Neuromuscular Function after Arthroscopic Partial Meniscectomy

Abstract

Background Quadriceps muscle strength, which is essential for the function and stability of the knee, has been found to be impaired even years after arthroscopic partial meniscectomy. However, the neuromuscular alterations that could account for such muscle weakness remain unclear. Questions/purposes We investigated (1) the side-to-side asymmetries in quadriceps muscle strength 6 months after arthroscopic partial meniscectomy, (2) the physiologic mechanisms (neural versus muscular) underlying muscle weakness, and (3) the impact of quadriceps weakness on muscle control at submaximal force levels. Patients and Methods We tested 14 volunteers (10 men, four women) with an average age of 44 ± 9 years (range, 24-59 years) at 6 ± 1 months after unilateral medial arthroscopic partial meniscectomy. We measured maximal voluntary strength and muscle activation during isometric, concentric, and eccentric contractions using isokinetic dynamometry and surface EMG, respectively. We assessed vastus lateralis muscle size and architecture using ultrasonography. We measured muscle control at submaximal force levels with a repositioning test (knee proprioception) and a low-force target-tracking task (steadiness, accuracy). Results Isometric and concentric quadriceps strength and vastus lateralis EMG activity were lower on the involved than on the uninvolved side. Muscle architecture and muscle control did not differ between the involved and uninvolved sides. Conclusions Our results showed quadriceps weakness exists 6 months after arthroscopic partial meniscectomy. As suggested by the EMG results, this is likely attributable to neural impairments (activation failure) that affect muscle control at maximal but not submaximal force outputs.

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

“…We attempted to contact via e-mail authors of 3 studies that only reported means and standard deviations in figures. 12,13,15 If we could not contact authors after several attempts, we excluded studies that did not report specific numeric means and standard deviations ( Figure 1). 12,15 Previously unpublished data were secured from 1 of the authors 13 contacted, resulting in 4 studies 3,9,11,13 included in our final analysis.…”

“…The skewedness of the funnel plot may be attributed to smaller studies with greater variability showing the largest effect sizes. 22 Among the studies we included in our analyses, the studies with the largest 11 and smallest 13 sample size appeared toward the base of our funnel with small effect sizes. Furthermore, the Gapeyeva et al 3 study appearing at the top of the funnel plot incorporated the smallest sample size and exhibited the greatest variance, likely contributing to the skewed nature of the funnel plot.…”

“…2,5,6,9 It has been reported that hamstrings strength resolves quickly after APM, yet quadriceps strength is markedly decreased immediately after APM, and weakness may persist long after the injury. 2,3,[9][10][11][12][13][14][15][16] APM patients often return to sport and activities of daily living weeks after surgery even in the presence of these neuromuscular quadriceps deficits. 17 The quadriceps play a critical role in joint stability and dynamic function at the knee, including force attenuation and resisting knee-adduction moments during the stance phase in walking gait.…”

“…3,11,18,19 Prolonged strength deficits may result in altered gait patterns and instability that can predispose individuals post-APM to reinjury and may accelerate joint degeneration. 2,3,9,11,13 Identifying these deficits and appropriate methods to restore quadriceps strength remains a concern in the rehabilitation process of individuals who may return to activity shortly after APM. Previous literature has reported that quadriceps neuromuscular control may be decreased long after injury is resolved.…”

The Effectiveness of Postoperative Physical Therapy Treatment in Patients Who Have Undergone Arthroscopic Partial Meniscectomy: Systematic Review With Meta-analysis

“…42 Despite the minimally invasive nature, studies have shown that patients undergoing arthroscopic meniscectomy have pain, effusion, loss of range of motion (ROM), functional changes, neuromuscular and biomechanical changes, loss of quadriceps muscle strength, and a reduced quality of life. 5,8,12,13,27,30,31,33 Herrlin et al 17 showed that for middleaged patients with simple lesions in the meniscus, physical therapy has yielded T T STUDY DESIGN: Systematic review with metaanalysis.…”