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Meta-Analysis
. 2025 Jan 24;20(1):95.
doi: 10.1186/s13018-025-05495-8.

A meta-analysis of randomized controlled trials: evaluating the efficacy of isokinetic muscle strengthening training in improving knee osteoarthritis outcomes

Wanqin Guo  1   2 , Jingyang Gao  1   2 , Dawazhuoma  1   2 , Xiuling Mi  1   2 , Ciwang  3 , Bianba  4   5   6
Affiliations
Meta-Analysis

A meta-analysis of randomized controlled trials: evaluating the efficacy of isokinetic muscle strengthening training in improving knee osteoarthritis outcomes

Wanqin Guo et al. J Orthop Surg Res. .

Abstract

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease. The primary pathological manifestations of KOA include articular cartilage degeneration, joint space narrowing, and osteophyte formation, leading to a spectrum of symptoms, including joint pain, stiffness, reduced mobility, diminished muscle strength, and severe disability. We aimed to utilize a meta-analysis to evaluate the efficacy of isokinetic muscle strengthening training (IMST) as a rehabilitation treatment for KOA in lowland areas.

Methods: The study conducted a comprehensive search of the CNKI, WanFang Data, VIP Database, PubMed, Ovid MEDLINE (1946-), Cochrane Library, Embase, and CBM databases. The databases were conducted from establishing each database to September 31, 2024. The studies included were randomized controlled trials (RCTs) with participants from the plains who met the diagnostic criteria for KOA as outlined in the 2019 edition, with no restrictions on gender, age, or disease course, and no patients with advanced disease; studies where in the control group was either a non-intervention group or a group receiving treatment, other than IMST, and the experimental group received IMST alone or in addition to the treatment administered to the control group; and studies with at least two of the following outcome indicators: (i) knee flexors (Flex)/extensors (Ext) peak torque (PT), (ii) knee Flex/Ext total work (TW), (iii) knee Flex/Ext max rep total work (MRTW), (iv) knee Flex/Ext average power (AP), (v) visual analogue scale (VAS) for pain, (vi) Lequesne index (LI), (vii) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), (viii) Lysholm Knee Scoring Scale (LKSS), (ix) range of motion (ROM) of the knee joint, and (x) 6-min walk test. We systematically reviewed the RCTs in both Chinese and English and evaluated the quality of the included literature. Data were processed and analyzed using ROB 2, RevMan 5.4, Stata17, and GRADEpro. The study protocol was registered on PROSPERO (CRD42024607528).

Results: Thirty-three (46 studies, 2,860 patients) had low-to-some concerns risk. IMST significantly improved physical therapy outcomes, including knee Flex PT and knee Ext PT at an angular velocity of 60°/second (standardized mean difference 13.19 [95% confidence interval 6.44, 19.94], P = 0.0001 and 16.34 [11.47, 21.22], P < 0.00001, respectively), and 180°/second (11.17 [2.86, 19.48], P = 0.008 and 12.62 [3.49, 21.75], P = 0.0077, respectively); knee Flex TW (79.77 [49.43, 110.10], P < 0.0001), Ext TW (86.27 [58.40, 114.15], P < 0.00001), knee Flex MRTW (9.38 [3.20, 15.56], P = 0.003), knee Ext MRTW (15.52 [8.96, 22.08], P < 0.0001), knee Flex AP (8.66 [0.70, 16.61], P = 0.03), knee Ext AP (7.27 [3.30, 11.23], P = 0.0003), knee Flex ROM (10.62 [7.94, 13.30], P < 0.00001), and LKSS scores (7.90 [5.91, 9.89], P < 0.00001). Additionally, it reduced VAS scores (- 0.70 [- 0.92, - 0.49], P < 0.00001), LI scores (- 1.24 [- 1.65, - 0.83], P < 0.00001), and WOMAC scores (- 6.05 [- 10.37, - 1.73], P = 0.006). Compared to the control group, superior clinical efficacy was noted in the experimental group. The quality of evidence the studies reported was poor, mainly due to original trials with high inter-study heterogeneity and imprecise results. The therapeutic effect of IMST on KOA remained significant after rigorous testing of subgroup and sensitivity analyses.

Conclusions: In patients with KOA, IMST improves muscle strength and relieves joint pain and stiffness. However, large-scale, high-quality, randomized controlled trials with extended observation periods are urgently needed to popularize the use of IMST in KOA patients.

Keywords: Flexors and extensors; Isokinetic muscle strengthening training; Knee osteoarthritis; Muscle strength; Qinghai-Tibetan plateau.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study is a systematic review. The Research Ethics Committee of Tibet University has confirmed that no ethical approval is required. Informed Consent was obtained from all individual participants included in the study. Consent for publication: No applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the literature retrieval and screening process
Fig. 2
Fig. 2
Risk of bias graph. Review of author judgments on each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
Risk of bias summary. Review of author judgments about each risk of bias item in each included study
Fig. 4
Fig. 4
Meta-analysis of flexor peak torque (Flex PT). Analysis of patients with knee osteoarthritis (KOA) at an angular velocity of 60°/second
Fig. 5
Fig. 5
Meta-analysis of extensor peak torque (Ext PT). Analysis of patients with knee osteoarthritis (KOA) at an angular velocity of 60°/second
Fig. 6
Fig. 6
Meta-analysis of flexor peak torque (Flex PT). Analysis of patients with knee osteoarthritis (KOA) at an angular velocity of 180°/second
Fig. 7
Fig. 7
Meta-analysis of extensor peak torque (Ext PT). Analysis of patients with knee osteoarthritis (KOA) at an angular velocity of 180°/second
Fig. 8
Fig. 8
Meta-analysis of flexor total work (Flex TW) in patients with knee osteoarthritis (KOA)
Fig. 9
Fig. 9
Meta-analysis of extensor total work (Ext TW) in patients with knee osteoarthritis (KOA)
Fig. 10
Fig. 10
Meta-analysis of flexor max rep total work (Flex MRTW) in patients with knee osteoarthritis (KOA)
Fig. 11
Fig. 11
Meta-analysis of extensor max rep total work (Ext MRTW) in patients with knee osteoarthritis (KOA)
Fig. 12
Fig. 12
Meta-analysis of flexor average power (Flex AP) in patients with knee osteoarthritis (KOA)
Fig. 13
Fig. 13
Meta-analysis of extensor average power (Ext AP) in patients with knee osteoarthritis (KOA)
Fig. 14
Fig. 14
Meta-analysis of visual analog scale (VAS) scores in patients with knee osteoarthritis (KOA)
Fig. 15
Fig. 15
Meta-analysis of Lequesne Index (LI) scores in patients with knee osteoarthritis (KOA)
Fig. 16
Fig. 16
Meta-analysis of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores in patients with knee osteoarthritis (KOA)
Fig. 17
Fig. 17
Meta-analysis of Lysholm knee scoring scale (LKSS) scores in patients with knee osteoarthritis (KOA)
Fig. 18
Fig. 18
Meta-analysis of flexor range of motion (Flex ROM) in patients with knee osteoarthritis (KOA)
Fig. 19
Fig. 19
Meta-analysis of extensor range of motion (Ext ROM) in patients with knee osteoarthritis (KOA)
Fig. 20
Fig. 20
Meta-analysis of 6-Minute Walk Test (6MWT) in patients with knee osteoarthritis (KOA)
Fig. 21
Fig. 21
Funnel plot analysis with 95% confidence intervals. Selecting outcome indicators from literature with ≥ 10 articles
Fig. 22
Fig. 22
Summary of findings table: Quality of evidence in included literature assessed by GRADE
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