Persistent altered knee loading in patients with meniscectomy: A systematic review and meta-analysis

Objectives

To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy.

Design

Meta-Analysis.

Setting

Laboratory.

Participants

332 meniscectomy patients and 137 healthy controls (from 13 qualified studies)

Main outcome measures

Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs.

Results

When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = −0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = −0.024; P = 0.716) but a significantly lower KFM (ES = −0.422; P < 0.001). High heterogeneity among study ESs was observed in patients’ between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I² = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I² = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics.

Conclusion

Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.