Amin, S. et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum. 60, 189-198

College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 01/2009; 60(1):189-98. DOI: 10.1002/art.24182
Source: PubMed


To determine the effect of quadriceps strength in individuals with knee osteoarthritis (OA) on loss of cartilage at the tibiofemoral and patellofemoral joints (assessed by magnetic resonance imaging [MRI]) and on knee pain and function.
We studied 265 subjects (154 men and 111 women, mean+/-SD age 67+/-9 years) who met the American College of Rheumatology criteria for symptomatic knee OA and who were participating in a prospective, 30-month natural history study of knee OA. Quadriceps strength was measured at baseline, isokinetically, during concentric knee extension. MRI of the knee at baseline and at 15 and 30 months was used to assess cartilage loss at the tibiofemoral and patellofemoral joints, with medial and lateral compartments assessed separately. At baseline and at followup visits, knee pain was assessed using a visual analog scale, and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index.
There was no association between quadriceps strength and cartilage loss at the tibiofemoral joint. Results were similar in malaligned knees. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint (for highest versus lowest tertile of strength, odds ratio 0.4 [95% confidence interval 0.2, 0.9]). Those with greater quadriceps strength had less knee pain and better physical function over followup (P<0.001).
Greater quadriceps strength had no influence on cartilage loss at the tibiofemoral joint, including in malaligned knees. We report for the first time that greater quadriceps strength protected against cartilage loss at the lateral compartment of the patellofemoral joint, a finding that requires confirmation. Subjects with greater quadriceps strength also had less knee pain and better physical function over followup.

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Available from: Mikayel Grigoryan, May 21, 2014
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    • "that even though ACL reconstruction restores TF kinematics, PF kinematics often remain changed from normal (Chaudhari et al., 2008; Van de Velde et al., 2008). Quadriceps strengthening exercises have been proposed as a therapeutic approach to retain knee extensor strength balance, and patellar stability, and to restore PF kinematics, thus preventing an accelerated development of PF-OA (Amin et al., 2009; Oiestad et al., 2010). "
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    ABSTRACT: Background: Anterior cruciate ligament deficiency and quadriceps muscle weakness are considered to be important risk factors for aberrant patellar tracking and subsequent patellofemoral osteoarthritis. However, data from in vivo experiments looking at dynamic patellar joint kinematics and muscle force are scarce. Therefore, the purpose of this study was to evaluate the effects of anterior cruciate ligament transection and loss of vastus medialis force on patellar tracking in the rabbit knee in vivo. Methods: Eight skeletally mature New Zealand White Rabbits, weighing 6.0kg (0.6kg standard deviation) were used. The experimental trials consisted of active, concentric and eccentric movements of the knee joint. Measurements were performed with the intact, the anterior cruciate ligament deficient, and the vastus medialis transected knee. Patellofemoral kinematics (shift, rotation) were quantified from high speed video. Findings: Following anterior cruciate ligament transection, patellar tracking occurred more laterally, and caused a significant lateral rotation of the patella. The addition of vastus medialis transection did not alter patellar tracking or rotation significantly for any of the force-matched experimental conditions. Interpretation: The loss of the anterior cruciate ligament results in lateral patellar shift and rotation while the loss of vastus medialis muscle force does not affect patellar tracking or rotation in the anterior cruciate ligament deficient knee. We suggest that the current results should be considered carefully in future interpretations of knee extensor imbalance. More research is needed to describe the contribution of vastus medialis muscle strength to medial patellofemoral stability and confirm these results in the human knee.
    Clinical biomechanics (Bristol, Avon) 05/2014; 29(5). DOI:10.1016/j.clinbiomech.2014.03.001 · 1.97 Impact Factor
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    • "Further study done by Boon Whatt LIM et al.28) concluded that quadriceps strengthening has beneficial effect on pain and function in patients with OA knee. The study done by Shreyasee Amin et al.29) reported that subjects having stronger quadriceps strength had less knee pain and better physical function as compared with those with the least strength. Strong muscles stabilize the joints in a proper alignment, attenuate shocks that are transmitted to the joints and minimize the effect of impact by spreading the forces out over a greater area so it may be hypothesized that improvement in muscle strength is one of the main causes of reduced pain and disability. "
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    ABSTRACT: [Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40-65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.
    Journal of Physical Therapy Science 05/2014; 26(5):745-8. DOI:10.1589/jpts.26.745 · 0.39 Impact Factor
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    • "including varus mal-alignment, laxity, and dynamic instability (Brouwer et al., 2007; Chang et al., 2004; Hunt et al., 2011; Lewek et al., 2004a; Sharma et al., 2013; Sharma et al., 1999, 2001; van der Esch et al., 2008a). Similarly, studies quantifying active neuromuscular control in knee OA often involve muscles primarily functioning in the sagittal plane (Amin et al., 2009; Lim et al., 2009; Mikesky et al., 2006; Roos et al., 2011; Segal et al., 2010b; Sharma et al., 2003). In a previous study of healthy participants, we found that using visual feedback display of torque magnitude, the participants could generate significant knee valgus and varus isometric torque measured by a 6-axis force sensor (Zhang et al., 2001). "
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    ABSTRACT: Impaired proprioception and poor muscular stabilization in the frontal plane may lead to knee instability during functional activities, a common complaint in persons with knee osteoarthritis (KOA). Understanding these frontal plane neuromechanical properties in KOA will help elucidate the factors contributing to knee instability and aid in the development of targeted intervention strategies. The objectives of the study were to compare knee varus-valgus proprioception, isometric muscle strength, and active muscular contribution to stability between persons with medial KOA and healthy controls. We evaluated knee frontal plane neuromechanical parameters in 14 participants with medial KOA and 14 age- and gender-matched controls, using a joint driving device (JDD) with a customized motor and a 6-axis force sensor. Analysis of covariance with BMI as a covariate was used to test the differences in varus-valgus neuromechanical parameters between these two groups. The KOA group had impaired varus proprioception acuity (1.08±0.59° vs. 0.69±0.49°, p<0.05), decreased normalized varus muscle strength (1.31±0.75% vs. 1.79±0.84% body weight, p<0.05), a trend toward decreased valgus strength (1.29±0.67% vs. 1.88±0.99%, p=0.054), and impaired ability to actively stabilize the knee in the frontal plane during external perturbation (4.67±2.86 vs. 8.26±5.95Nm/degree, p<0.05). The knee frontal plane sensorimotor control system is compromised in persons with medial KOA. Our findings suggest varus-valgus control deficits in both the afferent input (proprioceptive acuity) and muscular effectors (muscle strength and capacity to stabilize the joint).
    Journal of Biomechanics 11/2013; 47(2). DOI:10.1016/j.jbiomech.2013.11.024 · 2.75 Impact Factor
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