Influence of the Amount of Change in Quadriceps Tendon Young's Modulus on Amount of Change in Walking Speed before and after Total Knee Arthroplasty.

Bungo Ebihara,Koichi Iwai,Takashi Fukaya,Hirotaka Mutsuzaki

doi:10.3390/medicina57121329

Abstract

Background and Objectives: Walking speed after total knee arthroplasty (TKA) is an important outcome. However, the effect of quadriceps tendon stiffness on walking speed remains unclear. This study aimed to clarify the influence of the amount of change in quadriceps tendon stiffness on the degree of change in walking speed before and after TKA. Materials and Methods: Sixteen patients who underwent TKA for knee osteoarthritis participated in this study (median age: 74.0 years (interquartile range: 64.5–75.8)). Shear-wave elastography was deployed to measure quadriceps tendon stiffness using Young’s modulus. A motion analysis system was used to assess kinematic parameters and walking speed. Participants’ knee circumference, range of motion, extension strength, one-leg standing time, walking pain level, and activity level were measured preoperatively and one year after TKA, and changes in values were calculated. We used path analysis to clarify the influence of the amount of change in the quadriceps tendon Young’s modulus on the change in walking speed. Results: The quadriceps tendon Young’s modulus negatively affected the knee flexion angle during swing (standardized partial regression coefficients (β) = −0.513, p = 0.042). The knee flexion angle during swing positively affected step length (β = 0.586, p = 0.017). Step length positively affected cadence (β = 0.733, p = 0.001). Step length and cadence positively affected walking speed (β = 0.563, p < 0.001, β = 0.502, p < 0.001, respectively). Conclusions: The amount of change in the quadriceps tendon Young’s modulus may affect the degree of change in walking speed after TKA through the amount of change in the knee flexion angle during swing, step length, and cadence. Clinically, reducing quadriceps tendon stiffness can be addressed in rehabilitation programs to increase walking speed after TKA.

Highlights

Knee osteoarthritis (OA) has a complex pathological mechanism that can induce cartilage destruction and inflammation, causing pain, stiffness, swelling, and loss of function [1].Conservative treatments for knee OA include biomechanical interventions, intra-articular corticosteroids, exercise, self-management, education, strength training, weight management, and supplements for knee OA, including glucosamine sulphate, methylsulfonylmethane, and boswellic acids [2,3]
This study was conducted between August 2018 and March 2021
The knee flexion angle during swing can affect the speed of lower-limb swing, which can alter step length [12]

Summary

Introduction

Knee osteoarthritis (OA) has a complex pathological mechanism that can induce cartilage destruction and inflammation, causing pain, stiffness, swelling, and loss of function [1]. Conservative treatments for knee OA include biomechanical interventions, intra-articular corticosteroids, exercise, self-management, education, strength training, weight management, and supplements for knee OA, including glucosamine sulphate, methylsulfonylmethane, and boswellic acids [2,3]. Walking speed is a risk factor for disability, cognitive impairment, institutionalization, falls, and/or mortality in older people [4]; it decreases as knee joint destruction progresses [5]. Total knee arthroplasty (TKA) is the gold-standard treatment for patients with severe knee OA [6]. The decline in walking speed persists after TKA compared to that in healthy persons [8,9]

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