A Modified Neuromuscular Electrical Stimulation Protocol for Quadriceps Strength Training Following Anterior Cruciate Ligament Reconstruction

Abstract

Study Design: Randomized clinical trial, single-masked. Objectives: To determine the effectiveness of using a modified neuromuscular electrical stimulation (NMES) training program as an adjunct treatment for improving quadriceps strength and physical function in rehabilitation following anterior cruciate ligament reconstruction (ACLR). Background: NMES training for quadriceps strengthening has previously been shown to be an effective adjunct treatment following ACLR when performed against isometric resistance using a dynamometer with the knee positioned in flexion. We developed a modified version of published NMES protocol because some patients have difficulty tolerating the existing protocol and many clinics may not have instrumented dynamometers. There is a need to determine the effectiveness of this modified protocol. Methods and Measures: Forty-three subjects who had undergone ACLR were randomly assigned to either a group that received (NMES group) or did not receive (comparison group) the NMES treatment in conjunction with their rehabilitation. Group means for quadriceps strength and self-reported measures of knee function were compared after 12 and 16 weeks of rehabilitation. The proportion of subjects in each group achieving clinical criteria to initiate ambulation without crutches, treadmill running, and agility training at selected times during rehabilitation were also compared. Results:The NMES group demonstrated moderately greater quadriceps strength at 12 weeks (effect size, 0.48), and moderately higher levels of self-reported knee function at both 12 (effect size, 0.72) and 16 (effect size, 0.65) weeks of rehabilitation compared to the comparison group. A greater proportion of subjects in the NMES group achieved clinical criteria for advancing to agility training at 16 weeks. Conclusions: The modified NMES quadriceps training protocol can be a useful adjunct to ACLR rehabilitation programs, but the treatment effect is smaller than what has been reported in previous studies. J Orthop Sports Phys Ther 2003;33:492-501.

Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review

“…None of the studies described concealment of allocation at the time of randomization. Among the studies with drop outs, [13][14][15]21,22 only Fitzgerald et al 15 mentioned intentionto-treat analysis. The baseline participant characteristics were well described and the groups were comparable.…”

“…Blinded outcome assessment was reported in four studies. 15,21,23,24 None of the studies included reported sample size calculations.…”

“…Two studies 15,23 assessed the effectiveness of ES using the isometric quadriceps index at six, 12 and 16 weeks after surgery. There was a statistically significant difference in favor of ES six weeks after surgery (MD -27.10%; 95% CI: -39.37…”

“…13,14 ES is recommended as an adjunct treatment for quadriceps strengthening after anterior cruciate ligament reconstruction and has also been shown to improve quadriceps femoral torque produced after ligament knee surgery. 15,16 The most frequently used currents are: alternating current (2500 Hz) and pulsed biphasic asymmetric rectangular current. The choice of electrical current must be based on the capacity of electrical stimulation to produce an effective contraction.…”

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

“…Emphasis is placed on ability to produce a full sustained contraction of the quadriceps muscle. Several trials have demonstrated the benefits of high intensity electrical stimulation to improve quadriceps strength and gait parameters [3,4,[59][60][61][62][63][64]. It is not uncommon for patients to have poor quadriceps tone during the first postoperative visit.…”