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In female patients with knee osteoarthritis, maximum muscle strength is primarily associated with muscle quantity and motor unit firing rates in early stages, but shifts to being primarily associated with muscle quality in severe stages, indicating neuromuscular degeneration occurs throughout disease progression. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 17, 2025Annals of Biomedical Engineering1 citationsOpen Access

Relative Contributions of Motor Unit Firing Pattern, Muscle Quantity, and Muscle Quality to Maximum Muscle Strength in Female Patients with Early and Severe Knee Osteoarthritis

TWTakaya WatabeKanazawa University YNYuichi NishikawaKanazawa University HNHisashi NAITOKanazawa University

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Abstract

PURPOSE: While changes in muscle quality and quantity are common concerns as knee osteoarthritis (KOA) progresses, it is equally important to consider the central nervous system's role in regulating muscle force output. This study aimed to elucidate the firing properties of motor units (MUs), muscle quantity, and muscle quality during submaximal isometric contractions in patients with early and severe KOA. METHODS: This was a prospective study comparing 30 patients with KOA according to the Kellgren/Lawrence grading system divided into early and severe KOA groups. The participants performed ramp-up and sustained contractions at 10%, 30%, and 60% of their maximal voluntary contraction (MVC). High-density surface electromyography signals were recorded in the vastus medialis (VM) and vastus lateralis (VL) muscles on the affected side. Skeletal muscle quantity and quality were assessed using computed tomography based on cross-sectional area (CSA) and computed tomography attenuation value (CTV), respectively. RESULTS: The CSA of the VM muscle was significantly smaller in the severe KOA group than in the early KOA group (p = 0.021). A total of 682 MUs were detected (early KOA, n = 348, severe KOA, n = 334). The ramp-down phase of the discharge rate (DR) of MUs recruited by the VL muscle in the severe KOA group was significantly lower than that in the early KOA group (p = 0.004). In addition, the knee extension torque of patients with early KOA was significantly correlated with the CSA of the VM muscle (r = 0.405) and the DR obtained at 30% MVC of the VM (r = 0.503) and VL (r = 0.610) muscle. Furthermore, the knee extension torque in patients with severe KOA was significantly correlated with the CTV of the VM (r = 0.677) and VL (r = 0.599) muscles. CONCLUSIONS: In patients with severe KOA, a small CSA of the VM is associated with a characteristic DR pattern depending on the contraction level. The VM and VL muscles fired without a hierarchical pattern in the early and severe KOA groups. These findings suggest that neuromuscular degeneration may occur not only in patients with severe KOA but also in patients with early KOA.

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