Passive resistance of the human knee: the effect of remobilization

Changes of circumferential dimensions and passive resistance of the human knee caused by immobilization, were studied during remobilization. Patients immobilized with a long leg cast after tibial fractures or ligamentous injuries were studied immediately after removal of the cast and after mean periods of 18, 36 and 81 days of remobilization. Immobilization resulted in a decrease of circumferential dimensions. The difference in mid-thigh circumference between the immobilized and the unaffected leg was still present after 81 days of remobilization both for the patients with tibial fractures and for the remobilization both for the patients with tibial fractures and for the patients with ligamentous lesions. An increase of midpatellar circumference was present exclusively in the patients with ligamentous lesions at all four testing dates, indicating that this is an effect of the ligamentous lesion and not of immobilization per se. Variables of the hysteresis diagrams, resulting from sinusoidal movement of the knee at a range of knee angles, were used to quantify passive resistance of the knee in the flexion-extension plane (the muscles crossing the knee are inactive). Variables related to the elastic storage and release of energy, and variables related to energy dissipation were discerned. During remobilization the increased resistance to flexion (shown by the variables related to the elastic storage of energy), as found immediately after removal of the cast, disappears and the resistance becomes identical to the resistance of the unaffected leg. This may indicate a rapid readaptation of the length of ventral structures (shortened due to immobilization in a shortened position) to almost normal values.(ABSTRACT TRUNCATED AT 250 WORDS)