Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything

Jorge Amestoy; Daniel Pérez-Prieto; Raúl Torres-Claramunt; Juan Francisco Sánchez-Soler; Joan Leal-Blanquet; Jesús Ares-Vidal; Pedro Hinarejos; Joan Carles Monllau

doi:10.1177/23259671211013000

Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything

Orthop J Sports Med. 2021 Jun 29;9(6):23259671211013000. doi: 10.1177/23259671211013000. eCollection 2021 Jun.

Authors

Jorge Amestoy¹, Daniel Pérez-Prieto², Raúl Torres-Claramunt², Juan Francisco Sánchez-Soler², Joan Leal-Blanquet², Jesús Ares-Vidal³, Pedro Hinarejos², Joan Carles Monllau²

Affiliations

¹ Parc de Salut Mar, Barcelona, Spain.
² Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
³ Department for Radiology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.

Abstract

Background: It remains unclear as to why patellofemoral pain (PFP) appears in some patients after knee arthroscopy and what influence the quadriceps muscle has on its onset.

Purpose: To compare muscle thickness, neuromuscular contractility, and quadriceps femoris muscle strength between patients who develop PFP after arthroscopic partial meniscectomy and a control group and to compare functional outcomes between these entities.

Study design: Cohort study; Level of evidence, 3.

Methods: A prospective longitudinal cohort study was carried out on patients scheduled for arthroscopic partial meniscectomy. Patients were excluded if they had preoperative PFP, previous knee surgery, or additional surgical procedures (eg, meniscal repair or microfracture). The following were performed preoperatively: magnetic resonance imaging to quantify muscle thickness, surface electromyography to analyze electrical contractility, and an isokinetic study to assess the strength of the quadriceps femoris muscle. Patients also completed a Lysholm functional questionnaire. Six weeks after the index procedure, patients were questioned about the presence of PFP, and the same tests were repeated. The PFP group included patients who developed anterior knee pain postoperatively, while the control group included those who did not develop pain.

Results: Of 90 initial study patients, 20 were included in the PFP group (23.8%) and 64 in the control group (76.2%); 6 patients were lost to follow-up. Both study groups were comparable on all of the analyzed preoperative variables. Patients in the PFP group had worse results in terms of muscle thickness (9.67 vs 16.55 cm²), electrical contractility (1226.30 vs 1946.11 µV), and quadriceps strength (12.27 vs 20.02 kg; all P < .001). They also presented worse functional results on the Lysholm score (63.05 vs 74.45; P < .001).

Conclusion: Patients who developed PFP after arthroscopic partial meniscectomy had more quadriceps femoris muscle atrophy as well as a greater decrease in electrical contractility and muscle strength at 6 weeks postsurgically as compared with a control group. The PFP group also had worse postoperative functional results.

Keywords: anterior knee pain; knee arthroscopy; meniscectomy; patellofemoral pain; physical therapy; quadriceps muscle atrophy.