The effects of pain on quadriceps strength, joint proprioception and dynamic balance among women aged 65 to 75 years with knee osteoarthritis

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g ​= ​-1.33 [-2.33, -0.32], g = ​-2.29 [-2.82, -1.75] and g ​= ​-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g ​= ​-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Effects of a nighttime melatonin ingestion on dynamic postural balance and muscle strength the following morning in people living with multiple sclerosis: A preliminary study

BACKGROUND

Decreased endogenous melatonin concentrations in people with multiple sclerosis (PwMS) are associated with fatigue and pain that impair postural balance and muscle strength. Melatonin ingestion had analgesic and anti-fatigue effects. However, the acute effect of exogenous melatonin on dynamic postural stability and muscle strength has not been studied yet in PwMS. This study aimed to investigate the safety and the efficacy of a nighttime melatonin intake on dynamic postural balance and lower-extremity muscle strength the following morning in PwMS.

METHODS

Fourteen PwMS (28.36 ± 6.81 years) were assessed (8 a.m.) pre- and post-acute intake of melatonin or placebo (6mg, 30 minutes before nocturnal bedtime). Evaluated parameters included dynamic postural balance (force platform), lower-extremity muscle strength [Five-Repetition Sit-To-Stand Test (5-STST)], hand dexterity (Nine-Hole Peg Test), nociceptive pain [Visual Analogue Scale (VAS)], neuropathic pain [Neuropathic Pain 4 Questions (DN4)], sleep quality and fatigue perception [Hooper Index (HI)].

RESULTS

In the frontal plane, melatonin reduced the center of pressure (CoP) path length (CoPL), CoPL in the anteroposterior axis (CoPLY) and CoP sway area (CoPAr) compared with placebo by 7.56% (p=0.02, Cohens'd (d)=1.24), 19.27% (p<0.001, d=2.60) and 13.82% (p<0.001, d=2.02), respectively. Melatonin induced a higher decrease in these posturographic parameters compared with placebo in the sagittal plane [CoPL: 9.10% (p=0.005, d=1.02), CoPLY: 4.29% (p=0.025, d=1.07) and CoPAr: 7.45% (p=0.038, d=0.74)]. Melatonin decreased 5-STST duration as well as VAS, DN4, HI-fatigue and HI-sleep scores compared with placebo by 8.19% (p=0.008, d=1.19), 5.74% (p=0.04, d=0.82), 27.30% (p=0.023, d=0.98), 40.15% (p=0.044, d=0.85) and 30.16% (p=0.012, d=1.10), respectively.

CONCLUSION

This preliminary study, among PwMS, showed that acute melatonin ingestion was safe and efficient for improving dynamic postural stability and lower-extremity muscle strength probably through its analgesic and anti-fatigue effects.

Preoperative frailty assessment with ultrasound in elderly patients scheduled for total knee arthroplasty

BACKGROUND

Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty.

METHODS

Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded.

RESULTS

We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values.

CONCLUSIONS

Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.

Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations

BACKGROUND

It is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments.

METHODS

A Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables.

FINDINGS

Pain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations.

INTERPRETATION

Individuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.

Effects of basic body awareness therapy on pain, balance, muscle strength and functionality in knee osteoarthritis: a randomised preliminary trial

PURPOSE

This study aimed to investigate the effects of basic body awareness therapy (BBAT) on pain, balance, muscle strength, and functionality in knee OA.

METHODS

Forty patients (mean age: 55.20 ± 6.40 years) with knee OA were randomly assigned to experimental and control groups. Both groups participated in a home-based exercise programme. The home-based exercise programme was performed daily for 6 weeks. In addition to the home-based programme, patients in the experimental group participated in BBAT 3 days a week for 6 weeks. The visual analogue scale, fall risk assessment, single-leg stability test, knee extension muscle strength, five times sit-to-stand test, joint range of motion assessment, Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, and stair climb test were performed at baseline and after 6 weeks.

RESULTS

All outcomes in the experimental group significantly improved after 6 weeks (p < 0.05). There were significant differences between the two groups in terms of the experimental group in muscle strength (p = 0.018, η2= 0.191), five times sit-to-stand test (p < 0.001, η2= 0.510), and the stair climbing test (p = 0.012, η2=0.212).

CONCLUSION

This study showed that BBAT, in addition to a home-based exercise programme, can improve muscle strength and functionality in patients with knee OA.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04165187.

Joint pressure stimuli increase quadriceps strength and neuromuscular activity in patients with knee osteoarthritis

The study investigated the effects of periarticular knee pressure stimuli on quadriceps strength and neuromuscular activity in subjects with knee osteoarthritis. Twenty-five subjects with knee osteoarthritis and 25 age-matched healthy controls performed maximal voluntary knee extension tasks on an isometric dynamometer. Three different pressure stimuli (no-pressure, 60-mmHg, 120-mmHg) were applied using a sphygmomanometer via the cuff covering the knee joint. Peak torque and root-mean-square peak of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were collected and normalized for the no-pressure condition (nTorque-peak and nRMS-peak). Normalized Torque-peak increased from no-pressure to 60-mmHg and 120-mmHg in patients, which revealed higher nTorque-peak during 60-mmHg (MD: 10.9%, IC95: 1.8%, 20.1%, p = 0.020) and 120-mmHg (MD: 16.0%, IC95: 4.4%, 27.6%, p = 0.008) conditions than healthy subjects. Moreover, nRMS-peak increased from no-pressure to 60-mmHg for RF, from no-pressure to 120-mmHg for RF, VM and VL, and from 60-mmHg to 120 mm-Hg for VL in patients. Patients revealed higher nRMS-peak of RF and VM during 60-mmHg and 120-mmHg conditions than healthy subjects. Periarticular knee pressure stimuli enhanced quadriceps strength and neuromuscular activity in subjects with knee osteoarthritis. This approach may represent a new strength training modality in patients with neuromuscular activation deficits for knee osteoarthritis.

Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis

Background

Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols.

Methods

From Jan 2000 to Jun 2022, all the RCTs from SCOPUS, EMBASE and PUBMED comparing patient-related outcome measures between the smartphone-based app and conventional rehabilitation protocols were scanned and seven studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The quantitative analysis compared outcomes using the knee injury and osteoarthritis outcome score (KOOS), the knee society function score (KSFS), the active range of motion (AROM), Euro-Qol-5D-5L, and MUA. The qualitative analysis compared VAS, NRS, and Time up and go (TUG).

Results

The study shows statistically significant improvement in traditional rehabilitation over app based on KSFS score (M.D.: 6.05, p = 0.05) and AROM on long-term follow-up (12 months) (M.D.: 2.46, p = 0.02). AROM was insignificant on 3 months or less follow-up. NRS and VAS were found to be statistically better in app-based groups. No statistically significant results were seen on KOOS, Euro-Qol-5D-5L, MUA and TUG. 90 days of readmission and a number of physiotherapy visits were more in conventional groups. No difference was seen in single-leg stance and satisfaction rates.

Conclusions

The present review highlights improved early pain scores and comparable patient-reported outcome analysis at a short-term follow-up period among patients receiving mobile app-based rehabilitation. However, knee range of motion and KSFS score achieved after surgery is analysed to be better with traditional rehabilitation at the one-year end follow-up period.

Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore

OBJECTIVE

This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults.

METHODS

Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted.

RESULTS

Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls.

CONCLUSIONS

The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes.

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Evaluation of the balance function before and after total knee arthroplasty using Berg balance scale

INTRODUCTION

The purpose of this study was to evaluate balance function before and after total knee arthroplasty (TKA) using Berg balance scale (BBS). The study also aimed to identify factors associated with balance impairment.

MATERIALS AND METHODS

Ninety-three knees in 90 patients were prospectively evaluated using their BBS scores, passive knee extension/flexion angles, Visual analogue scale for pain scores, hip-knee-ankle angles, and knee extensor/flexor muscle strengths before and after TKA. A total BBS score of less than 45 indicates an enhanced risk of multiple falls. Multivariate logistic regression models were performed to elucidate factors associated with post-operative BBS score.

RESULTS

A significant difference in mean pre- and post-operative BBS scores were noted (49.3 ± 6.4 vs. 52.2 ± 4.7) (p < 0.05). The percentage of pre- and post-operative BBS scores less than 45 were 20% and 10% (p < 0.05). Rheumatoid Arthritis (RA), lower pre-operative BBS score, and larger post-operative knee flexion contracture were significantly associated with lower post-operative BBS score (p < 0.01). The post-operative knee flexion contracture greater than 10° was significantly associated with substantially high odds of post-operative BBS scores less than 45 (Odds ratio 7.6; 95% confidential interval 1.69-34.17).

CONCLUSIONS

While TKA significantly improved BBS scores, 10% of the patients remained at a risk for multiple falls. RA, lower pre-operative BBS score, and post-operative knee flexion contracture greater than 10° retained balance impairment even after TKA.

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

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

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

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

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

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

A Novel Mobile App-based Neuromuscular Electrical Stimulation Therapy for the Management of Knee Osteoarthritis: Results From an Extension Study of a Randomized, Double-blind, Sham-controlled, Multicenter Trial

Mobile app-based neuromuscular electrical stimulation (NMES) is a promising treatment of knee osteoarthritis as previously demonstrated in a 12-week, randomized, double-blind, sham-controlled, multicenter trial (parent study).

Impaired Modulation of Motor and Functional Performance in Patients after Total Knee Arthroplasty: A Prospective Observational Study

Submaximal levels of effort are required for the performance of the most common daily tasks. Inaccuracy in modulating motor outputs during submaximal tasks has been reported as indicator of safety during daily activities in subjects with lower limb musculoskeletal disorders. The study is aimed at investigating performance modulation ability during motor and functional tasks in patients after total knee arthroplasty (TKA). Sixteen patients with end-stage osteoarthritis undergoing TKA and twenty age-matched healthy participants performed isokinetic knee extension, sit-to-stand, and walking tasks at three levels of self-estimated effort (100%, 50%, and 25%) the day before (T0) and 4 days after surgery (T1). Maximum performance in terms of peak torque (PT—knee extension), overshoot (OS—sit-to-stand), and walking speed was evaluated. Subsequently, relative error (RE) between target and observed performance was computed for the submaximal tasks (RE_50% and RE_25%). Our results showed a decline of maximum performance after surgery, which resulted lower in patients compared to healthy subjects. RE_50% and RE_25% for knee extension (involved limb) (p < 0.001) and RE_25% for sit-to-stand (p < 0.001) increased from pre- to postsurgery. At T0, knee extension RE_25% and walking RE_50% and RE_25% were higher in patients. At T1, RE_50% and RE_25% were higher in patients for knee extension (involved limb), sit-to-stand, and walking. In conclusion, the ability to modulate motor and functional performance decreased after TKA and resulted impaired when compared to healthy age-matched subjects. Based on relationship between ability to modulate motor outputs and risk of falling, the role of modulation ability as indicator of readiness for discharge and safe return to daily activities deserves further investigations in patients in early phase after TKA.

Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative

OBJECTIVE

To describe the effect of knee symptoms and radiographic osteoarthritis (ROA) on the risk of falls, recurrent falls, and fractures.

DESIGN

Participants from the Osteoarthritis Initiative were classified as having 'no', 'unilateral' or 'bilateral' knee symptoms (≥19 on a 0-96 Western Ontario and McMaster Universities Osteoarthritis Index) and ROA (Kellgren-Lawrence grade ≥2) for each visit. Self-reported falls and fractures in the past 12 months were extracted at baseline and follow-up visits until month 96. Recurrent falls were defined as having ≥2 falls in the past 12 months. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using mixed-effects complementary log-log regression.

RESULTS

Of 4465 participants, 3145 (70%), 1681 (38%), and 806 (18%) experienced at least one fall, recurrent fall, and fracture, respectively, over 96 months. Compared to participants without symptomatic knee, unilateral and bilateral knee symptoms were associated with a 17% increased risk of falls and a 36-46% increased risk of recurrent falls, and bilateral knee symptoms increased the risk of fractures (HR 1.45, 95%CI 1.17 to 1.81). Compared to participants with no ROA in either knee, bilateral ROA was associated with a reduced risk of falls (HR 0.87, 95%CI 0.77 to 0.99) and fractures (HR 0.78, 95%CI 0.64 to 0.96). No statistically significant interactions between knee symptoms and ROA were observed.

CONCLUSIONS

This large population-based study showed that knee symptoms but not ROA increased the risk of falls, recurrent falls, and fractures, and that adults with bilateral ROA may have a lower risk of falls and fractures.

Hip strength, quadriceps strength and dynamic balance are lower in people with unilateral knee osteoarthritis compared to their non-affected limb and asymptomatic controls

BACKGROUND

There is insufficient literature on multi-directional hip strength differences and dynamic balance between people with knee osteoarthritis (KOA) and healthy controls.

OBJECTIVE

In people with unilateral KOA, determine if hip/knee strength and dynamic balance differs (i) between sides, and (ii) compared to controls.

METHODS

Thirty-six participants (17 women; 65.5 ± 8.9 years) with unilateral KOA and 36 age- and sex-matched controls were included in a cross-sectional study. Outcomes included hip strength, quadriceps strength, and dynamic balance (three directions) during the Star Excursion Balance Test. Mixed ANOVA analysis was completed to investigate differences between Limbs and Groups. Mean differences (MD) and 95% confidence intervals (CI) were calculated.

RESULTS

Quadriceps and hip adduction strength were 16% (95%CI:10, 22) and 9% [95%CI: 3, 16) lower on the affected compared to non-affected side. Quadriceps and hip abduction, adduction, flexion, and extension strength (MD varying from 16%, 95%CI: 8, 25; to 34%, 95%CI: 17, 50) were weaker bilaterally in individuals with KOA compared to control. Posteromedial balance was 4% (95%CI: 2, 6) lower for affected compared to non-affected limbs in those with KOA and 13% (95%CI: 6, 21) lower in the affected limb compared to controls. Individuals with KOA had lower balance bilaterally in the anterior 11% (95%CI: 7, 15) and posterolateral 21% (95%CI: 13, 30) directions.

CONCLUSION

Hip/knee strength (especially in the sagittal and frontal planes) and dynamic balance are lower bilaterally in people with KOA compared to controls. Hip adduction strength is lower on the affected than non-affected limbs of people with KOA. Clinicians should consider that knee extension strength, hip strength, and dynamic balance are lower bilaterally in people with unilateral KOA.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Efficacy evaluation of acupotomy combined with platelet-rich plasma in the treatment of early and middle osteoarthritis

OBJECTIVE

To investigate the efficacy of traditional Chinese medicine acupotomy combined with platelet-rich plasma (PRP) in the treatment of early and middle osteoarthritis.

METHODS

Eighty cases of early and middle knee joint pain patients admitted in our hospital were selected in this retrospective study. They were divided into the control group and observation group according to treatment methods, with 40 cases in each group. The control group was treated with PRP, and the observation group was treated with acupotomy + PRP. Clinical response rate, visual analogue scale (VAS) pain score, Lequesne score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and SF-36 quality of life score were compared between the two groups.

RESULTS

The total clinical response rate in the observation group was higher than that in control group (P<0.01). VAS pain score, knee joint WOMAC index and Lequesne score in the two groups after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). SF-36 quality of life score was significantly higher in the observation group than in the control group (all P<0.001).

CONCLUSION

Acupotomy combined with PRP in the treatment of early and middle osteoarthritis can relieve pain and improve joint function, which is worthy of clinical promotion.

The effect of scapular strengthening exercise using elastic band on balance and quality of life in the old people

The old people are weakened and misaligned due to aging, and their balance and quality of life are reduced. We investigated that the effect of scapular strengthening exercise on balance and quality of life in the old people. A scapular strengthening exercise was applied to the experimental group, and the general conditioning exercise was applied to the control group for 40 min per session, 5 times a week, for a total of 4 weeks. As a result, the static balance and Y-balance test performance improved in the experimental group (P<0.05). The physical function and mental health, and general health of 36-item Short Form health survey improved in the experimental group (P<0.05). Therefore, the scapular strengthening exercise could be suggested as an intervention method that could improve the balance and quality of life of the old people.

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL TRIAL REGISTRATION NUMBER

KA18/170.

Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain

Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that influences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibro-fascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by -17.2%±11.0% at lower end of shaft of femur, -21.1%±6.0% at upper border of patella, -36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.

Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis: A randomised clinical trial

Background

Knee osteoarthritis (KOA) is one of the leading causes of global disability, which causes knee pain, stiffness and swelling. Impaired neuromuscular function may cause joint instability, alignment changes and knee stress, which leads to the progression of KOA. Whole-body vibration (WBV) training is considered to improve pain and functional mobility effectively. However, few studies have investigated the therapeutic effect of WBV on neuromuscular function in KOA.

Material and methods

A single-blinded, randomised, controlled trial was performed on 81 participants diagnosed with KOA. The participants were randomised into three groups: (1) WBV group, in which participants performed strength training (ST) with vibration exposure for 8 weeks; (2) ST group, in which participants performed ST without vibration for 8 weeks; and (3) health education (HE) group, in which participants received a HE for 8 weeks. The visual analogue scale for knee pain, isokinetic muscle strength test, proprioception test, Timed Up and Go test (TUG) and 6-min Walk Distance test (6MWD) were performed before and after the interventions.

Results

No significant difference was found on pain, proprioception, TUG and 6MWD. A significant interaction effect was found in isokinetic muscle strength between groups. Further analysis showed that compared with the HE group, the WBV group exhibited significantly greater improvement in isokinetic muscle strength (peak torque [PT] of extensors, p < 0.01, 95% CI = 0.11-0.33 Nm/kg; PT of flexors, p = 0.01, 95% CI = 0.02-0.19 Nm/kg; peak work [PW] of extensors, p < 0.01, 95% CI = 0.12-0.75 W/kg). In addition, compared with the ST group, the muscle strength of the WBV group (PT of extensors, p < 0.01, 95% CI = 0.10-0.32 Nm/kg; PW of extensors, p < 0.01, 95% CI = 0.09-0.71 W/kg) improved significantly.

Conclusion

Our findings suggested that adding WBV training to ST might benefit muscle strength around the knee joint in patients with KOA.

Static balance assessment in patients with severe osteoarthritis of the knee

BACKGROUND

Pain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased.

METHODS

The study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS).

RESULTS

In the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (-0,227; P < 0.01) and max anteroposterior (-0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01).

CONCLUSIONS

Patients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.

Dysethesia due to irritation of the dorsal root ganglion following lumbar transforaminal endoscopy: Analysis of frequency and contributing factors

BACKGROUND

New onset of acute dysethetic leg pain due to irritation of the dorsal root ganglion (DRG) following uneventful recovery from an expertly executed lumbar transforaminal endoscopic decompression is a common problem. Its incidence and relation to any risk factors that could be mitigated preoperatively are not well understood.

METHODS

We performed a multicenter frequency analysis of DRG irritation dysesthesia in 451 patients who underwent lumbar transforaminal endoscopic decompression for herniated disc and foraminal stenosis. The 451 patients consisted of 250 men and 201 women with an average age of 55.77 ± 15.6 years. The average follow-up of 47.16 months. The primary clinical outcome measures were the modified Macnab criteria. Chi-square testing was employed to analyze statistically significant associations between increased dysesthesia rates, preoperative diagnosis, the surgical level(s), and surgeon technique.

RESULTS

At final follow-up, Excellent (183/451; 40.6 %) and Good (195/451; 43.2 %) Macnab outcomes were observed in the majority of patients (378/451; 83.8 %). The majority of study patients (354; 78.5 %) had an entirely uneventful postoperative recovery without any DRG irritation, but 21.5 % of patients were treated for it in the immediate postoperative recovery period with supportive care measures including activity modification, transforaminal epidural steroid injections, non-steroidal anti-inflammatories, gabapentin, or pregabalin. There was no statistically significant difference in dysesthesia rates between lumbar levels from L1 to S1, or between single (DRG rate 21.8 %) or two-level (DRG rate 20.2 %) endoscopic decompression (p = 0.742). A statistically significantly higher incidence of postoperative dysesthesia was observed in patients who underwent decompression for foraminal stenosis (38/103; 27 %), and recurrent herniated disc (7/10; 41.2 %; p = 0.039). There were also statistically significant variations in dysesthesia rates between the seven participating clinical study sites ranging from 11.6%-33% (p = 0.002). Unrelenting postoperative dysesthetic leg pain due to DRG irritation was statistically associated with less favorable long-term clinical outcomes with DRG rates as high as 45 % in patients with a Fair and 61.3 % in patients with Poor Macnab outcomes (p < 0.0001).

CONCLUSIONS

Postoperative dysesthesia following transforaminal endoscopic decompression should be expected in one-fifth of patients. There was no predilection for any lumbar level. Foraminal stenosis and recurrent herniated disc surgery are risk factors for higher dysesthesia rates. There was a statistically significant variation of dysesthesia rates between participating centers suggesting that the surgeon skill level is of significance. Severe postoperative dysesthesia may be a predictor of Fair of Poor long-term Macnab outcomes.

Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study

Background

To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints.

Methods

The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen’s d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance.

Results

The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] −0.73 [−1.26,-0.20], − 0.74 [−1.26,-0.21], −0.71 [−1.24,-0.19], respectively; p < 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint–strength directions: the involved leg’s ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg’s ankle dorsal flexion (p < 0.05). There was no significant difference for 17 of 24 tests.

Conclusions

For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings.