Leg extensor muscle strength, postural stability, and fear of falling after a 2-month home exercise program in women with severe knee joint osteoarthritis.

BACKGROUND AND OBJECTIVE. The aim of this study was to compare the leg extensor muscle strength, the postural stability, and the fear of falling in the women with severe knee joint osteoarthritis (OA) before and after a 2-month home exercise program (HEP). MATERIAL AND METHODS. In total, 17 women aged 46-72 years with late-stage knee joint OA scheduled for total knee arthroplasty participated in this study before and after the 2-month HEP with strengthening, stretching, balance, and step exercises. The isometric peak torque (PT) of the leg extensors and postural stability characteristics when standing on a firm or a foam surface for 30 seconds were recorded. The fear of falling and the pain intensity (VAS) were estimated. RESULTS. A significant increase in the PT and the PT-to-body weight (PT-to-BW) ratio of the involved leg as well as the bilateral PT and the PT-to-BW ratio was found after the 2-month HEP compared with the data before the HEP (P<0.05). The PT and the PT-to-BW ratio of the involved leg were significantly lower compared with the uninvolved leg before the HEP (P<0.05). The center of the pressure sway length (foam surface) decreased significantly after the HEP (P<0.05). Significant correlations were found between the PT of the involved leg and the bilateral PT and the fear of falling and between the PT of the involved leg and the postural sway (foam surface) before the HEP. CONCLUSIONS. After the 2-month HEP, the leg extensor muscle strength increased and the postural sway length on a foam surface decreased. The results indicate that the increased leg extensor muscle strength improves postural stability and diminishes the fear of falling in women with late-stage knee joint OA.

Quadriceps femoris muscle function prior and after total knee arthroplasty in women with knee osteoarthritis.

PURPOSE: The aim of the present study was to evaluate an isometric voluntary force generation and relaxation capacity of the quadriceps femoris (QF) muscle prior and after total knee arthroplasty (TKA). METHODS: Isometric maximal voluntary contraction force, rate of force development, voluntary activation, half-relaxation time, and latency of contraction of the QF muscle were recorded in 12 female patients (aged 49-68 years) with knee osteoarthritis one day before, 3 and 6 months following TKA in the operated and nonoperated leg. Knee pain intensity was assessed by visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used to assess knee problems during daily living. RESULTS: A significant decrease in knee pain and significant increase in KOOS were established after TKA. Maximal voluntary isometric force in the operated leg was lower (P < 0.05) before, 3 and 6 months after TKA as compared to the nonoperated leg. Rate of force development of the QF muscle in the operated leg compared to the nonoperated leg was significantly lower (P < 0.05) 3 and 6 months after TKA. Voluntary activation, latency of contraction, and half-relaxation time of the QF muscle did not differ significantly before, 3 and 6 months after TKA. CONCLUSIONS: The present study indicated reduced maximal and explosive strength of quadriceps femoris muscle in the operated leg 3 and 6 months after TKA with no significant changes in voluntary activation, and capacity for rapid contraction and relaxation. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

The spiral glenohumeral ligament: an open and arthroscopic anatomy study.

PURPOSE: The purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL). METHODS: Twenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated. RESULTS: The spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus. CONCLUSIONS: Our results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified. CLINICAL RELEVANCE: Advanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

Quadriceps femoris muscle voluntary isometric force production and relaxation characteristics before and 6 months after unilateral total knee arthroplasty in women.

The purpose of the present prospective intervention study was to evaluate voluntary isometric force production, relaxation and activation capacity of the quadriceps femoris (QF) muscle before and 6 months after unilateral total knee arthroplasty (TKA). TKA was performed in ten women with primary knee osteoarthritis (OA) using the condylar endoprostheses. Isometric maximal voluntary contraction (MVC) force, rate of force development at 50% of MVC (RFD50) and their ratio to body mass, half-relaxation time (HRT) and voluntary activation (VA) of the QF muscle were recorded in patients for operated and non-operated leg before and 6 months after TKA. Established characteristics were compared with data on the dominant leg of ten age- and gender-matched controls. The clinical examination was performed using the Knee Society System (KSS) scores and pain intensity was assessed by visual analogue scale. MVC force in operated leg was lower (P < 0.05) before and 6 months after TKA as compared with the non-operated leg (31 and 32%, respectively) and controls (48 and 44%, respectively). Patients had lower (P < 0.05) VA of the QF muscle in operated leg 6 months after TKA as compared to controls. Significant increase (P < 0.05) of KSS clinical scores and the tendency for the increasing of explosive force production of QF muscle in the operated leg were observed 6 months after TKA (RFD50 was 60% lower before TKA and 40% lower 6 months after surgery as compared to controls). When compared with the preoperative value, HRT prolongation (P < 0.05) was noted 6 months after TKA in QF muscle of both legs in patients. Therefore, the present study confirmed that patients with knee OA had reduced force generation ability of QF muscle before TKA and the improvement of explosive force was noted 6 months after surgery.

Altered mitochondrial apparent affinity for ADP and impaired function of mitochondrial creatine kinase in gluteus medius of patients with hip osteoarthritis.

The cellular energy metabolism in human musculus gluteus medius (MGM) under normal conditions and hip osteoarthritis (OA) was explored. The functions of oxidative phosphorylation and energy transport systems were analyzed in permeabilized (skinned) muscle fibers by oxygraphy, in relation to myosin heavy chain (MHC) isoform distribution profile analyzed by SDS-PAGE, and to creatine kinase (CK) and adenylate kinase (AK) activities measured spectrophotometrically in the intact muscle. The results revealed high apparent Km for ADP in regulation of respiration that decreased after addition of creatine in MGM of traumatic patients (controls). OA was associated with increased sensitivity of mitochondrial respiration to ADP, decreased total activities of AK and CK with major reduction in mi-CK fraction, and attenuated effect of creatine on apparent Km for ADP compared with control group. It also included a complete loss of type II fibers in a subgroup of patients with the severest disease grade. It is concluded that energy metabolism in MGM cells is organized into functional complexes of mitochondria and ATPases. It is suggested that because of degenerative remodeling occurring during development of OA, these complexes become structurally and functionally impaired, which results in increased access of exogenous ADP to mitochondria and dysfunction of CK-phosphotransfer system.

Extensive limb lengthening in Ollier's disease: 25-year follow-up.

A case of extensive lower limb lengthening (32 cm) in a 14-year-old male patient with Ollier's disease is reported. A varus deformity of the femur and a valgus deformity of the tibia were evident. The femur was successfully lengthened 22 cm by metaphyseal distraction, and the tibia was lengthened 10 cm by two-stage distraction-compression method with a cylindrical bone allograft. Ilizarov's distraction device was used. Radiologically, a good bone regenerate was formed. Host bone has incorporated (like sarcophagi) the allograft of tibia. No evidence of vascular or neural disturbances was found. The lengthening indices were counted for femur 22.5 days per centimeter and for tibia 21 days per centimeter, altogether 15.5 days per centimeter. Bone lengthening was performed through the Ollier's disease foci. Fine needle biopsy investigation showed that most embryonic cartilage cells had been replaced with bone tissue. After five years and a 25-year follow-up the patient was satisfied with the result. The function of the knee joint was limited, but the limb was fully weight-bearing. Signs of knee osteoarthritis were found.

Transport proteins in rats' renal corpuscle and tubules.

UNLABELLED: The localization of transepithelial transport proteins for glucose and water reabsorption in renal corpuscle and tubules epithelium was observed. MATERIAL AND METHODS: Immunohistochemistry of normal male Wistar rats' kidney has been performed. Facilitated diffusion glucose transporter GLUT4, Na(+)-dependent glucose co-transporter SGLT1, a cargo transporter TGN38, and water transporter aquaporin-2 (AQP2) were used. RESULTS: An intensive GLUT4 expression in renal proximal tubules and in convoluted segment of distal tubules has been observed. The intensive SGLT1 expression was marked in all renal tubules, and also in the glomerulus of the renal corpuscle. TGN38 was expressed mainly in the S1 of proximal tubules and a bit weaker in the distal tubules. The most intensive AQP2 expression in the proximal tubules and in the thin part of Henle's loop has been detected. In some cases AQP2 expression in the collecting tubules has been observed. The same tubules nephroni are marked heterogeneously. The distribution of transepithelial transport proteins in different parts of nephroni is also greatly heterogeneous because of weak determination of urinary system. CONCLUSION: The comparable transport-proteins distribution with technique of fluorescence immunohistochemistry in rats' renal corpuscle and tubules was elucidated. Data suggest that expression of glucose and water transepithelial transporter proteins is heterogeneous in all parts of nephron, and, probably, is in accordance with recycling of transport proteins.

Bone status in healthy Estonian women assessed with quantitative ultrasonometry.

We assessed age-related changes of bone status in healthy Estonian women in various age groups with quantitative ultrasonometry. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) of the calcaneus were measured in 288 women. BUA and SI values peaked at 30-39 years of age while SOS peaked at 20-29 years and decreased thereafter. We detected no statistically significant changes between the age groups of 20-29, 30-39 and 40-49 years. The total age-related decrease was 18% for BUA, 3% for SOS and 29% for SI. We found a statistically significant correlation between bone status and calcium intake, as well as physical activity in the age group over 40 years.