Knee Joint and Quadriceps Dysfunction in Individuals With Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Meniscus Surgery: A Cross-Sectional Study

Abstract

Context: While arthrogenous muscle inhibition associated with knee injuries is evident, the relative magnitude of functional deficiency related to each individual knee pathology is unclear. Objective: To compare the knee joint and quadriceps dysfunction among patients with anterior knee pain (AKP) without surgical history and those with surgical history (anterior cruciate ligament reconstruction [ACLR]; meniscus surgery) without current AKP, with matched healthy controls. Design: Cross-sectional study. Setting: Laboratory. Participants: A total of 66 patients with knee pathologies and 30 controls. Main Outcome Measures: Pain perception and lower-extremity functional outcomes were assessed. Knee joint function was measured by replication tests. Quadriceps function was measured by strength, voluntary activation, and torque-generating capacity. Results: Patients with AKP reported greater pain perception compared with the other knee conditions (4.3 vs 0.1 of 10 in Numeric Pain Rating Scale, P < .0001). Compared with the controls: (1) patients with AKP showed a greater error on knee-flexion replications at 75° (2.9° vs 5.4°, P = .002), (2) patients with AKP and ACLR showed less quadriceps strength (AKP: 3.3 vs 2.6 N·m/kg, P = .002; ACLR: 3.3 vs 2.7 N·m/kg, P = .02) and voluntary activation (AKP: 0.982 vs 0.928, P < .0001; ACLR: 0.982 vs 0.946, P = .003), and (3) all knee pathologies reported lower scores on functional outcomes (79 vs 65 of 80 points in Lower-Extremity Functional Scale, P < .0001) and showed less quadriceps torque-generating capacity (10.7 vs 7.8 N·m/s/kg, P < .0001). Among the knee pathologies, patients with AKP showed less quadriceps voluntary activation compared with the patients with meniscus surgery (0.928 vs 0.964, P = .03). Conclusion: As patients with AKP had an additional impairment in knee joint flexion replications and reported a less score in functional outcomes, knee pain may produce a greater impact on functional deficiency.