Abstract
Quadriceps neuromuscular function remains impaired in the short- and long-term following knee arthroscopy for meniscal surgery and/or anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare quadriceps neuromuscular impairments in patients following meniscal surgery with and without ACL reconstruction. Thirty patients were tested six months after meniscal surgery with (n = 15) and without (n = 15) ACL reconstruction. We bilaterally assessed knee extension maximal voluntary contraction (MVC) torque using dynamometry, vastus lateralis thickness using ultrasound, quadriceps voluntary activation and evoked knee extension torque with transcutaneous electrical stimulation. Patient-reported outcomes were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Compared with meniscus patients, ACL patients demonstrated larger asymmetries in MVC torque (15% vs. 5%, p = 0.049) and vastus lateralis thickness (6% vs. 0%, p = 0.021). In ACL patients, asymmetries in MVC torque correlated with asymmetries in evoked torque (r = 0.622, p = 0.013). In meniscus patients, asymmetries in muscle activation correlated with KOOS quality of life (r = 0.619, p = 0.018). Patients demonstrated persistent quadriceps muscle weakness six months after ACL reconstruction, but not after isolated meniscal surgery. Quantitative and/or qualitative muscular changes likely underlie quadriceps muscle weakness in ACL patients, whereas activation failure is associated with poor quality of life in some meniscus patients.
Highlights
Arthroscopic surgery of the knee joint is routinely used for the management of young adults with knee injuries, such as meniscal and/or anterior cruciate ligament (ACL) tears
Impairments in quadriceps neuromuscular function were reported to persist at short- and long-term follow-ups after ACL surgery, without differentiating between patients who had isolated ACL reconstruction, and patients who had an associated meniscal treatment [2,3]
In ACL + M patients, significant side-to-side asymmetries were found for maximal voluntary contraction (MVC) torque (2.85 vs. 3.40 Nm/kg, -15%, p = 0.001), vastus lateralis thickness (2.47 vs. 2.64 cm, -6%, p = 0.009) and evoked torque (0.97 vs. 1.06 Nm/kg, −8%, p = 0.014)
Summary
Arthroscopic surgery of the knee joint is routinely used for the management of young adults with knee injuries, such as meniscal and/or anterior cruciate ligament (ACL) tears. Impairments in quadriceps neuromuscular function were reported to persist at short- and long-term follow-ups after ACL surgery, without differentiating between patients who had isolated ACL reconstruction, and patients who had an associated meniscal treatment [2,3]. Short- and long-term impairments in quadriceps function were observed following isolated arthroscopic meniscal procedures [4,5]. Regardless of knee injury and associated surgical procedures, a quick recovery of quadriceps neuromuscular function through specific and effective rehabilitation protocols is of concern in this population of young and active patients. Patients with ACL injuries are subjected to larger unloading conditions than patients with isolated meniscal lesions, both before surgery—due to the larger physical dysfunction associated with ACL rupture/tear—and during postoperative rehabilitation due to the invasiveness of the surgical procedures
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