Comparative Study of Hamstring and Quadriceps Strengthening Treatments in the Management of Knee Osteoarthritis

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.Key words: Strengthening, Stretching, Pain     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

Knee Flexor Strength and Endurance Profiles After Ipsilateral Hamstring Tendons Anterior Cruciate Ligament Reconstruction

Objectives

To profile knee flexor strength and endurance responses to ipsilateral hamstring tendon autograft anterior cruciate ligament reconstruction in patients, and to describe knee flexor strength and endurance as predictors of subjective outcomes. The hypothesis was that the involved leg would demonstrate deficits compared with uninvolved and matched legs.

Design

Retrospective cohort.

Setting

Controlled laboratory.

Participants

Women (n=15; mean age, 20.47±1.96y; height, 1.69±.08m; weight, 68.51±12.64kg), who were a mean ± SD of 25.93±11.25 months postsurgery, were matched to 15 sex-matched controls (mean age, 20.93±1.22y; height, 1.65±.06m; weight, 66.52±10.69kg).

Interventions

Not applicable.

Main Outcome Measures

Concentric peak flexor moment over the entire isokinetic joint range of motion, peak flexor moment at 105° of joint flexion, and knee flexor total work, normalized to body mass, and subjective questionnaire scores for the involved leg.

Results

Significantly lesser peak flexor moment over the entire isokinetic joint range of motion (P=.034) and total work (P=.048) existed for the involved leg (.959±.186Nm/kg; 21.933±5.881J/kg) compared with the matched leg (1.108±.134Nm/kg; 27.431±6.499J/kg). Significantly lesser peak flexor moment at 105° of joint flexion (P=.002) existed between the involved (.221±.116Nm/kg) and uninvolved (.40±.234Nm/kg) and matched (.475±.183Nm/kg) legs. Significantly greater strength deficits (P≤.001) existed at peak flexor moment at 105° of joint flexion compared with peak flexor moment over the entire isokinetic joint range of motion for side (53.83%±38.8%; 9.87%±10.77%) and group (77.61%±44.14%; 18.09%±11.73%) differences. Peak flexor moment at 105° of joint flexion was a significant predictor of subjective pain (P=.007), symptoms (P=.006), function (P=.011), and sports (P=.022) outcomes.

Conclusions

Knee flexor strength and endurance deficits suggest susceptibility to reinjury, and strength in a deep joint angle predicts subjective outcomes.     

Effect of Isometric Quadriceps Exercise on Muscle Strength,Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study

[Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40–65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.Key words: Isometric exercise, Osteoarthritis, Rehabilitation     

关节镜下膝关节骨关节炎关节清理术的疗效分析

目的:观察285例(294膝)关节镜下膝关节骨关节炎患者手术治疗的方法与其疗效分析。方法:285例膝关节骨关节炎患者均采用关节镜下关节清理手术,并在术前后采用Lysholm评分评定膝关节功能进行。结果:术后经过平均(31.3±14.8)个月的随访,285例患者中37例(38膝)失访,余248例(256膝)患者Lysholm总分与手术前比较显著提高(84.8±5.0、54.6±6.4,P<0.001);Lysholm中的疼痛单项评分与手术前比较亦显著提高(19.7±4.7、6.7±3.0,P<0.001)。结论:关节镜术治疗膝关节骨关节炎创伤小、疗效佳,可以最大限度保存正常软骨,是行全膝关节置换术前的最佳治疗方案。     

综合治疗退行性膝关节骨性关节炎

目的分析综合治疗退行性膝关节骨性关节炎。方法选取我院2012年7月~2013年8月收治的110例退行性膝关节骨性关节炎的患者,随机分为对照组和观察组,各55例,对照组西医治疗,观察组在西医的基础上进行中西医综合性治疗,观察两组患者的治疗效果。结果两组患者通过治疗后,观察组患者治疗的总有效率为94.55%,对照组为78.18%,观察组患者的治疗效果明显优于对照组,差异显著(P0.05),具有统计学意义。结论退行性膝关节骨性关节炎的临床治疗应该以综合性治疗为主,有利于加快患者的康复进程,提高患者的生活质量,显著提高治疗效率,具有较高的临床应用价值。     

关节镜下关节清理术治疗膝骨关节炎

目的：探讨关节镜下清理术治疗膝骨关节炎的疗效。方法：自1999年3月-2002年6月采关节镜下清理术治疗膝关节骨关节炎患者125例(170膝)。结果：平均随访25个月(6—48个月)，优良率为78．2％。结论：关节镜对于膝骨关节炎可做出明确诊断并确定病变程度，应根据术前临床表现有针对性的进行操作，关节镜下清理术对治疗骨关节炎具有肯定的疗效。     

Weight-Bearing Asymmetry in Relation to Measures of Impairment and Functional Mobility for People With Knee Osteoarthritis

Christiansen CL, Stevens-Lapsley JE. Weight-bearing asymmetry in relation to measures of impairment and functional mobility for people with knee osteoarthritis.

Objectives

To compare weight-bearing asymmetry (WBA) for people with unilateral knee osteoarthritis (OA) with that for healthy adults of similar age. In addition, associations between WBA and clinical measures of knee impairment and functional mobility were evaluated.

Design

Cross-sectional design with age-matched control (CTL) group.

Setting

Clinical research laboratory.

Participants

People with end-stage unilateral knee OA (n=50) (OA group) and healthy people (n=17) (CTL group) were enrolled in the study (N=67).

Interventions

Not applicable.

Main Outcome Measures

WBA during a Five Times Sit-to-Stand Test (FTSST) based on average vertical ground reaction force under each foot, self-reported knee pain assessed using a Numerical Pain Rating Scale, knee extensor strength asymmetry based on peak isometric knee extension torque, knee motion asymmetry based on maximum passive knee extension and flexion angles, FTSST time, six-minute walk test distance, and Stair Climbing Test time.

Results

The OA group demonstrated greater WBA than the CTL group during transitions between sitting and standing as measured by an absolute symmetry index (P=.015). No correlation was found between WBA and knee motion asymmetry, but comparisons of WBA with all the other outcome variables indicated fair relationships (range, r=.29-.44).

Conclusions

Weight-bearing asymmetry during transitions between sitting and standing can serve as a clinically relevant measure related to both knee impairment and functional mobility for people with unilateral knee OA.     

“养筋汤”加味合盐酸氨基葡萄糖片口服治疗膝骨性关节炎28例

目的：观察“养筋汤”加味合盐酸氨基葡萄糖片口服治疗膝骨性关节炎的临床治疗疗效。方法：将56例膝骨性关节炎患者随机分为治疗组与对照组,治疗组28例采用“养筋汤加味”合盐酸氨基葡萄糖片口服治疗,对照组28例单纯采用盐酸氨基葡萄糖片口服治疗。结果：治疗组28例中,优秀18例,良好7例,无效3例,总优良率为89.2％;对照组28例中,优秀10例,良好8例,无效10例,总优良率为64.3％(P<0.05)。结论 “养筋汤”加味合盐酸氨基葡萄糖片口服治疗早期膝骨性关节炎临床效果较明显,临床上可供借鉴。     

膝关节骨关节炎患者屈伸膝肌群的等速肌力评价

目的：评价单侧膝关节骨关节炎患者屈伸肌群的肌肉功能。方法：用Ｃｙｂｅｘ－６０００型等速肌力测试系统对３０例单侧膝关节骨关节炎患者的肌肉功能进行测试。结果：患膝股四头肌和月国绳肌的峰力矩、作功量、平均功率和爆发力均较健侧显著降低，但两侧月国绳肌股四头肌峰力矩比值（Ｈ／Ｑ）未见差异。结论：废用性肌肉萎缩、关节不稳和关节源性肌肉抑制是导致肌肉功能降低的主要原因     

Isokinetic Training Effect of Ankle Positions on Knee Extensor Strength

[Purpose] The purpose of this study was to determine which ankle position most influences knee extensor strength in training programs for strengthening the knee extensors using three different active ankle positions. [Subjects] Twenty-one healthy adults (6 males and 15 females) participated in this study. [Methods] Subjects were trained isokinetically in knee extension and flexion at 70 or 80% of 1RM under three actively and naturally fixed, contracted ankle conditions: dorsiflexion, plantarflexion, and resting position. After each group successfully executed the training four times a week for three weeks, mean peak torque (PT) and total work (TW) variables were measured and compared at 60°/sec and 180°/sec among the three groups. [Results] Significant differences were revealed in knee extensor TW at 60°/sec, PT and TW at 180°/sec, with the greatest PT and TW observed with the ankle in active dorsiflexion position. [Conclusion] These results suggest that active ankle dorsiflexion in a knee strength training program may be more effective at increasing knee extensor strength than a resting or plantarflexion position.Key words: Ankle position, Knee extensor strength, Isokinetic training     

关节镜诊断和治疗膝关节骨关节炎的临床疗效观察

目的观察关节镜诊断和治疗膝关节骨关节炎的临床疗效。方法选取膝关节骨关节炎患者45例(54膝),所有患者均行关节镜诊断,并利用镜下关节清理术与软骨表面化技术展开治疗,术后展开6个月~2年随访,对治疗效果进行分析。结果治疗后优良率96.30%,术后6个月、1年及2年时优良率分别为92.59%、90.24%、85.29%。结论关节镜在膝关节骨关节炎诊断中准确率高,在该疾病治疗中镜下清理术与软骨表面化技术可显著改善患者关节功能,有效减轻患者疼痛,促使骨关节炎病程延长,手术安全微创,值得在临床中推广。     

Effectiveness of Thermotherapy Using a Heat and Steam Generating Sheet for Cartilage in Knee Osteoarthritis

[Purpose] Superficial heat treatment is one of the most widely used physical therapies for osteoarthritis (OA). We clinically evaluated the effects of local heat treatment and exercise therapy for knee OA, and evaluated the articular cartilage using magnetic resonance imaging (MRI) T2 mapping. [Subjects and Methods] Eighteen females aged 50–69 (59.5 ± 8.5 years, mean ± SD) years diagnosed with early-stage knee OA were randomly assigned using computer-generated random numbers to either a local heat treatment group (LH group, 9 subjects) or an exercise therapy group (EX group, 9 subjects). These groups were subjected to a 12-week intervention experiment. MRI T2 mapping was performed for cartilage imaging and quantitative evaluation. For clinical evaluation, the Japanese Knee Osteoarthritis Measure (JKOM) and the Timed Up and Go (TUG) test were performed. Both clinical and MRI evaluations were performed at the beginning and end of the intervention (0 week (Time 0) and 12 weeks). [Results] The total JKOM score had a significantly decreased in the LH group at 12 weeks. However, in the EX group the total JKOM scores at Time 0 and 12 weeks were not significantly different. The TUG time in the EX group was significant shorter at 12 weeks, whereas it showed no significant change in the LH group at 12 weeks, though the TUG times of 7 of the 9 patients decreased, exhibiting some improvement. The T2 value of the LH group was significantly shorter at 12 weeks. However, the T2 value in the EX group showed no significant change at 12 weeks. [Conclusion] After local heat treatment using heat- and steam moisture-generating sheets for 12 weeks, we observed improvements in clinical symptoms and walking abilities. Moreover, positive effects on cartilage metabolism were suggested.Key words: Osteoarthritis, Thermotherapy, Cartilage     

老年膝骨关节炎综合疗法的短期效果观察

目的观察综合疗法对老年膝骨关节炎的短期治疗效果。方法30例老年膝骨关节炎患者在接受健康教育指导的基础上,进行10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入、6次推拿手法治疗和每日1～2次的股四头肌肌力增强训练,并在治疗前、后完成视觉模拟疼痛评分(VAS)、10 m步行速度测试、5次起坐时间测试和下肢等速肌力测试。结果30例膝骨关节炎患者治疗前后的疼痛程度、步行能力、起坐能力、下肢肌力均有改善(P<0.05或P<0.001)。结论双氯芬酸二乙胺乳胶剂经脉冲超声波导入、推拿手法治疗联合股四头肌肌力增强训练对于膝骨关节炎具有较好的短期治疗效果。     

The Influence of Exercise on an Unstable Surface on the Physical Function and Muscle Strength of Patients with Osteoarthritis of the Knee

[Purpose] This study investigated the influence of exercise on an unstable surface on ROM of the knee, muscle strength and the physical function of patients with osteoarthritis of the knee. [Subjects] The subjects were 30 patients diagnosed with degenerative osteoarthritis of the knee, they were divided into an experimental group (n=15) and a control group (n=15). [Methods] The experimental group performed exercise using an aero step XL (TOGU, Germany) 3 times a week, for 6 weeks. A control group performed the same exercise on a stable surface and without aero step XL. [Results] After the intervention, the experimental group showed statistically significant improvements in active knee flexion, knee joint manual muscle test (MMT), knee joint MMT hamstring and WOMAC score. [Conclusion] Exercise on the unstable surface improved the symptoms of patient with osteoarthritis. Exercise on an unstable surface might be helpful for improving the muscle strength and alignment of lower extremities as well as improving physical function related to the knee joint.Key words: Osteoarthritis, Manual muscle test, Range of motion     

Minimal Detectable Change in Quadriceps Strength and Voluntary Muscle Activation in Patients With Knee Osteoarthritis

Kean CO, Birmingham TB, Garland SJ, Bryant DM, Giffin JR. Minimal detectable change in quadriceps strength and voluntary muscle activation in patients with knee osteoarthritis.

Objective

To examine the test-retest reliability and quantify the minimal detectable change (MDC) in quadriceps strength and voluntary activation in patients with knee osteoarthritis (OA).

Design

Repeated measures over a 1-week interval.

Setting

Tertiary care center.

Participants

A convenience sample of patients (N=20) diagnosed with knee OA.

Intervention

Isokinetic and isometric quadriceps strength testing and voluntary quadriceps activation testing using interpolated twitch technique.

Main Outcome Measures

Peak isokinetic and isometric knee extension torque (Nm) and percentage of voluntary quadriceps activation (%).

Results

The mean differences with 95% confidence intervals between the 2 test sessions for quadriceps isokinetic strength, isometric strength, and percent of voluntary activation were −4.34Nm (−14.01 to 5.34Nm), 1.56Nm (−5.56 to 8.68Nm), and 1.34% (−.53 to 3.22%), respectively. The intraclass correlation coefficients for all measures ranged from .93 to .98. The standard errors of measurement (SEMs) for quadriceps isokinetic and isometric strength were 14.57Nm and 10.76Nm, respectively. The SEM for percentage of voluntary activation was 2.84%. Based on these values, the MDCs were 33.90Nm, 25.02Nm, and 6.60% for quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation, respectively.

Conclusions

Maximal quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation measures demonstrate excellent test-retest reliability in patients with knee OA. In addition to research applications, the present findings suggest these measures are appropriate for use when evaluating change in neuromuscular function of the quadriceps in individual patients.     

Effects of Tai Chi for Patients with Knee Osteoarthritis: A Systematic Review

[Purpose] The aim of the present study was to seek evidence for the effectiveness of Tai Chi for patients with knee osteoarthritis (KOA). [Subjects and Methods] Systematic searches were conducted of the China Journals Full-text Database, Pubmed, Medline, Science Direct-Online Journals and CINAHL for studies published between 2000 and 2012. Studies were evaluated based on following inclusion criteria: 1) design: randomized control, clinical trial; 2) subjects: patients with a knee osteoarthritis diagnosis; 3) intervention: exercise involving Tai Chi; 4) studies published in English or Chinese. [Results] Six randomized control studies involving Tai Chi and knee osteoarthritis were found. [Conclusion] Tai Chi was an effective way of relieving pain and improving physical function. Further randomized controlled trials with large sample sizes and long training period are needed to compare groups who perform Tai Chi training with other groups who undergo other forms of physical exercise in order to confirm the efficacy of Tai Chi.Key words: Tai Chi, Knee osteoarthritis, Degenerative arthritis     

透明质酸钠治疗后膝骨性关节炎滑膜病理改变

目的 探讨透明质酸钠治疗后膝骨性关节炎(OA)滑膜病理的改变情况.方法 将60例后膝OA患者按随机数字表法分为2组:观察组30例给予关节腔内注射液透明质酸钠治疗,对照组30例未给予任何治疗.治疗前后2组均进行膝关节镜检查,比较2组滑膜病理改变情况.结果 治疗前2组骨性关节炎滑膜增生肥厚,毛细血管增生,淋巴细胞浸润和纤维化明显;治疗后观察组滑膜增生及淋巴细胞浸润显著改善.治疗后观察组患者Lequence指数评分明显低于对照组,2组比较差异具有统计学意义(P＜0.05).观察组治疗过程中未见肝功能、肾功能、血常规等生化项目的异常,无明显消化系统、神经系统及过敏症状发生.结论 透明质酸钠治疗后膝骨性关节炎滑膜病理改善明显,安全性高,值得应用.     

盐酸氨基葡萄糖治疗膝骨关节炎的临床研究

目的观察盐酸氨基葡萄糖治疗膝骨关节炎(KOA)的临床疗效。方法 2010年5月-2012年7月将130例经膝关节镜清理术后的KOA患者随机分成A、B两组,每组65例。A组联合口服盐酸氨基葡萄糖胶囊750 mg,2次/d,6周为1个疗程,治疗3个疗程;B组联合口服尼美舒利胶囊0.1 g,2次/d,服用12周。采用Lequesne指数作为疗效评定指标,观察治疗前后膝关节体征及症状变化,休息痛、运动痛、压痛、肿胀、晨僵和行走能力的改善情况。结果 B组患者在治疗早期症状改善优于同期A组,且在第3个月有统计学意义(P<0.05),随着治疗时间的延长,A组患者总有效率在1、3、6个月分别为70.8%、76.9%和92.3%,均呈逐渐上升趋势,且第6个月疗效较前2个时间点差异有统计学意义(P<0.05)。分别停药后继续随访至1年,两组患者总有效率均有所下降,但A组疗效仍优于B组,且有统计学意义(P<0.05)。A组出现不良反应2例,B组4例,均较轻微,无严重不良事件发生。结论盐酸氨基葡萄糖在改善OA患者膝关节症状等方面效果肯定,且疗效较稳定,安全性良好;但远期疗效仍需随访观察。     

长圆针治疗对膝关节骨性关节炎的作用

目的：观察长圆针治疗膝关节骨性关节炎（KOA）的疗效,以探讨治疗该病的最佳方法。方法：60例KOA患者随机分为长圆针组和传统针组各30例。长圆针组根据经筋自四肢末端向心性循行分布规律,以足三阳、三阴经筋受损的筋结点用长圆针进行刮拔,每周1次。对照组采用传统针刺方法治疗,每日1次。分别于治疗前后采用VAS疼痛评分和症状体征评分法进行评定和比较2组疗效。结果：长圆针组治疗3次,传统针组治疗30次后,VAS和症状体征评分均较治疗前明显降低（P〈0.01）,长圆针组明显低于传统针组（P〈0.05）;临床疗效比较,长圆针组显效率及总有效率均明显高于传统针组（46.7%、100.0%与23.3%、86.7%,P〈0.05）。结论：长圆针不仅能对KOA关节局部神经络穴位发挥针刺治疗作用,还能对病变组织进行松解、剥离及减压,阻断骨关节炎形成的病因,使关节内外应力平衡,达到解除疼痛、提高临床疗效的目的。