analysis with Healthy Controls

Bilateral knee osteoarthritis (OA) poses significant challenges to individuals' functional abilities, including quadriceps strength, postural stability, and pain perception. Understanding the complex relationships among these factors is crucial for enhancing knee OA management strategies. The primary objective of this research is to evaluate and draw comparisons between the strength of the quadriceps and the level of postural stability in two distinct groups: individuals afflicted with bilateral knee OA and those who are healthy. Furthermore, the study seeks to examine the potential correlation between the strength of the quadriceps and the level of postural stability in individuals with knee OA. In addition to this, an investigation into the potential mediating effect of pain on the relationship between these physiological factors will also be conducted. A total of 95 participants with bilateral knee OA and 95 healthy controls were recruited. Quadriceps strength was assessed using dynamometry and postural stability was evaluated through anterior-posterior and medial-lateral sway measurements along with the ellipse area using a force plate. Pain levels were measured using the Visual Analog Scale (VAS). Mediation analysis was employed to explore the role of pain in mediating the relationship between quadriceps strength and postural stability. Statistical analyses included t-tests, Pearson correlation coefficients, and mediation analysis. Knee OA participants exhibited significantly lower quadriceps strength (1.08 Nm/kg ± 0.54) compared to controls (1.54 Nm/kg ± 0.57, p < 0.001). They also demonstrated compromised postural stability with increased anterior-posterior sway (9.86 mm ± 3.017 vs. 2.98 mm ± 1.12, p < 0.001), medial-lateral sway (7.87 mm ± 2.23 vs. 3.12 mm ± 1.34, p < 0.001), and larger ellipse area (935.75 mm2 ± 172.56 vs. 436.19 mm2 ± 135.48, p < 0.001). Negative correlations were observed between quadriceps strength and postural stability variables (r = from -0.43 to -0.51, p < 0.001). Pain significantly mediated the relationship between quadriceps strength and postural stability variables (p < 0.05). This study highlights the associations between quadriceps strength, postural stability, and pain mediation in individuals with bilateral knee OA. Our findings emphasize the need for targeted interventions addressing quadriceps weakness and compromised postural stability. Additionally, the mediation effect of pain underscores the complexity of these relationships, offering insights for more effective management strategies.

The efficacy of the leg swing and quadriceps strengthening exercises versus platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: A retrospective comparative study

The aim of this was to investigate the efficacy of physical exercise (leg swing and quadriceps strengthening exercises) versus platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy. From January 2020 to August 2021, 106 patients with Kellgren-Lawrence Grade I-III knee osteoarthritis were divided into leg swing and quadriceps strengthening exercises (Group A) and intra-articular combination injections of PRP and HA (Group B) according to the treatment strategies. Patients in Group A received regular leg swing and quadriceps strengthening exercises for 3 months. Patients in Group B received 2 intra-articular combination injections of PRP (2 mL) and HA (2 mL) every 2 weeks. The primary outcome measures were the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) score. Secondary outcomes included single leg stance test and functional activity by 2-minute walk test and time up and go test. All outcomes were evaluated at baseline and again 1, 3, 6, and 12 months. The VAS and WOMAC scores were similar in both groups at 1 and 3 months after treatment (P > .05); however, Group A patients had significantly superior VAS and WOMAC scores than Group B patients at 6 and 12 months after treatment. For the single leg stance test, 2-minute walk test, and time up and go test, Group A patients were significantly superior to Group B throughout follow-up (P < .001). The leg swing and quadriceps strengthening exercises resulted in a significantly better clinical outcomes than the combined PRP and HA therapy, with a sustained lower pain score and improved quality of life, balance ability, and functional activity within 12 months.

Evaluation of a preemptive intervention regimen with hesperidin methyl chalcone in delayed-onset muscle soreness in young adults: a randomized, double-blinded, and placebo-controlled trial study

PURPOSE

Delayed-onset muscle soreness (DOMS) describes an entity characterized by ultrastructural muscle damage. Hesperidin methyl chalcone (HMC) is a synthetic flavonoid presenting analgesic, anti-inflammatory, and antioxidant properties. We evaluated the effects of HMC upon DOMS.

METHOD

In a preventive paradigm, 31 sedentary young men were submitted to a randomized, double-blinded parallel trial and received HMC 500 mg or one placebo capsule × 3 days before an intense dynamic exercise protocol (concentric/eccentric actions) applied for lower limbs for inducing muscle damage. Assessments were conducted at baseline, and 24 and 48 h after, comprising physical performance, and post-muscle soreness and damage, inflammation, recovery of muscle strength, and postural balance associated with DOMS. HMC safety was also evaluated. Thirty participants completed the study.

RESULTS

HMC improved the performance of participants during exercise (40.3 vs 51.3 repetitions to failure, p = 0.0187) and inhibited CPK levels (90.5 vs 57.9 U/L, p = 0.0391) and muscle soreness during passive quadriceps palpation (2.6 vs 1.4 VAS cm, p = 0.0439), but not during active actions, nor did it inhibit IL-1β or IL-10 levels. HMC improved muscle strength recovery, and satisfactorily refined postural balance, without inducing injury to kidneys or liver.

CONCLUSIONS

Preemptive HMC supplementation may be beneficial for boosting physical performance and for the amelioration of clinical parameters related to DOMS, including pain on muscle palpation, increased blood CPK levels, and muscle strength and proprioceptive deficits, without causing adverse effects. These data advance the understanding of the benefits provided by HMC for DOMS treatment, which supports its usefulness for such purpose.

Effects of core strengthening on balance in patients with hip osteoarthritis: a randomised controlled trial

Osteoarthritis is a condition commonly present in the elderly, with many having altered balance, aggravated with weak lower limb and core musculature predisposing them to falls. Despite the knowledge about the link between balance and core stability, studies investigating the importance of core stability exercise and their impact on balance are limited. Therefore, the authors aimed to explore whether core strengthening exercises in combination with hip exercises, when compared to a hip exercise programme and a control group, led to better improvements in balance in patients with hip osteoarthritis. In order to meet these aims, this paper reports the outcomes of a randomized, three-arm parallel, assessor-blinded, controlled clinical trial. Fifty-one participants awaiting a total hip replacement were recruited into this study. All patients were randomly allocated to a control, hip exercise group and hip and core exercise group. All participants were assessed for core muscle strength using a pressure biofeedback unit and balance using the four-stage balance test. The control group had no intervention. A 12-week hip and core exercise programme did not result in improvements over and above the hip exercise group in balance scores. However an improvement in core stability was noted for the hip and core exercise group ( P  = 0.001). Therefore, this study concluded that both exercise groups are resulted in improved balance with the core and hip exercise group noted to have added improvements, but the difference between the groups was not statistically significant.

Association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis

Objectives

This study aimed to investigate the association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis (OA).

Patients and methods

The cross-sectional study was conducted with 39 individuals (24 females, 15 males; mean age: 57.3±6.2 years; range, 40 to 65 years) with knee OA between January 2014 and July 2015. Ankle torque was determined using an isokinetic dynamometer. The 40-m fast-paced walk test and a stair climb test were used to assess functional performance. Self-reported pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pearson's correlation coefficients were calculated to test correlations between the dependent variables (40-m fast-paced walk test, stair climb test, WOMAC pain and physical function domains, sex, age, body mass index, and radiologic evidence of OA) and the independent variables (mean plantar flexor torque and dorsiflexor peak torque). A multiple linear regression analysis was applied to quantify the association between the dependent and independent variables.

Results

Dorsiflexor and plantar flexor peak torques in the concentric and eccentric modes were negatively correlated with the 40-m fast-paced walk and stair climb tests (r=-0.33 to -0.51, p≤0.05). A negative correlation was found between concentric plantar flexor torque and the WOMAC physical function score (r=-0.35, p=0.03). No correlation was found between ankle torques and the WOMAC pain score (p>0.05). The multiple linear regression analysis showed that the eccentric plantar flexor and dorsiflexor torques were significantly associated with the stair climb test (β=-0.001, 95% confidence interval [CI]: -0.001 to 0.000, p=0.03, and β=-0.002, 95% CI: -0.004 to 0.000, p=0.05, respectively). No significant associations were found between concentric plantar flexor and dorsiflexor torques and the stair climb test (p>0.05). No significant associations were found between the ankle torques and the 40-m fast-paced walk test and WOMAC physical function (p>0.05).

Conclusion

Ankle torque plays an important role in functional performance. Thus, ankle torque deficit, especially eccentric plantar flexor and dorsiflexor torques, may exert a negative influence on stair climbing performance in patients with knee osteoarthritis.

High tibial osteotomy improves balance control in patients with knee osteoarthritis and a varus deformity

BACKGROUND

Impaired knee stability is observed in patients with medial compartment knee osteoarthritis (OA) and varus malalignment. Although high tibial osteotomy (HTO) is widely used to treat OA-related knee varus deformity, its long-term influence on balance control in OA patients is poorly reported. This study aimed to evaluate the impact of HTO on balance control and assess its biological and functional significance.

METHODS

Thirty-two patients with medial compartment knee OA as well as varus deformity who were scheduled for HTO underwent static posturographic tests one month pre- and three months as well as one year postoperatively, respectively, along with forty matched control subjects. Radiographic and clinical evaluations were synchronously carried out on patients pre- and postoperatively.

RESULTS

Decreased postural sway was observed in patients one year after HTO. When compared to the control subjects, more postural sway was found in patients one month pre- and three months postoperatively. No difference was observed between the patients and control subjects one year postoperatively. The alignment and joint function of the affected knees significantly improved after HTO.

CONCLUSIONS

This study revealed that HTO improves balance control in patients with knee OA and varus deformity. Correct alignment and improved joint function enhance the likelihood of normal postural stability. Hence, this intervention allows the knee joint to recover its corrective compensatory role in postural regulation and should be taken into account for managing knee OA patients.

The effects of exercise training on knee repositioning sense in people with knee osteoarthritis: a systematic review and meta-analysis of clinical trials

OBJECTIVE

Osteoarthritis (OA) of the knee is one of the most common global joint disorders, especially in aging population, and is among leading health-related concerns of societies. Therefore, this systematic review and meta-analysis was done to investigate the results related to the effects of exercise interventions on knee repositioning sense in patients with knee OA.

METHODS

An extensive search was independently performed in electronic databases including PubMed, MEDLINE, Web of Science, SCOPUS, and Google Scholar, to identify randomized clinical trials (RCTs) conducted on knee OA and to evaluate knee repositioning sense before and after different exercise interventions. After extracting relevant data from eligible studies, results of the studies were pooled using a random-effects model of meta-analysis. The Physiotherapy Evidence Database (PEDro) of clinical trials was used for quality assessment of eligible studies.

RESULTS

Among 2702 studies identified in the initial search, 17 studies were eligible for final systematic review and meta-analysis. The results showed that the patients who participated in different exercise interventions had significantly less knee repositioning error (mean differences: -1.141 degrees (95%CI: -1.510, -0.772, P < .001) compared to those who did not undergo exercise interventions. The eligible studies exhibited publication bias (Intercept: -6.69, P = .002), and the data showed significant heterogeneity (I2 = 85.633%, Q = 153.125, P < .001). Moreover, meta regression showed more prolonged exercise duration might have more effects on knee repositioning error (Coefficient=-0.860, 95% CI=-1.705, -0.016, Z=-2.00, P = .045).

CONCLUSION

There is strong evidence that exercise interventions may effectively reduce knee repositioning error. Moreover, it seems that more prolonged exercise duration may be associated with the greater effect size.

Effect of autogenous osteochondral mosaicplasty on the balance control of patients with cartilage defects of the knee: a pilot study

BACKGROUND

Autogenous osteochondral mosaicplasty (AOM) is a widely used optimal surgical technique for cartilage repair in young patients with focal articular cartilage defects. However, the alterations in balance control in these patients after AOM have not been sufficiently investigated. This study aimed to compare different balance control performances between the patients with knee cartilage defects and healthy controls before and after AOM, as well as evaluate the influence of AOM on balance control in these patients.

METHODS

Static posturographic tests were performed in twenty-four patients who were scheduled for AOM two weeks pre-, three months, and one year postoperatively, along with thirty matched controls, respectively. All participants underwent posturography under four standing conditions: eyes open and closed, without and with foam support to assess the balance control ability. Subsequently, patient-reported outcome measures (PROMs) were synchronously obtained and analyzed.

RESULTS

Compared to the control subjects, less efficient balance control was observed in study patients at three testing phases (p < 0.05), whereas no alterations in postural control were visible in these patients within a year following AOM (p > 0.05). Significant improvements were found in all PROMs such as the International Knee Documentation Committee, the Lysholm Knee Score, and the visual analogue scale in the study patients postoperatively (p < 0.01).

CONCLUSION

The results indicated that patients with knee cartilage defects have a prominent balance control deficit compared to healthy individuals. Furthermore, AOM does not improve balance control in these patients for at least one year postoperatively, and more effective approaches for postural regulation are required for the management of cartilage defect patients.

More Predictable and Less Automatized Movements during Walking -not during Repetitive Punching- in Knee Osteoarthritis

Using the non-affected leg as stable frame of reference for the affected leg in gait assessment in knee osteoarthritis (KO) fails due to compensatory mechanisms. Assessing the cyclical movements of the upper extremities in a frequency-controlled repetitive punching task may provide an alternative frame of reference in gait assessment in patients with KO. Eleven participants with unilateral KO and eleven healthy controls were asked to perform treadmill walking and repetitive punching. The KO group showed more predictable (p = 0.020) and less automatized (p = 0.007) movement behavior than controls during treadmill walking. During repetitive punching, the KO group showed a similar degree of predictability (p = 0.784) but relative more automatized movement behavior (p = 0.013). Thus, the predictability of the movement behavior of the upper extremities during repetitive punching seems unaffected by KO and could provide an alternative frame of reference in gait assessment in patients with KO.

Effect of Knee Orthosis and Kinesio Taping on Clinical and Neuromuscular Outcomes in Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Objectives

Impaired proprioception and muscle weakness may not only be a consequence of knee osteoarthritis (OA) but also part of its pathogenesis. Thus, the enhancement of quadriceps strength and proprioceptive accuracy can play a pivotal role in the management of knee OA. This study aimed to investigate the effects of Kinesio tape and flexible knee orthosis in terms of clinical and neuromuscular outcomes in patients with knee OA.

Methods

This clinical trial was conducted on 56 patients with knee OA, randomly allocated to two groups: knee orthosis or Kinesio tape. The knee orthosis group wore a neoprene knee support for 4 weeks. For participants in the Kinesio tape group, tape was applied once a week, for 4 weeks. The primary outcomes were pain intensity and physical function evaluated through the visual analog scale and the Western Ontario and McMaster OA index. The secondary outcomes were concentric and isometric quadriceps strength, Joint Position Sense (JPS), Threshold to Detect Passive Motion (TTDPM), and force sense (FS), all measured by isokinetic dynamometry.

Results

All outcome measures were significantly improved in the orthosis group. The Kinesio tape group also demonstrated significant changes in all outcome measures except three proprioception components namely JPS (70° target), FS, and TTDPM. At the end of the fourth week, there were no significant between-group differences for measured parameters.

Conclusion

Wearing a flexible knee orthosis and/or Kinesio tape for 4 weeks significantly improved knee pain, physical function, and quadriceps strength. Although knee orthosis showed significant beneficial effects on various components of proprioception, there were no significant differences between the two groups at the end of the 4-week intervention.

Test-retest reliability of isometric and isokinetic wrist strength

BACKGROUND

The isokinetic dynamometer has been considered the gold-standard measurement of muscle performance. However, the reliability for the isometric and isokinetic wrist flexor and extensor strength using the Biodex isokinetic dynamometer has not been reported to date. This study evaluated test-retest reliability of isometric and isokinetic wrist strength using the Biodex System 3 isokinetic dynamometer.

METHODS

This is a test-retest reliability study. Peak concentric and isometric torque was determined of the dominant limb wrist flexor and extensor of healthy individuals using the Biodex Multi-Joint System 3 dynamometer. The participants were evaluated by the same examiner in two different sessions separated by an interval of two to seven days. Reliability was investigated using the intraclass correlation coefficient (ICC_2,1), standard error of measurement (SEM) and minimum detectable difference (MDD).

RESULTS

Twenty healthy subjects participated in the study. The ICCs for concentric and isometric torque of the wrist flexor and extensor ranged from 0.79 to 0.91, revealing excellent intra-examiner test-retest reliability; SEM ranging from 0.4 to 1.5; and MDD ranged from 1.12 Nm to 4.17 Nm.

CONCLUSIONS

Excellent intra-examiner test-retest reliability was found regarding peak concentric toque of the wrist flexor and extensor at an angular velocity of 45°/s as well as isometric torque of the wrist flexor and extensor in healthy individuals measured using the Biodex System 3 isokinetic dynamometer.

Effects of traditional Chinese herb hot compress combined with therapeutic exercise on pain, proprioception, and functional performance among older adults with knee osteoarthritis: A randomized controlled trial

Background: Knee osteoarthritis (KOA) is one of the most common chronic progressive diseases with degenerative destruction of articular cartilage and bone, leading to knee pain, impaired proprioception, and reduced functional performance. This study was to investigate the effects of an 8-week Traditional Chinese herb hot compress (TCHHC) combined with therapeutic exercise (TE) on pain, proprioception, and functional performance among older adults with KOA. Methods: Twenty-seven older adults with KOA were recruited and randomly assigned to the TCHHC + TE or TE groups. Thirteen participants received TCHHC + TE, and fourteen received TE. At pre- (week 0) and post-intervention (week 9), their pain, joint proprioception, and functional performance were measured. Two-way ANOVA with repeated measures was adopted to analyze the data. Results: Compared with week 0, the pain score, proprioception thresholds of knee extension and ankle plantarflexion, and the times of TUG and 20-m walk tests decreased more significantly in the TCHHC + TE group than in the TE group at week 9. Conclusion: Compared with TE, the 8-week TCHHC + TE was superior in relieving pain, recovering proprioception, and improving functional performance among older adults with KOA. It is recommended that TCHHC should be adopted prior to TE to enhance the effects of KOA rehabilitation.

Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial

BACKGROUND

Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA.

METHODS

In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction.

RESULTS

Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study.

CONCLUSIONS

A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021.

NAME OF TRIAL REGISTRY

Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis.

LEVEL OF EVIDENCE

Therapeutic Level 1.

Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis

Background: The pathological mechanism of knee osteoarthritis (KOA) is unknown. KOA degeneration may be associated with changes in muscle strength, proprioception, biomechanics, and postural stability.

Objective: This study aimed to assess asymmetries in muscle strength, proprioception, biomechanics, and postural stability of bilateral lower limbs in patients with unilateral KOA and healthy controls and analyze correlations between KOA and these parameters.

Methods: A total of 50 patients with unilateral KOA (age range: 50-70) and 50 healthy subjects were recruited as study participants (age range: 50-70). Muscle strength, proprioception, femorotibial angle (FTA), femoral condylar–tibial plateau angle (FCTP), average trajectory error (ATE), and center of pressure (COP) sways areas were accessed in study participants, and the correlation between these variables was investigated.

Results: In patients with unilateral KOA, lower limb muscle strength was significantly lower on the symptomatic side than on the asymptomatic side (p < 0.01), while the proprioception (degree error), FTA, FCTP, and ATE were substantially higher compared to the asymptomatic side (p < 0.01). However, no significant difference was observed in the healthy controls (p > 0.05). Patients with unilateral KOA had lower muscle strength than healthy controls (p < 0.05), but their proprioception (degree error: the difference between the target and reproduction angles), ATE, and COP sway areas were higher (p < 0.05). Muscle strength was found to be negatively correlated with ATE and COP sways areas (p < 0.05), whereas proprioception (degree error) was positively correlated with ATE and COP sways areas (p < 0.05) in all study participants. However, no correlation was found between FTA, FCTP, and ATE, COP sways areas in patients with unilateral KOA (p > 0.05).

Conclusion: In patients with unilateral KOA, muscle strength, proprioception, biomechanics, and postural stability of bilateral limbs are asymmetrical in unilateral KOA patients. Muscle strength, proprioception, and postural stability are significantly associated variables, and changes in these variables should be considered in KOA prevention and rehabilitation.

Static and local dynamic stability of subjects with knee joint osteoarthritis

Stability is defined as the ability to control the amplitude and velocity of center of gravity (CoG) changes during quiet standing, and to decrease the risk of falling during walking. Few studies exist which examine the local dynamic stability of those with knee joint osteoarthritis (OA). Nevertheless, it is debatable whether the stability of OA subjects differs from that of normal subjects or not. The aim of this study was to evaluate the static and local dynamic stability of the subjects with knee OA in comparison to normal subjects. Fifteen OA subjects and 15 healthy subjects with matching age, weight, and gender participated in this study. A Qualysis motion analysis system incorporating a Kistler force plate was used to record data during quiet standing and when walking on a treadmill. Static stability was evaluated based on center of pressure (COP) sways excursion, path length and velocity in mediolateral and anteroposterior axes. Local dynamic stability was evaluated by the use of short Lyapunov exponent when subjects walk on treadmill. A two-sample test-test was used for the final analysis (α = 0.05). Mean values of the COP excursion in mediolateral and anteroposterior directions, and the velocity of COP in both mediolateral and anteroposterior directions, differed significantly between healthy and OA subjects ( p < 0.05). Local dynamic stability of OA subjects appeared to be reduced compared to healthy subjects, especially when ambulating at higher walking speeds ( p-value < 0.05). Study results demonstrated that both static and local dynamic stability decreased in OA subjects. This may be in part due to altered control mechanisms which are required for response to perturbations during standing and walking to ensure stability. As a decrease in local dynamic stability is correlated to an increased risk of falling, it is important that this group should receive appropriate treatment interventions to improve standing and walking stability.

The efficacy of balance and proprioception exercises in female patients with knee osteoarthritis: A randomized controlled study

OBJECTIVE

Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis.

DESIGN

A single-center randomized trial with three parallel arms.

SETTING

A tertiary health care facility in Turkey.

PARTICIPANTS

Female patients with knee osteoarthritis aged 40-70 years.

INTERVENTIONS

Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups.

MAIN MEASURES

Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score).

RESULTS

Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance - Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor.

CONCLUSIONS

Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.

Changes in postural control strategy during quiet standing in individuals with knee osteoarthritis

BACKGROUND

Knee osteoarthritis (OA) impairs postural control and may affect how the lower limb joints are used for postural control.

OBJECTIVE

To investigate how individuals with knee OA use lower limb joints for static postural control.

METHODS

Ten patients with knee OA and thirteen healthy controls performed quiet standing for 30 s. The standard deviation of the center of mass (COM) and lower limb joint motions in the anterior-posterior (AP) and medial-lateral (ML) planes were calculated from three-dimensional marker trajectories. Pearson's correlation analysis and independent t-tests were conducted to investigate the relationship between COM and lower limb joint motion and to compare group difference, respectively.

RESULTS

The AP hip angular velocity alone in the knee OA group and the AP hip and knee angular velocity in the control group were significantly correlated with the AP COM velocity. The ML hip angular velocity was significantly correlated with the ML COM velocity in both groups. The knee OA group exhibited a significantly larger standard deviation of AP COM velocity than the control group.

CONCLUSIONS

Individuals with knee OA depended solely on the contribution of the hip to the AP COM velocity, which could not be successfully controlled by the knee.

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence

Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.

The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis

BACKGROUND

Giving way and knee instability are common problems in patients with knee osteoarthritis, disrupting the daily activities and balance of the affected individual. The present study aimed to evaluate the postural control status of women with knee osteoarthritis with and without self-report knee instability (KI).

METHODS

This cross-sectional, single-blind study was conducted on 57 female patients with knee osteoarthritis. The patients were selected based on the inclusion and exclusion criteria and divided into two groups of with KI (n = 26) and without KI (n = 31). Fear of movement was assessed using the Tampa questionnaire, the degree of knee instability was measured based on the Fitzgard scale, the static and dynamic balance of the subjects were evaluated with open and closed eyes using a Biodex balance device, and foot pressure distribution situation was measured using a FDM-S-Zebris device.

RESULTS

Mean comparison showed a significant difference between the subjects with and without KI in static balance only in anterior-posterior direction with open eyes (p = 0.01) and closed eyes (p = 0.0001). In the dynamic balance test, the subjects in both groups had significant differences in terms of all the indicators of anterior-posterior stability (p = 0.001), medial-lateral stability (p = 0.0001), and overall stability (p = 0.0001) with closed eyes. However, no significant difference was observed with open eyes (p > 0.05). Multiple regression also indicated significant positive correlations between pain intensity and disease duration with the degree of KI (p < 0.05).

CONCLUSIONS

According to the results, there were significant differences between the mean pain scores, static and dynamic balance, and the rate of fall between the women with knee osteoarthritis with and without the KI index. Therefore, patients with knee osteoarthritis, which also has an index of KI, are more susceptible to falls, and proper strategies are required to reduce the level of KI in these patients.

Patellar tendinopathy impairs postural control in athletes: A case-control study

OBJECTIVE

To compare postural control performance between athletes with and without patellar tendinopathy (PT).

DESIGN

Case-control study.

PARTICIPANTS

Fifty-eight athletes, 29 with PT (PT group: PTG) and 29 healthy ones (control group: CG).

MAIN OUTCOME MEASURES

Static and dynamic postural control were assessed with a force platform and the Y-Balance Test (Y-BT), respectively. Quadriceps strength of both limbs was evaluated using an isometric dynamometer.

RESULTS

The PTG exhibited significantly (p < 0.05) higher centre of pressure (CoP) values than the CG on the foam surface, and significantly lower (p < 0.001) anterior, posteromedial and posterolateral normalized reach distances, and composite score in dynamic postural control on the injured limb (IL) compared to non-injured limb (NIL) and dominant limb (DL) of the CG. The quadriceps muscle strength was significantly lower on the IL compared to the NIL (p < 0.01) and DL (p < 0.05) of the CG.

CONCLUSION

Athletes suffering from PT exhibited worse static and dynamic postural control compared to healthy peers. As players with PT frequently continue training despite their tendon pain, physiotherapists and clinicians should incorporate balance rehabilitation programs in the treatment of these players, not only to prevent further potential injuries but also to enhance sport performance.

Could emotional and sensitization status affect postural sway in adults with knee osteoarthritis?

BACKGROUND AND PURPOSE

The manipulation of sensory conditions and attentional demand affect the postural sway in older adults with knee osteoarthritis (KOA). However, it is not known if emotional and sensitization status affects postural sway in this population. This study aimed to test if older adults with mild and moderate knee osteoarthritis with symptoms of depression and high sensitization would change the profile of postural sway.

METHODS

Design: A cross-sectional study was undertaken.

PARTICIPANTS

The center of pressure parameters of 30 older adults with mild and moderate knee osteoarthritis and 15 healthy controls were evaluated under different conditions manipulating the visual and attentional demand. We used the pressure pain threshold to measure the sensitization status. Furthermore, we applied the Beck Depression Inventory index to assess emotional status.

RESULTS

Manipulating the visual demand affected the center of pressure parameters for both groups, without differences between them. Compared to the healthy control group, the knee osteoarthritis group presented with worse scores on the Beck Depression Inventory, lower pressure pain threshold scores, and the correlations between the symptoms of depression and sensitization status ranged from weak to moderate. Finally, in the knee osteoarthritis group, we observed few and weak significant associations between the center of pressure parameters and the Beck Depression Inventory and the pressure pain threshold scores.

DISCUSSION

Emotional and sensitization status seem not to be more associated with the center of pressure of older adults with mild to moderate KOA than healthy adults. Thus, it suggests that this population can safely maintain postural sway, irrespective of depression symptoms and high sensitization.

Athletes with unilateral patellar tendinopathy have increased subsequent lower extremity musculoskeletal injury risk

This study aimed to investigate static and dynamic postural balance inter-limb asymmetries in athletes with unilateral patellar tendinopathy (UPT) and estimate subsequent lower extremity musculoskeletal injury risk compared to controls. Twenty-eight athletes with UPT were recruited. Twenty-eight healthy athletes served as controls. Static postural balance inter-limb asymmetry (symmetry index: SI) was assessed based on differences in the mean centre of pressure (CoP) velocity (CoP_v) values between the affected leg (AL) and non-affected leg (NAL) for the UPT group, and the dominant leg (DL) and non-dominant leg (NDL) for controls. Outcome variables were dynamic postural balance, assessed with inter-limb asymmetry using the Y Balance Test (YBT), and injury risk. In static balance, SI values were significantly (P<0.001) higher in the UPT group compared to controls. In dynamic balance, normalized inter-limb asymmetry values were also significantly higher in athletes with UPT compared to controls in anterior (P<0.001), posteromedial (P<0.001) and posterolateral (P<0.01) directions, and in the composite score (P<0.001). Furthermore, the incidence of sustaining a non-contact lower extremity injury during the follow-up period (10 months) was significantly higher (P<0.05) in the UPT group compared to controls. Athletes with UPT had postural balance inter-limb asymmetries. Moreover, they had increased subsequent lower extremity musculoskeletal injury risk compared to controls. Since most athletes with UPT continue to train and compete, adequate training and rehabilitation programmes should be implemented to prevent potential subsequent injury occurrence.

Association between hip and knee osteoarthritis with falls: A systematic review and meta-analysis

OBJECTIVE

To examine the association between hip and knee osteoarthritis (OA) and falls. Potentially relevant articles that examine the association between hip, knee, radiological, and self-reported OA and falls were retrieved from PubMed, EMBASE, Scopus, and Web of Science up until March of 2020.

METHODS

The pooled risk ratios (RRs) as well as their related 95% confidence intervals (CIs) were calculated. Statistic and subgroup analyses were performed. A total of 21 studies involving 146 965 participants were included.

RESULTS

No association was found between hip OA and falls. The pooled RRs value suggested a higher prevalence of falls in knee OA patients (RR = 1.35, 95% CI: 1.20 to 1.51, P < .00001) and self-reported OA (RR = 1.33, 95% CI: 1.23 to 1.45, P < .00001) than in non-OA subjects. The pooled RR value suggested no difference between prevalence of falls in radiological OA patients compared to non-OA subjects (RR = 1.82, 95% CI: 0.89 to 3.73, P = .10). Both radiological and self-reported knee OA seem to be positively associated with falls, while no obvious association was found between hip OA and falls.

CONCLUSIONS

Therefore, knee OA is a risk factor for falls which should be closely monitored.

Functional outcomes and physical performance of knee osteoarthritis patients after ultrasound-guided genicular nerve radiofrequency ablation

OBJECTIVE

To elucidate the effectiveness of ultrasound-guided genicular nerve radiofrequency ablation in alleviating pain as well as its effects on functional outcomes, quality of life and physical performance in knee osteoarthritis patients.

DESIGN

Prospective observational study.

SETTING

Patients were recruited within one community hospital.

SUBJECTS

Patients with knee osteoarthritis.

METHODS

The subjects underwent ultrasound-guided radiofrequency ablation of genicular nerves after showing a positive response to a diagnostic block. Outcome assessments were performed at baseline and at 2 and 12 weeks posttreatments using the 36-item Short Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a physical performance evaluation including balance tests, quadriceps muscle strength test, two-minute walking test and knee joint proprioception test.

RESULTS

Thirteen out of 38 patients were eligible for genicular nerve radiofrequency ablation. There were significant improvements from baseline to posttreatment in the numeric rating scale score, physical health domain score of SF-36, and pain and stiffness domain scores of the WOMAC. Regarding physical performance, the step test result significantly improved over the 12 weeks of follow-up. On the other hand, no significant deteriorations in the single leg stance test, isokinetic quadriceps muscle strength test, knee joint proprioception test or two-minute walking test results were observed after radiofrequency ablation of genicular nerves.

CONCLUSIONS

Radiofrequency ablation of genicular nerves may significantly alleviate pain and improve functional outcomes in knee osteoarthritis patients. More importantly, static balance control and quadriceps muscle strength were preserved and there was a change of proprioception in the good direction.

Novel assessment of leukocyte-rich platelet-rich plasma on functional and patient-reported outcomes in knee osteoarthritis: a pilot study

Background: Leukocyte-rich platelet-rich plasma (LR-PRP) has demonstrated to be beneficial for patients with knee osteoarthritis (KOA); however, reliable objective end points to accurately assess its therapeutic effects is lacking. Aim: To investigate the efficacy of LR-PRP as assessed by functional and patient-reported outcomes at early time points (6 weeks). Materials & methods: We conducted a prospective cohort study in 12 patients with diagnosed KOA (Kellgren Lawrence score of II-III), who underwent a single ultrasound-guided LR-PRP injection. Results: There was significant improvement in timed up and go, pain and quality of life scales and balance parameters. There were nonsignificant improvements in range of motion and gait parameters. Conclusion: LR-PRP demonstrates efficacy in meaningful end points for functional and patient-reported outcomes at early time points in patients with KOA.

Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study

BACKGROUND

Exergaming (exercise and gaming) is useful in improving balance in various health conditions, yet there is limited research regarding its application in individuals with knee osteoarthritis (OA).

OBJECTIVES

The primary aim of this study was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA.

METHODS

A mixed-methods explanatory sequential study design was utilized in this study. Participants with knee OA and history of falling participated in a single-group pre-post experimental study design: eight weeks of usual care followed by eight weeks of an exergaming program. This was followed by semi-structured focus groups to determine the acceptability of the study.

RESULTS

The pre-defined feasibility criteria such as recruitment, retention rate (83%), and compliance (78%) were successfully met. The participants found the frequency and duration of the assessment and intervention sessions acceptable. Participants reported enjoying the exergaming, finding it motivating and interactive despite some barriers with technology. No adverse events were reported. There were encouraging results in the clinical outcome measures such as knee muscle strength, balance, fear of falling, and performance of physical function.

CONCLUSION

The study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. Findings from this feasibility study are encouraging and support the need to conduct a fully powered randomized controlled trial study.

Efficacy and Safety of a Single Intra-articular Injection of Platelet-rich Plasma on Pain and Physical Function in Patients With Ankle Osteoarthritis-A Prospective Study

Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. The aim was to evaluate the efficacy and safety of a single intraarticular injection of platelet-rich plasma (PRP) for patients with ankle OA. In a prospective study done in a university-affiliated tertiary care medical center, 44 patients with symptomatic ankle OA for at least 6 months were recruited. Patients received a single injection of PRP (3 mL) into symptomatic ankles. The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0-10 cm) at 6 months. Secondary outcomes included the Ankle Osteoarthritis Scale (AOS) score, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, single-leg stance test (SLS), rescue analgesics consumption and patient satisfaction. Thirty-nine participants (88.64%) completed the study. Significantly improvement in the VAS and AOS was noted at 1-, 3-, and 6-month follow-ups (p < .001). The mean VAS pain decreased significantly from 4.1 ± 1.7 at baseline to 2.2 ± 1.9, 1.7 ± 1.5, and 1.8 ± 1.6 at 1, 3, and 6 months (p < .001). The mean total AOS score reduced by 1.5, 2.2, and 2.1 from baseline respectively postinjection (p < .001). The mean AOFAS hindfoot-ankle score improved from 80.3 points at baseline to 87.2, 91.6, and 89.7 points at 1, 3, and 6 months (p < .001). SLS tests improved significantly (p < .001) at each follow-up. Acetaminophen consumption dropped significantly (p < .001) and no serious adverse events occurred. The study showed promise for a single intraarticular injection of PRP in the treatment of ankle OA.

Impaired muscle capacity of the hip and knee in individuals with isolated patellofemoral osteoarthritis: a cross-sectional study

AIMS

The aims of this study were to compare the capacity of the knee and hip muscles between individuals with and without isolated patellofemoral osteoarthritis (PFOA) and to evaluate the impact of PFOA on pain, stiffness, and physical function.

METHODS

This cross-sectional study evaluated muscle capacity of the hip and knee using an isokinetic dynamometer. The isokinetic variables used in the statistical analysis were peak torque, total work, and average power. Pain, stiffness, and physical function were assessed using questionnaires.

RESULTS

A total of 26 individuals participated in the study (13 with PFOA and 13 controls). The PFOA group exhibited lower peak torque, total work, and average power for knee extension and flexion in the concentric mode (p ⩽ 0.01) as well as lower peak torque and total work for knee extension (p ⩽ 0.005) and lower total work for knee flexion (p = 0.05) in the eccentric mode. The PFOA group exhibited lower peak torque of the extensor, abductor, adductor, and internal rotator muscles of the hip (p ⩽ 0.05), less total work of the abductor and adductor muscles (p ⩽ 0.04), and lower average power of eccentric adduction of the hip (p = 0.01) compared with the healthy controls. Compared with the control group, the PFOA group had a higher level of pain, stiffness, and compromised physical functioning self-reported (p ⩽ 0.005).

CONCLUSION

Participants with PFOA exhibited impairments regarding muscle capacity of the hip and knee, higher level of pain and stiffness as well as compromised physical functioning in comparison with healthy controls.

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective

Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients.

Methods

Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm²)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention.

Results

The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline (P < 0.05). Moreover, after 4-week intervention, the SA [(610.50 ± 464.26) mm² vs. (538.69 ± 420.52) mm²], NRS [(1.56 ± 0.63) vs. (2.25 ± 0.86)], and WOMAC [(11.69 ± 2.50) vs. (16.19 ± 3.94)] showed a significantly greater decrease in the BG compared to the CG (P < 0.05, respectively). However, the proprioception (ATE and CT) was closely similar between both groups at week 4 (P > 0.05).

Conclusion

BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA.

The Effect of Patellar Height by Using Insall Salvati Index on Pain, Function, Muscle Strength and Postural Stability in Patients with Primary Knee Osteoarthritis

PURPOSE

The Insall-Salvati Index (ISI) is the ratio of the patellar tendon length to the length of the patella. This ratio is the most commonly used method for evaluating patellar placement and patellofemoral imbalance. The position of the patella is important for the knee joint function and also for biomechanics. The abnormal position of the patella may lead to patellofemoral malalignment and instability. Herein, we aimed to analyze the relationship between the ISI and pain, physical function, muscle strength, fall risk, and postural stability in patients with primary knee osteoarthritis (OA).

METHODS

Sixty-two symptomatic knees of 45 patients (aged between 40 -75 years) who were suffering from the primary knee OA according to the American College of Rheumatology criteria were included retrospectively in the study. Patients with stages II and III osteoarthritis according to the Kellgren-Lawrence (K/L) radiological grading system were included. The ISI was measured on the lateral knee radiograph in a 30° flexed posture. Visual Analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Lequesne indexes were recorded for evaluating pain and function. Tetrax Interactive Balance System was used to assess fall risk and postural stability. Isokinetic muscle strength measurements of quadriceps and hamstrings were recorded at the constant angular velocities of 60 and 180°/sec.

RESULTS

The mean age of the study population was 58.52 ±8.01 years. The frequency of the patellar situation types was as follows; patella alta; 15 (24.2%), patella baja; n=2(3.2%), and normal patellar height; n=45(72.6%). The mean ISI was 1.19 ±0.17 on the right side and 1.18±0.16 on the left side. There was no significant correlation between the ISI and VAS, WOMAC and Lequesne indexes, postural stability scores, and isokinetic measurements (r<0.3, p>0.05).

CONCLUSION

In primary knee OA, the ISI may not have an effect on pain, physical function, fall risk, postural stability, and isokinetic muscle strength.

CLINICAL TRIAL REGISTRATION NUMBER

KA18/170.

Time-of-day effects on the postural control and symptoms in women with rheumatoid arthritis

The present study was designed to assess time-of-day effects on postural balance and symptoms of rheumatoid arthritis (RA) patients. A total of 15 American College of Rheumatology functional class I and II RA patients and 15 healthy controls aged between 45 and 55 (mean age: 50 ± 3) years of age voluntarily participated. We conducted a case-control, repeated-measures in design study. Postural balance, axillary temperature, pain intensity, fatigue, and sleepiness were measured during five test sessions at 06:00, 10:00, 14:00, 18:00, and 22:00 h. Participants were randomized to the order of test sessions, and each session was separated by >36 hours to minimize/eliminate learning effects. Center of pressure area (CoP_area) (p < .001), pain (p < .01), and sleepiness (p < .05) values were significantly higher at 06:00 and 22:00 h compared to 10:00, 14:00, and 18:00 h in the RA group. Fatigue significantly increased (p < .05) at 22:00 h in comparison to 10:00, 14:00, and 18:00 h in the RA group. Axillary temperature was significantly (p < .001) lower at 06:00 and at 22:00 h compared to 10:00, 14:00, and 18:00 h in the RA group. In the control group, there were no significant time-of-day difference in fatigue, but axillary temperature was significantly lower (p < .01) at 06:00 h compared to 10:00 h, 14:00, 18:00, and 22:00 h, sleepiness values were significantly higher (p < .05) at 06:00 and 22:00 h compared to 10:00, 14:00, and 18:00 h, and revealed CoP_area values were significantly (p < .05) higher at 06:00 h compared to 14:00 h. Finally, in the RA group, significant correlations were found between values of CoP_area and pain (r = 0.47; p < .001), sleepiness (r = 0.39; p < .01), fatigue (r = -0.46; p < .001), and also axillary temperature (r = -0.35; p < .001). Multiple linear regression analysis further indicated that in the RA group, time-of-day variation in postural balance was predicted collectively by that in pain and fatigue (30.7%) (R2 = 0.307; F = 11.53; p < .001). Our results first suggest that time-of-day significantly affects postural balance, axillary temperature, pain intensity, fatigue, and sleepiness in RA patients and second that the temporal variation observed in pain, fatigue, and somnolence are concomitant with that observed in postural balance.Abbreviations: RA: Rheumatoid arthritis; H&O questionnaire: Horne and Ostberg questionnaire; PSQI: Pittsburgh sleep quality index; HAQ: Health assessment questionnaire; SF-36: the short form-36; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; CoP: The Center of foot Pressure; CoP_area: The Center of foot Pressure area; VAS: The Visual Analogue Scale; KSS: Karolinska Sleepiness Scale.

Effects of Typical Athletic Shoes on Postural Balance According to Foot Type

BACKGROUND

The effects of shoes and foot type on balance are unclear. We aimed to investigate the differences between static and dynamic balance among three foot types and the changes in postural balance while wearing typical athletic shoes.

METHODS

Based on the Foot Posture Index, the feet of 39 participants were classified as pronated, neutral, or supinated by a physiatrist. Static and dynamic balance function were assessed by center of gravity (COG) sway velocity with eyes open and eyes closed and a modified Star Excursion Balance Test in a random order with participants either barefoot or wearing shoes.

RESULTS

The COG sway velocity was significantly higher in the supinated foot group than in the neutral foot group (barefoot: eyes open, P = .004, eyes closed, P = .001). Normalized composite reach distance (NCRD) was significantly lower in the pronated and supinated foot groups (barefoot: P = .039, P = .008; shoes: P = .018, P = .018). In all three foot type groups, COG sway velocity was significantly decreased (P < .05) and NCRD was significantly increased (P < .05) while wearing typical athletic shoes.

CONCLUSIONS

The medial longitudinal arch of the foot affects postural balance. Typical athletic shoes improve postural balance regardless of foot type. However, the pronated and supinated foot groups still had lower dynamic postural balance compared with the neutral foot group, even when wearing athletic shoes. People with pronated and supinated feet may need additional interventions, such as foot orthoses or balance training.

Knee Extensor Muscle Strength Is More Important Than Postural Balance for Stair-Climbing Ability in Elderly Patients with Severe Knee Osteoarthritis

Knee osteoarthritis is a chronic joint disease which damages articular cartilage. In its severe stages, it results in impairments in balance and muscle strength loss, which affect daily life activities such as walking or climbing stairs. This study sought to investigate associated factors with stair-climbing ability in this population, with special interest in measuring the relevance of postural balance for this task. Forty-four patients scheduled to undergo unilateral total knee arthroplasty were assessed. Timed up and go test, stair ascent–descent test, three different isometric strength tests (knee flexion, knee extension and hip abduction), active knee extension and flexion range of movement and static postural balance assessment were evaluated. Spearman’s correlation coefficients and multiple linear regression analysis determined the strength of association between the different variables and stair-climbing time. No significant association between the stair-climbing time and static balance was found. Significant associations were found between stair-climbing time and timed up and go (r = 0.71; p < 0.0001) and maximal knee extensor strength (r = –0.52; p = 0.0003). One-year increase in age was associated with 0.15 s (95% CI 0.00 to 0.30) slower stair-climbing time. In conclusion, muscle strength is more important than postural balance for stair-climbing ability in this population.

Comparison of proprioception between osteoarthritic and age-matched unaffected knees: a systematic review and meta-analysis

PURPOSE

Theoretically, proprioceptive acuity could decrease in patients with knee osteoarthritis. However, there have been conflicting results in terms of proprioceptive deficit in osteoarthritic knees. The purpose of this systematic review and meta-analysis was to compare knee proprioception between osteoarthritic and healthy control knees.

METHODS

Studies comparing proprioception in osteoarthritic and healthy knees of age-matched control group using thresholds to detect passive motion (TTDPM) or joint position sense (JPS) tests were identified. JPS was assessed by measuring the reproduction of passive positioning (RPP) or active positioning (RAP) of the knees.

RESULTS

Seventeen studies were finally included in this meta-analysis. The pooled results of the analyses of the TTDPM for both 30° and 45° knee flexion showed that the mean angle of error was 0.83° greater (95% confidence interval: 0.44 to 1.23°; p < 0.001) in the osteoarthritic knees than in control knees. The pooled data of the RAP and RPP also showed that the mean angle of error was 1.89° greater in the osteoarthritic knees than in the control group. The mean difference in the angle of error between the osteoarthritic knees and control group was 1.06° greater in the JPS test than in the TTDPM (p < 0.001).

CONCLUSION

The knee proprioceptive acuity of the patients with knee osteoarthritis was poorer than that of the patients with unaffected knees in the age-matched control group both in terms of the TTDPM and JPS; clinical relevance of these deficits needs to be clarified in further studies.

LEVEL OF EVIDENCE

Meta-analysis, Level II.

Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis

Intraarticular hyaluronan or platelet-rich plasma (PRP) is widely used in the treatment of knee osteoarthritis (OA). The efficacy of combined hyaluronan with PRP remained inconclusive. This study aimed to investigate the efficacy of combined a single crosslinked hyaluronan (HYAJOINT Plus) and a single PRP versus a single PRP in patients with knee OA. In a prospective randomized-controlled trial, 85 patients with knee OA (Kellgren-Lawrence 2) were randomized to receive a single intraarticular injection of HYAJOINT Plus (3 ml, 20 mg/ml) followed by 3 ml PRP (the combined-injection group, N = 43) or a single injection of 3 ml PRP (the one-injection group, N = 42). The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0–00 mm) at 6 months. Secondary outcomes included The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert Scale), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patient satisfaction at 1, 3 and 6 months. Seventy-eight patients were available for the intention-to-treat analysis at 6 months. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at each follow-up visit (p < 0.001). Patients receiving a single PRP experienced significantly greater improvements in VAS pain than patients receiving combined injections at 1-month follow-up (adjusted mean difference: − 5.6; p = 0.017). There were no significant between-group differences in several of the second outcomes at each follow-up visit, except the WOMAC-pain and WOMAC-stiffness scores favoring the one-injection group at 1 month (p = 0.025 and p = 0.011). However, at 6-month follow-up, the combined-injection group achieved significantly better VAS pain reduction (p = 0.020). No serious adverse events occurred following injections. In conclusion, either combined injections of HYAJOINT Plus and PRP or a single PRP alone was safe and effective for 6 months in patients with Kellgren-Lawrence 2 knee OA. Combined injections of HYAJOINT Plus and PRP achieved better VAS pain reduction than a single PRP at 6 months. The results indicating a long term benefit effect of a combination of HYAJOINT Plus and PRP in a particular subset of patients with moderate knee OA need to be replicated in larger trials.

ClinicalTrials.gov number NCT04315103.

Voluntary step execution in patients with knee osteoarthritis: Symptomatic vs. non-symptomatic legs

BACKGROUND

Individuals with osteoarthritis fall at a greater rate than the general population, likely as a result of weakness, pain, movement limitations, and a decline in balance. Due to the high prevalence of osteoarthritis in the population, understanding the mechanisms leading to greater fall risk is an important issue to better understand.

RESEARCH QUESTION

What is the influence of unilateral knee osteoarthritis on the characteristics of performing a voluntary step (i.e., similar to that performed to avoid a fall after a perturbation), compared to healthy age-matched controls?

METHODS

Case-control study performed in a Health maintenance organization physical therapy clinic. The research group consisted of a referred sample of 21 patients with unilateral knee osteoarthritis. The control group consisted of 22 age-matched healthy individuals. All participants were over 65 years of age. Participants were excluded if they had a surgical procedure to back or lower limb within one year before testing, oncological or neurological disease or a deficit in tactile sense. Movements were performed with and without dual tasking.

MEASUREMENTS

Duration of the initiation phase (cue to step initiation), preparatory phase (step initiation to foot off) and swing phase (foot off to foot contact).

RESULTS

In the preparatory phase and swing phase, the osteoarthritis group moved more slowly than the control group, and these differences were larger for forward compared to backward movements. Dual-tasking slowed responses in the pre-movement initiation stage across groups.

SIGNIFICANCE

The differences in basic parameters, and the slower movements in the osteoarthritis group, are consistent with known features of osteoarthritis, being a disease commonly regarded as primarily "mechanical", and are likely to increase fall risk. These response deficits suggest we should take advantage of advanced rehabilitation techniques, including cognitive loading, to help prevent falls in older adults with osteoarthritis.

A systematic review and meta-analysis of fall incidence and risk factors in elderly patients after total joint arthroplasty

BACKGROUND

Falls in the elderly have become a serious social problem worldwide. Approximately a third of persons fall at least once in the year after total joint arthroplasty (TJA), but preventing and treating falls is still challenging in clinical practice. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of falls after TJA. The present study aimed to quantitatively and comprehensively conclude the risk factors of falls after TJA in elderly patients.

METHODS

The electronic databases to be searched include CNKI, Embase, Medline, and Cochrane central database (all up to November 2018). All studies on the risk factors of falls after TJA in elderly patients without language restriction were reviewed. Process of evaluation of identified studies and extraction of data were independently conducted by 2 reviewers, qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis completed. All analyses were performed by the software Stata 11.0.

RESULTS

A total of 14 studies were included, which altogether included 1284456 patients with TJA, of them 12879 cases of falls occurred after surgery, suggesting the accumulated incidence of 13.1% and the prevalence of in-hospital falls was 1.0%. This study has provided evidence for the preventing of falls in the elderly patients who were underwent TJA. Outcome measures include advanced age, female, Overweight (BMI≥25 kg/m), falls history, use of walking aid, diabetes, cardiac disease, hypertension, COPD and depressive symptoms. The ABC Scale was significantly negatively correlated with falls after lower extremity joint replacement.

CONCLUSIONS

Related prophylaxis strategies should be implemented in elderly patients involved with above-mentioned risk factors to prevent falls after TJA.

Postural sway changes in genu recurvatum deformity during standing with manipulation of visual and proprioceptive systems

OBJECTIVES

Genu recurvatum deformity shifts the mechanical axis of lower extremity posteriorly which may disturb the balance and lead to injury. The aim of this research was to compare postural sways in genu recurvatum subjects with healthy controls while manipulating visual and proprioceptive systems.

METHODS

10 female subjects with genu recurvatum (20.04 ± 4.64 years) and 11 female healthy controls (20.11 ± 4.64 years) participated in the study. The back knee angle was measured using a goniometer. Dynamic BIODEX balance system was used to measure the total, anteroposterior, and mediolateral postural sways while manipulating the stability of the base of support (stable versus unstable) and visual system (open versus closed eyes).

RESULT

During standing on the stable level, in both visual conditions, genu recurvatum subjects demonstrated greater total and anteroposterior postural sways than controls in both standing on the right and left foot (p<0.05). Similarly, when standing on the unstable base of support, in all conditions, the postural sways of genu recurvatum subjects were significantly greater than controls in both right and left foot (p<0.05). The vision had a main effect on postural control of genu recurvatum group (p=0.0001). There was a significant interaction between vision, the stability of the base of support and group factors (p=0.003).

CONCLUSION

The results indicated that genu recurvatum subjects have a proprioceptive deficiency and they mainly rely on visual system inputs to control and maintain their balance. Thus, the proprioceptive system and balance control should be considered in assessment and designing an appropriate treatment regimen for genu recurvatum.