Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery

Abstract

Background: Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries. Hypothesis: This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits. Study Design: Case series. Level of Evidence: Level 4. Methods: Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment. Results: A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% ( P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment ( P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment ( P < 0.01). Conclusion: Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery. Clinical Relevance: This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.

Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group

“…34 This study demonstrates that with simple exercises for AMI, the majority of cases of preoperative extension deficit are easily resolved provided that specific approaches to fatigue the hamstrings and improve quadriceps activation while also influencing neural modulation, providing biofeedback, and facilitating motor excitability are used. 5,7,27,32,44 A further important finding of this study was that the reliability of the Sonnery-Cottet classification of AMI was established with good to excellent interobserver reliabilities.…”

“…These programs involved electromyographic biofeedback (converting the action potential of the quadriceps into feedback signals of a visual or auditory nature, so it can affect the patient's voluntary task) 19,24,36 and neuromotor reprogramming treatment based on the use of proprioceptive sensations associated with motor imagery and low-frequency sounds. 7…”

Exploring dynamic brain oscillations in motor imagery and low-frequency sound

“…Hence, it seems that both MI and low-frequency sound listening may influence cortical activities and motor performance. In light of these insights, Dos Anjos et al (2023) recently investigated whether the combination of MI and low-frequency sound listening could improve the neuromotor rehabilitation of patients following knee injuries. Their key result was an improved muscle activation associated with a reduced motor deficit after rehabilitation using MI and low-frequency sound listening.…”