Importance of Attenuating Quadriceps Activation Deficits After Total Knee Arthroplasty

Abbey C. Thomas; Jennifer E. Stevens-Lapsley, M.P.T., Ph.D.


Exerc Sport Sci Rev. 2012;40(2):95-101. 

In This Article

Future Directions

Reducing CAD early after TKA is essential for countering quadriceps weakness and more effectively restoring functional performance. Therefore, a deeper understanding of the mechanisms underlying quadriceps CAD is imperative to being able to successfully counter this impairment. Future studies should focus on differentiating the central (spinal and cortical) and peripheral contributions so that interventions targeted at the specific pathways involved can be implemented (Fig. 5). Additionally, advances in operative techniques to reduce trauma during surgery ought to be explored.

Figure 5.

Schematic depicting deficits that arise after total knee arthroplasty (TKA) and potential treatment strategies. TKA leads to functional performance deficits, which are largely attributable to pronounced quadriceps weakness. Quadriceps weakness results from a combination of central activation deficits (CAD) and muscle atrophy, with activation deficits explaining more of the muscle weakness than atrophy (thick arrows). Quadriceps CAD may be improved through neuromuscular electrical stimulation (NMES), altered surgical techniques (minimally invasive surgery, MIS) and high-intensity rehabilitation. Muscle atrophy also may be mitigated effectively by high-intensity rehabilitation. Ultimately, a combination of NMES, altered surgical techniques, and high-intensity rehabilitation may be most effective in reducing deficits.


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