Comparison of proprioception, strength, and dynamic balance between aquatic and cycling trainings after arthroscopic partial meniscectomy during early rehabilitation in young male athletes

Arthroscopic partial meniscectomy (APM) strives to preserve knee biomechanics and function after the meniscal rupture. However, patients undergoing APM experience long-term impacts like proprioceptive deficit and functional decline. This study aimed to examine and compare the effects of aquatic and leg cycling trainings on young athletes undergone APM. Ninety-seven male athletes with APM were assigned to aquatic training group (ATG, n = 49) and cycling training group (CTG, n = 48). Both intervention trainings were conducted three times a week for 6 weeks after 2 weeks of APM. The rehabilitation training was the same in each session. The International Knee Documentation Committee (IKDC) questionnaire scores, knee joint position sense, Y-balance test, and isokinetic knee strength were measured before and after the interventions. Significant improvements were observed after the trainings regarding measured variables for both ATG and CTG groups. Comparison of the two groups found that ATG group had higher scores in IKDC and Y-balance test, greater muscle power, and lower absolute error in the joint position sense test compared to the CTG group. ATG and CTG are thus considered effective training interventions in early rehabilitation phase following the APM. Moreover, ATG may be more conducive than CTG in improving subjective knee symptoms, proprioception, and muscle power.

Arthroscopic partial meniscectomy; Meniscal tear; Aquatic training; Bicycle training; Return to sports; Meniscus; Knee joint

[1] Drobnič M, Ercin E, Gamelas J, Papacostas ET, Slynarski K, Zdanowicz U, et al. Treatment options for the symptomatic post-meniscectomy knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2019; 27: 1817–1824.

[2] Başar B, Başar G, Aybar A, Kurtan A, Başar H. The effects of partial meniscectomy and meniscal repair on the knee proprioception and function. Journal of Orthopaedic Surgery. 2020; 28: 230949901989491.

[3] Rai MF, Brophy RH, Sandell LJ. Osteoarthritis following meniscus and ligament injury: insights from translational studies and animal models. Current Opinion in Rheumatology. 2019; 31: 70–79.

[4] Chambers HG, Chambers RC. The natural history of meniscus tears. Journal of Pediatric Orthopaedics. 2019; 39: S53–S55.

[5] Lee WQ, Gan JZ, Lie DTT. Save the meniscus—clinical outcomes of meniscectomy versus meniscal repair. Journal of Orthopaedic Surgery. 2019; 27: 230949901984981.

[6] Feeley BT, Lau BC. Biomechanics and clinical outcomes of partial meniscectomy. Journal of the American Academy of Orthopaedic Surgeons. 2018; 26: 853–863.

[7] Smith JH, Houck DA, Kraeutler MJ, McCarty EC, Frank RM, Vidal AF. Doctor, what happens after my meniscectomy? Journal of Bone and Joint Surgery. 2019; 101: 1965–1973.

[8] Zaffagnini S, Di Paolo S, Stefanelli F, Dal Fabbro G, Macchiarola L, Lucidi GA, et al. The biomechanical role of meniscal allograft transplantation and preliminary in-vivo kinematic evaluation. Journal of Experimental Orthopaedics. 2019; 6: 27.

[9] Abram SGF, Hopewell S, Monk AP, Bayliss LE, Beard DJ, Price AJ. Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. British Journal of Sports Medicine. 2020; 54: 652–663.

[10] Lee YS, Lee O, Lee SH. Return to sports after athletes undergo meniscal surgery: a systematic review. Clinical Journal of Sport Medicine. 2019; 29: 29–36.

[11] Khalil LS, Mehran N, Toor A, Matar RN, Kharrazi FD. National basketball association combine performance after a partial meniscectomy. Musculoskeletal Surgery. 2021; 105: 105–110.

[12] Adams BG, Houston MN, Cameron KL. The epidemiology of meniscus injury. Sports Medicine and Arthroscopy Review. 2021; 29: e24–e33.

[13] Laskowski ER, Newcomer-Aney K, Smith J. Proprioception. Physical medicine and rehabilitation clinics of north America. 2000; 11: 323–340.

[14] Malliou P, Gioftsidou A, Pafis G, Rokka S, Kofotolis N, Mavromoustakos S, et al. Proprioception and functional deficits of partial meniscectomized knees. European Journal of Physical and Rehabilitation Medicine. 2012; 48: 231–236.

[15] Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S. The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles, Ligaments and Tendons Journal. 2012; 2: 295–301.

[16] Chirichella PS, Jow S, Iacono S, Wey HE, Malanga GA. Treatment of knee meniscus pathology: rehabilitation, surgery, and orthobiologics. PM&R. 2019; 11: 292–308.

[17] Østerås H. A 12-week medical exercise therapy program leads to significant improvement in knee function after degenerative meniscectomy: a randomized controlled trial with one year follow-up. Journal of Bodywork and Movement Therapies. 2014; 18: 374–382.

[18] Prosser LA, Stanley CJ, Norman TL, Park HS, Damiano DL. Comparison of elliptical training, stationary cycling, treadmill walking and overground walking. Electromyographic patterns. Gait & Posture. 2011; 33: 244–250.

[19] Chen Y, Kim Y, Choi M. Effects of aquatic training and bicycling training on leg function and range of motion in amateur athletes with meniscal allograft transplantation during intermediate-stage rehabilitation. Healthcare. 2022; 10: 1090.

[20] Yesil M, Ozcan O, Dundar U, Toktas H, Yesil H. Aquatic vs. land-based exercise after arthroscopic partial meniscectomy in middle-aged active patients with a degenerative meniscal tear: a randomized, controlled study. Journal of Orthopaedic Science. 2023; 28: 391–397.

[21] Hajouj E, Hadian MR, Mir SM, Talebian S, Ghazi S. Effects of innovative aquatic proprioceptive training on knee proprioception in athletes with anterior cruciate ligament reconstruction: a randomized controlled trial. Archives of Bone and Joint Surgery. 2021; 9: 519–526.

[22] Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ. The international knee documentation committee subjective knee evaluation form. The American Journal of Sports Medicine. 2006; 34: 128–135.

[23] Négyesi J, Galamb K, Szilágyi B, Nagatomi R, Hortobágyi T, Tihanyi J. Age-specific modifications in healthy adults’ knee joint position sense. Somatosensory & Motor Research. 2019; 36: 262–269.

[24] Powden CJ, Dodds TK, Gabriel EH. The reliability of the star excursion balance test and lower quarter Y-balance test in healthy adults: a systematic review. International Journal of Sports Physical Therapy. 2019; 14: 683–694.

[25] Habets B, Staal JB, Tijssen M, van Cingel R. Intrarater reliability of the Humac NORM isokinetic dynamometer for strength measurements of the knee and shoulder muscles. BMC Research Notes. 2018; 11: 15.

[26] Kruel LFM, Posser MS, Alberton CL, Pinto SS, Oliveira ADS. Comparison of energy expenditure between continuous and interval water aerobic routines. International Journal of Aquatic Research and Education. 2009; 3: 9–20.

[27] Williams N. The borg rating of perceived exertion (RPE) scale. Occupational Medicine. 2017; 67: 404–405.

[28] Alansare A, Alford K, Lee S, Church T, Jung HC. The effects of high-intensity interval training vs. moderate-intensity continuous training on heart rate variability in physically inactive adults. International Journal of Environmental Research and Public Health. 2018; 15: 1508–1517.

[29] Quesada JIP, Jacques TC, Bini RR, Carpes FP. Importance of static adjustment of knee angle to determine saddle height in cycling. Journal of Science and Cycling. 2016; 5: 26–31.

[30] Liguori G, Medicine ACOS. ACSM’s guidelines for exercise testing and prescription. 11th edn. Lippincott Williams & Wilkins: Philadelphia. 2021.

[31] Gowd AK, Lalehzarian SP, Liu JN, Agarwalla A, Christian DR, Forsythe B, et al. Factors associated with clinically significant patient-reported outcomes after primary arthroscopic partial meniscectomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019; 35: 1567–1575.e3.

[32] Randsborg P, Cepeda N, Adamec D, Rodeo SA, Ranawat A, Pearle AD. Patient-reported outcome, return to sport, and revision rates 7–9 years after anterior cruciate ligament reconstruction: results from a cohort of 2042 patients. The American Journal of Sports Medicine. 2022; 50: 423–432.

[33] Holmberg PM, Gorman AD, Jenkins DG, Kelly VG. Lower-body aquatic training prescription for athletes. The Journal of Strength & Conditioning Research. 2021; 35: 859–869.

[34] Holmberg PM, Gorman AD, Jenkins DG, Kelly VG. Lower-body aquatic training prescription for athletes. Journal of Strength and Conditioning Research. 2021; 35: 859–869.

[35] Macefield VG. The roles of mechanoreceptors in muscle and skin in human proprioception. Current Opinion in Physiology. 2021; 21: 48–56.

[36] Kaya D, Guney-Deniz H, Sayaca C, Calik M, Doral MN. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. BioMed Research International. 2019; 2019: 1–7.

[37] Lai Z, Zhang Y, Lee S, Wang L. Effects of strength exercise on the knee and ankle proprioception of individuals with knee osteoarthritis. Research in Sports Medicine. 2018; 26: 138–146.

[38] Torres-Ronda L, Schelling i del Alcázar X. The properties of water and their applications for training. Journal of Human Kinetics. 2014; 44: 237–248.

[39] Park SB, Davare M, Falla M, Kennedy WR, Selim MM, Wendelschafer-Crabb G, et al. Fast-adapting mechanoreceptors are important for force control in precision grip but not for sensorimotor memory. Journal of Neurophysiology. 2016; 115: 3156–3161.

[40] Alarcón-Gómez J, Martin Rivera F, Madera J, Chulvi-Medrano I. Effect of a HIIT protocol on the lower limb muscle power, ankle dorsiflexion and dynamic balance in a sedentary type 1 diabetes mellitus population: a pilot study. PeerJ. 2020; 8: e10510–e10526.

[41] Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R. 2009; 1: 859–872.

[42] Mira NO, Soto Cardona IC, Martínez Osorno LV, Mercado Díaz DR, Henao Ceballos LM. Evaluating the effect of a water exercise routine on the postural stability of the elderly. Colombia Medica. 2021; 52: e2004537–e2004546.

[43] McLeod MM, Gribble P, Pfile KR, Pietrosimone BG. Effects of arthroscopic partial meniscectomy on quadriceps strength: a systematic review. Journal of Sport Rehabilitation. 2012; 21: 285–295.

[44] Glatthorn JF, Berendts AM, Bizzini M, Munzinger U, Maffiuletti NA. Neuromuscular function after arthroscopic partial meniscectomy. Clinical Orthopaedics & Related Research. 2010; 468: 1336–1343.

[45] Rocha LC, Jacob CDS, Barbosa GK, Pimentel Neto J, Krause Neto W, Gama EF, et al. Remodeling of the skeletal muscle and postsynaptic component after short-term joint immobilization and aquatic training. Histochemistry and Cell Biology. 2020; 154: 621–628.

[46] Versey NG, Halson SL, Dawson BT. Water immersion recovery for athletes: effect on exercise performance and practical recommendations. Sports Medicine. 2013; 43: 1101–1130.