Strategies of muscular support of varus and valgus isometric loads at the human knee

Lloyd, David G.; Buchanan, Thomas S.

doi:10.1016/s0021-9290(01)00095-1

Cited by 294 publications

(287 citation statements)

References 12 publications

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“…By combining the relative activation of 2 muscles (ratio) and multiplying it by the sum of the magnitudes, our method characterizes the cocontraction that could result in higher joint compression. Although the concurrent activation of quadriceps and hamstrings muscles is capable of resisting frontal plane forces (40), large magnitudes of medial co-contraction, as evident in the OA group, may result in greater damaging compressive loads in the knee. It may therefore be more beneficial to retrain muscles to be activated selectively, rather than simultaneously, to minimize joint compression and, perhaps, increase joint stability.…”

Section: Discussionmentioning

confidence: 97%

Knee stabilization in patients with medial compartment knee osteoarthritis

Lewek¹,

Ramsey²,

Snyder‐Mackler³

et al. 2005

Arthritis & Rheumatism

108

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Objective. Individuals with medial knee osteoarthritis (OA) experience knee laxity and instability. Strategies aimed at muscle stabilization may influence the long-term integrity of the joint. This study sought to determine how individuals with medial knee OA respond to a rapid valgus knee movement, to investigate the relationship between muscle-stabilization strategies and knee instability.Methods. Twenty-one subjects with medial knee OA and genu varum and 19 control subjects were tested. Subjects stood with the test limb on a movable platform, comprising a plate that translated laterally to rapidly stress the knee's medial periarticular structures and create a potentially destabilizing sensation at the knee joint. Knee motion and muscle responses were recorded. Subjects rated the condition of their knee with a selfreport questionnaire about knee instability during daily activities.Results. Prior to plate movement, the OA subjects demonstrated more medial muscle co-contraction than did controls (P‫؍‬ 0.014). Following plate movement, the OA subjects shifted less weight off the test limb (P ‫؍‬ 0.013) and had greater medial co-contraction (P ‫؍‬ 0.037). OA subjects without knee instability had higher co-contraction of the vastus medialis medial hamstrings than did those who reported having instability that affected their daily activities (P ‫؍‬ 0.038). More knee stability correlated positively with higher co-contraction of the vastus medialis medial hamstrings prior to plate movement (r ‫؍‬ 0.459, P ‫؍‬ 0.042).Conclusion. Individuals with medial knee OA attempt to stabilize the knee with greater co-contraction of the medial muscle in response to laxity that appears on the medial side of the joint only. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction, and therefore needs to be altered to slow or stop the progression of the OA disease process.

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Section: Discussionmentioning

confidence: 97%

Knee stabilization in patients with medial compartment knee osteoarthritis

Lewek¹,

Ramsey²,

Snyder‐Mackler³

et al. 2005

Arthritis & Rheumatism

108

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“…The link between valgus knee loading and resultant increases in ACL strain is demonstrated through cadaver, in vivo, and computer-modeling experiments. 27,39,49,50 Physiologic valgus torques on the knee can significantly increase tibial subluxation and load on the ACL. 27 A prospective combined biomechanicalepidemiologic study showed that knee abduction moments (valgus torques) and angles were significant predictors of future ACL injury.…”

Section: Stage 2: Criteria For Progressionmentioning

confidence: 99%

Rehabilitation After Anterior Cruciate Ligament Reconstruction: Criteria-Based Progression Through the Return-to-Sport Phase

Myer¹,

Paterno²,

Ford³

et al. 2006

J Orthop Sports Phys Ther

407

401

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Rehabilitation following anterior cruciate ligament (ACL) reconstruction has undergone a relatively rapid and global evolution over the past 25 years. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safe return to sport. Return-to-sport rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back into sport participation. The purpose of the following clinical commentary is to introduce an example of a criteria-driven algorithm for progression through return-to-sport rehabilitation following ACL reconstruction. Our criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patientreported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks. Although this algorithm has limitations, it serves as a foundation to expand future evidence-based evaluation and to foster critical investigation into the development of objective measures to accurately determine readiness to safely return to sport following injury.

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“…These MRI studies and randomized controlled trials have proven to be instrumental in providing reliable and sensitive infor-mation about these OA changes, as well as predicting clinically relevant outcomes, such as total knee replacement (10,11). An additional factor that could impact knee structure change over time is the vastus medialis (VM) status, since it is one of the principal contributors to functional knee joint stability through muscle support and loading during ambulation (12,13). A recent study using quantitative MRI to assess structure in knee OA has proposed the VM muscle cross-sectional area (VM area) as a novel variable associated with significant cartilage volume loss over time (14).…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging–Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression: Relevance From a Clinical Trial

Raynauld

Pelletier

Roubille

et al. 2015

Arthritis Care & Research

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Objective. Studies have proposed vastus medialis (VM) muscle cross-sectional area change as a variable associated with cartilage volume loss in knee osteoarthritis (OA). However, the VM also includes fat (%Fat), which may influence knee function. This study analyzed the VM area and %Fat data, separately and in combination, to predict symptoms, cartilage volume loss, and bone marrow lesion (BML) change in knee OA. Methods. This study included the according-to-protocol population (n 5 143) of a 2-year knee OA randomized clinical trial having magnetic resonance imaging at baseline and 2 years. Correlations used multivariate analyses. Results. Greater baseline value for VM area and %Fat were significantly associated with sex (male, area; female, %Fat), higher body mass index (BMI), and Western Ontario and McMaster Universities Osteoarthritis Index stiffness, function, and total scores (better, high area; worse, high %Fat). Moreover, a VM %Fat increase of 1% at 2 years was associated with worsening of cartilage volume loss in the global knee (P 5 0.015) and some subregions (P £ 0.030), and with an increment of BML global score change (P < 0.001). A 1% decrease in VM area at 2 years was associated with worsening of knee pain score (P 5 0.048). Importantly, the concurrent presence of low VM area, high VM %Fat, and high BMI identified a subgroup of patients with greater cartilage volume loss in the medial femur (P 5 0.028) than the rest of the cohort. Conclusion. These data demonstrated, for the first time, that VM fat content is a strong predictor of cartilage volume loss and the occurrence and progression of BML. Importantly, the combined data of VM area, VM %Fat, and BMI identified patients at higher risk for OA progression.

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Strategies of muscular support of varus and valgus isometric loads at the human knee

Cited by 294 publications

References 12 publications

Knee stabilization in patients with medial compartment knee osteoarthritis

Knee stabilization in patients with medial compartment knee osteoarthritis

Rehabilitation After Anterior Cruciate Ligament Reconstruction: Criteria-Based Progression Through the Return-to-Sport Phase

Magnetic Resonance Imaging–Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression: Relevance From a Clinical Trial

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