Monday, June 20, 2011

ACL Reconstruction and Neuromuscular Electrical Stimulation

The Effectiveness of Supplementing
a Standard Rehabilitation Program With
Superimposed Neuromuscular Electrical
Stimulation After Anterior Cruciate
Ligament Reconstruction
A Prospective, Randomized, Single-Blind Study

Sven Feil,*

MA, John Newell,

PhD, Conor Minogue,

M.Eng.Sc, and Hans H. Paessler,y MD

Investigation performed at Center for Knee and Foot Surgery Sports Traumatology, ATOS Clinic
Centre, Heidelberg, Germany

Background: Rehabilitation after anterior cruciate ligament reconstruction is a key determinant affecting patient return to usual
activity levels. Neuromuscular electrical stimulation is a treatment that can counteract strength loss and serve as an adjunct to
conventional therapy.

Purpose: To compare the effect of adding traditional neuromuscular electrical stimulation (Polystim) or a novel garmentintegrated neuromuscular electrical stimulation (Kneehab) to a standard postoperative rehabilitation program (control).
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Ninety-six patients, of a total enrolled cohort of 131 patients randomized to 1 of 3 intervention groups, completed
a standard rehabilitation program. In addition, the 2 neuromuscular electrical stimulation groups underwent 20-minute sessions
of neuromuscular electrical stimulation 3 times a day, 5 days a week, for 12 weeks, in which stimulation was superimposed on
isometric volitional contractions. Outcome measures including isokinetic strength of the knee extensors of the injured and uninjured leg at 90 and 180 deg/s, along with functional tests of proprioception, were assessed at baseline and at 6 weeks, 12 weeks,
and 6 months postoperatively.
Results: The Kneehab group achieved significantly better results at each time point compared with the Polystim and control groups
(P \ .001). Extensor strength of the Kneehab group at speeds of 90 and 180 deg/s increased by 30.2% and 27.8%, respectively,
between the preoperative measurements and the 6-month follow-up point in the injured leg. The corresponding changes for Polystim
were 5.1% and 5%, whereas for the control group they were 6.6% and 6.7%, respectively. The mean single-legged hop test hop score
of the Kneehab group improved by 50% between the 6-week and 6-month follow-up, whereas the corresponding changes for the
Polystim and control groups were 26.3% and 26.2%, respectively. Although there was no significant difference between the groups
with respect to the Tegner score and the International Knee Documentation Committee 2000 knee examination score, the Kneehab
group showed a significant difference in mean improvement for the baseline corrected Lysholm score compared with the control group
(P = .01; 95% confidence interval, 1.12-8.59) and with the Polystim group (P \ .001; 95% confidence interval, 1.34-9.09) with no significant difference evident between Polystim and control groups (P = .97; 95% confidence interval, 24.23 to 3.51).
Conclusion: Intensive garment-integrated stimulation combined with standard rehabilitation is effective at accelerating recovery
after knee surgery.

Keywords: knee pathology; anterior cruciate ligament (ACL); strength gains; functional recovery; neuromuscular electrical stimulation (NMES)

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