Cutoff values of knee extensor strength for stair ascent and descent after bicruciate-stabilized total knee arthroplasty

Taiki Furumoto; Daisuke Hamada; Keizo Wada; Ken Tomonari; Yasuaki Tamaki; Shota Shigekiyo; Tetsuya Matsuura; Koichi Sairyo

doi:10.1016/j.jor.2026.02.054

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doi:

10.1016/j.jor.2026.02.054

Cutoff values of knee extensor strength for stair ascent and descent after bicruciate-stabilized total knee arthroplasty

Taiki Furumoto^a, Daisuke Hamada^a,d, Keizo Wada^a, Ken Tomonari^b, Yasuaki Tamaki^a, Shota Shigekiyo^a, Tetsuya Matsuura^c, Koichi Sairyo^a,

a Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan

b Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan

c Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan

d Department of Orthopedics, Takamatsu Red Cross Hospital, Kagawa, Japan

⁎Corresponding author: Koichi Sairyo. sairyokun@gmail.com

Received: 2026-1-31, Accepted: 2026-2-19, Published: 2026-2-20

Professor P K Surendran Memorial Education Foundation

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Patient satisfaction after total knee arthroplasty (TKA) is strongly influenced by the ability to ascend and descend stairs. Although knee extensor strength is considered essential for stair negotiation, the specific functional threshold values required for stair ascent and descent after bicruciate-stabilized (BCS) TKA remain unclear. This study aimed to identify functional factors associated with stair ascent and descent after BCS TKA and to determine cutoff values for knee extensor strength.

This prospective cohort study included 94 patients (117 knees) who underwent unilateral BCS TKA between October 2017 and January 2023. Stair ascent and descent abilities were evaluated at 1 year postoperatively using a three-step staircase. Patients were classified into a normal ability group or a reduced ability group based on their stair negotiation pattern. Knee extensor strength, knee range of motion, and demographic variables were assessed. Multiple logistic regression analyses were performed separately for stair ascent and stair descent. Cutoff values were determined using receiver-operating characteristic (ROC) curve analysis.

For stair ascent, knee extensor strength, age, and sex were independently associated with stair ascent ability. The cutoff value of knee extensor strength required for normal stair ascent was 1.04 Nm/kg (area under the curve [AUC] = 0.76). For stair descent, knee extensor strength was the only independent factor associated with performance. The cutoff value required for normal stair descent was 1.10 Nm/kg (AUC = 0.86).

Successful stair ascent and descent after BCS TKA require sufficient knee extensor strength. The identified cutoff values may serve as clinically useful reference targets for postoperative rehabilitation aimed at improving stair negotiation ability.

Abstract

Highlights

•Knee extensor muscle strength is a key functional factor associated with successful stair ascent and descent after bicruciate-stabilized total knee arthroplasty.•Patients who achieved normal stair negotiation demonstrated superior knee extensor strength compared with those with reduced stair performance.•Knee extensor strength is crucial for successful stair negotiation after BCS TKA, and identified cutoff values may guide perioperative rehabilitation.

Keywords

Knee extensor strength

Stair ascent and descent

Bicruciate-stabilized total knee arthroplasty

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1 Introduction

Total knee arthroplasty (TKA) has been reported to improve quality of life and ability to perform activities of daily living by reducing pain and improving knee function, and it has been shown to have stable and durable results.¹ However, the dissatisfaction rate after TKA continues to be about 20%.²^,³ The exact reasons for this relatively high level of dissatisfaction are not yet understood but could involve loss of normal knee kinematics after TKA. Normal knee kinematics are guided by the interaction between the cruciate ligaments, collateral ligaments, articular surface, and soft tissue.⁴ In conventional TKA, the function of the posterior cruciate ligament (PCL) is preserved or compensated for but the anterior cruciate ligament (ACL) is dissected, leaving the post-TKA knee ACL-deficient. Loss of the ACL causes paradoxical motion and insufficient stability in the mid flexion angle.⁵ Bicruciate-stabilized (BCS) TKA, which incorporates a mechanism to substitute both the ACL and PCL, was developed to solve these problems. The BCS model has an anterior cam-post and confers anterior stability because of the shape of its articular surface, and in combination with a posterior stabilizer, compensates for the functions of the ACL and PCL.⁶In fact, the percentage of patients who can ascend stairs normally (i.e., one step per stair) is significantly higher after BCS TKA.⁷ In this BCS model, the implant design may improve anterior-posterior stability of the knee.

Factors that influence patient satisfaction include the absence of residual symptoms, the fulfillment of patient expectations, and the absence of functional impairment.⁸ One of the top preoperative expectations of patients is improved ability to ascend and descend stairs.⁹ And it has also been reported that difficulty with stair movement is highly associated with patient satisfaction.¹⁰ Therefore, stair movement in TKA patients is an important movement that has high patient expectations and influences satisfaction. The postoperative outcomes may be improved further if BCS TKA can improve the ability to ascend and descend stairs.

The kinematics and kinematic properties of the knee joint during stair movement have been demonstrated by a number of biomechanical studies. In general, stairway movements require a large knee joint angle compared to level walking.¹¹^,¹² The knee joint moment during stairway motion requires a large afferent internal knee joint extension moment to lift the body during ascent and to control the body's fall speed during descent.¹²^,¹³ It is conceivable that smooth stair movement requires a secure knee joint flexion angle and a certain level of knee extension muscle strength. In a systematic review of stair climbing ability in patients with knee arthritis (OA) and TKA, higher lower limb muscle strength and less knee pain are factors associated with improved stair climbing ability in patients with knee OA.¹⁴ However, studies on TKA patients are scarce and no clear conclusions have been reached. Several studies have shown a significant correlation between stair climbing ability and knee joint extensor strength in TKA patients,¹⁵^,¹⁶ but the specific knee joint functional values required for stair ascent and descent in TKA patients remain unclear.

The purpose of this study was to identify clinically relevant knee functional factors associated with the ability to ascend and descend stairs normally after BCS TKA and to determine target cutoff values of these factors for clinical decision-making and rehabilitation planning. We hypothesized that sufficient knee extensor strength, rather than knee flexion angle alone, would be associated with successful stair ascent and descent after BCS TKA.

2 Materials and methods

This prospective cohort study included 94 patients (117 knees) who underwent bicruciate-stabilized total knee arthroplasty (BCS TKA) at a single center between October 2017 and January 2023. The study population comprised 31 men and 63 women, with a mean age of 71.8 ± 9.1 years (mean ± standard deviation). Of the included knees, 102 were diagnosed with osteoarthritis and 15 with rheumatoid arthritis. Patients who were not independent in walking or stair negotiation, had cognitive impairment, or had missing data were excluded. The study protocol was approved by the institutional ethics committee (approval number: 3184-3) and was conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical Research Involving Human Subjects. Written informed consent was obtained from all participants after they received a full explanation of the study purpose.

2.1

2.1 Surgical procedure

The surgery was performed in all patients by the same surgical team using an image-free navigation system (Precision N; Stryker, Kalamazoo, MI) or a robotic system (NAVIO Surgical System; Smith & Nephew, Memphis, TN) under general anesthesia. A standard medial parapatellar approach was used for exposure. The minimum amount of soft tissue was released to enable bone resection. Registration in the navigation and robotic system was performed based on anatomic landmarks in accordance with the manufacturer's instructions. The ACL and PCL were removed before resection of bone. The distal femur was cut perpendicular to or within ±2° minor modification to the mechanical axis in the coronal plane and at 3-5° of flexion in the sagittal plane. The proximal tibia was then resected perpendicular to or within ±2° minor modification to the mechanical axis in the coronal plane. The posterior slope of the tibia was set at 3° in the sagittal plane. Next, the extension and flexion gap was measured using implant-specific spacer blocks. Femoral rotational alignment was determined using the posterior condylar angle on the preoperative computed tomography scan to set the femoral component parallel to the surgical epicondylar axis. The Journey II BCS knee system (Smith and Nephew, Memphis, TN, USA) was then fixed using cement. Patellar resurfacing was performed in all knees.

2.2

2.2 Rehabilitation intervention

All patients underwent preoperative physical therapy intervention, which included explanation of the protocol, knee joint movement instruction, and wheelchair operation instruction. Postoperative physical therapy was provided according to the protocol for all patients until they were discharged for 2 weeks postoperatively. The protocol at our hospital was to leave the bed the day after surgery and perform knee joint range-of-motion exercises and quadriceps muscle strengthening exercises at the bedside. For gait, patients begin walking on parallel bars and with a walker as early as possible after surgery. Walking with a cane and stairway exercises are performed at 1 week postoperatively.

2.3

2.3 Assessment of knee function and stair ascent and descent performance

Knee function and the ability to perform stair ascent and descent were assessed preoperatively and at 1 year postoperatively. The range of motion of the knee joint was measured in the dorsal recumbent position using a goniometer. Knee extensor strength on the operated side was assessed by measuring isometric knee extension torque at 60° of knee flexion twice using a BDX-4 device (Biodex Medical Systems, Shirley, NY, USA); the maximum value was standardized by body weight and used for analysis. The 2011 Knee Society Score (KSS) was used for patient-reported assessment. The patient-derived score of the 2011 KSS consists of four domains: symptoms, patient satisfaction, patient expectations, and functional activities. A three-step staircase with a step height of 20 cm was used to evaluate stair ascent and descent performance (Fig. 1). A single handrail was permitted to reduce the risk of falling. Participants were classified into two groups based on their ability to perform stair ascent and descent using a step-over-step pattern with the operated limb at a self-selected walking speed: those unable to perform the task (reduced ability group) and those able to perform the task (normal ability group).Background characteristics, including age, sex, and body mass index, were also recorded.

Evaluation of stair ascent and descent movement patterns. (a) Ascending stairs. (b) Descending stairs. Stair ascent and descent were evaluated using a three-step staircase with a step height of 20 cm. Participants ascended and descended the stairs at a self-selected speed using the operated limb. Use of a single handrail was permitted to reduce the risk of falling. Stair movement was classified as a one-step-at-a-time pattern or a reduced ability pattern.

2.4

2.4 Statistical analysis

For statistical analysis, the Shapiro-Wilk test was performed for each group of continuous variables, and subsequent tests were selected on the basis of the results. A corresponding t-test was used to compare measurements before and after surgery. The t-test or Fisher's exact test was used to compare measurements between the reduced and normal ability groups when negotiating stairs. Multiple logistic regression analysis was performed using the stair negotiation pattern as the dependent variable and age, sex, knee joint extensor strength, and knee joint flexion angle as independent variables. The variance inflation factor was also calculated for assessment of multicollinearity among the independent variables. Finally, the point with the maximum sensitivity and specificity on the receiver-operating characteristic curve was set as the cutoff value for each relevant factor selected by multivariate analysis. The functional knee joint factor that enabled normal ascent and descent of stairs one step at a time was selected. All statistical analyses were performed using R software (version 2.5.1; R Foundation for Statistical Computing, Vienna, Austria). A p-value of 0.05 was considered statistically significant. Sample size was determined based on a power analysis using G power 3.1 software. A priori power analysis indicated that 21 knees were sufficient (α = 0.05, power level = 0.8, effect size = 0.25).

3 Results

Table 1 shows the postoperative changes in knee joint function and stair negotiation pattern for the 94 patients (117 knees) who underwent BCS TKA during the study period. Knee joint extension and flexion angles were significantly increased after surgery. The proportion of patients who could ascend and descend stairs normally one step at a time increased significantly (p < 0.05). All four 2011 KSS items showed significant differences between preoperative and postoperative (p < 0.05). Basic characteristics and knee joint function are shown according to postoperative stair ascent pattern in Table 2. The normal ability group for ascend stairs had 93 knees, and the group with reduced ability had 24 knees. Age was significantly younger in the normal ability group than in the reduced ability group (p < 0.05). The percentage of men was significantly higher in the normal ability group than in the reduced ability group (p < 0.05). Knee extension strength and functional activity score in 2011 KSS were significantly greater in the normal ability group than in the reduced ability group (p < 0.05). Basic characteristics and knee joint function are compared according to postoperative stair descent pattern in Table 3. The normal ability group for stair descent movements had 58 knees, and the group with reduced ability had 59 knees. The percentage of men was significantly greater in the normal ability group than in the reduced ability group (p < 0.05). The knee flexion angle, knee extension strength satisfaction score and functional activities score in 2011 KSS were significantly greater in the normal ability group than in the reduced ability group (p < 0.05). The variance inflation factor between the independent variables for both ascent and descent of stairs was less than 5, indicating no multicollinearity. The results of logistic regression analysis with postoperative stair ascent pattern as the dependent variable and knee extension strength, sex, and age as the independent variables are shown in Table 4. Factors significantly associated with postoperative stair ascent movement patterns were knee extensor strength (odds ratio [OR] 13.4, 95% confidence interval [CI] 2.3–78.4; p < 0.05), age (OR 0.9, 95% CI 0.9–1.0; p < 0.05), and male sex (OR 8.5, 95% CI 1.0–72.7; p < 0.05).The results of logistic regression analysis with postoperative stair descent pattern as the dependent variable and knee extension strength, sex, knee flexion angle as independent variables are shown in Table 5. Factors associated with postoperative stair descent ability were knee extensor strength (OR 42.4, 95% CI 8.1–221.0; p < 0.05), male sex (OR 2.2, 95% CI 0.7–6.5; p = 0.17), and knee flexion angle (OR 1.0, 95% CI 1.0–1.1; p = 0.11).The cutoff value for knee joint extensor strength required to ascend stairs one step at a time was 1.04 Nm/kg (sensitivity 68.8%, specificity 75.0%) (Fig. 2). The cutoff value was 1.1Nm/kg for knee extension strength required to descend stairs one step at a time (sensitivity, 84.5%; specificity, 79.7%) (Fig. 3).

Table 1 Clinical variables before and after total knee arthroplasty.

	Before surgery	After surgery	p-value
Knee extension angle, degrees	−8.6 ± 7.8	−1.1 ± 3.7	<0.05
Knee flexion angle, degrees	118.9 ± 13.2	124.2 ± 11.1	<0.05
Knee extensor strength, Nm/kg	1.1 ± 0.5	1.2 ± 0.5	<0.05
2011 knee society score
Current knee symptom, score	6.6 ± 4.6	19.9 ± 4.8	<0.05
Satisfaction, score	14.6 ± 5.8	29.5 ± 6.8	<0.05
Expectation, score	13.2 ± 1.5	10.3 ± 2.5	<0.05
Functional activities, score	34.4 ± 15.3	68.8 ± 16.9	<0.05
Ascending stairs one step at a time,%	40.2	79.5	<0.05
Descending stairs one step at a time,%	9.4	49.6	0.13

Table 2 Demographic and clinical variables according to the ability to ascend stairs.

	Reduced ability group(N = 24knees)	Normal ability group (N = 93knees)	p-value
Age, years	75.9 ± 9.9	70.7 ± 8.6	<0.05
Male sex, %	4.2	37.2	<0.05
Body mass index, kg/m²	29.2 ± 8.4	26.3 ± 5.3	0.08
Knee extension angle, degrees	−0.8 ± 1.9	−1.2 ± 4.1	0.68
Knee flexion angle, degrees	122.7 ± 12.2	124.6 ± 10.8	0.45
Knee extensor strength, Nm/kg	0.9 ± 0.3	1.3 ± 0.5	<0.05
Satisfaction, score	27.9 ± 6.4	29.9 ± 6.8	0.19
Functional activities, score	58.9 ± 19.6	71.3 ± 15.3	<0.05

Table 3 Demographic and clinical variables according to the ability to descend stairs.

	Reduced ability group(N = 59knees)	Normal ability group (N = 58knees)	p-value
Age, years	72.6 ± 10.5	70.9 ± 7.4	0.33
Male sex, %	13.6	48.3	<0.05
Body mass index, kg/m²	28.1 ± 7.4	25.7 ± 4.1	<0.05
Knee extension angle, degrees	−1.9 ± 4.9	−0.6 ± 1.9	<0.05
Knee flexion angle, degrees	120.5 ± 12.5	127.3 ± 9.5	<0.05
Knee extensor strength, Nm/kg	1.0 ± 0.3	1.5 ± 0.4	<0.05
Satisfaction, score	28 ± 6.5	31 ± 6.7	<0.05
Functional activities, score	63.8 ± 17.3	73.8 ± 15.2	<0.05

Table 4 Results of logistic regression analysis of factors potentially affecting the ability to ascend stairs.

	Odds ratio	95% CI	p-value
Knee extension strength	13.4	2.3–78.4	<0.05
Age	0.9	0.9–1.0	<0.05
Male sex	8.5	1.0–72.7	<0.05

Table 5 Results of logistic regression analysis of factors potentially affecting the ability to descend stairs.

	Odds ratio	95% CI	p-value
Knee extension strength	42.4	8.1–221.0	<0.05
Male sex	2.2	0.7–6.6	0.17
Knee flexion angle	1.0	1.0–1.1	0.11

Receiver-operating characteristic curve used to calculate the knee extensor muscle strength required for ascending stairs. The area under the curve was 0.76. A knee extensor muscle force of 1.04 Nm/kg had the highest sensitivity (68.8%) and specificity (75.0%).

Receiver-operating characteristic curve used to calculate the knee extensor muscle strength required for descending stairs. The area under the curve was 0.86. A knee extensor muscle force of 1.10 Nm/kg had the highest sensitivity (84.5%) and specificity (79.7%).

4 Discussion

The most important finding of this study was that knee extensor strength, sex, and age were associated with the ability to ascend stairs in TKA patients after BCS, and knee extensor strength was associated with the ability to descend stairs. This is the first study to demonstrate that BCS-TKA patients need at least 1.04 Nm/kg of knee extensor strength for normal stair ascent and 1.11 Nm/kg for normal stair descent. Therefore, these results indicated that knee extensor muscle strength to support body weight is necessary for problem-free stair ascent and descent after BCS TKA.

Previous studies of the ability to negotiate stairs after TKA found that patients who could ascend and descend stairs rapidly had stronger quadriceps muscle,¹⁵^,¹⁶ which is in line with our finding that greater knee extensor strength is necessary for smooth ascent and descent of stairs. Regarding the value of their knee extension muscle strength, differences occurred between stair ascending and stair descending. It has been suggested that the functional role of the knee when ascending stairs is to propel the body forward and upward and that stability during the stance phase is preserved mainly by the extensor muscles of the lower extremities. It has been reported that the peak internal knee extension moment in normal subjects is in the range of approximately 0.5–1.5 Nm/kg during ascent of stairs.¹⁷^,¹⁸

The cutoff value for stair ascent identified in this study was also within this range and was considered to be sufficiently appropriate.¹⁹ The peak external knee joint flexion moment during stair ascent in a conventional model of posterior-stabilized (PS) TKA was reported to be 0.7-0.8 Nm/kg¹⁹.This value is below the cutoff value for knee extensor strength calculated in this study. This is because knee joint extensor muscle strength varies with step height with respect to stair ascent movements, and the step heights in this study were lower than in our study.²⁰ The quadriceps muscle, which is primarily involved in knee extension, receives more load depending on the height of the step, thus changing the muscle strength requirement.

On the other hand, when descending the stairs the speed of body descent must be controlled and the knee joint plays the largest role in this regard.²⁰^,²¹ It has been reported that the extension moment in the knee joint is changed by the vastus medialis, vastus lateralis and rectus femoris muscles to absorb the impact of descent of stairs, and that this extension moment is bimodal, with the first peak reaching 1.1 Nm/kg and the second peak reaching 1.4 Nm/kg^12,20. The cutoff value during the stair descent operation in this study was also within this range, and we believe that it was a sufficiently reasonable value. For smooth postoperative stair climbing and descending, BCS TKA patients require recovery of knee extensor strength to a level of 1.0 to 1.1 Nm/kg.

In addition to muscle strength, descent of stairs requires a large knee flexion angle. Regarding descending motion, the flexion speed increases from the end of the stance phase to the anterior swing phase at the knee and about 80°–90° of flexion allows the body to descend to a lower level.²²^,²³ Previous reports have shown that the required knee flexion angle is approximately 90° for stair ascent and 110° for descent.¹¹^,¹² In both groups of subjects in this study, the mean knee flexion angle at 1 year postoperatively was about 120°, and knee flexion angle was not detected as a factor related to stair descent motion. Men were significantly more likely to be able to descend stairs normally (i.e., one step at a time) after surgery. This finding may reflect the relationship between sex and muscle strength. In general, men have more skeletal muscle mass and are stronger than women.²⁴^,²⁵ The fact that a higher percentage of men exceeded the cutoff value of 1.1Nm/kg for knee joint extensor strength is thought to be the reason for the sex-related difference in ability to descend stairs normally.

This study has several limitations. First, the sample size was small; therefore, sex-specific cutoff values for functional knee joint factors could not be determined. Second, participants were allowed to use a handrail during stair ascent and descent to reduce the risk of falling, which may have resulted in an overestimation of their true stair negotiation ability. Third, comorbid conditions, including spinal disorders, hip or ankle joint diseases, and contralateral knee osteoarthritis, were not fully controlled for and may have influenced stair ascent and descent performance. Fourth, the evaluation focused solely on knee joint function, and functional contributions of the ankle joint, hip joint, and trunk were not assessed.

The results of this study suggest that sufficient knee joint extensor muscle strength is required to successfully perform stair ascent and descent after BCS-TKA. Previous studies have reported that the long-term postoperative improvement in knee joint extensor strength after TKA is limited to approximately 10–20% of the preoperative level and does not reach that of healthy individuals or the nonoperative level.²⁶ Therefore, performing surgery before the progression of quadriceps muscle atrophy and weakness is desirable, and strengthening knee joint extensor muscle strength is particularly important in postoperative rehabilitation. Using ROC analysis, this study identified cutoff values for knee joint extensor strength of 1.04 Nm/kg for ascending stairs and 1.10 Nm/kg for descending stairs when performed one step at a time. These values may serve as clinically relevant target levels of knee extensor strength for achieving stair negotiation ability in patients after BCS-TKA and may be useful for planning and evaluating postoperative rehabilitation programs.

Limitations and strengths of the study

This study has several limitations. First, the sample size was relatively small, which limited the ability to perform subgroup analyses and to determine sex-specific cutoff values. Second, participants were permitted to use a handrail during stair ascent and descent, which may have resulted in an overestimation of functional performance. Third, comorbidities and variations in postoperative rehabilitation adherence were not fully controlled and may have influenced the outcomes. Finally, this was a single-center study, which may limit the generalizability of the findings.

Despite these limitations, this study has notable strengths. This is one of the few studies to identify clinically meaningful knee extensor strength thresholds for stair ascent and descent after bicruciate-stabilized total knee arthroplasty. In addition, objective functional assessments were used, providing clinically applicable information that may assist in postoperative rehabilitation planning and goal setting.

5 Conclusion

Patients with bicruciate-stabilized total knee arthroplasty (BCS-TKA) require strong, weight-bearing knee extensor muscle strength to successfully perform stair ascent and descent. The cutoff values identified in this study may serve as clinically meaningful target levels of knee extensor strength to guide perioperative rehabilitation. Therefore, rehabilitation interventions aimed at strengthening knee extensor muscles before surgery and during the early postoperative period are important for improving stair negotiation ability in patients with BCS-TKA.

Ethical statement

The study protocol was approved by the institutional ethics committee (approval number: 3184-3) and was conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical Research Involving Human Subjects. Written informed consent was obtained from all participants after they received a full explanation of the study purpose.

CRediT author statement

Taiki Furumoto: Investigation, Data curation, Formal analysis, Writing – original draft.

Daisuke Hamada: Conceptualization, Methodology, Supervision, Writing – review & editing.

Keizo Wada: Investigation, Data curation, Formal analysis.

Ken Tomonari: Investigation, Data curation, Formal analysis.

Yasuaki Tamaki: Investigation, Data curation.

Shota Shigekiyo: Investigation, Data curation.

Tetsuya Matsuura: Supervision, Writing – review & editing.

Koichi Sairyo: Supervision, Writing – review & editing.

All authors have reviewed and approved the final manuscript.

Institutional ethical committee approval (for all human studies)

Funding/sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

Shan L., Shan B., Suzuki A., Nouh F., Saxena A., . Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am. 2015;97(2):156-168.
[Google Scholar]
Baker P.N., van der Meulen J.H., Lewsey J., Gregg P.J., . National joint registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the national joint registry for England and Wales. J Bone Joint Surg Br. 2007;89(7):893-900.
[Google Scholar]
Bourne R.B., Chesworth B., Davis A., Mahomed N., Charron K., . Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop. 2010;468(2):542-546.
[Google Scholar]
Victor J., Bellemans J., . Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop. 2006;452:53-58.
[Google Scholar]
Ries M.D., . Effect of ACL sacrifice, retention, or substitution on kinematics after TKA. Orthopedics. 2007;30(8 Suppl):74-76.
[Google Scholar]
Victor J., Mueller J.K.P., Komistek R.D., Sharma A., Nadaud M.C., Bellemans J., . In vivo kinematics after a cruciate-substituting TKA. Clin Orthop. 2010;468(3):807-814.
[Google Scholar]
Iriuchishima T., Ryu K., . Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019;53(5):641-645.
[Google Scholar]
Noble P.C., Conditt M.A., Cook K.F., Mathis K.B., . The john insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop. 2006;452:35-43.
[Google Scholar]
Trousdale R.T., McGrory B.J., Berry D.J., Becker M.W., Harmsen W.S., . Patients' concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74(10):978-982.
[Google Scholar]
Nakahara H., Okazaki K., Mizu-Uchi H., et al . Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren't patients satisfied? J Orthop Sci Off J Jpn Orthop Assoc. 2015;20(1):87-92.
[Google Scholar]
Andriacchi T.P., Andersson G.B., Fermier R.W., Stern D., Galante J.O., . A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62(5):749-757.
[Google Scholar]
McFadyen B.J., Winter D.A., . An integrated biomechanical analysis of normal stair ascent and descent. J Biomech. 1988;21(9):733-744.
[Google Scholar]
Novak A.C., Brouwer B., . Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults. Gait Posture. 2011;33(1):54-60.
[Google Scholar]
Whitchelo T., McClelland J.A., Webster K.E., . Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review. Disabil Rehabil. 2014;36(13):1051-1060.
[Google Scholar]
Mizner R.L., Snyder-Mackler L., . Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res Off Publ Orthop Res Soc. 2005;23(5):1083-1090.
[Google Scholar]
Yoshida Y., Mizner R.L., Ramsey D.K., Snyder-Mackler L., . Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech Bristol Avon. 2008;23(3):320-328.
[Google Scholar]
Costigan P.A., Deluzio K.J., Wyss U.P., . Knee and hip kinetics during normal stair climbing. Gait Posture. 2002;16(1):31-37.
[Google Scholar]
Nadeau S., McFadyen B.J., Malouin F., . Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clin Biomech Bristol Avon. 2003;18(10):950-959.
[Google Scholar]
Saari T., Tranberg R., Zügner R., Uvehammer J., Kärrholm J., . Total knee replacement influences both knee and hip joint kinematics during stair climbing. Int Orthop. 2004;28(2):82-86.
[Google Scholar]
Riener R., Rabuffetti M., Frigo C., . Stair ascent and descent at different inclinations. Gait Posture. 2002;15(1):32-44.
[Google Scholar]
Stacoff A., Diezi C., Luder G., Stüssi E., Kramers-de Quervain I.A., . Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture. 2005;21(1):24-38.
[Google Scholar]
Powers C.M., Boyd L.A., Torburn L., Perry J., . Stair ambulation in persons with transtibial amputation: an analysis of the Seattle LightFoot. J Rehabil Res Dev. 1997;34(1):9-18.
[Google Scholar]
Protopapadaki A., Drechsler W.I., Cramp M.C., Coutts F.J., Scott O.M., . Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals. Clin Biomech Bristol Avon. 2007;22(2):203-210.
[Google Scholar]
Delmonico M.J., Harris T.B., Visser M., et al . Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6):1579-1585.
[Google Scholar]
Ivey F.M., Tracy B.L., Lemmer J.T., et al . Effects of strength training and detraining on muscle quality: age and gender comparisons. J Gerontol A Biol Sci Med Sci. 2000;55(3):B152-B157.
[Google Scholar]
Hurley M.V., Newham D.J., . The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol. 1993;32(2):127-131.
[Google Scholar]

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[1] Shan L., Shan B., Suzuki A., Nouh F., Saxena A., . Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am. 2015;97(2):156-168.
[Google Scholar]

[2] Baker P.N., van der Meulen J.H., Lewsey J., Gregg P.J., . National joint registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the national joint registry for England and Wales. J Bone Joint Surg Br. 2007;89(7):893-900.
[Google Scholar]

[3] Bourne R.B., Chesworth B., Davis A., Mahomed N., Charron K., . Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop. 2010;468(2):542-546.
[Google Scholar]

[4] Victor J., Bellemans J., . Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop. 2006;452:53-58.
[Google Scholar]

[5] Ries M.D., . Effect of ACL sacrifice, retention, or substitution on kinematics after TKA. Orthopedics. 2007;30(8 Suppl):74-76.
[Google Scholar]

[6] Victor J., Mueller J.K.P., Komistek R.D., Sharma A., Nadaud M.C., Bellemans J., . In vivo kinematics after a cruciate-substituting TKA. Clin Orthop. 2010;468(3):807-814.
[Google Scholar]

[7] Iriuchishima T., Ryu K., . Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019;53(5):641-645.
[Google Scholar]

[8] Noble P.C., Conditt M.A., Cook K.F., Mathis K.B., . The john insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop. 2006;452:35-43.
[Google Scholar]

[9] Trousdale R.T., McGrory B.J., Berry D.J., Becker M.W., Harmsen W.S., . Patients' concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74(10):978-982.
[Google Scholar]

[10] Nakahara H., Okazaki K., Mizu-Uchi H., et al . Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren't patients satisfied? J Orthop Sci Off J Jpn Orthop Assoc. 2015;20(1):87-92.
[Google Scholar]

[11] Andriacchi T.P., Andersson G.B., Fermier R.W., Stern D., Galante J.O., . A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62(5):749-757.
[Google Scholar]

[12] McFadyen B.J., Winter D.A., . An integrated biomechanical analysis of normal stair ascent and descent. J Biomech. 1988;21(9):733-744.
[Google Scholar]

[13] Novak A.C., Brouwer B., . Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults. Gait Posture. 2011;33(1):54-60.
[Google Scholar]

[14] Whitchelo T., McClelland J.A., Webster K.E., . Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review. Disabil Rehabil. 2014;36(13):1051-1060.
[Google Scholar]

[15] Mizner R.L., Snyder-Mackler L., . Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res Off Publ Orthop Res Soc. 2005;23(5):1083-1090.
[Google Scholar]

[16] Yoshida Y., Mizner R.L., Ramsey D.K., Snyder-Mackler L., . Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech Bristol Avon. 2008;23(3):320-328.
[Google Scholar]

[17] Costigan P.A., Deluzio K.J., Wyss U.P., . Knee and hip kinetics during normal stair climbing. Gait Posture. 2002;16(1):31-37.
[Google Scholar]

[18] Nadeau S., McFadyen B.J., Malouin F., . Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clin Biomech Bristol Avon. 2003;18(10):950-959.
[Google Scholar]

[19] Saari T., Tranberg R., Zügner R., Uvehammer J., Kärrholm J., . Total knee replacement influences both knee and hip joint kinematics during stair climbing. Int Orthop. 2004;28(2):82-86.
[Google Scholar]

[20] Riener R., Rabuffetti M., Frigo C., . Stair ascent and descent at different inclinations. Gait Posture. 2002;15(1):32-44.
[Google Scholar]

[21] Stacoff A., Diezi C., Luder G., Stüssi E., Kramers-de Quervain I.A., . Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture. 2005;21(1):24-38.
[Google Scholar]

[22] Powers C.M., Boyd L.A., Torburn L., Perry J., . Stair ambulation in persons with transtibial amputation: an analysis of the Seattle LightFoot. J Rehabil Res Dev. 1997;34(1):9-18.
[Google Scholar]

[23] Protopapadaki A., Drechsler W.I., Cramp M.C., Coutts F.J., Scott O.M., . Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals. Clin Biomech Bristol Avon. 2007;22(2):203-210.
[Google Scholar]

[24] Delmonico M.J., Harris T.B., Visser M., et al . Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6):1579-1585.
[Google Scholar]

[25] Ivey F.M., Tracy B.L., Lemmer J.T., et al . Effects of strength training and detraining on muscle quality: age and gender comparisons. J Gerontol A Biol Sci Med Sci. 2000;55(3):B152-B157.
[Google Scholar]

[26] Hurley M.V., Newham D.J., . The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol. 1993;32(2):127-131.
[Google Scholar]

Cutoff values of knee extensor strength for stair ascent and descent after bicruciate-stabilized total knee arthroplasty

Abstract

Abstract

Abstract