Is There a Strength Deficit of the Quadriceps Femoris Muscle in Patients Treated Conservatively or Surgically after Primary or Recurrent Patellar Dislocations? A Systematic Review and Meta-Analysis

Abstract

Background: Patellar dislocation is a knee injury affecting generally young, active individuals, damaging joint ligaments and structures, and impacting sports activity and quality of life. Objective: This review aimed to evaluate the role of the quadriceps femoris muscle in knee extension and to consider whether extensor strength deficits are present in patients who have suffered from a primary or recurrent patellar dislocation and have been treated surgically or conservatively. Methods: This systematic literature review with meta-analysis was performed following the PRISMA Statement criteria. The search engines consulted to select studies were MEDLINE/PubMed, Scopus, and Web of Science/ISI. The JBI Critical Appraisal Checklist tools were applied for the quality assessment based on the specific study design. The outcomes were measurements of the knee extension force of the quadriceps femoris muscle, which were objectively quantifiable with an isokinetic or mobile dynamometer. Results: Of the 891 articles initially identified through the databases, 10 studies with a total of 370 patients were included in the analysis. The results indicated a strength deficit of the quadriceps in patients who had undergone a patellar dislocation, in comparison with the control group, when examining the uninvolved limb or in comparison with the pre-operative values. The overall effect size was large, with a value of -0.99. Conclusions: Our review concluded that after a primary or recurrent patellar dislocation, strength deficits of the quadriceps femoris muscle in the knee extension of the affected limb are frequently observed in surgically or conservatively treated patients. This deficit may persist even after a protracted follow-up of up to three years after injury.

Keywords: dynamometer; isokinetic; muscle strength; patellar dislocation; quadriceps femoris.

Figure 1

Flowchart of the search strategy conducted in compliance with the criteria outlined in the “Preferred Reporting Item for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines [33].

Figure 2

Forest plot of the studies assessing the recovery in quadriceps strength post intervention overall (A) and stratified based on the type of intervention—conservative or surgical (B) [45,46,48].

Figure 3

Forest plot of the studies assessing the residual deficit in quadriceps strength post-intervention compared to a control sample or to an unaffected contralateral limb, overall (A) and stratified based on the type of intervention—conservative or surgical (B) [39,40,42,44,47,48].

Figure 4

Funnel plot showing no evidence of publication bias.