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

Authors: Michelle M. McLeod, MA, ATC, Phillip Gribble, PhD, ATC, Kate R. Pfile, PhD, ATC, Brian G. Pietrosimone, PhD, ATC.

Affiliations: Department of Kinesiology, University of Toledo, Toledo, OH

Acceptance Date: September 19, 2011

Abstract:
Context: Arthroscopic partial meniscectomy (APM) following 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 post-surgical 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 inter-limb 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 standard deviations of isokinetic peak torque at 60 and 180 °/sec 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 time periods less than 1 month, 1-3 months, 3-6 months, and greater than 6 months.  Conclusion: Homogeneous effect sizes indicate quadriceps weakness in the involved limb.  Effects were strong at less than 1 month (d= -1.01 to -1.62), while weak to strong effects were found between 1-3 months (d= -.40 to -8.04), and 3-6 months (d= -.40 to -5.11). Weak effects were found at greater than 6 months (d= -.30 to-.37).  Definitive effects with a CI not crossing zero were found in 65% of the data.  Although APM patients return to function within weeks following surgery, prolonged quadriceps strength deficits may increase the risk of knee joint degeneration. 

Furthermore, evidence of bilateral dysfunction following unilateral injury may suggest neuromuscular deficits post APM are greater than the inter-limb differences found in this review.   Further research should be conducted to determine the nature of strength deficits and the best methods for restoring strength following APM.

Keywords: knee, muscle, isokinetic dynamometry