Knee Muscle Strength Research Articles

What Prognostic Indicators and Treatment Mechanisms Exist for Efficacious Treatments in People With Patellofemoral Pain? A Secondary Meta-Regression With an Updated Search

OBJECTIVE: To investigate the prognostic and mechanistic variables associated with efficacious treatments in people with patellofemoral pain (PFP). DESIGN: Updated intervention systematic review with de novo meta-regression. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus from inception until October 2023 for randomised controlled trials (RCTs) involving people with PFP. STUDY SELECTION CRITERIA: High-quality RCTs (scoring ≥7 on the PEDro scale) involving participants with PFP and at least one treatment arm involving an efficacious intervention. DATA SYNTHESIS: We extracted homogenous pain and function data to calculate effect sizes to regress with baseline prognostic (e.g., symptom duration) and mechanistic (e.g., strength change) data. RESULTS: Thirty-four high-quality RCTs involving 1,526 people with PFP were included. For knee-targeted exercise, we identified symptom duration (R2 = 0.68), older age (R2 = 0.31), and low baseline knee extensor strength (R2= 1.0) as significant prognostic variables. For hip-and-knee-targeted exercise, we identified older age (R2= 0.37), greater mass (R2= 0.28), and greater baseline hip abduction torque (R2= 1.0) as significant prognostic variables. We also identified a significant mechanistic association between pain and increased knee extensor torque (R2= 0.99). For hip-targeted exercise, we identified lower height as a significant prognostic variable (R2= 0.96-0.99) and a significant mechanistic association between both pain and function and increased hip abduction (R2= 0.93-0.96) and hip external rotation (R2= 0.96-0.97) strength. CONCLUSIONS: Prolonged symptom duration, older age, and greater mass are prognostic variables for people with PFP. Increasing hip and knee muscle strength may be mechanisms underpinning positive responses to exercise therapy.

Objective assessment of the effect of surgery on limb function after medial femoral condyle free flap harvest: biomechanical parameters

The aim of this study was to evaluate the influence of medial femoral condyle (MFC) free flap harvest on donor site muscle strength and kinematic parameters of gait. The study included 30 patients treated for head and neck squamous cell carcinoma who underwent reconstruction with an MFC free flap. In each case, the donor site was the left thigh. A dynamometer was used to measure muscle strength, in isokinetic bilateral mode and with concentric contraction for the extension/flexion knee pattern, at 18 months postoperative. In addition, kinematic data were obtained and evaluated. On statistical analysis, no significant difference in muscle strength of the quadriceps muscle was found between the left involved and right uninvolved lower extremities (P=0.124). Also, when comparing hamstring strength, no statistically significant difference was found between the left involved and right uninvolved sides (P=0.210). Moreover, spatiotemporal gait parameters did not differ significantly between the involved and uninvolved legs (all P>0.05), and no differences in kinematic or kinetic parameters were observed. This study reports the effects of MFC free flap harvest on the knee muscle strength and locomotion of patients. For most biomechanical parameters investigated, there was no effect (positive or negative).

Assessment of Quadriceps Muscle Strength and Thickness in Adolescents with Polycystic Ovary Syndrome: A Case-control and Longitudinal Follow-up Study.

No studies have investigated muscle strength and thickness in adolescents with polycystic ovary syndrome (PCOS). We investigated whether there were changes in quadriceps muscle thickness and strength between adolescents with PCOS and controls. Secondly, we evaluated the effects of six months of combined oral contraceptive (COC) treatment on the quadriceps muscle. The study included 20 adolescents with PCOS and 20 healthy adolescents. The isokinetic dynamometer for the knee muscle strengths and hand dynamometer for grip strength, and ultrasound for quadriceps muscle thickness were used. These measurements were repeated after six months of COCs treatment in the patient group. Age, weight, height, pubertal stage, Physical Activity Questionnaire scores, quadriceps muscle thickness, grip strength and all isokinetic knee strength values were similar between patients and controls (all p>0.05). Compared to baseline, weight, height, quadriceps strength and lipid profile increased (all p<0.05). According to subgroup analyses, significant (and greater) increases in quadriceps muscle strength were found in COC-containing levonorgestrel users (n=6) than in cyproterone acetate users (n=13) (both p<0.05). Quadriceps muscle thickness and strength values were similar between PCOS patients and controls. Significant and greater increases were observed in quadriceps muscle strength in levonorgestrel users than cyproterone acetate users. Further longitudinal studies with larger samples evaluating the COCs with different androgenic capacity are awaited to confirm our preliminary findings.

Rehabilitation success in ACL reconstruction and medial meniscus repair: A case of delayed recovery and optimized outcomes

This case report highlights the rehabilitation process of a 23-year-old male who underwent anterior cruciate ligament (ACL) reconstruction with medial meniscus repair. Early rehabilitation is critical to prevent complications, but this patient experienced a significant delay, resulting in functional deficits such as a 10-degree fixed flexion deformity (FFD) and quadriceps lag at post-operative day 14. A structured rehabilitation protocol was initiated at day 14 post-operation. Progress was tracked using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Leg Balance Scale (SLBS). The rehabilitation focused on improving knee extension, muscle strength, balance, and proprioception. Significant improvements were observed by week 12. The patient’s KOOS scores improved across all domains, with pain improving from 45 to 80 and sports function from 10 to 60. The SLBS showed increased balance on the affected leg, improving from 5 to 25 seconds. The delayed rehabilitation approach still yielded positive outcomes, underscoring the importance of a structured physiotherapy program. This case demonstrates that even with delayed rehabilitation, significant functional recovery can be achieved through a structured physiotherapy protocol. The results reinforce the necessity of early rehabilitation to avoid delays in recovery and improve long-term functional outcomes.

Comparison of Dynamic Postural Stability in Autografts Versus Allografts Following Anterior Cruciate Ligament Reconstruction With Remnant Preservation: A Prospective Study With 1-Year Follow-up.

Graft selection is an important part of preoperative planning for anterior cruciate ligament reconstruction (ACLR). In addition, ACLR with the remnant preservation technique has recently gained attention due to potential benefit in bone-tendon healing, graft revascularization, and proprioceptive nerve remodeling. However, the ideal graft choice remains controversial, and there is limited research comparing autograft and allograft in ACLR with remnant preservation. To compare knee muscle strength, neuromuscular control, and patient-reported outcomes between hamstring (HS) tendon autografts and tibialis anterior (TA) allografts in patients undergoing ACLR with remnant preservation through posterior transseptal portal for >1 year. Cohort study; Level of evidence, 3. A total of 70 patients who underwent ACLR with remnant preservation between 2018 and 2021 using HS tendon autograft (n = 35) or TA allograft (n = 35) were analyzed at 3 different time points (preoperative, 6 months, and 12 months). Quadriceps and HS muscle strengths were measured with an isokinetic device. Proprioception was evaluated with reproduction of passive positioning for joint position sense and overall stability index (OSI) for dynamic postural stability. Patient-reported outcomes included the Lysholm score and the International Knee Documentation Committee score. There were no significant differences in demographic information including age, body mass index, concomitant meniscal injuries, and sports activities (P > .05) between HS tendon autograft and TA allograft groups. Quadriceps and HS strength in both groups, HS strength in deep knee flexion in both groups, and OSI in the HS tendon autograft group significantly improved at 12 months (P < .05). Repeated-measures analysis of variance revealed significant interactions between time and grafts for OSI (F[2, 136] = 5.08; P = .007). The subsequent independent t test demonstrated that the OSI was significantly higher in the TA allograft group (2.7 ± 1.0) than that of the HS tendon autograft group (2.1 ± 0.8) at 12 months (P = .009), indicating better dynamic postural stability in the HS tendon autograft group. No significant differences were found in knee muscle strength or patient-reported outcomes between HS tendon autograft and TA allograft after ACLR with remnant preservation for up to 1 year except for dynamic postural stability favoring HS tendon autograft.

Effects of Melatonin Supplementation on Muscle Strength, Manual Dexterity, and Postural Balance in Patients Living with Multiple sclerosis - A Randomized Controlled Trial

Our previous study revealed the benefits of chronic melatonin intake on dynamic postural imbalance and poor walking capacity induced by multiple sclerosis but its impact on muscle weakness and poor manual dexterity related to this disease has not yet been explored. The objective of the current study was to investigate the effectiveness of 12-week melatonin supplementation on motor skills (i.e., muscle strength, manual dexterity, and static postural balance) and psycho-cognitive status among multiple sclerosis patients. For that, twenty-seven patients were divided into melatonin group (MG, n = 15) and placebo group (PG, n = 12). Melatonin and placebo were each taken at a dose of 3 mg per night, 30 min before bedtime, for 12 weeks. Before and after the intervention, we assessed isokinetic knee muscle strength (dynamometer), manual dexterity (Nine-Hole Peg Test (NHPT)), static postural balance (force platform), mood (Hospital Anxiety and Depression Scale (HADS)), and cognition (Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), and Trail Making Test (TMT)). The results showed that the peak torques of knee flexors (120°/s: p = 0.015, Hedges’g (g) = 1.84; 180°/s: p = 0.02, g = 2.06) and extensors (120°/s: p = 0.019, g = 1.63; 180°/s: p = 0.03, g = 2.01) increased in MG comparatively with PG. There was also a decrease in the sway area (bipedal stance) and mediolateral amplitude (unipedal stance) of the center of pressure in MG compared with PG in the eyes-open (both: p < 0.001; g = 4.32, g = 1.99, respectively) and eyes-closed (p = 0.0007, g = 1.31; p = 0.003, g = 1.79, respectively) conditions. The MG showed an increase in MoCA (p = 0.0006, g = 1.51) and SDMT (p = 0.02, g = 0.95) scores, as well as a decrease in HADS-Total score (p = 0.012, g = 1.06), TMT (p = 0.03, g = 0.91) and NHPT durations (p < 0.001, g = 2.36) comparatively with PG. Based on this study, the 12-week melatonin supplementation was effective in improving knee muscle strength, manual dexterity, static postural balance, mood, and cognition in multiple sclerosis patients. For clinical trial regsitration, this study was prospectively recorded in the Pan African Clinical Trial Registry (PACTR202007465309582).

COMPARISON OF FUNCTIONAL OUTCOMES AND KINESIOPHOBIA LEVELS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDON AUTOGRAFT VERSUS FRESH-FROZEN ALLOGRAFT: A CROSS-SECTIONAL STUDY

Objective: Determining the best graft in the selection of various graft types for anterior cruciate ligament reconstruction (ACLR) is still unclear. The study aimed to compare the functional outcomes and kinesiophobia among individuals who underwent ACLR with either hamstring tendon autograft or fresh-frozen allografts and healthy individuals. Method: A total of 44 individuals undergoing ACLR and 30 healthy individuals were assessed. Individuals who underwent ACLR with hamstring tendon autograft (Group 1) or fresh-frozen allograft (Group 2) and a control group with similar activity levels (Group 3) were included in this study. The surgical groups were evaluated 12-48 months after surgery. Evaluations included detailed history, knee muscle strength, single-leg hop test, and kinesiophobia. Results: There were 24 individuals (mean age 31.71±9.78 years) in Group 1, 20 individuals (mean age 32.35±5.58 years) in Group 2, and 30 healthy controls (mean age 33.77±7.09 years) in Group 3. There was no difference between the surgical groups in terms of single-leg hop test, kinesiophobia, and muscle strength (p&amp;gt;0.05). However, there were significant differences between the ACLR groups with the control group in terms of muscle strength of injured side (p&amp;lt;0.002), single-leg hop test (p&amp;lt;0.029), and kinesiophobia level (p=0.005). Conclusion: This study showed that no graft type was superior to another in terms of functional outcomes and kinesiophobia after ACLR. In addition, the need for long-term rehabilitation of individuals with ACLR should be taken into consideration to reach their pre-operative functional level.

Role of prehabilitation in hamstring tendon ACL reconstruction

Anterior cruciate ligament (ACL) reconstruction is a common procedure, with hamstring tendon autografts frequently used. Post-operative rehabilitation plays a crucial role in recovery, and prehabilitation, or pre-surgical rehabilitation, has shown potential in enhancing post-operative outcomes. Despite its proven benefits in other surgical fields, the specific role of prehabilitation in hamstring tendon ACL reconstruction remains understudied. This study aims to evaluate the impact of a prehabilitation program on muscle strength, knee function, range of motion (ROM), and overall recovery time in patients undergoing hamstring tendon ACL reconstruction. A randomized controlled trial was conducted with 60 patients scheduled for hamstring tendon ACL reconstruction at BIRRD HOSPITAL. Participants were randomly assigned to either a prehabilitation group (n = 30), which underwent a 4-week pre-surgical exercise regimen focusing on strength, flexibility, and proprioception, or a control group (n = 30), which received standard care without pre-surgical intervention. Outcome measures included knee function (IKDC and Lysholm scores), muscle strength (measured through isokinetic testing), and ROM, assessed at baseline, 3 months, 6 months, and 12 months post-surgery. The prehabilitation group demonstrated significantly improved knee function, muscle strength, and ROM at all follow-up intervals compared to the control group.

Intramuscular fatty infiltration and its correlation with muscle composition and function in hip osteoarthritis

BackgroundHip osteoarthritis patients display higher levels of fatty infiltration (FI) in the gluteus minimus (GM) compared to other hip muscles. We investigated specific histological factors such as fiber type composition and collagen deposition, and functional outcomes like muscle strength and activation associated with FI in these patients.MethodsIn twelve men (67 ± 6 y) undergoing total hip replacement (THR), hip and knee muscle strength and activation (electromyography, EMG) were assessed bilaterally. Magnetic resonance imaging (MRI) was used to compare the relative FI area and muscle cross sectional area (CSA) of the GM, rectus femoris (RF), tensor fascia latae (TFL) and vastus lateralis (VL). Adipocyte content, fiber type composition, grouping, fiber size, centrally nucleated fiber frequency, collagen deposition, satellite cell density and capillarization were assessed in intraoperative biopsies of the four muscles. Differences between GM and other muscles were assessed with repeated-measures one-way ANOVA followed by Dunnett’s post-hoc test. Pearson coefficients were calculated for the correlations between FI measurements and the other histological and functional parameters.ResultsStrength was lower in the affected limb. Knee extensor weakness was accompanied by lower VL muscle activation. Muscle CSA and FI did not differ between sides. In the affected limb, GM displayed larger relative FI area (MRI) compared to RF and VL. Biopsy adipocyte content was higher in GM than RF and TFL. Compared to the other hip muscles, GM displayed higher type 1 fiber content while its type 2X fiber content was lower. Fiber grouping levels were higher in GM than the other muscles. Collagen content was higher in GM than TFL and VL. FI in GM was associated with type 1 (r = 0.43) and type 2X (r = -0.34) fiber content, fiber grouping (r = 0.39), and collagen deposition (r = 0.37). FI in VL was negatively associated with maximal knee extension strength (r = -0.65).ConclusionsIn patients undergoing THR, the higher FI levels of GM compared to other hip muscles were associated with fiber type composition and grouping, and with higher collagen deposition. Experimental studies exploring these associations could potentially uncover new targets for the treatment of intramuscular FI and related impairments in muscle function.Trial registrationKEK number: 2016–01852, date of registration: 12-4-2017.

Progressive resisted exercise program combined with aerobic exercise on osteoporotic systemic lupus erythematous patients: a prospective randomized controlled trial

Purpose To investigate the effect of progressive resisted exercise (PRE) and aerobic exercise (AE) on bone mineral density (BMD), muscular strength, exercise capacity, and health related quality of life (HRQoL) in patients with osteoporotic systemic lupus erythematous (SLE). Methods This study was a single blinded randomized controlled trail. Eighty SLE participants, 30–50 years old, were randomly allocated into four equal groups. Group A received PRE and AE, group B received AE, group C received PRE, and group D received traditional medical treatment only. The intervention was implemented three days/week for six months. BMD was measured by Dual Energy X-ray Absorptiometry, muscle strength was measured by an isokinetic device, exercise capacity was measured by 6-min walk test, and HRQoL was measured by short form 36(SF-36). Every outcome was assessed at baseline, six months, and nine months. Results There were statistically significant differences among the groups in knee muscle strength, exercise capacity, and HRQol after 6 months (p < 0.05) in favor of the combined group. BMD increased significantly in the combined and PRE groups compared to the AE and control groups (p < 0.05). Conclusion PRE combined with AE were more beneficial than either exercise alone in improving knee muscle strength, exercise capacity, and HRQoL.

Knee Muscle Strength in Adult Women with and without Non-Specific Low Back Pain: A Comparative Study

Knee Muscle Strength in Adult Women with and without Non-Specific Low Back Pain: A Comparative Study

A100: Effect of Blood Flow Restriction Training on Knee Rehabilitation After ACL Reconstruction

Purpose: To systematically evaluate the effect of blood flow restriction training on knee rehabilitation of patients with anterior cruciate ligament reconstruction and compare the effect of blood flow restriction training and traditional resistance rehabilitation training on knee rehabilitation of patients with anterior cruciate ligament reconstruction. Method: The databases of EBSCO, Embase, PubMed, The Cochrane Library and Web of Science were searched, and the randomized controlled trials of knee rehabilitation after anterior cruciate ligament reconstruction were collected. The search time was from the establishment of the database to June 31st, 2023. After two researchers independently screened the literature, extracted the data and evaluated the bias risk included in the study, they used Stata version 14.0 software for meta-analysis. Results: A total of 8 studies were included, including 203 patients. Meta-analysis showed that blood flow restriction training was superior to traditional resistance rehabilitation training group in improving knee muscle strength [SMD=0.76, 95% CI: (0.42, 1.09), P &lt; 0.001], muscle mass around knee joint [SMD=0.71, 95% CI: (0.36, 1.06), P &lt; 0.001] and knee joint function [SMD=4.22, 95% CI: (2.18, 6.26), P &lt; 0.001]. Subgroup analysis showed that the rehabilitation effect of muscle mass around knee joint [SMD=0.53, 95% CI: (0.06, 1), P=0.03] was more effective than that of traditional resistance rehabilitation training group when training times were ≥ 3 times per week. Conclusion: Blood flow restriction training can improve knee muscle strength, muscle mass around knee joint and knee joint function more effectively than traditional resistance rehabilitation training after anterior cruciate ligament reconstruction. It is suggested that training three times a week or more during rehabilitation can better improve knee joint muscle mass. At the same time, pretreatment of long-term blood flow restriction training for 4–8 weeks before operation is more beneficial to the rehabilitation of knee joint after operation.

Effect of Weight Bearing Exercises on Pain, Leg Function, Balance and Bone Strength in Females of Postmenopausal Age with Osteoarthritis Knee

Background/Objectives: Osteoarthritis (OA) of the knee is prevalent among postmenopausal women (PMW), impacting their quality of life. This Randomized Controlled Trial (RCT) aimed to assess the effectiveness of conventional physiotherapy combined with joint-loading exercises on stable and unstable platforms in improving knee function, muscle strength, balance, and bone mineral density - an important strength of the study - in PMW with OA. Methods: Thirty PMWs with knee OA were randomly allocated to three groups (n=10): Group A got conventional physiotherapy, Group B got conventional physiotherapy plus joint-loading exercises on a stable platform, and Group C got conventional physiotherapy plus joint-loading exercises on an unstable platform. Key tools utilized in the study included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Manual Muscle Test (MMT), Timed Up and Go Test (TUGT), and Dual Energy X-ray absorptiometry (DEXA) for assessing pain, function, balance, and bone strength. The interventions lasted six weeks, with pre-and post-test assessments. Mention how the analysis was done Findings: All groups showed significant improvements in KOOS (G-A: 10.9%, G-B: 18.0%, G-C: 9.3%), MMT (G-A: 3.4 to 4.2, G-B: 3.4 to 4.6, G-C: 3.5 to 4.6), TUGT (G-A: 7.5%, G-B: 6.1%, G-C: 9.9%) and DEXA (G-A at -0.077 ± 0.4, G-B at 0.225 ± 0.5, and G-C at -0.246 ± 0.5) no significant differences were found between groups, though G- B showed the highest improvements. Novelty: While all interventions effectively improved knee function, muscle strength, and balance in PMW with OA, joint-loading exercises on a stable platform demonstrated the greatest benefits. Keywords: Osteoarthritis, Postmenopausal Women, Physiotherapy, Joint-loading exercises, Muscle Strength, Balance

Miodynamic and Radiographic Evaluation in Recreative Athletes with Patellofemoral Pain.

Background and Objectives: Patellofemoral pain (PFP) is frequent in the young and active population. The effect of muscle strength in the lower extremities after aerobic activity in patients with this condition has yet to be detailed. Our objective was to determine if patients with PFP show alterations in lower extremity muscle strength measurements after performing a session of ten minutes of aerobic activity on a treadmill compared to people without patellofemoral pain. Materials and Methods: We conducted a prospective experimental study with a stratified, non-randomized, and non-blinded population sample with group matching, including an experimental group with PFP and a control group with no pain. Subjects completed self-reported functional questionnaires (IKDC, Kujala, KOOS, SF-12), underwent radiographic studies, and were evaluated by measuring the strength of hip and knee muscles and the Single-Leg Triple-Hop (SLTH) test before and after ten minutes of exercise on a treadmill. Results: Seventeen subjects diagnosed with PFP and seventeen control subjects were evaluated. Both groups were homogeneous and had no significant differences in the demographic variables. A wider sulcus angle at 30° (136.8 ± 3.8° vs. 132.5 ± 5.6°, p = 0.0140), a decrease strength post-exercise in the hip abductor (37.9 ± 7.1 N⋅m vs. 45.6 ± 7.7 N⋅m, p < 0.05) and knee extensor (36.0 ± 9.1 N⋅m vs. 47.7 ± 14.0 N⋅m, p < 0.05), and a shorter distance in the SLTH test (337.9 ± 74.9 cm vs. 438.6 ± 65.8 cm, p < 0.01) was recorded in subjects with patellofemoral pain. Conclusions: Subjects with PFP had an overall lower strength of hip and knee muscles, showing significant differences in the hip abductors and knee extensors between people with PFP and healthy matched controls after aerobic exercise.

Early versus delayed start of weight-bearing after arthroscopic anterior cruciate ligament reconstruction with hamstring tendons.

The aim of this prospective randomized clinical study was to compare the clinical and second-look arthroscopic outcomes of early weight-bearing and delayed weight-bearing rehabilitation protocols following anterior cruciate ligament (ACL) reconstruction with hamstring tendons. This prospective study involved 90 patients who underwent ACL reconstruction with hamstring tendons. The patients were randomly assigned to either perform weight-bearing exercises at three weeks postoperatively (group A) or at one week postoperatively (group B). Evaluation of the patients was conducted at 3, 6, and 12 months postoperatively, focusing on knee range of motion, thigh circumference, and knee function assessed using the International Knee Documentation Committee (IKDC) form and Lysholm knee score. Graft evaluation was performed based on tension, tear, and synovial coverage via second-look arthroscopy at least one year after reconstruction. Group B exhibited significantly greater knee extension and flexion angles at 3 and 6 months compared to group A. IKDC and Lysholm scores were significantly higher in group B at 3 and 6 months. Additionally, the difference in thigh circumference between groups A and B was smaller at all evaluation periods, indicating less muscle atrophy in group B. Furthermore, there was no significant difference in synovial coverage, graft tear, or tension between the two groups based on second-look arthroscopy findings. This study demonstrates that an early weight-bearing protocol leads to faster recovery of knee joint function and muscle strength, facilitating a quicker return to sports activities. Additionally, there was no significant difference in graft morphology observed at second-look arthroscopy between the two groups at one year postoperative. Therefore, clinicians are encouraged to develop suitable early weight-bearing rehabilitation protocols for patients who have undergone ACL surgery.

Effects of Yi Jin Jing on enhancing muscle strength and physical performance in older individuals: a systematic review and meta-analysis.

The aging population is rapidly increasing, leading to physical decline and higher risks of chronic diseases, including sarcopenia, which adversely affects muscle quality and strength. Yi Jin Jing (YJJ), a traditional Chinese exercise method, can enhance flexibility and strength, but evidence regarding its effectiveness in older adults is conflicting. This meta-analysis aims to systematically evaluate the effects of YJJ on muscle strength and physical performance in this demographic. We searched seven electronic databases: China National Knowledge Infrastructure, Wanfang Data, Sinomed, Web of Science, PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs). Following PRISMA guidelines, we quantified the effects of YJJ on muscle strength (grip strength, isokinetic strength) and physical performance (chair sit-to-stand, squatting-to-standing, shoulder flexibility, sit-and-reach tests). Treatment effects were calculated using Hedges'g. The Cochrane tool assessed risk of bias, the PEDro scale evaluated methodological quality, and the GRADE method assessed evidence quality. Data analysis was conducted using Stata 17.0 software, utilizing standardized mean differences (SMD) and 95% confidence intervals (CIs). This meta-analysis included 10 RCTs involving 590 participants. The overall risk of bias was assessed to be low. The methodological quality of these studies was generally moderate, and the quality of the main results varied from low to moderate. The findings revealed that YJJ had considerable effects on the chair sit-to-stand test (Hedges'g = 1.06), squatting-to-standing test (Hedges'g = 1.08), and small to moderate effects on handgrip strength (Hedges'g = 0.25), 60°/s extensor peak torque (Hedges'g = 0.47), 60°/s extensor average power (Hedges'g = 0.31), 60°/s extensor total work (Hedges'g = 0.29), 60°/s flexor peak torque (Hedges'g = 0.42), 60°/s flexor average power (Hedges'g = 0.37), and 180°/s extensor peak torque (Hedges'g = 0.29), and left shoulder flexibility (Hedges'g = 0.4). However, there were no significant improvement effects in 180°/s extensor average power (Hedges'g = 0.19), 180°/s extensor total work (Hedges'g = 0.11), 180°/s flexor peak torque (Hedges'g = 0.01), 180°/s flexor average power (Hedges'g = -0.08), right shoulder flexibility (Hedges'g = 0.09), and sit-and-reach test (Hedges'g = 0.15). YJJ significantly enhances specific aspects of physical performance, particularly chair sit-to-stand and squatting-to-standing tests, while showing small and moderate improvements in handgrip strength and knee muscle strength. However, it had no significant effects on other metrics, including shoulder flexibility and sit-and-reach tests. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530487, Registration number: CRD42024530487.

The Benefits of a Rehabilitation Program Following Medial Patellofemoral Ligament Reconstruction.

The medial patellofemoral ligament (MPFL) is critical for patellar stability. This study investigates the efficacy of a one-year physical therapy rehabilitation program following MPFL reconstruction using Synthetic Graft (SG) and Quadriceps Tendon Autograft (QTA). Thirty-five patients aged 18-38 underwent MPFL reconstruction (20 SG, 15 QTA). They participated in a structured rehabilitation program to improve their range of motion (ROM), muscle strength, pain management, and overall quality of life (QoL). The program included physiotherapy and MLS laser, Game Ready Therapy, EMS, TENS, TECAR, and lymphatic drainage. Before and after the program, assessments included knee flexion and extension using goniometry, muscle strength via the Medical Research Council (MRC) scale, knee circumference, pain intensity on the Visual Analogue Scale (VAS), and QoL with the EQ-5D instrument. Significant improvements were observed in knee flexion (37.57° vs. 114.71°, p < 0.001), muscle strength (MRC scale 1-4 points vs. 4-5 points, p < 0.001), and pain reduction (VAS 6.66 vs. 0.46, p < 0.001). The functional coefficient of mobility and QoL scores also markedly increased. Patients with QTA improved some parameters better than those with SG. These findings support the effectiveness of a comprehensive rehabilitation program in enhancing knee functionality, reducing pain, and improving QoL post-MPFL reconstruction. Personalized rehabilitation protocols are recommended to optimize recovery outcomes.

The effectiveness of vitamin D supplementation in patients with end-stage knee osteoarthritis: Study protocol for a double-blinded, randomized controlled trial.

Osteoarthritis (OA) knee is one of the most common chronic degenerative conditions that imposes clinical and economic burdens on individuals and societies worldwide. Previous studies showed vitamin D levels correlated positively with lean muscle mass and grip strength, implying that vitamin D supplementation may improve muscle health in knee OA subjects. This randomized controlled trial (RCT) aims to compare the effects of vitamin D supplementation on knee muscle strength, physical function, pain, and sarcopenia status in patients with end-stage knee OA. Patients and outcome assessors will be blinded to group allocation. Fifty-six end-stage knee OA patients with vitamin D insufficiency fulfilling our inclusion criteria will be invited to participate in this study. Patients will be randomly assigned to take vitamin D supplementation (4,000 IU capsule daily) or placebo for six months. Measurements will be taken at baseline, three and six-month after the commencement of the vitamin D supplement, and 6-month after the interventional period. The primary outcome includes the isometric quadriceps and hamstring muscle strength measured by a hand-held dynamometer. Secondary outcomes include pain, performance-based and self-reported physical function and sarcopenia status. The success of this study will provide scientific evidence of whether the relatively cheap and well-tolerated vitamin D supplement can improve quadriceps muscle strength, physical function, pain symptoms, and sarcopenia status of this increasingly large population for end-stage knee OA patients. The study has great clinical significance given Hong Kong's lengthy and growing waiting list for complete knee replacement procedures. Trial registration: The trial was registered on clinicaltrials.gov (NCT05981534) on 31st July 2023.

The effects of pulsed electromagnetic field therapy on muscle strength and pain in patients with end-stage knee osteoarthritis: a randomized controlled trial.

Osteoarthritis (OA) of the knee is one of the most common chronic degenerative joint conditions affecting aging population. To investigate the effectiveness of a combination of home-based exercise and pulsed electromagnetic field (PEMF) therapy to improve muscle strength, physical function, and pain. Sixty patients were randomly assigned to either home-based exercise alone (control group; n = 30) or combined with PEMF therapy (treatment group; n = 30) twice a week for eight weeks. Knee extension, flexion muscle strength, gait speed (GS), 5 time sit-to-stand test (5STS), Visual Analogue Scale (VAS) pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded at baseline and 4 and 8 weeks. Significant improvements in symptomatic knee extension muscle strength (SKE, p = 0.001), flexion strength (SKF, p = 0.011), contralateral knee extension muscle strength (CKE, p = 0.002), and flexion strength (CKF, p = 0.009) were observed for the PEMF treatment group at 8 weeks. Significant reductions in VAS pain scores were observed in both the treatment (p < 0.001, partial η2 = 0.505) and control (p < 0.001, partial η2 = 0.268) groups. Significant differences were reported between groups in the 4 (p = 0.010, partial η2 = 0.111) and 8 (p = 0.046, partial η2 = 0.068) week assessment in VAS pain. A significant time difference was found in GS and 5STS between baseline and week 8 (GS: difference 0.051, p = 0.026; 5STS: difference 2.327, p < 0.001) in the treatment group. The significant group difference at week 8 was observed in SKE (p = 0.013) in female patients while pain in male patients (p = 0.026). Patients aged over 70 years have a significantly superior improvement in SKE, SKF, and CKF after 8 weeks of PEMF therapy. The combination of PEMF therapy and home-based exercise superiorly improved knee muscle strength and reduced pain in end-stage knee OA subjects and showed a promising tendency to improve performance-based physical function. PEMF therapy was shown to preferentially benefit knee muscle strength in female patients and patients aged over 70 years, whereas male patients were more responsive to PEMF therapy in the form of pain relief. clinicalTrials.gov, NCT05550428.

Quadriceps Strength Testing Practices & Barriers During Return to Sport from ACL Reconstruction: A Survey of Collegiate Athletic Trainers.

Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after ACL reconstruction (ACLR) surgery. 1) Describe the quadriceps strength testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. 2)Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings. Cross-sectional. Online survey. 243 full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past five years (age: 34.8±10.7, years of AT practice: 11.7±9.3, NCAA division I setting: 56%). Our survey included four sections: Demographics, General ACLR rehabilitation practices, Quadriceps strength testing methods & criteria, and Quadriceps strength testing barriers. Knee muscle strength was the most common (98%) outcome collegiate ATs use when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing (MMT) was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition max (RM) testing (35%) and handheld dynamometry (HHD) (22%). Most ATs (63-64%) used >90% side-to-side symmetry as their return to sport-specific activities criteria. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold-standard testing method. Compared to ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used MMT (47% vs 70%). While almost all college ATs considered knee muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps strength testing practices were highly variable among ATs and may be impacted by access to necessary resources.