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

Abstract

Objective. People with meniscal tears are at high risk to develop or progress to knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these individuals. The purpose of this systematic review and meta-analysis was to investigate knee extensor strength in people undergoing an arthroscopic partial meniscectomy (APM). Methods. Six databases (Medline, CINAHL, SPORTDiscus, Embase, PEDro, and AMED) were searched up to June 22, 2014. Studies that measured knee extensor muscle strength in people age ‡30 years undergoing APM for a meniscal tear and used either a healthy control group or the contralateral leg to compare knee extensor muscle strength were included. Methodological quality was assessed using guidelines from the Centre for Reviews and Dissemination.Results. Eleven studies, in which participants were predominantly male, were included (n 5 596). A moderate reduction in muscle strength was observed prior to APM compared to controls (standardized mean difference [SMD] 0.58, 95% confidence interval [95% CI] 0.04, 1.13) and continued up to 6 months postsurgery (SMD range 22.42 to 20.47). There was no difference in muscle strength at 2 years post-APM (SMD 20.01 [95% CI 20.36, 0.35]), while a moderate reduction was again apparent at 4 years post-APM (SMD 20.56, [95% CI 21.20, 0.08]) compared to controls. Conclusion. Our findings suggest that middle-aged and older individuals undergoing APM have reduced knee extensor muscle strength in the operated leg compared to control data. As meniscus pathology and knee extensor muscle weakness are risk factors for osteoarthritis, these results highlight the clinical importance of addressing muscle weakness in these individuals.

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

“…Muscle strength at three months for the first 82 patients has been previously reported 15. A recent meta-analysis of surgically treated patients found that weakness of the extensor muscle already existed in legs before surgery, and this remained largely for at least four years after surgery 16. Considering these results, we did not think that obtaining muscle function at 24 months in addition to at 12 months would have changed the interpretation of our results.…”

Effect of Knee Extensor Strength on Incident Radiographic and Symptomatic Knee Osteoarthritis in Individuals With Meniscal Pathology: Data From the Multicenter Osteoarthritis Study

“…We hypothesized that high knee extensor strength may be particularly important to delay or prevent knee OA development in participants already at higher risk of knee OA, such as those with medial meniscal pathology. Indeed, a recent systematic review and meta-analysis revealed that thighs of middle-aged and older individuals undergoing meniscal surgery show reduced knee extensor muscle strength both prior to surgery and up to 48 months after surgery (14). The results of the present study only partially confirm our hypothesis, as we observed a protective effect of high knee extensor muscle strength only for incident radiographic knee OA in women.…”

“…Knee pathology in general is known to be associated with impaired muscle function (14,15); thus individuals with a combination of knee injury or degenerative meniscal tears and low muscle strength may be at particularly high risk for knee OA. Indeed, a recent systematic review and meta-analysis reported middle-aged and older patients who had undergone meniscectomy to have impaired knee extensor strength up to 4 years post surgery (14). However, the importance of this impaired knee extensor strength in the risk for later knee OA has not been investigated in individuals with meniscal pathology.…”

Muscle assessment using multi‐frequency bioimpedance in a healthy Danish population aged 20–69 years: a powerful non‐invasive tool in sports and in the clinic

“…; Hall et al. ; Jones and Wortmann ), as well as by training/fitness level (Fiatarone et al. ; Bousquet‐Santos et al.…”

“…Praagh and Dor e 2002; Kasper 2011;Costa et al 2012;Landi et al 2012Landi et al , 2015Garatachea and Lucia 2013;Giordani and Puri 2013), presence of musculoskeletal diseases (Felin et al 2007;Henriksen et al 2009;Winters and Rudolph 2014;Colombo et al 2015;Davis et al 2015;Hall et al 2015;Jones and Wortmann 2015), as well as by training/fitness level (Fiatarone et al 1990;Bousquet-Santos et al 2006;Arnold and Bautmans 2014;Chung…”