Alpine Skiing With total knee ArthroPlasty (ASWAP): symmetric loading during skiing

Abstract

The aim of this pilot study was to determine the pressure distribution, symmetry of load between operated (OP) and non-operated (NOP) leg, and pain level during alpine skiing in participants with unilateral total knee arthroplasty (TKA). The responses of the dependent variables were analyzed following a 10-week guided skiing intervention of 2-3 days of skiing per week. Ground reaction force (GRF) was recorded bilaterally and was determined for 13 participants with TKA (65 ± 4 years) at pre- and post-test. Additionally, pain perception was determined using a numeric rating scale in the OP leg at both test sessions and after each skiing day. No statistical differences were observed between OP and NOP legs for peak and average GRF as well as the asymmetry indices at pre-test. Pain perception was low and was not increased as a consequence of the skiing intervention. In conclusion, alpine skiing did not lead to increased or decreased loading of the OP leg compared with the NOP leg. Therefore, alpine skiing may be allowed for patients with skiing experience and a good clinical outcome.

Alpine Skiing With total knee ArthroPlasty (ASWAP): effects on gait asymmetries

“…Consequently, these 12 weeks of functional training with eccentric muscle loading positively affected the stair descent walking performance and appears to be largely responsible for decreased asymmetries. Furthermore, in the study of Pötzelsberger et al (), a symmetrical loading of the OP and NOP legs during alpine ski turns at moderate skiing speeds was evident. Therefore, skiing seems to be a motor constraint beneficially forcing the skier to equally load both legs in a functional way and most likely improving eccentric as well as concentric muscle strength, especially in the weaker leg, as shown in the group of TKA participants in the current study (Pötzelsberger et al., ).…”

“…From a functional point of view, the question about the reasons for these positive asymmetry reductions by skiing especially during stair descent walking arises? The authors consider two main aspects as responsible for the beneficial effects of skiing for stair decent walking: (a) the eccentric muscle work as a functional characteristic of alpine skiing (Berg & Eiken, ; Vogt & Hoppeler, ) and (b) the proven forced symmetrical loading of both legs during alpine skiing turns (Pötzelsberger et al., ). During alpine skiing, leg extensor muscles were shown to work eccentrically because of high external loadings in the steering phases in order to control gravity and speed.…”

“…However, positive training effects of 12 weeks of alpine skiing by elderly people without TKA were reported, including increased strength (Müller et al., ), muscle quality (Narici et al., ), patellar tendon stiffness (Seynnes et al., ), and hypertrophy of knee extensor muscle (Flueck et al., ). Moreover, a preliminary study (Pötzelsberger et al., ) in participants with TKA demonstrated that during recreational skiing, no systematic differences in load distribution between the OP and NOP legs were found, suggesting equivalent training stimuli during turns for both legs. Furthermore, skiing is characterized by forceful turns on the slope and a mix of dynamic eccentric‐concentric muscle activity (Berg et al., ; Berg & Eiken, ; Müller et al., ; Vogt & Hoppeler, , ).…”

Endoprothetischer Gelenkersatz und Sport

“…Einfluss von Krafttraining auf die Kniegelenksmuskulatur bei liegender ProtheseRegelmäßiges Krafttraining (2-mal pro Woche über 13 Wochen) bei älteren Damen mit Kniegelenksarthrose und mit Kniegelenksprothesen kann geeignet sein, um ein Niveau der Muskelkraft, der Balance und der funktionellen Stabilität wieder herzustellen, welches dem eines Kontrollkollektivs ohne Kniegelenkspathologie vergleichbar ist[31,32].Petterson et al haben beschrieben, dass nach Knie TEP durch ein progressives Krafttraining innerhalb der ersten 4 Wochen zunächst die Normalisierung der willkürlichen Aktivierung des M. quadriceps wesentlich zur Maximalkraft beiträgt, bevor dann im Verlauf die physiologische Bedeutung des Muskelquerschnitts für die maximale Kraftentfaltung wieder zum Tragen kommt (12 und 52 Wochen post-OP) [33]. Einfluss von alpinem Skisport auf Knieendoprothesen Müller et al haben nach Knieprothesenimplantation den Effekt eines 12-wöchigen Alpin-Ski-Trainings auf multiple Aspekte untersucht und in Form einer Serie von Supplements publiziert: Es wurden positive Effekte auf das allgemeine Wohlbefinden der Patienten, die Kniefunktion und das Schmerzempfinden, auf die Patellarsehne, auf das Gangbild einschließlich seitengleicher Gewichtsverteilung, auf den Muskelquerschnitt des M. quadriceps (M. rectus femoris), auf die Adaptation der Typ I Muskelfasern, auf den Glukosestoffwechsel sowie auf die Kontraktionskraft von Kniestreckern und -beugern berichtet[34][35][36][37][38][39][40]. Nach drei Saisons Alpin-Ski mit jeweils 80 Skitagen wurde in einer Gruppe von 16 Patienten keine erhöhte Rate von PE-Abrieb, Osteolysen oder Implantatlockerungen konstatiert[41].…”

Good news for skiers with total knee arthroplasty

“…Interestingly, the intervention resulted in a more symmetric distribution of loads between legs during walking because of increased loading of the operated leg (Pötzelsberger et al., ). The distribution of loads during skiing, as assessed in a different group of patients, was also symmetric (Pötzelsberger et al., ). Although the patellar tendon cross‐sectional area (CSA) was larger in the operated leg than in the non‐operated leg at baseline, no differences between legs were observed in tensile stiffness and Young's modulus at baseline.…”