Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis

Michael D Lewek, Katherine S Rudolph, Lynn Snyder-Mackler, Michael D Lewek, Katherine S Rudolph, Lynn Snyder-Mackler

Abstract

Purpose: Quadriceps weakness is common in patients with knee osteoarthritis (OA), and has been attributed to failure of voluntary activation. Methodological differences may have contributed to previous reports of extensive failure of voluntary activation in patients with osteoarthritis. The purpose of this study was to determine the extent of quadriceps muscle weakness and activation failure in middle aged patients with symptomatic medial knee osteoarthritis using maximum voluntary isometric contractions (MVIC) and a burst superimposition technique.

Methods: Measurements of quadriceps MVIC and extent of voluntary activation were made in 12 subjects with knee OA and 12 similarly aged uninjured subjects. Voluntary activation was tested by superimposing a train of electrical stimulation on a maximal effort volitional contraction of the quadriceps muscle.

Results: The group of subjects with knee OA had significantly less quadriceps strength relative to body mass index (BMI) than the group of control subjects (p=0.010). No difference in voluntary activation was observed (p=0.233), however, 50% of the OA group, and only 25% of the control group failed to fully activate the quadriceps.

Discussion: The finding of quadriceps weakness is consistent with past literature. Providing adequate instruction, feedback, and several attempts to maximally contract the muscle likely yielded greater volitional activation (thus less activation failure) than had been reported previously. This finding has implications for the rehabilitation of weakened quadriceps in patients with knee osteoarthritis.

Figures

Figure 1
Figure 1
Two examples of a force curve for the calculation of quadriceps strength and CAR. The top curve represents a subject with a CAR of 0.944, while the curve for the bottom subject yields a CAR of 0.754.
Figure 2
Figure 2
Box and whiskers plot of normalized quadriceps strength between groups. The box represents the interquartile range containing the 50% of values. The whiskers are lines that extend from the box to the maximum and minimum values, excluding outliers. The line drawn across the box represents the median. The OA group had a significantly reduced normalized quadriceps strength compared to the healthy age matched control group (p = 0.010).
Figure 3
Figure 3
Relationship between CAR and normalized quadriceps strength. Three of 12 control subjects and 6 of 12 OA subjects had a CAR

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