Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review w
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SYSTEMATIC REVIEW
Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta‑Analyses Beyza Tayfur1 · Chedsada Charuphongsa1 · Dylan Morrissey1,2 · Stuart Charles Miller1
© The Author(s) 2020
Abstract Background Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. Objective To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. Design Systematic review with meta-analyses. Data Sources PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). Eligibility Criteria for Selecting Studies Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. Results A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at 75%) [38]. We used fixed (for homogenous data, I2 ≤ 25%) or random (for heterogeneous data, I2 > 25%) effects models for each meta-analysis according to the statistical heterogeneity. The magnitude of the pooled SMD was interpreted based on Cohen’s criteria, where SMD ≥ 0.8 indicated large, 0.5–0.8
Studies had to report at least one of the following neuromuscular outcome measures as the main outcome to be included: body-mass normalized muscle strength as measured by an isokinetic dynamometer or fixed force transducer, torque related outcomes such as rate of torque development, torque variability or electromechanical delay, muscle size or volume, voluntary activation deficits as measured by central activation ratio or twitch interpolation technique, spinal reflex excitability, or corticomotor excitability as measured by active motor threshold. We defined neuromuscular as including muscle size or volume, spinal reflex excitability and corticomotor excitability although we are aware that others may define it as outcomes specifically related to the force-generating capacity of the muscles.
2.4 Methodological Quality Assessment Risk of bias of the included studies was assessed using a modified version of the Downs and Black checklist [33, 34], a methodological quality assessment tool for both randomised and non-randomised interventional studies with high internal consistency and inter-rater reliability [33]. The modified version consists of 15 questions, excluding
2.6 Data Analysis
moderate, and 0.2–0.5 small effect sizes [39]. Potential publication biases were also examined by funnel plots for metaanalyses when 10 or more studies were included [37]. Level of evidence was reported
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