Abstract
PURPOSE: This study systematically evaluated the effects of isokinetic muscle strength training (IMST) on pain, function, and muscle performance in patients with knee osteoarthritis (KOA). PATIENTS AND METHODS: Randomized controlled trials comparing IMST with other interventions for KOA were searched across multiple international and Chinese databases up to January 2025. Two investigators independently screened literature, extracted data, and assessed risk of bias according to the Cochrane Handbook Version 6.1.0. The RevMan 5.4 software was used to perform the meta-analysis. Overall quality of evidence was rated using GRADE approach. RESULTS: Nineteen RCTs involving 1386 patients were finally included. Three of which had high risk bias. Compared with other treatments, IMST showed a borderline improvement in Lysholm score (MD = 1.21, 95% CI: [-0.62, 3.04], I (2)= 95%, very low certainty), and tended to enhance extensor peak torque (MD = 4.12, 95% CI: [-0.17, 8.41], I (2)= 74%, very low certainty) while significantly increasing flexor peak torque (MD = 7.94, 95% CI: [4.23, 11.66], I (2)= 71%, low certainty). Besides, IMST also significantly reduced VAS scores (MD = -0.64, 95% CI: [-1.19, -0.10], I (2)= 95%, Moderate certainty) and showed a trend toward lower (MD = -6.96, 95% CI: [-15.85, 1.92], I (2)= 98%, Moderate certainty), indicating overall improvements in knee function, pain, and stiffness. CONCLUSION: IMST appears to improve pain and function in patients with KOA, but the overall certainty of evidence is limited. Further high-quality RCTs are needed to confirm these benefits and guide clinical practice.