619 - Neuromuscular Electrical Stimulation utilization in Quadriceps Muscle Atrophy for ACL reconstruction patients.

Objectives: ACL surgeries lead to quadriceps long-lasting muscle atrophy and fatigue. Neuromuscular Electrical Stimulation(NMES) is used for ACL reconstruction patients to enhance functional performance by improving quadriceps muscle strength. A review of NMES was conducted to determine its benefits for patient recovery.

Design: 32 articles were reviewed regarding ACL reconstructions and Quadriceps Strength. 23 articles focused on the use of electrical stimulation in ACL reconstruction patients. The articles were retrieved through a PubMed search, using key search words such as “ACL injury,” “quadriceps strength,” “neuromuscular electrical stimulation,” and “muscle atrophy,” either alone or in combination.

Results: Following ACL surgery, Individuals often experience a decrease in quadriceps muscle strength and size, which can be attributed to both the initial injury as well as the trauma from the surgery. This joint trauma induces arthrogenic muscle inhibition of the quadriceps that inhibits appropriate recruitment of motor neurons. Muscle atrophy leads to alterations in type 1/2 muscle fibers and a reduction of the muscle’s isometric strength. This decrease in strength significantly impacts functional performance. NMES is indicated post-ACL reconstruction to induce electrical signals to nerves leading to muscle contractions that imitate the natural electrical impulses generated by the central nervous system. Early use of NMES has shown to improve quadriceps isometric and isokinetic muscle strength as well as muscle contractility following ACL reconstruction. ACL reconstruction patients also reported improved functional activities using the Knee Outcome Survey - Activities of Daily Living Scale(KOS-ADL).

Conclusions: Physiatrists primarily aim to restore function and prevent long-term muscle atrophy in the management of patient’s post ACL surgery. Effective management may include NMES, which has demonstrated improvements in muscle contractility and strength compared to physical therapy and eccentric exercises alone. NMES as an adjunctive therapy should be considered in the rehabilitation plan for patients recovering from ACL surgeries.