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Combination of eccentric exercise and neuromuscular electrical stimulation to improve biomechanical limb symmetry after anterior cruciate ligament reconstruction.

ABSTRACT: We have previously reported that an eccentrically-based rehabilitation protocol post-ACLr induced greater quadriceps activation and strength than a neuromuscular electrical stimulation (NMES) intervention and was just as effective as a combined NMES and eccentric intervention. However, the effect an eccentrically-based intervention has on restoring normal knee mechanics during a single-legged landing task remains unknown.Thirty-six individuals post-injury were placed into four treatment groups: NMES and eccentrics, eccentrics-only, NMES-only, standard of care, and healthy controls participated. NMES and eccentrics received a combined NMES and eccentric protocol post-reconstruction (each treatment 2× per week for 6 weeks), whereas groups NMES-only and eccentric-only received only the NMES or eccentric therapy, respectively. To evaluate knee mechanics limb symmetry, the area under the curve for knee flexion angle and extension moment was derived and then normalized to the contralateral limb. Quadriceps strength was evaluated using the quadriceps index.Compared to healthy, reduced sagittal plane knee limb symmetry was found for groups NMES-only, ECC-only and standard of care for knee extension moment (P<0.05). No difference was detected between healthy and NMES and eccentrics (P>0.06). No difference between groups was detected for knee flexion angle limb symmetry (P>0.05). Greater knee flexion angles and moments over stance were related to quadriceps strength.The NMES and eccentrics group was found to restore biomechanical limb symmetry that was most closely related to healthy individuals following ACL reconstruction. Greater knee flexion angles and moments over stance were related to quadriceps strength.

SUBMITTER: Lepley LK

PROVIDER: S-EPMC4523427 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Combination of eccentric exercise and neuromuscular electrical stimulation to improve biomechanical limb symmetry after anterior cruciate ligament reconstruction.

Lepley Lindsey K LK Wojtys Edward M EM Palmieri-Smith Riann M RM

Clinical biomechanics (Bristol, Avon) 20150429 7

<h4>Background</h4>We have previously reported that an eccentrically-based rehabilitation protocol post-ACLr induced greater quadriceps activation and strength than a neuromuscular electrical stimulation (NMES) intervention and was just as effective as a combined NMES and eccentric intervention. However, the effect an eccentrically-based intervention has on restoring normal knee mechanics during a single-legged landing task remains unknown.<h4>Methods</h4>Thirty-six individuals post-injury were ...[more]

PMID: 25953255

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Project description:BACKGROUND:Inadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation. METHODS:Subjects were randomized to quadriceps FES synchronized with walking group (n =?10) or quadriceps NMES (duty cycle of 10?s on/10?s off) group (n =?13). Both interventions were performed for 10?min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2?weeks before the ACLR (pre-ACLR), and 4?weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4?weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery. RESULTS:Subjects in both groups regained pre-ACLR gait speed and symmetry after 4?weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205?Nm, NMES -?225?Nm, p =?0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group (p =?0.02). In addition, after 4?weeks, the FES group had significantly better inter-limb strength symmetry 0.63?±?0.15 vs. 0.39?±?0.18 in the NMES group (p =?0.01). CONCLUSIONS:Quadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4?weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted. TRIAL REGISTRATION:ISRCTN 02817399 . First posted June 29, 2016.

Dataset Information

Combination of eccentric exercise and neuromuscular electrical stimulation to improve biomechanical limb symmetry after anterior cruciate ligament reconstruction.

Publications

Combination of eccentric exercise and neuromuscular electrical stimulation to improve biomechanical limb symmetry after anterior cruciate ligament reconstruction.

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