How Do Muscle Function and Quality Affect the Progression of KOA? A Narrative Review

Abstract

Knee osteoarthritis (KOA) is widely recognized as a chronic joint disease characterized by degeneration of knee cartilage and subsequent bone hyperplasia. However, it is important to acknowledge the significant role of muscles in the development and progression of KOA. Muscle function (MF) and muscle quality (MQ) are key factors in understanding the involvement of muscles in KOA. Quantitative indices such as muscle mass, muscle strength, muscle cross-sectional area, muscle thickness, and muscle fatigue are crucial in assessing MF and MQ. Despite the growing interest in KOA, there is a scarcity of studies investigating the relationship between muscles and this condition. This review aims to examine the commonly used indices and measurement methods for assessing MF and MQ in clinical settings, while also exploring the association between muscles and KOA. Furthermore, this article highlights the importance of restoring MF and MQ to enhance symptom management and improve the quality of life for patients with KOA.

Keywords

Muscle knee osteoarthritis / Muscle strength / Muscle / Knee osteoarthritis / Muscle cross section area

References

[1] LespasioMJ, PiuzziNS, HusniME, Muschler GF, GuarinoA, MontMA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16–183.

[2] JinX, JonesG, CicuttiniF, Wluka A, ZhuZ, HanW, et al. Effect of vitamin D supplementation on Tibial cartilage volume and knee pain among patients with symptomatic knee osteoarthritis: a randomized clinical trial. JAMA. 2016;315(10):1005–1013.

[3] SegalNA, GlassNA. Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis? Phys Sportsmed. 2011;39(4):44–50.

[4] JavadianY, AdabiM, HeidariB, Babaei M, FirouzjahiA, GhahhariBY, et al. Quadriceps muscle strength correlates with serum vitamin D and knee pain in knee osteoarthritis. Clin J Pain. 2017;33(1):67–70.

[5] GohirSA, Greenhaff P, AbhishekA, ValdesAM. Evaluating the efficacy of internet-based exercise programme aimed at treating knee osteoarthritis (iBEAT-OA) in the community: a study protocol for a randomised controlled trial. BMJ Open. 2019;9(10):e030564.

[6] PattersonBE, Girdwood MA, WestTJ, BruderAM, Øiestad BE, JuhlC, et al. Muscle strength and osteoarthritis of the knee: a systematic review and meta-analysis of longitudinal studies. Skeletal Radiol. 2022;52:2085–2097.

[7] CawthonPM, FoxKM, GandraSR, Delmonico MJ, ChiouCF, AnthonyMS, et al. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc. 2009;57(8):1411–1419.

[8] SimaoAP, Mendonca VA, AvelarNCP, da FonsecaSF, SantosJM, de OliveiraACC, et al. Whole body vibration training on muscle strength and brain-derived neurotrophic factor levels in elderly woman with knee osteoarthritis: a randomized clinical trial study. Front Physiol. 2019;10:756.

[9] PerrinDH, Robertson RJ, RayRL. Bilateral lsokinetic peak torque, torque acceleration energy, power, and work relationships in athletes and nonathletes. J Orthop Sports Phys Ther. 1987;9(5):184–189.

[10] JanssenJC, Le-Ngoc L. Intratester reliability and validity of concentric measurements using a new hand-held dynamometer. Arch Phys Med Rehabil. 2009;90(9):1541–1547.

[11] MeyerC, CortenK, WesselingM, Peers K, SimonJP, JonkersI, et al. Test-retest reliability of innovated strength tests for hip muscles. PLoS One. 2013;8(11):e81149.

[12] ChamorroC, Armijo-Olivo S, De la FuenteC, FuentesJ, Javier Chirosa L. Absolute reliability and concurrent validity of hand held dynamometry and isokinetic dynamometry in the hip, knee and ankle joint: systematic review and meta-analysis. Open Med. 2017;12:359–375.

[13] Chopp-HurleyJN, Wiebenga EG, GattiAA, MalyMR. Investigating the test-retest reliability and validity of hand-held dynamometry for measuring knee strength in older women with knee osteoarthritis. Physiother Can. 2019;71(3):231–238.

[14] MartinsJ, da Silva JR, da SilvaMRB, Bevilaqua-GrossiD. Reliability and validity of the belt-stabilized handheld dynamometer in hip- and knee-strength tests. J Athl Train. 2017;52(9):809–819.

[15] LuoJ, LiY, HeM, WangZ, LiC, LiuD, et al. Rehabilitation of total knee arthroplasty by integrating conjoint isometric Myodynamia and real-time rotation sensing system. Adv Sci. 2022;9(8):e2105219.

[16] WangC, QuX, ZhengQ, Liu Y, TanP, ShiB, et al. Stretchable, self-healing, and skin-mounted active sensor for multipoint muscle function assessment. ACS Nano. 2021;15(6):10130–10140.

[17] ØiestadBE, Juhl CB, CulvenorAG, BergB, Thorlund JB. Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46 819 men and women. Br J Sports Med. 2022;56(6):349–355.

[18] SegalNA, TornerJC, FelsonD, Niu J, SharmaL, LewisCE, et al. Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort. Arthritis Rheum. 2009;61(9):1210–1217.

[19] SlemendaC, BrandtKD, HeilmanDK, Mazzuca S, BraunsteinEM, KatzBP, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997;127(2):97–104.

[20] CulvenorAG, FelsonDT, NiuJ, WirthW, SattlerM, Dannhauer T, et al. Thigh muscle specific-strength and the risk of incident knee osteoarthritis: the influence of sex and greater body mass index. Arthritis Care Res. 2017;69(8):1266–1270.

[21] HerzogW, Longino D, ClarkA. The role of muscles in joint adaptation and degeneration. Langenbecks Arch Surg. 2003;388(5):305–315.

[22] MikeskyAE, MeyerA, ThompsonKL. Relationship between quadriceps strength and rate of loading during gait in women. J Orthop Res. 2000;18(2):171–175.

[23] EnglundM. The role of biomechanics in the initiation and progression of OA of the knee. Best Pract Res Clin Rheumatol. 2010;24(1):39–46.

[24] LattanzioPJ, Petrella RJ, SprouleJR, FowlerPJ. Effects of fatigue on knee proprioception. Clin J Sport Med. 1997;7(1):22–27.

[25] SkinnerHB, WyattMP, HodgdonJA, Conard DW, BarrackRL. Effect of fatigue on joint position sense of the knee. J Orthop Res. 1986;4(1):112–118.

[26] HortobagyiT, GarryJ, HolbertD, Devita P. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis Rheum. 2004;51(4):562–569.

[27] PowersCM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.

[28] PrinsMR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15.

[29] MuchaMD, Caldwell W, SchlueterEL, WaltersC, HassenA. Hip abductor strength and lower extremity running related injury in distance runners: a systematic review. J Sci Med Sport. 2017;20(4):349–355.

[30] Raghava NeelapalaYV, Bhagat M, ShahP. Hip muscle strengthening for knee osteoarthritis: a systematic review of literature. J Geriatr Phys Ther. 2020;43(2):89–98.

[31] WildCY, SteeleJR, MunroBJ. Insufficient hamstring strength compromises landing technique in adolescent girls. Med Sci Sports Exerc. 2013;45(3):497–505.

[32] HatfieldGL, Costello KE, Astephen WilsonJL, StanishWD, Hubley-Kozey CL. Association between knee joint muscle activation and knee joint moment patterns during walking in moderate medial compartment knee osteoarthritis: implications for secondary prevention. Arch Phys Med Rehabil. 2021;102(10):1910–1917.

[33] HallM, HinmanRS, WrigleyTV, Kasza J, LimBW, BennellKL. Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial. Osteoarthr Cartil. 2018;26(4):495–500.

[34] LiaoCD, LiaoYH, LiouTH, Hsieh CY, KuoYC, ChenHC. Effects of protein-rich nutritional composition supplementation on sarcopenia indices and physical activity during resistance exercise training in older women with knee osteoarthritis. Nutrients. 2021;13(8):2487.

[35] AkyolY, DurmusD, AlayliG, Tander B, BekY, CanturkF, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325–336.

[36] KnoopJ, DekkerJ, van der LeedenM, van der EschM, Thorstensson CA, GerritsenM, et al. Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial. Osteoarthr Cartil. 2013;21(8):1025–1034.

[37] RätsepsooM, Gapeyeva H, SokkJ, ErelineJ, HavikoT, PäsukeM. Leg extensor muscle strength, postural stability, and fear of falling after a 2-month home exercise program in women with severe knee joint osteoarthritis. Medicina. 2013;49(8):54.

[38] SuzukiY, IijimaH, TashiroY, Kajiwara Y, ZeidanH, ShimouraK, et al. Home exercise therapy to improve muscle strength and joint flexibility effectively treats pre-radiographic knee OA in community-dwelling elderly: a randomized controlled trial. Clin Rheumatol. 2019;38(1):133–141.

[39] DingS, DaiQ, HuangH, Xu Y, ZhongC. An overview of muscle atrophy. Adv Exp Med Biol. 2018;1088:3–19.

[40] DhillonRJ, HasniS. Pathogenesis and Management of Sarcopenia. Clin Geriatr Med. 2017;33(1):17–26.

[41] BosaeusI, WilcoxG, RothenbergE, Strauss BJ. Skeletal muscle mass in hospitalized elderly patients: comparison of measurements by single-frequency BIA and DXA. Clin Nutr. 2014;33(3):426–431.

[42] TewariN, AwadS, MacdonaldIA, Lobo DN. A comparison of three methods to assess body composition. Nutrition. 2018;47:1–5.

[43] CeniccolaGD, CastroMG, PiovacariSMF, HorieLM, CorreaFG, BarrereAPN, et al. Current technologies in body composition assessment: advantages and disadvantages. Nutrition. 2019;62:25–31.

[44] LustgartenMS, Fielding RA. Assessment of analytical methods used to measure changes in body composition in the elderly and recommendations for their use in phase II clinical trials. J Nutr Health Aging. 2011;15(5):368–375.

[45] HeymsfieldSB, Gonzalez MC, LuJ, JiaG, ZhengJ. Skeletal muscle mass and quality: evolution of modern measurement concepts in the context of sarcopenia. Proc Nutr Soc. 2015;74(4):355–366.

[46] JeonH, LeeSU, LimJY, Chung SG, LeeSJ, LeeSY. Low skeletal muscle mass and radiographic osteoarthritis in knee, hip, and lumbar spine: a cross-sectional study. Aging Clin Exp Res. 2019;31(11):1557–1562.

[47] SuhDH, HanKD, HongJY, Park JH, BaeJH, MoonYW, et al. Body composition is more closely related to the development of knee osteoarthritis in women than men: a cross-sectional study using the fifth Korea National Health and nutrition examination survey (KNHANES V-1, 2). Osteoarthr Cartil. 2016;24(4):605–611.

[48] ParkHM, KimHJ, LeeB, KwonM, JungSM, Lee SW, et al. Decreased muscle mass is independently associated with knee pain in female patients with radiographically mild osteoarthritis: a nationwide cross-sectional study (KNHANES 2010-2011). Clin Rheumatol. 2018;37(5):1333–1340.

[49] LeeJY, HanK, McAlindonTE, Park YG, ParkSH. Lower leg muscle mass relates to knee pain in patients with knee osteoarthritis. Int J Rheum Dis. 2018;21(1):126–133.

[50] TaniguchiM, Fukumoto Y, KobayashiM, KawasakiT, Maegawa S, IbukiS, et al. Quantity and quality of the lower extremity muscles in women with knee osteoarthritis. Ultrasound Med Biol. 2015;41(10):2567–2574.

[51] SegalNA, Findlay C, WangK, TornerJC, NevittMC. The longitudinal relationship between thigh muscle mass and the development of knee osteoarthritis. Osteoarthr Cartil. 2012;20(12):1534–1540.

[52] LeeSY, RoHJ, ChungSG, Kang SH, SeoKM, KimDK. Low skeletal muscle mass in the lower limbs is independently associated to knee osteoarthritis. PLoS One. 2016;11(11):e0166385.

[53] MetterEJ, ConwitR, MetterB, Pacheco T, TobinJ. The relationship of peripheral motor nerve conduction velocity to age-associated loss of grip strength. Aging. 1998;10(6):471–478.

[54] RuhdorferAS, Dannhauer T, WirthW, CotofanaS, RoemerF, NevittM, et al. Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison. Osteoarthr Cartil. 2014;22(10):1634–1638.

[55] JonesEJ, BishopPA, WoodsAK, Green JM. Cross-sectional area and muscular strength: a brief review. Sports Med. 2008;38(12):987–994.

[56] MaughanRJ, WatsonJS, WeirJ. Relationships between muscle strength and muscle cross-sectional area in male sprinters and endurance runners. Eur J Appl Physiol Occup Physiol. 1983;50(3):309–318.

[57] DonsB, Bollerup K, Bonde-PetersenF, HanckeS. The effect of weight-lifting exercise related to muscle fiber composition and muscle cross-sectional area in humans. Eur J Appl Physiol Occup Physiol. 1979;40(2):95–106.

[58] StrandbergS, Wretling ML, WredmarkT, ShalabiA. Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation. BMC Med Imaging. 2010;10:18.

[59] e LimaKM, da Matta TT, de OliveiraLF. Reliability of the rectus femoris muscle cross-sectional area measurements by ultrasonography. Clin Physiol Funct Imaging. 2012;32(3):221–226.

[60] SponbeckJK, Frandsen CR, RidgeST, SwansonDA, Swanson DC, JohnsonAW. Leg muscle cross-sectional area measured by ultrasound is highly correlated with MRI. J Foot Ankle Res. 2021;14(1):5.

[61] GalanisN, Savvidis M, TsifountoudisI, GkouvasG, Alafropatis I, KirkosJ, et al. Correlation between semitendinosus and gracilis tendon cross-sectional area determined using ultrasound, magnetic resonance imaging and intraoperative tendon measurements. J Electromyogr Kinesiol. 2016;26:44–51.

[62] SattlerM, Dannhauer T, HudelmaierM, WirthW, SangerAM, KwohCK, et al. Side differences of thigh muscle cross-sectional areas and maximal isometric muscle force in bilateral knees with the same radiographic disease stage, but unilateral frequent pain—data from the osteoarthritis initiative. Osteoarthr Cartil. 2012;20(6):532–540.

[63] DannhauerT, Sattler M, WirthW, HunterDJ, KwohCK, EcksteinF. Longitudinal sensitivity to change of MRI-based muscle cross-sectional area versus isometric strength analysis in osteoarthritic knees with and without structural progression: pilot data from the osteoarthritis initiative. Magn Reson Mater Phys Biol Med. 2014;27(4):339–347.

[64] YamauchiK, KatoC, KatoT. Characteristics of individual thigh muscles including cross-sectional area and adipose tissue content measured by magnetic resonance imaging in knee osteoarthritis: a cross-sectional study. Rheumatol Int. 2019;39(4):679–687.

[65] FerrazRB, Gualano BR, RodriguesRE, KurimoriCO, FullerR, LimaFR, et al. Benefits of resistance training with blood flow restriction in knee osteoarthritis. Med Sci Sports Exerc. 2018;50(5):897–905.

[66] SilvaJMS, Alabarse PVG, TeixeiraVON, FreitasEC, de Oliveira FH, ChakrR, et al. Muscle wasting in osteoarthritis model induced by anterior cruciate ligament transection. PLoS One. 2018;13(4):e0196682.

[67] RuhdorferA, WirthW, DannhauerT, Eckstein F. Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs painless knees—data from the osteoarthritis initiative. Osteoarthr Cartil. 2015;23(8):1348–1356.

[68] CaoRY, LiJ, DaiQ, LiQ, YangJ. Muscle atrophy: present and future. Adv Exp Med Biol. 2018;1088:605–624.

[69] SchiaffinoS, DyarKA, CiciliotS, Blaauw B, SandriM. Mechanisms regulating skeletal muscle growth and atrophy. FEBS J. 2013;280(17):4294–4314.

[70] KemnitzJ, WirthW, EcksteinF, Culvenor AG. The role of thigh muscle and adipose tissue in knee osteoarthritis progression in women: data from the osteoarthritis initiative. Osteoarthr Cartil. 2018;26(9):1190–1195.

[71] MizunoT, MatsuiY, TomidaM, Suzuki Y, NishitaY, TangeC, et al. Differences in the mass and quality of the quadriceps with age and sex and their relationships with knee extension strength. J Cachexia Sarcopenia Muscle. 2021;12(4):900–912.

[72] KumarD, Karampinos DC, MacLeodTD, LinW, NardoL, LiX, et al. Quadriceps intramuscular fat fraction rather than muscle size is associated with knee osteoarthritis. Osteoarthr Cartil. 2014;22(2):226–234.

[73] KocaI, BoyaciA, TutogluA, Boyaci N, OzkurA. The relationship between quadriceps thickness, radiological staging, and clinical parameters in knee osteoarthritis. J Phys Ther Sci. 2014;26(6):931–936.

[74] GandeviaSC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev. 2001;81(4):1725–1789.

[75] Mau-MoellerA, Jacksteit R, JackszisM, FeldhegeF, Weippert M, MittelmeierW, et al. Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients. PLoS One. 2017;12(5):e0176976.

[76] WatanabeK, AkimaH. Neuromuscular activation of vastus intermedius muscle during fatiguing exercise. J Electromyogr Kinesiol. 2010;20(4):661–666.

[77] CallaghanMJ, McCarthy CJ, OldhamJA. The reliability of surface electromyography to assess quadriceps fatigue during multi joint tasks in healthy and painful knees. J Electromyogr Kinesiol. 2009;19(1):172–180.

[78] ChenG, WuJ, ChenG, Lu Y, RenW, XuW, et al. Reliability of a portable device for quantifying tone and stiffness of quadriceps femoris and patellar tendon at different knee flexion angles. PLoS One. 2019;14(7):e0220521.

[79] LeeJY, HanK, ParkYG, Park SH. Association of leg muscle symmetry with knee osteoarthritis. Clin Rheumatol. 2019;38(12):3549–3556.

[80] BannuruRR, OsaniMC, VaysbrotEE, Arden NK, BennellK, Bierma-ZeinstraSMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–1589.

[81] JevsevarDS. Treatment of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg. 2013;21(9):571–576.

[82] BartholdyC, JuhlC, ChristensenR, LundH, ZhangW, HenriksenM. The role of muscle strengthening in exercise therapy for knee osteoarthritis: a systematic review and meta-regression analysis of randomized trials. Semin Arthritis Rheum. 2017;47(1):9–21.

[83] StensrudS, Risberg MA, RoosEM. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears: a 3-mo follow-up of a randomized controlled trial. Am J Phys Med Rehabil. 2015;94(6):460–473.

[84] GurH, CakinN. Muscle mass, isokinetic torque, and functional capacity in women with osteoarthritis of the knee. Arch Phys Med Rehabil. 2003;84(10):1534–1541.

[85] BartelsEM, JuhlCB, ChristensenR, HagenKB, Danneskiold-Samsoe B, DagfinrudH, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3(3):CD005523.

[86] RaposoF, RamosM, Lucia CruzA. Effects of exercise on knee osteoarthritis: a systematic review. Musculoskeletal Care. 2021;19(4):399–435.

[87] LeeHY. Comparison of effects among Tai-Chi exercise, aquatic exercise, and a self-help program for patients with knee osteoarthritis. J Korean Acad Nurs. 2006;36(3):571–580.

[88] Bruce-BrandRA, WallsRJ, OngJC, Emerson BS, O'ByrneJM, MoynaNM. Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:118.

[89] CushnaghanJ, McCarthy C, DieppeP. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? BMJ. 1994;308(6931):753–755.

[90] HinmanRS, Bennell KL, CrossleyKM, McConnellJ. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology. 2003;42(7):865–869.

[91] HinmanRS, Crossley KM, McConnellJ, BennellKL. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. BMJ. 2003;327(7407):135.

[92] KusG, YeldanI. Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis. Rheumatol Int. 2019;39(2):203–218.

[93] Stevens-LapsleyJE, Balter JE, WolfeP, EckhoffDG, KohrtWM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012;92(2):210–226.

[94] IijimaH, EguchiR, ShimouraK, Yamada K, AoyamaT, TakahashiM. Transcutaneous electrical nerve stimulation improves stair climbing capacity in people with knee osteoarthritis. Sci Rep. 2020;10(1):7294.

[95] Kaya MutluE, ErcinE, Razak OzdinclerA, OnesN. A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: a randomized three arm clinical trial. Physiother Theory Pract. 2018;34(8):600–612.

[96] TsokanosA, Livieratou E, BillisE, TsekouraM, Tatsios P, TsepisE, et al. The efficacy of manual therapy in patients with knee osteoarthritis: a systematic review. Medicina. 2021;57(7):696.

[97] ZhengY, RenJ, ZhangS, Zhou X, HeT, KongL. The effects on pain and quality of life of traditional Chinese manual therapy for knee osteoarthritis: a protocol for systematic review and meta-analysis. Medicine. 2022;101(3):e28595.

[98] WangZ, WangY, WangC, Li X, ZhouZ, ZhangL, et al. Systematic review and network meta-analysis of acupuncture combined with massage in treating knee osteoarthritis. Biomed Res Int. 2022;2022:4048550.

[99] HenriksenM, Christensen R, Danneskiold-Samsøe B, BliddalH. Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. Arthritis Rheum. 2012;64(2):438–442.

[100] ZhangZK, LiJ, LiuJ, GuoB, LeungA, Zhang G, et al. Icaritin requires phosphatidylinositol 3 kinase (PI3K)/Akt signaling to counteract skeletal muscle atrophy following mechanical unloading. Sci Rep. 2016;6:20300.

[101] OhM, KimSY, ParkS, Kim KN, KimSH. Phytochemicals in Chinese chive (Allium tuberosum) induce the skeletal muscle cell proliferation via PI3K/Akt/mTOR and Smad pathways in C2C12 cells. Int J Mol Sci. 2021;22(5):2296.

[102] JuddDL, Eckhoff DG, Stevens-LapsleyJE. Muscle strength loss in the lower limb after total knee arthroplasty. Am J Phys Med Rehabil. 2012;91(3):220–226; quiz 227–230.

[103] ArdeljanAD, Polisetty TS, PalmerJ, VakhariaRM, RocheMW. Comparative analysis on the effects of sarcopenia following primary Total knee arthroplasty: a retrospective matched-control analysis. J Knee Surg. 2022;35(2):128–134.

[104] Stevens-LapsleyJE, Balter JE, KohrtWM, EckhoffDG. Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res. 2010;468(9):2460–2468.

[105] ChughtaiM, Elmallah RD, MistryJB, BhaveA, Cherian JJ, McGinnTL, et al. Nonpharmacologic pain management and muscle strengthening following Total knee arthroplasty. J Knee Surg. 2016;29(3):194–200.

[106] KlikaAK, Yakubek G, PiuzziN, CalabreseG, Barsoum WK, HigueraCA. Neuromuscular electrical stimulation use after Total knee arthroplasty improves early return to function: a randomized trial. J Knee Surg. 2022;35(1):104–111.

[107] GoldmanLH, TangK, FacchettiL, Heilmeier U, JosephGB, NevittMC, et al. Role of thigh muscle cross-sectional area and strength in progression of knee cartilage degeneration over 48 months—data from the osteoarthritis initiative. Osteoarthr Cartil. 2016;24(12):2082–2091.

RIGHTS & PERMISSIONS

2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.