HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mizner, R. L Articles by Snyder-Mackler, L. Search for Related Content PubMed PubMed Citation Articles by Mizner, R. L Articles by Snyder-Mackler, L. Related Collections Injuries and Conditions: Knee Social Bookmarking                      What's this?

Voluntary Activation and Decreased Force Production of the Quadriceps Femoris Muscle After Total Knee Arthroplasty

RL Mizner, PT, MPT, is a doctoral student, Biomechanics and Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Del
JE Stevens, PT, MPT, PhD, was a doctoral student, Biomechanics and Movement Science Program, University of Delaware, at the time of the study. Dr Stevens is currently Post-doctoral Associate, Department of Physical Therapy, University of Florida
L Snyder-Mackler, PT, ScD, SCS, ATC, is Professor, Department of Physical Therapy, University of Delaware, 301 McKinly Laboratory, Newark, DE 19716 (USA) (smack{at}udel.edu).

Address all correspondence to Dr Snyder-Mackler

Background and Purpose. Quadriceps femoris muscle weakness as manifested by a decrease in force-generating capability is a persistent problem after total knee arthroplasty (TKA). The authors hypothesized that (1) patients with a TKA would have decreased quadriceps femoris muscle performance (weakness) and impaired volitional activation when compared with a group of older adults without knee pathology, (2) pain and age would account for a large portion of the variability in volitional activation after surgery, and (3) volitional activation in the TKA group would account for a large portion of the variability in force production. Subjects. Comparison subjects were 52 volunteers (mean age=72.2 years, SD=5.34, range=64–85). The TKA group comprised 52 patients (mean age=64.9 years, SD=7.72, range=49–78) with a diagnosis of osteoarthritis who had undergone a tricompartmental, cemented TKA. Methods. Knee extension force was measured using a burst superimposition technique, where a supramaximal burst of electrical stimulation was superimposed on a maximal voluntary isometric contraction (MVIC). The amount of failure of volitional activation is determined by the amount of electrical augmentation of force beyond a person's MVIC at the instant of the application of the electrical burst. Results. The average normalized knee extension force of the TKA group was 64% lower than that of the comparison group. The average volitional activation deficit in the TKA group (26%) was 4 times as great as the comparison group's deficit (6%). Age did not correlate with quadriceps femoris muscle activation, and knee pain explained only a small portion of the variance in knee extension force (r²=.17). Volitional activation was highly correlated with knee extension force production (r²=.65). Discussion and Conclusion. Considerable quadriceps femoris muscle inhibition after surgery has several implications for recovery. Rehabilitation programs that focus on volitional exercise alone are unlikely to overcome this pronounced failure of activation. Early interventions focused at improving quadriceps femoris muscle voluntary activation may improve efforts to restore muscle force.

Key Words: Knee replacement • Muscle inhibition • Volitional activation

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. L. Mizner, S. C. Petterson, J. E. Stevens, K. Vandenborne, and L. Snyder-Mackler Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation J. Bone Joint Surg. Am., May 1, 2005; 87(5): 1047 - 1053. [Abstract] [Full Text] [PDF]