Osteoarthritis causes quadriceps and hamstring dynapenia as

measured with DINABANG

Darío Santos1-2-3, Juan Del Castillo4, María Rene Ledezma1, Andrea Mattiozzi5, Rodrigo
Barboza6, Jorge Dominguez6, Cristina Touriño7 and Franco Simini1

1. Núcleo de Ingeniería Biomédica de las Facultades de Medicina e Ingeniería, Univ. de la República

2. Escuela Universitaria de Tecnología Médica, Facultad de Medicina, Univ. de la República, Uruguay
3. Departamento de Rehabilitación, Hospital de Clínicas, Universidad de la República, Uruguay
4. Clínica de Ortopedia y Traumatología, Facultad de Medicina, Universidad de la República, Uruguay
5. Cátedra de Medicina del Deporte, Hospital de Clínicas, Universidad de la República, Uruguay
6. MOVI Technology for Life, Montevideo, Uruguay
7 Departamento Básico de Medicina, Facultad de Medicina, Univ. de la República, Uruguay

INTRODUCTION
Knee osteoarthritis (KOA) affects the strength of both the flexion movement performed
by hamstring muscles and the extension by quadriceps. Dynapenia is usually detected
clinically by manual muscular testing, resulting in a subjective score such as the Lovett
scale [1]. The word “dynapenia” is been used since 2008 [2] and increasingly thereafter
to refer to a loss of strength (dyna=strength and penia=poverty, low content). This loss
of strength is not necessarily associated to neurologic conditions [2]. In order to
quantify dynapenia, clinicians can either use standard dynamometers for static
measurements or new devices designed specifically for the purpose, such as
DINABANG® [3][4] which includes power and torque measures.
Clinical observations of patients with knee osteoarthritis, who develop less strength [5],
led us to formulate the hypothesis that the Lovett subjective scale could be further
refined using a quantitative evaluation. To do so, we suggest doing a combination of
dynamometer and flexo-extension angular measurements using a strength, torque and
angular velocity measurement device called DINABANG [6]
The aim of the present article is to compare the isometric strength of lower limbs in
patients with ostearthritis with that of normal volunteers.
MATERIALS and METHODS
We measured the hamstring strength of both lower limbs of 10 normal volunteers (age
29,2 ± 7,3 years, BMI 23,0 ± 2,7) and 7 KOA patients (60,0 ± 4,9 years, BMI 29,6 ± 3,3
with mild to moderate symptomatic unilateral primary knee osteoarthritis, according to
Kellgren Lawrence II-III radiological classification. They all signed an informed
consent as approved by the Ethics Committee (Number 2910-21 of 29 October 2021) of
the “Hospital de Clínicas Dr Manuel Quintela”. To standardize all measurements, we
used a specially designed chair called Chakadina [7] and DINABANG® to determine
with three consecutive trials the maximum isometric strength of hamstring and
quadriceps muscles, tending towards knee flexion and towards knee extension
respectively at an angle of 60 degrees.
RESULTS
Flexion strength was 270,5 ± 17,5 N for normal volunteers and 130,3 ± 35,5 N for KOA
patients. The loss of strength of KOA patients compared to normal subjets was 52 % in
hamstring force. Extension strength was 480 ± 20,8 N for normal volunteers and 180 ±
57,0 N for KOA patients. The loss of strength of KOA patients compared to normal
subjets was 62 % in quadriceps force.

DISCUSSION AND CONCLUSION

KOA more than halves the strength of both lower limb main movements: flexion and
extension. Quadriceps loss appears somewhat more dramatic (62% loss) than hamstring
(52% lower). The age difference may also explain such difference between normal
volunteers with a mean age of 29, and KOA patients with a mean age of 60 years
Several papers have described the loss of muscular strength in KOA patients due to the
consequences of pain and other proprioceptive processes within the articulation and
around it. Our results represent an attempt to quantify such loss, or dynapenia.

Key Words: Knee, Osteoarthritis, Strength, DINABANG®

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