Quadriceps Exercise Research Articles

Swing Phase Mechanics of Maximal Velocity Sprints-Does Isokinetic Lower-Limb Muscle Strength Matter?

Concentric hip and eccentric knee joint mechanics affect sprint performance. Although the biarticular hamstrings combine these capacities, empirical links between swing phase mechanics and corresponding isokinetic outcome parameters are deficient. This explorative study aimed (1)to explain the variance of sprint velocity, (2)to compare maximal sprints with isokinetic tests, (3)to associate swing phase mechanics with isokinetic parameters, and (4)to quantify the relation between knee and hip joint swing phase mechanics. A total of 22 sprinters (age = 22y, height = 1.81m, weight = 77kg) performed sprints and eccentric knee flexor and concentric knee extensor tests. All exercises were captured by 10 (sprints) and 4 (isokinetics) cameras. Lower-limb muscle balance was assessed by the dynamic control ratio at the equilibrium point. The sprint velocity (9.79 [0.49]m/s) was best predicted by the maximal knee extension velocity, hip mean power (both swing phase parameters), and isokinetic peak moment of concentric quadriceps exercise (R2 = 60%). The moment of the dynamic control ratio at the equilibrium point (R2 = 39%) was the isokinetic parameter with the highest predictive power itself. Knee and hip joint mechanics affected each other during sprinting. They were significantly associated with isokinetic parameters of eccentric hamstring tests, as well as moments and angles of the dynamic control ratio at the equilibrium point, but restrictedly with concentric quadriceps exercise. The maximal sprints imposed considerably higher loads than isokinetic tests (eg,13-fold eccentric knee joint peak power). Fast sprinters demonstrated distinctive knee and hip mechanics in the late swing phase, as well as strong eccentric hamstrings, with a clear association to the musculoarticular requirements of the swing phase in sprinting. The transferability of isokinetic knee strength data to sprinting is limited inter alia due to different hip joint configurations. However, isokinetic tests quantify specific sprint-related muscular prerequisites and constitute a useful diagnostic tool due to their predicting value to sprint performance.

Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures

Background: The tibia constitutes one of two bones of the leg. Recently, minimally invasive percutaneous medial locked plating has been described in the literature with promising results. Expert Tibial Nail currently represents an effective approach to the treatment of complex extraarticular distal tibial fractures. Hence; the present study was undertaken for comparing the results of Expert Tibial nailing with results of Distal Tibial Plating in patients with Distal 1/3rd extraarticular Tibial Fractures. Materials & Methods: The study was conducted on 40 patients with extraarticular distal 1/3rd tibia fractures. All the patients were divided into two study groups randomly with 20 patients in each group as follows: Expert Tibial Nailing group, & Distal Tibial Plating group. All the patients underwent procedures according to their respective study groups. During the postoperative phase, static quadriceps exercises & toe movements, as tolerated were started from 1st postoperative day. Full weight-bearing was allowed after 10 to 12 weeks, depending on the radiographic signs of fracture healing. Patients were followed up for 6 months after operation and evaluated as per Johner and Wruss Criteria. Results: The mean age of the patients of the expert tibial nailing group and distal tibial plating group was 48.12 years and 49.71 years respectively.Mean operative time among the patients of the expert tibial nailing group was 83.15 minutes and was significantly lower in comparison to the patients of the distal tibial plating group (101.2 minutes). Mean intraoperative blood loss was compared between expert tibial nailing and distal tibial plating. Torniquet was used in all the cases. Mean intraoperative blood loss among the patients of the expert tibial nailing group was 51.6 ml and was significantly lower in comparison to the patients of the distal tibial plating group (89.1 ml). Mean postoperative weight-bearing time among the patients of expert tibial nailing was 8.95 weeks and was significantly lower in comparison to the patients of the distal tibial plating (14.35 weeks). Mean fracture union time among the patients of the expert tibial nailing group was 18.6 weeks and was significantly lower in comparison to the patients of the distal tibial plating group (25.84 weeks). Excellent results were obtained in 80 percent of the patients of the expert tibial nailing group and 55 percent of the patients of the distal tibial plating group respectively. Conclusion: The results of present study with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enable it to use in proximal and distal metaphyseal fractures of tibia.

Exercise and education for community-dwelling older participants with knee osteoarthritis: a video-linked programme protocol based on a randomised controlled trial

BackgroundNeuromuscular and quadriceps exercises have been shown to be effective approaches to relieve pain and to improve function for patients with knee osteoarthritis. In this study, we aim to provide an informative feasible model in which therapeutic exercise and education will be undertaken with physiotherapy supervision and instruction via video link. We also aim to explore the relationship between program-induced pain alleviation/functional improvements and reduction in irritability, which might be mediated through program-induced psychosocial benefits.MethodsIn this proposed two-parallel group (neuromuscular exercise versus quadriceps exercise), single-blinded, randomised controlled trial, participants aged ≥50 years with osteoarthritic knee pain will undergo a 12-week intervention, comprising video-linked education, supervised exercises, and a 12-week follow-up. Seven measurements will be taken to collect longitudinal data. A generalised estimating equation will be used to establish the adjusted difference in effectiveness on pain, function, irritability, and psychosocial outcomes between participants undertaking neuromuscular exercises and those undertaking quadriceps exercises. The primary outcomes are overall average pain in the knee joint during walking, as assessed through the 11-point Numerical Pain Rating Scale, and the Western Ontario and McMaster Universities osteoarthritis index physical function subscale. Furthermore, pressure pain threshold and changes in self-report pain scores pre-, during, and post-exercise were also measured as an indication of irritability. In addition, both the 6-min walk test and a timed up & go test were used to assess walking function performance. Finally, patients’ emotions (e.g., fear and catastrophising), self-trust, needs in terms of disease knowledge, mental resilience, social support and health-related quality of life were investigated. Two four-wave cross-lagged models will be used to investigate directional relationships, aiming to investigate the complex mechanisms concerning the effects of exercise programmes.DiscussionThrough summarising the study’s strengths and limitations, this study may provide promising insights in terms of exercise therapy optimisation for people with knee osteoarthritis and/or other chronic pain within a psychosocial framework.Trial registrationChiCTR2100041978 (chictr.org.cn), January 10, 2021.

Muscle strength gains after strengthening exercise explained by reductions in serum inflammation in women with knee osteoarthritis

BackgroundIndividuals with knee osteoarthritis have elevated circulating inflammatory markers and altered cartilage properties but it is unclear if these features adapt to exercise. We aimed to determine (1) whether inflammatory markers, cartilage transverse relaxation time and thickness mediate the effect of body mass index (BMI) on quadriceps strength at baseline; and (2) whether these changes explain variance in quadriceps strength improvements after 12 weeks of exercise in women with knee osteoarthritis.MethodsThis secondary analysis (17 women with clinical knee osteoarthritis) of a randomized control trial compared supervised group interventions, 3 times/week for 12 weeks (36 sessions): (a) weight-bearing progressive resistive quadriceps exercise or (b) attention control. (1) From baseline, separate linear regressions were conducted with strength (Nm/kg) as the dependent, BMI as the predictor, and c-reactive protein, tumor necrosis factor, interleukin-6, cartilage transverse relaxation time or thickness as potential mediators. (2) Multiple linear regression analyses were completed with 12-week strength change (post-pre) as the dependent, change in serum inflammatory markers and cartilage measurements as predictors, and age, BMI and adherence as covariates.Findings(1) At baseline, there was no mediation. (2) A decrease in each of interleukin-6 (β = −0.104 (95% confidence intervals: −0.172, −0.036), R2 = 0.51, P < 0.007) and tumor necrosis factor (β = −0.024 (−0.038, −0.009), R2 = 0.54, P < 0.005) was associated with strength gains.InterpretationAt baseline, inflammatory markers and cartilage measurements do not act as mediators of BMI on quadriceps strength. After 12 weeks of exercise, reduced interleukin-6 and tumor necrosis factor were associated with increased quadriceps strength in women with knee osteoarthritis.

Isometric Exercise of Quadriceps and Gluteal Muscle in Patient with Close Femur Fracture

Femur fracture is a fracture in the largest bone in the body. The femur requires significant force to fracture. One of the treatments for femoral fracture is reduction and immobilization using traction. Immobilization in traction-attached patients before preoperatively requires isometric exercises to maintain muscle strength. Isometric exercise is a muscle contraction exercise, the patient contracts the muscles without moving the muscles to maintain muscle and prevent atrophy. The purpose of this paper is to identify the effectiveness of isometric exercises to increase isometric muscle strength in patients with lower limb fracture. The methodology used is a case study. The application of isometric exercises can increase muscle strength in patients with skin traction attached. Nurses need to pay attention to factors that can affect the patient's ability to perform isometric exercises so that the results obtained can be more optimal and the patient experiences an increase in the ability of his limbs.&#x0D; &#x0D; Keywords : Isometric Exercises; Muscle Strength, lower limb fracture

Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial.

AimTo investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis.MethodsRandomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later.ResultsAfter the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4–143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups.ConclusionHBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.

Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome

BackgroundWhether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown.MaterialsFrom June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated.ResultsIn the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05).ConclusionIn patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0–20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.

Considerations with Open Kinetic Chain Knee Extension Exercise Following ACL Reconstruction.

By Kevin E Wilk, Christopher A Arrigo & 2 more. This clinical viewpoint addresses the use of open kinetic chain quadriceps exercises following ACL reconstruction and the crucial considerations in using these exercises safely.

A comparative retrospective analysis of indoor patients between 50 to 85 years of age suffering from osteoarthritis to determine the effectiveness of epidural and intravenous tramadol in pain relief and functional recovery after total knee replacement surgery

BACKGROUND: Total knee replacement surgery is among the most common major orthopedic surgery performed in cases of osteoarthritis on the knee joint. Total knee arthroplasty is considered to cause moderate-to-severe postoperative pain. No clear consensus in the available literature suggests a clear advantage between epidural tramadol and intravenous tramadol postoperatively due to the complications associated with an epidural catheter. AIM: This study aimed to determine the effectiveness of epidural tramadol and intravenous tramadol in pain relief and functional recovery in postoperative total knee replacement patients. MATERIALS AND METHODS: All cases operated for total knee replacement and postoperatively managed by epidural tramadol and intravenous tramadol were studied. This group included 20 patients of total knee replacement managed by epidural tramadol compared to 20 patients of total knee replacement managed by intravenous tramadol. RESULTS: Patients in the group managed postoperatively with intravenous tramadol for postoperative pain management showed a better functional outcome and pain relief as compared to patients managed with epidural tramadol. It was noted that in patients managed with intravenous tramadol, the knee range of motion and static and dynamic quadriceps exercises were started earlier and the patients were more compliant, which intern helped to achieve a better functional outcome posttotal knee replacement surgery. CONCLUSION: We would like to suggest in our limited 40 patient study group, the pain managed in patients by intravenous tramadol showed a better functional outcome as compared to the pain managed in the patients by epidural tramadol. Within our study group of 40 patients, it was noted that patient compliance and comfort was better in cases where tramadol was administered through an intravenous line as compared to an epidural catheter with no statistically significant difference in postoperative pain as well as functional outcome and recovery.

Sympathetic reactivity and inflammation: another joint problem in rheumatoid arthritis?

Sympathetic reactivity and inflammation: another joint problem in rheumatoid arthritis?

COMPARISON OF THE EFFECT OF ULTRASOUND VERSUS LASER ON PAIN AND FUNCTION IN SUBJECTS WITH OSTEOARTHRITIS KNEE

Background:Osteoarthritis(OA) is a degenerative joint disease which leads to loss of hyaline articular cartilage associated with underlying bony changes. Knee osteoarthritis(KOA) is associated with pain and functional impairment which negatively affects the patients quality of life. Ultrasound and LASER have been found effective in KOA but studies comparing the two are less. Method:An experimental study was conducted with 21 patients of unilateral KOA randomized into three groups. Each group had 7 patients. Group A- Ultrasound- 1MHz, Pulsed1:1, 0.8W/cm2, 10 min on medial knee joint line. Group B- LASER- 7.6J for 1 min and 30 sec for each trigger point. Group C-Conventional physiotherapy. All subjects received conventional physical therapy with hot packs and quadriceps exercise of affected knee. Outcome measures used were Numerical pain rating scale(NPRS), Sit to stand(STS) and Timed up and go test(TUG). Result:Using Wilcoxon test, mean difference in painin Group A(W=-2.414,p=0.016), GroupB(W=-2.460,p=0.014 ), GroupC(W=-2.392 ,p=0.017). Mean difference in STS in GroupA(W=-2.392,p=0.017 ), Group B(W=-2.392,p=0.017 ), Group C(W=-2.428,p=0.015). Mean difference in TUG, Group A(W=-2.366,p=0.018),GroupB(W=-2.371,p=0.018 ) Group C(W=-2.375 ,p=0.018 ). Applying Kruskal-Wallis test, mean difference between the groups, for pain(KW=6.612,p=0.037), STS(KW=3.020,p=0.221) and TUG(KW=7.822,p=0.020). Applying Bonferronis post hoc test mean difference in pain between groups Aand B was statistically significant(p=0.03), and mean difference in TUG between groups Band C was statistically significant(p=0.013). Conclusion:Ultrasound,LASER and conventional physiotherapy are effective in reducing pain, improving function and mobility in subjects with OA knee. LASER is more effective than ultrasound and conventional PT for pain and more effective than conventional PT for mobility.

Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial.

Severe acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.

EFFECTIVENESS OF SHORT ARC AND ISOMETRIC QUADRICEPS EXERCISES ON PAIN, MUSCLE ACTIVITY AND HEALTH RELATED QUALITY OF LIFE IN PATIENTS WITH ANTERIOR KNEE PAIN

ABSTRACT AIMS &amp; OBJECTIVES The aim of this study is to evaluate and compare the effects of Short-Arc and Isometric Quadriceps exercises on Quadriceps strength and health related quality of life among Anterior Knee pain patients by using EMG biofeedback. METHODOLOGY Total 80 participants were recruited and randomly distributed in two groups; A and B. Individuals in group A performed isometric quadriceps exercise while group B participants performed short-arc exercise for 1st, 6th and 8th week along with a home exercise programme. Pre and post treatment assessment was performed using EMG Biofeedback, VAS, and KUJALA scoring questionnaire. Statistically, data was analysed using SPSS version 20. RESULTS After 8 weeks, EMG Biofeedback revealed the higher effectiveness short-arc exercises with value 88.20mv ± 6.64 comparing isometric quadriceps exercises. Moreover, Wilcoxon rank test revealed statistically significant improvement in VAS score with p-value &lt;0.05. Furthermore, KUJALA score also advocated the effectiveness of short-arc exercises with statistically significant values (p-value &lt; 0.05). CONCLUSION The study concluded the effectiveness of Short-arc quadriceps exercises comparing to static-quadriceps exercises in improving muscles strength, pain and health related quality of life after 8 weeks of intervention.

Comparison between 25% dextrose prolotherapy and single dose of platelet rich plasma in the management of pain and improvement of functional outcome in patients suffering from primary knee osteoarthritis: a randomized controlled trial

Background: One of the most prevalent and disabling diseases worldwide, which decreases patients' quality of life (QoL) is knee osteoarthritis. However, pharmacological and non-pharmacological treatments, apart from complications, could not desirably control the disease. Limited studies are available in management of primary osteoarthritis of knee with prolotherapy with 25% dextrose and platelet rich plasma (PRP). Objective was to compare between 25% dextrose prolotherapy and single dose of PRP injection in the management of pain and improvement of functional outcome in patients suffering from primary knee osteoarthritis.Methods: A comparative study was conducted to see the effectiveness of 25% dextrose prolotherapy and PRP in primary osteoarthritis (OA) of knee in the management of pain and improvement of functional outcome in sixty-six patients in age group of 50 to 70 years attending PMR department OPD, RIMS, Imphal between october2018 to April 2020. The first group received 6 ml injections of 25% dextrose 3 times at baseline, 1 month and 4th month, whereas the 2nd group received single dose of 5ml PRP at baseline.Results: In both the groups 50 mg of tramadol tablet and isometric strengthening exercise of quadriceps was given. Assessment was done at baseline, at 1, 4 and 8 months by visual analogue scale (VAS) and western Ontario and McMaster university arthritis (WOMAC) index. Statistically significant improvement was noted in VAS (5.91±0.82 to 2.65±0.94) and WOMAC score (45.25±6.68 to 20.25±7.67) at end of 8 month in first group.Conclusion: It was concluded that 25% dextrose was more effective than in management of primary osteoarthritis of knee.

The Effectiveness of Quadriceps Exercise, Home-Based Exercise Program and Home-Based Exercise Program in Combination with Physical Modalities for Treatment in Osteoarthritis Knee: A Randomized Control Study

Objectives: Therapeutic exercise is one of the most commonly used non-pharmacological methods for treating knee osteoarthritis (OA). This study proposed to compare the effectiveness of quadricep exercise, home-based exercise program and home-based exercise program in combination with physical modalities. Method: Patients with primary knee OA had been selected to receive the treatment. They were randomly allocated into three groups: Quadriceps Exercise, Home Exercise Protocol and Home Exercise Protocol with Physical Modalities. The outcomes were measured regarding six-minute walk test (6MWT) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness and function at baseline, six weeks and 12 weeks. Results: 123 patients were recruited to participate this study and randomly divided into three groups. The results show the progressive improvement of each group. The mean of 6MWT had no significant difference among the studied groups at 12 weeks. WOMAC scores of the groups were not significantly different. Conclusion: These three exercise protocols can be used for patients with osteoarthritis knee. The outcomes in terms of 6MWT and WOMAC scores were not significantly different. They were proved that the protocols allow to improve the patients’ physical performances within 12 weeks.

Chronic nerve health following implantation of femoral nerve cuff electrodes

BackgroundPeripheral nerve stimulation with implanted nerve cuff electrodes can restore standing, stepping and other functions to individuals with spinal cord injury (SCI). We performed the first study to evaluate the clinical electrodiagnostic changes due to electrode implantation acutely, chronic presence on the nerve peri- and post-operatively, and long-term delivery of electrical stimulation.MethodsA man with bilateral lower extremity paralysis secondary to cervical SCI sustained 5 years prior to enrollment received an implanted standing neuroprosthesis including composite flat interface nerve electrodes (C-FINEs) electrodes implanted around the proximal femoral nerves near the inguinal ligaments. Electromyography quantified neurophysiology preoperatively, intraoperatively, and through 1 year postoperatively. Stimulation charge thresholds, evoked knee extension moments, and weight distribution during standing quantified neuroprosthesis function over the same interval.ResultsFemoral compound motor unit action potentials increased 31% in amplitude and 34% in area while evoked knee extension moments increased significantly (p < 0.01) by 79% over 1 year of rehabilitation with standing and quadriceps exercises. Charge thresholds were low and stable, averaging 19.7 nC ± 6.2 (SEM). Changes in saphenous nerve action potentials and needle electromyography suggested minor nerve irritation perioperatively.ConclusionsThis is the first human trial reporting acute and chronic neurophysiologic changes due to application of and stimulation through nerve cuff electrodes. Electrodiagnostics indicated preserved nerve health with strengthened responses following stimulated exercise. Temporary electrodiagnostic changes suggest minor nerve irritation only intra- and peri-operatively, not continuing chronically nor impacting function. These outcomes follow implantation of a neuroprosthesis enabling standing and demonstrate the ability to safely implant electrodes on the proximal femoral nerve close to the inguinal ligament. We demonstrate the electrodiagnostic findings that can be expected from implanting nerve cuff electrodes and their time-course for resolution, potentially applicable to prostheses modulating other peripheral nerves and functions.Trial registrationClinicalTrials.govNCT01923662, retrospectively registered August 15, 2013.

Management of proximal tibial fractures by posteromedial locking compression plate

Management of tibial plateau fractures aims to restore normal knee functionality by near normal anatomical restoration of the articulating surfaces, thereby maintaining the mechanical axis and restoring ligamentous stability. Plate fixation is important when a medial plateau is involved in proximal tibial fractures. The present study was designed to assess the management of medial condylar fractures of proximal tibia treated by posteromedial locking compression plate. A total of 30 cases with Schatzker type IV-VI fractures to the proximal tibia, who followed up for clinic radiological evaluation, between age group 20-60 years were recruited. Clinical examination and radiological investigations were performed to review the fractures. The fractures to the medial condyle of tibia were treated by posteromedial approach. Post-operative care has been initiated with physical therapy in the form of quadriceps exercises. The postoperative follow up was continued at the end of one month, three months and six months and outcomes were recorded by using Lysholm knee score. According to Schatzker type of fractures 46.6% had type IV, 33.3% had type V and 20% had type VI fractures. Majority cases had fractures due to road traffic accidents (70%). Postoperative fracture outcome showed excellent outcome in 78% cases, good results in 16%, fair results in 6% and none of the case had a poor outcome. In postoperative complications, 80% cases were recovered without complications, 10% cases had superficial infection, 7% cases had knee pain, and 3% cases had knee stiffness. The posteromedial approach of tibial fracture management is safe with minimal complications. Fixation of posteromedial tibia permits quick reformation of the patient with outstanding functional outcome with minimal incidence of complication.

Patient Adherence Impacts The Effectiveness Of Neuromuscular Electrical Stimulation Treatment After Articular Cartilage Knee Surgery

PURPOSE: Articular cartilage patients commonly display persistent strength deficits despite extensive rehabilitation prescriptions. The purpose was to evaluate the effectiveness of a postoperative home based neuromuscular electrical stimulation (NMES) treatment on clinical outcomes. METHODS: Eligible patients were consented preoperatively and randomized to a 12-week postoperative home based NMES program or the standard quadriceps exercise program, both inconjunction with formal physical therapy. Patients completed patient reported outcomes (PROs)(KOOS, VAS) and isometric quadriceps strength testing (peak torque and limb symmetry index (LSI=involved peak torque/uninvolved peak torque)) preoperatively and 3-months (3m) postoperatively. The NMES group’s treatment adherence was measured via an internal monitor. An RM-ANOVA was used to compare each dependent variable between baseline and 3m postoperative. RESULTS: 25 patients (11F, 30 ± 10yrs, BMI: 28.15 ± 5.97) were enrolled. The surgical limb peak torque strength (p<0.00) and the LSI (p<0.00) decreased significantly, while KOOS pain statistically improved (p=0.02) (Table 1). At 3m post-operative, there were no statistical differences between groups for any dependent variable (Table 1). Patients in the NMES group completed 25.49 +25.32% of the prescribed treatment. Comparing the 3m strength values between two moderately adherent patients (completed 50-80% of the treatment) and the control group we see a trend favoring NMES (NMES: 1.33 Nm/kg, control: 0.92 Nm/kg). CONCLUSIONS: Overall patients experienced a decrease in quadriceps strength but an improvement in KOOS pain. While there was a trend with 3-month quadriceps strength values being higher in patients who were moderately adherent, the overall majority of the patients were not adherent. Thus, due to the lack of adherence, an NMES home treatment program may be an ineffective treatment option for articular cartilage knee surgery patients.Table 1:: Repeated measures ANOVA results for all outcome variables

Effect of hip abductor strengthening exercises in knee osteoarthritis: a randomized controlled trial

BackgroundOsteoarthritis knee (OA) for patients whom had varus malalignment had higher peak adductor moment. Hip abductor strength played an important role in the decreasement of knee adduction moment. This study aimed to evaluate the effect of hip abductor exercises for patients who had medial compartment knees OA.MethodsPatients who had medial compartmental OA knee were randomized into two groups. The first group performed hip abductor strengthening exercises, combined with quadriceps strengthening exercises; whereas, the second group performed standalone quadriceps strengthening exercises. Self-reported Knee Injury and Osteoarthritis Outcome Scores (KOOS) were collected by patients on follow-up visits.ResultsEighty-six patients completed the trial. All KOOS subscales were significantly improved in both groups after 10 weeks of treatment. However, there was no significant difference in the scores between either group at 2–10 weeks after treatment. Nevertheless, the effects of exercise for pain, symptoms, function in daily living and knee-related quality of life were found to have faster improvement within the hip abduction exercise group compared to the control group (2 weeks faster; pain, function in daily living and knee-related quality of life, 4 weeks faster; symptoms.)ConclusionSince, adding quadriceps exercises could expedite improvement of less pain, symptoms, activity in daily living and quality of life faster than quadriceps exercises solely for a 2–4 weeks period. However, the effect size was small and there were no differences after this; hence, consideration of adding hip abductor exercises in the treatment protocol should be based on the patients and doctors appraisal.Trial registrationTCTR, TCTR20180517005. Registered 17 May 2018.

The Effect of Dexterity and Perturbation Exercise on Knee Osteoarthritis through Functional Balance and Power Improvement of Quadriceps and Hamstring

Backgrounds and Objective: Osteoarthritis (OA) is a set of joint disorders caused by different factors but has the same pathological changes. OA of the knee joint occurs mainly due to the tibiofemoral and patelofemoral joints as a continuous body weight support throughout human life both static and dynamic, thus gradually causing changes in the structure of the knee joint tissue. This study aimed to know the function and strengthening of muscle strength of quadriceps and hamstring in patient with knee osteoarthritis. Method: Twenty-two patients with knee OA (average age of 51.7 years; range 40 to 65 years) were randomly grouped into intervention group (agility and perturbation exercises plus strengthening exercise of quadriceps and hamstring muscles) and the control group (strengthening exercise of quadriceps and hamstring muscles). Both group participated in a four-week exercise. Balance function, quadriceps and hamstring muscles strength (BBS, TUG, EN-Tree 1 RM) were assessed before and after intervention. Result: The intervention and control group improved 1 RM quadriceps muscle (p = 0.0001) and 1 RM hamstring muscle (p = 0.0001) but there was no statistically significant difference between groups, score of BBS in intervention group improved significantly (p = 0.0001) and statistically increased significant between groups (p = 0.0001), score of TUG in intervention group improved significantly (p = 0.002) but there was no statistically significant difference between groups (p = 0.324). Conclusion: Supplementation of agility and perturbation exercises on strengthening exercise of quadriceps and hamstring to balance function provided additional benefit with respect to the BBS score after four-week intervention of patients with knee osteoarthritis.