Asymmetry in Quadriceps Rate of Force Development as a Functional Outcome Measure in TKA

Quadriceps muscle strength is an important predictor of functional abilities in patients having TKA. However, because several daily activities are characterized by a limited time to generate force, it has been suggested that rate of force development (RFD) could better predict functional difficulties than maximal strength. We therefore hypothesized the side-to-side asymmetry would be larger for RFD than for maximal strength, and RFD asymmetry relates to subjective symptoms and/or functional daily living activities. We studied 31 subjects (17 women, 14 men) 6 +/- 1 months after undergoing TKA for unilateral osteoarthritis. Symptoms and limitations during activities of daily living were quantified using the knee outcome survey-activities of daily living scale (KOS-ADLS). Quadriceps maximal strength and RFD at different times (50 to 200 ms from contraction onset) were quantified during unilateral maximal voluntary isometric actions. Side-to-side asymmetries (involved versus uninvolved side) were larger for RFD (approximately 36%) than for maximal strength (approximately 24%). Subjective knee function related to all RFD asymmetry variables, but not to maximal strength asymmetry. In addition to maximal strength, quadriceps RFD in the first 100 to 200 ms from contraction onset provides an alternative functional outcome measure for individuals undergoing TKA.