Current Evidence in Anterior Cruciate Ligament Rehabilitation: Neuromuscular Electrical Stimulation Combined With a Strengthening Program: A Critically Appraised Topic

2017 ◽  
Vol 22 (6) ◽  
pp. 5-11
Author(s):  
Michael E. Lynch ◽  
Christine A. Lauber
Keyword(s):  
Anterior Cruciate Ligament ◽  
Electrical Stimulation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Strength ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Bottom Line ◽  
Anterior Cruciate

Clinical Question:Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?Clinical Bottom Line:There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.

Effect of Eccentric Strengthening After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength

2013 ◽  
Vol 22 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Lindsey K. Lepley ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Attractive Alternative ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Rehabilitation Period ◽  
Anterior Cruciate

Clinical Scenario:Interventions aimed at safely overloading the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction are essential to reducing quadriceps muscle weakness that often persists long after the rehabilitation period. Despite the best efforts of clinicians and researchers to improve ACL rehabilitation techniques, a universally effective intervention to restore preinjury quadriceps strength has yet to be identified. A muscle’s force-producing capacity is most optimal when an external force exceeds that of the muscle while the muscle lengthens. Hence, the potential to improve muscle strength by overloading the tissue is greater with eccentric strengthening than with concentric strengthening. Traditionally, the application of early postoperative high-intensity eccentric resistance training to the ACL-reconstructed limb has been contraindicated, as there is potential for injury to the ACL graft, articular cartilage, or surrounding soft-tissue structures. However, recent evidence suggests that the application of early, progressive, high-force eccentric resistance exercises to the involved limb can be used to safely increase muscle volume and strength in ACL-reconstructed individuals. As a result, eccentric strengthening may be another attractive alternative to traditional concentric strengthening to improve quadriceps strength after ACL reconstruction.Focused Clinical Question:In patients who have undergone ACL reconstruction, is there evidence to suggest that eccentric exercise positively affects postoperative quadriceps strength?

scholarly journals The Effectiveness of Nonoperative Treatment for Anterior Cruciate Ligament Rupture on Patient-Reported Outcomes and Muscular Strength: A Critically Appraised Topic

2020 ◽  
Vol 29 (7) ◽  
pp. 1032-1037
Author(s):  
Emily R. Hunt ◽  
Cassandra N. Parise ◽  
Timothy A. Butterfield
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Nonoperative Treatment ◽  
Long Term Results ◽  
Bottom Line ◽  
Hop Tests ◽  
Patient Reported ◽  
Anterior Cruciate

Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical “control” for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.

Comparing the Diagnostic Accuracy of Two Selective Tissue Tests for Anterior Cruciate Ligament Injuries: A Critically Appraised Topic

2019 ◽  
Vol 24 (4) ◽  
pp. 145-150
Author(s):  
Rafael Squillantini ◽  
Brielle Ringle ◽  
Julie Cavallario
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Sufficient Evidence ◽  
Sign Test ◽  
Bottom Line ◽  
Lachman Test ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate ◽  
Acute Knee

Clinical Question:In patients with acute knee injuries, is there evidence to support that the lever sign test is more accurate in diagnosing an anterior cruciate ligament sprain than the Lachman test?Clinical Bottom Line:The evidence does not indicate that the lever sign test can be used in isolation in lieu of the Lachman test, but there is sufficient evidence to support adding the lever sign test to the examination of potential anterior cruciate ligament sprains.

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