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J Knee Surg
DOI: 10.1055/a-2631-4611
Original Article

Correlation of Isokinetic Strength Deficits and Subjective Complaints in Patients with Knee Osteoarthritis Scheduled for Total Knee Arthroplasty

Anna Gerg
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Felix Greimel
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Jan Reinhard
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Tobias Kappenschneider
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Stefano Pagano
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Günther Maderbacher
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
,
Florian Zeman
2   Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
,
Joachim Grifka
3   Research Centre for Orthopaedics and Ergonomics, East Bavarian Technical University of Applied Sciences Regensburg, Regensburg, Germany
,
Julia Schiegl 
1   Department of Orthopedics, University Medical Center Regensburg, Bad Abbach, Germany
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Abstract

This study investigated isokinetic muscle strength deficits in patients with advanced knee osteoarthritis (KOA) scheduled for total knee arthroplasty (TKA) to explore the relationship between objective strength measures and subjective symptoms such as pain and functional limitations. By analyzing muscle function using isokinetic dynamometry, the study aimed to provide insights into how strength deficits relate to patient-reported outcomes and whether these assessments could inform surgical decision-making. A total of 52 patients (mean age: 66.96 years, 53.85% female) with advanced KOA awaiting TKA were included. Isokinetic muscle strength of the knee, measured in peak torque (Newton-meters), work (Joules), and power (Watts), was assessed bilaterally before surgery using a Biodex dynamometer at angular velocities of 180 degrees/s and 60 degrees/s. Subjective symptoms were evaluated using standardized assessments, including the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 (SF-12), Hospital Anxiety and Depression Scale (HADS-D), and EuroQol 5-Dimension 3-Level questionnaire. Findings revealed a significant strength deficit on the affected side scheduled for surgery (p < 0.050). However, correlations between isokinetic knee parameters and symptom scores were weak (|r| ≤0.5), suggesting that subjective complaints do not necessarily align with objective strength measurements. Notably, isokinetic parameters were significantly intercorrelated (p < 0.050). These results indicate that isokinetic dynamometry effectively quantifies muscle strength differences in KOA patients, yet its findings should be considered alongside clinical assessments and patient-reported symptoms to form a comprehensive evaluation of disease severity and surgical necessity.

Keywords

Biodex - isokinetic dynamometer - isokinetic muscle strength - knee osteoarthritis - total knee arthroplasty


Publication History

Received: 12 March 2025

Accepted: 13 May 2025

Article published online:
09 July 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 2014; 10 (07) 437-441
    CrossrefPubMedSearch in Google Scholar
  • 2 Bannuru RR, Osani MC, Vaysbrot EE. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27 (11) 1578-1589
    CrossrefPubMedSearch in Google Scholar
  • 3 GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5 (09) e508-e522
    CrossrefPubMedSearch in Google Scholar
  • 4 Gademan MG, Hofstede SN, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 2016; 17 (01) 463
    CrossrefPubMedSearch in Google Scholar
  • 5 Schmitt J, Lange T, Günther KP. et al. Indication criteria for total knee arthroplasty in patients with osteoarthritis - A multi-perspective consensus study. Z Orthop Unfall 2017; 155 (05) 539-548
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Rupprecht TN, Oczipka F, Lüring C, Pennekamp PH, Grifka J. Is there a correlation between the clinical, radiological and intrasurgical findings of osteoarthritis of the knee? A prospective study on 103 patients [in German]. Z Orthop Unfall 2007; 145 (04) 430-435
    PubMedSearch in Google Scholar
  • 7 Bichsel D, Liechti FD, Schlapbach JM, Wertli MM. Cross-sectional analysis of recommendations for the treatment of hip and knee osteoarthritis in clinical guidelines. Arch Phys Med Rehabil 2022; 103 (03) 559-569.e5
    PubMedSearch in Google Scholar
  • 8 Ventura A, Muendle B, Friesenbichler B, Casartelli NC, Kramers I, Maffiuletti NA. Deficits in rate of torque development are accompanied by activation failure in patients with knee osteoarthritis. J Electromyogr Kinesiol 2019; 44: 94-100
    PubMedSearch in Google Scholar
  • 9 Hortobágyi T, Garry J, Holbert D, Devita P. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis Rheum 2004; 51 (04) 562-569
    PubMedSearch in Google Scholar
  • 10 Slemenda C, Brandt KD, Heilman DK. et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997; 127 (02) 97-104
    CrossrefPubMedSearch in Google Scholar
  • 11 Devasenapathy N, Maddison R, Malhotra R, Zodepy S, Sharma S, Belavy DL. Preoperative quadriceps muscle strength and functional ability predict performance-based outcomes 6 months after total knee arthroplasty: a systematic review. Phys Ther 2019; 99 (01) 46-61
    CrossrefPubMedSearch in Google Scholar
  • 12 Wilk KE, Arrigo CA, Davies GJ. Isokinetic testing: Why it is more important today than ever?. Int J Sports Phys Ther 2024; 19 (04) 374-380
    PubMedSearch in Google Scholar
  • 13 Domínguez-Navarro F, Roig-Casasús S, Díaz-Díaz B. et al. The condition of the contralateral knee may induce different degrees of knee extensor strength asymmetry and affect functionality in individuals with unilateral or bilateral osteoarthritis. Knee 2020; 27 (06) 1795-1800
    PubMedSearch in Google Scholar
  • 14 Yang K, Ding Y, Chu L. et al. Altered activation patterns of the sensory-motor cortex in patients with knee osteoarthritis during knee isokinetic movement at different speeds. Front Bioeng Biotechnol 2024; 12: 1444731
    PubMedSearch in Google Scholar
  • 15 Goetz J, Maderbacher G, Gerg A. et al. Isokinetic knee muscle strength comparison after enhanced recovery after surgery (ERAS) versus conventional setup in total knee arthroplasty (TKA): a single blinded prospective randomized study. J Exp Orthop 2023; 10 (01) 44
    PubMedSearch in Google Scholar
  • 16 Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 2004; 91 (01) 22-29
    CrossrefPubMedSearch in Google Scholar
  • 17 Kannus P. Normality, variability and predictability of work, power and torque acceleration energy with respect to peak torque in isokinetic muscle testing. Int J Sports Med 1992; 13 (03) 249-256
    PubMedSearch in Google Scholar
  • 18 Kannus P. Isokinetic evaluation of muscular performance: implications for muscle testing and rehabilitation. Int J Sports Med 1994; 15 (Suppl. 01) S11-S18
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Farrar JT, Polomano RC, Berlin JA, Strom BL. A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity. Anesthesiology 2010; 112 (06) 1464-1472
    PubMedSearch in Google Scholar
  • 20 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    CrossrefPubMedSearch in Google Scholar
  • 21 Singh A, Gnanalingham K, Casey A, Crockard A. Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine 2006; 31 (06) 639-643
    PubMedSearch in Google Scholar
  • 22 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52 (02) 69-77
    CrossrefPubMedSearch in Google Scholar
  • 23 EUROQOL. EUROQOL Research Foundation. Accessed November 22, 2024 at: https://euroqol.org/
    PubMed
  • 24 Wang XF, Ma ZH, Teng XR. Isokinetic strength test of muscle strength and motor function in total knee arthroplasty. Orthop Surg 2020; 12 (03) 878-889
    PubMedSearch in Google Scholar
  • 25 Cavanellas NT, Cossich VRA, Nicoliche EB, Martins MB, Sousa EB, Salles JI. Comparative analysis of quadriceps and hamstrings strength in knee osteoarthritis before and after total knee arthroplasty: a cross-sectional study. Rev Bras Ortop 2018; 53 (02) 158-164
    PubMedSearch in Google Scholar
  • 26 Murray MP, Duthie Jr EH, Gambert SR, Sepic SB, Mollinger LA. Age-related differences in knee muscle strength in normal women. J Gerontol 1985; 40 (03) 275-280
    PubMedSearch in Google Scholar
  • 27 Wilk KE, Romaniello WT, Soscia SM, Arrigo CA, Andrews JR. The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. J Orthop Sports Phys Ther 1994; 20 (02) 60-73
    CrossrefPubMedSearch in Google Scholar
  • 28 Moffroid MT, Kusiak ET. The power struggle: definition and evaluation of power of muscular performance. Phys Ther 1975; 55 (10) 1098-1104
    PubMedSearch in Google Scholar
  • 29 Kannus P, Järvinen M. Maximal peak torque as a predictor of peak angular impulse and average power of thigh muscles–an isometric and isokinetic study. Int J Sports Med 1990; 11 (02) 146-149
    PubMedSearch in Google Scholar
  • 30 Kannus P. Relationship between peak torque and total work in an isokinetic contraction of the medial collateral ligament insufficient knee. Int J Sports Med 1988; 9 (04) 294-296
    PubMedSearch in Google Scholar
  • 31 Madsen OR, Bliddal H, Egsmose C, Sylvest J. Isometric and isokinetic quadriceps strength in gonarthrosis; inter-relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain. Clin Rheumatol 1995; 14 (03) 308-314
    PubMedSearch in Google Scholar
  • 32 Zhai G, Blizzard L, Srikanth V. et al. Correlates of knee pain in older adults: Tasmanian Older Adult Cohort Study. Arthritis Rheum 2006; 55 (02) 264-271
    PubMedSearch in Google Scholar
  • 33 Stevens-Lapsley JE, Schenkman ML, Dayton MR. Comparison of self-reported knee injury and osteoarthritis outcome score to performance measures in patients after total knee arthroplasty. PM R 2011; 3 (06) 541-549 , quiz 549
    PubMedSearch in Google Scholar
  • 34 Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010; 40 (09) 559-567
    CrossrefPubMedSearch in Google Scholar
  • 35 Terwee CB, Mokkink LB, Steultjens MP, Dekker J. Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Rheumatology (Oxford) 2006; 45 (07) 890-902
    PubMedSearch in Google Scholar
  • 36 Horstmann T, Maschmann J, Mayer F, Heitkamp HC, Handel M, Dickhuth HH. The influence of age on isokinetic torque of the upper and lower leg musculature in sedentary men. Int J Sports Med 1999; 20 (06) 362-367
    PubMedSearch in Google Scholar
  • 37 Schönle C, Kling P, Bäumer C, Carstensen S, Kuss A, Lepthin HJ. Software and system-induced errors in isokinetic force measurements [in German]. Z Orthop Ihre Grenzgeb 1995; 133 (01) 84-91
    PubMedSearch in Google Scholar
  • 38 Fillyaw M, Bevins T, Fernandez L. Importance of correcting isokinetic peak torque for the effect of gravity when calculating knee flexor to extensor muscle ratios. Phys Ther 1986; 66 (01) 23-31
    PubMedSearch in Google Scholar
  • 39 Van Driessche S, Van Roie E, Vanwanseele B, Delecluse C. Test-retest reliability of knee extensor rate of velocity and power development in older adults using the isotonic mode on a Biodex System 3 dynamometer. PLoS ONE 2018; 13 (05) e0196838
    PubMedSearch in Google Scholar
  • 40 Hartmann A, Knols R, Murer K, de Bruin ED. Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults. Gerontology 2009; 55 (03) 259-268
    PubMedSearch in Google Scholar
  • 41 Lund H, Søndergaard K, Zachariassen T. et al. Learning effect of isokinetic measurements in healthy subjects, and reliability and comparability of Biodex and Lido dynamometers. Clin Physiol Funct Imaging 2005; 25 (02) 75-82
    PubMedSearch in Google Scholar