Background and Objectives: Walking speed after total knee arthroplasty (TKA) is an important outcome. However, the effect of quadriceps tendon stiffness on walking speed remains unclear. This study aimed to clarify the influence of the amount of change in quadriceps tendon stiffness on the degree of change in walking speed before and after TKA. Materials and Methods: Sixteen patients who underwent TKA for knee osteoarthritis participated in this study (median age: 74.0 years (interquartile range: 64.5-75.8)). Shear-wave elastography was deployed to measure quadriceps tendon stiffness using Young's modulus. A motion analysis system was used to assess kinematic parameters and walking speed. Participants' knee circumference, range of motion, extension strength, one-leg standing time, walking pain level, and activity level were measured preoperatively and one year after TKA, and changes in values were calculated. We used path analysis to clarify the influence of the amount of change in the quadriceps tendon Young's modulus on the change in walking speed. Results: The quadriceps tendon Young's modulus negatively affected the knee flexion angle during swing (standardized partial regression coefficients (β) = -0.513, p = 0.042). The knee flexion angle during swing positively affected step length (β = 0.586, p = 0.017). Step length positively affected cadence (β = 0.733, p = 0.001). Step length and cadence positively affected walking speed (β = 0.563, p < 0.001, β = 0.502, p < 0.001, respectively). Conclusions: The amount of change in the quadriceps tendon Young's modulus may affect the degree of change in walking speed after TKA through the amount of change in the knee flexion angle during swing, step length, and cadence. Clinically, reducing quadriceps tendon stiffness can be addressed in rehabilitation programs to increase walking speed after TKA.
Keywords: Young’s modulus; elastography; path analysis; quadriceps tendon; total knee arthroplasty; walking speed.