The main aim of this review is to discuss some evidence-based physiological and methodological considerations for optimal use of neuromuscular electrical stimulation (NMES) in healthy and impaired skeletal muscles. After a quick overview of the main applications, interests and limits of NMES use, the first section concentrates on two crucial aspects of NMES physiology: the differences in motor unit recruitment pattern between NMES and voluntary contractions, and the involvement of the nervous system during peripheral NMES. The second section of the article focuses on the most common NMES parameters, which entail the characteristics of both the electrical current (the input) and the evoked contraction (the output).

Physiological and methodological considerations for the use of neuromuscular electrical stimulation

Synopsis The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non-weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines...

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Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression

Maximizing Quadriceps Strength After ACL Reconstruction

Study Design Cross-sectional study. Objectives To investigate the impact of quadriceps femoris (QF) muscle strength asymmetry at the time of return to sport on self-reported function and functional performance of individuals following anterior cruciate ligament reconstruction (ACLR). Background Evidence-based QF strength guidelines for return-to-sport decision making are lacking. Objective guidelines necessitate understanding the impact of QF strength deficits at the time of return to sport on function and performance. Methods Fifty-five individuals (mean age, 17.3 years) who were cleared for return to sport following primary ACLR (ACLR group) and 35 uninjured individuals (mean age, 17.0 years) in a control group participated in the study. QF strength (maximum voluntary isometric contraction) was assessed, and the quadriceps index (QI) was calculated [(involved strength/uninvolved strength) × 100%]. The ACLR group was further subdivided into 2 groups, based on the QI: high quadriceps (QI of 90% or greater...

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The Impact of Quadriceps Femoris Strength Asymmetry on Functional Performance at Return to Sport Following Anterior Cruciate Ligament Reconstruction

BACKGROUND:

The evaluation and management of knee dislocations remain variable and controversial. The purpose of this study was to describe our method of surgical treatment of knee dislocations with use of a standardized protocol and to report the clinical results.

METHODS:

Forty-seven consecutive patients presented with an occult (reduced) or grossly dislocated knee. Fourteen of these patients were not included in this series because of confounding variables: four had an open knee dislocation, five had vascular injury requiring repair, three were treated with external fixation, and two had associated injury. The remaining thirty-three patients underwent surgical treatment for the knee dislocation with our standard approach. Anatomical repair and/or replacement was performed with fresh-frozen allograft tissue. Thirty-one of the thirty-three patients returned for subjective and objective evaluation with use of four different knee-rating scales at a minimum of twenty-four months after the operation.

RESULTS:

Nineteen of the thirty-one patients were treated acutely (less than three weeks after the injury) and twelve, chronically. The mean Lysholm score was 91 points for the acutely reconstructed knees and 80 points for the chronically reconstructed knees. The Knee Outcome Survey Activities of Daily Living scores averaged 91 points for the acutely reconstructed knees and 84 points for the chronically reconstructed knees. The Knee Outcome Survey Sports Activity scores averaged 89 points for the acutely reconstructed knees and 69 points for the chronically reconstructed knees. According to the Meyers ratings, twenty-three patients had an excellent or good score and eight had a fair or poor score. Sixteen of the nineteen acutely reconstructed knees and seven of the twelve chronically reconstructed knees were given an excellent or good Meyers score. The average loss of extension was 1°, and the average loss of flexion was 12°. There was no difference in the range of motion between the acutely and chronically treated patients. Four acutely reconstructed knees required manipulation because of loss of flexion. Laxity tests demonstrated consistently improved stability in all patients, with more predictable results in the acutely treated patients.

CONCLUSIONS:

Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

Surgical management of knee dislocations.

Background and Purpose. Electrical stimulation has been shown to be effective in aiding the recovery of quadriceps femoris muscle force production after anterior cruciate ligament reconstruction. The actual dosage of stimulation (training intensity) has not been well described. The purpose of this investigation was to establish a dose-response curve for electrical stimulation regimens designed to improve quadriceps femoris muscle recovery in patients after anterior cruciate ligament reconstruction. Subjects and Methods. We analyzed data from a subsample (n=52) of patients receiving electrical stimulation (N=110) who were involved in a large, multicenter randomized clinical trial investigating treatment strategies designed to enhance quadriceps femoris muscle recovery. Fifty-two subjects (40 male, 12 female), with an age range of 15 to 43 years (X=25, SD=7), participated in 4 weeks of quadriceps femoris muscle training using either portable, battery-powered home stimulators or console stimulators designed for clinical use. Training intensities were monitored by logging the electrically elicited knee extension torque and expressing this torque as a percentage of the uninvolved quadriceps femoris muscles' maximal voluntary contraction force. After the 4 weeks of training, isometric muscle torque was assessed and a dose-response curve was generated. The relationship between training intensity and quadriceps femoris muscle torque was assessed with Pearson Product-Moment Correlation Coefficients. Results. A significant, linear correlation was found between training intensity and quadriceps femoris muscle torque. Subjects training with console, clinical generators trained at higher intensities than those training with portable, battery-operated generators; such training resulted in higher quadriceps femoris muscle torque. Conclusion and Discussion. These results support the use of high-intensity electrical stimulation and do not support the use of low-intensity or battery-powered stimulators when the goal is recovery of quadriceps femoris muscle force production in the early phases of rehabilitation after anterior cruciate ligament surgery.

Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

Reconstruction Patients Following Anterior Cruciate Ligament Quadriceps Femoris Muscle Force Production in Use of Electrical Stimulation to Enhance Recovery of

Sherri L Bailey

Papers

Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

Reconstruction Patients Following Anterior Cruciate Ligament Quadriceps Femoris Muscle Force Production in Use of Electrical Stimulation to Enhance Recovery of