Rehabilitation of Arthrogenic Muscle Inhibition in Patients with Knee Osteoarthritis and after Knee Arthroplasty.

purpose of reviewArthrogenic muscle inhibition (AMI) is a key neurophysiological mechanism that impairs voluntary quadriceps activation following total knee arthroplasty (TKA), potentially limiting functional recovery despite technically successful surgery. This review aims to synthesize current evidence on the neurophysiological mechanisms underlying AMI and to propose a mechanism-based rehabilitation framework targeting these inhibitory processes. RECENT

findingsEmerging evidence indicates that AMI is mediated by altered afferent input from the joint, leading to changes in spinal reflex excitability and supraspinal motor control. Mechanisms such as presynaptic inhibition, reduced α-motoneuron excitability, and impaired γ-loop function contribute to diminished quadriceps activation. In addition, recent studies suggest that AMI may manifest at the level of motor unit recruitment and firing behavior, reflecting persistent neuromuscular adaptations. These inhibitory processes are further influenced by joint effusion, pain, and pre-existing neuromotor deficits in patients with knee osteoarthritis. AMI represents a multilevel sensorimotor dysfunction that may act as a major limiting factor in postoperative recovery after TKA. A targeted rehabilitation approach addressing peripheral, spinal, and supraspinal mechanisms-including effusion control, neuromuscular electrical stimulation, blood flow restriction training, and sensorimotor retraining-may improve quadriceps activation and functional outcomes. Integrating neurophysiological principles into rehabilitation strategies may enhance recovery trajectories and should be a focus of future clinical research.