Neuromuscular Electrical Stimulation Superimposed on Movement Early after ACL Surgery

Abstract

PURPOSE = Quadriceps weakness and asymmetrical loading of lower limbs are two major issues following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate the effectiveness of a 6-week training protocol involving neuromuscular electrical stimulations (NMES) of the quadriceps muscle superimposed on repeated sit-to-stand-to-sit exercises (STSTS), as an additional treatment to standard rehabilitation, from the 15th to the 60th day following ACLR. METHODS = Sixty-three ACLR patients were randomly allocated to one of the three treatment groups: NMES superimposed on STSTS (NMES+STSTS), STSTS only, or no additional treatment (NAT) to standard rehabilitation. Maximal isometric strength of knee extensor and flexor muscles was measured 60 and 180 days after surgery. Asymmetry in lower extremity loading was measured during a sit-to-stand movement at 15, 30, 60 and 180 days after surgery and during a countermovement jump 180 days after surgery by means of two adjacent force platforms placed under each foot. RESULTS = The NMES+STSTS participants showed higher muscle strength of the knee extensors, which was accompanied by lower perception of pain, and higher symmetry in lower extremity loading compared to STSTS-only and NAT participants after both 60 and 180 days from surgery. Participants in the STSTS-only treatment group showed higher symmetry in lower extremity loading compared to those in the NAT group 60 days post-surgery. CONCLUSION = These results suggest that an early intervention based on NMES superimposed to repeated STSTS exercises is effective for recovering quadriceps strength and symmetry in lower extremity loading by the time of return to sport.