Abstract
BackgroundMeniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy.Methods/design62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters.DiscussionThe findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during various tasks in people with a partial medial meniscectomy. If shown to reduce the knee adduction moment, neuromuscular exercise has the potential to prevent the onset of osteoarthritis or slow its progression in those with early disease.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12612000542897
Highlights
Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group
Accumulating magnetic resonance imaging (MRI) data suggest that structural changes begin soon after arthroscopic partial meniscectomy (APM)
The peak external knee adduction moment (KAM) during a one-leg rise is included as a primary outcome considering it is a challenging task that pilot research has shown can be reduced following a neuromuscular training intervention [36]
Summary
There is a need to assess the effect of neuromuscular exercise on knee joint loading [66]. The peak external KAM was chosen as a primary outcome during normal pace walking for two reasons This parameter has been previously shown to be elevated post-APM relative to healthy controls [18] and secondly because of its association with medial compartment knee joint load and knee OA progression [20,25]. Two parameters of KAM are of interest, the peak KAM and KAM impulse during tasks of varying difficulty (walking, one-leg rise, one-leg hop for distance) These tasks were chosen to determine if medial knee joint load regardless of task can be reduced following this neuromuscular program. Summary This study uses a randomised controlled design to investigate the effect of a neuromuscular exercise program delivered by physiotherapists on medial knee joint load post-APM. All authors provided feedback on drafts of this manuscript and have read and approved the final paper
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call