Summary

Strength-based rehabilitation may be important in order to reduce postoperative pain and improve knee-related quality of life and symptoms, however more research is needed in order to elucidate the specifics behind these strength-based programs.

Abstract

Introduction

To determine the effect of strength-based rehabilitation programs on patients who were diagnosed with a meniscal tear and underwent meniscectomy procedures.

Methods

Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as KOOS and VAS and complications were recorded. The Detsky and MINORS scores were used for all randomized controlled trials (RCTs) and non-RCTs respectively.

Results

A total of nine studies comprising 417 patients were included in this review. The mean pooled standardized mean difference in post-intervention quadriceps strength in four studies comprising 107 total patients in the exercise group was 0.238 (95% CI = -0.385-0.860, p=0.453, I2= 80.7%) compared to a value of 0.0131 (95% CI = -0.339-0.365, p=0.941, I2 = 13.7%) in three studies comprising 70 patients in the control group. The mean pooled standardized mean difference in post-intervention hamstring strength in four studies comprising 107 total patients in the exercise group was 0.157 (95% CI = -0.444-0.758, p=0.607, I2= 80.7%) compared to a difference of 0.102 (95% CI = -0.224-0.427, p=0.538, I2= 0%).in three studies comprising 70 patients in the control group. There were no significant differences in either strength measures between pre and post-intervention for both groups. The pooled standardized mean difference in total KOOS scores in four studies comprising 126 patients (3.8% loss to follow-up) in the exercise group was 1.7 (95% CI 1.4-2, P<0.001, I2=0%) compared to 0.916 (95% CI 0.46-1.34, P<0.001, I2=47%) in the control group comprising 75 patients (8.5% loss to follow-up). The mean follow-up time postoperatively was 33.3 and 36.3 weeks for the exercise and control groups respectively. KOOS scores still significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in five studies consisting of 155 patients in the exercise arm and 3.1cm to 1.9cm in the control arm in five studies comprising 59 patients.

Conclusion

Strength-based exercise programs for post-meniscectomy patients resulted in greater effect sizes on quadriceps strength and KOOS scores, while having a greater decrease in VAS scores. There was no difference in effect size with regards to hamstring strength between both programs. Physiotherapy focused on strength and neuromuscular improvements are important, and further studies, specifically a well-designed systematic RCT is necessary in order to elucidate the specifics behind what exercises to use in addition to frequency of training and range-of-motion used for each exercise.