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.

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.

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.

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.

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.

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.

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.

Effect Of Whole Body Vibration On Lower Body Strength And Balance In Osteoarthritis Knee

Background: Knee osteoarthritis causes pain, functional limitation, and disability in the elderly. Whole-body vibration has gained a lot of attention in recent years. It is currently used in alleviating pain and improve physical function along with strength and balance. Methods: 34 individuals aged between 50-70 years fulfilling the inclusion criteria were selected and randomized into two groups. Baseline assessment was done using the VAS scale, WOMAC scale, Berg Balance Scale, and 30seconds chair stand test. Group A received whole-body vibration, and knee strengthening exercises, and group B received only strengthening exercises. The treatment was given thrice in a week for four weeks. The assessment was done by the end of the 2nd and 4th weeks. Results: Whole body vibration had shown greater improvement of VAS on rest (p<0.05) compared to VAS on activity. Also, the WOMAC score was statistically improved between and within the group with p<0.05. Conclusion: Whole body vibration, along with strengthening exercises, showed superior effects in reducing pain, stiffness, physical function, balance, and lower limb strength in osteoarthritis knee patients.

A Study on the Effect of Isometric Quadriceps Activation and Vastus Medialis Obliquus Strengthening in Decreasing Q-Angle among Young Females

Females are more prone for lateral displacement of patella than males due to increased Q-angle (15–18°) in them compared to males (12–15°). In a normal state, lateral displacement is prevented by geometry of the joint and by the passive stabilizers. Even though contraction of the quadriceps tends to displace the patella laterally, vastus medialis oblique (VMO) acts medially and posteriorly as much as it acts proximally, and so its tension helps in resisting the Q angle effect. There are two procedures in common practice to reduce Q-angle and thereby to prevent lateral displacement of patella– either through vastus medialis oblique (VMO) strengthening or by isometric quadriceps activation (quadriceps muscle strengthening). We wanted to compare the effects of isometric quadriceps activation and VMO strengthening in reducing Q angle in a group of young females.METHODSA non-randomized, two group, pre-test, post-test assessment of Q-angle was done. Twenty healthy females of 18-20 age group were selected and randomly divided into two groups. Isometric quadriceps activation and VMO strengthening was done for 4 weeks. Q-angles were measured before and after the strengthening exercise using a long arm goniometer.RESULTSThe mean q angle before treatment was 21. (minimum 20 and maximum 23). While after the treatment, q angles were significantly reduced in both the groups and mean q angle was 16.3.CONCLUSIONSBoth the isometric quadriceps activation and VMO strengthening reduced Q-angle significantly and there was no significant difference between the two procedures. Results of this study help the physiotherapist in choosing the exercise for the management of patellofemoral pain and lateral displacement of patella.

Clinical observation of acupuncture at tendon blockage point of quadriceps femoris muscle belly for patella femoral arthritis / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of acupuncture at tendon blockage point of quadriceps femoris muscle belly for mild to moderate patella femoral arthritis.@*METHODS@#A total of 76 patients with mild to moderate patella femoral arthritis were randomly divided into an observation group and a control group, 38 cases in each group. The patients in the observation group were treated with acupuncture at tendon blockage point of quadriceps femoris muscle belly, and the needles were stayed for 20 min each time for twice a week; while the patients in the control group were treated with sodium hyaluronate injection into articular cavity, once a week, and both groups were treated for 4 weeks. The pain symptoms and joint function of the patients were evaluated with pain visual analogue scale (VAS) score, tenderness value of the most obvious pain point in front of the knee, and Lysholm knee function score before and one week after treatment, and the clinical effect was observed.@*RESULTS@#After treatment, VAS scores, tenderness value of the most obvious pain point in front of the knee and Lysholm knee function scores of the two groups were improved compared with before treatment (<0.05); the improvement of VAS score and tenderness value of the most obvious pain point in front of the knee in the observation group was more obvious than that in the control group (<0.05). The total effective rate in the observation group was 94.7% (36/38), which was higher than 81.6% (31/38) in the control group (<0.05).@*CONCLUSION@#Acupuncture at tendon blockage point of quadriceps femoris muscle belly can relieve pain and improve the function of patella femoral joint for patients with patella femoral arthritis, and the clinical effect is better than that of sodium hyaluronate injected into articular cavity.

Moderate intensity is a better stimulus to induce quadripecs femoris power in elderly adults / Intensidade moderada é o estímulo mais adequado para induzir potência de quadriceps em idosos / Intensidad moderada es el más adecuado para inducir potencia de quadriceps en ancianos

ABSTRACT Introduction: The best strategy for improving knee extensor power, a major functional capacity indicator in older adults, is power training. Nonetheless, the training intensity required to induce optimal gains is yet to be found. Objective: Our purpose was to compare knee extensor peak power responses between low, moderate, and high intensity load conditions (30%, 50% and 70% of 1RM). Methods: Thirteen sedentary elderly women performed six knee extensions in each load condition, calculating knee extensor mechanical work/power output and knee extension peak angular velocity. Results: No difference in peak power was found between the high (207.0 ± 68.1 W) and moderate (206.1 ± 71.6 W) load conditions (p = 0.994), and both had higher values (p ≤0.004) than the low intensity condition (135.6 ± 56.3 W). Conclusion: Moderate load at 50% of 1RM appears to be the preferred strategy for inducing knee extensor power output because in contrast with the high intensity condition, the moderate load yielded higher angular peak velocity, which is also a functional indicator. Level of Evidence ll; Therapeutic studies - Investigating treatment results.

RESUMO Introdução: A melhor estratégia para melhorar a potência dos extensores do joelho, principal indicador da capacidade funcional em idosos, é o treinamento de força. No entanto, a intensidade do treinamento exigida para induzir a maiores benefícios ainda não é conhecida. Objetivo: Nosso objetivo consistiu em comparar as respostas de potência máxima dos extensores do joelho entre as condições de carga baixa, moderada e de alta intensidade (30%, 50% e 70% de uma repetição máxima). Métodos: Treze mulheres idosas sedentárias realizaram seis extensões de joelho em cada condição de carga, sendo calculado o trabalho mecânico/débito de força e a velocidade angular máxima (ou pico) dos extensores do joelho. Resultados: Não houve diferença significativa na potência máxima entre as condições de carga alta ((207,0 ± 68,1 W) e moderada (206,1 ± 71,6 W) (p = 0,994), e ambas apresentaram valores maiores (p ≤ 0,004) do que a condição de baixa intensidade (135,6 ± 56,3 W). Conclusão: A carga moderada a 50% de 1RM parece ser a estratégia preferida para induzir o débito de força dos extensores do joelho, uma vez que quando comparada com a condição de alta intensidade, a carga moderada apresentou um pico de velocidade angular maior, o que também é um indicador funcional. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: La mejor estrategia para mejorar la potencia de los extensores de la rodilla, principal indicador de la capacidad funcional en personas de la tercera edad, es el entrenamiento de fuerza. Sin embargo, la intensidad del entrenamiento exigida para inducir a mayores beneficios aún no es conocida. Objetivo: Nuestro objetivo consistió en comparar las respuestas de potencia máxima de los extensores de la rodilla entre las condiciones de carga baja, moderada y de alta intensidad (30%, 50% y 70% de una repetición máxima). Métodos: Trece mujeres de la tercera edad sedentarias realizaron seis extensiones de rodilla en cada condición de carga, siendo calculado el trabajo mecánico/débito de fuerza y la velocidad angular máxima (o pico) de los extensores de la rodilla. Resultados: No hubo diferencia significativa en la potencia máxima entre las condiciones de carga alta ((207,0 ± 68,1 W) y moderada (206,1 ± 71,6 W) (p = 0,994), y ambas presentaron valores mayores (p ≤ 0,004) que la condición de baja intensidad (135,6 ± 56,3 W). Conclusión: La carga moderada a 50% de 1RM parece ser la estrategia preferida para inducir el débito de fuerza de los extensores de la rodilla, dado que cuando comparada con la condición de alta intensidad, la carga moderada presentó un pico de velocidad angular mayor, lo que también es un indicador funcional. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Anatomical attributes of the musculus quadriceps femoris responsible for poor crawling ability in the greater horseshoe bat ( Rhinolophus ferrumequinum ) / Atributos anatómicos del músculo cuádriceps femoral responsable de la limitada capacidad de arrastre en el murciélago grande de herradura ( Rhinolophus ferrumequinum )

SUMMARY: In mammals, the Musculus quadriceps femoris is a well-developed extensor muscle of the thigh. It is also relatively well developed in bats. The muscle group consists of a distally elongated muscle belly, which is important for the full extension of the knee joint during terrestrial locomotion. However, most bats species demonstrate poor terrestrial locomotion, although several species are able to crawl on the ground. Among the crawling bats, knee joint extension is necessary for crawling. Among bat species generally, the M. quadriceps femoris has a distally elongated belly for extending the shank, although the feature also occurs among poor crawling bat species. The relationship between a relatively well-developed M. quadriceps femoris and poor crawling ability in bats is incongruous, but there is a possibility that bats with a reduced M. quadriceps femoris have not yet been found. The greater horseshoe bat (Rhinolophus ferrumequinum) has long been known to be incapable of crawling, but there are no detailed descriptions in the literature concerning this bat's M. quadriceps femoris. The findings of this study reveal that the M. quadriceps femoris of Rh. ferrumequinum has a short muscle belly attached to the proximal portion of the femur; furthermore, the insertional tendon of this muscle and its patellar ligament are very thin. These morphological features suggest that this species cannot exert a strong and long-distance extension of its knee joints, unlike most other bat species. In addition to the above described morphological features, the M. rectus femoris of Rh. ferrumequinum is fused with the vasti in the M. quadriceps femoris. This M. quadriceps femoris arises from the pelvis and inserts onto the femur. Therefore, Rh. ferrumequinum has an M. quadriceps femoris specialized for flexion of the hip joint.

RESUMEN: En los mamíferos, el Musculus quadriceps femoris es un músculo extensor bien desarrollado del muslo. Este músculo también está relativamente bien desarrollado en murciélagos. El grupo muscular consiste en un vientre muscular distalmente alargado, lo que es importante para la extensión completa de la articulación de la rodilla durante la locomoción terrestre. Sin embargo, la mayoría de las especies de murciélagos muestran limitada locomoción terrestre, aunque varias especies pueden arrastrarse por el suelo. Entre los murciélagos reptantes, la extensión de la articulación de la rodilla es necesaria para gatear. Entre las especies de murciélagos en general, el M. quadriceps femoris tiene un vientre distalmente alargado para extender la rodilla, aunque la característica también ocurre entre las especies de murciélagos de rastreo limitado. La relación entre un M. quadriceps femoris relativamente bien desarrollado y la escasa capacidad de rastreo en los murciélagos es incongruente, pero existe la posibilidad de que aún no se hayan encontrado murciélagos con M. cuádriceps femoral poco desarrollado. Se sabe desde hace tiempo que el murciélago de herradura (Rhinolophus ferrumequinum) es incapaz de gatear, pero no hay descripciones detalladas en la literatura sobre el M. quadriceps femoris de este murciélago. Los hallazgos de este estudio revelan que el M. quadriceps femoris de Rh. ferrumequinum tiene un vientre muscular corto, unido a la epífisis proximal del fémur; además, el tendón de inserción de este músculo y su ligamento patelar son muy delgados. Estas características morfológicas sugieren que esta especie no puede ejercer una extensión importante y de larga distancia de la articulación de la rodilla, a diferencia de la mayoría de otras especies de murciélagos. Además de las características morfológicas descritas anteriormente, el M. rectus femoris de Rh. ferrumequinum está fusionadocon el vasto del M. quadriceps femoris. El M. quadriceps femoris se origina de la pelvis y se inserta en el fémur. Por lo tanto, Rh. ferrumequinum tiene un M. quadriceps femoris especializado para la flexión de la articulación de la cadera.

A Comparison of the Results from Femoral Nerve Block Using Different Concentration of Ropivacaine after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. MATERIALS AND METHODS: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. RESULTS: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. CONCLUSION: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.

Effects of Kilohertz-frequency Electrical Stimulation on Muscle Performance and Adverse Event in Individuals with Neuromuscular Skeletal Disorders：A Systematic Review / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to examine the effects of kilohertz-frequency alternating current (KFAC) on muscle performance and adverse event in patients with neuromuscular skeletal disorders.Methods：A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL until September 2017. The reviewer extracted data on subject characteristics, intervention, target muscle, and outcome measures in accordance with the Cochrane Handbook.Results：The literature search yielded 1295 studies, and 3 studies met the inclusion criteria (n＝32；mean age：45.3 years). KFAC stimulation combined with land-based exercise was likely more effective in increasing the quadriceps femoris muscle strength than exercise alone in patients after total knee arthroplasty (TKA). However, KFAC was not superior to low-frequency pulsed current in increasing pedaling work in patients with spinal cord injury. No severe adverse event relevant to KFAC was reported in all 3 studies. The quality of evidence was very low according to the GRADE approach.Conclusion：Additional KFAC may be more effective than exercise alone in improving the quadriceps femoris muscle strength in patients after TKA without any severe adverse event. Further studies to investigate the effects of KFAC are warranted to increase the confidence for the effects of KFAC treatment.

Morphometric study of tensor of vastus intermedius in South Indian population / 대한해부학회지

Tensor of vastus intermedius is a newly discovered muscle located between vastus lateralis and vastus intermedius. The purpose of this study was to investigate the detailed morphology of tensor of vastus intermedius, specifically to provide data pertaining to the attachments, innervations, variation in the types and its morphometry in South Indian population. The tensor of vastus intermedius was studied in thirty six cadaveric lower limbs using macrodissection techniques. The origin of the muscle was from upper part of intertrochanteric line and anterior part of greater trochanter of femur inserted to medial aspect of upper border of patella. The muscle was classified into four types based on the origin and also the aponeurosis course with independent type (type 1) being common. The mean and standard deviation of the length of tensor of vastus intermedius and aponeurosis were 145.40±37.55 mm and 193.55±42.32 mm, respectively. The results of the study suggest that tensor of vastus intermedius is variable and the information provided regarding the attachments, types and quantitative data will contribute to the existing knowledge of the muscle.

Effects of different-states-squatting on surface electromyography of thigh muscles and lumbar multifidus muscle / 实用医学杂志

Objective This work aimed to observe averaged electromyogram(AEMG)changes in surface electromyography(sEMG)of thigh muscles and lumbar multifidus muscles in different states of squat training. Then,to find out which is the most effective for squat training. Methods A total of 46 healthy volunteers were selected and divided into two groups,namely,with and without leaning against the wall.sEMG was used to record vastus lateralis muscle,vastus medialis muscle,biceps femoris muscle,and lumbar multifidus muscles at differ-ent knee flexion angles(30°,45°,60°,and 75°). AEMG was analyzed by repeated-measures analysis of vari-ance. Results Different knee flexion angles exerted significant effects on AEMG of all tested muscles(P <0.001).Whether leaning against the wall to squat had a significant impact on AEMG of biceps femoris muscle,but not on vastus lateralis muscle,vastus medialis muscle and lumbar multifidus muscles. Significant difference was detected in interactions of knee flexion angle,and the same to the factor of with and without leaning against the wall on examined AEMG of the thigh muscle,but not for lumbar multifidus muscles. Multiple comparisons showed,the AEMG level of the tested muscles was significantly increased when the knee flexion angles was 75°. Conclusions With increased knee flexion angle,muscle activation has enheanced for vastus lateralis muscle, vastus medialis muscle,biceps femoris muscle and lumbar multifidus muscles. Squatting without leaning against the wall exerts a more marked influence on activation of biceps femoris muscle,but no activation for vastus lateralis muscle,vastus medialis muscle and lumbar multifidus muscles.

A quantitative analysis of lower limb muscle spasticity in stroke survivors / 中华物理医学与康复杂志

Objective To relate the results of surface electromyography (sEMG) of the femoris among patients with hemiplegia after a brain lesion with scores on the modified Ashworth scale (MAS),and to decide whether sEMG can be used as a quantitative index for evaluating spasm.Methods The affected quadriceps femoris of sixty hemiplegic stroke survivors were assessed by the same therapist using the MAS.sEMGs were also recorded and the root mean square and average sEMG readings from the vastus medialis (VM),rectus femoris (RF) and vastus lateralis (VL) were extracted.The correlation between these sEMG indexes and the MAS grading was analyzed.Results The average sEMG signals from the VM,RF and VL were strongly correlated with the MAS grading,and they increased with increasing MAS grade.Spearman correlation analysis demonstrated highly significant correlation (P ≤ 0.001) when the quadriceps femoris was moved passively.Conclusions Surface EMG signals from the VM,RF and VL correlate well with MAS grades,rising when the affected quadriceps femoris of a stroke survivor is moved passively.sEMG can present the electrical activity during passive movements of the quadriceps femoris and can be useful in spasticity assessment and clinical treatment.