Assessment of Quadriceps Femoris Muscle Function in Patients After Arthroscopic Knee Surgery in Outpatient Rehabilitation

Measuring thigh circumference using a centimeter tape (cm) is a simple yet effective way to track changes in muscle mass, body composition, or to monitor progress. In order to obtain accurate data, the distance between the anterior angle of the iliac wing and the upper edge of the patella is measured with a centimeter tape. Mark the point: ⅓ from the edge of the patella. At the marked point, the thigh circumference is estimated with a centimeter tape, the measurement is repeated 3 times, and the average of the measurements is derived.

Ultrasound (Mindray DC-80a device) Subject position: During the study, the subject lies on his back, with the knee joints in 15° passive flexion (a cushion is used under the knee joints). During the study, the participants were instructed to relax the thigh muscles. Measurements are performed after the subject has been in a horizontal position for 5 min., to determine the distribution of body fluids [Berg et al., 1993]. Assessment methodology: in order to obtain accurate data, the distance between the greater trochanter of the femur and the upper edge of the patella is measured with a centimeter tape. A point is marked in the distal quarter (75% of the total distance). At the marked point, the ultrasound transducer is placed perpendicular to the longitudinal axis of the thigh on the medial surface, the edge of the quadriceps muscle VM is visualized, and from the starting point, a continuous single image is scanned with the transducer traveling transversely across the thigh along the m

is performed using an ultrasound device (Mindray, DC-80a), in order to obtain accurate data, the distance between the greater trochanter of the femur and the upper edge of the patella is measured with a centimeter tape. A point is marked in the distal quarter (75% of the total distance). At the marked points, the ultrasound transducer is placed perpendicular to the longitudinal axis of the thigh. At the mentioned points, the heads of the quadriceps muscle are visualized, with clear contours, and the image is captured. The image is processed by the ImageJ program, and the visual quantitative scale (VAS echogenicity) is evaluated from 0 to 100.

Quadriceps muscle strength will be assessed manually using a manual muscle testing device - Lafayette. Measurements are performed with the subject sitting; the back is supported, the pelvis and knees are bent at an angle of 90°. Then the subjects voluntarily perform 3 consecutive maximal voluntary extensions through the knee joint. (contraction time 3 sec., rest time 7 sec.), the highest value during the assessment was considered the maximal force.

Pain at rest and during movement will be assessed using the visual analogue scale (VAS)-a line marked with dashes and marked with 11 numbers, from 0 to 10. The subject will be asked to mark a number that indicates the intensity of the pain experienced. Pain is assessed on a scale of 0 to 10, where 0 is no pain, 1, 2, 3 is mild pain, 4, 5, 6 is severe pain, 7, 8, 9 is very severe pain, and 10 is unbearable pain.

Active range of motion through the joints is measured with a plastic goniometer (SEAHAN® Grid, 360° per 1° 20 cm) using the neutral zero method. The minimum significant change in range of motion is 5°. The measurements will be repeated three times. After adding all the results obtained during one measurement, the arithmetic mean is calculated.

The test was used to assess the level of physical fitness. Subjects were asked to walk at their usual maximum pace along a 30-meter long, level, straight hospital corridor without encouragement. The test measured the distance the patient walked in 6 minutes.

The European Quality of Life and Health Status Questionnaire (EQ-5D-3L) is a standardized quality of life and health status assessment scale developed by the international EuroQoL group. This questionnaire consists of two parts: i. a descriptive part of 5 questions, in which the subject rates his/her health status in 5 dimensions: mobility, self-care, usual activities, pain or discomfort, anxiety or depression, choosing from three options (no problems, some problems or moderate pain, major problems); ii. a visual analogue scale, in which the subject is asked to rate his/her health status on a scale from 0 to 100, where 100 is the highest rating and 0 is the lowest.

Patients are asked to answer the following questions posed by the researcher:

• "Did you experience any discomfort/pain during the procedure?"
• "What was the intensity of the discomfort/pain during the stimulation and for the first 2-3 hours after the stimulation" (subjects were asked to rate the pain on the VAS scale)
• "Do you have any other comments that are important to you about the discomfort/sensations experienced during the procedure? If so, describe them"