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A case highlighting the influence of knee joint effusion on muscle inhibition and size

Nature Clinical Practice Rheumatology volume 4, pages 153–158 (2008)Cite this article

Abstract

Background The patient sustained an injury that caused knee joint effusion. The patient had undergone reconstruction of the anterior cruciate ligament on the right knee ∼8 years before this injury.

Investigations The influence of knee joint effusion on the isometric and dynamic torque characteristics, neural drive and muscle size of the knee extensors was analyzed during the first 11 weeks of recovery. Maximum knee extensor torque and electromyographic (EMG) activity were assessed on a weekly basis. MRI scans of the thigh were taken to quantify vastus medialis muscle cross-sectional area.

Diagnosis Initial knee joint aspiration resulted in an 85–399% increase in isometric knee extensor torque and a 9–706% increase in vastus lateralis and vastus medialis muscle EMG activity, indicating muscle inhibition due to effusion. The knee extensors were inhibited to a greater extent in the most flexed position than in the more extended knee joint positions. After the initial aspiration, the knee extensor torque–velocity relationship increased by 56–453% with a corresponding increase in EMG activity.

Management Repetition of aspiration and instigation of a resistance training program resulted in the injured leg having a torque and muscle size comparable with the contralateral healthy leg 11 weeks after initiation of the rehabilitation program.

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Figure 1: Schematic diagram showing the assessment time-points during the 11-week examination period.
Figure 2: Axial plane MRI images of the right knee joint, providing an indication of the effusion volume present over the examination period.
Figure 3: Knee extensor isometric torque (A), VL muscle EMG activity (B) and VM muscle EMG activity (C) as a function of knee joint angle (0 degrees = full extension) during the examination period.
Figure 4: Knee extensor torque (A), VL muscle EMG activity (B) and VM muscle EMG activity (C) as a function of knee joint angular velocity during the study period.
Figure 5: VM muscle CSA measured at four different levels during the study period for the injured leg, and at a single time-point for the contralateral (healthy) leg.
Figure 6: Knee extensor torque–angle (A) and torque–velocity (B) relationships for the injured leg (measurement sessions 7 and 11 weeks after the initial aspiration) and the contralateral (healthy) leg (mean of the two measurement sessions at weeks 7 and 11 of the program).

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Author information

Authors and Affiliations

  1. ND Reeves is a Postdoctoral Research Fellow at the Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Cheshire, UK.,

    Neil D Reeves

  2. N Maffulli is Professor and Chair of Trauma and Orthopaedic Surgery at Keele University Medical School, Staffordshire, UK, and a Consultant in Trauma and Orthopaedic Surgery at the University Hospital of North Staffordshire, Staffordshire, UK.,

    Nicola Maffulli

Authors
  1. Neil D Reeves
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  2. Nicola Maffulli
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Correspondence to Neil D Reeves.

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The authors declare no competing financial interests.

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Reeves, N., Maffulli, N. A case highlighting the influence of knee joint effusion on muscle inhibition and size. Nat Rev Rheumatol 4, 153–158 (2008). https://doi.org/10.1038/ncprheum0709

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