Muscle Force Steadiness in Older Adults Before and After Total Knee Arthroplasty

Smith, Jessica; Marcus, Robin L.; Peters, Christopher L.; Pelt, Christopher E.; Tracy, Brian; LaStayo, Paul C.

doi:10.1016/j.arth.2013.11.023

Cited by 19 publications

(22 citation statements)

References 42 publications

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“…Less steady maximal isokinetic knee-extension contractions have been observed in participants with ACL-deficient 18,19 or ACL-reconstructed 19 knees than in healthy control participants, and less steady torque output has been associated with decreased singlelegged-hop performance during timed and distance tasks. 18,19 Osteoarthritic knees have also demonstrated greater variability in torque 20,21 and poorer matching accuracy 20 than healthy knees during submaximal isokinetic knee-extension force-matching contractions, which were correlated with time to complete functional tasks. 20 Excessive unsteadiness of torque production may reflect changes in motor-output variability 27 due to disrupted sensorimotor pathways after ACL-R. 28 Evidence from animal models 29,30 has suggested that damage to articular tissues and receptors can alter sensory information from the knee.…”

Section: Discussionmentioning

confidence: 99%

“…4,6À8,16,17 Torque variability (ie, force steadiness, force control) is a measure of motor control that describes a patient's ability to produce smooth and steady muscle contractions and focuses on the quality of torque production rather than traditionally reported quantity. Researchers have identified diminished quadriceps muscle control in patients with ACL-deficient, 18,19 ACL-reconstructed, 12,19 and osteoarthritic 20,21 knees using measures of maximal and submaximal, isometric, and isokinetic knee-extension contractions. Assessments of muscle control, or the quality of muscle contractions, are seldom used in clinical settings; however, these measures may provide valuable insight into motor recovery and disability after ACL-R.…”

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confidence: 99%

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Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

Goetschius¹,

Hart

2016

Journal of Athletic Training

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Context: When returning to physical activity, patients with a history of anterior cruciate ligament reconstruction (ACL-R) often experience limitations in knee-joint function that may be due to chronic impairments in quadriceps motor control. Assessment of knee-extension torque variability may demonstrate underlying impairments in quadriceps motor control in patients with a history of ACL-R.Objective: To identify differences in maximal isometric knee-extension torque variability between knees that have undergone ACL-R and healthy knees and to determine the relationship between knee-extension torque variability and selfreported knee function in patients with a history of ACL-R.Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 53 individuals with primary, unilateral ACL-R (age ¼ 23.4 6 4.9 years, height ¼ 1.7 6 0.1 m, mass ¼ 74.6 6 14.8 kg) and 50 individuals with no history of substantial lower extremity injury or surgery who served as controls (age ¼ 23.3 6 4.4 years, height ¼ 1.7 6 0.1 m, mass ¼ 67.4 6 13.2 kg).Main Outcome Measure(s): Torque variability, strength, and central activation ratio (CAR) were calculated from 3-second maximal knee-extension contraction trials (908 of flexion) with a superimposed electrical stimulus. All participants completed the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and we determined the number of months after surgery. Group differences were assessed using independent-samples t tests. Correlation coefficients were calculated among torque variability, strength, CAR, months after surgery, and IKDC scores. Torque variability, strength, CAR, and months after surgery were regressed on IKDC scores using stepwise, multiple linear regression.Results: Torque variability was greater and strength, CAR, and IKDC scores were lower in the ACL-R group than in the control group (P , .05). Torque variability and strength were correlated with IKDC scores (P , .05). Torque variability, strength, and CAR were correlated with each other (P , .05). Torque variability alone accounted for 14.3% of the variance in IKDC scores. The combination of torque variability and number of months after surgery accounted for 21% of the variance in IKDC scores. Strength and CAR were excluded from the regression model.Conclusions: Knee-extension torque variability was moderately associated with IKDC scores in patients with a history of ACL-R. Torque variability combined with months after surgery predicted 21% of the variance in IKDC scores in these patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

Goetschius¹,

Hart

2016

Journal of Athletic Training

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“…After linear detrending of the middle 2s, mean torque, SD of torque, and CV of torque were calculated using Matlab software (Mathworks, Inc.; Natlick, MA, Matlab 2009). 32 MFS test trials where the mean torque produced was within ± 20% of the target force were included as part of the data analysis. MFA was expressed as a percentage of the target force (%TF).…”

Section: Methodsmentioning

confidence: 99%

The Association Between Knee Extensor Force Steadiness, Force Accuracy, and Mobility in Older Adults Who Have Fallen

Chung-Hoon

Tracy

Dibble

et al. 2016

Journal of Geriatric Physical Therapy

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Background Older adults often experience impaired mobility, lower extremity muscle weakness, and increased fall risk. Furthermore, when older adults perform tasks that require control of submaximal force, impairments in their ability to maintain steady and accurate force output has been reported. Such problems may be related to deteriorating levels of mobility, particularly in older adults who have fallen. Purpose The purpose of this study was to determine whether an association exists between muscle force steadiness (MFS) or muscle force accuracy (MFA) of the knee extensors and mobility in older adults who have fallen. Methods Twenty older adults (x̄ = 77.5 ± 7yrs, 5 males and 15 females) with 2 or more co-morbid conditions and who experienced a fall in the past year underwent assessment of maximal voluntary isometric contraction (MVIC) of the knee extensors. A submaximal target force of 50% of their MVIC was used to determine concentric (CON) and eccentric (ECC) steadiness (the fluctuations in force production) and accuracy (the average distance of the mean force from the target force) measures. Mobility was indicated by the 6 minute walk test (6MWT), the timed up and go (TUG), stair ascent (StA), and stair descent (StD) tests. Correlation analysis was used to assess the relation between measures of muscle force control and mobility. Results The correlations between MFS and mobility were not significant (p>0.05) for either contraction type. However, MFA during ECC contractions only, were correlated significantly with all measures of mobility: 6MWT (r=−0.48, p=0.03), TUG (r=0.68, p=0.01), StA (r=0.60, p=0.01), StD (r=0.75, p<0.01). Conclusion The identification of the relationship between ECC MFA and mobility in older adults who have fallen is novel. While the correlations are not causal, these relationships suggest inaccurate force output during ECC contractions of the knee extensors is linked to impaired mobility.

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“…Hortobagyi et al investigated force fluctuations at two fixed force levels (50 N and 100 N) which, however, did not represent the same relative target forces in % of IMVC strength of both groups [28]. Smith et al measured force control at 50% of IMVC strength during concentric and eccentric voluntary contractions [35]. We present the first study on torque control at 20%, 40% and 60% of IMVC strength.…”

Section: Introductionmentioning

confidence: 97%

“…To the best of our knowledge, only two studies have investigated force control in KOA and they showed modulations depending on the contraction type [28, 35]. Hortobagyi et al investigated force fluctuations at two fixed force levels (50 N and 100 N) which, however, did not represent the same relative target forces in % of IMVC strength of both groups [28].…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients

et al. 2017

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IntroductionKnee osteoarthrosis (KOA) is commonly associated with a dysfunction of the quadriceps muscle which contributes to alterations in motor performance. The underlying neuromuscular mechanisms of muscle dysfunction are not fully understood. The main objective of this study was to analyze how KOA affects neuromuscular function of the quadriceps muscle during different contraction intensities.Materials and methodsThe following parameters were assessed in 20 patients and 20 healthy controls: (i) joint position sense, i.e. position control (mean absolute error, MAE) at 30° and 50° of knee flexion, (ii) simple reaction time task performance, (iii) isometric maximal voluntary torque (IMVT) and root mean square of the EMG signal (RMS-EMG), (iv) torque control, i.e. accuracy (MAE), absolute fluctuation (standard deviation, SD), relative fluctuation (coefficient of variation, CV) and periodicity (mean frequency, MNF) of the torque signal at 20%, 40% and 60% IMVT, (v) EMG-torque relationship at 20%, 40% and 60% IMVT and (vi) performance fatigability, i.e. time to task failure (TTF) at 40% IMVT.ResultsCompared to the control group, the KOA group displayed: (i) significantly higher MAE of the angle signal at 30° (99.3%; P = 0.027) and 50° (147.9%; P < 0.001), (ii) no significant differences in reaction time, (iii) significantly lower IMVT (-41.6%; P = 0.001) and tendentially lower RMS-EMG of the rectus femoris (-33.7%; P = 0.054), (iv) tendentially higher MAE of the torque signal at 20% IMVT (65.9%; P = 0.068), significantly lower SD of the torque signal at all three torque levels and greater MNF at 60% IMVT (44.8%; P = 0.018), (v) significantly increased RMS-EMG of the vastus lateralis at 20% (70.8%; P = 0.003) and 40% IMVT (33.3%; P = 0.034), significantly lower RMS-EMG of the biceps femoris at 20% (-63.6%; P = 0.044) and 40% IMVT (-41.3%; P = 0.028) and tendentially lower at 60% IMVT (-24.3%; P = 0.075) and (vi) significantly shorter TTF (-51.1%; P = 0.049).ConclusionKOA is not only associated with a deterioration of IMVT and neuromuscular activation, but also with an impaired position and torque control at submaximal torque levels, an altered EMG-torque relationship and a higher performance fatigability of the quadriceps muscle. It is recommended that the rehabilitation includes strengthening and fatiguing exercises at maximal and submaximal force levels.

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Muscle Force Steadiness in Older Adults Before and After Total Knee Arthroplasty

Cited by 19 publications

References 42 publications

Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

The Association Between Knee Extensor Force Steadiness, Force Accuracy, and Mobility in Older Adults Who Have Fallen

Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients

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