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Randomized Controlled Trial
. 2025 Feb 20;20(1):181.
doi: 10.1186/s13018-025-05568-8.

EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

Najla Alsiri  1   2 , Sharifa A Alshatti  3 , Maryam Al-Saffar  3 , Rashida S Bhatia  3 , Fatemah Fairouz  3 , Shea Palmer  4
Affiliations
Randomized Controlled Trial

EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

Najla Alsiri et al. J Orthop Surg Res. .

Abstract

Background: Mobilization with Movement (MWM) is an examination and management approach for correcting the intra-articular translational and rotational movements to facilitate the active physiological movement. The study aimed to determine the effects of MWM on Total Knee Arthroplasty (TKA) using a randomized controlled trial (RCT) design.

Methods: The trial is registered (ISRCTN ref: 13,028,992). A blinded examiner assessed patients at pre-surgical (before TKA), post-surgical (at 3-weeks post-TKA), 6-weeks and 6-months post-TKA. Participants were randomly assigned to receive MWM (six sessions, between 3 and 6 weeks post-TKA) plus standard rehabilitation (intervention group) or standard rehabilitation alone (control group) of outpatient rehabilitation including range of motion and strengthening exercises, cycling, gait and stair training. Outcome measures were range of motion (goniometer), pain (visual analogue scales), physical function (Timed Up and Go (TUG)), a 15-m walk test, and health status (Western Ontario and McMaster (WOMAC) Osteoarthritis Index). Change in outcome measures from post-surgical to 6 weeks and 6 months post-TKA were compared between groups. The primary outcome was change in knee flexion range of motion at 6 weeks.

Results: 84 women scheduled for TKA were randomly allocated to intervention (n = 42) or control (n = 42); mean ± (SD) age 65.1 ± 7.4 and 66.8 ± 8.9 years, respectively. The intervention group demonstrated significantly greater increase in knee flexion at both 6 weeks (median (IQR) + 10.000 (20.000) compared with + 2.500 (6.250) in the control group) and 6 months (+ 12.500 (15.000) and + 5.000 (10.000) respectively) (both p < 0.05). There were no differences between groups in secondary outcomes.

Conclusion: Introducing MWM for TKA rehabilitation has greater benefits for women post-TKA in increasing knee joint flexion range of motion than the standard rehabilitation programs in the short and medium-term. This evidence-based approach offers a promising adjunctive intervention for optimizing recovery and rehabilitation process following TKA in women. Clinicians should consider including MWM approach in post-TKA rehabilitation programs.

Level of evidence: I.

Keywords: Knee arthroplasty; Manual therapy; Mulligan approach; Range of motion; Rehabilitation; Surgery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Kuwait Ministry of Health Research Committee (ref:767/2018). Written informed consent was obtained from participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The landmarks for goniometer application; axis at the lateral femoral epicondyle, stationary arm aligned with the greater trochanter and moving arm aligned with the lateral malleolus
Fig. 2
Fig. 2
The flow diagram of the Consolidated Standards of Reporting Trials (CONSORT) demonstrates the enrolment of patients, randomization, allocation to groups, disposition status, and analysis []
Fig. 3
Fig. 3
The frequency of the used Mulligan Mobilization with Movement approach with knee flexion for the intervention group
See this image and copyright information in PMC

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