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Lopes HS, Waiteman MC, Priore LB, Glaviano NR, Bazett-Jones DM, Briani RV, Azevedo FM. There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:521-536. [PMID: 37669706 PMCID: PMC11184318 DOI: 10.1016/j.jshs.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. METHODS Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created. RESULTS Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders. CONCLUSION Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.
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Affiliation(s)
- Helder S Lopes
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil.
| | - Marina C Waiteman
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Liliam B Priore
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT 06269, USA
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH 43606, USA
| | - Ronaldo V Briani
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Fábio M Azevedo
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
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Ucurum SG, Kirmizi M, Umay Altas E, Ozer Kaya D. Postural stability and its relation to knee flexor/extensor strength ratio in women with mild to moderate unilateral knee osteoarthritis: a case-control study. Somatosens Mot Res 2024; 41:69-76. [PMID: 36740748 DOI: 10.1080/08990220.2023.2175809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Sevtap Gunay Ucurum
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Katip Celebi University, Izmir, Turkey
| | - Muge Kirmizi
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Katip Celebi University, Izmir, Turkey
| | - Elif Umay Altas
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bakircay University, Izmir, Turkey
| | - Derya Ozer Kaya
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Katip Celebi University, Izmir, Turkey
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Schaefer LV, Dech S, Carnarius F, Rönnert F, Bittmann FN, Becker R. Adaptive Force of hamstring muscles is reduced in patients with knee osteoarthritis compared to asymptomatic controls. BMC Musculoskelet Disord 2024; 25:34. [PMID: 38178020 PMCID: PMC10768123 DOI: 10.1186/s12891-023-07133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Quadriceps strength deficits are known for patients with knee osteoarthritis (OA), whereas findings on hamstrings are less clear. The Adaptive Force (AF) as a special neuromuscular function has never been investigated in OA before. The maximal adaptive holding capacity (max. isometric AF; AFisomax) has been considered to be especially vulnerable to disruptive stimuli (e.g., nociception). It was hypothesized that affected limbs of OA patients would show clear deficits in AFisomax. METHODS AF parameters and the maximal voluntary isometric contraction (MVIC) of hamstrings were assessed bilaterally comparing 20 patients with knee OA (ART) vs. controls (CON). AF was measured by a pneumatically driven device. Participants were instructed to maintain a static position despite an increasing load of the device. After reaching AFisomax, the hamstrings merged into eccentric action whereby the force increased further to the maximum (AFmax). MVIC was recorded before and after AF trials. Mixed ANOVA was used to identify differences between and within ART and CON (comparing 1st and 2nd measured sides). RESULTS AFisomax and the torque development per degree of yielding were significantly lower only for the more affected side of ART vs. CON (p ≤ 0.001). The percentage difference of AFisomax amounted to - 40%. For the less affected side it was - 24% (p = 0.219). MVIC and AFmax were significantly lower for ART vs. CON for both sides (p ≤ 0.001). Differences of MVIC between ART vs. CON amounted to - 27% for the more, and - 30% for the less affected side; for AFmax it was - 34% and - 32%, respectively. CONCLUSION The results suggest that strength deficits of hamstrings are present in patients with knee OA possibly attributable to nociception, generally lower physical activity/relief of lower extremities or fear-avoidance. However, the more affected side of OA patients seems to show further specific impairments regarding neuromuscular control reflected by the significantly reduced adaptive holding capacity and torque development during adaptive eccentric action. It is assumed that those parameters could reflect possible inhibitory nociceptive effects more sensitive than maximal strengths as MVIC and AFmax. Their role should be further investigated to get more specific insights into these aspects of neuromuscular control in OA patients. The approach is relevant for diagnostics also in terms of severity and prevention.
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Affiliation(s)
- Laura V Schaefer
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany.
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany.
| | - Silas Dech
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Friederike Carnarius
- Health Education in Sports, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Florian Rönnert
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Frank N Bittmann
- Regulative Physiology and Prevention, Department of Sport and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Roland Becker
- Department of Orthopedics and Traumatology, University Hospital Brandenburg, Brandenburg an der Havel, Berlin, Germany
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Yue H, Li Y, Ma J, Xie C, Xie F, Cai J, Fang M, Yao F. Effect of Tai Chi on knee pain and muscle strength in middle-aged and older adults with knee osteoarthritis: a randomized controlled trial protocol. BMC Complement Med Ther 2023; 23:256. [PMID: 37474949 PMCID: PMC10360298 DOI: 10.1186/s12906-023-04070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common public health problem and a leading cause of long-term pain, decreased muscle strength, and even disability. Tai Chi has been proved effective and highly recommended for KOA management worldwide. However, little is known about its benefits on quadriceps strength which is closely associated with relieving knee pain. This trial is designed to evaluate the efficacy and safety of Tai Chi on knee pain and muscle strength in middle-aged and older adults with KOA. METHODS A total of 100 participants will be randomly divided into a Tai Chi group (TC group) (1x/week for 12 weeks) and a control group with a health education and stretching program (1x/week for 12 weeks) with a follow-up period of 6 weeks. The primary outcome is the change of Western Ontario and McMaster Universities (WOMAC) pain subscale at week 12 compared with baseline. Secondary outcomes include WOMAC stiffness and function subscales, data from isokinetic dynamometry, gait analysis with electromyography (EMG), and a 36-item short form health survey (SF-36). The daily dose of pain-relieving medication will also be recorded. All adverse effects will be assessed by the Treatment Emergent Symptom Scale (TESS). DISCUSSION We expect this randomized trial to evaluate the effectiveness of Tai Chi on relieving pain and increasing quadriceps strength in KOA patients. This protocol, if proven effective, will contribute to providing a promising alternative intervention for middle-aged and older adults with KOA. TRIALS REGISTRATION NUMBER This trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2300069339).
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Affiliation(s)
- Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianwen Ma
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chaoqun Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junhao Cai
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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5
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Mezey GA, Paulik E, Máté Z. Effect of osteoarthritis and its surgical treatment on patients' quality of life: a longitudinal study. BMC Musculoskelet Disord 2023; 24:537. [PMID: 37386476 DOI: 10.1186/s12891-023-06662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is one of the primary causes of pain and disability worldwide leading to patients having some of the worst health-related quality of life (QOL). The purpose of our study was to investigate the progression of the generic and disease-specific QOL of osteoarthritic patients going through total hip or knee replacement surgery and the factors that might alter the effect of surgery on QOL. METHODS A longitudinal study was performed based on data collected from 120 OA patients who filled in the short version of the WHO's generic measure of quality of life (WHOQOL-BREF) and the disease-specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and after surgery. RESULTS Domains related to physical health status showed relatively lower scores in patients before surgery. Patients reported a significant increase of QOL after surgery in the WHOQOL-BREF physical domain, especially if they were from the younger group (< 65 years, p = 0.022) or had a manual job (p = 0.008). Disease-specific QOL outcome results indicate that overall patients gained significantly better QOL in all domains of the WOMAC score. Patients with hip OA seemed to have the most benefit of their operation as they reported better outcome in WOMAC pain (p = 0.019), stiffness (p = 0.010), physical function domains (p = 0.011) and total score (p = 0.007) compared to knee OA patients. CONCLUSION There was a statistically significant improvement in all domains concerning physical functions in the study population. Patients also reported significant improvement in the social relationship domain, which indicates that OA itself as well as its management might have a profound effect on patients' life beyond the reduction of their pain.
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Affiliation(s)
- Gyöngyi Anna Mezey
- Department of Public Health, Albert Szent-Györgyi Medical School, University of Szeged, 10 Dóm Square, Szeged, Hungary, 6720.
| | - Edit Paulik
- Department of Public Health, Albert Szent-Györgyi Medical School, University of Szeged, 10 Dóm Square, Szeged, Hungary, 6720
| | - Zsuzsanna Máté
- Department of Public Health, Albert Szent-Györgyi Medical School, University of Szeged, 10 Dóm Square, Szeged, Hungary, 6720
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Shiojima Y, Takahashi M, Takahashi R, Maruyama K, Moriyama H, Bagchi D, Bagchi M, Akanuma M. Efficacy and Safety of Dietary Undenatured Type II Collagen on Joint and Motor Function in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2023; 42:224-241. [PMID: 35512781 DOI: 10.1080/07315724.2021.2024466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prevalence of osteoarthritis (OA) is increasing alarmingly worldwide. Slowing down the progression of OA and diverse locomotive organ disorders is gaining interest in improving the quality of life (QOL) and extending healthy life-span. In a pilot study, intake of a small amount of undenatured type II collagen exhibited suppression of damage to the articular cartilage via oral immune tolerance. It also demonstrated improvement of knee and joint flexibility and mobility with continued intake of undenatured type II collagen (NEXT-II®) derived from chicken sternum cartilage. This randomized, double-blind, placebo-controlled, parallel-group clinical investigation (RCT) evaluated the efficacy and safety of 12 weeks of regular intake of NEXT-II® on joint and motor function in healthy Japanese male and female participants (aged 20 to <75 years). Sixty-four participants were randomized to receive either NEXT-II® (undenatured type II collagen 3.2 mg/d) or placebo over a period of 12 consecutive weeks. Efficacy on joint and motor functions were evaluated measuring knee passive range of motion as the primary outcome; the Japan Knee Osteoarthritis Measure (JKOM), Visual Analog Scale (VAS) for knee discomfort, and motor functions (10-meter walking and stair-climbing test) as the secondary outcomes; and Japan Low back pain Evaluation Questionnaire (JLEQ) and VAS for lower back discomfort as the exploratory outcomes. Fifty-eight participants (placebo = 28; NEXT-II® group = 30) completed the study. In the assessment of knee passive range of motion, significant improvements in "flexion" and "flexible angle (range)" were observed in the NEXT-II® group at 4, 8, and 12 weeks of treatment. NEXT-II® induced significant improvements in JKOM, VAS for knee and lower back discomfort, 10-meter walking test, stair-climbing test, and JLEQ. Results demonstrate that undenatured type II collagen is safe and efficacious in improving knee flexibility and mobility, reducing knee and lower back pain, and enhancing motor function.
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Affiliation(s)
| | - Megumi Takahashi
- Ryusendo Co., Ltd., R&D, Tokyo, Japan.,Laboratory of Ultrasound Theranostics, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Ryohei Takahashi
- Ryusendo Co., Ltd., R&D, Tokyo, Japan.,Laboratory of Ultrasound Theranostics, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Kazuo Maruyama
- Laboratory of Ultrasound Theranostics, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | | | - Debasis Bagchi
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA
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Ferrari AV, Perea JPM, Dantas LO, Silva HJA, Serrão PRMDS, Sendín FA, Salvini TF. Effect of compression by elastic bandages on pain and function in individuals with knee osteoarthritis: protocol of a randomised controlled clinical trial. BMJ Open 2022; 12:e066542. [PMID: 36385041 PMCID: PMC9670940 DOI: 10.1136/bmjopen-2022-066542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although compression is used to control pain in knee osteoarthritis (KOA), its clinical application is poorly supported, and there is a lack of scientific evidence to support its clinical use. As a low-cost and accessible protocol, compression using elastic bands could be a non-pharmacological intervention to reduce pain and improve physical function in individuals with KOA. This study aims to evaluate the effects of compression on pain and function in individuals with KOA. METHODS AND ANALYSIS A randomised controlled clinical trial will be conducted. Individuals with KOA (n=90; both sexes; between 40 and 75 years old) will be allocated to three groups (n=30/group): compression (compression by the elastic bandage on the affected knee, once a day for 20 min, on four consecutive days); sham (same protocol, but the elastic band is placed around the affected knee without compression) and control (no intervention). The individuals in the three groups will be evaluated 1 day before the first intervention, 1 day after the last intervention, and at the 12th and 24th weeks after the end of the intervention. Pain intensity by the Visual Analogue Scale and pain scale from Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) will be the primary outcomes. The secondary variables will be physical function assessed by the WOMAC questionnaire and physical tests (step test; 30 s sit and stand test; 40 m accelerated walk test). The Global Rating of Change Scale (GRC) will also be applied to quantify the volunteers' perceived change. ETHICS AND DISSEMINATION The project was approved by the Human Research Ethics Committee of the Federal University of São Carlos, São Paulo, Brazil (3955692). The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04724902.
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Affiliation(s)
| | | | - Lucas Ogura Dantas
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | | | - Francisco Alburquerque Sendín
- Sociosanitary Sciences, Radiology and Physical Medicine and Instituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Tania F Salvini
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
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Lin PL, Yu LF, Kuo SF, Wang XM, Lu LH, Lin CH. Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial. BMC Geriatr 2022; 22:809. [PMID: 36266615 PMCID: PMC9585859 DOI: 10.1186/s12877-022-03498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated. Methods Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention. Results Participants’ functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10–5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10−5), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10−5), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η2 = 0.17–0.42), than those in the CON group after the intervention. Conclusions Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach. Trial registration The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).
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Affiliation(s)
- Pei-Ling Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Lee-Fen Yu
- Department of Nursing, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Fen Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, Wenzhou, China
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan. .,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
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9
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Bowen W, Frazer AK, Tallent J, Pearce AJ, Kidgell DJ. Unilateral Strength Training Imparts a Cross-Education Effect in Unilateral Knee Osteoarthritis Patients. J Funct Morphol Kinesiol 2022; 7:jfmk7040077. [PMID: 36278738 PMCID: PMC9589957 DOI: 10.3390/jfmk7040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p < 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p < 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention.
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Affiliation(s)
- Warren Bowen
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne 3125, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Ashlyn K. Frazer
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
| | - Jamie Tallent
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK
| | - Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Dawson J. Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- Correspondence: ; Tel.: +61-3-9904-4119
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10
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Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Front Physiol 2022; 12:794062. [PMID: 34975542 PMCID: PMC8716769 DOI: 10.3389/fphys.2021.794062] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.
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Affiliation(s)
- Chu-Yang Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen-Rong Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Zhi-Ming Tang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Fu-Zhou Hua
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Tossini NB, Lessi GC, Simões Zacharias AL, Corrêa E Silva GR, Seraphim Abrantes LS, Mendes da Silva Serrão PR. Impairment of electrical activation of wrist flexor and extensor muscles during gripping and functional activities in the early stage of hand osteoarthritis: A cross-sectional study. J Hand Ther 2021; 34:109-115. [PMID: 32156575 DOI: 10.1016/j.jht.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional study. INTRODUCTION The wrist extensor muscles have a fundamental role in the stabilization of the wrist while performing manual activities. However, it is unknown if the clinical signs of hand osteoarthritis (HOA) cause impairment in the activation of these muscles PURPOSE OF THE STUDY: The purpose of this study was to investigate whether early-stage HOA affects the magnitude of activation and coactivation between the wrist extensor and flexor muscles METHODS: Thirty-two subjects were divided into two groups: control group (n = 16; 55 ± 7.42 years) and a group with HOA grades 2 or 3 (HOAG; n = 16; 57 ± 7.82 years). Muscle activation was measured in m. flexor digitorum superficialis, m. flexor carpi ulnaris (FCU) and extensors (EXT) during the evaluation of grip strength and three manual activities (write, cut a paper with scissors, and close and open a bottle). The coactivation index was calculated between the electromyography of the flexors (FCU and FSD) and wrist EXT. RESULTS HOAG presented reduced muscle activation in all tasks, with a statistical difference for the flexor digitorum superficialis and EXT in the scissors activity, and for the FCU in the bottle activity. No differences were found between groups for the coactivation index and grip strength. DISCUSSION The reduced muscle activity may be due to an inability of the patients of the HOAG to recruit all motor units or to an inhibition related to the presence of pain. CONCLUSION In the early stages of HOA, there is a functional deficit associated with a reduced muscle activity of the wrist muscles during manual activities.
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Affiliation(s)
- Natália Barbosa Tossini
- Departament of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Lloyd D. The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries. Sports Biomech 2021:1-29. [PMID: 34496728 DOI: 10.1080/14763141.2021.1959947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.
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Affiliation(s)
- David Lloyd
- School of Health Sciences and Social Work, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), in the Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Griffith University, Australia
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Adapted protocol of rate of force development and relaxation scaling factor for neuromuscular assessment in patients with knee osteoarthritis. Knee 2020; 27:1697-1707. [PMID: 33197807 DOI: 10.1016/j.knee.2020.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The linear relationship between muscle torque and rate of torque rise/relaxation during rapid muscle contractions has been recently introduced as a novel measure of muscle quickness, termed rate of torque development/relaxation scaling factor (RTD-SF/RTR-SF). Because the standard assessment protocol includes potentially painful muscle contractions, the first purpose of this study was to validate an adapted RTD-SF/RTR-SF protocol for knee extensor muscles that utilizes lower submaximal intensities and can be used in knee osteoarthritis patients. METHODS A cross-sectional study was performed on a group of healthy controls (n = 24) who underwent the standard RTD-SF/RTR-SF protocol (20-80% of maximum) and the knee osteoarthritis group (n = 24) who underwent the adapted protocol (20-60% of maximum). We calculated the RTD-SF, RTR-SF and the linearity (r2) for both relationships, based on both protocols in controls. RESULTS The validity of the adapted protocol was acceptable (intraclass correlation coefficient = 0.77-0.93), with low within-participant variation (coefficient of variability <10%) for both outcome measures. Compared with the control group, the knee osteoarthritis group had similar RTD-SF, but lower linearity of RTD-SF (0.90 vs. 0.82). The RTR-SF (8.0/s vs. 6.7/s) and its linearity (0.87 vs. 0.73) were significantly reduced. Comparing the affected and the unaffected leg in the knee osteoarthritis group, the unaffected leg had greater maximal torque (96.2 vs. 84.1 Nm) and higher linearity for RTD-SF (0.86 vs. 0.80) and RTR-SF (0.82 vs. 0.73). CONCLUSIONS We confirmed the validity of the adapted RTD/RTR-SF protocol and its sensitivity to impairments associated with knee osteoarthritis.
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Abstract
CONTEXT Osteoarthritis (OA) is the most common chronic joint condition. Muscle dysfunction plays a critical role in the pathogenesis of knee OA. OBJECTIVE It has been suggested that the agonist-antagonist strength relationship for the knee may be better described by a functional hamstring/quadriceps (H/Q) ratio (Hconcentric/Qeccentric: the representative of knee flexion and Qeccentric/Hconcentric: the representative of knee extension). Therefore, in this study, the authors aimed to investigate this ratio and its importance for knee OA. DESIGN Cross-sectional study. SETTING Research clinic. Patients or Other Participant(s): Twenty healthy women and 20 women with grade 2 or grade 3 primer knee OA between the age of 50 and 80 years were included in this study. INTERVENTION(S) Concentric and eccentric peak torque of quadriceps and hamstring muscles were evaluated for all individuals in patient and control groups with a Cybex isokinetic device. Functional H/Q ratio is calculated manually. MAIN OUTCOME MEASURE(S) Functional H/Q torque ratios were analyzed between the patients with OA and healthy individuals by using the isokinetic system. RESULTS The values of peak torque of hamstring concentric and eccentric and quadriceps concentric for the patient group were significantly lower than the control group (P < .05). No statistically important difference was found for quadriceps eccentric peak torque between 2 groups (P > .05). H/Q ratio for extension in the patient group was significantly higher than the control group (P < .05), whereas the H/Q ratio for flexion in the patient group was significantly lower than the control group (P < .05). CONCLUSION This study showed the weakness of both quadriceps and hamstring muscles in patients with knee OA. The combination of functional H/Q ratio with hamstring and quadriceps muscles concentric and eccentric strength values can help to analyze the knee functions and develop preventive-therapeutic approaches for knee OA.
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Sisante JF, Wang N, Felson DT, Nevitt MC, Lewis CE, Frey-Law L, Segal NA. Influence of Antagonistic Hamstring Coactivation on Measurement of Quadriceps Strength in Older Adults. PM R 2020; 12:470-478. [PMID: 31585496 PMCID: PMC8016551 DOI: 10.1002/pmrj.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is limited understanding of how antagonist muscle coactivation relates to measurement of strength in both individuals with and without knee osteoarthritis (KOA). OBJECTIVE This study sought to determine whether hamstring coactivation during a maximal quadriceps activation task attenuates net quadriceps strength. DESIGN Cross-sectional cohort analysis was conducted using data from the 60-month visit of the Multicenter Osteoarthritis Study (MOST). SETTING Laboratory. PARTICIPANTS A sample of 2328 community-dwelling MOST participants between the ages of 55 and 84 years, with or at elevated risk for KOA, completed the 60-month MOST follow-up visit. Of these, 1666 met inclusion criteria for the current study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Quadriceps strength; percentage of combined hamstring coactivation (HC), medial HC, and lateral HC. Quadriceps and hamstring strength were assessed using an isokinetic dynamometer. Surface electromyography was used to assess muscle activation patterns. General linear models, adjusted for age, BMI, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Kellgren-Lawrence (KL) grade and study site, modeled the relationship between antagonist hamstring coactivation and quadriceps strength. RESULTS Men had significantly greater quadriceps strength (P < .001), history of knee injury (P < .001) and surgery (P = .002), and greater presence of varus malalignment (P < .001). Women had greater pain (P < .001) and proportion of KL grade ≥2 (P = .017). Gender-specific analyses revealed combined HC (P = .013) and lateral HC inversely associated with quadriceps strength in women (P = .023) but not in men (combined HC P = .320, lateral HC P = .755). A nonlinear association was detected between quadriceps strength and medial HC. Assessment of quartiles of medial HC revealed the third quartile had reduced quadriceps strength when compared to the lowest quartile of coactivation in both men and women. CONCLUSIONS Hamstring coactivation attenuates measured quadriceps strength in women with or at elevated risk for KOA. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Na Wang
- Boston University, Boston, MA, United States
| | | | - Michael C. Nevitt
- University of California San Francisco, San Francisco, CA, United States
| | - Cora E. Lewis
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Neil A. Segal
- The University of Kansas, Kansas City, KS, United States
- The University of Iowa, Iowa City, IA, United States
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Nilmart P, Vongsirinavarat M, Somprasong S, Apinonkul B. Development of an extensive assessment list for knee osteoarthritis based on the International Classification of Functioning, Disability and Health: a Delphi study. Int J Rehabil Res 2019; 42:240-248. [PMID: 31283550 DOI: 10.1097/mrr.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to develop an extensive assessment list for individuals with knee osteoarthritis based on the International Classification of Functioning, Disability and Health (ICF) osteoarthritis comprehensive Core Set. Ten experienced physical therapists including five lecturers and five clinicians were purposively nominated to form an expert panel. Consensus among the experts was obtained through a four-iteration Delphi technique. A list of ICF categories and their third- and fourth-level categories were selected and matched with outcome measures associated with knee osteoarthritis. The expert panel agreed that 26 out of 38 second-level categories of the comprehensive ICF core set for osteoarthritis were relevant to identify problems related to knee osteoarthritis. The information relevant to the specific categories for knee osteoarthritis was obtained from self-reported, subjective observation and physical examination. The extensive assessment list for knee osteoarthritis based on the comprehensive ICF core set for osteoarthritis was assembled. This assessment tool can be used to expansively identify the multidimensional disabilities of impairment, activity limitation and participation restriction in individuals with knee osteoarthritis.
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Affiliation(s)
- Patcharin Nilmart
- Faculty of Physical Therapy, Mahidol University, Putthamonthon, Nakhon Pathom, Thailand
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Vitaloni M, Botto-van Bemden A, Sciortino Contreras RM, Scotton D, Bibas M, Quintero M, Monfort J, Carné X, de Abajo F, Oswald E, Cabot MR, Matucci M, du Souich P, Möller I, Eakin G, Verges J. Global management of patients with knee osteoarthritis begins with quality of life assessment: a systematic review. BMC Musculoskelet Disord 2019; 20:493. [PMID: 31656197 PMCID: PMC6815415 DOI: 10.1186/s12891-019-2895-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is a prevalent form of chronic joint disease associated with functional restrictions and pain. Activity limitations negatively impact social connectedness and psychological well-being, reducing the quality of life (QoL) of patients. The purpose of this review is to summarize the existing information on QoL in KOA patients and share the reported individual factors, which may influence it. Methods We conducted a systematic review examining the literature up to JAN/2017 available at MEDLINE, EMBASE, Cochrane, and PsycINFO using KOA and QOL related keywords. Inclusion criteria were QOL compared to at least one demographic factor (e.g., age, gender), lifestyle factor (e.g., functional independence), or comorbidity factor (e.g., diabetes, obesity) and a control group. Analytical methods were not considered as part of the original design. Results A total of 610 articles were reviewed, of which 62 met inclusion criteria. Instruments used to measure QoL included: SF-36, EQ-5D, KOOS, WHOQOL, HAS, AIMS, NHP and JKOM. All studies reported worse QoL in KOA patients when compared to a control group. When females were compared to males, females reported worse QOL. Obesity as well as lower level of physical activity were reported with lower QoL scores. Knee self-management programs delivered by healthcare professionals improved QoL in patients with KOA. Educational level and higher total mindfulness were reported to improve QoL whereas poverty, psychological distress, depression and lacking familial relationships reduce it. Surgical KOA interventions resulted in good to excellent outcomes generally; although, results varied by age, weight, and depression. Conclusion KOA has a substantial impact on QoL. In KOA patients, QoL is also influenced by specific individual factors including gender, body weight, physical activity, mental health, and education. Importantly, education and management programs designed to support KOA patients report improved QoL. QoL data is a valuable tool providing health care professionals with a better comprehension of KOA disease to aid implementation of the most effective management plan.
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Affiliation(s)
| | | | | | | | - Marco Bibas
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | | | - Jordi Monfort
- Rheumatology Service, Del Mar Hospital, Barcelona, Spain
| | - Xavier Carné
- Clinical Pharmacology Department, Clinic Hospital, Barcelona, Spain
| | | | | | - Maria R Cabot
- Faculty of Nursing, Clinic Hospital, Barcelona, Spain
| | - Marco Matucci
- Rheumatology Service, University of Florence, Florence, Italy
| | | | - Ingrid Möller
- Poal Institute, University of Barcelona, Barcelona, Spain
| | | | - Josep Verges
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
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Possible association between circulating CTRP3 and knee osteoarthritis in postmenopausal women. Aging Clin Exp Res 2019; 31:927-934. [PMID: 30191454 DOI: 10.1007/s40520-018-1035-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is considered as one of the most common cause of chronic pain and functional disabilities in the elderly. AIM To examine serum levels of complement-C1q TNF-related protein 3 (CTRP3) in postmenopausal women with knee OA. METHODS A population-based cross-sectional study was performed in women who complained of chronic knee pain. All subjects were followed by clinical and weight-bearing bilateral anteroposterior radiographical examinations. The Kellgren and Lawrence (K&L) score was used for knee OA classification. Two groups of postmenopausal women were chosen to investigate CTRP3 as an OA marker who had the K&L score ≥ 3 as a case group and K&L ≤ 1 as a control group. Serum levels of CTRP3 were measured in two groups. RESULTS According to K&L classification, 36 subjects with knee OA and 54 age-matched without or mild OA were selected. After adjusting the obtained data for taking NSAID drugs, the concentration of Ln CTRP3 in serum of patients with OA was lower compared to control group [mean ± SE, (0.39 ± 0.05 ng/ml vs. 0.48 ± 0.03 ng/ml, respectively, p = 0.04)]. DISCUSSION There is a possible role for CTRP3 as an anti-inflammatory mediator in knee OA in postmenopausal women. CONCLUSIONS Our results indicate an association between CTRP3 and knee OA. However, a much more robust study is required to draw that circulating CTRP3 could be a clinical marker for osteoarthritis.
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A calibrated EMG-informed neuromusculoskeletal model can appropriately account for muscle co-contraction in the estimation of hip joint contact forces in people with hip osteoarthritis. J Biomech 2019; 83:134-142. [DOI: 10.1016/j.jbiomech.2018.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022]
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Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty: A systematic review and best evidence synthesis. J Orthop 2018; 15:903-908. [PMID: 30174378 DOI: 10.1016/j.jor.2018.08.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives Falls occur frequently in patients with impaired ambulation and may dramatically affect the elderly population. Aim was to document the incidence of falls in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA), and to identify factors and treatments that may influence the risk of falls. Methods A systematic literature search was conducted on three medical electronic databases, PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to falls were analyzed: prevalence, risk factors, correlation with clinical outcome, effect of treatments. Results The systematic review identified 11 papers on 1237 patients. Pre-operative fall prevalence ranged from 23% to 63%, while post-operative values ranged from 12% to 38%. Moderate evidence was found on no influence of clinical scales, no BMI differences between "faller" and "non-faller", and on influence of limited pre-operative range of motion. Conflicting evidence was found for sex, history of previous falls, age, kyphosis, muscle weakness, fear of falling, depression, balance, gait impairment. No evidence was found for the effectiveness of surgical or rehabilitative strategies on falls reduction. Conclusions OA patients undergoing TKA are at high risk of falls, which is reduced but still present after surgery. Although some risk factors were identified, there are no studies demonstrating the possibility of reducing the incidence of this deleterious event, which warrants further research efforts to better manage this fragile population of elderly patients.
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van Tunen JAC, Dell'Isola A, Juhl C, Dekker J, Steultjens M, Thorlund JB, Lund H. Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis. BMC Musculoskelet Disord 2018; 19:273. [PMID: 30055600 PMCID: PMC6064629 DOI: 10.1186/s12891-018-2202-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background To investigate (1) the association of specific biomechanical factors with knee osteoarthritis and knee osteoarthritis development, and (2) the impact of other relevant risk factors on this association. Methods MEDLINE, EMBASE, CINAHL and SPORTDiscus were searched up until April 2017. Studies were included if they fulfilled the following criteria: the study 1) assessed the association of a biomechanical factor with knee osteoarthritis, or knee osteoarthritis development; 2) reported on skeletal malalignment, muscular dysfunction, impaired proprioception, laxity and abnormal loading during gait; 3) was a cohort study with participants developing knee osteoarthritis and participants not developing knee osteoarthritis, or a case-control or cross-sectional study with participants with knee osteoarthritis and without knee osteoarthritis. Risk of bias was assessed with the QUIPS tool and meta-analyses were performed using random effects models. Results Of 6413 unique studies identified, 59 cross-sectional studies were eligible for meta-analyses (9825 participants, 5328 with knee osteoarthritis). No cohort studies fulfilled the inclusion criteria. Compared with healthy controls, patients with knee osteoarthritis have higher odds of having lower muscle strength, proprioception deficits, more medial varus-valgus laxity and less lateral varus-valgus laxity. Patients with medial knee osteoarthritis have higher odds of having a higher knee adduction moment than healthy controls. Level of evidence was graded as ‘very low’ to ‘moderate’ quality. Due to large between study differences moderation of other risk factors on biomechanical risk factors could not be evaluated. Conclusions Patients with knee osteoarthritis are more likely to display a number of biomechanical characteristics. The causal relationship between specific biomechanical factors and the development of knee osteoarthritis could not be determined as no longitudinal studies were included. There is an urgent need for high quality, longitudinal studies to evaluate the impact of specific biomechanical factors on the development of knee osteoarthritis. Trial Registration (PROSPERO ID: CRD42015025092). Electronic supplementary material The online version of this article (10.1186/s12891-018-2202-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joyce A C van Tunen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Andrea Dell'Isola
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.,Department of Rehabilitation, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, EMGO Insitute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Jonas B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Hans Lund
- Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
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Joint angle and movement velocity effects on muscle activity of elderly with knee osteoarthritis - Categorized and probabilistic analysis. J Electromyogr Kinesiol 2018; 41:50-59. [PMID: 29763884 DOI: 10.1016/j.jelekin.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/24/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to determine the effects of joint angle position and angular velocity on concentric and eccentric knee muscles activity of elderly with osteoarthritis (OA) in a deterministic and probabilistic approach compared to matched controls. Concentric and eccentric muscle activation of vastus medialis (VM) and semitendinous (ST) muscles were recorded of eleven elderly women with knee OA (median (Md (25-75%)) age of 62 years (60-72) and Md of body mass index (BMI) of 26 kg/m2 (24.5-27.2)) and ten controls (Md 65 years (62-69) and Md of BMI 24.5 kg/m2 (23.6-28.9), during twenty-five knee extension-flexion movements. Activation type, angular velocities (90° s-1 and 240° s-1) and joint angle intervals were categorized into groups. The cumulative frequency distributions of the normalized sEMG envelope were computed and the probability to be out of specific norm-reference limits (controls) was calculated. No statistical differences between groups were found. Higher probabilities were found for VM and ST (concentric) and ST (eccentric) activation to be out of norm (55%, 53% and 84%, respectively) at 240 s-1 in different joint angles. During dynamic contractions, concentric and eccentric activity of medial knee muscles of elderly with OA were affected in a different way by joint angles and angular velocity compared to matched controls. The probabilistic analysis provided an additional understanding of the muscle activation between elderly with knee OA and healthy older people.
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Abdollahi A, Hajizadeho M, Mohseni R, Aliakbar S, Veisy Z, Saeed Yeka M, Maghbooli Z, Mirzaei K. Association Between Major Dietary Patterns and Grades of Knee Osteoarthritis in Women. ACTA ACUST UNITED AC 2017. [DOI: 10.3923/ajcn.2018.16.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pizzolato C, Reggiani M, Saxby DJ, Ceseracciu E, Modenese L, Lloyd DG. Biofeedback for Gait Retraining Based on Real-Time Estimation of Tibiofemoral Joint Contact Forces. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1612-1621. [PMID: 28436878 DOI: 10.1109/tnsre.2017.2683488] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biofeedback assisted rehabilitation and intervention technologies have the potential to modify clinically relevant biomechanics. Gait retraining has been used to reduce the knee adduction moment, a surrogate of medial tibiofemoral joint loading often used in knee osteoarthritis research. In this paper, we present an electromyogram-driven neuromusculoskeletal model of the lower-limb to estimate, in real-time, the tibiofemoral joint loads. The model included 34 musculotendon units spanning the hip, knee, and ankle joints. Full-body inverse kinematics, inverse dynamics, and musculotendon kinematics were solved in real-time from motion capture and force plate data to estimate the knee medial tibiofemoral contact force (MTFF). We analyzed five healthy subjects while they were walking on an instrumented treadmill with visual biofeedback of their MTFF. Each subject was asked to modify their gait in order to vary the magnitude of their MTFF. All subjects were able to increase their MTFF, whereas only three subjects could decrease it, and only after receiving verbal suggestions about possible gait modification strategies. Results indicate the important role of knee muscle activation patterns in modulating the MTFF. While this paper focused on the knee, the technology can be extended to examine the musculoskeletal tissue loads at different sites of the human body.
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Mid Term Outcome of Home-Based Exercises vs. Sophisticated Physiotherapy Protocol After Total Knee Arthroplasty. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2017. [DOI: 10.5812/jost.11197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Goldman LH, Tang K, Facchetti L, Heilmeier U, Joseph GB, Nevitt MC, McCulloch CE, Souza RB, Link TM. Role of thigh muscle cross-sectional area and strength in progression of knee cartilage degeneration over 48 months - data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:2082-2091. [PMID: 27457100 PMCID: PMC5614519 DOI: 10.1016/j.joca.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine in a 48-month longitudinal study the association of thigh muscle cross-sectional area (CSA) and strength on progression of morphologic knee cartilage degeneration using 3T magnetic resonance imaging (MRI). DESIGN Seventy Osteoarthritis Initiative (OAI) subjects aged 50-60 years, with no radiographic evidence of osteoarthritis (OA) and constant muscle strength over 48 months as measured by isometric knee extension testing were included. Baseline right thigh muscle CSAs were assessed on axial T1-weighted magnetic resonance (MR) images, and extensor to flexor CSA ratios were calculated. Degenerative knee abnormalities at baseline and 48-months were graded on right knee 3T MRIs using a modified whole organ MRI score (WORMS). Statistical analysis employed Student's t-tests and multivariable regression models adjusted for age, body mass index and gender. RESULTS Extension strength was significantly and positively correlated with baseline thigh muscle CSA (r = 0.65, P < 0.001). Greater baseline total thigh muscle CSA was significantly associated with increase of cartilage WORMS scores over 48 months in patellar (P = 0.027) and trochlear (P = 0.038) compartments, but not in other knee compartments. Among specific muscle groups, CSA of extensors (P = 0.021) and vastus medialis (VM) (P = 0.047) were associated with patellar cartilage increase in WORMS. Baseline E/F ratio had a significant positive association with patellar WORMS cartilage score increase over 48 months, P = 0.0015. There were no other significant associations between muscle CSA/ratios and increase in WORMS scores. CONCLUSION Maintenance of proper extensor to flexor muscle balance about the knee through decreased E/F ratios may slow patellofemoral cartilage deterioration, while higher extensor and VM CSA may increase patellofemoral cartilage loss.
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Affiliation(s)
- Lauren H. Goldman
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Radiology, Montefiore Medical Center
| | - Kenneth Tang
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Radiology, University of Brescia, Brescia, Italy
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of
California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of
California, San Francisco
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Physical Therapy and Rehabilitation Science,
University of California, San Francisco
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
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Gade V, Allen J, Cole JL, Barrance PJ. Upright Magnetic Resonance Imaging Tasks in the Knee Osteoarthritis Population: Relationships Between Knee Flexion Angle, Self-Reported Pain, and Performance. Arch Phys Med Rehabil 2016; 97:1107-14. [PMID: 26723855 DOI: 10.1016/j.apmr.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize the ability of patients with symptomatic knee osteoarthritis (OA) to perform a weight-bearing activity compatible with upright magnetic resonance imaging (MRI) scanning and how this ability is affected by knee pain symptoms and flexion angles. DESIGN Cross-sectional observational study assessing effects of knee flexion angle, pain level, and study sequence on accuracy and duration of performing a task used in weight-bearing MRI evaluation. Visual feedback of knee position from an MRI compatible sensor was provided. Pain levels were self-reported on a standardized scale. SETTING Simulated MRI setup in a research laboratory. PARTICIPANTS Convenience sample of individuals (N=14; 9 women, 5 men; mean, 69±14y) with symptomatic knee OA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Averaged absolute and signed angle error from target knee flexion for each minute of trial and duration tolerance (the duration that subjects maintained position within a prescribed error threshold). RESULTS Absolute targeting error increased at longer trial durations (P<.001). Duration tolerance decreased with increasing pain (mean ± SE, no pain: 3min 19s±11s; severe pain: 1min 49s±23s; P=.008). Study sequence affected duration tolerance (first knee: 3min 5s±9.1s; second knee: 2min 19s±9.7s; P=.015). CONCLUSIONS The study provided evidence that weight-bearing MRI evaluations based on imaging protocols in the range of 2 to 3 minutes are compatible with patients reporting mild to moderate knee OA-related pain.
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Affiliation(s)
- Venkata Gade
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ
| | - Jerome Allen
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ
| | - Jeffrey L Cole
- Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ
| | - Peter J Barrance
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ.
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Hashida R, Matsuse H, Takano Y, Omoto M, Nago T, Shiba N. Walking exercise combined with neuromuscular electrical stimulation of antagonist resistance improved muscle strength and physical function for elderly people: A pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.7600/jpfsm.5.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital
| | - Yoshio Takano
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare
| | | | - Takeshi Nago
- Division of Rehabilitation, Kurume University Hospital
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital
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The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis. J Orthop Sports Phys Ther 2016; 46:19-25. [PMID: 26556391 DOI: 10.2519/jospt.2016.5093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Secondary analysis of a randomized controlled trial. BACKGROUND The use of external supports has been questioned because they may lead to weakness in the surrounding muscles. To our knowledge, there is no investigation into the effect of knee supports or braces on quadriceps muscle strength and quadriceps inhibition in individuals with patellofemoral joint (PFJ) osteoarthritis (OA). OBJECTIVES To investigate the effects of a flexible knee support on quadriceps maximum voluntary contraction (MVC) and arthrogenous muscle inhibition (AMI) in patients with PFJ OA. METHODS The study included 108 participants who had at least 3 months of patellofemoral pain and a Kellgren-Lawrence score of 2 or 3 for PFJ OA. The participants were randomized to a group that wore a flexible knee support (brace) or a group that did not wear a support (no brace) in a 6-week randomized controlled trial, followed by an open-label trial, in which all participants wore the brace for a total of 12 weeks. Quadriceps MVC, measured isometrically, and quadriceps AMI, measured by twitch interpolation, were assessed at the 6-week and 12-week time points. RESULTS After 6 weeks, MVC did not differ between the brace and no-brace groups (9.09 Nm; 95% confidence interval [CI]: -4.89, 23.07; P = .20). Arthrogenous muscle inhibition significantly decreased in the brace group (-8.62%; 95% CI: -13.90%, -3.33%; P = .002). After 12 weeks, in all of the participants who wore a flexible knee support, MVC increased by 7.98 Nm (95% CI: 2.52, 13.45; P = .004) and AMI decreased (-8.42%; 95% CI: -11.48%, -5.36%; P<.001). Although statistically significant, these results have doubtful clinical significance. CONCLUSION A patellofemoral flexible knee support in participants with PFJ OA does not have an adverse effect on quadriceps MVC or AMI. Using a knee support should not be discouraged because of concerns about deleterious effects on quadriceps strength and inhibition. LEVEL OF EVIDENCE Therapy, level 1b.
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Longpré HS, Acker SM, Maly MR. Muscle activation and knee biomechanics during squatting and lunging after lower extremity fatigue in healthy young women. J Electromyogr Kinesiol 2014; 25:40-6. [PMID: 25258248 DOI: 10.1016/j.jelekin.2014.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 08/22/2014] [Accepted: 08/24/2014] [Indexed: 11/28/2022] Open
Abstract
Muscle activations and knee joint loads were compared during squatting and lunging before and after lower extremity neuromuscular fatigue. Electromyographic activations of the rectus femoris, vastus lateralis and biceps femoris, and the external knee adduction and flexion moments were collected on 25 healthy women (mean age 23.5 years, BMI of 23.7 kg/m(2)) during squatting and lunging. Participants were fatigued through sets of 50 isotonic knee extensions and flexions, with resistance set at 50% of the peak torque achieved during a maximum voluntary isometric contraction. Fatigue was defined as a decrease in peak isometric knee extension or flexion torque ≥25% from baseline. Co-activation indices were calculated between rectus femoris and biceps femoris; and between vastus lateralis and biceps femoris. Fatigue decreased peak isometric extension and flexion torques (p<0.05), mean vastus lateralis activation during squatting and lunging (p<0.05), and knee adduction and flexion moments during lunging (p<0.05). Quadriceps activations were greater during lunging than squatting (p<0.05). Thus, fatigue altered the recruitment strategy of the quadriceps during squatting and lunging. Lunging challenges quadriceps activation more than squatting in healthy, young women.
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Affiliation(s)
- Heather S Longpré
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Stacey M Acker
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Monica R Maly
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
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Serrão PRMS, Vasilceac FA, Gramani-Say K, Lessi GC, Reiff RBM, Mattiello-Sverzut AC, Mattiello SM. Expression of receptors of advanced glycation end product (RAGE) and types I, III and IV collagen in the vastus lateralis muscle of men in early stages of knee osteoarthritis. Connect Tissue Res 2014; 55:331-8. [PMID: 25039336 DOI: 10.3109/03008207.2014.947368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Alterations in the contractile and non-contractile proteins of the skeletal muscle may reduce muscle function in knee osteoarthritis (OA), and the formation and accumulation of advanced glycation end products, particularly in collagen, can influence the quality of these muscle proteins. The objective of this study was to evaluate the reactivity of types I, III and IV collagen and the expression and localization of receptor for advanced glycation end products (RAGE) in the vastus lateralis (VL) muscle in early stages of knee OA. The hypothesis was that these patients present a higher expression of RAGE and increased immunoreactivity in the collagen. Thirty-five men were divided into two groups: the control group (CG; n = 17) and the osteoarthritis group (OAG; n = 18). All participants were submitted to a biopsy of the VL. The muscle samples were analyzed by immunohistochemistry for collagen and for RAGE and laminin. The expression of RAGE was counted (intracellular, extracellular and total). Student's t-test for independent samples and Mann-Whitney U test were used for the RAGE's intergroup analysis (α ≤ 0.05). A semiquantitative analysis was performed to assess the collagen reactivity. No significant differences were observed in the intracellular, extracellular or total localization of RAGE (p > 0.05). Higher immunoreactivity was observed in the OAG for all types of collagen, with more reactivity for collagen III and IV. We concluded that in the initial stages of knee OA, no differences were observed for RAGE levels between the groups. However, the OAG's higher collagen expression may represent adaptations for reducing muscle stiffness and avoiding injury.
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Effect of Submaximal Repetitive Exercise on Knee Coactivation in Young and Middle-Aged Women. J Appl Biomech 2014; 30:269-75. [DOI: 10.1123/jab.2013-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coactivation of the knee extensors and flexors increases knee joint contact forces, which may lead to degradation of the articular surfaces. This study investigated the effect of neuromuscular fatigue induced by submaximal, repetitive, dynamic contractions on coactivation of knee musculature in young and middle-aged women. Data from 10 young women (24.6 ± 1.8 years) and 8 middle-aged women (55.4 ± 4.2 years) were analyzed. Measures included peak knee extension and flexion torques and the average amplitude of surface electromyography of rectus femoris and biceps femoris. Coactivation ratios were calculated from these activations. To induce fatigue, participants completed up to ten sets of 50 concentric knee extension and flexion contractions at 60°/s. A two-factor analysis of variance was used to determine the effect of age and fatigue. The young group showed higher peak torque compared with the middle-aged group (P< .001). During flexion, biceps femoris activity increased after fatigue when both groups were considered together (P= .018). During extension, biceps femoris activity was higher in the middle-aged than young group (P= .043). Middle-aged women exhibited a trend for greater coactivation during knee extension compared with young women (P= .066). This coactivation likely contributed to extension torque decrements in middle-aged women.
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Lugo JP, Saiyed ZM, Lau FC, Molina JPL, Pakdaman MN, Shamie AN, Udani JK. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. J Int Soc Sports Nutr 2013; 10:48. [PMID: 24153020 PMCID: PMC4015808 DOI: 10.1186/1550-2783-10-48] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND UC-II contains a patented form of undenatured type II collagen derived from chicken sternum. Previous preclinical and clinical studies support the safety and efficacy of UC-II in modulating joint discomfort in osteoarthritis and rheumatoid arthritis. The purpose of this study was to assess the efficacy and tolerability of UC-II in moderating joint function and joint pain due to strenuous exercise in healthy subjects. METHODS This randomized, double-blind, placebo-controlled study was conducted in healthy subjects who had no prior history of arthritic disease or joint pain at rest but experienced joint discomfort with physical activity. Fifty-five subjects who reported knee pain after participating in a standardized stepmill performance test were randomized to receive placebo (n = 28) or the UC-II (40 mg daily, n = 27) product for 120 days. Joint function was assessed by changes in degree of knee flexion and knee extension as well as measuring the time to experiencing and recovering from joint pain following strenuous stepmill exertion. RESULTS After 120 days of supplementation, subjects in the UC-II group exhibited a statistically significant improvement in average knee extension compared to placebo (81.0 ± 1.3º vs 74.0 ± 2.2º; p = 0.011) and to baseline (81.0 ± 1.3º vs 73.2 ± 1.9º; p = 0.002). The UC-II cohort also demonstrated a statistically significant change in average knee extension at day 90 (78.8 ± 1.9º vs 73.2 ± 1.9º; p = 0.045) versus baseline. No significant change in knee extension was observed in the placebo group at any time. It was also noted that the UC-II group exercised longer before experiencing any initial joint discomfort at day 120 (2.8 ± 0.5 min, p = 0.019), compared to baseline (1.4 ± 0.2 min). By contrast, no significant changes were seen in the placebo group. No product related adverse events were observed during the study. At study conclusion, five individuals in the UC-II cohort reported no pain during or after the stepmill protocol (p = 0.031, within visit) as compared to one subject in the placebo group. CONCLUSIONS Daily supplementation with 40 mg of UC-II was well tolerated and led to improved knee joint extension in healthy subjects. UC-II also demonstrated the potential to lengthen the period of pain free strenuous exertion and alleviate the joint pain that occasionally arises from such activities.
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Affiliation(s)
- James P Lugo
- InterHealth Nutraceuticals, Benicia, CA 94510, USA
| | | | | | | | - Michael N Pakdaman
- Medicus Research LLC, 28720 Roadside Drive, Suite 310, Agoura Hills, CA 91301, USA
| | | | - Jay K Udani
- Medicus Research LLC, 28720 Roadside Drive, Suite 310, Agoura Hills, CA 91301, USA
- Northridge Hospital Integrative Medicine Program, Northridge, CA 91325, USA
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Physical activity patterns and function 3 months after arthroscopic partial meniscectomy. J Sci Med Sport 2013; 16:195-9. [DOI: 10.1016/j.jsams.2012.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 07/16/2012] [Accepted: 08/17/2012] [Indexed: 12/20/2022]
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Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci 2013; 5:30-8. [PMID: 23559821 PMCID: PMC3612336 DOI: 10.4103/0975-7406.106561] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/30/2012] [Accepted: 08/30/2012] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
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Affiliation(s)
- Dinesh Bhatia
- Department of Biomedical Engineering, Adaptive Neural Systems Laboratory, Miami, Florida, USA
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Biomechanical changes at the knee after lower limb fatigue in healthy young women. Clin Biomech (Bristol, Avon) 2013; 28:441-7. [PMID: 23528628 DOI: 10.1016/j.clinbiomech.2013.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/01/2013] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to identify changes in knee kinematics, kinetics and stiffness that occur during gait due to lower limb neuromuscular fatigue. METHODS Kinematic, kinetic and electromyographic measures of gait were collected on healthy, young women (n=20) before and after two bouts of fatigue. After baseline gait analysis, two bouts of fatiguing contractions were completed. Fatigue was induced using sets of 50 isotonic knee extensions and flexions at 50% of the peak torque during a maximum voluntary isometric contraction. Fatigue was defined as a drop in knee extension or flexion maximum voluntary isometric torques of at least 25% from baseline. Gait analyses were completed after each bout of fatigue. Dynamic knee stiffness was calculated as the change in knee flexion moment divided by the change in knee flexion angle from 3 to 15% of the gait cycle. Co-activations of the biceps femoris and rectus femoris muscles were calculated from 3 to 15% and 40 to 52% of gait. Repeated measures analyses of variance assessed differences in discrete gait measures, knee torques, and electromyography amplitudes between baseline and after each bout of fatigue. FINDINGS Fatigue decreased peak isometric torque. Fatigue did not alter knee adduction moments, knee flexion angles, dynamic knee stiffness, or muscle co-activation. Fatigue reduced the peak knee extension moment. INTERPRETATION While neuromuscular fatigue of the knee musculature alters the sagittal plane knee moment in healthy, young women during walking, high intensity fatigue is not consistent with known mechanical environments implicated in knee pathologies or injuries.
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Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis. Sports Health 2012; 4:284-92. [PMID: 23016099 PMCID: PMC3435919 DOI: 10.1177/1941738112445726] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Context: Muscle impairments associated with knee osteoarthritis (OA) are the primary underlying cause of functional limitations. Understanding the extent of muscle impairments, its relationship with physical function and disease progression, and the evidence behind exercise therapy that targets muscle impairments is crucial. Evidence Acquisition: An electronic search for relevant articles using MEDLINE and CINHAL databases up to September 2011 was performed. In addition to the electronic search, retrieved articles were searched manually for relevant studies. Results: Quadriceps, hamstrings, and hip muscles are significantly impaired in subjects with knee OA compared with age-matched controls. Muscle strength, especially quadriceps, is a major determinant of both performance-based and self-reported physical function. Whether stronger quadriceps is protective against knee OA onset and progression is not clear. Exercise therapy, including global and targeted resistance training, is effective in reducing pain and improving function in subjects with knee OA. Conclusions: Subjects with knee OA have significant muscle impairments. These muscle impairments affect physical function and should be targeted in therapy. Further research is needed to explore the relationship between quadriceps strength and knee OA initiation and progression and to determine the optimal exercise prescription that augments outcomes in this patient population.
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Affiliation(s)
- Ali H Alnahdi
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, and King Saud University, Riyadh, Saudi Arabia
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Patsika G, Kellis E, Amiridis IG. Neuromuscular efficiency during sit to stand movement in women with knee osteoarthritis. J Electromyogr Kinesiol 2012; 21:689-94. [PMID: 21689947 DOI: 10.1016/j.jelekin.2011.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/19/2011] [Accepted: 05/19/2011] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to investigate the neuromuscular efficiency of women with knee osteoarthritis (OA) when performing a sit-to-stand movement and during maximum strength efforts. Twelve women with unilateral knee OA (age 60.33±6.66 years, height 1.61±0.05 m, mass 77.08±9.2 kg) and 11 controls (age 56.54±5.46 years, height 1.64±0.05 m, mass 77.36±13.34 kg) participated in this study. Subjects performed a sit-to-stand movement from a chair while position of center of pressure and knee angular speed were recorded. Furthermore, maximal isokinetic knee extension and flexion strength at 60°/s, 120°/s and 150°/s was measured. Surface, electromyography (EMG) from the biceps femoris (BF), vastus lateralis (VL) and vastus medialis (VM) was recorded during all tests. Analysis of variance (ANOVA) showed that during the sit-to-stand OA group demonstrated significantly lower knee angular speed (44.49±9.61°/s vs. 71.68±19.86°/s), a more posterior position of the center of pressure (39.20±7.02% vs. 41.95±2.49%) and a higher antagonist BF activation (57.13±20.55% vs. 32.01±19.5%) compared with controls (p<0.05). Further, women with knee OA demonstrated a lower Moment-to-EMG ratio than controls in extension and eccentric flexion at 60°/s and 150°/s, while the opposite was found for concentric flexion at 60°/s (p<0.05). Among other factors, the slower performance of the sit-to-stand movement in women with OA is due to a less efficient use of the knee extensor muscles (less force per unit of EMG) and, perhaps, a higher BF antagonist co-activation. This may lead subjects with OA to adopt a different movement strategy compared with controls.
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Affiliation(s)
- Glykeria Patsika
- Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Segal NA, Glass NA. Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis? PHYSICIAN SPORTSMED 2011; 39:44-50. [PMID: 22293767 DOI: 10.3810/psm.2011.11.1938] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The role of the quadriceps muscle in mediating risk for knee osteoarthritis (OA) is a common subject of investigation. The quadriceps muscle is a principal contributor to knee joint stability and provides shock absorption for the knee during ambulation. Clinically, weakness of the quadriceps muscle is consistently found in patients with knee OA. Research has shown that higher quadriceps muscle strength is associated with a reduced risk for incident symptomatic knee OA. However, there is limited evidence to suggest that quadriceps muscle plays a significant role in the incidence of radiographic knee OA. In addition, greater quadriceps muscle strength is associated with a lower risk for progression of tibiofemoral joint space narrowing and cartilage loss in women. This article summarizes knowledge of the relationship between quadriceps muscle strength and risk for knee OA.
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Affiliation(s)
- Neil A Segal
- Department of Orthopaedics and Rehabilitation, Iowa City, IA, USA.
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Rice DA, McNair PJ, Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis Res Ther 2011; 13:R151. [PMID: 21933392 PMCID: PMC3308081 DOI: 10.1186/ar3467] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/13/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether γ-loop dysfunction contributes to AMI in people with knee joint OA. METHODS Fifteen subjects with knee joint OA and 15 controls with no history of knee joint pathology participated in this study. Quadriceps and hamstrings peak isometric torque (Nm) and electromyography (EMG) amplitude were collected before and after 20 minutes of 50 Hz vibration applied to the infrapatellar tendon. Between-group differences in pre-vibration torque were analysed using a one-way analysis of covariance, with age, gender and body mass (kg) as the covariates. If the γ-loop is intact, vibration should decrease torque and EMG levels in the target muscle; if dysfunctional, then torque and EMG levels should not change following vibration. One-sample t tests were thus undertaken to analyse whether percentage changes in torque and EMG differed from zero after vibration in each group. In addition, analyses of covariance were utilised to analyse between-group differences in the percentage changes in torque and EMG following vibration. RESULTS Pre-vibration quadriceps torque was significantly lower in the OA group compared with the control group (P = 0.005). Following tendon vibration, quadriceps torque (P < 0.001) and EMG amplitude (P ≤0.001) decreased significantly in the control group but did not change in the OA group (all P > 0.299). Hamstrings torque and EMG amplitude were unchanged in both groups (all P > 0.204). The vibration-induced changes in quadriceps torque and EMG were significantly different between the OA and control groups (all P < 0.011). No between-group differences were observed for the change in hamstrings torque or EMG (all P > 0.554). CONCLUSIONS γ-loop dysfunction may contribute to AMI in individuals with knee joint OA, partially explaining the marked quadriceps weakness and atrophy that is often observed in this population.
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Affiliation(s)
- David A Rice
- Health and Rehabilitation Research Institute, AUT University, 90 Akoranga Drive, Northcote, 0627 Auckland, New Zealand
| | - Peter J McNair
- Health and Rehabilitation Research Institute, AUT University, 90 Akoranga Drive, Northcote, 0627 Auckland, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, AUT University, 90 Akoranga Drive, Northcote, 0627 Auckland, New Zealand
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Pietrosimone BG, Hertel J, Ingersoll CD, Hart JM, Saliba SA. Voluntary quadriceps activation deficits in patients with tibiofemoral osteoarthritis: a meta-analysis. PM R 2011; 3:153-62; quiz 162. [PMID: 21333954 DOI: 10.1016/j.pmrj.2010.07.485] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 07/01/2010] [Accepted: 07/29/2010] [Indexed: 01/18/2023]
Abstract
The objective of this study was to assess the magnitude of quadriceps activation deficits in the involved extremity and contralateral extremity of patients with knee joint osteoarthritis (OA), as well as matched controls. An exhaustive search of the literature was performed using Web of Science between 1970 and February 24, 2010, using the search terms "osteoarthritis" AND "quadriceps activation" OR "quadriceps inhibition" and cross-referencing pertinent articles. Studies written in English reporting quadriceps activation means and standard deviations in patients with tibiofemoral OA via a method using an exogenous electrical stimulation were evaluated for methodological quality and were included for data analysis. Fourteen individual studies met the criteria for inclusion into data analysis. The number of participants and mean activation levels were used to calculate weighted means for the involved limb (14 studies), the contralateral limb (from a subset of 6 studies), and an involved limb subset from only the studies evaluating the contralateral limb and population of control subjects (5 studies). Weighted means from the involved limb (82.2; 95% CI = 81.4-83.3%), contralateral limb (81.7; 80.1-83.3%), and involved limb subset (76.8; 74.8-78.8%) groups were found to have lower volitional quadriceps activation compared with the control groups (90; 88.9-91.7%). Although the weighted involved limb mean was not different from that of the contralateral limb, the mean and 95% confidence intervals for the involved limb subset were lower than that of the contralateral limb group, suggesting that the involved limb had less volitional activation within OA subjects. This provides evidence that bilateral quadriceps volitional activation deficits are present in persons with knee OA.
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Affiliation(s)
- Brian G Pietrosimone
- Department of Kinesiology, College of Health Science and Human Services, University of Toledo, MS 119 2801 W. Bancroft Street, Toledo, OH 43606-3390, USA.
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Sturnieks DL, Besier TF, Lloyd DG. Muscle activations to stabilize the knee following arthroscopic partial meniscectomy. Clin Biomech (Bristol, Avon) 2011; 26:292-7. [PMID: 21146908 DOI: 10.1016/j.clinbiomech.2010.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 08/03/2010] [Accepted: 11/04/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy patients are at increased risk of developing knee osteoarthritis. This population, particularly those with weaker quadriceps, have larger-than-normal knee adduction moments, which tend to load the medial tibiofemoral joint. Larger knee adduction moments predict progression of knee osteoarthritis and may contribute to the increased risk in meniscectomy patients. Increased muscle activity to support these large moments may further elevate articular loads. We examined a) the muscle activity while walking in a meniscectomy and control population, and b) the relationship between knee strength and muscle activity. METHODS Gait patterns and knee extension strength were assessed in 89 male arthroscopic partial meniscectomy patients and 30 age-matched healthy controls. Surface electromyography was recorded during walking from ten muscles that cross the knee. FINDINGS Compared to controls, the meniscectomy group displayed greater muscle activity while walking, with increased hamstrings activation, yet no difference in directed co-contraction. While controlling for age, no differences were found between meniscectomy subjects with weak and normal knee extension strength, in hamstrings activity, quadriceps activity or directed co-contraction. INTERPRETATION The generalised increase in non-directed muscle activity in the meniscectomy group may provide enhanced muscular support of larger-than-normal knee adduction moments. Higher levels of antagonist co-contraction may increase muscle forces and, subsequently, joint articular loads, contributing to the increased risk of developing knee osteoarthritis following arthroscopic partial meniscectomy.
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Affiliation(s)
- Daina L Sturnieks
- School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Australia.
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