THE EFFECTIVENESS OF SUPPLEMENTING A STANDARD REHABILITATION PROGRAM WITH SUPER-IMPOSED NEUROMUSCULAR ELECTRICAL STIMULATION, FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Abstract

Background: Rehabilitation interventions following anterior cruciate ligament (ACL) reconstruction are key determinants affecting patient return to usual activity levels. Studies show that neuromuscular electrical stimulation (NMES) can counteract loss of strength in the quadriceps and is a beneficial enhancement to traditional forms of therapy.

Purpose: This study compared the effect of adding traditional NMES or garment integrated NMES to a standard postsurgery rehabilitation program. The effect on the strength of the femoral, the ability of patients to perform the single leg hop test (SLH), the shuttle run and other measures of proprioception were assessed.

Study Design: Prospective, randomised, single-blind study in patients undergoing rehabilitation following ACL reconstruction.

Methods: 69 patients were randomly assigned to one of three post-surgery rehabilitation treatment groups. All patients followed a standard rehabilitation program. Additionally, the PS group, (n=29), trained with a traditional NMES device and the KH group (n=33) trained with a garment integrated NMES device with multipath activation, (n=33). The control group (CO, n=34) performed only volitional maximum quadriceps muscle contraction. Functional tests were assessed at baseline and at 6 weeks, 12 weeks and 6 months post operatively.

Results: KH achieved statistically significant results over PS and CO for measurements of the isokinetic strength of the extensors of the injured leg at an angular velocity of 90°/sec in Nm/kg for time effect (p< 0.001), for treatment effect between the groups (p=0.044) and when examination times are considered (p< 0.05). Strength values for KH after 6 months were 30.2% higher than before the surgery, compared with 5.1% (PS) and 6.6% (CO). At an angular velocity of 180°/sec, KH achieves significance (p< 0.05) compared with CO at 12 weeks and 6 months, and compared with PS, achieved significance (p< 0.05) for the entire duration of the study. Strength values for KH were 27.8% higher than before the surgery compared with 5% (PS) and 3.7% (CO). For the SLH with the injured leg, KH achieved significantly better results for the entire period of the investigation compared with PS (p=0.038) and compared with CO (p=0.002). At the times of all three examinations after surgery KH achieved significantly better values (all p< 0.05) than PS CO. Patients in the KH group achieved full weight bearing and return to usual work activities 7 days before either the PS or CO groups.

Conclusions: The results of this study confirm that garment integrated NMES devices, designed for use by patients at home, are a beneficial addition to rehabilitation therapy following anterior cruciate ligament reconstruction, strengthening the quadriceps and accelerating recovery.