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The Journal of Bone and Joint Surgery, Vol 77, Issue 8 1166-1173, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation
L Snyder-Mackler, A Delitto, SL Bailey and SW Stralka
Department of Physical Therapy, University of Delaware, Newark 19716, USA.
Immediately after reconstruction of the anterior cruciate ligament, 110
patients were randomly assigned to treatment with high-intensity
neuromuscular electrical stimulation (thirty-one patients), high-level
volitional exercise (thirty-four patients), low-intensity neuromuscular
electrical stimulation (twenty-five patients), or combined high and
low-intensity neuromuscular electrical stimulation (twenty patients). All
treatment was performed isometrically with the knee in 65 degrees of
flexion. All of the patients participated in an intensive program of
closed-kinetic-chain exercise. After four weeks of treatment, the strength
of the quadriceps femoris muscle and the kinematics of the knee during
stance phase were measured. Quadriceps strength averaged 70 per cent or
more of the strength on the uninvolved side in the two groups that were
treated with high-intensity electrical stimulation (either alone or
combined with low-intensity electrical stimulation), 57 per cent in the
group that was treated with high-level volitional exercise, and 51 per cent
in the group that was treated with low-intensity electrical stimulation.
The kinematics of the knee joint were directly and significantly (p <
0.05) correlated with the strength of the quadriceps. There was a
clinically and statistically significant (p < 0.05) difference in the
recovery of the quadriceps and the gait parameters according to the type of
operation that had been performed: the patients who had had reconstruction
of the anterior cruciate ligament with use of an autologous
patellar-ligament graft did poorly compared with the other patients.
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