Observational studyKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty.
Observational study in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- Sarcopenia and Postoperative Outcomes Following Total Knee Arthroplasty: A Systematic Review of Observational Studies.Journal of clinical medicine · 2026Review
- Assessing symptom clusters in post-total knee arthroplasty patients: development and validation of a new scale.BMC musculoskeletal disorders · 2026Article
- Early-Phase Quadriceps Activation After Knee Surgery: A Narrative Review of Current Rehabilitation Interventions and Identification of an Unmet Clinical Need.Journal of clinical medicine · 2026Review
- Neuromuscular Reactivation Through Guided Visualization Combining Mindfulness and Motor Imagery via the Yuzit App: Protocol for a Randomized Controlled Trial.JMIR research protocols · 2026Article
- Article
- Application of wearable neuromuscular electrical stimulation in home-based rehabilitation following total knee arthroplasty- a retrospective cohort comparison.BMC musculoskeletal disorders · 2026Article
- Quadriceps muscle force magnitude and control in the knee scheduled for arthroplasty versus the contralateral knee: A cross-sectional study in patients with end-stage osteoarthritis.Knee surgery & related research · 2026Article
- Effect of iPACK block versus femoral nerve block on postoperative movement pain and muscle strength in patients undergoing total knee replacement.American journal of translational research · 2026Article
- Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Observational
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7 authors.
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Abstract
purposeFlexion contracture is a multifactorial complication after knee osteoarthritis and knee arthroplasty. Among the causes, arthrogenic muscle inhibition (AMI) has never been studied. It is a failure to achieve proper quadriceps motor activation, which can lead to flexion contracture due to hamstring contracture. In this study, we hypothesised that AMI is present in patients with knee osteoarthritis and after knee arthroplasty. The aims were to assess: (1) the prevalence of preoperative AMI, for patients without preoperative AMI, (2) the incidence of post-operative AMI at 2 weeks, (3) its associated factors at 2 weeks and (4) the incidence 90 days after surgery.
methodsAn international, prospective study enroled 341 patients undergoing knee arthroplasty across three centres. 316 patients met the inclusion criteria: symptomatic knee requiring unicompartmental, total or revision arthroplasty. Twenty-five patients undergoing simultaneous bilateral procedures were excluded. Among the included patients, 275 patients without preoperative AMI were analysed for post-operative incidence and associated factors. AMI was assessed using the SANTI classification on the day of surgery, at 15 days, and at 3 months. One patient was lost to follow-up at 3 months.
resultsPreoperative AMI ≥ 1 was observed in 13% (95% confidence interval [CI] = 9-17). At 2 weeks post-operatively, AMI ≥ 1 occurred in 36% (95% CI = 30-42), with 13% showing AMI ≥ 2, characterised by quadriceps inhibition and flexion contracture. Female gender (odds ratio [OR] = 2.81; p < 0.002), early post-operative flexion contracture attitude such as keeping the knee bent, placing a pillow under the knee, or folding the hospital bed (OR = 5.89; p < 0.001), and high pain scores (OR = 13.57; p < 0.001) were significantly associated with AMI ≥ 1 at 2 weeks. At 3 months, AMI ≥ 1 occurred in 12.4% (95% CI = 8.7-16.9).
conclusionAMI is a prevalent issue both pre- and post-operatively. Its incidence underscores the relevance of this condition; it should be considered in the management of post-operative flexion contracture in knee arthroplasty. LEVEL OF EVIDENCE: Level III, observation cohort study.
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