Kazandra Rodriguez1, Steven A Garcia2, Cathie Spino3, Lindsey K Lepley2, Yuxi Pang4, Edward Wojtys5, Asheesh Bedi5, Mike Angelini2, Bethany Ruffino6, Tyler Bolley7, Corey Block7, Jessica Kellum7, Andrew Swartout7, Riann M Palmieri-Smith8. 1. School of Kinesiology, University of Michigan, Ann Arbor, Michigan; and Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan. 2. School of Kinesiology, University of Michigan; and Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan. 3. School of Public Health, University of Michigan. 4. Department of Radiology, Michigan Medicine, Ann Arbor, Michigan. 5. Michigan Medicine; and Department of Orthopaedic Surgery, Michigan Medicine. 6. Department of Orthopaedic Surgery, Michigan Medicine. 7. Michigan Medicine. 8. School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI 48109 (USA); Orthopaedic Rehabilitation and Biomechanics Laboratory, University of Michigan; and Department of Orthopaedic Surgery, Michigan Medicine.
Abstract
OBJECTIVE: Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR. METHODS: This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging). IMPACT: The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.
OBJECTIVE: Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR. METHODS: This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging). IMPACT: The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.
Authors: Steven A Garcia; Kazandra M Rodriguez; Scott R Brown; Riann M Palmieri-Smith; Chandramouli Krishnan Journal: J Sport Health Sci Date: 2019-12-20 Impact factor: 7.179
Authors: Stefan W Stahl; Elias M Puchner; Alexander Alexandrovich; Mathias Gautel; Hermann E Gaub Journal: Biophys J Date: 2011-10-19 Impact factor: 4.033