Total diz artroplastisinde quadriceps kas kuvveti, diz eklem propriosepsiyonu ve quadriceps kuvvet hissi: Sağlıklı kontrollerle karşılaştırmalı bir çalışma

Abstract

Amaç: Bu çalışma eklem propriosepsiyonunun çoğunlukla ekstraartiküler proprioseptörler tarafından sağlandığı total diz artroplasti (TDA) cerrahisi geçiren bireyler ile sağlıklı kontroller arasında quadriceps kas kuvveti, diz eklemi propriosepsiyonu ve quadriceps kuvvet hissinin karşılaştırılması ve quadriceps kas kuvveti ile diz eklem propriosepsiyonu ve quadriceps kuvvet hissi arasındaki ilişkinin incelenmesi amacı ile planlandı. Yöntem: Bu çalışmaya en az dört ay önce TDA cerrahisi geçirmiş 46 birey (ortalama yaş: 67, %80,4 kadın) ve benzer yaş aralığında 46 sağlıklı kontrol (ortalama yaş: 63, %73,9 kadın) dahil edildi. Quadriceps kas kuvveti maksimal izometrik kasılma testi ile, diz eklemi pozisyon duyusu (aktif ve pasif olarak) yeniden konumlandırma hata testi ve quadriceps kası kuvvet hissi kuvvet hassasiyet testi ile değerlendirildi. Tüm değerlendirmelerde izokinetik dinamometre kullanıldı. Bulgular: Total diz artroplasti grubunda quadriceps kuvveti (p<0,001), aktif ve pasif eklem pozisyon hissi (tüm p<0,001) ve quadriceps kuvvet hissi (p=0,023) sağlıklı kontrollere göre anlamlı olarak az idi. TDA grubunda quadriceps kas kuvveti ile proprioseptif ölçümler arasında ve kontrol grubunda quadriceps kas kuvveti ile quadriceps kuvvet hissi arasında anlamlı bir ilişki bulunmazken (tüm p>0,05), kontrol grubunda quadriceps kas kuvveti ile quadriceps kuvvet hissi arasında düşük düzeyde negatif bir ilişki tespit edildi (p=0,007, rho=-0,391). Sonuç: Çalışmamızın sonuçları kuvvetli bir kasın aynı zamanda duyusal açıdan zengin olmayabileceğine ve bu yüzden bir kasın değerlendirilmesi ve tedavi süreçlerinde kuvvet bileşenine ek olarak kasın proprioseptif fonksiyonunun ayrıca ele alınması gerektiğine dair ipuçları sağlamaktadır.

Keywords

• Total diz artroplastisi
• Propriosepsiyon
• Quadriceps kası
• Kas kuvveti

Quadriceps muscle strength, knee joint proprioception and quadriceps force sense in total knee arthroplasty: A comparative study with healthy controls

Abstract

Purpose: This study was planned to compare the quadriceps muscle strength, knee joint proprioception, and quadriceps force sense between individuals with total knee arthroplasty (TKA) and healthy controls and investigate the relationship between quadriceps muscle strength, knee joint proprioception, and quadriceps force sense in individuals with TKA, in which joint proprioception is mostly provided by extra-articular proprioceptors. Methods: Forty-six individuals (mean age: 67, 80.4% female) who had undergone TKA surgery at least four months before and 46 age-matched healthy controls (mean age: 63, 73.9% female) were included in this study. Quadriceps muscle strength was assessed by maximal isometric contraction test, knee joint position sense (active and passive) with repositioning error test, and quadriceps force sense with force sensitivity test. An isokinetic dynamometer was used in all assessments. Results: In the total knee arthroplasty group, quadriceps strength (p<0.001), active and passive joint position sense (all p<0.001) and quadriceps muscle force sense (p=0.023) were significantly lower than in healthy controls. While there was no significant relationship between quadriceps muscle strength and proprioceptive measurements in the TKA group and quadriceps muscle strength and quadriceps force sensitivity in the control group (all p>0.05), a weak negative correlation was found between quadriceps muscle strength and quadriceps force sensitivity in the control group (p=0.007, rho=-0.391). Conclusion: Our findings provide clues that a muscle's strength is not always correlated with its sensory richness and therefore the proprioceptive function of the muscle should be considered separately in addition to the strength component in the evaluation and treatment processes of a muscle.

Keywords

• Total knee arthroplasty
• Proprioception
• Quadriceps muscle
• Muscle strength

References

1. Di Laura Frattura G, Filardo G, Giunchi D, et al. Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty: A systematic review and best evidence synthesis. J Orthop. 2018;15:903-998. Bączkowicz D, Skiba G, Czerner M, et al. Gait and functional status analysis before and after total knee arthroplasty. Knee. 2018;25:888-896.
2. Van der Linden ML, Rowe PJ, Myles CM, et al. Knee kinematics in functional activities seven years after total knee arthroplasty. Clin Biomech. 2007;22:537-542.
3. Di Laura Frattura G, Zaffagnini S, Filardo G, et al. Total knee arthroplasty in patients with knee osteoarthritis: Effects on proprioception. A systematic review and best evidence synthesis. J Arthroplasty. 2019;34:2815-2822.
4. Sherrington CS. The integrative action of the nervous system. Routledge. 2023;217-253.
5. Niessen MH, Veeger DH, Janssen TW. Effect of body orientation on proprioception during active and passive motions. Am J Phys Med Rehabil. 2009;88:979-985.
6. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 2012;92:1651-1697.
7. Chromiak JA, Antonio J. Skeletal muscle plasticity. Essentials of Sports Nutrition and Supplements. Totowa, NJ: Humana Press. 2008;21-52.
8. Rogers SL. Muscle spindle formation and differentiation in regenerating rat muscle grafts. J Dev Biol. 1982;94:265-283.

9. Kröger S, Watkins B. Muscle spindle function in healthy and diseased muscle. Skelet Muscle. 2021;11:3.
10. Keskinoglu P, Ucku R, Yener G, et al. Reliability and validity of revised Turkish version of Mini Mental State Examination (rMMSE-T) in community-dwelling educated and uneducated elderly. Int J Geriatr Psychiatry. 2009;24:1242-1250.
11. Parcell AC, Sawyer RD, Tricoli VA, et al. Minimum rest period for strength recovery during a common isokinetic testing protocol. Med Sci Sports Exerc. 2002;34:1018-1022.
12. Rainoldi A, Bullock-Saxton J, Cavarretta F, et al. Repeatability of maximal voluntary force and of surface EMG variables during voluntary isometric contraction of quadriceps muscles in healthy subjects. J Electromyogr Kinesiol. 2001;11:425-438.
13. Clark NC, Röijezon U, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 2: Clinical assessment and intervention. Man Ther. 2015;20:378-387.
14. Sahin N, Baskent A, Cakmak A, et al. Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome. Rheumatol Int. 2008;28:995-1000.
15. Janicijevic D, Knezevic OM, Garcia-Ramos A, et al. Isokinetic testing: sensitivity of the force-velocity relationship assessed through the two-point method to discriminate between muscle groups and participants’ physical activity levels. Int J Environ Res Public Health. 2020;17:8570.
16. Han J, Waddington G, Adams R, et al. Assessing proprioception: a critical review of methods. J Sports Health Sci. 2016;5:80-90.
17. Raizah A, Reddy RS, Alshahrani MS, et al. Investigating knee joint proprioception and its impact on limits of stability using dynamic posturography in individuals with bilateral knee osteoarthritis - a cross-sectional study of comparisons and correlations. J Clin Med. 2023;12:2764.
18. Paravlic AH, Meulenberg CJ, Drole K. The time course of quadriceps strength recovery after total knee arthroplasty is influenced by body mass index, sex, and age of patients: systematic review and meta-analysis. Front Med. 2022;9:865412.
19. Xue Y-Y, Shi J-N, Zhang K, et al. The effects of total knee arthroplasty on knee proprioception of patients with knee osteoarthritis: A meta-analysis. J Orthop Res. 2022;17:258.
20. Bragonzoni L, Rovini E, Barone G, et al. How proprioception changes before and after total knee arthroplasty: a systematic review. Gait Posture. 2019;72:1-11.
21. Isaac S, Barker K, Danial I, et al. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee. 2007;14:212-217.
22. Van der Esch M, Steultjens M, Harlaar J, et al. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Care Res. 2007;57:787-793.
23. Ghez C, Gordon J, Ghilardi MF. Impairments of reaching movements in patients without proprioception. II. Effects of visual information on accuracy. J Neurophysiol. 1995;73:361-372.
24. Messier J, Adamovich S, Berkinblit M, et al. Influence of movement speed on accuracy and coordination of reaching movements to memorized targets in three-dimensional space in a deafferented subject. Exp Brain Res. 2003;150:399-416.
25. Lieber RL, Fridén J. Functional and clinical significance of skeletal muscle architecture. Muscle & Nerve. 2000;23:1647-1666.
26. Niespodziński B, Kochanowicz A, Mieszkowski J, et al. Relationship between joint position sense, force sense, and muscle strength and the impact of gymnastic training on proprioception. Biomed Res Int. 2018;18;2018:5353242.
27. Kaynak H, Altun M, Tok S. Effect of force sense to active joint position sense and relationships between active joint position sense, force sense, jumping and muscle strength. J Mot Behav. 2020;52:342-351.
28. Akyol Y, Ulus Y, Tander B, et al. Muscle strength, fatigue, functional capacity, and proprioceptive acuity in patients with fibromyalgia. Turk J Physical Med Rehabil. 2013;59:292-298.
29. Ribot-Ciscar E, Roll J-P. Ago-antagonist muscle spindle inputs contribute together to joint movement coding in man. Brain Res J. 1998;791:167-176.