Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: This systematic review and meta-analysis aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength, pain, and function outcomes following total knee arthroplasty (TKA).Methods: PubMed/Medline, Embase, Web of Science, CENTRAL, Scopus, PsycINFO, PEDro, CINAHL, CNKI, and Wanfang were systematically searched for randomized controlled trials (RCTs) from their inception to 18 June 2021.Results: Nine RCTs that involving 691 patients were included in the meta-analysis. Our pooled analysis showed that NMES improved quadriceps muscle strength after TKA within 1 months [standardized mean difference (SMD): 0.81; 95% CI: 0.51–1.11], 1–2 months (SMD: 0.55; 95% CI: 0.13–0.97), 3–4 months (SMD: 0.42; 95% CI: 0.18–0.66), and 12–13 months (SMD: 0.46; 95% CI: 0.18–0.74), pain between 1 and 2 months [mean difference (MD): −0.62; 95% CI: −1.04 to −0.19], pain between 3 and 6 months (MD: −0.44; 95% CI: −0.74 to −0.14) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between 3 and 4 months (MD: −0.43; 95% CI: −0.82 to −0.05), timed up and go test (TUG) within 1 month (MD: −2.23; 95% CI: −3.40 to −1.07), 3 minutes walk test between 3 and 6 months (MD: 28.35; 95% CI: 14.55–42.15), and SF-36 MCS between 3 and 6 months after TKA (MD: 4.20, 95% CI: 2.41–5.98).Conclusion: As a supplementary treatment after TKA, postoperative NMES could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function following TKA. However, many outcomes failed to achieve statistically meaningful changes and minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed.Level of Evidence: Therapeutic level I.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021265609.

Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft

Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38). Conclusions ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb. Level of evidence Level: Level: 4.

Functional Outcomes and Physical Performance of Knee Osteoarthritis Patients After Ultrasound-Guided Genicular Nerve Radiofrequency Ablation

Objective To elucidate the effectiveness of ultrasound-guided genicular nerve radiofrequency ablation in alleviating pain as well as its effects on functional outcomes, quality of life and physical performance in knee osteoarthritis patients. Design Prospective observational study. Setting Patients were recruited within one community hospital. Subjects Patients with knee osteoarthritis. Methods The subjects underwent ultrasound-guided radiofrequency ablation of genicular nerves after showing a positive response to a diagnostic block. Outcome assessments were performed at baseline and at 2 and 12 weeks posttreatments using the 36-item Short Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a physical performance evaluation including balance tests, quadriceps muscle strength test, two-minute walking test and knee joint proprioception test. Results Thirteen out of 38 patients were eligible for genicular nerve radiofrequency ablation. There were significant improvements from baseline to posttreatment in the numeric rating scale score, physical health domain score of SF-36, and pain and stiffness domain scores of the WOMAC. Regarding physical performance, the step test result significantly improved over the 12 weeks of follow-up. On the other hand, no significant deteriorations in the single leg stance test, isokinetic quadriceps muscle strength test, knee joint proprioception test or two-minute walking test results were observed after radiofrequency ablation of genicular nerves. Conclusions Radiofrequency ablation of genicular nerves may significantly alleviate pain and improve functional outcomes in knee osteoarthritis patients. More importantly, static balance control and quadriceps muscle strength were preserved and there was a change of proprioception in the good direction.

The Role of Eccentric Training and Pain Neuroscience Education (PNE) to Improve Quadriceps Muscle Strength, and Function in Post ACL Repair: A Case Report

Background: A 19-year-old man presented with right knee pain while bearing weight on the right leg and difficulty bending the right knee. He was diagnosed with a complete -tear of the anterior cruciate ligament. After ACL reconstruction this individual was referred to physical therapy treatment. Objective: To investigate if neuroscience pain education, and eccentric training, have any therapeutic significance in post-ACL reconstructive patients. Method: After assessment, the first day of the first week, introduced a treatment protocol consisting of basic range of motion (ROM) and isometric exercises for three sets of 10–30 sec hold. From first to fourth week eccentric exercises along with pain neuroscience education (PNE) sessions were given on alternate days, with three sessions for PNE and eccentric exercises until fourth week. Result: As shown in this study, treatment with a combination of PNE and eccentric training results in improved quadriceps muscle strength, range of motion, and overall function. Conclusion: This report suggested that PNE in conjunction with eccentric exercise has clinical merit. Clinical implication of study is examining the effectiveness of this approach should be conducted in the form of well-designed, clinical studies.

Comparison of Y-Balance Test Performance by maturation status in youth distance runners

Background: Distance running is a popular interscholastic sport, but also has an associated high risk of running-related injuries. Recent literature suggests that functional tests may help to identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength and balance and to expose asymmetries between tested limbs. Purpose: To determine if YBT performance was associated with maturation status in healthy, youth distance runners. We hypothesized that mid-pubertal (MP) runners would demonstrate less functional reach distance than pre-pubertal (PrP) or post-pubertal (PoP) runners. Methods: A convenience sample of 142 (Females: n=79, Males: n=63) uninjured youth runners (ages 13.5±2.7 years; weekly running distance: 18.2±20.4 km) were recruited from the local community. All runners met inclusion criteria, indicating that they were between 9 and 19 years old and participated in long-distance running activities such as school/club track and field, cross country, road races, trail running, and/or soccer. The runners completed a modified Pubertal Maturational Observation Scale (PMOS), then were screened for right (R) and left (L) anterior (ANT), posteromedial (PM) and posterolateral (PL) reach distances (cm) normalized by lower limb length (cm). Composite reach distance was calculated by the sum of the three reach distances divided by three times the limb length multiplied by 100 for R and L limbs. ANOVA with Bonferroni post hoc tests were used to compare maximum normalized reach distances for the three directions and composite reach distance by maturation status and sex. Results: Overall, 31.7% were classified as PrP status, 26.1% as MP, and 42.3% as PoP, with similar percentages by sex ( p=0.84). The only significant mean difference was found for R ANT maximum normalized reach distance between PrP and PoP ( p=0.02), indicating a greater normalized reach in PrP athletes. No significant mean differences were found for R or L PM and PL maximum normalized reach distances, or for R or L composite reach distances, by maturation status or when stratified by maturation and sex ( p>0.05). Conclusions: In this sample of youth runners, the YBT was only a discriminator of anterior reach distance between pre-pubertal and post-pubertal runners. As decreased anterior reach is associated with reduced quadriceps muscle strength and anterior knee pain, reduced anterior reach in post-pubertal runners may potentially signify an increased risk of sustaining a running-related injury. Thus, preventive efforts to ensure good functional quadriceps muscle strength may be merited.

The correlation between quadriceps muscle strength and endurance and exercise performance in patients with COPD

Purpose To determine the association between quadriceps muscle strength (QMS) and endurance (QME) and exercise capacity in COPD patients after stratification for sex and resting lung function (LF). Methods Data were collected in 3246 COPD patients (60% men, 64±9 years), including measures of exercise capacity (peak aerobic capacity (peakVO2)), six-minute walk distance (6MWD)) and isokinetic QMS and QME. Patients were stratified for sex, forced expiratory volume in 1 s (>50/≤50% predicted), single breath carbon monoxide diffusing capacity (>50/≤50% predicted) and residual volume (>140/≤140% predicted). Results After stratification for resting LF, QMS and QME were significantly associated with peakVO2 (r range: 0.47-0.61 and 0.49-0.65 for men; and 0.53-0.66 and 0.48-0.67 for women, respectively)and 6MWD (r range: 0.29-0.42 and 0.44-0.55 for men; and 0.25-0.54 and 0.34-0.55 for women, respectively) (p<0.001). Regression models demonstrated that QMS and QME were significant determinants of peakVO2 (explained variance R2 range: 35.6-48.8% for men; and 36.8-49.0% for women) and 6MWD (R2 range: 24.3-43.3% for men; and 28.4-40.3% for women), independent of age and fat-free mass. Conclusion Quadriceps muscle function was significantly associated with peakVO2 and 6MWD in male and female COPD patients after stratification for resting LF, in which QME appear to be a more important determinant than QMS. This underlines the importance of systematically evaluating both quadriceps muscle strength and endurance in in all COPD patients.

Effects of TheraBand and Theratube Eccentric Exercises on Quadriceps Muscle Strength and Muscle Mass in Young Adults

Purpose. This study was aimed at comparing the effects of TheraBand and theratube eccentric exercises on quadriceps muscle strength in young adults. Methods. Thirty young adults (19 females, 11 males) participated in this pretest-posttest experimental study. Participants were randomly assigned to one of the two groups: TheraBand and theratube groups. They received the training intervention 3 times a week for 4 weeks (12 sessions) with progression after 2 weeks. Maximum eccentric quadriceps strength was assessed using the Biodex isokinetic dynamometer system. Additionally, quadriceps muscle mass was measured using a tape. Results. Both groups showed a significant improvement in the peak torque of the eccentric isokinetic quadriceps’ strength after weeks 2 and 4. Strength change in the quadriceps was nonsignificant in the theratube group compared to the TheraBand group after 4 weeks of training ( p < 0.05 ). There was no increase in muscle mass during the 4 weeks of training in any group ( p > 0.05 ). Conclusion. Both the TheraBand and theratube are equally effective in the strengthening of the quadriceps muscle in young adults. Therefore, either the TheraBand or theratube may be used according to the availability and feasibility of the subjects for training intervention.

Empirical study of the 30-s chair-stand test as an indicator for musculoskeletal disorder risk of sedentary behaviour in Japanese office workers: a cross-sectional empirical study

ObjectivesSedentary behaviour among office workers and the risk of adverse health outcomes are public health problems. However, risk indicators for these outcomes require invasive biochemical examination. A proactive screening tool using a non-invasive, easy-to-use method is required to assess the risk focused on musculoskeletal health for primary prevention. However, middle-aged adults have insufficient awareness of musculoskeletal disorders. This study examined to determine whether the 30-s chair-stand test (CS-30) can be used as a proactive screening index for musculoskeletal disorder risk of sedentary behaviour in office workers.DesignCross-sectional study using self-administered questionnaires and physical measurements.SettingFour workplaces located in a metropolitan area of Japan.Participants431 Japanese office workers aged 20–64 years. 406 valid sets of results remained (valid response rate: 94.2%).Primary and secondary outcome measuresMusculoskeletal function was measured using the CS-30, quadriceps muscle strength. Receiver operating characteristic curve analysis was used to determine the sensitivity, specificity and optimal cut-off value for the CS-30. The risk of future incidence of musculoskeletal disorders was calculated using current quadriceps muscle strength.ResultsIn total participants, 47.0% were male and the mean sitting time in work duration was 455.6 min/day (SD=111.2 min). The mean lower limb quadriceps muscle strength was 444.8 N (SD=131.3 N). For the optimum cut-off value of 23 on the CS-30 for all participants, sensitivity was 0.809 and specificity was 0.231. For men, the optimum cut-off was 25, with a sensitivity of 0.855 and a specificity 0.172. For women, the optimum cut-off was 21, with a sensitivity of 0.854 and a specificity 0.275.ConclusionsSensitivity was high, but specificity was insufficient. The CS-30 may be a potential proactive screening index for musculoskeletal disorder risk of sedentary behaviour, in combination with other indicators.