Impact of Kinesiotherapy Rehabilitation on Quadriceps Femoris Muscle Strength and Functionality in Total Hip Arthroplasty Patients / Impacto de la Rehabilitación con Kinesioterapia en la Fuerza y Funcionalidad del Músculo Cuádriceps Femoral en Pacientes con Artroplastía Total de Cadera

SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.

El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.

Value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis.However,some patients still experience chronic post-surgical pain.It is significant to find out the influencing factors of chronic post-surgical pain.Demographic factors,social psychological factors and perioperative pain were the focus of previous studies,but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported. OBJECTIVE:To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty. METHODS:A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected.All patients were treated with the same anesthesia and operative methods.Before the surgery,clinical data were recorded,and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging,which could quantify the degree of quadriceps femoris atrophy.Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain,and receiver operating characteristic curves were used to evaluate its predictive value. RESULTS AND CONCLUSION:(1)250 subjects were involved in the result analysis,and 91 of them had chronic post-surgical pain,with an incidence of 36.4%.(2)There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement,preoperative Western Ontario and McMaster University Osteoarthritis Index,preoperative anxiety and depression scale score,preoperative muscle thickness and echo intensity of quadriceps femoris,and postoperative acute pain score(P<0.05).(3)Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an independent protective factor for chronic post-surgical pain and preoperative pain score during movement was an independent risk factor for chronic post-surgical pain.(4)Receiver operating characteristic curves showed that the area under the curve of the preoperative thickness of quadriceps femoris was 0.625(95%CI:0.555-0.695),and the critical value was 2.78 cm,sensitivity was 0.802,specificity was 0.415.(5)It is concluded that the preoperative thickness of quadriceps femoris is an independent protective factor for chronic post-surgical pain,but its predictive efficacy is low,and its clinical application needs to be further verified or modified.

Strategies for repairing injured anterior cruciate ligament and promoting graft healing / 中国组织工程研究

BACKGROUND:In recent years,the treatment of anterior cruciate ligament injury has become more and more mature.However,there are still disputes about the timing of surgery,the choice of surgical methods,the choice of grafts,and the methods to promote graft healing after anterior cruciate ligament injury. OBJECTIVE:To summarize the latest research progress of surgical timing,surgical methods,graft selection and methods to promote graft healing after anterior cruciate ligament injury,and to find new treatment directions for anterior cruciate ligament injury. METHODS:Relevant articles concerning anterior cruciate ligament injury were retrieved from PubMed,CNKI,WanFang Date,VIP,SinoMed,ScienceDirect,Springer and Cochrane Library.After the screening,72 related articles were finally included. RESULTS AND CONCLUSION:(1)Surgical timing:Compared with delayed anterior cruciate ligament reconstruction,early reconstruction can reduce meniscus injury,elevate quality of life,and improve functional recovery.However,it is still uncertain whether the different operation timing will accelerate cartilage injury.(2)Surgical methods:Arthroscopic anterior cruciate ligament reconstruction is a common surgical method for anterior cruciate ligament injury.Dynamic internal stabilization repair of anterior cruciate ligament can bring similar results to traditional anterior cruciate ligament reconstruction in short-term and long-term effects.(3)Graft selection:Autogenous hamstring tendon is the first choice of anterior cruciate ligament graft,while bone-patellar tendon-bone grafts and allografts are the secondary choices.(4)Among the methods to promote graft healing,suture band strengthening can increase knee joint stability and ensure graft healing.Stem cells promote the tendon-bone healing of grafts through anti-inflammatory action,angiogenesis,inhibition of osteolysis and promotion of chondrocyte differentiation.Preserving the residual end of the anterior cruciate ligament can maintain the stability of the knee joint,promote the recovery of proprioception,and provide a prerequisite for the healing of the graft.The effectiveness of platelet-rich plasma in promoting graft healing remains to be discussed.However,biomaterials,gene therapy,stem cell application and other methods to promote tendon healing remain in the stage of molecular and animal researches.Clinical transformation is also needed in the future.

Knee function recovery in patients with anterior cruciate ligament reconstruction after blood flow restriction training:a meta-analysis / 中国组织工程研究

OBJECTIVE:To systematically review the clinical effect of blood flow restriction training on rehabilitation after anterior cruciate ligament reconstruction to provide a reference for clinical practice. METHODS:Databases including CNKI,WanFang,PubMed,Web of Science and EBSCO were searched to collect randomized controlled trials of blood flow restriction training in the intervention of anterior cruciate ligament reconstruction from inception to August 10,2022.Outcomes included knee muscle strength,knee muscle mass,and knee function evaluation,all of which were continuous variables.Two reviewers independently screened the literature and extracted data.Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the bias risk of the included articles.Meta-analysis was then performed using RevMan 5.4 software. RESULTS:A total of 9 publications were included,including 226 subjects,114 in the trial group and 112 in the control group.Meta-analysis results showed that compared with conventional resistance training,the blood flow restriction training group could significantly improve knee muscle strength[SMD=0.54,95%CI(0.29,0.79),P＜0.01],muscle mass[SMD=0.26,95%CI(0.06,0.46),P=0.01]and knee joint function[SMD=1.17,95%CI(0.53,1.80),P＜0.01].Subgroup analysis showed that only when the intervention time was more than 4 weeks,there were significant improvements in knee joint muscle strength[SMD=0.68,95%CI(0.38,0.97),P＜0.01]and muscle mass[SMD=0.38,95%CI(0.09,0.68),P=0.01]. CONCLUSION:Current evidence shows that blood flow restriction training can improve muscle strength and knee function in patients with anterior cruciate ligament reconstruction and reduce muscle atrophy.It is recommended that the postoperative intervention time should be more than 4 weeks to achieve better muscle strength and muscle mass improvement.

Rate of force development and its relationship with functional performance in patients after anterior cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND:The maximum muscle strength is typically used for evaluating the recovery of muscle function after anterior cruciate ligament reconstruction.Recent studies have suggested that neuromuscular function should also be considered,such as rate of force development,which measures the slope of the force time curve at different time intervals under conditions of isometric muscle contraction. OBJECTIVE:To elaborate on the current research status and shortcomings of muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction surgery,and analyze the degree of defects in quadriceps femoris and hamstring isometric rate of force development at different times after surgery;to analyze the effect of isometric rate of force development on postoperative functional performance,thereby providing important information for optimizing postoperative rehabilitation following anterior cruciate ligament reconstruction,reducing secondary injury to patients,and reducing the incidence of knee osteoarthritis. METHODS:Literature retrieval of CNKI,VIP,WanFang and PubMed was performed using"anterior cruciate ligament,rate of force development"as Chinese search terms and"anterior cruciate ligament,rate of force development,rate of torque development"as English search terms.Finally,69 articles were included according to inclusion and exclusion criteria. RESULTS AND CONCLUSION:Most studies have found defects in bilateral muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction within 6 months.Early isometric rate of force development of the bilateral hamstring muscles(i.e.the slope of the force time curve at any time interval during muscle contraction of 100 ms)showed significant improvement after 6 months.However,long-term defects in early isometric rate of force development of the bilateral quadriceps indicate long-term damage to the neuromuscular function of the quadriceps after surgery.There is limited research on late isometric rate of force development(the slope of the force time curve at any time interval after 100 ms of muscle contraction),and conclusions cannot be drawn.Regarding landing exercises(jumping to the ground,lateral cutting,etc.)and daily activities(walking,running),early isometric rate of force development of the quadriceps is more correlated with isometric peak torque.Abnormal biomechanical changes during exercise are considered an important risk factor for secondary injury and traumatic knee osteoarthritis in patients.Actively improving early isometric rate of force development of the quadriceps may reduce the incidence of secondary injury and traumatic knee osteoarthritis.Currently,there is limited evidence to suggest that whole-body vibration training can improve early isometric rate of force development of the quadriceps femoris in patients undergoing anterior cruciate ligament reconstruction.It is recommended to use neuromuscular electrical stimulation to intervene in the quadriceps and hamstring in the early postoperative stage and implement explosive force and high resistance training in the late postoperative stage,which may improve the isometric rate of force development in patients.Generating sufficient muscle strength in a short period of time is necessary to effectively protect the anterior cruciate ligament,while the relationship between isometric rate of force development in the hamstring muscle and functional performance is still unclear,which may provide information on preventing secondary injury in patients.It is recommended to use the isometric rate of force development as one of the evaluation indicators for guiding rehabilitation and restoring movement.In addition to focusing on improving symmetry and differences from normal individuals,the hamstring to quadriceps strength ratio should also be considered.An appropriate range of ratios can ensure the balance of muscles during rapid muscle exertion,which may reduce the occurrence of secondary injuries.However,the normal range of ratios is not yet clear.Future research should consider the effects of graft type and knee flexion angle on isometric rate of force development,in order to identify neuromuscular dysfunction in patients as much as possible and help them recover better.

The biomechanical research of knee osteoarthritis patients under different angular velocities based on the characteristic multichannel surface electromyography / 中国康复医学杂志

Objective:To observe and analyze the surface electromyography activity of quadriceps femoris of knee osteoar-thritis(KOA)patients. Method:The surface electromyography of vastus lateralis,rectus femoris,and vastus medialis were recorded and analyzed in 30 KOA patients and 30 normal people during isokinetic knee flexion or extension at veloci-ties of 60 °/s,90 °/s or 180 °/s.We also record clinical indicators(muscle thickness and degree of knee pain)of the KOA group and evaluate the correlation between electromyographic data and clinical indicators. Result:Compared with the healthy control group,the KOA group had significantly lower knee extensor mo-ment during isokinetic knee flexion or extension at velocities of 60°/s(P＜0.001),90°/s(P＜0.01),or 180°/s(P＜0.01).Statistics showed that there were significant differences in the median frequency difference rate of vastus lateralis(P＜0.05)and root mean square value of rectus femoris(P＜0.01)between the healthy control group and the KOA group under 60°/s angular velocities.There was a significant difference in the root mean square value of rectus femoris(P＜0.05)between the two groups at velocities of 90°/s.Statistics revealed that the median frequency difference rate(P＜0.05)and root mean square value(P＜0.05)of rectus femoris had changed significantly at the velocities of 180°/s.The results of both multiple regression and random forest algo-rithm showed that knee extensor moment was the strongest predictor between electromyographic characteristics and clinical indicators. Conclusion:The strength of quadriceps femoris in KOA patients was decreased.Thus,the patient may need more muscles to complete the same action,which was easy to cause muscle fatigue.The knee extensor moment was closely related to the quadriceps femoris thickness and the degree of knee pain.It offers important advantag-es for the diagnosis and assessing the severity,which may provide the way for the future study of KOA.

Comparative analysis of lower limb muscle strength in amateur runners with patellofemoral pain / 中国康复医学杂志

Objective:To investigate the lower limb muscle strength characteristics in amateur runners with patellofemoral pain(PFP). Method:Thirty PFP amateur runners(20 males and 10 females)were recruited as the knee pain group,and 30 matched non-injured amateur runners were recruited as the non-knee pain group.The hip abductor strength,quadriceps strength,hamstring strength,hamstring/quadriceps ratio,and bilateral limb symmetry index were col-lected for all participants.Independent sample t-tests were used to compare the differences between the groups. Result:The hip abductor strength and bilateral limb symmetry index,quadriceps strength and bilateral limb symmetry index of male PFP amateur runners were significantly lower than those of the non-knee pain group,while the hamstring/quadriceps ratio was significantly higher than that of the non-knee pain group.The hip ab-ductor strength and bilateral limb symmetry index of female PFP amateur runners were significantly lower than those of the non-knee pain group. Conclusion:PFP amateur runners exhibit different lower limb muscle strength characteristics compared to non-knee pain runners,and the lower limb strength characteristics of male and female PFP amateur runners are not consistent.Therefore,functional and gender differences should be considered in the clinical treatment and rehabilitation training of PFP.

Observation on changes of quadriceps tendon in type 2 diabetes mellitus patients based on ultrasonic elastography / 中国医学影像技术

Objective To observe the changes of quadriceps tendon in type 2 diabetes mellitus(T2DM)patients based on ultrasonic elastography.Methods Data of 80 T2DM patients(T2DM group)and 80 healthy subjects(control group)were retrospectively analyzed.The general information and ultrasound elastography parameters,including strain ratio(SR)of the ratio of the proximal,middle and distal segments of quadriceps tendon and ipsilateral anterior femoral fat pad were compared between groups,while the correlations of the above SR with the disease course of T2DM and glycosylated hemoglobin(HbA1c)were explored.Results Fasting blood glucose and HbA1c in T2DM group were both significantly higher than those in control group(both P＜0.05).Compared with control group,SR of the proximal,middle and distal segments of quadriceps tendon in T2DM group were all significantly higher(all P＜0.05),especially the distal and proximal segments(t=6.01,5.92).In T2DM group,SR of the proximal,middle and distal segments of quadriceps tendon were positively correlated with the disease course of T2DM(r=0.45,0.20,0.43,all P＜0.05)and HbA1c(r=0.44,0.40,0.33,all P＜0.05).Conclusion SR of quadriceps tendon in T2DM patients significantly increased and positively correlated with the course of disease and HbA1c.

Quadricipital Tendon Simultaneous Bilateral Tear in a Patient with Type-II Diabetes Mellitus after Low-energy Trauma: Case Report / Ruptura bilateral simultânea do tendão quadricipital em paciente portador de diabetes mellitus do tipo II após trauma de baixa energia: Relato de caso

Abstract Simultaneous bilateral rupture of the quadricipital tendon is an extremely rare lesion. We report a case of this injury after low-energy trauma in a patient with type-II diabetes mellitus. Both knees were surgically approached in the same surgical procedure. Early rehabilitation is essential for the adequate functional recovery of the knee. The aim of the present report was to describe an atypical case of this type of injury after minimal trauma, as well as to detail the surgical technique used to treat it.

Resumo A ruptura bilateral simultânea do tendão do quadríceps é uma lesão extremamente rara. Relatamos um caso desta lesão após trauma de baixa energia em paciente portador de diabetes mellitus do tipo II. O diagnóstico é essencialmente clínico, e requer tratamento precoce. Os dois joelhos foram abordados cirurgicamente no mesmo ato operatório. A reabilitação precoce é fundamental para a recuperação funcional adequada do joelho. O objetivo deste relato foi descrever um caso atípico deste tipo de lesão após trauma mínimo, bem como detalhar a técnica cirúrgica utilizada para o tratamento.

Comparação das respostas neuromusculares e bioquímicas entre pacientes com DPOC e indivíduos saudáveis / Comparison of neuromuscular and biochemical responses between patients with COPD and healthy subjects

Objetivo: Comparar as respostas neuromusculares e bioquímicas do dano e fadiga muscular do quadríceps femoral entre indivíduos com doença pulmonar obstrutiva crônica (DPOC) e saudáveis. Métodos: Estudo observacional, transversal e comparativo. A amostra foi composta por 18 indivíduos alocados em dois grupos distintos: Grupo DPOC (GD) e grupo saudáveis (GS), os quais foram avaliados por meio da espirometria, do desempenho neuromuscular do quadríceps, dos marcadores bioquímicos do dano e fadiga muscular, da fatigabilidade e da dor muscular. Resultados: Observou-se diferença estatisticamente significante na potência média entre o GD e GS (99,9 ± 21,0 vs 145,1 ± 51,5, respectivamente; p= 0,02) e uma tendência das médias de pico de torque (85,7 ± 24,4 vs 104,4 ± 31,0; p= 0,45) e trabalho total (1.305,5 ± 329,9 vs 1.671,5 ± 444,5; p= 0,06) serem menores no GD que no GS, respectivamente. A concentração da LDH imediatamente após o teste isocinético foi significantemente maior no GD que no GS (402,3 ± 33,6 vs 289,4 ± 33,6, respectivamente; p= 0,03). Conclusões: O presente estudo mostrou que pacientes com DPOC tem redução da capacidade de gerar força em um determinado período de tempo quando comparado a indivíduos saudáveis. A dosagem plasmática dos marcadores bioquímicos não permitiu confirmar que os pacientes com DPOC tem maior nível de dano muscular quando realizam exercício que os controles saudáveis.

Objective: To compare neuromuscular and biochemical responses of femoral quadriceps muscle damage and fatigue between chronic obstructive pulmonary disease (COPD) and healthy subjects. Methods: Observational, transversal and comparative study. The sample consisted of 18 subjects assigned to two distinct groups: COPD group (CG) and healthy group (HG), who were assessed by spirometry, quadriceps neuromuscular performance, biochemical markers of muscle damage and fatigue, fatigability and muscle pain. Results: Statistically significant difference was observed in mean power between CG and HG (99.9 ± 21.0 vs. 145.1 ± 51.5, respectively; p= 0.02) and a tendency of mean peak torque (85.7 ± 24.4 vs 104.4 ± 31.0, p= 0.45) and total work (1,305.5 ± 329.9 vs 1.671.5 ± 444.5; p= 0.06) were smaller in the CG than HG, respectively. The LDH concentration immediately after the isokinetic test was significantly higher in the CG than HG (402.3 ± 33.6 vs 289.4 ± 33.6, respectively; p= 0.03). Conclusions: The present study showed that patients with COPD have a reduced ability to generate force over a given period of time when compared to healthy subjects. The plasma levels of biochemical markers did not confirm that patients with COPD have a higher level of muscle damage when exercising than healthy controls.

Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Relationship between intramuscular fat content in the quadriceps muscle and clinical severity in patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore relationship between intramuscular fat content of quadriceps femoris and clinical severity of knee osteoarthritis (KOA).@*METHODS@#Totally 30 KOA patients were selected from February 2021 to June 2021, including 6 males and 24 females, aged with an average of (64.20±9.19) years old, and body mass index (BMI) was (24.92±3.35) kg·m-2. Patients were divided into relative severe leg (RSL) and relative moderate leg (RML) according to severity of pain on visual analogue scale(VAS). Musculoskeletal ultrasound was used to collect muscle images of quadriceps muscles on both sides of the patient, and Image J was used to analyze echo intensity (EI) of each muscle. Both VAS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess pain and function. Quadriceps muscle EI on both sides of patients was compared. Pearson correlation analysis was conducted to analyze correlation between quadriceps muscle EI value between RSL and RML, and linear regression was used to analyze relationship between each muscle EI and VAS and WOMA scores of patients.@*RESULTS@#The EI of RSL lateral vastus lateralis (VL) was 123.78±36.25 and RSL vastus medialis (VM) was 109.46±30.36 which were significantly higher than those of 108.03±31.34 and 93.32±26.04 of RML (P<0.05), but there was no statistical significance in EI values of rectus femoris (RF) on both sides (P>0.05). EI values of VL and VM on both sides were significantly correlated (P<0.05). There was a significant positive correlation between VM EI value and VAS score in RSL and RML (P<0.05). VM EI values in RSL were positively correlated with total WOMAC (P<0.05), and VM VL EI values in RML were positively correlated with total WOMAC score (P<0.05).@*CONCLUSION@#Intramuscular fat content of quadriceps is closely related to severity of clinical symptoms in KOA patients, and the most obvious one is VM. Therefore, the intramuscular fat content of quadriceps may be an objective indicator to evaluate severity of KOA patients. At the same time, reducing intramuscular fat content of the quadriceps muscle of KOA patients may be a new direction for the prevention and treatment of KOA.

The effects of blood flow restriction on the quadriceps femoris and knee stability after anterior cruciate ligament reconstruction / 中华物理医学与康复杂志

Objective:To explore the effect of blood flow restriction training on the quadriceps femoris and on knee stability after anterior cruciate ligament reconstruction.Methods:Forty patients recovering from anterior cruciate ligament reconstruction were randomly divided into an experimental group and a control group, each of 20. In addition to routine rehabilitation training, the control group was given routine knee flexion and extension strength training, while the experimental group trained for an additional 20 minutes doing knee flexion and extension resistance training with the blood pressure in their groins at 70% of their individual arterial occlusive pressure. (The mean pressure was (123±11.23)mmHg). The training lasted 8 weeks, three times a week. Knee function and hamstring and quadriceps peak torque were assessed before and after the intervention using a Lysholm scale and Humac Norm isokinetic muscle strength tests.Results:There were no significant differences between the two groups in any of the measurements before the training. After the intervention, all of the measurements had improved significantly in both groups, with the average Lysholm score, H/Q% and peak torque of the experimental group significantly better than the control group′s averages.Conclusions:Blood flow restriction training can improve the effectiveness of quadriceps femoris strength, knee stability and knee function training after anterior cruciate ligament reconstruction.

Surface electromyography of lower limb muscles in healthy middle-aged and old women during stair ascent and descent / 中国康复理论与实践

ObjectiveTo observe the lower limb muscle activation strategy of healthy middle-aged and old women during stair ascent and descent with surface electromyography. MethodsFrom August, 2021 to February, 2022, 20 healthy middle-aged and old women were measured the surface electromyography root mean square (RMS) and integrated electromyography (iEMG) of bilateral vastus lateral, rectus femoris, vastus medialis, biceps femoris and semitendinosus during stair ascent and descent, and co-contraction ratio was calculated. ResultsDuring stair ascent, the RMS of bilateral vastus lateral, rectus femoris and vastus medialis was higher at starting stage than at following stage (|t| > 6.650, P < 0.001), while the RMS of biceps femoris and semitendinosus was lower (t > 3.559, P < 0.01); and the co-contraction ratio of hamstrings/quadriceps was lower at starting stage than at following stage (t > 8.185, P < 0.001). During stair descent, the RMS of bilateral vastus lateral, vastus medialis, biceps femoris and semitendinosus was higher at following stage than at starting stage (t > 2.345, P < 0.05), as well as the co-contraction ratio of hamstrings/quadriceps (t > 2.405, P < 0.05). ConclusionThe activities of the muscles around the knees are almost symmetrical during stair ascent and descent for healthy middle-aged and old women. The activation and co-contraction ratio of quadriceps and hamstring are various at starting/following stages.

Reliability on evaluation of quadriceps femoris muscle quality by ultrasonic echo intensity in patients with knee osteoarthritis / 中国康复理论与实践

ObjectiveTo evaluate the inter-rater and test-retest reliability of echo intensity of ultrasound image for quality of quadriceps femoris in patients with knee osteoarthritis (KOA). MethodsFrom March to December, 2021, 33 patients with unilateral KOA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine were included. Ultrasound was used to observe the cross sections of rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL), and the images were saved. Two independent raters analyzed the average gray value of the picture with the Image J. One of the raters repeated the measurement. The intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and coefficient of variation (CV) were calculated and the Bland-Altman charts were drawn. ResultsThe gray value was higher in the RF, VM and VL in the affected side than in the healthy side (t > 2.262, P < 0.05). The inter-rater reliability was excellent, with ICC 0.982 to 0.995, SEM 1.60 to 3.82, CV 1.49% to 5.90%, and MDC value 4.43 to 10.59. The test-retest reliability of the rater was excellent, with ICC 0.969 to 0.990, SEM 2.37 to 5.41, CV 2.22% to 4.84%, and MDC value 6.57 to 15.00. Bland-Altman charts analysis showed that the consistency was good. ConclusionThe quadriceps femoris muscle quality is different between the affected and the healthy sides in patients with unilateral KOA. It is reliable to evaluate muscle echo intensity by Image J.

Riesgo nutricional y ultrasonido muscular en el paciente críticamente enfermo / Assessment of nutritional risk and muscle in critically ill patients / Risco nutricional e ultrassom muscular no paciente em estado crítico

Resumen: Se ha propuesto el uso de la escala nutritional risk in the critically ill (NUTRIC) como una herramienta para la valoración nutricional en el paciente crítico. Una de las principales desventajas es que dicha escala no considera variables críticas en la determinación de desnutrición como el desgaste muscular. El objetivo del presente estudio es evaluar la importancia del músculo valorado por ultrasonido del recto femoral y vasto intermedio, en conjunto con el riesgo nutricional por la escala NUTRIC en los resultados clínicos de pacientes críticamente enfermos. Se realizó ultrasonido muscular dentro de las primeras 48 horas de ingreso a pacientes adultos. A su vez se calculó el riesgo nutricional con la escala NUTRIC, y se dio seguimiento detectando mortalidad hospitalaria. Se incluyeron 43 pacientes, 21 presentaron riesgo nutricional (48.8%) sin mostrar diferencia en el grosor muscular. En el modelo de regresión ajustado por la escala NUTRIC, ventilación mecánica mayor de 48 horas, índice de masa corporal y grosor muscular, este último se mostró como un factor protector de mortalidad (OR: 0.21, IC 95%: 0.03-0.83). El presente estudio resalta la necesidad de una valoración integral considerando la masa muscular como variable cardinal en la detección de desnutrición en pacientes críticamente enfermos.

Abstract: Nutritional Risk in the critically ill score, it has been used like tool to asses nutritional state in critically ill patient. A mayor limitation of this score is that not include important variables in the assessment of malnutrition, like muscular wasting. The main goal of this study is to evaluate the relevance of the muscle, by measuring the femoral quadriceps, along with NUTRIC score of critically ill patients results. An ultrasound in the first 48 hours of admission to ICU was made plus NUTRIC score and a follow up detecting in-hospital mortality. We included 43 patients, with 21 with nutritional risk (48.8%) showing no difference in muscular thickness. The NUTRIC score adjusted regression model, mechanical ventilation longer than 48 hours, body weight index and muscular thickness. The muscular thickness shows as mortality protector factor (OR: 0.21, 95% CI: 0.03-0.83). This study remarks the need for integral assessment considering muscular mass as a main variable in the malnutrition detection in critically ill patients.

Resumo: A utilização da escala de Nutritional Risk in the Critically Ill tem sido proposta como uma ferramenta para avaliação nutricional em pacientes em estado crítico. Uma das principais desvantagens é que esta escala não considera variáveis críticas na determinação da desnutrição, como a perda de massa muscular. O objetivo do presente estudo é avaliar a importância do músculo, avaliado por ultrassom do reto femoral e vasto intermediário, em conjunto com o risco nutricional por NUTRIC score nos resultados clínicos de pacientes em estado crítico. O ultrassom muscular foi realizado nas primeiras 48 horas de internação em pacientes adultos. Paralelamente, calculou-se o risco nutricional pelo NUTRIC, bem como o seguimento detectando a mortalidade hospitalar. Incluíram-se 43 pacientes, 21 apresentando risco nutricional (48.8%) sem diferença na espessura muscular. No modelo de regressão ajustado pelo NUTRIC, ventilação mecânica maior a 48 horas, índice de massa corporal e espessura muscular, esta última se mostrou fator protetor para mortalidade (OR: 0.21, IC 95%: 0.03-0.83). Este estudo destaca a necessidade de uma avaliação abrangente considerando a massa muscular como uma variável cardinal na detecção de desnutrição em pacientes em estado crítico.

Effect of electrical stimulation on oxidative stress in tissues in a rat model with incision wound

Electrical stimulation (ES) are known to have beneficial effects in wound healing. However, the effect of electrical stimulation in wound theraphy on the oxidant and antioxidant levels of various tissues in the body remains unclear. Here, we investigated the effects of electrical stimulation on the oxidative stress capacity of tissues in a rat model with a surgical incision wound on the lateral line of the femoral region. Rats divided in two groups: control and ES group. A longitudinal skin incision was made only from the right lateral line of all rats. ES was applied 200 ?s, 20 Hz, 2mA for 20 min during 15 days. Some oxidative stress parameters (malondialdehyde (MDA), reduced glutathione (rGSH), glucose-6-phosphate dehydrogenase (G6PD), glutathione peroxidase (GPx) and catalase (CAT)) in tissues (brain, heart, kidney, liver, testis, gastrocnemius and quadriceps femoris muscle) were obtained spectrophotometrically. The ES reduced oxidative stress by decreasing MDA and simultaneously increasing different antioxidants in different tissues. The results suggest that incision wound could induce oxidative stress in tissues and electrical stimulation post-incision wound may have ameliorative effect.

Análisis biomecánico de la continuación prepatelar del cuádriceps / Biomechanical assessment of the prepatellar quadriceps continuation

OBJETIVO Determinar la resistencia máxima a la tracción (RMT) de la continuación prepatelar del cuádriceps (CPC).MATERIALES Y MÉTODOS Se realizó un estudio en cadáveres humanos. Fueron incluidos diez especímenes, en los cuales se utilizaron los tercios proximal y medial de la cortical anterior de la patela para evaluar las propiedades mecánicas de la CPC. En cada espécimen, se estudió un área de sección transversal de 0,2 cm2 (A1) y 1 cm2 (A2). Se aplicó una carga gradual para determinar la RMT.RESULTADOS La mediana de la RMT en el A1 fue de 232,56 N (rango: 141,23 N a 295,33 N) y en el A2 fue de 335,30 N (rango: 216,45 N a 371,40 N). El incremento en la TMR fue significativo entre las 2 áreas (p = 0,006).CONCLUSIÓN El ignificado clínico de este estudio es que la CPC es un tejido fuerte que puede servir de anclaje seguro para reconstrucciones alrededor de la patela. Un área relativamente pequeña tolera al menos 140 N y, a medida que crece el área, también aumenta la RMT.

OBJETIVE To determine the ultimate tensile strength (UTS) of the prepatellar quadriceps continuation (PQC). MATERIALS AND METHODS A human cadaveric study was performed. Ten fresh-frozen specimens were used. The proximal and medial thirds of the anterior cortex of the patella were used to assess the mechanical properties of the PQC. In each specimen, transverse section areas measuring 0.2 cm2 (A1) and 1 cm2 (A2) were studied. A gradual load was applied to determine the UTS. RESULTS The median UTS of A1 was of 232.56 N (range: 141.23 N to 295.33 N), and that of A2 was of 335.30 N (range: 216.45 N to 371.40 N). The increment in UTS was significant between the 2 areas (p » 0.006). CONCLUSION The clinical significance of the present study lies in the fact that it shows that the PQC is a strong tissue that can be a safe anchor for reconstruction around the patella. A relatively small area supports at least 140 N, and, as the area grows, the UTS increases as well.

Diagnostic value of early bedside ultrasound measurement of quadriceps femoris on in-hospital mortality of septic patients / 中华危重病急救医学

Objective:To investigate the changes of quadriceps femoris thickness with the length of stay in intensive care unit (ICU) in patients with sepsis, and to evaluate the diagnostic value of muscle changes in mortality.Methods:A prospective study was conducted, and 92 patients with sepsis who were admitted to the ICU of the Affiliated Hospital of Jining Medical College from January 2020 to December 2021 were enrolled. The thickness of quadriceps femoris [including the quadriceps femoris muscle thickness at the midpoint of the anterior superior iliac spine and the upper edge of the patella (M-QMLT), and at the middle and lower 1/3 of the patella (T-QMLT)] measured by ultrasound 1 day (D1), 3 days (D3), and 7 days (D7) after admission to the ICU were collected. The atrophy rate of quadriceps femoris was calculated 3 and 7 days after admission to the ICU compared with 1 day [(D3-D1)/D1 and (D7-D1)/D1, (TD3-TD1)/TD1 and (TD7-TD1)/TD1, respectively]. The demographic information, underlying diseases, vital signs when admission to the ICU and in-hospital mortality of all patients were recorded, and the differences of the above indicators between the two groupswere compared. Multivariate Logistic regression was used to analyze the influence of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients.Results:A total of 92 patients with severe sepsis were included, of which 41 patients died in hospital, 51 patients discharged. The in-hospital mortality was 44.6%. The muscle thickness of quadriceps femoris in severe septic patients decreased with the prolongation of ICU stay, and there was no significant difference between the two groups at the first and third day of ICU admission. The muscle thickness of quadriceps femoris at different measuring positions in the survival group was significantly greater than those in the death group 7 days after admission to the ICU [M-QMLT D7 (cm): 0.50±0.26 vs. 0.39±0.19, T-QMLT D7 (cm): 0.58±0.29 vs. 0.45±0.21, both P < 0.05]. The atrophy rate of quadriceps femoris muscle thickness at different measuring positions 3 and 7 days after admission to ICU in the survival group was significantly lower than those in the death group [(D3-D1)/D1: (8.33±3.44)% vs. (9.74±3.91)%, (D7-D1)/D1: (12.21±4.76)% vs. (19.80±6.15)%, (TD3-TD1)/TD1: (7.83±4.26)% vs. (10.51±4.75)%, (TD7-TD1)/TD1: (11.10±5.46)% vs. (20.22±6.05)%, all P < 0.05]. Multivariate Logistic regression analysis showed that M-QMLT D7, T-QMLT D7, (D3-D1)/D1, (D7-D1)/D1, (TD3-TD1)/TD1, (TD7-TD1)/TD1 were independent risk factors for in-hospital mortality (all P < 0.05). The results were stable after adjusting for confounding factors. ROC curve analysis showed that (TD7-TD1)/TD1 [area under the ROC curve (AUC) was 0.853, 95% confidence interval (95% CI) was 0.773-0.934] was superior to (D7-D1)/D1, T-QMLT D7, M-QMLT D7, (TD3-TD1)/TD1 and (D3-D1)/D1 [AUC was 0.821 (0.725-0.917), 0.692 (0.582-0.802), 0.683 (0.573-0.794), 0.680 (0.569-0.791), 0.622 (0.502-0.742)]. Conclusions:For septic patients in ICU, bedside ultrasound monitoring of quadriceps femoris muscle thickness and atrophy rate has a certain predictive value for in-hospital mortality, and a certain guiding significance in clinical treatment and predicting the prognosis of sepsis.

Isokinetic muscle strength of knee for patients with chondromalacia patellae / 中国康复理论与实践

@#Objective To analyze the characteristics of the muscle strength around the knee joint of chondromalacia patellae patients, and to explore the difference with normal people.Methods In March, 2021, 70 knee-onset chondromalacia patellae patients (experimental group) and 35 normal people (control group) were measured isokinetic muscle strength of flexion and extension of knee in angular velocities of 60°/s and 180°/s.Results At 60°/s and 180°/s, the peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles on the affected side in the experimental group were lower than that of the control group (U > 1097.0, P<0.001). The peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles at 60°/s and extensor muscles at 180°/s were lower on the affected side than on the healthy side in the experimental group (|Z| > 2.121, P<0.05). The peak torque ratios at 60°/s and 180°/s were more in the affected knees than in the healthy knees of experimental group and in the control group (U > 1810.0, |Z| >3.691, P<0.01).Conclusion The explosive force and endurance of the knee flexor and extensor has weakened in patients with chondromalacia patellae, and there is imbalance in knee joint muscle strength.