Active Knee Range Of Motion Research Articles

Effect of home exercise programme on thigh muscle strength before total knee arthroplasty

The aim of the study was to assess the effect of home exercise programme (HEP) on thigh muscle strength in patients with knee osteoarthritis (OA) before unilateral total knee arthroplasty (TKA). Five female OA patients with mean age 67.8±5.9 years participated in the study. Isometric maximal voluntary contraction (MVC) force of the quadriceps femoris (QF) and hamstring (HM) muscles was measured by hand-held dynamometry. Knee active range of motion (aROM) in flexion was measured by goniometer. Knee pain score was evaluated by knee pain scale before and after HEP. A significant reduction (p 0.05) were observed between the limbs. MVC force of the HM muscle and aROM in flexion remained significantly lower (p<0.05) for the involved leg as compared with the uninvolved leg after HEP. Knee pain score was significantly (p<0.05) higher for the involved leg before and after HEP as compared with the uninvolved leg. Two months before the operation, HEP was an effective therapeutic procedure for increasing QF muscle strength in patients who underwent TKA.

Paper 8: Lower Extremity Neuromuscular Compensations During Instrumented Single Leg Hop Five Years Following ACL Reconstruction

Anterior cruciate ligament (ACL) injury may lead to neuromuscular activation changes long after surgical reconstruction and rehabilitation. This study compared bilateral lower extremity EMG and kinematic characteristics during the performance of a single leg hop. Our hypothesis was that lower extremity neuromuscular activation characteristics would differ between the lower extremity that had undergone ACL reconstruction and the noninvolved contralateral lower extremity. Seventy subjects at a mean of 5 years (range 2-10 years) following unilateral ACL reconstruction using allograft tissue participated in this study. All subjects had complied with rehabilitation program recommendations. Active knee range of motion was bilaterally equivalent and knee laxity was within 2 mm. Most subjects (66%) displayed normal or nearly normal 2000 IKDC SelfReported Knee Evaluation scores. EMG (1000 Hz) and two-dimensional sagittal plane kinematic (60 Hz) data were collected as subjects performed 3 single leg hops with each lower extremity. Gluteus maximus, vastus medialis, medial hamstring, and gastrocnemius EMG amplitudes were standardized to levels attained during single repetition, maximal volitional effort isometric contractions (%MVIC) using conventional manual muscle tests. Paired t-tests were used to compare side-to-side differences (P .05). Peak bilateral lower extremity joint displacement (noninvolved, involved) did not differ at the knee (56.7 13° vs. 57.8 14°) or ankle (13.8 5° vs. 13.3 5°) during single leg hop performance. Hip displacement however was increased (63.9 17° vs. 67.2 16°, P .03) and single leg hop distance was decreased at the involved side (42.3 15 cm vs. 40.0 15 cm, P .001). EMG activation sequence and duration did not differ between extremities. Vastus medialis and medial hamstring EMG amplitudes did not display differences during single leg hop propulsion or landing. Gluteus maximus EMG amplitudes did not display differences during single leg hop propulsion. Gastrocnemius EMG amplitudes during both single leg hop propulsion (1.2 .4%MVIC vs. 1.3 .3%MVIC, P .04) and landing (1.2 .5%MVIC vs. 1.3 .5%MVIC, P .01), and gluteus maximus muscle EMG amplitudes during landing (1.3 .5%MVIC vs. 1.5 1%MVIC, P .04) were increased at the involved lower extremity compared to the noninvolved lower extremity. Despite predominantly satisfactory self-reported knee outcome scores evidence of side-to-side neuromuscular differences were observed. Increased gluteus maximus and gastrocnemius muscle activation amplitudes and increased hip displacement magnitude at the involved lower extremity at a mean 5 years post-ACL reconstruction suggest long-term compensatory changes toward a hip and ankle joint bias to decrease knee joint loading forces. ACL reconstruction corrects knee joint ligamentous laxity, however compensatory neuromuscular changes still occur. Paper 9: What Can We Really Do Following TKA, UKA and HTO? MICHEL P BONNIN, MD, FRANCE, PRE-

Predictors of postoperative movement and resting pain following total knee replacement

This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery, and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (ie, during active knee range of motion), and quantitative sensory tests were performed preoperatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2, analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity, and heat pain threshold. People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR, and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery.

Treatment of Compartment Syndrome of the Thigh Associated With Acute Renal Failure After the Wenchuan Earthquake

Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.

Minimally Invasive Total Knee Arthroplasty Improves Early Knee Strength But Not Functional Performance: A Randomized Controlled Trial

A prospective, randomized investigation compared early clinical outcomes of total knee arthroplasty (TKA) using conventional or minimally invasive surgical (MIS) approaches (n = 44). Outcome measures included isometric quadriceps and hamstrings strength, quadriceps activation, functional performance, knee pain, active knee range of motion, muscle mass, the Short Form-36, and Western Ontario and McMaster University Osteoarthritis Index, assessed preoperatively and 4 and 12 weeks after TKA. Four weeks after TKA, the MIS group had greater hamstring strength (P = .02) and quadriceps strength (P = .07), which did not translate to differences in other outcomes. At 12 weeks, there were no clinically meaningful differences between groups on any measure. Although MIS may lead to faster recovery of strength in patients undergoing TKA, there was no benefit on longer-term recovery of strength or functional performance.

Uninvolved versus target muscle contraction during contract–relax proprioceptive neuromuscular facilitation stretching

Objective The purpose of this study was to compare the acute effect of the contract–relax (CR) stretching technique on knee active range of motion (ROM) using target muscle contraction or an uninvolved muscle contraction. Design pre-test post-test control experimental design. Setting Clinical research laboratory. Participants Sixty healthy men were randomly assigned to one of three groups. Interventions The Contract–Relax group (CR) performed a traditional hamstring CR stretch, the Modified Contract–Relax group (MCR) performed hamstring CR stretching using contraction of an uninvolved muscle distant from the target muscle, and the Control group (CG) did not stretch. Main Outcome Measures Active knee extension test was performed before and after the stretching procedure. Results Two-way between-within analysis of variance (ANOVA) results showed a significant interaction between group and pre-test to post-test ( p < 0.001). Post-hoc examination of individual groups showed no significant change in ROM for the CG (0.8°, p = 0.084), and a significant moderate increase in ROM for both the CR (7.0°, p < 0.001) and MCR (7.0°, p < 0.001) groups. Conclusions ROM gain following a CR PNF procedure is the same whether the target stretching muscle is contracted, or an uninvolved muscle is contracted.

The role of active knee rom for posterior thigh muscle injuries prevention

Athletes' physiological characteristics are fundamental both in terms of performance and injuries prevention. One of those is flexibility. Using an easy and cheap method, goniometry, estimating active knee range of...

Longitudinal Gait and Strength Changes Prior to and Following an Anterior Cruciate Ligament Rupture and Surgical Reconstruction: A Case Report

Case report. Cross-sectional studies have examined deficits following anterior cruciate ligament (ACL) rupture and subsequent reconstructive surgery. Few studies present preinjury data that may assist in identifying risk factors for ACL rupture. This case report compares gait and strength measures obtained prior to ACL rupture, with follow-up assessments of these measures after rupture and reconstructive surgery. A 23-year-old woman sustained a noncontact rupture of her right ACL. Kinematic and kinetic gait data were collected using 3-dimensional motion analysis and a synchronized force plate. Knee strength was measured using an isokinetic dynamometer. Data for knee active range of motion (AROM) and the Lower Extremity Functional Scale (LEFS) were also collected. The analyses were descriptive and interpreted based on previously published minimal detectable change and minimal clinically important difference values. Before her injury, the patient demonstrated a low external knee flexion moment during gait. Kinematic and kinetic gait abnormalities were present following rupture and persisted at 13 months postsurgery. The patient demonstrated knee strength deficits following ACL rupture and surgery. Steady gains in LEFS and knee AROM occurred following rupture and surgery. Preinjury data may identify risk factors for ACL rupture. Future studies should examine whether a low external knee flexion moment during gait or sport-related activity is a risk factor for ACL rupture. The patient demonstrated deficits in gait and strength that persisted at 13 months postsurgery. Therapy, level 4.

Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

BackgroundArthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA.MethodsFunctional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use.ResultsForty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p < 0.05). Persons that underwent TKA were also significantly weaker, had lower self-reported function and had less knee extension than persons who did not undergo TKA. No differences between groups were seen for BMI, gender, knee flexion ROM and unilateral versus bilateral joint disease. Using backward regression, age, knee extension ROM and KOS-ADLS together significantly predicted whether or not a person would undergo TKA (p ≤ 0.001, R2 = 0.403).ConclusionsYounger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.

An acute care episode of a patient following bilateral total knee arthroplasty

More patients with bilateral joint problems are choosing to go through one surgery to replace both joints simultaneously rather than having two separate surgeries. The goals of physical therapy following the surgery are to decrease pain, maximize range of motion (ROM) and strength, improve ambulation, and improve overall function. Few studies have focused on the importance of the acute phase of rehabilitation and most concentrate instead on long-term outcomes and outpatient care. The patient was a 62-year-old male diagnosed with osteoarthritis of both knees. The day before the initial physical therapy evaluation, the patient underwent a bilateral total knee arthroplasty. By the end of his stay, active knee ROM increased to −6° to 88° on the right and −6° to 83° on the left. Passive ROM also increased to −5° to 90° on the right and −5° to 86° on the left. The patient was able to perform supine to sit transfers with supervision and sit to stand transfers with contact guard assistance and his ambulation progressed to walking 100 feet on level surfaces with a rolling walker and supervision. The positive gains of this patient suggest the potential value of high motivation combined with early aggressive physical therapy.

Use of continuous passive motion after total knee arthroplasty

Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospective study. Twenty-six patients who had unilateral knee arthroplasty were randomized to receive continuous passive motion (CPM) or immobilization in the first week. The 2 groups of patients were comparable in demographic data and preoperative knee range of motion (ROM). In 17 patients who had 1-stage sequential bilateral arthroplasties, one side had CPM and the other side was immobilized. The active knee ROM was assessed regularly until 1 year after the operation. For all patients, the early active knee ROM in the CPM group was significantly better than the immobilization group. There was no difference after 7 days, however. For patients who had 1-stage bilateral total knee arthroplasties, the active knee ROM was significantly better on the CPM side until day 28. After 4 weeks, there was no difference between the CPM group and the immobilization group. Immobilization after total knee arthroplasty does not preclude good ROM.

Exercise Combined With Continuous Passive Motion or Slider Board Therapy Compared With Exercise Only: A Randomized Controlled Trial of Patients Following Total Knee Arthroplasty

The primary purpose of this randomized controlled trial was to determine which method of mobilization - (1) standardized exercises (SE) and continuous passive motion (CPM), (2) SE and slider board (SB) therapy, using an inexpensive, nontechnical device that requires minimal knee active range of motion (ROM), or (3) SE alone-achieved the maximum degree of knee ROM in the fIrst 6 months following primary total knee arthroplasty (TKA). The secondary purpose was to compare health-related quality of life among these 3 groups. The subjects were 120 patients (n=40/group) who received a TEA at a teaching hospital between June 1997 and July 1998 and who agreed to participate in the study. Subjects were examined preoperatively, at discharge, and at 3 and 6 months after surgery. The examination consisted of measurement of knee ROM and completion of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The 3 treatment groups were similar with respect to age, sex, and diagnosis at the start of the study. There were no differences in knee ROM or in WOMAC Osteoarthritis Index or SF-36 scores at any of the measurement intervals. The rate of postoperative complications also was not different among the groups. When postoperative rehabilitation regimens that focus on early mobilization of the patient are used, adjunct ROM therapies (CPM and SB) that are added to daily SE sessions are not required. Six months after TEA, patients attain a satisfactory level of knee ROM and function.

Effect of ultrasound on mobility in osteoarthritis of the knee. A randomized clinical trial

Ultrasound increases soft tissue extensibility and may be an effective adjunct in the treatment of knee contractures secondary to connective tissue shortening. A randomized clinical trial was conducted to determine the effectiveness of ultrasound in relieving stiffness and pain in patients (age mean = 67.5 years, SD = 13.0) who had osteoarthritis (OA) and a chronic knee contracture. Subjects received 12 treatments of exercise preceded by either ultrasound (n = 34) or sham ultrasound (n = 35) and a blinded evaluation at baseline, after treatment, and 2 months after treatment. MANCOVA controlling for baseline scores showed that there were no significant differences in knee active range of motion (ROM) (goniometry) or pain (visual analogue scale) between experimental and control groups. Possible explanations for the no difference finding involve dosage issues, muscle shortening, transiency of effects, and the effects of exercise. Paired t-tests revealed that both groups significantly improved (p less than 0.05) in active ROM, pain, and gait velocity, and maintained improvement for at least 2 months. Although ultrasound may not contribute to the management of patients with chronic knee stiffness and OA, benefits of the exercise program and increased activity secondary to program participation probably influenced the overall improvement.

Normal Hip and Knee Active Range of Motion: The Relationship to Age

Abnormal joint mobility is an important factor in movement dysfunction and physical disability. Because the decision to treat impaired joint mobility in an older individual may be influenced by assumptions concerning normal range of motion (ROM) at older ages, it is important to establish population-based normative values for hip and knee ROM by age, race, and sex. This study used data from the first National Health and Nutrition Examination Survey (NHANES 1), which involved a national probability sample of persons drawn from the civilian noninstitutionalized population of the United States. Goniometric measurements of hip and knee active range of motion (AROM) were obtained from a subset of the sample consisting of 1,892 subjects. This analysis was limited to the 1,313 white and 370 black subjects. Univariate statistics, weighted by the probability of selection into the sample, were calculated for 12 sex-race-age-group-specific categories. These normal AROM values for the hip and knee calculated from this population based sample were found to differ from estimates found in textbooks by as much as 18 degrees. With one exception, normal values for all motions were lower in the oldest age group than in the youngest age group. The differences in mean AROM were generally small, ranging from 3 to 5 degrees. Only in the case of hip extension did the difference in mean AROM between the youngest and the oldest age groups constitute a decline of more than 20% of the arc of motion. With the possible exception of hip extension, this study supports the conclusion that, at least to age 74 years, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging and therefore should be treated much as it would be in a younger individual.