Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study

Abstract

Background Inadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation. Methods Subjects were randomized to quadriceps FES synchronized with walking group ( n = 10) or quadriceps NMES (duty cycle of 10 s on/10 s off) group ( n = 13). Both interventions were performed for 10 min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2 weeks before the ACLR (pre-ACLR), and 4 weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4 weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery. Results Subjects in both groups regained pre-ACLR gait speed and symmetry after 4 weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205 Nm, NMES − 225 Nm, p = 0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group ( p = 0.02). In addition, after 4 weeks, the FES group had significantly better inter-limb strength symmetry 0.63 ± 0.15 vs. 0.39 ± 0.18 in the NMES group ( p = 0.01). Conclusions Quadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4 weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted. Trial registration ISRCTN 02817399 . First posted June 29, 2016.

Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction

“…85 Several studies have shown that NMES prevents muscle atrophy in orthopaedic populations, but the overall strength of patients who receive increased NMES therapy has not been reported to be superior. [86][87][88] This is clinically important because residual muscle weakness after ACLR is associated with patient dissatisfaction, pathologically alters knee biomechanics, and contributes to the development of osteoarthritis. 89 Toth et al 86 showed that muscle biopsies of patients undergoing an NMES protocol 5 times/week in the immediate 3 weeks after surgery reduces atrophy of myosin heavy chain II fibers while maintaining myosin heavy chain I fibers.…”

Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial

“…Restoration of muscle strength determines patient's return to activity after reconstruction [1][2][3]. For many years neuromuscular electrical stimulation (NMES) has been applied in order to prevent muscular atrophy and restore their strength [4][5][6][7]. The primary effect of the NMES after ACL is restoration and improvement of the quadriceps function.…”

“…This kind of therapy helps to activate the muscle whose activity is inhibited mostly by pain or effusion. In the literature there are a lot of contradictions regarding the effectiveness and benefits of using NMES in patients after ACL reconstruction (ACLr) [4][5][6][7].…”

Quadriceps Muscle Strength Recovery With the Use of High Tone Power Therapy After ACL Reconstruction: a Randomized Controlled Trial

“…This kind of therapy helps to activate the muscle which activity is inhibited mostly by pain or effusion. In the literature there are a lot of contradictions regarding the effectiveness and bene ts of using NMES in patients after ACL reconstruction (ACLr) [4,5,6,7].…”