Isometric Quadriceps Strength in Women with Mild, Moderate, and Severe Knee Osteoarthritis
ABSTRACT Quadriceps weakness is a common clinical sign in persons with moderate-to-severe osteoarthritis and results in physical disability; however, minimal data exist to establish whether quadriceps weakness is present in early stages of the disease. Therefore, our purpose was to determine whether quadriceps weakness was present in persons with early radiographic and cartilaginous evidence of osteoarthritis. Further, we sought to determine whether quadriceps strength decreases as osteoarthritis severity increases.
Three hundred forty-eight women completed radiologic and magnetic resonance imaging evaluation, in addition to strength testing. Anterior-posterior radiographs were graded for tibiofemoral osteoarthritis severity using the Kellgren-Lawrence scale. Scans from magnetic resonance imaging were used to assess medial tibiofemoral and patellar cartilage based on a modification of the Noyes scale. The peak knee extension torque recorded was used to represent strength.
Quadriceps strength (Nm/kg) was 22% greater in women without radiographic osteoarthritis than in women with osteoarthritis (P < 0.05). Quadriceps strength was also greater in women with Noyes' medial tibial and femoral cartilage scores of 0 when compared in women with Noyes' grades 2 and 3-5 (P < or = 0.05).
Women with early evidence of osteoarthritis had less quadriceps strength than women without osteoarthritis as defined by imaging.
Full-textDOI: · Available from: Riann M Palmieri-Smith, Jun 20, 2014
- SourceAvailable from: Isabel A C Baert
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- "Muscle strength significantly contributes to knee joint loading during walking (Pandy and Andriacchi, 2010) with recent attention being focused on lower limb muscle strength among knee OA patients. While quadriceps muscle weakness is well documented among knee OA patients (Lewek et al., 2004b; Palmieri-Smith et al., 2010; Tan et al., 1995), hamstring muscle strength is less studied and the results are contradictory (Slemenda et al., 1998; Tan et al., 1995). New evidence suggests hip muscles to be weaker in knee OA patients than in controls (Costa et al., 2010; Hinman et al., 2010). "
ABSTRACT: BACKGROUND: Based on novel classification criteria using magnetic resonance imaging, a subpopulation of "early knee osteoarthritis patients" was clearly defined recently. This study assessed whether these early osteoarthritis patients already exhibit gait adaptations (knee joint loading in particular) and changes in muscle strength compared to control subjects and established knee osteoarthritis patients. METHODS: Fourteen female patients with early knee joint degeneration, defined by magnetic resonance imaging (early osteoarthritis), 12 female patients with established osteoarthritis and 14 female control subjects participated. Specific gait parameters and lower limb muscle strength were analyzed and compared between groups. Within the osteoarthritis groups, association between muscle strength and dynamic knee joint loading was also evaluated. FINDINGS: Early osteoarthritis patients presented no altered gait pattern, no significant increase in knee joint loading and no significant decrease in hamstring muscle strength compared to controls, while established osteoarthritis patients did. In contrast, early osteoarthritis patients experienced significant quadriceps weakness, comparable to established osteoarthritis patients. Within the osteoarthritis groups, muscle strength was not correlated with knee joint loading during gait. INTERPRETATION: The results suggest that gait changes reflect mechanical overload and are most likely the consequence of structural degeneration in knee osteoarthritis. Quadriceps weakness might however contribute to the onset and progression of the disease. This study supports the relevance of classification of early osteoarthritis patients and assists in identifying their functional characteristics. This helps to understand the trajectory of disease onset and progression and further develop more targeted strategies for prevention and treatment of knee osteoarthritis.Clinical biomechanics (Bristol, Avon) 11/2012; 28(1). DOI:10.1016/j.clinbiomech.2012.10.007 · 1.88 Impact Factor
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ABSTRACT: Context: Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive. Objective: To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction. Design: Crossover study. Setting: University research laboratory. Patients or Other Participants: Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers. Intervention(s): All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee. Main Outcome Measure(s): Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced. Results: Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05). Conclusions: Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Journal of athletic training 03/2013; 48(2):186-191. DOI:10.4085/1062-6050-48.2.10 · 1.51 Impact Factor
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ABSTRACT: Quadriceps strength and activation may play an important role in the recovery from ACL revision surgery. The purpose of this study was to describe quadriceps strength and central activation ratio (CAR) and correlate with radiographic findings in patients with ACL revision surgery. Twenty-one patients who were on average 47.5 ± 21.1 months [range: 14-85 months] post-revision ACL reconstruction. We performed knee joint physical examination and radiographic evaluation. Quadriceps strength testing consisted of maximal voluntary isometric contractions (MVIC) with the knee bent to 90-degrees bilaterally. We calculated quadriceps central activation ratio using the superimposed burst technique. Radiographs (bilateral standing antero-posterior in knee flexion and lateral in full extension) were evaluated by a fellowship-trained orthopedic surgeon using the International Knee Documentation Committee (IKDC) grading system. Mean CAR was 83.9 ± 12.0% on the reconstructed limb and 85.5 ± 9.5% on the contralateral limb. Average, normalized MVIC torque was 2.5 ± 1.0 Nm/kg on the reconstructed limb and 2.7 ± 1.0 N m/kg for the contralateral limb. Patient age at the time of follow-up evaluation was related to severity of knee joint degeneration, particularly the medial, anterior and patellofemoral compartments. Younger patients with lower CARs tended to have more severe degeneration in the patellofemoral joint. Older patients with lower normalized MVIC torque values tended to exhibit more severely graded degeneration in the patellofemoral joint. Bilateral quadriceps central activation deficits and radiographic osteoarthritis are evident in patients with revision ACL reconstruction.Knee Surgery Sports Traumatology Arthroscopy 11/2010; 19(4):634-40. DOI:10.1007/s00167-010-1321-z · 2.84 Impact Factor