Quadriceps Muscle Strength Research Articles

Quadriceps muscle strength at 2years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume.

Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2years following ACLR and determine the influence of concomitant meniscal pathology. The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40years were tested at 2.4 ± 0.4years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. III.

Use of the Tokyo Cognitive Assessment for mild cognitive impairment to characterize elderly people that use day care services in Japan.

[Purpose] This study compared the motor skills and cognitive functions of elderly participants who required support with those who did not require support. We aimed to evaluate the characteristics of impairment in sub-items of cognitive function in patients who needed support to predict future clinical issues. [Participants and Methods] We surveyed 31 participants requiring support under the day care service insurance system for which they attended day care service centers in Japan (rehabilitation users) and 10 healthy participants who attended a university for lifelong learning (healthy elders). Data on personal attributes of the participants were collected, and the Cardio-Ankle Vascular Index and motor and cognitive functions were assessed. [Results] Although the participants undergoing rehabilitation were, on average, 6 years older than the healthy elders, we found no significant differences between the two groups in closed-eye, one-legged standing, grip strength, or quadriceps muscle strength. In terms of the Tokyo Cognitive Assessment for mild cognitive impairment, we found no significant differences between those undergoing rehabilitation and healthy elders in clock drawing performance, serial 7 task performance, or orientation; however, there were significant differences in erase character, copy of triangular pyramid, composition, read of digits, go/no-go, word recall, story reproduction, ToCA total score. [Conclusion] We believe that it is imperative for day care service centers to conduct programs that maintain cognitive function in addition to programs for improvement of physical function.

Efficacy of Quadriceps sets with Biofeedback and Modified Quadriceps sets with Biofeedback along with Ultrasound in Reduction of Pain and Active Extension Lag in Bilateral Knee Osteoarthritis”- A Comparative Study

Introduction: The functional dysfunction in the osteoarthritis knee is caused by pain and quadriceps muscle weakness. Physiotherapy treatment includes isometric and isotonic exercises for improving joint range of motion and muscle strength of quadriceps muscle. Biofeedback can be combined with these exercises to enhance awareness about the extent of work done by the muscle. Aim: The aim of the study was to compare the efficacy of quadriceps sets with biofeedback and modified quadriceps sets with biofeedback along with ultrasound in the reduction of pain and active extension lag in knee osteoarthritis. Methodology: A total number of 30 participants were divided into group A and B, 15 each group according to inclusion and exclusion criteria using simple random sampling. Group A received quadriceps sets exercises with biofeedback and group B received modified quadriceps sets with biofeedback. Both groups also received pulsed ultrasounds prior to exercise. The outcome measures were pain and extensor lag, which were assessed at baseline and after 2 weeks of the treatment protocol. Results: Both the groups showed improvement but between-group analysis showed a significant reduction of pain (mean 1.53 right side and mean 1.73 left side, p&lt;.0001) and active extension lag (mean 5.33 right side and mean 6.06 left side, p&lt;.0001) bilaterally in group B who had received modified quadriceps sets with biofeedback when compared with group A. Conclusion: Modified quadriceps sets with biofeedback were more effective than quadriceps sets with biofeedback along with ultrasound in reduction of pain and active extension lag in knee osteoarthritis patients.

Does a Lower Limb Balance Test after Anterior Cruciate Ligament Reconstruction Have a Significant Correlation with Postoperative Clinical Score, Stability, and Functional Performance Test?

Lower limb balance ability is reduced after anterior cruciate ligament reconstruction (ACLR). However, the recovery of balance based on functional test scores after ACLR is not known because the correlation between balance and clinical scores remains unclear. We aimed to analyze the correlation between lower limb balance assessed by functional test and clinical knee test scores after ACLR. We evaluated lower limb balance using the anterior-posterior stability index (APSI) of the Biodex Balance System (BBS). Patients underwent clinical tests to evaluate the knee, including the Tegner activity score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and KT-2000 arthrometer measurement, hamstring per quadriceps muscle strength ratio at 60°/sec (HQ ratio), and functional performance tests (single-leg hop and single-leg vertical jump tests) 1 year after ACLR. We used a paired t-test to compare continuous preoperative and postoperative variables and Pearson's correlation coefficient to determine the relationship between BBS-APSI and clinical scores. Forty-eight patients (35 men and 13 women; mean age, 28.9 ± 8.3 years) were included. The follow-up period and BBS-APSI were 12.4 ± 2.0 months and 0.9 ± 0.4, respectively. Tegner activity score, IKDC subjective score, Lysholm score, and KT-2000 arthrometer measurement improved significantly postoperatively (p < 0.001). BBS-APSI was correlated with the Tegner activity score (r = -0.335, p = 0.020), IKDC subjective score (r = -0.301, p = 0.037), Lysholm score (r = -0.323, p = 0.025), single-leg hop test results (r = -0.300, p = 0.038), and single-leg vertical jump test results (r = -0.336, p = 0.019). There was no correlation between KT-2000 arthrometer measurement and HQ ratio. BBS-APSI was correlated with functional performance test scores after ACLR, rendering the BBS-APSI as a useful assessment tool to evaluate postoperative functional recovery. Continuously improving balance after ACLR could be useful for functional recovery after surgery.

Isometric quadriceps pressure difference: A simple and cost-effective tool to identify and regain quadriceps muscle strength following anterior cruciate ligament reconstruction - A case series

Introduction: Quadriceps weakness and extension deficit of the knee following anterior cruciate ligament (ACL) reconstruction (ACLR) can threaten rehabilitation, and isometric quadriceps exercise is the usual prescription. However, the outcome depends more on the individual's re-learning process. Identification of this lacuna and focussed attention to the isometric strength of quadriceps are lacking in the current practice, and developing a tool can lead to optimal outcomes in ACLR. The objective of this study was to assess the role of 'isometric quadriceps pressure difference' (IQPD) in regaining quadriceps strength following the ACLR using a simple tool.Patients and Methods: Eight patients who underwent post-operative ACL rehabilitation between March 2016 and May 2018 were analysed retrospectively. A 'progressive isometric training protocol (PITP)' based on IQPD was prescribed along with the standard protocol. Data were collected from the case records of the patients. IQPD, thigh muscle girth and heel height difference (HHD) were noted pre-operatively, immediately following surgery and 3 months post-operatively. A non-parametric test was used to compare the outcomes before and after surgery.Results: Based on the analysis, the inclusion of IQPD-based PITP in regaining the terminal extension had a significant statistical difference in the IQPD, HHD and girth (p < 0.007, p < 0.005 and p = 0.027, respectively).Conclusion: IQPD can be a simple, cost-effective strategy to identify subtle quadriceps weakness. Further, PITP can improve the isometric quadriceps strength in the acute post-operative period and reduce the incidence of knee extension deficit in post-ACLR.

Measurement of quadriceps strength among patients of Dhulikhel hospital following anterior cruciate ligament reconstruction: A descriptive cross-sectional study

Background: Anterior cruciate ligament is the key structure of the knee joint. Quadriceps weakness in the involved leg is frequently seen in the rehabilitation setting even when an individual returns to their functional activity. Objectives: To measure the quadriceps strength following an anterior cruciate ligament reconstruction and evaluate the functional activity level. Methods: An analytical cross-sectional study was conducted among 30 anterior cruciate ligament reconstruction patients visiting physiotherapy outpatient department of Dhulikhel hospital between 2nd May 2019 to 4th May 2020. Nonprobability purposive sampling was used for the study. Participants with a history of primary unilateral anterior cruciate ligament reconstruction no less than six months were recruited for the study. Study excluded other lower limb surgeries, anterior cruciate ligament reinjury, multiligament injury, and pregnant women. Quadriceps muscle strength was assessed by using a handheld dynamometer, MicroFET2 and functional activity level with Lysholm scale. Independent sample t-test was done to assess the association between quadriceps strength and different variables. Results: Quadriceps strength deficit in an involved limb was 17.5% and mean length physiotherapy follow up was 11.7 ± 5.9 days in six months. Quadriceps strength was significantly different between genders. There was no statistical significance between quadriceps strength and body mass index. Higher quadriceps strength had greater levels of function. Conclusion: Quadriceps strength deficit was found after anterior cruciate ligament reconstruction. Functional activity was affected even after an individual returned to their normal daily activities.

Validation of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire in patients with interstitial lung disease.

ABSTRACTObjective:To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD). Methods:Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach’s alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman’s or Pearson’s correlation coefficient. Results:Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (−0.40 ≤ r ≤ −0.74); six-minute walk distance (r = −0.38); and quadriceps muscle strength (r = −0.41). Conclusions:The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.

Respiratory muscle strength, exercise capacity and physical activity in patients with primary ciliary dyskinesia: A cross-sectional study

Background and objectivesThe pathophysiological mechanisms of primary ciliary dyskinesia (PCD) may affect many functions, including respiratory, physical, and health status. This study aimed to compare respiratory muscle strength, inspiratory muscle endurance, muscle strength, exercise capacity, physical activity levels, and quality of life in PCD patients and controls. MethodsTwenty-seven patients and 28 controls were included. Respiratory muscle strength (maximal inspiratory (MIP) and maximal expiratory (MEP) pressures), inspiratory muscle endurance (incremental threshold loading test), muscle strength (quadriceps femoris, shoulder abductor, elbow flexor, handgrip), exercise capacity (6-min walk test (6MWT)), physical activity and quality of life (QOL-PCD) were evaluated. ResultsMIP, inspiratory muscle endurance, quadriceps femoris, and handgrip muscle strength, 6MWT distance, total energy expenditure; childrens' (6–12 years) and their parents' physical function, upper, lower respiratory, and hearing symptoms and treatment burden QOL-PCD subscales scores were significantly lower in patients compared with controls (p < 0.05). The 66.7% of patients did not meet the optimal number of steps. MEP, shoulder abductor, and elbow flexor muscle strength, active energy expenditure, physical activity duration, average metabolic equivalents, number of steps, lying time, and sleep duration; childrens' and their parents' other subscales and adolescents’ all QOL-PCD subscales scores were similar between groups (p > 0.05). ConclusionInspiratory muscle strength and endurance, lower extremity and total muscle strength, exercise capacity, total energy expenditure, and childrens’ quality of life are impaired compared to healthy controls. Decreased physical activity level is prevalent in these patients. Effects of pulmonary rehabilitation on these impaired outcomes for PCD patients should be investigated. Trial registrationClinicaltrials.gov: NCT03370029; December 12, 2017.

Type 2 Diabetes Mellitus Related to Decreased Peripheral and Respiratory Muscle Strength in Sarcopenic Thai Elderly.

Age is related to a decline in muscle mass and physical function in both respiratory and peripheral muscle strength, which could lead to mobility and mortality. In addition, older people have suffered from one or multiple chronic conditions in particular in type 2 Diabetes Mellitus (type 2 DM). However, a few studies have reported the relationship between sarcopenic elderly and respiratory and peripheral muscle strengths in type 2DM. To explore the prevalence of sarcopenia in type 2 DM elderly people among community- dwelling patients and the relationships with peripheral and respiratory muscle loss in sarcopenic type 2 DM older patients. A total of 330 older individuals were recruited from community-dwelling centers. Respiratory muscle and quadriceps muscle were assessed. According to the defined criteria for sarcopenia (defined by Asian Working Group for Sarcopenia), muscle mass, gait speed (six-meter walk test), and handgrip strength were examined. Of 330 elderly people, 82 volunteers had a history of type 2 DM. Participants with type 2DM had a risk for sarcopenia (odds ratio= 2.324, 95% CI=1.251-4.317). The prevalence of sarcopenia was 25.61% among older participants with type 2 DM. In addition, decreased respiratory muscle strength and quadriceps muscle strength were observed in type 2 DM with sarcopenia compared to type 2 DM with non-sarcopenia. These relationships also remained after controlling for age and sex. Sarcopenia in type 2 DM leads to a decrease in respiratory muscle and peripheral muscle strength.

Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries.

Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.

The effects of preoperative neuromuscular electrical stimulation on the postoperative quadriceps muscle strength and functional status in patients with fast-track total knee arthroplasty.

This study aimed to investigate the effect of pre- operative neuromuscular electrical stimulation (NMES) on postoperative quadriceps muscle strength, functional status, and quality of life in patients with fast-track total knee arthroplasty (TKA). This prospective study was carried out at Orthopedics department from September 2017 to October 2018. A total of 40 patients were randomly divided into NMES (n=20) and control group (n=20). Patients in NMES group were asked to use home NMES device daily for 20 minutes, 5 times a day, for 6 weeks before surgery. The control group was placed on the 6-week waiting list for surgery without any preoperative intervention. Standard home exercise program was applied to both groups after discharge. The patients were evaluated baseline, preoperatively (6-weeks after baseline) and at the 4th and 12th weeks after surgery. Knee range of motion, quadriceps muscle strength, patient-reported (WOMAC and KOOS) and performance-based activity limitation (30-second chair-stand test, 40-meter fast-paced walk test, and stair-climb test) were evaluated at each visit. Preoperative NMES resulted in significant improvement in KOOS-function in daily living and WOMAC total score (p≤0.05) but had a non-significant trend toward to improve quadriceps muscle strength, KOOS-pain and -other symptoms, performance- based activity limitation, and quality of life scores (p>0.05). However, there was no significant difference between groups in the postoperative period (p>0.05). NMES has beneficial effects in terms of patient- reported and performance-based physical functions and quality of life in preoperative period ; however, it does not provide any additional benefit for post- operative outcomes in patients with fast-track TKA.

Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

ObjectiveTo evaluate the efficacy and safety of early pulmonary rehabilitation (PR) (ie, <3 days of hospitalization) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsEmbase, Web of Science, PubMed and Cochrane Library were searched from their inception to 1 April 2021. Randomized controlled trials were included if they observed the efficacy of early PR in AECOPD patients. Study selection, data extraction, risk of bias and quality of evidence were assessed by two researchers independently. Assessment of the risk of bias and eidence quality were evaluated by the Cochrane Collaboration’s tool and Grading of Recommendations, Assessment, Development and Evaluation system, respectively.ResultsFourteen trials (829 participants) were identified. Significant improvement was found in the 6-minute walk distance (6MWD; mean difference (MD): 69.64; 95% CI: 40.26 to 99.01; Z = 4.65, P < 0.0001, low quality). In the subgroup analysis, the exercise-training group showed marked improvement (MD: 96.14; 95% CI: 20.24 to 172.04; Z = 2.48, P = 0.001). The Saint George’s Respiratory Questionnaire (SGRQ) total score was low (MD: −12.77; 95% CI: −16.03 to −9.50; Z = 7.67, P < 0.0001, moderate quality). Significant effects were not found for the duration of hospital stay, quadriceps muscle strength or five times sit to stand test. Only one serious adverse event was reported in experimental group, which was not associated with early PR.ConclusionPR initiated <3 days of hospitalization may increase exercise capacity and improve quality of life, but the results should be interpreted prudently and dialectically, and the role of early PR in AECOPD needs further exploration.

Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial

BackgroundThere are no scientific reports clearly describing the effectiveness of the High Tone Power Therapy in patients after ACL reconstruction. This caused that in own research an attempt was made to present the possibilities of using the selected method of electrical stimulation in the treatment of an orthopaedic patient. The aim was to assess the effectiveness of electro stimulation of the quadriceps muscle in patients after ACL reconstruction, with the use of High Tone Power Therapy.MethodsIn randomized controlled trial took part thirty-five men, aged 21–50, after ACL reconstruction. The tests were carried prior to and 6 months following the ACL reconstruction. After the surgery, the patients were randomly divided into experimental group (17 patients) with the High Tone Power Therapy in rehabilitation and control group (18 patients) without the High Tone Power Therapy. Patients were subjected to 6-month rehabilitation. Research tools included the measurement of muscle strength torque, ROM, knee and thigh circumference measurements, the Lysholm and the VAS scale.ResultsAfter applying HiToP, the analysis showed a statistically significant improvement of muscle torque (p = 0.041, Es = 3.71), knee circumference (p = 0.039, Es = 1.65), thigh circumference (p = 0.049, Es = 1.26), knee extension (p < 0.001, Es = 2.20) in Experimental group compared to the control group. Only the results of the VAS scale did not differ statistically significantly both within a given group and between groups.ConclusionsThe results confirm the hypothesis that the use of HiToP in patients after ACLr have a beneficial effect on muscle strength, reduction of joint effusion, muscle mass gain and joint function. The assumption that HiToP significantly reduces pain levels is not supported - the results in both groups are statistically insignificant.Trial registrationThe research project was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of first registration 11.10.2016. Registration number: ACTRN12616001416482.

A Comparative Study to Evaluate the Effect of Blood Flow Restriction Therapy and Retro Walking on Pain, Strength of Muscles and WOMAC Score in Patients of Osteoarthritis of Knee

Aim: To assess the impact of blood flow restriction and retro walking in knee osteoarthritis subjects.&#x0D; Study Design: It was a comparative study. All the participants who meet inclusion criteria gave a written consent and were allocated to Group A or Group B randomly by chit method and the pre and post test scores were derived. The scores obtained in the two groups were compared and the results were derived.&#x0D; Place and Duration of the Study: This study was conducted in musculoskeletal sciences division, RNPC Sawangi, Wardha, for 12 months&#x0D; Methodology: A total of 150 samples were chosen. Using the chit method, they were divided into two groups at random, Group A and Group B. Blood Flow Restriction Training was given to Group A, while retro walking training was given to Group B. The training lasted 15 days. After 15 days, the pain, strength, and WOMAC score were tested again.&#x0D; Result: Out of 150 patients 75 were placed in each group, where p=.0001. Significant increase was seen in mean of group I and II in pre ad post-test NPRS score, Quadricep and hamstrings muscle strength and WOMAC score. Analysis showed significant improvement in both the groups.&#x0D; Conclusion: Both the interventions included in this study, have been shown to help individuals with osteoarthritis reduce pain, enhance strength, and improve their WOMAC score. Both the interventions are easy to practice and can be easily performed by the older population. When these two interventions were compared blood flow restriction therapy was proved to be better than retro walking.

Ultrasound Guided Fascia Iliaca Block versus Adductor Canal Block for Postoperative Analgesia in Knee Arthroscopic Surgeries. "A prospective comparative randomized clinical study"

Background: Early rehabilitation after knee arthroscopic surgery is needed to improve functional recovery which is achieved by ideal analgesia. Aim of the work: This study aims to compare between safety and efficacy of fascia iliaca block [FIB] versus adductor canal block [ACB] using ultrasound guidance for post-operative analgesia and motor affection of quadriceps muscle after knee arthroscopic surgeries. Patients and Methods: Sixty patients classified by American Society of Anesthesiologist [ASA] into ASA I/II who were submitted to elective knee arthroscopic surgeries between April 2017 and October 2018. They were randomly allocated to receive either FIB or ACB using bupivacaine 0.25 with ultrasound guidance. Results: At 30 min, 1, 2, 4, 6, 8, 12 and 24 h; there were no significant differences among the mean value of Numerical Rating Scale [NRS] between FIB and ACB. The first time to introduce morphine and total morphine consumption showed no significant difference between FIB and ACB. There was significant motor affection of FIB in comparison with ACB. Conclusion: FIB and ACB provided effective and safe postoperative analgesia for patients scheduled for knee arthroscopic surgeries, with sparing of quadriceps muscle strength and early ambulation in ACB patients.

“But it feels swollen!”: the frequency and clinical characteristics of people with knee osteoarthritis who report subjective knee swelling in the absence of objective swelling

There are complex interactions between pain and perceptions of the painful body part in musculoskeletal disorders, and disruption of various body representations in people with chronic pain. The purpose of this study was to investigate how frequently people with knee osteoarthritis (OA) complain of swelling without objective evidence of swelling, and describe the clinical characteristics of this population. Forty-six people with knee OA (68.1 ± 8.8 years) participated in this cross-sectional study. Subjective and objective swelling was evaluated by knee-specific body perception questionnaire and ultrasonography, respectively. Pain intensity, disability, pain-related beliefs, 2-point discrimination threshold, and quadriceps muscle strength were also evaluated. Approximately 1/3 of participants (n = 15) had subjective feelings of knee swelling in the absence of objective swelling (S only). Fifteen participants had both subjective and objective knee swelling (S + O group) and 16 had neither subjective nor objective knee swelling (No S/O group). Participants in the S only group had similar pain or disability as those in the S + O group but had more severe pain or disability than those with in the No S/O group. Those in the S only group also had larger 2-point discrimination distance threshold at the medial knee (impaired tactile acuity) than those in the S + O group and had more dysfunctional pain catastrophizing and pain-related self-efficacy than both other groups. Our results suggest that about 30% of people with knee OA perceive swelling of the knee in the absence of any objective swelling and that this is accompanied by severe pain and functional disability. Considering altered body image of the knee may reveal relevant treatment-based subgroups in people with knee OA.

Comparison of sensory posterior articular nerves of the knee (SPANK) block versus infiltration between the popliteal artery and the capsule of the knee (IPACK) block when added to adductor canal block for pain control and knee rehabilitation after total knee arthroplasty---A prospective randomised trial.

Background and Aims:Adductor canal block (ACB), though an effective procedure for postoperative analgesia in total knee arthroplasty (TKA), does not provide analgesia to the posterior articular aspect of the knee joint. Infiltration between the popliteal artery and the capsule of the knee (IPACK block) and sensory posterior articular nerves of the knee (SPANK block) are two single injection techniques that have been shown to provide effective analgesia in posterior knee pain. This study aims to compare the effect of IPACK block and SPANK block when combined with ACB for analgesia and postoperative rehabilitation in TKA.Methods:A total of 82 patients were randomised into two groups: (1) ACB combined with IPACK, (2) ACB combined with SPANK block. The primary outcome was the pain scores from 6 h to 48 h after surgery and the duration of postoperative analgesia. The secondary outcome measures were 24 h opioid consumption, ambulation parameters like mobilisation ability, quadriceps muscle strength and patient satisfaction score at discharge.Results:Numerical rating scale (NRS) scores at rest and on movement, duration of analgesia, total opioid consumption, and patient satisfaction were significantly better (P < 0.05%) in the IPACK group than in the SPANK block. There were no significant differences in the knee rehabilitation parameters between the blocks.Conclusion:ACB with IPACK block offers better analgesia, less opioid consumption and better patient satisfaction with comparable knee rehabilitation parameters in the immediate postoperative period after TKA compared to ACB with SPANK block.

Patellar tendinopathy impairs postural control in athletes: A case-control study

ObjectiveTo compare postural control performance between athletes with and without patellar tendinopathy (PT). DesignCase-control study. ParticipantsFifty-eight athletes, 29 with PT (PT group: PTG) and 29 healthy ones (control group: CG). Main outcome measuresStatic and dynamic postural control were assessed with a force platform and the Y-Balance Test (Y-BT), respectively. Quadriceps strength of both limbs was evaluated using an isometric dynamometer. ResultsThe PTG exhibited significantly (p < 0.05) higher centre of pressure (CoP) values than the CG on the foam surface, and significantly lower (p < 0.001) anterior, posteromedial and posterolateral normalized reach distances, and composite score in dynamic postural control on the injured limb (IL) compared to non-injured limb (NIL) and dominant limb (DL) of the CG. The quadriceps muscle strength was significantly lower on the IL compared to the NIL (p < 0.01) and DL (p < 0.05) of the CG. ConclusionAthletes suffering from PT exhibited worse static and dynamic postural control compared to healthy peers. As players with PT frequently continue training despite their tendon pain, physiotherapists and clinicians should incorporate balance rehabilitation programs in the treatment of these players, not only to prevent further potential injuries but also to enhance sport performance.

Diaphragmatic excursion is correlated with the improvement in exercise tolerance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

BackgroundIn patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aimed to elucidate the utility of DEmax to predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD.MethodsThis was a prospective cohort study. Of the 62 patients with stable COPD who participated in the outpatient PR programme from April 2018 to February 2021, 50 completed the programme. Six-minute walk distance (6MWD) was performed to evaluate exercise tolerance, and ultrasonography was performed to measure DEmax. Responders to PR in exercise capacity were defined as patients who demonstrated an increase of > 30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmax to predict responses to PR.ResultsBaseline levels of forced expiratory volume in 1 s, 6MWD, maximum inspiratory pressure, DEmax and quadriceps muscle strength were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale score was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmax was significantly correlated with an increase of > 30 m in 6MWD. The area under the ROC curve of DEmax to predict responders was 0.915, with a sensitivity and specificity of 83% and 95%, respectively, at a cut-off value of 44.9 mm of DEmax.ConclusionDEmax could adequately predict the improvement in exercise tolerance after PR in patients with COPD.

Exercise capacity, muscle strength, dyspnea, physical activity, and quality of life in preoperative patients with lung cancer.

To detect the extent to which physical impairments are observed in patients with lung cancer awaiting lung surgery, exercise capacity, muscle strength, physical activity, dyspnea, and quality of life (QOL) were objectively compared between the patients and healthy individuals in current study. Patients with lung cancer (n = 26) and healthy individuals (n = 21) were included. Exercise capacity, respiratory (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) and quadriceps femoris muscle strength, physical activity, dyspnea and QOL were evaluated using 6-min walk test (6-MWT), a mouth pressure device, a hand-held dynamometer, a metabolic holter device, Modified Medical Research Council dyspnea scale and European Organization for Research and Treatment of Cancer QOL Questionnaire C30 version 3.0, respectively. The 6-MWT distance (mean difference: 78.97 m), percentages of predicted MIP and MEP values, physical activity parameters (energy expenditures, physical activity duration, average metabolic equivalent and number of steps) and QOL subscales scores (functional, social function and global health status) were significantly lower in the patients than healthy individuals (p < 0.05). Dyspnea perception and other QOL subscales scores (symptom and fatigue) were significantly higher in patients than healthy individuals (p < 0.05). No significant difference was prevalent in quadriceps femoris muscle strength (p > 0.05). Sixteen (66.7%) patients were sedentary. Severe reductions in exercise capacity, respiratory muscle strength, and physical activity level, poorer QOL and evident dyspnea exist in preoperative patients with lung cancer. Therefore, patients should be included in early protective rehabilitation program including aerobic exercise, respiratory muscle training and physical activity counseling before lung surgery.