Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction

• Published in: The knee Vol. 22; no. 3; pp. 270 - 277
• Main Authors: Lepley, Lindsey K, Wojtys, Edward M, Palmieri-Smith, Riann M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-06-2015; Elsevier Limited
• Subjects: ACL; Adolescent; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction - rehabilitation; Arthritis; Biomechanical Phenomena; Eccentric; Electric Stimulation - methods; Electrostimulation; Exercise Therapy - methods; Female; Follow-Up Studies; Humans; Knee; Knee Injuries - physiopathology; Knee Injuries - rehabilitation; Knee Injuries - surgery; Knee Joint - physiopathology; Knee Joint - surgery; Ligaments; Male; Older people; Orthopedics; Quadriceps Muscle - physiopathology; Rehabilitation; Sports injuries; Strength training; Surgery; Young Adult; ACL; Eccentric; Rehabilitation; Electrostimulation; Strength training
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2014.11.013

Abstract Background Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. Methods Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2 × per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2 × per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. Results No differences in pre-operative measures existed (P > 0.05). E-only recovered quadriceps activation better than N-only or STND (P < 0.05). N&E and E-only recovered strength better than N-only or the STND (P < 0.05) and had strength values that were similar to healthy at return-to-play (P > 0.05). Conclusion Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. Level of evidence: Level 3, Parallel longitudinal study