The biomechanical changes during sport-specific tasks and different commercially available footwear in individuals following meniscectomy

Walters, V

Abstract

Injuries to the meniscus are common particularly in sporting individuals. Traumatic meniscal tears typically occur due to a high impact twisting action on a planted foot, which can be seen in sports such as basketball, football and skiing. Competitive athletes generally agree to having a meniscectomy surgery with the objective of returning to the same level of activity as was considered normal before the injury, however the effect of returning to sport and performing sport-specific tasks has not been researched in depth following meniscectomy. Altered knee mechanics and increased knee loading, like those seen in knee osteoarthritis (OA), have been observed following a meniscectomy, therefore identifying ways to reduce knee loading and slow the progression of OA are a priority. Individuals following meniscectomy have been reported to be 15 times more likely to develop knee OA compared to the general healthy population. Whilst it is well researched that medial partial meniscectomies result in the onset of medial (OA), little is known about the biomechanical effects following lateral meniscectomy in comparison to individuals following medial meniscectomy. Therefore, an improved understanding of biomechanical changes following medial and lateral meniscectomy, specifically during both functional and sport-specific tasks is vital and whether approaches such as the use of different footwear have an influence to aid in offloading the knee.

To develop a robust and reliable test protocol for the investigation of the biomechanical outcomes in individuals following meniscectomy, a repeatability study was performed, which enabled the development of a protocol that was applied in the following studies of the thesis. The BOOM study investigated biomechanical and clinical outcomes following meniscectomy surgery in 29 individuals following both medial and lateral meniscectomy in comparison to 20 healthy controls. It was found that there were few differences when comparing individuals following medial and lateral meniscectomy, therefore the sub-groups were combined to analyse the knee joint loading. Knee loading was increased in the early stages of rehabilitation during walking, running and landing, highlighting initial effects of non-effective rehabilitation with muscle weakness, stiffness in joint motion and kinesiophobia, which may have the potential to lead on to knee joint degeneration.

Lastly, the Meni-Foot study looked at the use of three different types of footwear including cushioning footwear, stability footwear and lateral wedge footwear in comparison to neutral footwear, to find a way to offload the affected compartment of the knee and slow the risk of OA progression, specifically in a young active population. Lateral wedge footwear was found to offload the medial compartment of the knee and aid individuals following medial meniscectomy, however further research needs to be done looking at a more comfortable shoe with a lateral wedge to offload the medial compartment and a greater medial arch support to offload the lateral compartment whilst considering pain and motion during dynamic tasks.

To summarise the findings in this thesis, other than greater trunk lean in the lateral meniscectomy during walking, there were no significant differences in knee loading between individuals following a medial meniscectomy and individuals following a lateral meniscectomy. The lack of differences in knee loading between medial and lateral meniscectomy groups was unexpected, however it suggested combining groups in the short-term period following surgery was applicable. Individuals on average 6 months post-meniscectomy showed reduced balance, isometric strength and self-reported function. Individuals showed a quadriceps avoidance strategy, with altered muscle activation, stiffer movement patterns and greater kinesiophobia compared to healthy controls. Non-invasive interventions such as lateral wedge footwear can be used to offload the medial compartment of the knee during walking and therefore, could be beneficial for individuals following medial meniscectomy. Further research needs to be done on sport specific tasks and different footwear conditions depending on which compartment of the knee it aims to offload.

Citation

Walters, V. The biomechanical changes during sport-specific tasks and different commercially available footwear in individuals following meniscectomy. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: May 7, 2021
• Publicly Available Date: May 7, 2021
• Award Date: Sep 20, 2020