Effects of Arthroscopic Partial Meniscectomy on Quadriceps Strength: A Systematic Review

Abstract

Context: Arthroscopic partial meniscectomy (APM) after meniscal tear has been widely accepted and associated with quick return to activity. Unfortunately, meniscectomy is associated with risk for knee osteoarthritis, which may be attributed to postsurgical quadriceps weakness. This has important implications, as the quadriceps play a prominent role in knee stabilization and energy attenuation in the lower extremity. Objective: To determine the magnitude of interlimb quadriceps strength deficits in people with unilateral APM by systematically reviewing the current literature. Evidence Acquisition: The Web of Knowledge databases were searched on September 22, 2010, using terms meniscus OR meniscectomy AND quadriceps strength OR quadriceps weakness. Included articles were written in English, reporting means and SDs of isokinetic peak torque at 60° and 180°/s for both limbs. Evidence Synthesis: Four articles were included in the final analysis. Effect sizes and 95% confidence intervals (CI) were calculated between limbs for periods less than 1 mo, 1-3 mo, 3-6 mo, and more than 6 mo. Conclusion: Homogeneous effect sizes indicate quadriceps weakness in the involved limb. Effects were strong at less than 1 mo (d = -1.01 to -1.62), while weak to strong effects were found for 1-3 mo (d = -0.40 to -8.04) and 3-6 mo (d = -0.40 to -5.11). Weak effects were found at more than 6 mo (d = -0.30 to -0.37). Definitive effects with a CI not crossing zero were found in 65% of the data. Although APM patients return to function within weeks after surgery, prolonged quadriceps strength deficits may increase the risk of knee-joint degeneration. Furthermore, evidence of bilateral dysfunction after unilateral injury may suggest that neuromuscular deficits post-APM are greater than the interlimb differences found in this review. Further research should be conducted to determine the nature of strength deficits and the best methods for restoring strength after APM.

Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis

“…18 Additionally, partial meniscectomy has been associated with decreased quadriceps strength, which may alter lower extremity biomechanics and complicate the already decreased ability to attenuate energy at the knee. 57 We found that in patients with ACL rupture and meniscal damage, ACL-R and meniscectomy demonstrated greater prophylactic benefits in decreasing knee OA than in those with ACL-D who underwent meniscectomy.…”

Knee Extensor Muscle Strength in Middle‐Aged and Older Individuals Undergoing Arthroscopic Partial Meniscectomy: A Systematic Review and Meta‐Analysis

“…First, 5 studies failed to blind the assessor to the leg with the meniscal tear. Second, many studies (k = 6) did not account for body size when reporting strength, which we consider important as body size influences muscle strength . However, this was not considered problematic for cross‐sectional studies that compared strength to the contralateral leg, as there is no logical need to adjust for body size when comparing strength within participants.…”

Cross-Education Strength and Activation After Eccentric Exercise

“…However, despite the best efforts of clinicians and researchers to improve rehabilitative techniques, quadriceps weakness often persists long after rehabilitation concludes. [1][2][3] Given the importance of the quadriceps muscle to knee-joint health, it is critical that rehabilitation approaches that are capable of maximizing postoperative quadriceps function be identified.…”