Transcutaneous Electrical Nerve Stimulation Provides Early Recovery from Arthrogenic Muscle Inhibition Post-Anterior Cruciate Ligament Reconstruction

Abstract

Abstract Background: Quadriceps weakness that ensues anterior cruciate ligament (ACL) reconstruction, a common procedure done in sportspersons, is a hindrance in the active rehabilitation and delays return to sport. This weakness of quadriceps muscle is a complex neural phenomenon ascribed to arthrogenic muscle inhibition (AMI). Purpose: The purpose of the study was to assess the effectiveness of transcutaneous electrical nerve stimulation (TENS) in AMI post-ACL reconstruction (ACLR). Methods: A prospective randomized study involving 60 patients with isolated ACL injury above 18 years of age were included. Patients with osteoarthritis knee, multiligament injury, previous knee surgery, and inflammatory knee pathology were excluded from the study. Patients were divided into Groups A and B (n = 30, each). Group A received TENS therapy with exercises and ice packs, whereas Group B received only exercise and ice packs post-ACLR. All patients were assessed subjectively using Visual Analog Scale score for pain, Lysholm, and IKDC score for functional outcome pre and postoperatively on day 2, 1 month, 3 months, 6 months, and 1 year. Objective assessment was done by measuring thigh girth (10 cm above knee joint line) and isometric quadriceps strength (using David Biofeedback Strength Evaluation Machine) pre and postoperatively at day 2, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. Results: Pain decreased in both groups at 1 month, 3 months, and 6 months, but there was significantly lower pain in Group A in comparison to Group B at 1 month (P = 0.003), 3 months (P = 0.001), and 6 months (P ≤ 0.0001). There was no pain at 1 year in both the groups. Lysholm score improved in both groups, but there was statistically significantly better Lysholm score in Group A in comparison to Group B at each follow-up. IKDC score improved in both groups, but the improvement in Group A was significantly higher than Group B at each follow-up. No significant difference in mean thigh girth was observed. Mean quadriceps strength was similar in both groups except at 6 months where Group A was better than Group B (<0.001). Conclusion: Addition of TENS in ACLR rehabilitation decreases pain and provides better clinical outcome.