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Friedemann Awiszus

Publications and source records attributed to Friedemann Awiszus.

12 recordsLinked to original sources
PubMed2007

Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches.

To determine and compare the influence of 2 different approaches on quadriceps femoris muscle function in total knee arthroplasty (TKA), 20 patients (14 women, 6 men) with bilateral knee osteoarthritis underwent a 1-stage bilateral TKA. Surgical approaches (subvastus, midvastus) were performed by a random selection. Measurements of quadriceps voluntary activation and maximal voluntary contraction were estimated by a twitch interpolation technique before, 3 and 6 months after TKA. Knee pain was quantified by the Lewis Score. There was no difference between the 2 approaches at 3 and 6 months after TKA with regard to maximal voluntary contraction (P = 0.84, F = 0.041) and voluntary activation (P = .863, F = 0.031). In the subvastus group was a significantly higher knee pain until 6 months after surgery (P = .02). The subvastus approach for TKA does not provide any advantages compared with the midvastus approach with respect to the quadriceps femoris muscle strength in the early postoperative period. Furthermore, the subvastus approach caused significantly more pain postoperatively.

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PubMed2005

Effect of transcranial magnetic stimulation on voluntary activation in patients with quadriceps weakness.

Joint disease causes weakness and wasting of adjacent muscles, in part because of inability to fully activate these muscles voluntarily. Previous findings suggest that transcranial magnetic stimulation (TMS) paired with muscle contractions enhances maximal voluntary contraction force (MVC) in healthy subjects by improving voluntary activation (VA). The aim of the present study was to evaluate whether such an effect is also present in subjects suffering from diminished muscle force due to decreased VA. Three single TMS over resting motor threshold were applied in 10 patients with a mean age of 62 years after total-knee arthroplasty either during MVC or during muscle relaxation (control experiment) in a blinded randomized crossover study. MVC and VA were determined using a twitch-interpolation technique at 1, 15, 30, and 60 min after stimulation. There was a significant effect of TMS on MVC if applied in synchrony with muscle contraction, and this persisted for at least 60 min beyond stimulation. In patients suffering from joint disease, TMS might make physiotherapy more effective.

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PubMed2005

Donor-site morbidity of the pedicled rectus femoris muscle flap.

The rectus femoris muscle flap is well known for its reliable anatomy, the ease with which it can be harvested, and its great versatility. As a pedicled or free flap, it is used to cover soft-tissue defects and to recreate motor function. Although the muscle is very reliable, it is not well respected because of its assumed donor-site morbidity, such as weakened knee extension force and decreased range of motion of the knee. To date, these clinical assumptions have only rarely been quantified in terms of objective scores, concerning force deficit and functional or aesthetic outcome. From 1995 to 2002, the authors treated 24 patients with pedicled rectus femoris muscle flaps. Fourteen patients were followed up. Follow-up time ranged from 3 to 56 months postoperatively. The results were evaluated by a standard questionnaire in which pain in relation to walking distance, subjective feeling of weakness, sensibility disorders, everyday function, and aesthetic aspects were assessed. Range of motion in the hip and the knee was measured. For objective verification of a decrease of maximal voluntary contraction force of the remaining quadriceps muscle and for detecting differences in true muscular capacity and voluntary activation, 10 patients with unilateral rectus femoris flaps were tested using the twitch interpolation technique. The authors' patients assessed the remaining function and the aesthetic result of the thigh as at least satisfactory. Two patients complained about pain and weakness in the thigh. Eight patients reported hypesthesia in the lateral suprapatellar region. The maximal voluntary contraction and true muscular capacity values were reduced by 21.8 percent and 18 percent, respectively, when compared with the healthy leg. The range of motion in the knee and hip was not influenced by muscle harvesting. The twitch interpolation technique revealed a mild voluntary activation deficit, probably caused by inhibitory regulation in the spinal cord. In conclusion, donor-site morbidity of the rectus femoris muscle flap is evident but well compensated. There is no decrease in active range of motion in the knee and hip. Patient satisfaction with the functional and aesthetic outcome was high.

Adult↗
PubMed2004

Postcontraction changes of muscle architecture in human quadriceps muscle.

Maximal voluntary contraction changes the mechanical properties of skeletal muscle. Using ultrasound, we investigated whether these changes are reflected by changes in muscle architecture in the vastus lateralis muscle of 8 healthy volunteers. The mean pennation angle during the time interval from 3 to 6 min after maximal voluntary contraction (late postcontraction state) was 14.4 +/- 1.11 degrees (mean +/- SEM) and differed significantly from the precontraction state (16.2 +/- 1.39 degrees ), but the pennation angle in the early postcontraction state did not change statistically from the precontraction angle. Thus, postcontraction changes of the muscle-tendon interface appeared for 6 min after a maximal contraction, which may be important for biomechanical optimization of force transmission in vivo.

Adult↗
PubMed2004

Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee.

Decreased maximal quadriceps strength and voluntary activation has been observed in patients with osteoarthritis in previous studies, but those results do not allow any conclusions to be drawn as to whether quadriceps dysfunction precedes or follows osteoarthritis. Thirty-two patients (group a) who underwent partial meniscectomy 48+/-9 month prior to the study were matched according to their weight and body mass index with a control group (group b). The twitch interpolation technique was used to determine maximal voluntary contraction (MVC) and voluntary activation (VA) of the quadriceps muscle of both legs. Subjective assessment of the knee was performed using the Lysholm-Score. AP and lateral X-rays of the operated knee were obtained. None of the participants showed any evidence of characteristic radiological or clinical signs for osteoarthritis. A significantly lower MVC was noticed in both the affected and the contralateral knee of group a in comparison to group b (p < 0.01). The VA in group a yielded 80.9+/-15.4% for the injured side and 83.1+/-11.5% for the contralateral side, with no statistical difference (p = 0.18). The VA in group b was 89.4+/-5.8% for the right side and 88+/-6.8% for the left side both being significantly higher in comparison to group a. This study has shown, that patients following meniscus resection present with bilateral quadriceps weakness as already described in patients with manifest osteoarthritis. The authors hypothesise that muscle dysfunction may be an etiologic factor underlying the pathologic changes of osteoarthritis. Whether muscle dysfunction occurs also at other sites, e.g. in the upper extremity, remains unclear but would be of interest in order to detect a generalized neuromuscular dysfunction.

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PubMed2004

Strength and voluntary activation of the quadriceps femoris muscle at different severities of osteoarthritic knee joint damage.

OBJECTIVE: Improvements of quadriceps motor deficits represent a major therapeutical target in knee osteoarthritis (OA). In the present study, we investigated changes in quadriceps function at different stages of osteoarthritic cartilage damage. METHODS: Measurements of quadriceps voluntary activation (VA) and maximum voluntary contraction (MVC) were performed by a twitch interpolation technique and the total muscular capacity (TMC) was calculated as the ratio of MVC and VA. We assessed 68 patients (56.7+/-9.5 years) with stage II and 154 patients (65.6+/-6.0 years) with stage IV chondropathy. As controls, we used 85 age related healthy subjects (58.1+/-8.7 years). RESULTS: While TMC was significantly lower in stage IV (90.6+/-43.7 Nm) than in stage II chondropathy (109.6+/-51.0) there were no differences in the MVCs between both groups. Quadriceps VA was even higher in stage IV (77.2+/-13.2%) than in stage II chondropathy (70.8+/-16.0%). In the controls, MVC, VA and TMC were significantly higher than in both OA groups. CONCLUSION: We assume that a decrease of TMC might occur within the course of OA and, in consequence, VA increases to maintain quadriceps MVC.

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PubMed2002

Evaluation of quadriceps strength and voluntary activation after unicompartmental arthroplasty for medial osteoarthritis of the knee.

INTRODUCTION: In early and moderate stages of osteoarthritis (OA) of the knee, arthrogenous muscle inhibition (AMI) is an important factor for the initiation and the progression of the disease. Although AMI has been shown to be reduced after physiotherapeutical exercises resulting in significant improvements in disability, implantation of unicondylar knee arthroplasties is much provided in these stages of OA. Therefore, in the present study we investigate changes in quadriceps muscle after implantation of such prostheses as compared to physiotherapeutical treatment, alone. METHODS: In eighteen patients with bilateral moderate knee OA, who were treated with unicondylar knee arthroplasty we investigated voluntary activation (VA) and maximum voluntary contraction (MVC) of the quadriceps femoris muscle. There were 7 males and 11 females, the mean age at time of operation was 67 years (range 58-76 years). Measurements on both sides were performed preoperatively and 18 months postoperatively using the twitch-interpolation technique. RESULTS: Follow-up assessment revealed a significant VA and MVC increase in both the surgically treated knees and in the contralateral knees treated by physiotherapy alone. However, VA and MVC improvements were significantly higher in the operated on knees than in those treated by physiotherapy alone. DISCUSSION: Both physiotherapeutical exercise and unicondylar knee replacements lead to an improvement of quadriceps motor function in knee OA. The greater improvement in knees with both knee replacement and physiotherapy might be related to the intraoperative removal of arthritic tissue in these knees.

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PubMed2002

Improvement of voluntary quadriceps muscle activation after total knee arthroplasty.

OBJECTIVE: To evaluate the maximal voluntary contraction (MVC) force and the voluntary activation of the quadriceps femoris muscle in patients with knee osteoarthritis (OA) before and after total knee arthroplasty (TKA). DESIGN: A prospective intervention study. SETTING: University hospital clinic in Germany. PATIENTS: Fifty patients (32 women, 18 men; mean age +/- standard deviation, 65.8+/-5.6 y) with knee OA and 23 healthy age- and gender-matched control subjects. INTERVENTION: Unilateral TKA without patella resurfacing. MAIN OUTCOME MEASURES: Voluntary activation, MVC, and true maximal contraction forces of the bilateral quadriceps femoris muscles, using the twitch interpolation technique before and 33+/-8 months after TKA. Assessment of postoperative knee pain by the Lewis score. RESULTS: Voluntary activation increased bilaterally after surgery (P<.01 operated side, P=.02 nonoperated side) but remained lower than the voluntary activation of the controls. MVC (P<.001) and true maximal contraction forces (P=.01) increased significantly on the operated side. MVC remained unchanged (P=.45), and true maximal contraction forces decreased significantly (P=.04) on the nonoperated side. CONCLUSION: Patients with knee OA have significant bilateral voluntary activation deficits that are, at least in part, reversible within 3 years after TKA. Rehabilitation programs immediately after TKA should focus on reduction of voluntary activation deficits. After voluntary activation improves, physical therapy should target the augmentation of quadriceps femoris muscle strength.

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PubMed2002

Quadriceps muscle function after high tibial osteotomy for osteoarthritis of the knee.

In patients with osteoarthritis of the knees, quadriceps muscle dysfunction is an early and common clinical feature and an important determinant of disability. In the current study, changes in quadriceps muscle strength and voluntary quadriceps muscle activation after high tibial osteotomies for primary osteoarthritis of the knee in 19 patients were investigated. Quadriceps muscle function was assessed during different degrees of isometric maximum voluntary contraction using a specially built chair. One year after surgery all patients had reexamination of their surgically treated and contralateral knees. Voluntary activation and maximum voluntary contraction values of the followup assessment were significantly lower in the surgically treated knees compared with the preoperative assessment. In the contralateral knees, there were no differences between preoperative and followup measurements. High tibial osteotomy is an extraarticular operative therapeutic approach to treatment of osteoarthritis of the knee that does not lead to improvement of quadriceps muscle function. Because there is evidence that quadriceps sensorimotor dysfunction is important not only for the disability in osteoarthritis of the knee, but also for progression of the disease, knee function may be worsened by high tibial osteotomy in some patients.

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PubMed2001

Stimulus strength related effect of transcranial magnetic stimulation on maximal voluntary contraction force of human quadriceps femoris muscle.

It is well accepted that transcranial magnetic stimulation (TMS) can modulate motor cortex excitability long after application. Furthermore, a positive TMS effect on the ability to perform a maximal voluntary contraction (MVC) of the quadriceps femoris muscle has been described. However, stimulus strength dependence and duration of this effect are currently unknown. In the present study these parameters of the TMS-induced MVC enhancement were investigated in seven healthy subjects. Initially, three repetitive transcranial magnetic stimuli of varying stimulus strength were applied every 4 s either during MVC or relaxation. Thereafter, MVC and the ability to activate the quadriceps muscle voluntarily (voluntary activation) were determined using a sensitive twitch interpolation technique. In a second experiment we investigated the effect of three transcranial magnetic stimuli applied either during MVC or during relaxation on MVC over a time period of 30 min. There was a small but significant and stimulus strength related positive effect of TMS on MVC. The effect of TMS on voluntary activation was not significant. TMS had to be given during MVC to be effective and the positive effect of TMS when applied during MVC was still present after 30 min. These results indicate that TMS acts differently on the motor cortex depending on its activation status. TMS might have potential therapeutic applications in diseases associated with diminished cortical motor drive and subsequent muscle weakness.

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