| ObjectiveTo systematic review the rehabilitation program after anterior cruciate ligament(ACL)reconstruction and to determine the effectiveness of using neuromuscular electrical stimulation(NMES)for improving quadriceps strength and physical function in rehabilitation following ACL reconstruction.Methods1.A systematic review was conducted of the literature published between January 1,1990 and December 1,2017 on MEDLINE and Cochrane Library.2.Clinical trial:Subjects who had undergone ACL reconstruction were randomly assigned to either a group that received(treatment group)or did not receive(control group)the NMES treatment in conjunction with their rehabilitation.IKDC score,Lysholm score,thigh circumference,range of motion and visual analogue scale were measured before surgery and the day 3,week 1,week 2,month 1,month 2 and month 3 postoperative.We followed up once a week in the first month postoperative and then once in the second and third month respectively.Results1.Systematic evaluation results:(1)Closed kinetic chain exercise is safe and effective which can be started from week 2 postoperative.Open kinetic chain exercise can be started from 4 weeks postoperative.Extra resistance is allowed for bone-patellar tendon-bone(BPTB)autografts,but for hamstring(HS)autografts,no extra weight should be added in the first 12 weeks.(2)The isometric contraction training of the quadriceps should start in the first week after ACL reconstruction,and immediate weight bearing seems safe.It is safe to start concentric exercise from week 3 postoperative,which may be the most effective way to restore the strength of the quadriceps.Neuromuscular training should be added to strength training to achieve better outcomes.Exercise training improves function as well as promote positive changes in psychosocial status and return-to-play in week 12 postoperative.Whole body vibration exercise in month 1 postoperative may improve the proprioception and balance.(3)Men were 1.4 times more likely to return to their preinjury sport level than women and BPTB autografts was 1.2 times more likely than HS autografts.65%of patients after ACL reconstruction returned to preinjury competitive sport level within 2 years,but only 38%remained at the same level>2 years after surgery.(4)A series of strength tests and hop tests and measurement of quality of movement should be used to determining the moment for return to play.2.Clinical trial results:Sixty-six subjects including 44 patients from the treatment completed the study.The effects of neuromuscular electrical stimulation in the thigh circumference between the two groups were statistically significant on the time factor(P<0.001)and the interaction(P<0.001).There was no significant difference in the thigh circumference between the two groups before surgery or day 7,week 2 after surgery(P>0.05).The difference in the thigh circumference in the treatment group was higher than control group in month 1,month 2,and month 3 postoperative,which was statistically significant(P<0.05).There was no significant difference in the range of motion(ROM)between two groups preoperative or day 7,week 2 postoperative(P<0.05).The recovery of ROM in the treatment group was better than control group in month 1 and month 2 postoperative(P>0.05).From month 3 postoperatively,there was no statistically significant difference in ROM between the two groups(P>0.05).The results of IKDC,Lysholm and VAS of the two groups showed that the time factor was statistically significant(P<0.05),but the interaction was not statistically significant(P>0.05).The preoperative IKDC,Lysholm and thigh circumference was related to the time from injury to surgery.The longer the time,the higher the scores of IKDC and Lysholm was and the greater difference in the thigh circumference was.Preoperative VAS is related to the time from injury to surgery and meniscus injury.The longer the time,the lower of VAS was and the better ROM was.More serious the meniscus injury was related to higher VAS and worse ROM.Preoperative IKDC,Lysholm,VAS and thigh circumference were not related to age,sex,or meniscus injury.None of the outcomes in month 3 postopertative was associated with age,sex,time from injury to surgery or meniscus injury.Conclusion(1)A rehabilitation program following ACL reconstruction mainly includes various exercise training,such as isometric quadriceps exercise,open kinetic chain training,closed kinetic chain training,concentric and eccentric exercise.It is recommended to add neuromuscular training such as balance exercise or proprioceptive training to improve patient self-report results.A series of tests should include strength tests and hop tests and measurement of quality of movement for determing the moment for return to play.However,there is no standard for these tests widely accepted.(2)After ACL injury,the function and clinical performance were related to the time from injury to surgery.The ROM preoperative was also related to the meniscus injury.The function and clinical performance were not related to age,sex,time from injury to surgery or meniscus injury in month 3 postoperatively.The factors may affect the function need further study.(3)NMES for rehabilitation of ACL reconstruction can reduce the quadriceps atrophy and promote ROM in month 1 and 2 postopertative,but no significant effect on subjective function score or pain. |
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