Comparing the Effect of Transcutaneous Electrical Nerve Stimulation, Biofeedback Electromyography and Functional Electrical Stimulation on Quadriceps Disinhibition after Anterior Cruciate Ligament Reconstruction

Patients with ACL reconstruction often return back to activity with diminished quadriceps activity and strength. (Patients suffering from ACL can be often rehabilitated with the help of ACL reconstruction, although quadriceps strength and muscle activity might be weak or limited after the surgery.)The present study aimed to compare the effect of Transcutaneous Electrical Nerve Stimulation (TENS), Functional Electrical Stimulation (FES) and Biofeedback Electromyography (B-EMG) on improvement in quadriceps strength and mean value of VMO activation pattern (MVVA) among patients with reconstruction of ACL.

The study was designed as a randomized control trial. 102 patients, who filled a demographic questionnaire relating to important factors mainly age, height, and weight before the intervention, (all sportsmen) were randomly divided into four groups known as, FES (n=21), TENS (n=21), B-EMG (n=22) and control (n=38). In this study, hand-held dynamometry and biofeedback electromyography were used to assess Quadriceps strength and MVVA respectively. All samples were evaluated at three different time intervals, including prior to the, after and 4 weeks after the treatment. Additionally, all four groups received Ice pack around the knee and Michle Duck exercise therapy protocol. The treatments provided totally lasted 3 to 5 weeks. The participants in 4 groups received TENS, FES and B-EMG as their main treatments 5 times a week for 45, 15 and 15 minutes successively.

The mean scores of MVVA and quadriceps strength after the intervention and after the follow-up increased significantly in all four groups. However the effect of FES on MVVA in comparison with TENS and control group was statistically meaningful in favor of FES group. (As instructed here the last sentence omitted)

TENS, FES and B-EMG in combination with cryotherapy and exercise as well as cryotherapy with exercise can reduce VMO inhibition and improve quadriceps strength in patients who undergo ACL reconstruction. However FES in combination with cryotherapy and exercise can be the most effective one.