1
|
Cheuy VA, Dayton MR, Hogan CA, Graber J, Anair BM, Voigt TB, Nelms NJ, Stevens-Lapsley JE, Toth MJ. Neuromuscular electrical stimulation preserves muscle strength early after total knee arthroplasty: Effects on muscle fiber size. J Orthop Res 2023; 41:787-792. [PMID: 35856287 PMCID: PMC9852352 DOI: 10.1002/jor.25418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Loss of quadriceps strength after total knee arthroplasty (TKA) is most pronounced acutely but persists long-term, negatively impacting physical function in daily activities. Neuromuscular electrical stimulation (NMES) early after surgery is an effective adjuvant to standard of care rehabilitation (SOC) for attenuating strength loss following TKA, but the mechanisms whereby NMES maintains strength are unclear. This work aimed to determine the effects of early NMES on quadriceps strength and skeletal muscle fiber size 2 weeks after TKA compared to SOC. Patients scheduled for primary, unilateral TKA were enrolled and randomized into SOC (n = 9) or NMES plus SOC (n = 10) groups. NMES was started within 48 h of TKA, with 45-min sessions twice a day for 2 weeks. Isometric quadriceps strength was assessed preoperatively and 2 weeks following TKA. Vastus lateralis muscle biopsies of the involved leg were performed at the same time points and immunohistochemistry conducted to assess muscle fiber cross-sectional area and distinguish fiber types. Groups did not differ in age, body mass index, sex distribution, or preoperative strength. Both groups got weaker postoperatively, but the NMES group had higher normalized strength. After 2 weeks, the group receiving NMES and SOC had significantly greater MHC IIA and MHC IIA/IIX fiber size compared to SOC alone, with no group differences in MHC I fiber size. These results suggest that NMES mitigates early muscle weakness following TKA, in part, via effects on fast-twitch, type II muscle fiber size. This investigation advances our understanding of how adjuvant, early postoperative NMES aids muscle strength recovery.
Collapse
Affiliation(s)
- Victor A Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Michael R Dayton
- Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Craig A Hogan
- Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Bradley M Anair
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Thomas B Voigt
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel J Nelms
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michael J Toth
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
2
|
Toth MJ, Savage PD, Voigt TB, Anair BM, Bunn JY, Smith IB, Tourville TW, Blankstein M, Stevens-Lapsley J, Nelms NJ. Effects of total knee arthroplasty on skeletal muscle structure and function at the cellular, organellar, and molecular levels. J Appl Physiol (1985) 2022; 133:647-660. [PMID: 35900327 PMCID: PMC9467475 DOI: 10.1152/japplphysiol.00323.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Total knee arthroplasty (TKA) is an important treatment option for knee osteoarthritis (OA) that improves self-reported pain and physical function, but objectively measured physical function typically remains reduced for years after surgery due, in part, to precipitous reductions in lower extremity neuromuscular function early after surgery. The present study examined intrinsic skeletal muscle adaptations during the first 5 weeks post-TKA to identify skeletal muscle attributes that may contribute to functional disability. Patients with advanced stage knee OA were evaluated prior to TKA and 5 weeks after surgery. Biopsies of the vastus lateralis were performed to assess muscle fiber size, contractility, and mitochondrial content, along with assessments of whole muscle size and function. TKA was accompanied by marked reductions in whole muscle size and strength. At the fiber (i.e., cellular) level, TKA caused profound muscle atrophy that was approximately twofold higher than that observed at the whole muscle level. TKA markedly reduced muscle fiber force production, contractile velocity, and power production, with force deficits persisting in myosin heavy chain (MHC) II fibers after expression relative to fiber size. Molecular level assessments suggest reduced strongly bound myosin-actin cross bridges and myofilament lattice stiffness as a mechanism underlying reduced force per unit fiber size. Finally, marked reductions in mitochondrial content were apparent and more prominent in the subsarcolemmal compartment. Our study represents the most comprehensive evaluation of skeletal muscle cellular adaptations to TKA and uncovers novel effects of TKA on muscle fiber size and intrinsic contractility early after surgery that may contribute to functional disability.NEW & NOTEWORTHY We report the first evaluation of the effects of total knee arthroplasty (TKA) on skeletal muscle at the cellular and subcellular levels. We found marked effects of TKA to cause skeletal muscle fiber atrophy and contractile dysfunction in older adults, as well as molecular mechanisms underlying impaired contractility. Our results reveal profound effects of TKA on muscle fiber size and intrinsic contractility early after surgery that may contribute to functional disability.
Collapse
Affiliation(s)
- Michael J Toth
- Department of Medicine, College of Medicine, University of Vermont, Burlington, Vermont
- Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - Patrick D Savage
- Department of Medicine, College of Medicine, University of Vermont, Burlington, Vermont
| | - Thomas B Voigt
- Department of Medicine, College of Medicine, University of Vermont, Burlington, Vermont
| | - Bradley M Anair
- Department of Medicine, College of Medicine, University of Vermont, Burlington, Vermont
| | - Janice Y Bunn
- Department of Medical Biostatistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Isaac B Smith
- Department of Medicine, College of Medicine, University of Vermont, Burlington, Vermont
| | - Timothy W Tourville
- Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont
| | - Michael Blankstein
- Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
| | - Nathaniel J Nelms
- Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| |
Collapse
|
3
|
Toth MJ, Tourville TW, Voigt TB, Choquette RH, Anair BM, Falcone MJ, Failla MJ, Stevens-Lapslaey JE, Endres NK, Slauterbeck JR, Beynnon BD. Utility of Neuromuscular Electrical Stimulation to Preserve Quadriceps Muscle Fiber Size and Contractility After Anterior Cruciate Ligament Injuries and Reconstruction: A Randomized, Sham-Controlled, Blinded Trial. Am J Sports Med 2020; 48:2429-2437. [PMID: 32631074 PMCID: PMC7775613 DOI: 10.1177/0363546520933622] [Citation(s) in RCA: 20] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries and reconstruction (ACLR) promote quadriceps muscle atrophy and weakness that can persist for years, suggesting the need for more effective rehabilitation programs. Whether neuromuscular electrical stimulation (NMES) can be used to prevent maladaptations in skeletal muscle size and function is unclear. PURPOSE To examine whether early NMES use, started soon after an injury and maintained through 3 weeks after surgery, can preserve quadriceps muscle size and contractile function at the cellular (ie, fiber) level in the injured versus noninjured leg of patients undergoing ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients (n = 25; 12 men/13 women) with an acute, first-time ACL rupture were randomized to NMES (5 d/wk) or sham (simulated microcurrent electrical nerve stimulation; 5 d/wk) treatment to the quadriceps muscles of their injured leg. Bilateral biopsies of the vastus lateralis were performed 3 weeks after surgery to measure skeletal muscle fiber size and contractility. Quadriceps muscle size and strength were assessed 6 months after surgery. RESULTS A total of 21 patients (9 men/12 women) completed the trial. ACLR reduced single muscle fiber size and contractility across all fiber types (P < .01 to P < .001) in the injured compared with noninjured leg 3 weeks after surgery. NMES reduced muscle fiber atrophy (P < .01) through effects on fast-twitch myosin heavy chain (MHC) II fibers (P < .01 to P < .001). NMES preserved contractility in slow-twitch MHC I fibers (P < .01 to P < .001), increasing maximal contractile velocity (P < .01) and preserving power output (P < .01), but not in MHC II fibers. Differences in whole muscle strength between groups were not discerned 6 months after surgery. CONCLUSION Early NMES use reduced skeletal muscle fiber atrophy in MHC II fibers and preserved contractility in MHC I fibers. These results provide seminal, cellular-level data demonstrating the utility of the early use of NMES to beneficially modify skeletal muscle maladaptations to ACLR. CLINICAL RELEVANCE Our results provide the first comprehensive, cellular-level evidence to show that the early use of NMES mitigates early skeletal muscle maladaptations to ACLR. REGISTRATION NCT02945553 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Michael J. Toth
- Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bradley M. Anair
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael J. Falcone
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | | | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| |
Collapse
|
4
|
Senior EE, Poulin HE, Dobecki MG, Anair BM, Fabian-Fine R. Co-expression of the neuropeptide proctolin and glutamate in the central nervous system, along mechanosensory neurons and leg muscle in Cupiennius salei. Cell Tissue Res 2020; 382:281-292. [PMID: 32556729 DOI: 10.1007/s00441-020-03217-6] [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: 01/17/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022]
Abstract
Similar to hair cells in the mammalian cochlear system, mechanosensory neurons in the Central American wandering spider Cupiennius salei are strongly innervated by efferent fibers that originate from neurons whose somata are located in the central nervous system (CNS). In both the mammalian and arachnid systems, efferent fibers have been shown to co-express two or more transmitters; however, our understanding regarding co-transmission and how it affects sensory signal transduction and processing in these systems is only fragmentary. The spider model system is exceptionally suitable for this type of investigation due to the large size and easy accessibility of the sensory and efferent neurons in this system. Thus far, GABA and glutamate have been identified as the main fast-acting transmitters in efferent axons that form synaptic contacts onto sensory neurons in slit sense organs. Ultrastructural investigations suggest an abundance of neuropeptides within these peripheral synapses. In an effort to identify these peptides and conduct functional studies, we have employed immunohistochemistry to investigate whether the neuropeptide proctolin is present in neurons of the leg ganglia and in peripheral leg structures. Here, we demonstrate that ~ 73% of all neurons in the CNS of C. salei show proctolin-like immunoreactivity (proc-LIR) including the leg ganglia. We demonstrate that both strongly and weakly labeled neurons can be distinguished. The majority of proc-LIR neurons show weak labeling intensity and ~ 86.2% co-localize with glutamate. In future experiments, we plan to undertake functional studies to investigate the significance of this co-expression, which has yet to be investigated.
Collapse
Affiliation(s)
- Elizabeth E Senior
- Department of Biology, Saint Michael's College, One Winooski Park, Colchester, VT, 05349, USA
| | - Hailee E Poulin
- Department of Biology, Saint Michael's College, One Winooski Park, Colchester, VT, 05349, USA
| | - Madison G Dobecki
- Department of Biology, Saint Michael's College, One Winooski Park, Colchester, VT, 05349, USA
| | - Bradley M Anair
- Department of Biology, Saint Michael's College, One Winooski Park, Colchester, VT, 05349, USA
| | - Ruth Fabian-Fine
- Department of Biology, Saint Michael's College, One Winooski Park, Colchester, VT, 05349, USA.
| |
Collapse
|