Marmon Adam R, Snyder-Mackler Lynn
University of Delaware, Newark DE, USA.
Int J Sports Phys Ther. 2014 May;9(3):329-37.
PURPOSE/BACKGROUND: Patients after total knee arthroplasty (TKA) are known to exhibit deficits in quadriceps muscle activation. The purpose of this study was to determine if quadriceps activation levels in patients after TKA at the beginning of rehabilitation would influence quadriceps strength after rehabilitation.
A secondary analysis of data from a prospective, randomized, longitudinal clinical trial.
Institutional clinic and research laboratory.
Patients who underwent unilateral TKA (Men= 102; Female= 84).
Voluntary activation of the quadriceps during maximal voluntary isometric contractions (MVIC) was measured using the central activation ratio (CAR). Hierarchical multivariate regression analysis was used to determine if CAR prior to treatment could predict MVIC after the strength training intervention.
After controlling for age, sex, and initial strength levels (R(2)= 0.548; p<0.001), the predictability of quadriceps strength after the 6-week intervention did not change when pain during MVIC (R(2)= 0.551; p= 0.317) and pre-rehabilitation activation levels (R(2)= 0.551; p= 0.818) were introduced into the regression.
Initial quadriceps activation levels, for patients who underwent TKA, did not predict the quadriceps strength following a strength training intervention. Therefore, deficits in voluntarily activation post-operatively should not be considered as a rate-limiting factor in recovering quadriceps strength after TKA.
Retrospective cohort study. Level IIb.
目的/背景：全膝关节置换术（TKA）后的患者已知存在股四头肌激活不足的情况。本研究的目的是确定TKA后康复开始时患者的股四头肌激活水平是否会影响康复后的股四头肌力量。
对一项前瞻性、随机、纵向临床试验的数据进行二次分析。
机构诊所和研究实验室。
接受单侧TKA的患者（男性 = 102；女性 = 84）。
使用中枢激活率（CAR）测量最大自主等长收缩（MVIC）期间股四头肌的自主激活。采用分层多元回归分析来确定治疗前的CAR是否可以预测力量训练干预后的MVIC。
在控制年龄、性别和初始力量水平后（R² = 0.548；p < 0.001），当将MVIC期间的疼痛（R² = 0.551；p = 0.317）和康复前激活水平（R² = 0.551；p = 0.818）纳入回归时，6周干预后股四头肌力量的可预测性没有变化。
对于接受TKA的患者，初始股四头肌激活水平不能预测力量训练干预后的股四头肌力量。因此，术后自主激活不足不应被视为TKA后股四头肌力量恢复的限速因素。
回顾性队列研究。IIb级。
