{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:25:28Z","timestamp":1793395528970,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Flexion contracture is a multifactorial complication after knee osteoarthritis and knee arthroplasty. Among the causes, arthrogenic muscle inhibition (AMI) has never been studied. It is a failure to achieve proper quadriceps motor activation, which can lead to flexion contracture due to hamstring contracture. In this study, we hypothesised that AMI is present in patients with knee osteoarthritis and after knee arthroplasty. The aims were to assess: (1) the prevalence of preoperative AMI, for patients without preoperative AMI, (2) the incidence of post\u2010operative AMI at 2 weeks, (3) its associated factors at 2 weeks and (4) the incidence 90 days after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An international, prospective study enroled 341 patients undergoing knee arthroplasty across three centres. 316 patients met the inclusion criteria: symptomatic knee requiring unicompartmental, total or revision arthroplasty. Twenty\u2010five patients undergoing simultaneous bilateral procedures were excluded. Among the included patients, 275 patients without preoperative AMI were analysed for post\u2010operative incidence and associated factors. AMI was assessed using the SANTI classification on the day of surgery, at 15 days, and at 3 months. One patient was lost to follow\u2010up at 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Preoperative AMI\u2009\u2265\u2009\u202f1 was observed in 13% (95% confidence interval [CI]\u2009=\u20099\u201317). At 2 weeks post\u2010operatively, AMI\u2009\u2265\u2009\u202f1 occurred in 36% (95% CI\u2009=\u200930\u201342), with 13% showing AMI\u2009\u2265\u2009\u202f2, characterised by quadriceps inhibition and flexion contracture. Female gender (odds ratio [OR]\u2009=\u2009\u202f2.81;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.002), early post\u2010operative flexion contracture attitude such as keeping the knee bent, placing a pillow under the knee, or folding the hospital bed (OR\u2009=\u2009\u202f5.89;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and high pain scores (OR\u2009=\u200913.57;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were significantly associated with AMI\u2009\u2265\u2009\u202f1 at 2 weeks. At 3 months, AMI\u2009\u2265\u20091 occurred in 12.4% (95% CI\u2009=\u20098.7\u201316.9).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AMI is a prevalent issue both pre\u2010 and post\u2010operatively. Its incidence underscores the relevance of this condition; it should be considered in the management of post\u2010operative flexion contracture in knee arthroplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, observation cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12804","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T11:23:47Z","timestamp":1753356227000},"page":"3873-3883","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4249-5329","authenticated-orcid":false,"given":"Alexandre","family":"Le Guen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery H\u00f4pital Pierre Paul Riquet, CHU de Toulouse Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9124-3774","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Parratte","sequence":"additional","affiliation":[{"name":"International Knee and Joint Centre Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4586-9175","authenticated-orcid":false,"given":"Vincent","family":"Marot","sequence":"additional","affiliation":[{"name":"Hospital Nostra Senyora de Meritxell Les Escaldes Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9gis","family":"Pailh\u00e9","sequence":"additional","affiliation":[{"name":"Clinique Aguilera RAMSAY Sant\u00e9 Biarritz France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasnae","family":"Ben\u2010Roummane","sequence":"additional","affiliation":[{"name":"Research Methodological Support Unit (USMR), Department of Clinical Epidemiology and Public Health Toulouse University Hospital (CHU) Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"B\u00e9rard","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Public Health CERPOP, INSERM\u2010University of Toulouse III, Toulouse University Hospital (CHU) Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1043-7567","authenticated-orcid":false,"given":"Etienne","family":"Cavaignac","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery H\u00f4pital Pierre Paul Riquet, CHU de Toulouse Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2018.03.008"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelekin.2017.09.006"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.21380"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200112000-00013"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2021.08.025"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2020.09.005"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzac033"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2023.100429"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519897064"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40798-024-00710-y"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/19417381231169285"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2021.110367"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2023.103592"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1615\/CritRevBiomedEng.2013008373"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14093150"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","unstructured":"HopkinsJT IngersollCD. 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