Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything

Abstract

Background: It remains unclear as to why patellofemoral pain (PFP) appears in some patients after knee arthroscopy and what influence the quadriceps muscle has on its onset. Purpose: To compare muscle thickness, neuromuscular contractility, and quadriceps femoris muscle strength between patients who develop PFP after arthroscopic partial meniscectomy and a control group and to compare functional outcomes between these entities. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective longitudinal cohort study was carried out on patients scheduled for arthroscopic partial meniscectomy. Patients were excluded if they had preoperative PFP, previous knee surgery, or additional surgical procedures (eg, meniscal repair or microfracture). The following were performed preoperatively: magnetic resonance imaging to quantify muscle thickness, surface electromyography to analyze electrical contractility, and an isokinetic study to assess the strength of the quadriceps femoris muscle. Patients also completed a Lysholm functional questionnaire. Six weeks after the index procedure, patients were questioned about the presence of PFP, and the same tests were repeated. The PFP group included patients who developed anterior knee pain postoperatively, while the control group included those who did not develop pain. Results: Of 90 initial study patients, 20 were included in the PFP group (23.8%) and 64 in the control group (76.2%); 6 patients were lost to follow-up. Both study groups were comparable on all of the analyzed preoperative variables. Patients in the PFP group had worse results in terms of muscle thickness (9.67 vs 16.55 cm2), electrical contractility (1226.30 vs 1946.11 µV), and quadriceps strength (12.27 vs 20.02 kg; all P < .001). They also presented worse functional results on the Lysholm score (63.05 vs 74.45; P < .001). Conclusion: Patients who developed PFP after arthroscopic partial meniscectomy had more quadriceps femoris muscle atrophy as well as a greater decrease in electrical contractility and muscle strength at 6 weeks postsurgically as compared with a control group. The PFP group also had worse postoperative functional results.

Preoperative muscle thickness influences muscle activation after arthroscopic knee surgery

“…It is likely that there are a wide range of factors involved in the aetiology of anterior knee pain [ 10 , 32 , 33 ]. Muscle atrophy as well as the delay in the activation of the quadriceps femoris muscle have already been identified as risk factors for developing patellofemoral pain after arthroscopic knee surgery [ 1 ]. Quadriceps femoris muscle thickness has been decreased between 25 and 50% in the PFP group.…”

“…A threshold of 6 weeks was set for the measurements. It is the moment in which the incidence of patellofemoral pain increases after knee arthroscopy [ 1 , 2 ]. In general terms, although the treatment must be individualized for each patient, sixth weeks is the time point from which the patient should be able to return to play after an APM [ 16 ].…”

“…It might cause patellofemoral pain (PFP), a dreaded complication after knee surgery. It affects up to 23% of patients who undergo arthroscopic partial meniscectomy (APM) [ 1 , 5 ].…”

“…Muscle hypotrophy as well as the delayed onset of electromyographic activity of the quadriceps femoris muscle after arthroscopic partial meniscectomy predispose to the development of postoperative PFP. Furthermore, these two risk factors also predispose to worse postoperative functional results [ 1 ].…”