Original research| Volume 99, ISSUE 1, P99-106, January 2018

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Performance on a Clinical Quadriceps Activation Battery Is Related to a Laboratory Measure of Activation and Recovery After Total Knee Arthroplasty

Published:August 29, 2017DOI:


      • The quadriceps activation battery (QAB) is the first clinical battery of tests shown to be related to recovery of activation, strength, and function after total knee arthroplasty (TKA).
      • Timing of assessment of the QAB is critical because patient performance on the QAB was most informative in the initial postoperative period (4d after surgery).
      • The QAB could be used to identify individuals who may need specific interventions such as neuromuscular electrical stimulation to target activation deficits or prolonged physical therapy intervention to achieve optimal results after TKA.



      To determine the relation between performance on a clinical quadriceps activation battery with (1) activation measured by doublet interpolation and (2) recovery of quadriceps strength and functional performance after total knee arthroplasty (TKA).


      Planned secondary analysis of a randomized controlled trial.


      University research laboratory.


      Patients (N=162; mean age, 63±7y; 89 women) undergoing TKA.

      Main Outcome Measures

      Patients were classified as high (quadriceps activation battery ≥4/6) or low (quadriceps activation battery ≤3/6) based on performance on the quadriceps activation battery measured 4 days after TKA. Differences between groups in activation and recovery at 1, 2, 3, 6, and 12 months after TKA were compared using a repeated-measures maximum likelihood model.


      The low quadriceps activation battery group demonstrated poorer quadriceps activation via doublet interpolation (P=.01), greater quadriceps strength loss (P=.01), and greater functional performance decline (all P<.001) at 1 month after TKA compared with the high quadriceps activation battery group. Differences between low and high quadriceps activation battery groups on all measures did not persist at 3 and 12 months (all P>.05).


      Poor performance on the quadriceps activation battery early after TKA is related to poor quadriceps activation and poor recovery in the early postoperative period. Patients in the low quadriceps activation battery group took 3 months to recover to the same level as the high quadriceps activation battery group. The quadriceps activation battery may be useful in identifying individuals who need specific interventions to target activation deficits or different care pathways in the early postoperative period to speed recovery after TKA.


      List of abbreviations:

      6MWT (6-minute walk test), MVIC (maximum voluntary isometric contraction), NMES (neuromuscular electrical stimulation), OA (osteoarthritis), SCT (stair climbing test), TKA (total knee arthroplasty), TUG (Timed Up and Go)
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