Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis

Transcranial magnetic stimulation and electrical stimulation techniques used to measure the excitability of distinct neuronal populations that influence motor output in people with persistent musculoskeletal conditions: A scoping review and narrative synthesis of evidence

Functional impairments are evident in persistent musculoskeletal (MSK) conditions, and linked to altered excitability of neuronal elements contributing to motor output. In MSK conditions, transcranial magnetic stimulation (TMS) or electrical stimulation (ES) techniques have been used to investigate intracortical, corticospinal, spinal and neuromuscular excitability, which influence the efficacy of descending volley transmission to produce movement. This review compiled studies using TMS or ES to investigate neuronal excitability in persistent MSK conditions, to identify techniques used, and to synthesis evidence for neural deficits. We used narrative synthesis to summarise individual study findings. We included 60 studies; 52/60 used at least one TMS technique, and more frequently measured corticospinal tract excitability (48/52). 15/60 studies used at least one ES technique, and more frequently measured neuromuscular excitability (15/15). In tendinopathy, excitability was assessed for a range of distinct neurones; no study measured neuromuscular excitability in low back pain, osteoarthritis or shoulder pain, nor spinal or intracortical excitability in shoulder pain. This review identified a range of TMS and ES techniques used to assess excitability of neural elements. It provides insight for specific deficits contributing to functional impairments in certain persistent MSK conditions, while highlighting evidence gaps hindering the ability to draw meaningful inferences.

Thigh muscle features in female patients with severe knee osteoarthritis: a cross-sectional study

BACKGROUND

Muscle function deterioration in female patients with severe knee osteoarthritis (KOA) is linked to alterations in muscle morphology, composition, and mechanical properties. This study evaluates thigh muscle features in female patients with severe KOA and explores correlations with knee joint function.

METHODS

Ultrasound and shear wave elastography measured physiological cross-sectional area (PCSA), echo intensity (EI), and shear modulus (G) in the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), and semitendinosus (ST) of 24 KOA patients and 24 controls. EI indicates intramuscular fat, while G reflects stiffness. Muscle characteristics were compared between groups, and correlations with knee function scores (WOMAC, KSS, HSS) were analyzed.

RESULTS

In patients, the symptomatic side displayed reduced PCSA for RF, VL, VM, BFL, and ST (15.85[Formula: see text], 28.18[Formula: see text], 21.53[Formula: see text], 11.67[Formula: see text], 6.59[Formula: see text] respectively) vs. controls (19[Formula: see text], 36.32[Formula: see text], 23.37[Formula: see text], 14.15[Formula: see text], 7.12[Formula: see text] respectively). EI was elevated (128.95, 121.12, 105.72, 90.52, 93.15) vs. controls (100.39, 93.97, 88.14, 77.69, 78.73), and G values (9.48 kPa, 7.88 kPa, 6.9 kPa, 7.2 kPa, 9.03 kPa) was higher than controls (8.85 kPa, 5.28 kPa, 5.98 kPa, 6.58 kPa, 6.73 kPa). BFL`s G, ST`s G, and VM`s EI, negatively correlated with knee function, whereas BFL`s PCSA positively correlated. The variable importance of BFL's PCSA and G ranked at the top in all scores.

CONCLUSIONS

Compared to controls, PCSAs in muscles on both sides of KOA patients were lowered by up to 22%, indicative of muscle loss and diminished strength. The G value is 20.65% higher, suggesting poor flexibility and elevated passive tension. EI in muscles on both sides of KOA patients was greater, reaching up to 23.88%, possibly reducing contractile components and muscle force. G, PCSA, and EI are closely correlated with function scores, and PCSA and G of BFL are the most significant predictors of knee function. These results may help explain muscle dysfunction in KOA patients.

CLINICAL TRIAL NUMBER

Not applicable.

Automatic Segmentation of Quadriceps Femoris Cross-Sectional Area in Ultrasound Images: Development and Validation of Convolutional Neural Networks in People With Anterior Cruciate Ligament Injury and Surgery

OBJECTIVE

Deep learning approaches such as DeepACSA enable automated segmentation of muscle ultrasound cross-sectional area (CSA). Although they provide fast and accurate results, most are developed using data from healthy populations. The changes in muscle size and quality following anterior cruciate ligament (ACL) injury challenges the validity of these automated approaches in the ACL population. Quadriceps muscle CSA is an important outcome following ACL injury; therefore, our aim was to validate DeepACSA, a convolutional neural network (CNN) approach for ACL injury.

METHODS

Quadriceps panoramic CSA ultrasound images (vastus lateralis [VL] n = 430, rectus femoris [RF] n = 349, and vastus medialis [VM] n = 723) from 124 participants with an ACL injury (age 22.8 ± 7.9 y, 61 females) were used to train CNN models. For VL and RF, combined models included extra images from healthy participants (n = 153, age 38.2, range 13-78) that the DeepACSA was developed from. All models were tested on unseen external validation images (n = 100) from ACL-injured participants. Model predicted CSA results were compared to manual segmentation results.

RESULTS

All models showed good comparability (ICC > 0.81, < 14.1% standard error of measurement, mean differences of <1.56 cm2) to manual segmentation. Removal of the erroneous predictions resulted in excellent comparability (ICC > 0.94, < 7.40% standard error of measurement, mean differences of <0.57 cm2). Erroneous predictions were 17% for combined VL, 11% for combined RF, and 20% for ACL-only VM models.

CONCLUSION

The new CNN models provided can be used in ACL-injured populations to measure CSA of VL, RF, and VM muscles automatically. The models yield high comparability to manual segmentation results and reduce the burden of manual segmentation.

Evaluation of the impact of a 3-week specific-sport rehabilitation program on neuromotor control during single-leg countermovement-jump tests in professional soccer players with lower-limb injuries

Purpose

This study investigated the evolution of neuromotor control during a typical short sport-specific rehabilitation program (SSR) in professional soccer players who had incurred a major lower-limb injury (n = 15, chondral and muscle injuries, ACL-reconstruction).

Methods

All injured participants (n = 15) were in the on-field rehabilitation phase of their specific sport rehabilitation process, prior to return to play. An experimental group (EG, chondral and muscle injuries, ACL-reconstruction) followed a 3-week SSR-program composed of muscular and core strengthening (weightlifting, functional stability, explosivity and mobility exercises), running and cycling, neuromotor reprogramming, cognitive development and specific soccer on-field rehabilitation (acceleration, braking, cutting, dual-contact, high-speed-running, sprint, jump, drills with ball). Neuromotor control via analysis of movement kinematics, muscle activation and kinetic parameters was evaluated using a single-leg Countermovement-Jump, pre- and post- rehabilitation program. A control group (n = 22) of healthy soccer players of similar standards performed the same single-leg Countermovement-Jump to provide reference values regarding the level to be attained by the injured players for return to play.

Results

In the experimental group, almost all kinetic analyses values progressed during the program and significantly for concentric Rate-of-Force-Development (p < 0.05), height jump (p < 0.001) and Reactive-Strength-Index Modified (p < 0.001) but remained lower than control group values for RSI-Mod (p < 0.05) and RFDconcentricLate (p < 0.001). Activation changed (p < 0.05) for all muscles except for rectus femoris and medial gastrocnemius in the pushing phase and rectus femoris during landing in the EG. Activation of all muscles decreased for EG, except for semitendinous which increased. Regarding kinematic analyses during the landing phase, there were a significant decrease in peak trunk flexion (p < 0.001) and lateroflexion (p < 0.001) and an increase in peak knee flexion (p < 0.001) for both legs. Trunk flexion (p < 0.001) and lateroflexion (p < 0.001) values were again higher for EG while knee flexion remained significantly lower than the CG (p < 0.001).

Conclusion

The SSR generally improved neuromotor control suggesting that the present specific sport rehabilitation program, albeit of only three weeks duration, was effective in aiding elite footballers recover their neuromotor qualities although this was potentially insufficient to return to the values observed in healthy players.

Effects of three types of resistance training on knee osteoarthritis: A systematic review and network meta-analysis

BACKGROUND

Resistance training (RT) is recognized in clinical guidelines as a beneficial treatment for knee osteoarthritis (KOA), but the efficacy of different RT types is not well-established.

OBJECTIVE

This network meta-analysis (NMA) aimed to compare the effects of different types of RT, namely, isometric muscle strengthening (IMMS), isokinetic muscle strengthening (IKMS) and isotonic muscle strengthening (ITMS), on pain, function and quadriceps muscle strength of patients with KOA.

METHODS

A systematic search was conducted up to September 2023 on databases, including PubMed, Cochrane Library, EMbase, Web of Science and China National Knowledge Infrastructure. The included studies comprised randomised controlled trials (RCTs) comparing RT with conventional rehabilitation and physiotherapy or other types of RT.

RESULTS

Compared with the control group (CG) that received conventional physiotherapy, IKMS was optimal in terms of pain relief (MD = -1.33, 95% CI: -1.83 to -0.83), function (MD = -12.24, 95% CI: -17.29 to -7.19) and knee extension torque (SMD = -0.44, 95% CI: -0.74 to -0.14).

CONCLUSIONS

Compared with conventional rehabilitation therapy, all three types of RT can improve pain and knee-joint function in KOA patients. IKMS demonstrated the best results among the different RT modalities.

PROSPERO REGISTRATION

PROSPERO registration number: CRD42023448579.

Comparing selective and general hamstring stretching and strengthening for pain, disability, and quality of life in patients with primary knee osteoarthritis and varus deformity: A randomized clinical trial

BACKGROUND

A combination of hamstring stretching and strengthening exercises may benefit patients with knee osteoarthritis by promoting pain relief and disability improvement.

PURPOSE

The current study aimed to compare the effects of lateral hamstring strengthening and medial hamstring stretching with general hamstring stretching and general hamstring strengthening on pain, disability, and quality of life in patients with primary knee osteoarthritis and varus deformity.

METHODS

Forty patients with knee osteoarthritis were randomly assigned to two groups: a general hamstring strengthening group (14 women, 6 men) and a selective hamstring strengthening group (16 women, 4 men). In the general hamstring strengthening group, participants performed hamstring stretching and strengthening exercises broadly. In contrast, the selective hamstring strengthening group specifically targeted lateral hamstring strengthening and medial hamstring stretching. The treatment program was conducted three times a week for 4 weeks. Pain and disability levels were evaluated before and after treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), quality of life was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire, and physical activity levels were determined using the Tegner activity scale.

RESULTS

Both groups demonstrated significant improvement in all outcomes except for the quality of life subscale of the KOOS questionnaire (p = .98) in the general hamstring strengthening group. However, the selective hamstring strengthening group exhibited greater improvements in symptoms (p = .02, effect size (d) = 0.92) and pain subscales (p = .01, d = 0.80) according to the KOOS questionnaire. Additionally, the pain subscale (p = .02, d = 0.79) of the OAKHQOL questionnaire exhibited greater improvements in the selective hamstring strengthening group. Tegner activity scale scores significantly improved in both groups.

CONCLUSION

Strengthening the lateral hamstring and stretching the medial hamstring muscles seem to be beneficial for reducing pain in patients with primary knee osteoarthritis and varus deformity. Attention to stabilization in frontal and horizontal planes in the knee joint might be better than simply evaluating the joint in the sagittal plane.

Effect of high plant protein/peptide nutrition supplementation on knee osteoarthritis in older adults with sarcopenia: A randomized, double-blind, placebo-controlled trial

BACKGROUND & AIMS

Skeletal muscle is an important contributor to joint health. Previous studies have shown that age-related muscle mass and strength loss are closely associated with the development of knee osteoarthritis. The objective of this study is to investigate whether a high plant protein/peptide nutrition supplementation can alleviate knee osteoarthritis by improving muscle mass and strength.

METHODS

This randomized, double-blind, placebo-controlled trial that included participants aged 50-70 years diagnosed with knee osteoarthritis and sarcopenia was conducted in China from February 2022 to September 2022 (ChiCTR2200056415). Participants were randomly assigned to receive either a 12-week high plant protein/peptide nutrition supplementation or a placebo twice daily, with one serving each after breakfast and dinner, respectively. The primary outcome analyzed using intention-to-treat analysis was difference in Short Physical Performance Battery (SPPB) from baseline to week 12 between the two groups. The secondary outcomes included changes in muscle mass, strength, symptom and imaging of knee osteoarthritis, body composition, biochemical parameters, and health quality scores.

RESULTS

After 12 weeks, a total of 124 participants (38.7% male) completed the trial and were included in the final analysis. Over the 12-week follow-up, the experimental group showed a significant improvement in the SPPB total score (1.03, 95% CI, 0.69 to 1.38, P < 0.0001) compared with the placebo group. Grip strength (2.83 kg, 95% CI, 2.13 to 3.53, P < 0.0001) and skeletal muscle mass index (0.66 kg/m2, 95% CI, 0.45 to 0.86, P < 0.0001) were also significantly increased in the experimental group relative to the placebo group. The mean change in Western Ontario and McMaster Universities Osteoarthritis Index total score was -3.95 points (95% CI, -5.02 to -2.89, P < 0.0001) in the experimental group and 0.23 points (95% CI, -0.17 to 0.63, P = 0.253) in the placebo group. Additionally, within the experimental group, nine participants experienced an improvement in osteophyte magnetic resonance imaging results, while no improvement was observed in the placebo group. The experimental group also exhibited significant improvements in health quality compared with the placebo group as assessed by Short Form 36, the World Health Organization Quality of Life Brief Scale, and the Chalder Fatigue Scale. No serious adverse events were reported during the trial.

CONCLUSION

Oral supplementation with high levels of plant protein/peptides can alleviate symptoms of osteoarthritis in elderly individuals with minor or mild knee osteoarthritis and sarcopenia. This improvement may be attributed to the enhancements of muscle mass, strength, and physical performance.

The Differences in Parameters in Ultrasound Imaging and Biomechanical Properties of the Quadriceps Femoris with Unilateral Knee Osteoarthritis in the Elderly: A Preliminary Observational Study

Purpose

Our study aims to evaluate differences in muscle parameters of the quadriceps muscles in patients with knee osteoarthritis (KOA) in older adults.

Methods

The study included 40 patients diagnosed with unilateral knee osteoarthritis in the KOA group (KG) and 40 asymptomatic elderly individuals in the control group (CG). Muscle ultrasonic mean echo intensity and shear modulus, as well as tone and stiffness of the rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were analyzed. Additionally, clinical correlations were performed.

Results

In the KG group, there were significant differences in echo intensity, shear modulus, and tone between the affected and unaffected sides for RF (p=0.003, 0.019, 0.014), while VM showed significant differences in shear modulus and tone (p=0.006, 0.002). Additionally, VL exhibited significant differences in echo intensity, shear modulus, and stiffness (p=0.007, 0.006, 0.010). Compared to the CG group, the KG group showed significant differences in echo intensity of the affected side RF (p=0.001). VM exhibited statistically significant differences in echo intensity and shear modulus (p < 0.001, p=0.008), while VL showed statistically significant differences in echo intensity, tone, and stiffness (p < 0.001, p=0.028, p < 0.001). The correlation results showed that patients with unilateral KOA, VM, and VL echo intensity were correlated with K-L grade (r = 0.443, p=0.004; r = 0.469, p=0.002). The tone of VL was correlated with VAS and WOMAC (r = 0.327, p=0.039; r = 0.344, p=0.030).

Conclusion

The parameters of the quadriceps femoris muscle exhibit asymmetry between the affected and unaffected sides in patients with unilateral KOA, as well as a difference between the dominant side of healthy older individuals and the affected side of KOA.

The impact of Yoga on patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The objective of this review is to conduct a comprehensive and systematic assessment of the efficacy of Yoga as an intervention for knee osteoarthritis (KOA).

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, and PEDro as of January 3, 2024. Retrieved a total of 200 articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated.

RESULTS

The study included a total of 8 trials and involved 756 KOA patients. The results indicated that compared to the control group, Yoga exercise showed significant improvements in alleviating pain (SMD = -0.92; 95% CI = -1.64 ~ - 0.20; P = 0.01, I2 = 94%), stiffness (SMD = -0.51; 95% CI = -0.91 ~ -0.12; P = 0.01; I2 = 66%) and physical function (SMD = -0.53; 95% CI = -0.89 ~ -0.17; P = 0.004; I2 = 59%) among KOA patients. However, there was no significant improvement observed in terms of activities of activity of daily living (ADL) (SMD = 1.03; 95% CI = -0.01 ~ 2.07; P = 0.05; I2 = 84%), and quality of life (QOL) (SMD = 0.21; 95% CI = -0.33 ~ 0.74; P = 0.44; I2 = 83%) with the practice of Yoga.

CONCLUSIONS

In general, Yoga has been found to be effective in reducing pain and stiffness in KOA patients, it can also improve the physical function of patients. However, there is limited evidence to suggest significant improvements in terms of ADL and QOL.

Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol

INTRODUCTION

Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA.

METHODS AND ANALYSIS

This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment.

ETHICS AND DISSEMINATION

This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78).

TRIAL REGISTRATION NUMBER

ChiCTR2200065178.