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Ong MTY, Lu X, Choi BCY, Wan SW, Wang Q, Man GCW, Lui PPY, Fong DTP, Mok DKW, Yung PSH. Vitamin D as an intervention for improving quadriceps muscle strength in patients after anterior cruciate ligament reconstruction: study protocol for a randomized double-blinded, placebo-controlled clinical trial. Trials 2024; 25:251. [PMID: 38605374 PMCID: PMC11008016 DOI: 10.1186/s13063-024-08094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The goal of anterior cruciate ligament reconstruction (ACLR) is to restore the preinjury level of knee function to return to play (RTP). However, even after completing the rehabilitation programme, some patients may have persistent quadriceps muscle weakness affecting knee function which ultimately leads to a failure in returning to play. Vitamin D has been long recognized for its musculoskeletal effects. Vitamin D deficiency may impair muscle strength recovery after ACLR. Correcting vitamin D levels may improve muscle strength. METHODS This is a double-blinded, randomized controlled trial to investigate the effects of vitamin D supplementation during the post-operative period on quadriceps muscle strength in anterior cruciate ligament (ACL)-injured patients. Patients aged 18-50 with serum vitamin D < 20 ng/ml, unilateral ACL injury, > 90% deficit in total quadriceps muscle volume on the involved leg compared with uninvolved leg, Tegner score 7 + , and no previous knee injury/surgery will be recruited. To assess patient improvement, we will perform isokinetic and isometric muscle assessments, ultrasound imaging for quadriceps thickness, self-reported outcomes, KT-1000 for knee laxity, biomechanical analysis, and Xtreme CT for bone mineral density. To investigate the effect of vitamin D status on quadriceps strength, blood serum samples will be taken before and after intervention. DISCUSSION Patients with low vitamin D levels had greater quadriceps fibre cross-sectional area loss and impaired muscle strength recovery after ACL. The proposed study will provide scientific support for using vitamin D supplementation to improve quadriceps strength recovery after ACLR. TRIAL REGISTRATION ClinicalTrials.gov NCT05174611. Registered on 28 November 2021.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Xiaomin Lu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ben Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Siu-Wai Wan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, TU314, Block U, Hung Hom, Hong Kong SAR, China
| | - Qianwen Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Pauline Po-Yee Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Daniel Tik-Pui Fong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Daniel Kam-Wah Mok
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, TU314, Block U, Hung Hom, Hong Kong SAR, China.
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Anne-Sophie A, Penelle M, Clémence G, Berardis S, Goubau C, Reychler G, Gohy S. One year effect of tezacaftor and ivacaftor on functional exercise capacity and muscle strength in people with cystic fibrosis. Heliyon 2024; 10:e26729. [PMID: 38434346 PMCID: PMC10907658 DOI: 10.1016/j.heliyon.2024.e26729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background The 1-min sit-to-stand test (1STST) is a practical tool to evaluate physical capacity. The aim of this study was to assess the impact of tezacaftor and ivacaftor on functional exercise capacity, muscle strength and symptoms in people with cystic fibrosis (PwCF). Methods The assessments were performed during the first year of tezacaftor and ivacaftor using the 1STST, 6-min walk test (6MWT), MicroFET2 dynamometer®, CF Questionnaire-Revised (CFQ-R), Leicester Cough Questionnaire (LCQ). Forced expiratory volume in 1 s (FEV1), body mass index (BMI), pancreatic sufficiency status, genotype and microbiologic data were also collected. Results Fifty-four PwCF participated to the study and took at least one dose of tezacaftor-ivacaftor. Mean age was 26y±10 (±SD), median BMI 20.9 kg/m2 (interquartile range) (19.4; 23.5) and mean FEV1 82 percent of predicted values (%PV) ± 21. Significant correlations were found at baseline between the 1STST and the 6MWT (r = 0.617, p < 0.0001), the quadriceps strength (r = 0.6556, p < 0.0001) and the FEV1 (r = 0.29, p = 0.03). After one year of treatment, the 1STST increased significantly in terms of number of repetitions (n) (median 50 versus 58.5, p < 0.0001), %PV (101.1 versus 115.2%PV, p = 0.0003) and n times weight in kg (2885 versus 3389nxkg, p < 0.0001). The 6MWT distance and quadriceps strength were not modified after treatment but during the 6MWT, oxygen desaturation decreased significantly. FEV1, BMI, CFQ-R, LCQ improved as previously demonstrated. Conclusion After one year of tezacaftor and ivacaftor, the 1STST improves, suggesting that the 1STST seems more responsive than the 6MWT and the MicroFET2 dynamometer® to assess the effects of CFTR modulators.
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Affiliation(s)
- Aubriot Anne-Sophie
- Département de pédiatrie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Morgane Penelle
- Département de pédiatrie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gonçalvès Clémence
- Département de pédiatrie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Silvia Berardis
- Département de pédiatrie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Goubau
- Département de pédiatrie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Service de pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 54/B1-54.04, B-1200 Brussels, Belgium
| | - Sophie Gohy
- Cystic Fibrosis Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Service de pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 54/B1-54.04, B-1200 Brussels, Belgium
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Koyanagi M, Matsuo T, Nakae N, Okimoto R, Nobekawa S, Tsukuda H, Ogasawara I, Shino K. Leaf spring exercise: A safe quadriceps strengthening exercise after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 113:106213. [PMID: 38458001 DOI: 10.1016/j.clinbiomech.2024.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Leg extensions should be avoided in the early stages after anterior cruciate ligament reconstruction because the force exerted by the quadriceps muscle leads to anterior tibial displacement. To allow for safe quadriceps training in the knee extension range during this period, we devised the leaf spring exercise, which involves placing subjects in the prone position with their knee slightly flexed and instructing them to perform maximum isometric quadriceps contractions while supporting the proximal region of the lower leg's anterior surface and immobilizing the femur's posterior surface to prevent lifting. The current study aimed to examine the safety of Leaf spring exercise by determining the femur-tibia relationship using ultrasound imaging. METHODS This controlled laboratory study included patients with unilateral anterior cruciate ligament-deficient knees (8 men and 8 women; age, 24.2 ± 8.3 years) who were instructed to perform Leaf spring exercise of both lower limbs. We measured the femur-tibia-step-off, which indicates the distance between the last point of the medial and lateral condyles of the femur and posterior margin of the tibial plateau, as a parameter to evaluate anterior tibial displacement via ultrasound diagnostic device. Further, peak torque of the quadriceps muscle was calculated using force measurement device. FINDINGS No difference in anterior tibial displacement and peak torque was observed between the uninjured and injured sides during Leaf spring exercise. INTERPRETATION Leaf spring exercise may add some strain on the reconstructed anterior cruciate ligament; hence, it can be considered a safe quadriceps exercise in the knee extension range.
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Affiliation(s)
- Maki Koyanagi
- Faculty of Medical Science and Health-Promotion, Osaka Electro-communication University, 1130-70 Kiyotaki, Shijonawate, Osaka 575-0063, Japan.
| | - Takayuki Matsuo
- Osaka Yukioka College of Health Science, 1 Chome, 1-41 Sojiji, Ibaraki, Osaka 567-0801, Japan
| | - Naruhiko Nakae
- Department of Rehabilitation, Kansai Medical Hospital, 1 Chome-1-7-2 Shinsenri Nishimachi, Toyonaka, Osaka 560-0083, Japan
| | - Ryo Okimoto
- Department of Rehabilitation, Yokoi Health Care Sports Clinic, 1 Chome-1-31 Nishimidorigaoka, Toyonaka, Osaka 560-0005, Japan
| | - Shota Nobekawa
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Hideki Tsukuda
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2 Chome-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
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Pavão DM, de Sousa EB, Fogagnolo F, de Faria JLR, Titonelli VE, Gavilão UF, Laett CT, Cosich VRA. The optimized tourniquet versus no tourniquet in total knee arthroplasty. Analysis of muscle injury, functional recovery, and knee strength. J Orthop 2024; 48:72-76. [PMID: 38059212 PMCID: PMC10696425 DOI: 10.1016/j.jor.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Tourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet. Methods In a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05. Results Creatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments. Conclusions The optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use.
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Affiliation(s)
- Douglas Mello Pavão
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
- University of São Paulo –Ribeirão Preto Medicine School, Brazil
| | - Eduardo Branco de Sousa
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | | | - José Leonardo Rocha de Faria
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
- University of São Paulo –Ribeirão Preto Medicine School, Brazil
| | - Victor Elias Titonelli
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Ubiratã Faleiro Gavilão
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Conrado Torres Laett
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
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Li Z, Huang C, Leung KL, Huang J, Huang X, Fu SN. Strength and passive stiffness of the quadriceps are associated with patellar alignment in older adults with knee pain. Clin Biomech (Bristol, Avon) 2023; 110:106131. [PMID: 37925827 DOI: 10.1016/j.clinbiomech.2023.106131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Maintaining normal patellar alignment is important for knee health. Altered activation of individual quadriceps muscles have been found related to patellar alignment. However, the relationships between strength and passive stiffness of the quadriceps and patellar alignment remains unexplored. METHODS Participants aged between 60 and 80 years with activity-induced knee pain were recruited. Knee pain was quantified using an 11-point numeric rating scale. Quadriceps strength was assessed using a Cybex dynamometer and passive stiffness of rectus femoris, vastus lateralis, and vastus medialis were measured by shear-wave ultrasound elastography. Patellar alignments were assessed using MR imaging. Linear regression was used to examine relationships between quadriceps properties and patellar alignments with and without controlling for potential covariates. FINDINGS Ninety-two eligible participants were assessed (71.7% females, age: 65.6 ± 3.8 years; pain scale: 4.6 ± 2.0), most of whom had knee pain during stair climbing (85.9%). We found that 17% of patellar lateral tilt angle could be explained by lower quadriceps strength (adjusted R2 = 0.117; P < 0.001), especially in females (R2 = 0.281; P < 0.001; adjusted R2 = 0.211; P < 0.001). In addition, a higher stiffness ratio of vastus lateralis/medialis accounted for 12% of patellar lateral displacement (adjusted R2 = 0.112; P = 0.008). INTERPRETATION Quadriceps strength and relative stiffness of lateral to medial heads are associated with patellar alignment in older adults with knee pain. It suggests that quadriceps weakness and relatively stiffer lateral quadriceps may be risk factors related to patellar malalignments in the elderly.
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Affiliation(s)
- Zongpan Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kam Lun Leung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiebin Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiuping Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Khan ZM, Khalid M, Kumar S. Re. "Association between dietary diversity and sarcopenia in community dwelling older adults". Nutrition 2023; 114:112138. [PMID: 37499563 DOI: 10.1016/j.nut.2023.112138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Zoraiz Munir Khan
- Allama Iqbal Medical College, Lahore, Garden Town, Gujranwala, Pakistan.
| | - Mubashra Khalid
- Allama Iqbal Medical College, Lahore, Garden Town, Gujranwala, Pakistan
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College, Karachi
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Ueda Y, Matsushita T, Shibata Y, Takiguchi K, Ono K, Kida A, Nishida K, Nagai K, Hoshino Y, Matsumoto T, Sakai Y, Kuroda R. Combining age, sex, body mass index, sport level, and preoperative quadriceps strength improves the predictive ability of quadriceps strength recovery after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:4390-4398. [PMID: 37354214 PMCID: PMC10471663 DOI: 10.1007/s00167-023-07492-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE This study compared the predictive ability of each independent predictor with that of a combination of predictors for quadriceps strength recovery one year after anterior cruciate ligament (ACL) reconstruction. METHODS Patients who underwent primary ACL reconstruction using hamstring autografts were enrolled. Quadriceps strength, hamstring strength, and anterior tibial translation were measured, and the limb symmetry index (LSI) of the quadriceps and the hamstrings was calculated preoperatively and one year after surgery. Patients were classified into two groups according to the LSI of the quadriceps strength at one year postoperatively (≥ 80% or < 80%). Multivariate logistic regression analysis identified the independent predictors of quadriceps strength recovery, and the cut-off value was calculated using the receiver operating characteristic curve. A model assessing predictive ability of the combination of independent predictors was created, and the area under the curve (AUC) for each independent predictor was calculated by using the receiver-operating characteristic curves and the DeLong method. RESULTS Of the 646 patients, 414 (64.1%) had an LSI of at least 80% for quadriceps strength one year after surgery, and 232 patients (35.9%) had an LSI of < 80%. Age, sex, body mass index (BMI), preinjury sport level, and LSI of preoperative quadriceps strength were independently associated with quadriceps strength recovery one year after ACL reconstruction. The cut-off values were age: 22.5 years; sex: female; BMI: 24.3 kg/m2; preinjury sport level: no sport; and LSI of preoperative quadriceps strength: 63.3%. The AUC of the model assessing the predictive ability of the combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength was significantly higher (0.73) than that of similar factors of preoperative quadriceps strength (AUC: 0.63, 0.53, 0.56, 0.61, and 0.68, p < 0.01, respectively). CONCLUSION The combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength had a superior predictive ability for quadriceps strength recovery at one year after ACL reconstruction than these predictors alone. Multiple factors, including patient characteristics and preoperative quadriceps strength, should be considered when planning rehabilitation programs to improve quadriceps strength recovery after ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yuya Ueda
- Kobe University Graduate School of Health Sciences, Kobe, Japan
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan.
| | - Yohei Shibata
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Kohei Takiguchi
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Kumiko Ono
- Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Kida
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe, Hyogo, 650‑0017, Japan
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Rousseau AF, Dardenne N, Kellens I, Bornheim S, Misset B, Croisier JL. Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures. Intensive Care Med Exp 2023; 11:39. [PMID: 37394577 DOI: 10.1186/s40635-023-00523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one. METHODS AND RESULTS Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland-Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59-0.94) and the bias was - 0.49 N/Kg (limits of agreement: - 1.76-0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24-0.78), and the bias was - 0.53 N/Kg (limits of agreement: - 1.01-2.07 N/kg). CONCLUSIONS As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.
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Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium.
| | - Nadia Dardenne
- Biostatistics Center (B-STAT), University Hospital and University of Liège, Liège, Belgium
| | - Isabelle Kellens
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium
| | - Stephen Bornheim
- Department of Sport Sciences and Rehabilitation, University of Liège, Liège, Belgium
| | - Benoit Misset
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, Liège, Belgium
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Murakami R, Fukai A, Yoshitomi H, Honda E, Sanada T, Iwaso H. Quadriceps strength is an early indicator of return to competitive sports 1 year after anterior cruciate ligament reconstruction in adult amateur athletes. Eur J Orthop Surg Traumatol 2023; 33:361-366. [PMID: 34988722 DOI: 10.1007/s00590-021-03195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Return to sports is one of the important reasons why athletes with an anterior cruciate ligament (ACL) injury undergo surgery. There are few reports on return to sports among adult amateur athletes (individuals older than the college age who participate in competitive sports). This study aimed to investigate the return of adult amateur athletes to competitive sports 1 year after ACL reconstruction and to identify the indicators for return to competitive sports. METHODS Between January 2015 and December 2017, adult amateur athletes who underwent primary ACL reconstruction were retrospectively investigated. The rate of return to competitive sports 1 year after surgery was evaluated. The patients were categorized into two groups: return to sports group (R group) and non-return to sports group (N group). Pre- and postoperative range of motion, pivot-shift test, anteroposterior laxity, quadriceps strength, Lysholm score, and the International Knee Documentation Committee score were compared between the groups. RESULTS This study included 78 patients (48 men, 30 women; age range, 22-53 years). Five months after ACL reconstruction, quadriceps strength was significantly lower in the N group than in the R group, denoting muscle weakness in the N group at that time. No significant differences were found in the other items between the groups preoperatively and 1 year after surgery. CONCLUSION In this study, the rate of return to competitive sports of adult amateur athletes 1 year after ACL reconstruction was 76.9%. Quadriceps strength may be an early indicator of return to competitive sports 1 year after reconstruction.
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Norozian B, Arabi S, Marashipour SM, Khademi Kalantari K, Akbarzadeh Baghban A, Kazemi SM, Jamebozorgi AA. Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction. J Lasers Med Sci 2023; 14:e6. [PMID: 37089769 PMCID: PMC10114001 DOI: 10.34172/jlms.2023.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/17/2022] [Indexed: 04/25/2023]
Abstract
Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.
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Affiliation(s)
- Bahman Norozian
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Arabi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahta Marashipour
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedics hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Jamebozorgi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to Ali Asghar Jamebozorgi,
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11
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Ithurburn MP, Barenius B, Thomas S, Paterno MV, Schmitt LC. Few young athletes meet newly derived age- and activity-relevant functional recovery targets after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:3268-76. [PMID: 34762143 DOI: 10.1007/s00167-021-06769-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE National registry data have established Knee injury and Osteoarthritis Outcome Score (KOOS) functional recovery target values for adults after anterior cruciate ligament (ACL) reconstruction. However, the specificity of these target values for young athletes after ACL reconstruction is unclear. The purpose of this analysis was to (1) derive age- and activity-relevant KOOS functional recovery target values from uninjured young athlete data and (2) determine clinical measures at the time of RTS clearance associated with meeting the newly-derived functional recovery target values in young athletes following ACLR. METHODS Two hundred and twenty-two young athletes (56 uninjured controls, 17.2 ± 2.4 years, 73% female; 166 after ACL reconstruction, 16.9 ± 2.2 years, 68% female) were included in this cross-sectional analysis from a larger cohort study. Uninjured control participants completed the KOOS, and functional recovery target values were defined as the lower bound of the 95% confidence interval for KOOS subscales. ACL reconstruction participants completed testing within 4 weeks of return-to-sport clearance, including the KOOS, single-leg hop tests, and isometric quadriceps strength. In ACL reconstruction participants, logistic regression was used to determine predictors of meeting all KOOS functional recovery target values (primary outcome) among demographic/injury, hop, and strength data (α ≤ 0.05). RESULTS KOOS functional recovery target values for each subscale from uninjured athlete data were: Pain ≥ 94, Symptoms ≥ 92, Activities of Daily Living ≥ 97, Sport ≥ 92, and Quality-of-Life ≥ 92. At the time of return-to-sport clearance, ACL reconstruction participants met the KOOS functional recovery targets in the following proportions: Pain, 63%; Symptoms, 42%; Activities of Daily Living, 80%; Sport, 45%; Quality-of-Life, 24%; overall functional recovery (met all subscale targets), 17%. In ACL reconstruction participants, significant predictors of overall functional recovery (primary outcome) were: younger age, hamstring graft, pediatric ACL reconstruction, quadriceps strength limb-symmetry index > 90%, single-hop limb-symmetry index > 90%, and crossover-hop limb-symmetry index > 90%. CONCLUSIONS KOOS functional recovery target values derived from uninjured young athletes were higher than those previously reported. Small proportions of young athletes following recent RTS clearance after ACLR met these newly-derived functional recovery target values, and factors associated with meeting functional recovery target values included younger age, hamstring autograft and pediatric ACLR, and having > 90% LSI for quadriceps strength and single-leg hop tests. LEVEL OF EVIDENCE I.
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12
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Hardy S, Berardis S, Aubriot AS, Reychler G, Gohy S. One-minute sit-to-stand test is practical to assess and follow the muscle weakness in cystic fibrosis. Respir Res 2022; 23:266. [PMID: 36151560 DOI: 10.1186/s12931-022-02176-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quadriceps muscle weakness and reduced exercise tolerance are prevalent and associated with a worse prognosis in patients with cystic fibrosis (CF). The one-minute sit-to-stand test (1STST) has been proposed to evaluate functional exercise capacity and quadriceps strength. RESEARCH QUESTION The aim of the study was to verify the relationship between the 1STST and the maximal isometric voluntary contraction of the quadriceps (MVCQ) evaluated by the dynamometer in stable patients with CF and to evaluate the impact of intravenous (IV) antibiotherapy. METHODS Dynamometer and 1STST were performed in stable patients with CF at a routine visit, the admission and the discharge of an IV antibiotherapy. Patients wore an activity monitor during 72 h during IV treatment. RESULTS AND SIGNIFICANCE 51 stable patients with CF at a routine visit and 30 treated with IV antibiotherapy were recruited. In stable patients, the 1STST was reduced to a mean of 2101 nxkg (657-SD), representing a median of 79% (7; 142-min; max)) of the predicted values (%PV) as well as the MVCQ to 78.64 N-m (23.21; 170.34), representing 57%PV (26). The 1STST was correlated to MVCQ (r = 0.536; p < 0.0001) and lung function (r = 0.508; p = 0.0001). Over the IV antibiotherapy course, the 1STST improves significantly like lung function and body mass index while a positive trend for MVCQ was observed. The gain of 1STST was correlated to the change in MVCQ (r = 0.441; p = 0.02) and was significantly higher in hospitalized patients versus home therapy. The 1STST is a good alternative to the dynamometer to evaluate and assess muscular weakness for the routine visit and IV antibiotherapy.
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13
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Gong Z, Li J, He Z, Li S, Cao P, Ruan G, Zhang Y, Zeng Q, Chen R, Zheng P, Fan T, Zhao Y, Lu P, Zhu Z, Huang G. Quadriceps strength is negatively associated with knee joint structural abnormalities-data from osteoarthritis initiative. BMC Musculoskelet Disord 2022; 23:784. [PMID: 35978313 PMCID: PMC9382744 DOI: 10.1186/s12891-022-05635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the longitudinal associations between baseline quadriceps strength and knee joint structural abnormalities in knee osteoarthritis (KOA). METHODS This study is a longitudinally observational study based on Osteoarthritis Initiative (OAI) cohort, including men and women aged 45-79. Quadriceps strength was measured by isometric knee extension testing at baseline. Knee joint structural abnormalities, including cartilage damage, bone marrow lesions (BMLs), effusion-synovitis and Hoffa-synovitis, were evaluated by Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS) at baseline and 1-year follow-up. Generalized estimating equations were employed to examine the associations between quadriceps strength and knee structural abnormalities. All analyses were stratified by sex. RESULTS One thousand three hundred thirty-eight participants (523 men and 815 women) with a mean age of 61.8 years and a mean BMI of 29.4 kg/m2 were included in this study. For men, no significantly longitudinal association of quadriceps strength with structural abnormalities was detected. In contrast, quadriceps strength was significantly and negatively associated with changes in cartilage damage and BMLs in lateral patellofemoral joint (PFJ) (cartilage damage: OR: 0.91, 95% CI 0.84 to 0.99, P = 0.023; BMLs: OR: 0.85, 95% CI 0.74 to 0.96, P = 0.011) and effusion-synovitis (OR = 0.88, 95% CI 0.78 to 0.99, P = 0.045) among females longitudinally. Higher quadriceps strength was significantly associated with less progression of lateral PFJ cartilage damage, BMLs and effusion-synovitis in females. CONCLUSIONS Higher quadriceps strength was associated with changes in cartilage damage and BMLs within the lateral PFJ and effusion-synovitis among females, suggesting the potential protective role of quadriceps strength on joint structures in women.
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Affiliation(s)
- Ze Gong
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Jia Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zijun He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Shilin Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Haizhu District 510280, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Clinical Research Centre, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Haizhu District 510280, Guangzhou, Guangdong, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Rong Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Peng Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Tao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Yijin Zhao
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Pengcheng Lu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Haizhu District 510280, Guangzhou, Guangdong, China.
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China. .,School of Rehabilitation Medicine, Southern Medical University, Haizhu District, 510280, Guangzhou, China.
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14
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Hipsley A, Hall M, Saxby DJ, Bennell KL, Wang X, Bryant AL. Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:1949-1957. [PMID: 34997247 DOI: 10.1007/s00167-021-06853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. METHODS The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. RESULTS In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. CONCLUSION Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony Hipsley
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.
| | - Michelle Hall
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Gold Coast, Australia.,Gold Coast Orthopaedic Research and Education Alliance, Gold Coast, Australia
| | - Kim L Bennell
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Xinyang Wang
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Beijing Chao-Yang Hospital, Beijing, China
| | - Adam L Bryant
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
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15
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Cristiani R, Forssblad M, Edman G, Eriksson K, Stålman A. Age, time from injury to surgery and hop performance after primary ACLR affect the risk of contralateral ACLR. Knee Surg Sports Traumatol Arthrosc 2022; 30:1828-1835. [PMID: 34617125 PMCID: PMC9033698 DOI: 10.1007/s00167-021-06759-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate factors affecting the risk of contralateral anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR. METHODS Primary ACLRs performed at Capio Artro Clinic, Stockholm, Sweden, during the period 2005-2014, were reviewed. The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for contralateral ACLR. RESULTS A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age ≥ 25 years, BMI ≥ 25 kg/m2, time from injury to surgery ≥ 12 months and the presence of a cartilage injury reduced the odds, whereas female gender, pre-injury Tegner activity level ≥ 6, quadriceps and hamstring strength and a single-leg-hop test LSI of ≥ 90% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age ≥ 25 years (OR 0.40; 95% CI 0.28-0.58; P < 0.001), time from injury to surgery ≥ 12 months (OR 0.48; 95% CI 0.30-0.75; P = 0.001) and a single-leg-hop test LSI of ≥ 90% (OR 1.56; 95% CI 1.04-2.34; P = 0.03). CONCLUSION Older age (≥ 25 years) and delayed primary ACLR (≥ 12 months) reduced the odds, whereas a symmetrical (LSI ≥ 90%) 6-month single-leg-hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Edman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden
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16
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Potts G, Reid D, Larmer P. The effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction: A systematic review. Phys Ther Sport 2021; 54:16-28. [PMID: 34933208 DOI: 10.1016/j.ptsp.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES to evaluate the effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction. DESIGN Systematic review. METHODS a systematic review was undertaken, included studies were evaluated using the Modified Downs and Black checklist which is appropriate for determining the quality of randomised and non-randomised studies. Scientific databases searched included PubMED, EBSCO Health, CINAHL, Medline, and Cochrane Library databases from inception to March 2021. RESULTS Ten studies met the inclusion criteria. There were six randomised studies and four prospective studies. The level of evidence is categorised as 'limited' due to heterogenicity and only six studies reported quadriceps strength increases. Five studies demonstrated preoperative exercise of 4-16 weeks duration can significantly increase preoperative quadriceps strength. One study demonstrated preoperative OKC exercise produced significantly stronger preoperative quadriceps compared to CKC exercise. One study showed no between group (intervention vs control) quadriceps strength difference pre or 12 weeks postoperatively. CONCLUSIONS 4-16 weeks of preoperative exercise could increase quadriceps strength preoperatively but any persistent postoperative strength benefit from undertaking a standardised preoperative intervention is unclear. There is considerable variation and methodological limitations across the included studies and the composition of optimal preoperative ACLR exercise is currently unknown.
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Affiliation(s)
- Geoff Potts
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand; KneeCare, 5 Akoranga Drive, Northcote, 0627, Auckland, New Zealand.
| | - Duncan Reid
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Peter Larmer
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
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17
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Felson D, Rabasa G, Jafarzadeh SR, Nevitt M, Lewis CE, Segal N, White DK. Factors associated with pain resolution in those with knee pain: the MOST study. Osteoarthritis Cartilage 2021; 29:1666-1672. [PMID: 33901642 PMCID: PMC9444184 DOI: 10.1016/j.joca.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine how many persons with knee pain have subsequent pain resolution and what factors are associated with resolution, focusing especially on types of physical activity. METHODS Using data from MOST, an NIH funded longitudinal cohort study of persons with or at risk of knee osteoarthritis, we studied participants who at baseline reported knee pain on most days at both a telephone interview and clinic visit. We defined pain resolution if at 30 and 60 month exams, they reported no knee pain on most days and compared these participants to those who reported persistent pain later. In logistic regression analyses, we examined the association of baseline risk factors including demographic factors, BMI, depressive symptoms, isokinetic quadriceps strength and both overall physical activity (using the PASE survey) and specific activities including walking, gardening, and different intensities of recreational activities with pain resolution. RESULTS Of 1,304 participants with knee pain on most days at baseline, 265 (20.3%) reported no knee pain at 30 and 60 months. Lower BMI and stronger quadriceps were associated with higher odds of pain resolution while overall physical activity was not. Of activities, walking decreased the odds of pain resolution (adjOR = 0.86 (95% CI 0.76, 0.98)), but gardening (adjOR = 1.59 (1.16, 2.18)) and moderate intensity recreational activities ((adjOR = 1.24 (1.05, 1.46)) increased it. CONCLUSION Pain resolution is common in those with knee pain. Factors increasing the odds of pain resolution include lower BMI, greater quadriceps strength and gardening and moderately intensive recreational activities.
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Affiliation(s)
- D Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA; University of Manchester and the NIHR, Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - G Rabasa
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - S R Jafarzadeh
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - M Nevitt
- University of California at San Francisco, San Francisco, CA, USA
| | - C E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Segal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware Newark, DE, USA; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
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18
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Ference D, Ference RJ, Rempher E, Freeman DC. Total knee arthroplasty patients using the in-home X10 machine fully recovered. No additional therapy required. J Orthop 2021; 27:79-83. [PMID: 34588742 DOI: 10.1016/j.jor.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022] Open
Abstract
Following total knee arthroplasties patients using the X10 increased their quadriceps strength 120% at 30 days post-surgery compared to their pre-surgical baseline. This contrasts sharply with contrast studies outpatient physical therapy that show patients suffer a 50-60% quadriceps strength deficit at 30 days post-surgery. For X10 patients, the average range of motion at 30 days was 124° and at discharge it was 128° (mean 43 days). The trial involved a single surgeon and two groups. Group one (21 patients) used only the X10 for pre-habilitation and rehabilitation, while group two (20 patients) used X10 alone for pre-habilitation and then utilized the X10 plus home care plus outpatient physical therapy for rehabilitation. Adding home care and outpatient physical therapy did not improve outcomes compared to patients who utilized X10 alone. Our results show no significant difference between the two groups. Indicating that the X10 by itself is adequate to completely rehabilitation patients from total knee arthroplasties. Finally, we compared our results to those of Calatayud et al.1 who monitored two groups of patients, one group had only physical therapy for rehabilitation while the other group used physical therapy for both prehabilitation and rehabilitation. Our results were superior to Calatayud et al.1 for extension, flexion, and quadriceps strength; for each of these measures the X10 treatment groups improved over time, while the Calatayud et al.1 groups showed losses.
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Affiliation(s)
- Daisy Ference
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | | | | | - D Carl Freeman
- Department of Biological Science, Wayne State University, Detroit, MI, 48202, USA
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19
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Roman DP, Ness BM, Giampetruzzi N, Cleland JA, Weaver A. Knee strength outcomes in adolescents by age and sex during late-stage rehabilitation after anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 51:102-109. [PMID: 34311174 DOI: 10.1016/j.ptsp.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine if knee strength differences exist according to age group and sex among adolescents during late-stage anterior cruciate ligament reconstruction (ACLR) rehabilitation. DESIGN Retrospective cohort study. METHODS Consecutive patients who had undergone ACLR with a hamstring autograft completed isokinetic knee strength assessment. Patients were categorized into early (ages 11-14 years) and middle (ages 15-17 years) adolescence. A two-way MANOVA was used to examine strength differences according to age group and sex. RESULTS 144 patients were included in the analysis (56.9% females, age = 15.3 ± 1.5 years; days since surgery = 228.2 ± 41.2). Differences in quadriceps peak torque were identified between age groups on the involved (p = 0.001) and uninvolved limbs (p < 0.001), however, no differences in quadriceps peak torque were found between age groups when normalized to body mass (p = 0.16-0.49). Differences between groups according to sex were identified for each strength outcome (p < 0.01), with decreased normalized quadriceps (12-13%) and hamstring (13-16%) peak torque for females. No interactions between age group and sex were noted, F(8, 133) = 1.48, p = 0.17. CONCLUSION Early adolescents produced less quadriceps and hamstring peak torque compared to middle adolescents after ACLR. No differences were found between age groups when normalized to body mass.
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Affiliation(s)
- Dylan P Roman
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, United States.
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, United States
| | | | - Joshua A Cleland
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, United States
| | - Adam Weaver
- Connecticut Children's, Sports Physical Therapy, Farmington, CT, United States
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Nishino K, Koga H, Koga Y, Tanaka M, Nawata A, Endoh K, Arakawa M, Omori G. Association of isometric quadriceps strength with stride and knee kinematics during gait in community dwelling adults with normal knee or early radiographic knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 84:105325. [PMID: 33770532 DOI: 10.1016/j.clinbiomech.2021.105325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Identifying indicators of early knee osteoarthritis is important for preventing the onset and/or progression of the disease. Although low quadriceps strength and changes in stride and knee kinematics during gait have been suggested as possible indicators, their relevance and relationships have not been fully examined. This study aimed to analyze the association of quadriceps strength with stride and knee kinematics during gait in adults with normal knee or early knee osteoarthritis. METHODS A total of 881 knees from 474 community dwelling adults (238 males and 236 females) were included. Radiographic images of the knee in standing position were obtained, and grading of knee osteoarthritis was classified. Isometric quadriceps strength was measured using a force detector device. Three-dimensional knee kinematics during gait was obtained by a motion capture system. Sex-based difference of quadriceps strength, stride and knee kinematics during gait was evaluated by multiple comparison among grades by sex and multiple regression of quadriceps strength was analyzed by stride and knee kinematics during gait. FINDINGS Stride length and quadriceps strength were significantly reduced with higher grade in both sexes, and changes in knee kinematics during gait differed by sex from early knee osteoarthritis. Quadriceps strength in both sexes was significantly correlated with changes in stride length and knee kinematics during gait. INTERPRETATION Improving quadriceps strength in early knee osteoarthritis was related with maintaining gait ability and restraining abnormal knee kinematics during gait. This may help to develop clinical approaches to prevent the onset and/or progression of knee osteoarthritis.
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Affiliation(s)
- Katsutoshi Nishino
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan.
| | - Hiroshi Koga
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata city, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopedic Surgery, Ninohji Onsen Clinic, 452Toramaru, Shibata city, Niigata, Japan
| | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan
| | - Atsushi Nawata
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata city, Niigata, Japan
| | - Kazuo Endoh
- Department of Health and Nutrition, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city, Niigata, Japan
| | - Masaaki Arakawa
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city, Niigata, Japan
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Wongsak S, Chulsomlee K, Jarungvittayakon C, Jaovisidha S, Sa-Ngasoongsong P. Is continuous locking suture with braided suture sufficient for arthrotomy repair in the conventional TKR? A randomized controlled trial study. J Orthop 2021; 24:47-53. [PMID: 33679027 DOI: 10.1016/j.jor.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Medial-parapatellar-arthrotomy is the standard approach for total knee replacement(TKR). No studies have clarified the outcomes as quadriceps-strength-recovery (QS) and safety of Continuous-locking-suture-technique(CLS) for the arthrotomy-repair. Methods Patients were randomly assigned into a CLS(n = 40) and an interrupted-horizontal-mattress(IHM, n = 40). QS, visual-analog-scale(VAS), modified-timed-up-and-go(TUGT) test, Western-Ontario-and McMasters-Universities-Osteoarthritis-Index[WOMAC] and Knee-Society-Score[KSS] were followed for 6 months’. Results A significantly-shorter capsular-closure-time in CLS(233 ± 40 VS 388 ± 47 sec)(p < 0.0001). There were insignificant difference in QS, VAS, TUGT, WOMAC and KSS during the 6-month follow-up period(p > 0.05 all). No wound complications were found. Conclusion CLS with braided-suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to IHM. Trial registration This study was registered in Thai Clinical Trials Registry on December 2015 (https://www.clinicaltrials.in.th). The registration number was TCTR20151208003.
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Ohji S, Aizawa J, Hirohata K, Ohmi T, Mitomo S, Koga H, Yagishita K. Single-leg hop can result in higher limb symmetry index than isokinetic strength and single-leg vertical jump following anterior cruciate ligament reconstruction. Knee 2021; 29:160-166. [PMID: 33631644 DOI: 10.1016/j.knee.2021.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/18/2020] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND A single-leg vertical jump height (SLVJ) may reflect knee extension strength more than a single-leg hop for distance (SLH). This study aimed to examine the relationships between the isokinetic knee extension torque, SLH, and SLVJ after anterior cruciate ligament reconstruction (ACLR). METHODS Forty-four patients post-ACLR (median 12.0 months) participated in the study. The isokinetic knee extension peak torque at 60°/s and 180°/s (Ext 60, 180), SLH, and SLVJ were measured. The limb symmetry index (LSI) was calculated as the ratio of the operated side to the unoperated side. RESULTS There were moderate-to-strong positive correlations between isokinetic knee extension torque and both SLH (r = 0.72-0.77, P < 0.001) and SLVJ (r = 0.73-0.79, P < 0.001). Significant side-to-side differences in isokinetic knee extension torque and SLVJ between the operated and unoperated sides were found (P < 0.05), but not for SLH (P = 0.065). The results of the analysis of variance (ANOVA) and post hoc analyses showed that the LSI of SLH (98.2%) was higher than that of the LSI of Ext 180 and SLVJ (P < 0.05). Fisher's exact test showed a significant relationship between the LSI of Ext 180 and that of SLVJ (cut-off 85%; P = 0.041). No patients had LSI < 85% in SLH. CONCLUSIONS Even though SLH asymmetry improved approximately 12 months after ACLR, the asymmetry of isokinetic knee extension torque and SLVJ remained. The LSI of SLVJ could be an indicator of the recovery of isokinetic knee extension torque.
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Affiliation(s)
- Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Junya Aizawa
- Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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Cristiani R, Mikkelsen C, Wange P, Olsson D, Stålman A, Engström B. Autograft type affects muscle strength and hop performance after ACL reconstruction. A randomised controlled trial comparing patellar tendon and hamstring tendon autografts with standard or accelerated rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29:3025-3036. [PMID: 33128587 PMCID: PMC8384829 DOI: 10.1007/s00167-020-06334-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE To evaluate and compare changes in quadriceps and hamstring strength and single-leg-hop (SLH) test performance over the first 24 postoperative months in patients who underwent anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autografts and followed either a standard or an accelerated rehabilitation protocol. METHODS A total of 160 patients undergoing ACLR were randomised in four groups depending on the graft that was used and the rehabilitation protocol (40 BPTB/standard rehab, 40 BPTB/accelerated rehab, 40 HT/standard rehab, 40 HT/accelerated rehab). Isokinetic concentric quadriceps and hamstring strength at 90°/s and the SLH test performance were assessed preoperatively and 4,6,8,12 and 24 months postoperatively. The results were reported as the limb symmetry index (LSI) at the same time point. Linear mixed models were used to compare the groups at the different time points. RESULTS An average quadriceps strength LSI of 78.4% was found preoperatively. After ACLR, the LSI first decreased at 4 months and then increased from 6 to 24 months, reaching an overall value of 92.7% at the latest follow-up. The BPTB group showed a significantly decreased LSI at 4, 6, 8 and 12 months compared with the HT group. No significant differences between the graft groups were found at 24 months. An average hamstring strength LSI of 84.6% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months in the BTPB group. In the HT group, the LSI first decreased at 4 months and then increased from 6 to 24 months. An LSI of 97.1% and 89.1% was found at the latest follow-up for the BPTB and the HT group, respectively. The HT group showed a significantly decreased LSI at all follow-ups compared with the BPTB group. An average SLH test LSI of 81% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months, reaching 97.6% overall at the latest follow-up. The BPTB group showed a significantly decreased LSI only at 4 months postoperatively compared with the HT group. No significant differences in any of the three tests were found between the standard and accelerated rehabilitation groups for either of the graft groups at any time point. CONCLUSION Muscle strength and SLH test performance recovered progressively after ACLR overall, but they did not all fully recover, as the injured leg performed on average less than 100% compared with the uninjured leg even 24 months postoperatively. After ACLR, inferior quadriceps strength and a poorer SLH test performance were found at 4, 6, 8 and 12 months and at 4 months, respectively, for the BTPB group compared with the HT group. Persistent, inferior hamstring strength was found at all postoperative follow-ups in the HT group. Rehabilitation, standard or accelerated, had no significant impact on the recovery of muscle strength and SLH test performance after ACLR in any of the graft groups. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. .,Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Christina Mikkelsen
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
| | - Peter Wange
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,Aleris Sports Medicine and Orthopedics Sabbatsberg, Crafoords väg 6, 11382 Stockholm, Sweden
| | - Daniel Olsson
- Unit of Medical Statistics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
| | - Björn Engström
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
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Cristiani R, Forssblad M, Edman G, Eriksson K, Stålman A. Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:4154-62. [PMID: 33661322 DOI: 10.1007/s00167-021-06517-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/19/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify preoperative, intraoperative and postoperative factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 2 years of primary ACLR. METHODS Patients who underwent primary ACLR at our institution, from January 2005 to March 2017, were identified. The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side-to-side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for revision ACLR. RESULTS A total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age < 25 years, BMI < 25 kg/m2, time from injury to surgery < 12 months, pre-injury Tegner activity level ≥ 6, LM repair, STS laxity > 5 mm, quadriceps strength and single-leg-hop test LSI of ≥ 90% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age < 25 years (OR 6.25; 95% CI 3.57-11.11; P < 0.001), time from injury to surgery < 12 months (OR 2.27; 95% CI 1.25-4.17; P = 0.007) and quadriceps strength LSI of ≥ 90% (OR 1.70; 95% CI 1.16-2.49; P = 0.006). CONCLUSION Age < 25 years, time from injury to surgery < 12 months and 6-month quadriceps strength LSI of ≥ 90% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery. LEVEL OF EVIDENCE III.
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Wada O, Yamada M, Kamitani T, Mizuno K, Kurita N. The associations of phase angle with the structural severity and quadriceps strength among patients with hip osteoarthritis: the SPSS-OK study. Clin Rheumatol 2020; 40:1539-1546. [PMID: 32996070 DOI: 10.1007/s10067-020-05419-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION/OBJECTIVES This study examined whether phase angle (PhA) is associated with hip osteoarthritis (HOA) severity and quadriceps strength in patients with HOA. METHOD A series of 549 patients with HOA, obtained from the Screening for People Suffering Sarcopenia in the Orthopedic cohort of Kobe study, were analyzed. PhA and quadriceps strength were measured using bioelectrical impedance analysis and a handheld dynamometer, respectively. The HOA severity was graded using the Kellgren-Lawrence radiographic scale. We estimated (1) mean differences in PhA by differences in HOA severity and (2) mean differences in quadriceps strength by differences in PhA using general linear models. RESULTS The patients' mean age was 64.9 years, and 85% were women. A decreasing trend of PhA associated with increasing HOA severity was observed (P for trend < 0.001). PhA was statistically associated with a decrease in HOA grade 4 compared with that associated with HOA grade 1 (mean difference, - 0.40°; 95% confidence interval (CI), - 0.51° to - 0.30°). PhA per leg was associated with greater quadriceps strength per leg independent of age, sex, leg muscle mass, and HOA severity (mean difference per 1° increase, 3.80 Nm; 95% CI, 0.93 to 6.66). There was insufficient evidence of any difference in the association between PhA and quadriceps strength by HOA severity and sex (P for interaction = 0.07 and 0.06, respectively). CONCLUSIONS PhA gradually decreased with increasing HOA severity, especially in patients with end-stage HOA. Paying close attention to PhA might provide a key to increasing quadriceps strength, regardless of HOA severity. Key Points • PhA gradually decreased with progression of HOA, particularly in patients with end-stage HOA. • PhA was positively associated with quadriceps strength, regardless of HOA severity. • PhA could be one of the indicators of quadriceps strength in patients with HOA.
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Affiliation(s)
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan. .,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan. .,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
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Everhart JS, Hughes L, Abouljoud MM, Swank K, Lewis C, Flanigan DC. Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:1894-900. [PMID: 31317214 DOI: 10.1007/s00167-019-05628-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether femoral nerve blockade (FNB) at the time of primary ACL reconstruction is associated with meeting isokinetic extension strength return to sport criteria near completion of physical therapy and whether FNB affects 1-year or 2-year risk of ipsilateral ACL graft rupture or contralateral native ACL injury. METHODS Three-hundred and sixty patients (n = 244 with FNB, n = 116 no FNB) underwent primary ACL reconstruction. All patients completed rehabilitation and underwent functional strength testing towards the end of knee rehabilitation (mean 5.6 months post-surgery). Association between FNB and isokinetic extension strength limb symmetry index (LSI) (goal LSI ≥ 90% for return to sport) as well as risk of recurrent ACL injury within first or second year after surgery was evaluated. RESULTS Ipsilateral or contralateral ACL injury within 2 years occurred in 11.2% of patients with FNB and 5.7% without FNB (p = 0.01). Patients with FNB had higher incidence of ipsilateral graft rupture within the first year after surgery but no difference in graft rupture during the second. Two-year risk of contralateral ACL injury was similar in both groups. At the time of initial testing, patients who received FNB had lower fast isokinetic extension LSI versus patients without FNB and were less likely achieve a goal ≥ 90% LSI; slow extension LSI was unaffected. CONCLUSION Use of FNB at the time of primary ACL reconstruction can negatively affect achievement of isokinetic extension strength return to sport criteria. FNB increases risk of graft rupture within the first year after surgery but does not affect re-injury risk during the second. FNB may not be appropriate for use in patients already at high risk of ACL re-injury. LEVEL OF EVIDENCE III.
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Kline PW, Jacobs CA, Duncan ST, Noehren B. Step descent strategy is altered bilaterally despite unilateral muscle strength impairment after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1508-15. [PMID: 31201440 DOI: 10.1007/s00167-019-05554-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Muscle weakness and difficulty descending stairs are common after unilateral total knee arthroplasty (TKA), but the relationship between each is unclear. The purpose of this study was to compare lower extremity muscle strength, lower extremity support moments during step descent, and assess relationships between each. METHODS The study included 40 subjects (20 post-TKA, 20 control). Knee extensor, hip abductor, and hip external rotator strength were measured and biomechanical analyses of step descent performed. Patients with TKA were assessed 3 and 6 months post-surgery. RESULTS At 3 and 6 months post-TKA, operated limb hip external rotator and knee extensor strength were impaired compared to the non-operated limb (p < 0.01); however, no between-limb differences were observed during step descent. Compared to the control group, hip external rotator and knee extensor strength, total lower extremity support moment, and knee support moment during step descent were impaired post-TKA (p < 0.05). At 6 months post-TKA, knee extensor and hip external rotator strength correlated with total support moment during step descent (rs = 0.40, 0.41, p < 0.02). Hip abductor and external rotator strength negatively correlated with knee support moment during step descent (rs = - 0.35, - 0.39, p < 0.03). CONCLUSIONS Persistent operative limb knee extensor and hip external rotator muscle weakness are noted following unilateral TKA. Despite unilateral weakness, bilateral alterations in step descent strategy occur following TKA. Patients with TKA utilize hip musculature to reduce knee muscle demand during step descent, possibly contributing to limitations in long-term step descent performance.
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Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Toyabe SI. Association of knee osteoarthritis grade with one-leg standing balance and quadriceps strength in male independent ambulators aged ≥80 years. J Orthop 2020; 21:79-83. [PMID: 32255985 DOI: 10.1016/j.jor.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background One-leg standing (OLS) balance is an important predictor of falls in people of advanced age. In this population, muscle weakness and knee osteoarthritis also contribute to falls and resultant fractures and thereby affect mortality rates. The Kellgren-Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. This study was performed to evaluate OLS balance and the quadriceps strength (QS) for each KL grade and to clarify the impact of the knee osteoarthritis grade on OLS balance and QS. Hypothesis OLS balance shows results compatible with those of previous reports when independent walking is possible because of maintenance of QS regardless of the OA grade. Methods This single-center prospective cross-sectional study included data on 106 male orthopedic patients (106 knees) aged ≥80 years who could walk independently. OLS balance with eyes open was assessed using the patient's preferred leg. A handheld dynamometer was used to measure QS. The ratio of muscle strength to body weight (QS/BW ratio) was used to evaluate outcomes. Weight-bearing standing knee radiographs were evaluated using the KL classification. OLS balance and the QS/BW ratio were evaluated for each KL grade, and the correlations of the KL grade with OLS balance and the QS/BW ratio were assessed simultaneously. Results For each KL grade, the number of participants (n), median OLS balance (seconds), and QS/BW ratio (N/kg) were as follows: grade I: 24, 12, and 4.9; grade II: 51, 14, and 5.2; grade III: 22, 14, and 4.9; and grade IV: 9, 26, and 5.7, respectively. There were no significant differences in either OLS balance or the QS/BW ratio among the four grades. Conclusions Participants exhibited good OLS balance and QS/BW ratio regardless of their KL grade. This study demonstrated an absence of correlations of the KL grade with OLS balance and the QS/BW ratio, as was previously reported for the KL grade and pain. Level of evidence Level II prospective study.
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Cristiani R, Mikkelsen C, Edman G, Forssblad M, Engström B, Stålman A. Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:369-80. [PMID: 31230125 DOI: 10.1007/s00167-019-05576-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/17/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the percentage of patients achieving an acceptable symptom state 2 years after primary anterior cruciate ligament reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort. METHODS Patients who underwent primary ACLR at Capio Artro Clinic, Stockholm, Sweden, from 2005 to 2015, were identified in our clinic registry. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at the 2-year follow-up were included. The primary outcome was the achievement of a patient-acceptable symptom state (PASS) for each KOOS subscale. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury, the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair and the recovery of 6-month symmetrical (limb symmetry index [LSI] of ≥ 90%) isokinetic quadriceps or hamstring strength and single-leg-hop test performance were factors associated with the achievement of a PASS for each KOOS subscale. RESULTS A total of 2335 primary ACLRs were included. More than 60% of the patients reported a PASS on four of the five KOOS subscales. Age ≥ 30 years and an LSI of ≥ 90% for 6-month isokinetic quadriceps strength increased the odds of achieving a PASS across all KOOS subscales. Female gender reduced the odds of achieving a PASS on the Pain (OR 0.76; 95% CI 0.62-0.94; P = 0.01), activities of daily living (ADL) (OR 0.79; 95% CI 0.64-0.97; P = 0.02) and sport and recreation (OR 0.72; 95% CI 0.58-0.89; P = 0.003) subscales. The presence of an MM repair reduced the odds of achieving a PASS on the Pain (OR 0.59; 95% CI 0.36-0.96; P = 0.03) subscale. Hamstring tendon (HT) autograft rather than bone-patellar tendon-bone (BPTB) autograft showed increased odds (OR 2.02; 95% CI 1.31-3.10; P = 0.001), whereas a cartilage injury showed reduced odds (OR 0.73; 95% CI 0.55-0.97; P = 0.03) of achieving a PASS on the sport and recreation subscale. An LSI of ≥ 90% for 6-month single-leg-hop test performance increased the odds of achieving a PASS on the ADL (OR 1.37; 95% CI 1.09-1.71; P = 0.005), Sport and Recreation (OR 1.40; 95% CI 1.11-1.77; P = 0.004), and quality of life (OR 1.28; 95% CI 1.00-1.63; P = 0.04) subscales. CONCLUSION More than 60% of the patients reported an acceptable symptom state on four of the five KOOS subscales 2 years after primary ACLR. Age ≥ 30 years and female gender were the non-modifiable factors that consistently increased and reduced, respectively, the odds of achieving a PASS. A symmetrical 6-month isokinetic quadriceps strength and single-leg-hop test performance were the modifiable factors that consistently increased the opportunity of achieving a PASS 2 years after primary ACLR. LEVEL OF EVIDENCE III.
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Wada O, Kurita N, Kamitani T, Mizuno K. Implications of evaluating leg muscle mass and fat mass separately for quadriceps strength in knee osteoarthritis: the SPSS-OK study. Clin Rheumatol 2020; 39:1655-61. [PMID: 31889244 DOI: 10.1007/s10067-019-04879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/16/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the influence of obesity on quadriceps strength by separately analyzing body mass index (BMI) as fat mass and leg muscle mass in patients with knee osteoarthritis (KOA). METHODS The Screening for People Suffering Sarcopenia in Orthopedic cohort of Kobe (SPSS-OK) study was a single-center cross-sectional study that recruited 906 patients with KOA. Fat mass and leg muscle mass were measured by bio-impedance. Isometric knee extension torque (Nm) was measured as quadriceps strength. A series of general linear models were fitted to estimate the continuous associations of BMI and fat mass with quadriceps strength, with adjustment of confounders. In the fitted models, both BMI and fat mass were treated as restricted cubic spline functions. RESULTS A continuous, non-linear relationship between BMI and quadriceps strength was found (P = 0.008 for non-linearity). In patients with a BMI of 16-25 kg/m2, increasing quadriceps strength was observed. However, in patients with a BMI of 25-40 kg/m2, quadriceps strength seemed similar. Additionally, an inverted U-shaped relationship between fat mass and quadriceps strength was demonstrated (P = 0.04 for non-linearity). In those with a fat mass of 10-20 kg, increasing quadriceps strength was seen. However, in patients with a fat mass of 20-30 kg, quadriceps strength showed a decreasing trend. Independent of fat mass, leg muscle mass was linearly associated with greater quadriceps strength. CONCLUSION Our study suggests that there are independent associations between the leg muscle mass, fat mass, and quadriceps strength. It is difficult to easily predict quadriceps strength using only BMI. KEY POINTS • An increase in body mass index (BMI) up to 25 kg/m2was associated with increasing quadriceps strength. • Quadriceps strength remained almost unchanged among patients with a BMI of > 25 kg/m2. • The association between fat mass and quadriceps strength had an inverted U-shaped relationship, suggesting the importance of the separate assessment of fat mass and muscle mass in patients with knee osteoarthritis, especially those who are overweight or obese.
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Kittichaikarn C, Kuptniratsaikul V. Design of an Underwater Treadmill System for rehabilitation of older obese adults: a pre-post study. BMC Geriatr 2019; 19:310. [PMID: 31727018 PMCID: PMC6854739 DOI: 10.1186/s12877-019-1334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with knee osteoarthritis (OA) who are obese have problems performing land-based exercises. The reduced joint stress associated with aquatic exercise may benefit these patients. This study aimed to develop an underwater treadmill (UTM) machine that is affordable and suitable for use in developing countries, and to evaluate its efficacy in decreasing pain and increasing functional improvement. Methods Clinical testing of the UTM machine was performed in an outpatient setting at Siriraj Hospital during January–June 2017. Patients with knee OA, aged 50–85 years, numerical rating scale (NRS) ≥5/10, and body mass index (BMI) ≥25 kg/m 2 were recruited. The UTM exercise protocol was 30 min/session, 3 days/week, for 4 weeks. The main outcomes were NRS pain score, 6-min walk distance (6MWD), quadriceps strength (QS) and body weight. Those outcomes were evaluated at baseline and at week 4. Results The UTM was constructed with safety, ergonomically designed and user-friendly control panel with push button for emergency stopping. Thirty patients were included for clinical testing. The mean age was 62.8 years, and almost all were female. The mean BMI was 28.9 kg/m 2. Most patients (65.0%) developed bilateral knee OA, used pain medication (56.7%), and engaged in regular knee exercise (73.3%). Of the 30 enrolled patients, 6 withdrew. All of the remaining 24 patients attended all 12 sessions. The mean difference between baseline and the end of the study was − 2.3 (95% CI: − 3.0, − 1.5; p < 0.001) for NRS pain; 34.9 m (95% CI: 14.1, 55.8; p = 0.002) for 6MWD; and, 1.8 kg (95% CI, 1.1, 2.6; p < 0.001) for QS. Concerning adverse events, 4 patients (15.4%) developed muscle pain, 2 patients (7.7%) had joint pain, and 1 patient (3.9%) withdrew due to severe knee pain. Two-thirds of patients described themselves as being ‘very satisfied’ with UTM exercise, and approximately 90% of participants rated their symptoms as ‘improved’ or ‘much improved’. Conclusions 4-week exercise with UTM can significantly improve NRS pain, 6MWD, and QS. UTM could be an alternative treatment for patients with knee OA who are obese due to small size, durability, and ecofriendly design as an exercise modality.
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Affiliation(s)
- C Kittichaikarn
- Chawalit Kittichaikarn Department of Mechanical Engineering, Faculty of Engineering, Kasetsart University, 50 Ngam Wong Wan Road, Jatujak, Bangkok, 10900, Thailand
| | - V Kuptniratsaikul
- Vilai Kuptniratsaikul Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Shi H, Huang H, Ren S, Yu Y, Liang Z, Wang Q, Hu X, Ao Y. The relationship between quadriceps strength asymmetry and knee biomechanics asymmetry during walking in individuals with anterior cruciate ligament reconstruction. Gait Posture 2019; 73:74-79. [PMID: 31302335 DOI: 10.1016/j.gaitpost.2019.07.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/16/2019] [Accepted: 07/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity movement asymmetries may lead to re-injury and knee osteoarthritis after anterior cruciate ligament (ACL) reconstruction surgery. However, there is no consensus regarding the effect of quadriceps strength asymmetry on lower extremity movement asymmetry after ACL reconstruction. RESEARCH QUESTION What is the relationship between quadriceps strength asymmetry and asymmetries in lower extremity kinematics and kinetics during walking in individuals who underwent ACL reconstruction surgery?. METHODS Isometric quadriceps strength, kinematic, and kinetic data during walking were collected from 24 men with unilateral ACL reconstruction. Knee joint angles and moments were reduced. Pearson correlation coefficients between asymmetry in selected knee biomechanics and isometric quadriceps strength asymmetry were determined. RESULTS The isometric quadriceps strength of the injured leg was significantly lower than that of the uninjured leg (P < 0.001). Knee flexion angles and knee extension moments were smaller in the injured leg than that in the uninjured leg during both loading response (P = 0.007, P = 0.047) and mid-stance phases (P = 0.005, P = 0.028). Isometric quadriceps strength asymmetry was significantly correlated with asymmetry in the peak knee flexion angle during loading response and mid-stance phases (r = -0.48, P = 0.017, r = -0.48, P = 0.017). Isometric quadriceps strength asymmetry was also significantly correlated with asymmetry in the peak knee extension moment during the mid-stance phase (r = -0.44, P = 0.033). SIGNIFICANCE Individuals with ACL reconstruction demonstrate knee movement asymmetry in the sagittal plane. Isometric quadriceps strength asymmetry is significantly correlated with asymmetry in knee flexion angles during the early stance phase and knee extension moments during the mid-stance phase. Rehabilitation programs should emphasise eccentric exercise to beneficially modify quadriceps neuromuscular control.
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Affiliation(s)
- Huijuan Shi
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Yuanyuan Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Zixuan Liang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Qi Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
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Madadi-Shad M, Jafarnezhadgero A, Zago M, Granacher U. Effects of varus knee alignment on gait biomechanics and lower limb muscle activity in boys: A cross sectional study. Gait Posture 2019; 72:69-75. [PMID: 31173948 DOI: 10.1016/j.gaitpost.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is evidence that frontal plane lower limb malalignment (e.g., genu varus) is a risk factor for knee osteoarthritis development. However, only scarce information is available on gait biomechanics and muscle activity in boys with genu varus. RESEARCH QUESTION To examine the effects of knee varus alignment on lower limb kinematics, kinetics and muscular activity during walking at self-selected speed in boys with genu varus versus healthy age-matched controls. METHODS Thirty-six boys were enrolled in this study and divided into a group of boys with genu varus (n = 18; age: 11.66 ± 1.64 years) and healthy controls (n = 18; age: 11.44 ± 1.78 years). Three-dimensional kinematics, ground reaction forces, loading rates, impulses and free moments of both limbs were recorded during five walking trials at self-selected speed. Surface electromyography was recorded for rectus femoris and vastus lateralis/medialis muscles. RESULTS No significant between-group differences were found for gait speed. Participants in the genu varus group versus controls showed larger peak knee flexion (p = 0.030; d = 0.77), peak knee adduction (p < 0.001; d = 1.63), and peak ankle eversion angles (p < 0.001; d = 2.06). Significantly higher peak ground reaction forces were found at heel contact (vertical [p = 0.002; d = 1.16] and posterior [p < 0.001; d = 1.63] components) and at push off (vertical [p = 0.010; d = 0.93] and anterior [p < 0.001; d = 1.34] components) for genu varus versus controls. Peak medial ground reaction force (p = 0.032; d = 0.76), vertical loading rate (p < 0.001; d = 1.52), anterior-posterior impulse (p = 0.011; d = 0.92), and peak negative free moment (p = 0.030; d = 0.77) were significantly higher in genu varus. Finally, time to reach peak forces was significantly shorter in genu varus boys compared with healthy controls (p < 0.01; d = 0.73-1.60). The genu varus group showed higher activities in vastus lateralis (p < 0.001; d = 1.82) and vastus medialis (p = 0.013; d = 0.90) during the loading phase of walking. SIGNIFICANCE Our study revealed genu varus specific gait characteristics and muscle activities. Greater knee adduction angle in genu varus boys may increase the load on the medial compartment of the knee joint. The observed characteristics in lower limb biomechanics and muscle activity could play a role in the early development of knee osteoarthritis in genu varus boys.
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Affiliation(s)
| | - AmirAli Jafarnezhadgero
- Department of Physical Education and Sport Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
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Dijkhuizen A, Waninge A, Hermans S, van der Schans CP, Krijnen WP. Progressive resistance training for persons with intellectual disabilities and visual impairment. J Appl Res Intellect Disabil 2019; 32:1194-1202. [PMID: 31111635 DOI: 10.1111/jar.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Knowledge concerning the feasibility and effects of progressive resistance training (PRT) for persons with intellectual disabilities and visual impairment who are categorized in Gross Motor Function Classification System (GMFCS) Level 1 is limited. The aim of our study was to evaluate feasibility and effect of PRT on participants' Quadriceps strength and personal goals. METHODS Eight Participants followed a PRT program for 10 weeks. Feasibility was determined by percentage of attendance and compliance. The effect of PRT was analyzed with a linear mixed model (p < 0.05) and by normalized bootstrap (95% CI). RESULTS Participants attended 87.8% of the sessions and trained according to the PRT program, indicating sufficient compliance. Quadriceps strength increased significantly by 69%, and participants' personal goals were achieved. CONCLUSION PRT is a feasible and potentially effective method for increasing Quadriceps strength as well as achieving personal goals in persons with intellectual disabilities and visual impairment with GMFCS Level 1.
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Affiliation(s)
- Annemarie Dijkhuizen
- Research Group Healthy Aging, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
| | - Aly Waninge
- Research Group Healthy Aging, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands.,Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Seph Hermans
- Revant Medical Specialist Rehabilitation, Rehabilitation Centre Breda, Breda, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Aging, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Aging, Allied Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
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Fryer C, Ithurburn MP, McNally MP, Thomas S, Paterno MV, Schmitt LC. The relationship between frontal plane trunk control during landing and lower extremity muscle strength in young athletes after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2019; 62:58-65. [PMID: 30690410 PMCID: PMC6457265 DOI: 10.1016/j.clinbiomech.2018.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/18/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower extremity landing asymmetries are common and associated with strength deficits after anterior cruciate ligament reconstruction. However, less is known regarding trunk control during landing. This study's hypotheses were that frontal plane trunk excursion during single-leg landing would be greater in young athletes after anterior cruciate ligament reconstruction compared to controls and would be associated with strength deficits. METHODS Participants included 130 young athletes recently cleared for return-to-sport following anterior cruciate ligament reconstruction and 56 uninjured young athletes. Frontal plane trunk excursion was quantified using three-dimensional motion analysis during a single-leg landing task. Quadriceps and hip abduction strength were measured using an isokinetic dynamometer. Frontal plane trunk excursion was compared between the anterior cruciate ligament reconstruction and control groups and among quadriceps strength subgroups using independent t-tests and one-way analysis of variance. Linear regression examined the association between frontal plane trunk excursion and strength measures in the anterior cruciate ligament reconstruction group. FINDINGS The anterior cruciate ligament reconstruction group demonstrated greater frontal plane trunk excursion compared to controls. The low-quadriceps group demonstrated greater frontal plane trunk excursion compared to both the high-quadriceps and control groups. Additionally, the high-quadriceps group demonstrated greater frontal plane trunk excursion compared to controls. In the anterior cruciate ligament reconstruction group, lower quadriceps and hip abduction strength were weakly associated with greater frontal plane trunk excursion. INTERPRETATION Young athletes at time of return-to-sport after anterior cruciate ligament reconstruction demonstrated increased frontal plane trunk excursion during single-leg landing. Additionally, increased frontal plane trunk excursion was weakly associated with strength deficits.
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Affiliation(s)
- Conor Fryer
- College of Arts and Sciences, The Ohio State University, Columbus, OH, USA
| | - Matthew P. Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA,School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Michael P. McNally
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, USA
| | - Mark V. Paterno
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, USA,Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura C. Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University; Columbus, OH, USA
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Iwata A, Sano Y, Wanaka H, Yamamoto S, Yano Y, Iwata H. Different improvement trends in gait function and quadriceps strength early after total knee arthroplasty. J Phys Ther Sci 2019; 31:57-62. [PMID: 30774206 PMCID: PMC6348170 DOI: 10.1589/jpts.31.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/07/2018] [Indexed: 01/12/2023] Open
Abstract
[Purpose] Improved quadriceps strength is a primary target of rehabilitation early after total knee arthroplasty. However, patients demonstrate varying improvement trends in gait function and quadriceps strength. This study evaluated the relationship between improvements in quadriceps strength and gait function. [Participants and Methods] The study included 49 patients who were scheduled to undergo unilateral total knee arthroplasty. Gait function, bilateral quadriceps strength, and pain were assessed in all patients. All assessments were performed preoperatively and at 2 and 3 weeks postoperatively. [Results] A significant correlation between gait function and the quadriceps strength on the operated side was observed preoperatively and 3 weeks postoperatively. The quadriceps strength on the non-operated side was significantly correlated with gait function at all time points. Multiple regression analysis showed that the quadriceps strength on the non-operated side was significantly associated with gait function, except the gait speed at 2 weeks. However, the quadriceps strength on the operated side was not observed to be an independent variable at all time points. [Conclusion] The quadriceps strength on the operated side is not an important determinant of gait function. It may be necessary to reconsider typical rehabilitation programs by focusing on the quadriceps strength on the operated side in patients undergoing total knee arthroplasty.
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Affiliation(s)
- Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Sano
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Hideyuki Wanaka
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Yano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
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Christensen JC, Mizner RL, Foreman KB, LaStayo PC, Peters CL, Pelt CE. Preoperative quadriceps weakness preferentially predicts postoperative aberrant movement patterns during high-demand mobility following total knee arthroplasty. Knee 2019; 26:79-87. [PMID: 30600199 PMCID: PMC6377852 DOI: 10.1016/j.knee.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/01/2018] [Accepted: 12/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nearly all patients with total knee arthroplasty show aberrant movement patterns during tasks requiring greater joint demand compared to matched peers. Greater movement compensation leads to increased loading onto other joints, decreased functional capacity and limited reserve for independence later in life. Understanding how preoperative predictors contribute to postoperative aberrant movement patterns is needed to make better decisions for patients considering total knee arthroplasty. METHODS Forty-seven patients were tested preoperatively and six months following primary total knee arthroplasty. Demographic (age, sex, body mass), self-reported (knee pain, perception of physical performance, physical activity level), physical performance (quadriceps strength, lower limb power and timed stair climbing) and surgical metrics were collected as predictor variables. Three-dimensional models based on joint mechanic asymmetry during a decline walking task were collected at six months postoperatively. Decline walking is a preferred means to assess the surgical knee's contribution to limb performance during high-demand tasks. Bootstrap inclusion fraction was employed to compare the stability of each predictor variable prior to the final regression model. RESULTS Preoperative quadriceps strength (β = 0.33; p = 0.04) showed a significant relationship with knee extensor angular impulse during loading phase. No other predictor variable had any meaningful relationship with aberrant movement patterns (p > 0.05). CONCLUSION Our findings highlight patients' preoperative quadriceps strength as a meaningful predictor of postoperative performance. Preoperative quadriceps strength should be addressed when considering the knee's ability to contribute to higher demanding mobility tasks following surgery.
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Affiliation(s)
- Jesse C. Christensen
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Ryan L. Mizner
- University of Montana, School of Physical Therapy & Rehabilitation Science, 32 Campus Dr., Missoula, MT
| | - K. Bo Foreman
- University of Utah, Department of Physical Therapy & Athletic Training, 520 Wakara Way, Salt Lake City, UT 84108
| | - Paul C. LaStayo
- University of Utah, Department of Physical Therapy & Athletic Training, 520 Wakara Way, Salt Lake City, UT 84108
| | - Christopher L. Peters
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Christopher E. Pelt
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
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Barfod KW, Feller JA, Hartwig T, Devitt BM, Webster KE. Knee extensor strength and hop test performance following anterior cruciate ligament reconstruction. Knee 2019; 26:149-154. [PMID: 30554909 DOI: 10.1016/j.knee.2018.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/28/2018] [Accepted: 11/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee extensor strength and single limb hop for distance have been suggested as useful measures to evaluate readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The aim of the study was to examine the association between knee extensor strength and single leg hop for distance following ACL reconstruction and to determine the proportion of patients with knee extensor strength symmetry deficits at six and 12 months. METHODS From December 2013 to December 2015 69 patients aged 14 to 45 undergoing primary ACL reconstruction were recruited. Isokinetic concentric knee extensor strength testing and single limb hop for distance were performed six and 12 months postoperatively. Satisfactory knee extensor strength was defined as a leg symmetry index (LSI) ≥85%. RESULTS At six months 27.5% (19/69) of patients had recovered satisfactory knee extensor strength in the injured leg, improving to 46.4% (32/69) at 12 months. Recovery of satisfactory strength was associated with hopping distance. Hop symmetry was achieved considerably faster than knee extensor symmetry, with 66.7% (46/69) of patients demonstrating satisfactory hopping symmetry at six months, 89.9% (62/69) at 12 months. Recovery of hopping distance was not associated with knee extensor strength. CONCLUSIONS Single leg hop test cannot be used as a surrogate measure for knee extensor strength as no association was found between hop tests and knee extensor strength. Less than one in three patients at six months and one in two at 12 months had recovered satisfactory knee extensor strength.
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Affiliation(s)
- Kristoffer W Barfod
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia; Afdelingslæge Artroskopisk Center, Hvidovre Hospital, Denmark
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Taylor Hartwig
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Brian M Devitt
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Kate E Webster
- School of Allied Health, College of Science, Health & Engineering, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
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Cristiani R, Mikkelsen C, Forssblad M, Engström B, Stålman A. Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3461-70. [PMID: 30778627 DOI: 10.1007/s00167-019-05396-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the percentage of patients achieving symmetrical knee function 6 months after primary anterior cruciate ligament (ACL) reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort. METHODS Data were extracted from our clinic database. Patients who underwent primary ACLR from 2000 to 2015 and were assessed with the isokinetic quadriceps and hamstring muscles strength tests and single-leg-hop test at the 6-month follow-up were included in the study. Demographic data, information on the graft used, cartilage injuries and concomitant meniscal surgery were reviewed. Patients who reached a limb symmetry index (LSI) of ≥ 90% in all three tests were considered to have achieved symmetrical knee function. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury and the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair were factors associated with the achievement of symmetrical knee function 6 months after primary ACLR. RESULTS A total of 4093 patients (54.3% males) with a mean age of 28.3 ± 10.7 years were included. Data from all three tests were available for 3541 patients. The proportion of patients that achieved a LSI of ≥ 90% was 35.7%, 47.3% and 67.9% for isokinetic quadriceps muscle strength, hamstring muscles strength and the single-leg-hop test, respectively. A total of 693 patients (19.6%) achieved symmetrical knee function, reaching a LSI of ≥ 90% in all three tests. Older age (≥ 30 years) (OR, 0.50; 95% CI 0.41-0.61; P < 0.001), MM resection (OR, 0.75; 95% CI 0.57-0.98; P = 0.03) and MM repair (OR, 0.63; 95% CI 0.40-0.98; P = 0.04) reduced the odds, whereas the use of hamstring tendon (HT) autograft (OR, 2.28; 95% CI 1.51-3.45; P < 0.001) over bone-patellar tendon-bone (BPTB) autograft increased the odds of achieving symmetrical knee function. CONCLUSION Only 19.6% of the patients achieved symmetrical knee function 6 months after primary ACLR. Age ≥ 30 years, MM resection and MM repair reduced the chance, whereas the use of HT autograft over BPTB autograft increased the chance of achieving symmetrical knee function 6 months after primary ACLR. This study shows that most of the patients are yet to regain symmetrical knee function 6 months after primary ACLR and, moreover, it identifies several factors affecting its achievement in a large cohort. The results of this study should be used to counsel patients about their expected functional recovery and to optimize rehabilitation and maximize knee function after ACLR. LEVEL OF EVIDENCE III.
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Harput G, Ulusoy B, Yildiz TI, Demirci S, Eraslan L, Turhan E, Tunay VB. Cross-education improves quadriceps strength recovery after ACL reconstruction: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:68-75. [PMID: 29959448 DOI: 10.1007/s00167-018-5040-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/26/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of concentric and eccentric cross-education (CE) on quadriceps strength and knee function recoveries after anterior cruciate ligament (ACL) reconstruction. METHODS Forty-eight patients (age: 29.5 ± 6.8 years, body mass index: 26.1 ± 3.2 kg/m2) who had undergone ACL reconstruction with hamstring tendon autograft were included in the study. The patients were randomly divided into three groups when they reached four weeks post surgery: (1) concentric CE (n = 16); (2) eccentric CE (n = 16); and (3) control (n = 16). All groups followed the same post-surgical rehabilitation program for their reconstructed limb. Additionally, the two experimental groups followed eight weeks of isokinetic training for the uninjured knee at 60°/s for 3 days per week. Quadriceps maximum voluntary isometric strength (MVIC) was measured during the 4th week (pre-training), 12th week (post training), and 24th week post surgery. The single-leg hop distance and International Knee Documentary Committee (IKDC) scores were also evaluated during the 24th week post surgery. Analysis of variance was used for statistical analysis. RESULTS Group-by-time interaction was significant for quadriceps MVICs for reconstructed and healthy limbs (p = 0.02). Quadriceps strength of both knees was greater in concentric and eccentric CE groups compared to control group during the 12th- and 24th weeks post surgery (p < 0.05). Strength gain was 28% and 31% in concentric and eccentric CE groups, respectively, when compared with the control group. Concentric and eccentric CE had similar effects on quadriceps strength recovery (n.s.). IKDC score, and single-leg hop distances were not significantly different among groups (n.s.). CONCLUSIONS Concentric and eccentric quadricep strengthening of healthy limbs in early phases of ACL rehabilitation improved post-surgical quadriceps strength recovery of the reconstructed limb. CE should be integrated into ACL reconstruction rehabilitation, especially in the early rehabilitative phases to restore quadriceps strength. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- Gulcan Harput
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey.
| | - Burak Ulusoy
- Department of Physiotherapy and Rehabilitation, Karatekin University, Çankırı, Turkey
| | - Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey
| | - Serdar Demirci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey
| | - Leyla Eraslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey
| | - Egemen Turhan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey
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Page RS, Williams S, Selvaratnam A, Waring S, Conroy M, Thomson A, Beattie S, Ganeshalingam R, Gill SD. Protocol for a single-centre, parallel-arm, double-blind randomised trial evaluating the effects of tourniquet use in total knee arthroplasty on intra-operative and post-operative outcomes. BMC Musculoskelet Disord 2018; 19:435. [PMID: 30522462 PMCID: PMC6284289 DOI: 10.1186/s12891-018-2352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tourniquet use during total knee replacement is common, yet uncertainty exists regarding its benefits and harms. The primary aim of the current study is to investigate whether tourniquet use during total knee replacement leads to greater reduction in quadriceps strength than non-tourniquet use at three months post-surgery. Secondary aims include investigating the effects of tourniquet use on: quadriceps strength at day 2 and 5, and 12 months post-surgery; pain and analgesia requirements; self-reported physical function and quality of life; blood loss and replacement; surgeon satisfaction with the intra-operative visual field; operation and anaesthetic time; complications; cement mantle quality; patient satisfaction; and hospital length of stay. METHODS The study is a single centre, parallel-arm, double-blind (participant and assessor), randomised trial with 1:1 random allocation. Participants will be undergo total knee replacement with or without tourniquet. Linear mixed models will be used for group comparisons of continuous outcomes available at multiple timepoints. Other continuous outcomes that are assessed at baseline and once/twice at follow-up will be analysed using linear regression. Categorical outcomes will be analysed using logistic regression models. DISCUSSION This study will provide high-quality evidence regarding the effects of tourniquet use during total knee replacement, which can be used to inform surgeon decision-making. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000425291 . Retrospectively registered 23 March 2018.
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Affiliation(s)
- Richard S. Page
- Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, 80 Myers St, Geelong, 3220 Australia
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, 3216 Australia
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Simon Williams
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Avanthi Selvaratnam
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Shaun Waring
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Myles Conroy
- Anaesthetics Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Andrew Thomson
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Sally Beattie
- Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, 80 Myers St, Geelong, 3220 Australia
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Rekha Ganeshalingam
- Orthopaedic Department, University Hospital Geelong, 272-322 Ryrie Street, Geelong, 3220 Australia
| | - Stephen D. Gill
- Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, 80 Myers St, Geelong, 3220 Australia
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, 3216 Australia
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Fitz W, Shukla P, Li L, Scott RD. Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty. Arch Bone Jt Surg 2018; 6:523-531. [PMID: 30637308 PMCID: PMC6310182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic chain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However, current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure and weakness. To investigate whether patients who use a continuous active motion (CAM) device that follows closed kinetic chain principles have better early post-operative functional improvements than patients who use a continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospective randomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110 patients signed the consent form and 83 patients participated in the study. METHODS Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control group), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours after knee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalence of one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia, quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption. RESULTS At 4 weeks, all outcome measurements were comparable between the two groups, with the exception of sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group (P=0.016). Balance was significantly better in both control (P=0.001) and treatment group (P=0.032) compared to prior surgery. CONCLUSION Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without increasing the risk of falls. We observed balance and kinesthesia improvements after surgery using either device which may be important to benefit fast recovery programs. Further research is warranted to see whether additional active closed kinetic chain exercised following knee replacement surgery could improve specific functional outcomes such the observed sit-to-stand test. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Wolfgang Fitz
- Research performed at New England Baptist Hospital, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
- Great Plains Orthopedics, North Platte, NE, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- New England Baptist Hospital, Boston, MA, USA
| | - Pinak Shukla
- Research performed at New England Baptist Hospital, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
- Great Plains Orthopedics, North Platte, NE, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- New England Baptist Hospital, Boston, MA, USA
| | - Ling Li
- Research performed at New England Baptist Hospital, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
- Great Plains Orthopedics, North Platte, NE, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- New England Baptist Hospital, Boston, MA, USA
| | - Richard D Scott
- Research performed at New England Baptist Hospital, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
- Great Plains Orthopedics, North Platte, NE, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- New England Baptist Hospital, Boston, MA, USA
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Garrison JC, Hannon J, Goto S, Giesler L, Bush C, Bothwell JM. Participants at three months post-operative anterior cruciate ligament reconstruction (ACL-R) demonstrate differences in lower extremity energy absorption contribution and quadriceps strength compared to healthy controls. Knee 2018; 25:782-789. [PMID: 30001937 DOI: 10.1016/j.knee.2018.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare hip and knee energy absorption contribution (EAC) during a double limb squat (DLS) and quadriceps strength in patients three months post-operative ACL-R versus matched healthy controls. METHODS Twenty-four ACL-R participants (Age = 15.5 ± 1.3 yrs; Ht = 1.66 ± .07 m; Mass = 66.3 ± 15.5 kg) were compared to 24 age, sex, limb, and activity-matched healthy controls (Age = 15.5 ± 1.2 yrs; Ht = 1.65 ± .08 m; Mass = 59.0 ± 9.8 kg). Lower extremity biomechanical data was collected at three months post-operative ACL-R during five consecutive DLS. EAC was calculated during DLS descent. Isokinetic quadriceps strength was collected at 60°/s. Normalized quadriceps peak torque (QUADS) was averaged across five trials. Independent t-tests examined differences in group hip and knee EAC during each task. Separate Pearson product-moment correlations examined the relationship between QUADS and hip and knee EAC during the DLS. RESULTS ACL-R demonstrated greater injured limb hip EAC (46.4 ± 16.0) than Healthy (31.7 ± 11.0) during a DLS (p = 0.001). ACL-R demonstrated less injured limb knee EAC (42.7 ± 14.6) than Healthy (60.6 ± 8.9) during DLS (p < 0.001). No differences were seen between uninjured limb hip (ACL-R = 0.0 ± 14.2; Healthy = 33.4 ± 9.1, p = 0.629) or knee (ACL-R = 56.9 ± 15.6; Healthy = 59.1 ± 9.8, p = 0.561) EAC and matched limbs. ACL-R injured limb QUADS was decreased compared to Healthy (ACL-R = 1.1 ± 0.5; Healthy = 2.0 ± 0.5, p < 0.001). No differences were seen in QUADS on the uninjured and matched limbs (ACL-R = 2.0 ± 0.6; Healthy = 1.9 ± 0.5, p = 0.894). There was a weak, negative correlation between injured limb QUADS and hip EAC (r = -0.471, p = 0.001) and moderate, positive correlation between injured limb QUADS and knee EAC (r = 0.615, p < 0.001). CONCLUSIONS ACL-R participants demonstrate different eccentric loading strategies during a DLS at three months postoperative compared to matched healthy controls.
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Affiliation(s)
- J Craig Garrison
- Texas Health Sports Medicine, 800 5th Ave. Suite 150, Fort Worth, TX 76104, United States of America.
| | - Joseph Hannon
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX 76132, United States of America
| | - Shiho Goto
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX 76132, United States of America
| | - Laura Giesler
- Texas Health Sports Medicine, 800 5th Ave. Suite 150, Fort Worth, TX 76104, United States of America
| | - Curtis Bush
- Orthopedic Specialty Associates, 800 5th Ave, Suite 500, Fort Worth, TX 76104, United States of America
| | - James M Bothwell
- Fort Worth Orthopedics, 6301 Harris Pkwy. Suite 200, Fort Worth, TX 76132, United States of America
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Baek J, Park N, Lee B, Jee S, Yang S, Kang S. Effects of Repetitive Peripheral Magnetic Stimulation Over Vastus Lateralis in Patients After Hip Replacement Surgery. Ann Rehabil Med 2018; 42:67-75. [PMID: 29560326 PMCID: PMC5852231 DOI: 10.5535/arm.2018.42.1.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the vastus lateralis (VL) in the early stage after hip replacement surgery. Methods Twenty-two patients who underwent hip replacement after proximal femur fracture were included in this study. After hip surgery, the experimental group was applied with 15 sessions of 10 Hz rPMS over the VL 5 times per week for 3 weeks, while the control group took sham stimulation. All patients were also given conventional physical therapy. The VL strength was measured with the root mean square (RMS) value of the VL with surface electromyography technique. The ratio of RMS values between fractured and unfractured legs and tandem stand test were used to assess standing balance. Usual gait speed was measured to evaluate gait function. Pain in two groups was assessed with visual analog scale (VAS). Results Both RMS value of the VL and the ratio of RMS values after rPMS were significantly improved (p<0.05). Also, tandem standing time and usual gait speed in rPMS group were dramatically increased (p<0.05). However, no significant difference in VAS was found between the two groups after 3 weeks. Conclusion rPMS on the VL improved muscle strength, standing balance and gait function in the early stage after hip surgery. Therefore, rPMS could be applied to patients who cannot take electrical stimulation due to pain and an unhealed wound.
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Affiliation(s)
- Junghyun Baek
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Nohkyoung Park
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Bongju Lee
- Department of Orthopedic Surgery, Sun General Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Physical Medicine and Rehabilitation, Chungnam National University Hospital, Daejeon, Korea
| | - Shinseung Yang
- Department of Physical Medicine and Rehabilitation, Chungnam National University Hospital, Daejeon, Korea
| | - Sangkuk Kang
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
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Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH. Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities. J Phys Ther Sci 2018; 30:307-312. [PMID: 29545702 PMCID: PMC5851371 DOI: 10.1589/jpts.30.307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
[Purpose] To examine the effect of physiotherapy rehabilitation program on moderate knee osteoarthritis in patients with different pain intensities. [Subjects and Methods] Sixty subjects (37 men and 23 women) with moderate knee osteoarthritis participated in the current study. Randomization software was used to select the participating subjects' numbers from the clinic records. They were classified into three groups according to pain intensity: mild, moderate, and severe pain groups. All groups underwent a standard set of pulsed electromagnetic field, ultrasound, stretching exercises, and strengthening exercises. Pain intensity, knee range of motion, knee function, and isometric quadriceps strength were evaluated using the visual analogue scale, universal goniometer, Western Ontario and McMaster Universities osteoarthritis index, and Jamar hydraulic dynamometer, respectively. The evaluation was performed before and after a 4-week rehabilitation program. [Results] All groups showed significant differences in pain intensity, knee range of motion, isometric quadriceps strength, and knee function. The score change in moderate pain group was significantly greater than those in mild and severe pain groups. [Conclusion] Pain intensity is one of the prominent factors that are responsible for the improvement of knee osteoarthritis. Consequently, pain intensity should be considered during rehabilitation of knee osteoarthritis.
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Affiliation(s)
- Amr Almaz Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University: 7 Ahmed Elziat Street, Ben Elsaryat, El Dokki, Giza, Egypt
| | - Elsadat Saad Soliman
- Department for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
| | | | - Amira Hussin Draz
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Egypt
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Ithurburn MP, Altenburger AR, Thomas S, Hewett TE, Paterno MV, Schmitt LC. Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later. Knee Surg Sports Traumatol Arthrosc 2018; 26:426-433. [PMID: 28918506 DOI: 10.1007/s00167-017-4678-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Quadriceps femoris (QF) strength deficits at return-to-sport (RTS) after ACL reconstruction (ACLR) contribute to decreased knee function at the same time point. However, the impact of QF strength at RTS on longitudinal function has not been examined. The purpose of this study was to test the hypothesis that young athletes after ACLR with QF strength asymmetry at RTS would demonstrate decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS compared to young athletes following ACLR with nearly symmetric QF strength at RTS. METHODS Participants included 76 young athletes (74% female; mean age at RTS = 17.3 years) after primary, unilateral ACLR, cleared to RTS, and followed for 1 year after RTS. At the time of RTS, QF strength was quantified on an isokinetic dynamometer and a Limb Symmetry Index (LSI) was calculated [(involved/uninvolved) × 100%]. The cohort was subdivided into two groups based on RTS QF LSI: high quadriceps (HQ; LSI ≥ 90%; n = 36) and low quadriceps (LQ; LSI < 85%; n = 36). The cohort was followed for 1 year post-RTS, and knee-related function was assessed using the International Knee Documentation Committee subjective form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and LSI of single-leg hop tests. Functional recovery at 1 year post-RTS was defined as KOOS scores above literature-reported cut-offs. RESULTS While the HQ group demonstrated higher symmetry on all 1 year post-RTS hop tests, only the triple-hop test (p = 0.020) was found to be statistically different. Similarly, while the HQ group scored higher on all 1 year post-RTS self-reported knee function measures, only differences on the KOOS-Sport/Rec score (p = 0.039) and IKDC score (p = 0.011) were statistically different. Additionally, the HQ group demonstrated higher proportions of functional recovery at 1 year post-RTS than the LQ group on the KOOS-Symptoms (HQ: 88.9%, LQ: 69.4%; p = 0.040) and KOOS-Sport/Rec (HQ: 91.7%, LQ: 69.4%; p = 0.017). CONCLUSIONS Young athletes after ACLR with QF strength asymmetry at RTS demonstrated decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS. However, group differences did not exceed reported minimal clinically important difference values. Further study is warranted to understand factors that contribute to longitudinal knee function after ACLR. Clinicians should focus on restoring symmetric QF strength at RTS after ACLR, which may promote higher longitudinal knee function. LEVEL OF EVIDENCE Level II, Prospective cohort study.
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Affiliation(s)
- Matthew P Ithurburn
- Movement Analysis and Performance Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, 2050 Kenny Road, Columbus, OH, USA
- OSU Sports Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex R Altenburger
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA
| | - Staci Thomas
- Divisions of Occupational and Physical Therapy and Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, USA
| | - Timothy E Hewett
- Biomechanics Laboratories and Sports Medicine, Departments of Orthopaedic Surgery, Physical Medicine and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, RO_GU_01_22, Rochester, MN, USA
| | - Mark V Paterno
- Divisions of Occupational and Physical Therapy and Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Laura C Schmitt
- Movement Analysis and Performance Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, 2050 Kenny Road, Columbus, OH, USA.
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA.
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Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, Miralles-Muñoz FA, Marco-Gomez L, Lopez-Prats FA, Gil-Guillen V. Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 2017; 25:3508-3514. [PMID: 27522590 DOI: 10.1007/s00167-016-4273-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether the design of the femoral component influenced patient outcomes. METHODS Two hundred and thirty-seven patients were randomized to compare functional outcomes between single-radius TKA (SR, 118 patients) and multi-radius TKA (MR, 119 patients) with a minimum follow-up of 5 years. Prospective pre- and postoperative assessments were performed by the clinical and radiological criteria of the Knee Society Score (KSS), WOMAC and Short-Form 12 (SF12) questionnaires. The extension mechanism was assessed based on the quadriceps strength and chair test. Patient satisfaction was also assessed. RESULTS The median follow-up was 5.7 (range 5-7) years. At last follow-up, significant better KSSs (p = 0.001), range of motion (p = 0.001), extension lag (p = 0.020), quadriceps strength (p = 0.004), chair test (p = 0.032) and WOMAC pain (p = 0.002) were found in the SR group. Moreover, the improvements of these variables were early in the SR group (from 6 postoperative months). There were no significant differences in WOMAC function or SF12 physical and mental components. The revision rate and implant survival were similar in both groups. Satisfaction rate was significantly higher in SR group (p = 0.032). CONCLUSION This study shows better results with SR cruciate-retaining femoral component than MR component. The use of SR system is recommended because, although the clinically relevant differences were moderate, the functional improvement was earlier and the patient satisfaction higher with this design. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Isabel Collados-Maestre
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain. .,Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Luis Marco-Gomez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Fernando A Lopez-Prats
- Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Ishii Y, Noguchi H, Sato J, Sakurai T, Toyabe SI. Quadriceps strength impairment in the mid- to long-term follow-up period after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3372-3377. [PMID: 27650527 DOI: 10.1007/s00167-016-4333-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Quadriceps strength impairment after total knee arthroplasty (TKA) continues to be a concern. However, most studies of quadriceps strength have short-term follow-up periods. Whether quadriceps strength impairment occurs in the long-term follow-up period after TKA remains unclear. The purpose of this study was to compare the quadriceps strength between posterior cruciate ligament-retaining (CR) and substituting (PS) design mobile-bearing TKA (1) in the same patients after an average of 10 years and (2) between TKA patients and age-matched controls. METHODS A prospective, quasi-randomized design was used. Thirty-four patients (68 knees) who underwent bilateral TKA (CR on one side and PS on the other) were followed for a minimum of 5 years, and 35 age-matched controls (70 knees) were evaluated. A handheld dynamometer was used to measure quadriceps isometric strength. For each patient, the maximum value of three trials was used. The ratio of muscle strength to body weight (MS/BW ratio; N/kg) was used to evaluate outcomes. RESULTS The median MS/BW ratio was 3.3 (range 1.4-10.5) for CR 3.4 (range 0.9-9.3) for PS, and 4.6 (range 0.4-8.8) for controls. The MS/BW ratio did not differ between prosthesis designs, but was significantly smaller in both CR (p = 0.020) and PS (p = 0.024) than in controls. CONCLUSIONS Posterior cruciate ligament-retaining TKA does not confer a substantial advantage an average of 10 years postoperatively. In addition, quadriceps strength, as measured using a hand-held dynamometer, was significantly lower in both TKA patient groups than in age-matched controls. Clinically, the results of this study indicate that quadriceps-strengthening exercises should be continued in the long term after TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Tetsuya Sakurai
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Pozzi F, Marmon AR, Snyder-Mackler L, Zeni J. Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty. Gait Posture 2016; 49:41-46. [PMID: 27362279 PMCID: PMC9148504 DOI: 10.1016/j.gaitpost.2016.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 05/27/2016] [Accepted: 06/12/2016] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to assess the ankle, knee, and hip joint contributions to the total support moment (TSM) and the activation patterns of muscles in the lower leg in patients after total knee arthroplasty (TKA) and healthy older adults during the step up and over task. Moreover, the relationship between quadriceps strength and knee contribution to TSM was measured. Twenty patients six-months after TKA and twenty healthy controls were recruited for this study. Motion and surface electromyographic (EMG) analyses were performed during a step up and over task. Biomechanics and EMG variables were compared between groups using ANCOVA models with movement speed as covariate. Patients after TKA had reduced contribution to the TSM from the knee joint, and greater contribution from the hip and ankle joints, possibly to compensate for the reduced contribution at the knee. No consistent differences of EMG activation or co-contraction were found between groups. Patients with stronger quadriceps had significantly higher knee contribution to TSM during the lowering phase of the task. The results of this study suggest that patients after TKA may use compensatory strategies at the hip and ankle joints to safely perform the step up and over task. Patients may rely on the force generating ability of the quadriceps during the lowering phase as they are not able to compensate with other joints of the lower extremity during this phase of the task.
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Affiliation(s)
- Federico Pozzi
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CPH 155, Los Angeles, CA 90266, United States.
| | - Adam R Marmon
- Department of Physical Therapy, University of Delaware, United States; Department of Orthopaedics and Rehabilitation Services, Christiana Health Care System, United States
| | | | - Joseph Zeni
- Department of Physical Therapy, University of Delaware, United States
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Alnahdi AH, Zeni JA, Snyder-Mackler L. Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2587-94. [PMID: 26450826 DOI: 10.1007/s00167-015-3827-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to examine interlimb differences in muscle strength and sit-to-stand (STS) kinetics in persons who underwent unilateral total knee arthroplasty (TKA) and to determine whether knee pain, quadriceps or hip abductor weakness contributes to altered STS performance. It was hypothesized that the operated limb would have weaker muscles, lower mechanical loading and that operated knee pain and muscle strength symmetry would predict loading symmetry between limbs during STS. METHODS One hundred and forty-two patients, 6 or 12 months post-unilateral TKA, underwent 3D motion analysis (VICON) of the STS task and isometric strength testing of the quadriceps and hip abductors. Knee pain was also quantified using a question from the Knee Outcome Survey-Activities of Daily Living Scale. RESULTS The operated limb had weaker quadriceps (P < 0.001), lower hip (P = 0.004) and knee extension moments (P < 0.001), and lower vertical ground reaction forces (P < 0.001). Operated knee pain and quadriceps strength symmetry were related to symmetry in knee extension moment (P < 0.04), and vertical ground reaction forces (P < 0.02) 6 months after surgery, while quadriceps strength symmetry was related to symmetry in vertical ground reaction forces (P = 0.03), 1 year after surgery. CONCLUSION Patients with unilateral TKA unload the operated limb and shift the mechanical load to the joints of the contralateral limb even 1 year after surgery. Knee pain and quadriceps strength asymmetry may play a role in the asymmetrical loading during STS post-TKA. Clinicians should consider addressing these modifiable impairments to resolve the loading asymmetry. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali H Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
| | - Joseph A Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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