The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial

Franz Christanell, Christian Hoser, Reinhard Huber, Christian Fink, Hannu Luomajoki, Franz Christanell, Christian Hoser, Reinhard Huber, Christian Fink, Hannu Luomajoki

Abstract

Background: Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB) therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated.

Method: Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups:• Control group (8 patients): standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion), electrical stimulation, aquatics and proprioceptive training.• The EMG BFB group (8 patients): EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks.Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD) Test, range of motion (ROM) and integrated EMG (iEMG) for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales.

Results: At 6 weeks, passive knee extension (p < 0.002) and the HHD Test were significantly (p < 0.01) better in the EMG BFB group compared to controls. Integrated EMG (vastus medialis) of the EMG BFB group also showed a significant increase after 2 (p < 0.01) and 6 (p < 0.01) weeks. At the 6-week follow up, no significant (p > 0.01) differences were found between the two groups for the assessment of knee function, swelling and pain.

Conclusion: The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional therapeutic modalities.

Figures

Figure 1
Figure 1
HHD Test for measuring passive knee extension.
Figure 2
Figure 2
The iEMG measuring.
Figure 3
Figure 3
Vastus medialis-activation with BFB.
Figure 4
Figure 4
One-leg-stabilisation exercises with BFB-control on Posturomed©.
Figure 5
Figure 5
Knee extension deficit (°) (mean value ± SD) between involved and non-involved knee pre- and postoperative 6 weeks follow up (4 = 11-15°, 3 = 6-10°, 2 = 3-5°, 1 = 

Figure 6

HHD Test (mm) (mean value…

Figure 6

HHD Test (mm) (mean value ± SD) between involved and non-involved knee pre-…

Figure 6
HHD Test (mm) (mean value ± SD) between involved and non-involved knee pre- and postoperative 6 weeks follow up (preop. = preoperative, 1., 2., 4., and 6. pop. W. = 1., 2., 4., and 6. postoperative week).

Figure 7

“Symptomatic giving way ” patients…

Figure 7

“Symptomatic giving way ” patients (mean value ± SD) of the affected knee…

Figure 7
“Symptomatic giving way ” patients (mean value ± SD) of the affected knee preoperative and 6 weeks follow up (4 = Always, 3 = Frequent, 2 = Partly, 1 = None / preop. = preoperative, 1., 2., 4., and 6. Post-op. / W. = 1., 2., 4., and 6. Post-operative week).

Figure 8

Comparison of percentage vastus medialis…

Figure 8

Comparison of percentage vastus medialis contraction (% μV-EMG) within two groups (mean value…

Figure 8
Comparison of percentage vastus medialis contraction (% μV-EMG) within two groups (mean value ± SD) pre- and postoperative 6 weeks follow up (preop. = preoperative, 1., 2., 4., and 6. pop. W. = 1., 2., 4., and 6. postoperative week).
All figures (8)
Figure 6
Figure 6
HHD Test (mm) (mean value ± SD) between involved and non-involved knee pre- and postoperative 6 weeks follow up (preop. = preoperative, 1., 2., 4., and 6. pop. W. = 1., 2., 4., and 6. postoperative week).
Figure 7
Figure 7
“Symptomatic giving way ” patients (mean value ± SD) of the affected knee preoperative and 6 weeks follow up (4 = Always, 3 = Frequent, 2 = Partly, 1 = None / preop. = preoperative, 1., 2., 4., and 6. Post-op. / W. = 1., 2., 4., and 6. Post-operative week).
Figure 8
Figure 8
Comparison of percentage vastus medialis contraction (% μV-EMG) within two groups (mean value ± SD) pre- and postoperative 6 weeks follow up (preop. = preoperative, 1., 2., 4., and 6. pop. W. = 1., 2., 4., and 6. postoperative week).

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