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Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies

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Abstract

Purpose of Review

To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes.

Recent Findings

Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures. These facts underscore the need for continued investigation into the potential detrimental effects of regional anesthetic and intraoperative tourniquet use on postoperative quadriceps function, with an outward focus on innovation within the field of postoperative rehabilitation. Neuromuscular stimulation, nutritional supplementation, cryotherapy, blood flow restriction (BFR), and open-chain exercises are all potential additions to postoperative regimens. There is compelling literature to suggest that these modalities are efficacious and may diminish the magnitude and duration of postoperative QD.

Summary

A clear understanding of QD, with respect to its pathophysiology, should guide perioperative treatment and rehabilitation strategies and influence ongoing rehabilitation-based research and innovation. Moreover, clinicians must appreciate the magnitude of QD’s effect on diminished clinical outcomes, risk for re-injury and patients’ ability (or inability) to return to pre-injury level of activity following knee joint preservation procedures.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA

    Daniel J. Cognetti, Thomas B. Lynch & Andrew J. Sheean

  2. Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA

    Elizabeth Rich

  3. Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    Asheesh Bedi

  4. Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State Health, Hershey, PA, 17033, USA

    Aman Dhawan

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Contributions

All authors contributed substantially to the manuscript. Andrew Sheean conceptualized the article. Literature search, review, analysis, and manuscript organization were performed by Daniel Cognetti, Thomas Lynch, and Elizabeth Rich. Daniel Cognetti and Elizabeth Rich were responsible for manuscript drafting, with Asheesh Bedi, Aman Dhawan, and Andrew Sheean critically revising the work. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Daniel J. Cognetti.

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Conflict of Interest

DJC: Reports being an editorial board member for Arthroscopy Journal, a board member for the AAOS Resident Assembly and being a co-investigator on a grant investigating blood flow restriction therapy following ACLR. TBL: Reports no disclosures. ER: Reports no disclosures. AB: Reports being a board or committee member for the American Orthopaedic Society for Sports Medicine, receives intellectual property royalties and is a paid consultant for Arthrex, Inc, receives publishing royalties from SLACK Incorporated and Springer. AD: Reports being a board or committee member for the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America and Orthopaedic Journal of Sports Medicine, is a paid consultant for Avenue Therapeutics, Biomet, Smith & Nephew, is a paid speaker for Arthrex, Inc., Biomet and Smith and Nephew and receives other financial or material support from DJ Orthopaedics and Stryker. AJS: Reports being a board or committee member for the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Society of Military Orthopaedic Surgeons and reports research support from Embody, Inc. and being a primary investigator on a grant investigating blood flow restriction therapy following ACLR.

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Cognetti, D.J., Lynch, T.B., Rich, E. et al. Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies. Curr Rev Musculoskelet Med 16, 338–345 (2023). https://doi.org/10.1007/s12178-023-09844-0

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