Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO 80045, USA.
Clin Orthop Relat Res. 2010 Sep;468(9):2460-8. doi: 10.1007/s11999-009-1219-6. Epub 2010 Jan 20.
BACKGROUND/RATIONALE: Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function.
QUESTIONS/PURPOSES: The purposes of this study were to (1) evaluate postoperative quadriceps and hamstrings muscle strength loss after TKA and subsequent recovery using the nonoperative legs and healthy control legs for comparison, and (2) measure hamstrings coactivation before and after TKA during a maximal isometric quadriceps muscle contraction and compare with nonoperative and healthy control legs.
We prospectively followed 30 patients undergoing TKA at 2 weeks preoperatively and 1, 3, and 6 months postoperatively and compared patient outcomes with a cross-sectional cohort of 15 healthy older adults. Bilateral, isometric strength of the quadriceps and hamstrings was assessed along with EMG measures of hamstrings coactivation during a maximal isometric quadriceps contraction.
There were no differences in strength loss or recovery between the quadriceps and hamstrings muscles of the operative leg throughout the followup, although differences existed when compared with nonoperative and healthy control legs. Hamstrings muscle coactivation in the operative leg during a maximal quadriceps effort was elevated at 1 month (144.5%) compared to the nonoperative leg.
Although quadriceps dysfunction after TKA typically is recognized and addressed in postoperative therapy protocols, hamstrings dysfunction also is present and should be addressed.
Quadriceps and hamstrings muscle strengthening should be the focus of future rehabilitation programs to optimize muscle function and long-term outcomes.
背景/理由：尽管全膝关节置换术（TKA）能可靠地减轻膝关节骨关节炎的疼痛，但很少能完全恢复肌肉力量和身体功能至正常水平。我们推测，更好地了解腘绳肌和股四头肌肌肉性能的急性变化，将使我们能够加强 TKA 后的早期康复，并改善长期功能。
问题/目的：本研究的目的是：（1）评估 TKA 后股四头肌和腘绳肌肌肉力量的丧失，并通过非手术侧和健康对照组进行比较，以评估随后的恢复情况；（2）测量 TKA 前后最大等长股四头肌收缩时腘绳肌的协同收缩，并与非手术侧和健康对照组进行比较。
我们前瞻性地随访了 30 例接受 TKA 的患者，分别在术前 2 周、术后 1、3 和 6 个月进行评估，并与 15 例健康的老年成年人进行了横断面队列比较。评估双侧股四头肌和腘绳肌的等长力量，以及最大等长股四头肌收缩时腘绳肌协同收缩的肌电图测量。
在整个随访过程中，手术侧的股四头肌和腘绳肌的力量丧失或恢复没有差异，尽管与非手术侧和健康对照组相比存在差异。在最大股四头肌收缩时，手术侧的腘绳肌协同收缩在术后 1 个月（144.5%）升高，与非手术侧相比。
尽管 TKA 后股四头肌功能障碍通常在术后治疗方案中得到识别和处理，但腘绳肌功能障碍也存在，也应得到处理。
股四头肌和腘绳肌肌肉强化应成为未来康复计划的重点，以优化肌肉功能和长期结果。
