Publications by authors named "Jesse C Christensen"

26 Publications

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Longitudinal study of knee load avoidant movement behavior after total knee arthroplasty with recommendations for future retraining interventions.

Knee 2021 Apr 16;30:90-99. Epub 2021 Apr 16.

University of Montana, School of Physical Therapy & Rehabilitation Science, Missoula, MT, United States. Electronic address:

Background: This study aimed to evaluate clinical and biomechanical changes in self-report survey, quadriceps strength and gait analysis over 3- and 6-months post-total knee arthroplasty (TKA) and confirm the immediate effects of two forms of kinetic biofeedback on improving inter-limb biomechanics during a physically demanding decline walking task.

Methods: Thirty patients with unilateral TKA underwent testing at 3- and 6-months following surgery. All underwent self-report survey, quadriceps strength and gait analysis testing. Patients were assigned to one of two types of biofeedback [vertical ground reaction force (vGRF), knee extensor moment (KEM)].

Results: No decrease in gait asymmetry was observed in non-biofeedback trials over time (p > 0.05), despite significant improvements in self-report physical function (p < 0.01, Cohen d = 0.44), pain interference (p = 0.01, Cohen d = 0.68), numeric knee pain (p = 0.01, Cohen d = 0.74) and quadriceps strength (p = 0.01, Cohen d = 0.49) outcomes. KEM biofeedback induced significant decrease in total support moment (p = 0.05, Cohen f = 0.14) and knee extensor moment (p = 0.05, Cohen f = 0.21) asymmetry compared to using vGRF biofeedback at 6-months. vGRF biofeedback demonstrated significant decrease in hip flexion kinematic asymmetry compared to KEM biofeedback (p = 0.05, Cohen f = 0.18) at 6-months.

Conclusion: Gait compensation remained similar from 3- to 6-months during a task requiring greater knee demand compared to overground walking post-TKA, despite improvements in self-report survey and quadriceps strength. Single session gait symmetry training at 6-month supports findings at 3-month testing that motor learning is possible. KEM biofeedback is more effective at immediately improving joint kinetic loading compared to vGRF biofeedback post-TKA.
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http://dx.doi.org/10.1016/j.knee.2021.03.014DOI Listing
April 2021

A multi-center trial of exercise and testosterone therapy in women after hip fracture: Design, methods and impact of the COVID-19 pandemic.

Contemp Clin Trials 2021 Mar 11;104:106356. Epub 2021 Mar 11.

Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO, United States of America.

Background: Up to 75% of hip fracture patients never recover to their pre-fracture functional status. Supervised exercise that includes strength training can improve functional recovery after hip fracture. The role of testosterone replacement for augmenting the effects of exercise in older women after hip fracture is unknown.

Methods: The Starting Testosterone and Exercise after Hip Injury (STEP-HI) Study is a 6-month Phase 3 multicenter randomized placebo-controlled trial designed to compare supervised exercise (EX) plus 1% testosterone topical gel, with EX plus placebo gel, and with enhanced usual care (EUC). Female hip fracture patients age ≥ 65 years are being recruited from clinical centers across the United States. Participants are community dwelling and enrolled within 24 weeks after surgical repair of the fracture. The EX intervention is a center-based program of progressive resistance training. The EUC group receives a home exercise program and health education. Participants receive dietary counseling, calcium and vitamin D. The primary outcome is the Six Minute Walk Distance. Secondary outcomes include physical performance measures, self-reported function and quality of life, and dual energy x-ray absorptiometry measures of body composition and bone mineral density.

Results: Enrollment, interventions, and follow-up are ongoing. We describe the impact of the coronavirus disease 2019 pandemic on the trial, including modifications made to allow continuation of the interventions and outcome data collection using remote video and audio technology.

Conclusions: Results from the STEP-HI study are expected to have important clinical and public health implications for management of the growing population of hip fracture patients.
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http://dx.doi.org/10.1016/j.cct.2021.106356DOI Listing
March 2021

Gait mechanics are influenced by quadriceps strength, age, and sex after total knee arthroplasty.

J Orthop Res 2020 Oct 9. Epub 2020 Oct 9.

Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.

Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post-TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self-reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested 191 patients cross-sectionally at 6-24 months after primary, unilateral TKA. Quadriceps weakness in the surgical limb was associated with less peak vertical ground reaction force (PvGRF) (β = .245, p = .044), knee extension moment (β = .283, p = .049), and knee extension excursion (β = .298, p = .038). Older age (β = .168, p = .050) was associated with less PvGRF. Quadriceps strength in the nonsurgical limb (β = -.357, p = .021) was associated with greater knee extension excursion in the surgical limb. Females with TKA (β = -.276, p = .007) had less knee flexion excursion compared to males. Faster gait speed was also associated with greater PvGRF (β = .585, p < .001), knee extensor moment (β = .481, p < .001), and knee flexion excursion (β = .318, p < .001). Statement of Clinical Significance: This study showed quadriceps weakness, slower gait speed, older age and being female were related to altered gait mechanics post-TKA. These findings will help clinicians better educate patients and develop targeted interventions for improving care in patients post-TKA.
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http://dx.doi.org/10.1002/jor.24878DOI Listing
October 2020

Movement asymmetry during low and high demand mobility tasks after dysvascular transtibial amputation.

Clin Biomech (Bristol, Avon) 2020 12 7;80:105102. Epub 2020 Jul 7.

University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America. Electronic address:

Background: Movement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown.

Methods: Kinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Analysis of covariance was used to compare sagittal-plane peak knee moment and joint angle (primary) and hip and ankle moments and joint angles, vertical ground reaction force and impulse (secondary).

Findings: Within transtibial amputation group comparisons showed significantly greater between-limb asymmetry in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .05), peak ankle angle (p < .01) and peak ankle moment (p < .01) with the step ascent task compared to overground walking. The transtibial amputation group had greater between-limb asymmetry during step ascent in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .04) and peak ankle angle (p < .01) than healthy matched peers. During overground walking, the transtibial amputation group had greater between-limb asymmetry in peak vertical impulse (p = .05) and peak ankle moment (p < .01) than healthy matched peers.

Interpretation: Movement asymmetry is increased during step ascent compared to overground walking for adults with transtibial amputation. While the restoration of overground walking is the focus of post-amputation rehabilitation and prosthetic design, higher demand tasks should also be considered to maximize mobility for adults with transtibial amputation.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105102DOI Listing
December 2020

Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.

BMC Musculoskelet Disord 2020 Jul 22;21(1):482. Epub 2020 Jul 22.

Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.

Background: Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery.

Methods: Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. the percent of observed data represented below specified centiles). The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset.

Results: A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees).

Conclusion: A reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA.
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http://dx.doi.org/10.1186/s12891-020-03493-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376933PMC
July 2020

Movement pattern biofeedback training after total knee arthroplasty: Randomized clinical trial protocol.

Contemp Clin Trials 2020 04 12;91:105973. Epub 2020 Mar 12.

University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America.

Introduction: Total knee arthroplasty (TKA) reduces joint symptoms, but habitual movement compensations persist years after surgery. Preliminary research on movement training interventions have signaled initial efficacy for remediating movement compensations and restoring knee joint loading symmetry during dynamic functional tasks after TKA. The purpose of this clinical trial is to determine if physical rehabilitation that includes movement training restores healthy movement patterns after TKA and reduces the risk of osteoarthritis (OA) progression in the contralateral knee.

Methods/design: 150 participants will be enrolled into this randomized controlled trial. Participants will be randomly allocated to one of two dose-equivalent treatment groups: standard rehabilitation plus movement training (MOVE) or standard rehabilitation without movement training (CONTROL). Movement training will promote between-limb symmetry and surgical knee loading during activity-based exercises. Movement training strategies will include real-time biofeedback using in-shoe pressure sensors and verbal, visual, and tactile cues from the physical therapist. The primary outcome will be change in peak knee extension moment in the surgical knee during walking, from before surgery to six months after surgery. Secondary outcomes will include lower extremity movement symmetry during functional tasks, physical function, quadriceps strength, range of motion, satisfaction, adherence, contralateral knee OA progression, and incidence of contralateral TKA.

Discussion: This study will provide insights into the efficacy of movement training after unilateral TKA, along with mechanisms for optimizing long-term physical function and minimizing negative sequelae of compensatory movement patterns.
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http://dx.doi.org/10.1016/j.cct.2020.105973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263966PMC
April 2020

Reliability, responsiveness, and validity of handheld dynamometry for assessing quadriceps strength in total knee arthroplasty.

Disabil Rehabil 2020 Mar 6:1-8. Epub 2020 Mar 6.

Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.

To determine the reliability, responsiveness, validity, and agreement of handheld dynamometry, relative to electromechanical dynamometry, for assessing quadriceps strength surrounding total knee arthroplasty. Fifty-six patients (48% female) undergoing total knee arthroplasty were assessed prior to surgery and at 2 and 6 weeks following surgery. Maximum isometric quadriceps force was assessed at each time point by handheld dynamometry and electromechanical dynamometry. Within-session test-retest reliability was determined by intraclass correlation coefficient (ICC). Standard error of measurement and relative standard error (RSE) values were calculated. Standardized response means were used to describe responsiveness. Pearson's correlations examined construct validity. Agreement was assessed by the Bland-Altman method. Both handheld dynamometry and electromechanical dynamometry demonstrated excellent test-retest reliability (ICC >0.90) and RSE (<15%). Both methods were responsive, with large postoperative standardized response means of 1.57 (handheld dynamometry) and 1.37 (electromechanical dynamometry). Pearson's correlations were moderate to strong. The Bland-Altman analysis revealed underestimation of force by handheld dynamometry, although this effect was diminished in the early postoperative period. Our results suggest handheld dynamometry is a promising tool for monitoring quadriceps strength in patients pre- and post-total knee arthroplasty.IMPLICATIONS FOR REHABILITATIONThis study provides evidence of high reliability and responsiveness of handheld dynamometry for assessing quadriceps strength throughout a clinically relevant time frame for patients with total knee arthroplasty.There is construct validity of handheld dynamometry for measuring quadriceps strength, with moderate to high correlations between handheld dynamometry and electromechanical dynamometry, both pre- and post-total knee arthroplasty.Rehabilitation professionals should be aware that handheld dynamometry and electromechanical dynamometry do not agree in terms of the force measurement itself; particularly at higher force values, handheld dynamometry underestimates force output relative to electromechanical dynamometry.Overall, this study supports the use of handheld dynamometry for monitoring quadriceps strength in clinical settings for patient with total knee arthroplasty.
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http://dx.doi.org/10.1080/09638288.2020.1730454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483560PMC
March 2020

Characteristics of young and lower functioning patients following total knee arthroplasty: a retrospective study.

BMC Musculoskelet Disord 2019 Oct 27;20(1):483. Epub 2019 Oct 27.

Department of Physical Medicine and Rehabilitation, Eastern Colorado Geriatric Research Education and Clinical Center, 13001 E. 17th Pl, Aurora, CO, 80045, USA.

Background: Rates of total knee arthroplasty (TKA) procedures in younger, more medically complex patients have dramatically increased over the last several decades. No study has examined categorization of lower and higher functioning subgroups within the TKA patient population. Our study aimed to determine preoperative characteristics of younger patients who are lower functioning following TKA.

Methods: Patients were categorized into higher and lower functioning subgroups defined using a median split of 1) postoperative Timed Up and Go (TUG) test times and 2) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale scores. A split in age (65 years) was used to further classify patients into four categories: younger lower functioning, younger higher functioning, older lower functioning and older higher functioning. Measures from preoperative domains of health, psychological, physical performance and pain severity were examined for between-group differences.

Results: Comparing mean values, the younger lower functioning subgroup using the TUG had significantly weaker knee extensor, slower gait speed, higher body mass index and greater pain compared to other subgroups. The younger lower functioning subgroup using the WOMAC physical function subscale demonstrated higher pain levels and Coping Strategies Questionnaire-Catastrophizing Subscale scores compared to the older lower functioning subgroup.

Conclusions: Poorer preoperative physical performance and pain severity appear to have the largest influence on early postoperative TKA recovery in younger lower functioning patients relative to both younger and older higher functioning patients.
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http://dx.doi.org/10.1186/s12891-019-2817-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815380PMC
October 2019

Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations.

J Hip Preserv Surg 2019 Jan 20;6(1):25-32. Epub 2019 Mar 20.

Intermountain Healthcare, Murray, UT, USA.

To describe the recovery trajectory in a group of relatively older borderline dysplastic female femoroacetabular impingement syndrome (FAIS) patients following arthroscopic surgery, to determine if outcomes in this group differs from females with different age and bony morphology characteristics. Four subgroups were created to define (i) older females (>35 years), borderline dysplastic (lateral center edge angle [LCEA] ≤ 25 degrees) and anterior wall index (AWI) deficient (AWI ≤ 0.40) (older, borderline dysplastic, anterior wall deficient [ODD, reference]); (ii) younger (≤35 years), borderline dysplastic (LCEA ≤ 25 degrees) and deficient anterior wall (AWI ≤ 0.40) (younger, borderline dysplastic, anterior wall deficient [YDD]); (iii) older (>35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (older, non-dysplastic, non-deficient anterior wall [ONN]); and (iv) younger (≤35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (younger, non-dysplastic, non-deficient anterior wall [YNN]). One hundred and seventy-three female patients were included. Comparing mean scores, the ODD group reported significantly lower International Hip Outcome Tool (iHOT-12) change scores compared with the ONN group [23.58 ± 9.73; = 0.03] at 12 months. ODD group also demonstrated significantly lower iHOT-12 change scores compared with the ONN (27.62 ± 8.22; < 0.01) and YNN (25.39 ± 7.68; < 0.01) groups at 24 months. Relatively older females with borderline dysplasia and anterior acetabular wall deficiencies had poorer iHOT-12 outcomes at both 12 and 24 months post-operatively compared with other female subgroups. In the absence of hip dysplasia and anterior wall deficiencies, superior iHOT-12 outcomes were observed in both older and younger females post-operatively.
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http://dx.doi.org/10.1093/jhps/hnz011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501448PMC
January 2019

Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty.

Disabil Rehabil 2020 03 7;42(5):660-666. Epub 2019 Jan 7.

Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.

To investigate the effectiveness of home health physical therapy followed by outpatient physical therapy as compared to patients discharged directly to outpatient physical therapy in improving functional performance, strength/activation and residual knee pain outcomes among patients who received a total knee arthroplasty. A secondary analysis of longitudinal data in which patients with total knee arthroplasty underwent home health physical therapy or were discharged directly to outpatient physical therapy. Main outcome measures included the stair climb test, timed up and go, 6-min walk test, quadriceps and hamstring strength, quadriceps activation and residual knee pain. Patients referred to home health physical therapy prior to outpatient physical therapy demonstrated significantly greater declines in stair climb test (10.3; 95% CI [6.5, 14.1];  = 5.41;  < 0.0001), timed up and go (2.0; 95% CI [1.0, 3.0];  = 4.10;  < 0.0001), 6-min walk (53.8; 95% CI [29.4, 78.2];  = 4.35;  < 0.0001), quadriceps strength (21.7%; 95% CI [19.3%, 24.9%];  = 2.53;  = 0.01), hamstring strength (44.7%; 95% CI [43.4%, 45.7%],  = 3.17;  = 0.002) and higher residual knee pain (0.53; 95% CI [0.04, 1.03];  = 2.17;  = 0.03) 1 month after total knee arthroplasty compared to those referred directly to outpatient physical therapy. These findings suggest that patients discharged directly to outpatient physical therapy had a more rapid recovery 1 month after total knee arthroplasty. Additional research is needed to investigate the potential causal relation between care pathways and clinical outcomes following total knee arthroplasty.Implications for rehabilitationTotal knee arthroplasty, typically performed to alleviate end-stage knee osteoarthritis, is the most commonly performed elective surgery in the United States.Despite improvement in pain, objective measurements of functional performance and strength often remain at preoperative levels one year after total knee arthroplasty.Patients discharged directly to higher intensity outpatient physical therapy have a more rapid recovery after total knee arthroplasty compared with those patients who received two weeks of home health prior to undergoing outpatient physical therapy.
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http://dx.doi.org/10.1080/09638288.2018.1505968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612479PMC
March 2020

Preoperative quadriceps weakness preferentially predicts postoperative aberrant movement patterns during high-demand mobility following total knee arthroplasty.

Knee 2019 Jan 29;26(1):79-87. Epub 2018 Dec 29.

University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA. Electronic address:

Background: Nearly all patients with total knee arthroplasty show aberrant movement patterns during tasks requiring greater joint demand compared to matched peers. Greater movement compensation leads to increased loading onto other joints, decreased functional capacity and limited reserve for independence later in life. Understanding how preoperative predictors contribute to postoperative aberrant movement patterns is needed to make better decisions for patients considering total knee arthroplasty.

Methods: Forty-seven patients were tested preoperatively and six months following primary total knee arthroplasty. Demographic (age, sex, body mass), self-reported (knee pain, perception of physical performance, physical activity level), physical performance (quadriceps strength, lower limb power and timed stair climbing) and surgical metrics were collected as predictor variables. Three-dimensional models based on joint mechanic asymmetry during a decline walking task were collected at six months postoperatively. Decline walking is a preferred means to assess the surgical knee's contribution to limb performance during high-demand tasks. Bootstrap inclusion fraction was employed to compare the stability of each predictor variable prior to the final regression model.

Results: Preoperative quadriceps strength (β = 0.33; p = 0.04) showed a significant relationship with knee extensor angular impulse during loading phase. No other predictor variable had any meaningful relationship with aberrant movement patterns (p > 0.05).

Conclusion: Our findings highlight patients' preoperative quadriceps strength as a meaningful predictor of postoperative performance. Preoperative quadriceps strength should be addressed when considering the knee's ability to contribute to higher demanding mobility tasks following surgery.
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http://dx.doi.org/10.1016/j.knee.2018.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377852PMC
January 2019

Comparison of 2 Forms of Kinetic Biofeedback on the Immediate Correction of Knee Extensor Moment Asymmetry Following Total Knee Arthroplasty During Decline Walking.

J Orthop Sports Phys Ther 2019 Feb 20;49(2):105-111. Epub 2018 Aug 20.

Background: Individuals with total knee arthroplasty (TKA) display interlimb knee extensor moment (KEM) asymmetry during level walking that is exacerbated as task demands are increased. Studies using biofeedback to correct interlimb KEM asymmetry following TKA have reported mixed results.

Objective: To compare the immediate effect of 2 forms of real-time kinetic biofeedback-vertical ground reaction force (vGRF) or KEM-on improving interlimb peak KEM symmetry during the weight-acceptance phase of decline walking in persons who have undergone TKA.

Methods: In this cross-sectional, controlled laboratory study, 30 participants (17 men; mean ± SD age, 61.9 ± 8.5 years; body mass index, 28.4 ± 3.7 kg/m) were allocated to either a vGRF or KEM real-time biofeedback group. Peak KEM interlimb asymmetry was obtained during both nonbiofeedback and biofeedback decline walking trials 3 months following TKA.

Results: Significant interlimb asymmetry in peak KEM was observed in both groups during the nonbiofeedback condition (KEM, P = .02; vGRF, P<.01). The KEM biofeedback group demonstrated an immediate improvement in peak KEM asymmetry (P = .42). No change in peak KEM asymmetry was observed in the vGRF biofeedback group (P = .01).

Conclusion: Knee extensor moment biofeedback has an immediate effect on improving peak KEM asymmetry 3 months post TKA. J Orthop Sports Phys Ther 2019;49(2):105-111. Epub 20 Aug 2018. doi:10.2519/jospt.2019.7800.
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http://dx.doi.org/10.2519/jospt.2019.7800DOI Listing
February 2019

The Recovery Curve for the Patient-Reported Outcomes Measurement Information System Patient-Reported Physical Function and Pain Interference Computerized Adaptive Tests After Primary Total Knee Arthroplasty.

J Arthroplasty 2018 08 17;33(8):2471-2474. Epub 2018 Mar 17.

Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah.

Background: We sought to characterize the typical recovery in physical function (PF) and pain interference (PI) after TKA using Patient-Reported Outcomes Measurement Information System (PROMIS) patient-reported outcome (PRO) measures.

Methods: Ninety-one patients were enrolled into an institutional review board -approved prospective observational study. PROs were obtained preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 year. PROs included the PROMIS PF computerized adaptive test (CAT) and the PROMIS PI CAT. Generalized estimating equations were used to evaluate outcomes over time.

Results: There was no difference in the preoperative and 6-week postoperative T-scores for the PF CAT (P = .410). However, all subsequent postoperative T-scores were greater than the preoperative T-score (all, P < 0.05). There was a significant reduction in PI CAT T-scores between the preoperative and all subsequent postoperative T-scores (all, P < .05). A clinically important difference in PF CAT T-scores (β = 5.44, 95% confidence interval 4.10-6.80; P < .001) and PI CAT T-scores (β = -7.46, 95% confidence interval -9.52 to -5.40; P < 0.001) was seen between the preoperative and 3-month postoperative visits. Sixty-three percent of the improvement in PF occurred by 3 months, and 89% had occurred by 6 months. The majority of reduction in PI (68%) occurred by 3 months and 90% had occurred by 6 months.

Conclusion: The greatest magnitude of improvement in both PF and PI occurred within the first 3 months. After 6 months, patients might expect modest improvements in PF and mild reductions of PI. Patients and surgeons should use this information for setting expectations, planning for recovery, and improving care.
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http://dx.doi.org/10.1016/j.arth.2018.03.020DOI Listing
August 2018

The Positive Benefits of Negative Movement Patterns Following Total Knee Arthroplasty.

Geriatr Orthop Surg Rehabil 2018 26;9:2151458518757796. Epub 2018 Mar 26.

Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.

Introduction: Eccentric (negative) resistance exercise of the legs using specialized machines has been reported to be useful and often superior to standard exercise following total knee arthroplasty (TKA). Movements that utilize body mass and gravity as a mode of eccentric resistance exercise in a more pragmatic rehabilitation paradigm may also be useful in reversing chronic muscle impairments observed years following surgery. This study explores whether an eccentrically biased, body mass resistance exercise induces greater magnitude of sagittal plane extensor angular impulse of the support torque and individual net joint torque contributions during both squatting and lunging movement patterns 6 weeks following TKA.

Methods: Cross-sectional laboratory-based study design including 10 patients following primary unilateral TKA (6.5 ± 0.8 weeks.). All patients completed 3 trials of the squat and lunge movement pattern under both a concentric and an eccentric condition. Extensor angular impulse of the support torque and net joint torque contributions were calculated by integrating the joint torque versus time curves. A Two-way analysis of covariance was conducted and contracts of clinical interest were computed using Wald posttest. Values for all pairwise comparisons were adjusted for multiplicity using Bonferroni multiple comparison procedure.

Results: The eccentric condition, compared to the concentric condition, displayed larger magnitude of extensor angular impulse during both the squat ( < .001) and lunge ( < .001) movement patterns for the support torques. Similarly, the eccentric condition, compared to the concentric condition, displayed larger magnitude of extensor angular impulse of the hip, knee, and ankle ( < .001) during both movement patterns.

Conclusion: Eccentrically biased, body mass movement exercises can produce higher levels of extensor angular impulse on the surgical limb in patients early after TKA. Patients in this study were able to tolerate the higher extensor angular impulse demands and performed the eccentrically biased conditions (without specialized machines) that could be beneficial in postoperative rehabilitation.
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http://dx.doi.org/10.1177/2151458518757796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881975PMC
March 2018

Quadriceps weakness preferentially predicts detrimental gait compensations among common impairments after total knee arthroplasty.

J Orthop Res 2018 09 24;36(9):2355-2363. Epub 2018 Apr 24.

Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, Utah 84108.

Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age-matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty-six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (M ) (β = 0.431; p < 0.001) and knee extensor moment (M ) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to M (β = 0.432; p < 0.001) and M (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355-2363, 2018.
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http://dx.doi.org/10.1002/jor.23894DOI Listing
September 2018

Visual knee-kinetic biofeedback technique normalizes gait abnormalities during high-demand mobility after total knee arthroplasty.

Knee 2018 Jan 2;25(1):73-82. Epub 2018 Jan 2.

University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States. Electronic address:

Background: Abnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities.

Methods: Twenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed.

Results: Patients with TKA had lower knee extensor angular impulse (p<0.001), vGRF (p=0.001) and knee flexion motion (p=0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p=0.991) and peak vGRF (p=0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p>0.05).

Conclusion: Patients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA.
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http://dx.doi.org/10.1016/j.knee.2017.11.010DOI Listing
January 2018

Joint mechanical asymmetries during low- and high-demand mobility tasks: Comparison between total knee arthroplasty and healthy-matched peers.

Gait Posture 2018 02 21;60:104-110. Epub 2017 Nov 21.

University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States.

Chronic inter-limb joint mechanical asymmetry has been reported following total knee arthroplasty (TKA) during low-demand mobility tasks such as level walking. However, no study has compared the inter-limb asymmetry during a high-demand mobility task such as decline walking. The objective of this cross-sectional study was to compare inter-limb asymmetry differences during both level and decline walking tasks at six months following TKA compared to asymmetry present in an age, gender, body mass index and activity level matched healthy cohort. Kinetic and kinematic gait analysis was conducted on 42 patients with TKA and 15 healthy-matched peers. Our inter-limb asymmetry results demonstrated significantly (p<0.05) greater combined limb support moment (M) (mean differences [MD]=0.17; 95% CI=0.07, 0.22), knee extensor moment (M) (MD=0.05; 95% CI=0.02, 0.09) and vertical ground reaction force (vGRF) (MD=0.03; 95% CI=0.01, 0.08) differences during decline walking compared to level walking in patients with TKA. Greater M (MD=0.24; 95% CI=0.13, 0.35), M (MD=0.08; 95% CI=0.03, 0.18), vGRF (MD=0.04; 95% CI=0.01, 0.08) and knee joint angle (MD=2.4; 95% CI=0.37, 3.80) differences were present in patients with TKA compared to healthy-matched peers during decline walking. Greater M (MD=0.13; 95% CI=0.05, 0.20) and plantarflexor moment (MD=0.06; 95% CI=0.04, 0.16) differences were present in patients with TKA compared to healthy-matched peers during level walking. Post-TKA inter-limb asymmetry during level walking worsens as the physical demands of the task are increased. Thus, even patients with good self-reported outcomes after TKA exhibit substantial deficits in their mobility reserves that could limit their independence and community mobility as they age.
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http://dx.doi.org/10.1016/j.gaitpost.2017.11.017DOI Listing
February 2018

Influence of Demographics and Utilization of Physical Therapy Interventions on Clinical Outcomes and Revision Rates Following Anterior Cruciate Ligament Reconstruction.

J Orthop Sports Phys Ther 2017 Nov 9;47(11):834-844. Epub 2017 Oct 9.

Study Design Retrospective cohort from the Intermountain Healthcare system, January 2007 to December 2014. Background Recent evolutions in health care delivery are putting physical therapists in the forefront to be more responsible for providing high-quality rehabilitation care in a more cost-effective manner. Studies investigating the association between physical therapy visit utilization and outcomes in vulnerable patient populations following anterior cruciate ligament (ACL) reconstruction may provide useful insights. Objectives To examine the relationship between patient age, sex, physical therapy visit utilization, and physical therapy intervention charges with revision rates and patient-reported outcomes in individuals following primary ACL reconstruction. Methods A sample of 660 patients who had an ACL reconstruction was identified through an electronic medical record database. Age and physical therapy visit utilization were categorized to examine effects between groups (20 years of age or younger, 21 to 34 years of age, 35 years of age or older; fewer than 9 visits, 9 to 14 visits, 15 or more visits). Multilevel mixed-effects linear models were conducted to compare differences between revision rates and patient-reported outcomes during the episode of care. Receiver operating characteristic curve analyses were also used to determine visit-number and charge-per-visit cut points to discriminate patients who achieved at least a minimal clinically important difference on the patient-reported outcomes. Results Of 660 patients, 22 (3.3%) had revision surgery. Compared with patients 20 years and younger, the incidence rate ratio of ACL reconstruction revision was lower in patients who were 35 years and older (85%) and 21 to 34 years (59%). Of 470 patients who attended physical therapy for longer than 3 months, change in Knee Outcome Survey activities of daily living subscale score was significantly lower among patients 20 years of age and younger and in the lowest visit category. Conclusion Achievement of favorable outcomes following ACL reconstruction may require categorization of patients beyond surgical diagnosis alone. Younger patients (aged 20 years or less) attending fewer physical therapy visits (fewer than 9) were more likely to have ACL revision surgery and had inferior patient-reported outcomes compared to older patients and those with higher physical therapy visit utilization. The study design of a retrospective cohort limits the ability to identify causal relationships. Additionally, this study was conducted in only 1 geographic region within a single health care delivery system, which may limit the generalizability of the results. Level of Evidence Prognosis, level 2c. J Orthop Sports Phys Ther 2017;47(11):834-844. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7048.
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http://dx.doi.org/10.2519/jospt.2017.7048DOI Listing
November 2017

Effect of Physical Therapy Visits on Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction With and Without Concurrent Meniscal Repair.

J Sport Rehabil 2019 Jan;28(1):24-32

Background: Health care payment reform has increased employers and health insurance companies' incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair.

Objective: To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation.

Study Design: Retrospective cohort.

Level Of Evidence: 2b.

Methods: Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database.

Results: Patients with more PT visits had higher knee outcome survey-activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair.

Conclusions: Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery.

Clinical Relevance: These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.
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http://dx.doi.org/10.1123/jsr.2017-0088DOI Listing
January 2019

Kinematics of the Pelvis, Torso, and Lower Limb During Obstacle Negotiation While Under Temporal Constraints.

Anat Rec (Hoboken) 2017 04;300(4):732-738

Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah.

Biomechanics of unobstructed locomotion consists of synchronized complex movements of the pelvis, torso, and lower limbs. These movement patterns become more complex as individuals encounter obstacles or negotiate uneven terrain. To date, limited research has explored how specifically the pelvis, torso, and lower limb segments relate to obstacle negotiation of varying sized objects combined with temporal constraints to perform the task. Understanding pelvis and adjoining segment movements during object negotiation will provide necessary information in identifying abnormal mechanics and potential fall risk characteristics in balance compromised patient populations. In this prospective cohort study, we aimed to compare pelvic, torso, and lower limb kinematics during unobstructed locomotion with obstacle negotiation of varying heights. Ten healthy young adults (7 females and 3 males, mean age 28.4 ± 4.1 years, mean body mass index 22.5 ± 3.6 kg/m ) enrolled in this study. Analysis of within-subject differences revealed a significant increase in sagittal (posterior tilt) and frontal (ipsilateral hike) plane pelvic angular displacement and higher sagittal plane posterior torso lean angular displacement with increased obstacle height. Furthermore, both sagittal plane hip and knee maximum joint flexion were significantly higher with increasing heights of the obstacles during negotiation. These data provide insight on segment mechanics within a non-mobility-impaired population; therefore, providing a baseline to understand the kinematic demands necessary for safe and effective gait in mobility-compromised populations. Anat Rec, 300:732-738, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ar.23554DOI Listing
April 2017

Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty.

Clin Orthop Relat Res 2017 Jan;475(1):62-69

Department of Orthopaedics, University of Utah, 590 S Wakara Way, Salt Lake City, UT, 84108, USA.

Background: With as many as 25% of patients reporting residual knee symptoms after primary total knee arthroplasty (TKA), alternative implant designs and surgical techniques have been proposed to further reduce these symptoms. There is growing evidence that retention of the anterior cruciate ligament (ACL) results in more natural knee kinematics; thus, implants with more normal joint mechanics could provide improved physical function postoperatively and reduce the amount of residual symptoms. Advancements in the bicruciate-retaining (BCR) TKA implant design have been made, and based on these, we wished to compare the BCR with a more traditional cruciate-retaining (CR) implant.

Questions/purposes: (1) Was there a difference in the risk of reoperation after primary TKA between BCR and CR implant designs? (2) Was there a difference in the radiographic findings of radiolucent lines (RLLs) between the implant designs? (3) Was there a difference in patient-reported and clinical outcomes between the two implant designs?

Methods: Between January 2013 and May 2014, two surgeons performed 475 primary TKAs. During this time, 78 (16%) of these were performed with BCR implants and 294 (62%) with CR implants; the remainder were performed with anterior-stabilized or more constrained designs as a result of increased deformity and/or ligamentous deficiencies. During this period, the general indications for BCR TKA were arthritic knees with only slight to moderate deformity and sufficient ligamentous integrity of both the ACL and posterior cruciate ligament. The indications for CR TKA were similar other than these patients presented with a deficient ACL. A total of 66 (85%) of the BCR and 237 (81%) of the CR TKAs were available for followup at a minimum of 12 months or when reoperation occurred before 12 months (mean, 18 months; range, 2-32 months). With the numbers available, there were no differences between the groups in terms of age and sex, but the patients undergoing CR TKA had a greater mean body mass index (33 ± 7 versus 31 ± 5 kg/m, p = 0.032). The frequency of early reoperation was compared between the groups as were radiographic evidence of RLL, patient-reported outcomes, and knee range of motion (ROM).

Results: Knees in the BCR group had a higher frequency of all-cause revision (5% [three of 66] versus 1.3% [three of 237]; hazard ratio (HR), 7.44; 95% confidence interval [CI], 1.24-44.80; p = 0.028). Knees in the BCR group had a higher frequency of irrigation and débridement with component retention (HR, 0.07; 95% CI, 0.02-0.28; p < 0.001). No differences were found between groups for subsequent manipulation (HR, 0.34; 95% CI, 0.08-1.42; p = 0.137). The proportion of RLLs was greater in the BCR group (HR, 2.93; 95% CI, 1.62-5.32; p < 0.001) compared with the CR group. There were no differences between the groups in terms of the Physical Function Computerized Adaptive Test scores, Global10 scores or knee ROM outcomes.

Conclusions: Preliminary short-term findings suggest the BCR implant has inferior survivorship and concerning radiographic findings when compared with a conventional CR implant with respect to complications after primary TKA. These findings raise concerns about the new BCR design; however, further randomized trials are necessary to determine superiority between alternative implant designs.

Level Of Evidence: Level III, therapeutic study.
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http://dx.doi.org/10.1007/s11999-016-4812-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174026PMC
January 2017

Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study.

Hum Mov Sci 2016 Feb 17;45:53-62. Epub 2015 Nov 17.

Department of Bioengineering, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA; Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA.

The main objectives of this pilot study were to: (1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and (2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71±6.84years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility.
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http://dx.doi.org/10.1016/j.humov.2015.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688059PMC
February 2016

What can the first 2 months tell us about outcomes after anterior cruciate ligament reconstruction?

J Athl Train 2015 May 16;50(5):508-15. Epub 2015 Jan 16.

The Orthopedic Specialty Hospital, Murray, UT;

Context: Substantial research has been conducted on anterior cruciate ligament reconstruction (ACLR) to evaluate patient outcomes. However, little attention has been given to outcomes during the early phase of recovery and how early deficits affect both short- and long-term outcomes.

Objective: To identify relationships between demographic (age, sex, and body mass index [BMI]) and intraoperative (isolated ACLR versus primary ACLR + secondary procedures), and postoperative (range-of-motion [ROM] and peak isometric knee-extension force [PIF]) variables during the first 2 months after ACLR using self-reported outcomes.

Design: Cohort study.

Setting: Outpatient orthopaedic hospital.

Patients Or Other Participants: A total of 63 patients (38 men, 25 women; age = 33.0 ± 12.1 years; BMI = 26.3 ± 6.5 kg/m(2)) who underwent ACLR.

Main Outcome Measure(s): Demographic, intraoperative, and postoperative variables were collected at 1 and 2 months after ACLR and were compared with International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores at 1, 2, and ≥12 months.

Results: Significant relationships were identified between ≥12-month IKDC scores and the 1-month (Pearson correlation, r = 0.283, r(2) = 0.08; P = .025) and 2-month (r = 0.301, r(2) = 0.09; P = .017) IKDC scores. After controlling for other variables, we found that the PIF ratio measures at 1 and 2 months were positively associated with 1- and 2-month IKDC scores (P < .001) and BMI was negatively associated with both 1- and 2-month IKDC scores (P < .05). One-month IKDC scores were related to the 1-month difference in knee-flexion ROM (P = .04).

Conclusions: The IKDC scores during the first 2 months were positively correlated with patients' perceptions of function on long-term IKDC scores. It also appears that improvements in lower extremity strength and flexion ROM deficits were positively associated with short-term IKDC scores. Higher BMI was negatively associated with patients' perceptions of function on short-term IKDC scores.
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http://dx.doi.org/10.4085/1062-6050-49.3.95DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560015PMC
May 2015

Muscle force and movement variability before and after total knee arthroplasty: A review.

World J Orthop 2014 Apr 18;5(2):69-79. Epub 2014 Apr 18.

Jessica W Smith, Paul C LaStayo, Department of Bioengineering, University of Utah, Salt Lake City, UT 84108-1290, United States.

Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis (OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty (TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improved long-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict long-term functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.
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http://dx.doi.org/10.5312/wjo.v5.i2.69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017309PMC
April 2014

The effects of early aggressive rehabilitation on outcomes after anterior cruciate ligament reconstruction using autologous hamstring tendon: a randomized clinical trial.

J Sport Rehabil 2013 Aug 9;22(3):191-201. Epub 2013 Apr 9.

Physical therapist, The Orthopedic Specialty Hospital, Murray, UT, USA.

Study Design: Prospective randomized clinical trial.

Methods And Measures: Thirty-six patients who had a primary anterior cruciate ligament reconstruction (ACL-R) with a semitendinosus-gracilis (STG) autograft from a single orthopedic surgeon were prospectively randomized into 2 groups. Nineteen patients were randomized to the aggressive group (53% male, mean age 30.1 + 10.5 y) and 17 to the nonaggressive group (88% male, mean age 33.1 + 10.9 y). Impairment measures of anteroposterior (A-P) knee laxity, range of motion (ROM), and peak isometric force (PIF) values were obtained 12 wk postoperatively. Subjective response to the International Knee Documentation Committee knee form (IKDC) was collected 1, 12, and 24 wk postoperatively. One-way ANOVA was used to analyze differences between groups at 12 wk for A-P knee laxity, ROM, and PIF. Differences between the groups for the IKDC scores were determined using 1-way ANOVA with repeated measures 1, 12, and 24 wk postoperatively. Bonferroni adjustment was used for multiple comparisons.

Results: There were no differences between the groups for the baseline characteristics (P > .05). There was no difference found between the groups in respect to A-P knee laxity, ROM, or PIF at 12 wk (P > .05). Further analysis also showed no significant differences in the IKDC scores between groups at 12 or 24 wk (P > .05).

Conclusions: No differences were found between early aggressive and nonaggressive rehabilitation after an isolated ACL-R using STG autografts for the primary outcomes of A-P knee laxity and subjective IKDC score. In addition, no differences were observed for secondary outcomes between groups for differences in ROM and PIF values.
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http://dx.doi.org/10.1123/jsr.22.3.191DOI Listing
August 2013

Rehabilitation after arthroscopic repair of intra-articular disorders of the hip in a professional football athlete.

J Sport Rehabil 2009 Feb;18(1):118-34

Clinical Research, the Steadman Hawkins Research Foundation, Edwards, CO, USA.

Objective: To report the 4-phase rehabilitation progression of a professional athlete who underwent arthroscopic intra-articular repair of the hip after injury during the 2006-07 season.

Design: Case study; level of evidence, 4.

Main Outcome Measures: Objective values were obtained by standard goniometric measurements, handheld dynamometer, dynamic sports testing, and clinical testing for intra-articular pathology.

Results: This case report illustrates improvements in hip mobility, muscle-force output, elimination of clinical signs of intra-articular involvement, and ability to perform high-level sport-specific training at 9 wk postsurgery. At 16 wk postsurgery, the patient was able to return to full preparation for sport for the following season.

Conclusion: After the 4-phase rehabilitation program, the patient demonstrated improvement in all areas of high-level function after an arthroscopic intra-articular repair of the hip. The preoperative management to return to sport is outlined, with clinical outcomes and criteria for return to competition.
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http://dx.doi.org/10.1123/jsr.18.1.118DOI Listing
February 2009