| Purpose:Long term quadriceps femoris muscle weakness after anterior cruciate ligament reconstruction is an important cause of abnormal gait pattern,and long-term abnormal gait is considered to be an important risk factor for the occurrence and development of traumatic knee osteoarthritis.Neuromuscular electrical stimulation has been proved to improve the strength of quadriceps femoris and gait kinematics parameters of patients,but there are few studies on the impact of gait dynamics,which is the key factor affecting cartilage degeneration.Therefore,this experiment plans to study the impact of neuromuscular electrical stimulation on gait kinematics characteristics,and to explore the impact of neuromuscular electrical stimulation on gait dynamics(i.e.plantar pressure related parameters).Methods: 48 subjects were randomly divided into two groups: 24 in the routine rehabilitation group(32.5 ± 11.4 years old)and 24 in the neuromuscular electrical stimulation group(29.7 ± 6.7 years old).Both groups received the same routine rehabilitation.The neuromuscular electrical stimulation group received neuromuscular electrical stimulation while training the quadriceps 8 weeks after operation.Neuromuscular electrical stimulation was treated for 6 weeks,3 days a week,once a day,20 minutes each time.Lysholm score,peripheral diameter difference of thigh,isometric peak torque of quadriceps femoris on the affected side,gait kinematics and plantar pressure were collected and evaluated at 8 weeks and 14 weeks after operation.Result:1.Intra-group comparison(1)Conventional rehabilitation group: compared with 8 weeks after operation,there was no significant difference in the gait kinematics and plantar pressure indexes of the healthy side at 14 weeks after operation(P>0.05).Compared with 8 weeks after operation,Lysholm score(P = 0.001< 0.05),isometric peak moment of quadriceps femoris(P = 0.000 < 0.05),peak flexion angle of hip joint(P = 0.033 < 0.05),forefoot impulse(P = 0.017 < 0.05)and peak vertical ground reaction force(P = 0.033 < 0.05)were significantly higher at 14 weeks after operation,the impulse of the affected side's hind foot(P = 0.012<0.05),the percentage of the time of the affected side's front foot touching the ground(P = 0.009 <0.05)and the difference of thigh circumference(P = 0.04 < 0.05)decreased significantly.(2)Neuromuscular electrical stimulation group: compared with 8 weeks after operation,there were no significant differences in the gait kinematics and plantar pressure of the healthy side at 14 weeks after operation(P>0.05).Compared with 8 weeks after operation,the Lysholm score(P=0.000<0.05),the isometric peak torque of the quadriceps femoris on the affected side(P=0.005<0.05),and the range of knee flexion angle in the standing stage of the affected side were significantly higher at 14 weeks after operation(P=0.000<0.05),peak extension angle of ipsilateral hip joint(P=0.033<0.05),ipsilateral forefoot impulse(P=0.007<0.05),percentage of ipsilateral forefoot kicking off stage(P=0.002<0.05),ipsilateral peak lateral heel pressure(P=0.018<0.05),ipsilateral peak vertical ground reaction force(P=0.001<0.05),and ipsilateral peak vertical ground reaction force linear loading rate(P=0.005<0.05)significantly increased,the difference in thigh circumference(P=0.000<0.05),the hindfoot impulse on the affected side(P=0.005<0.05)and the percentage of the duration of the full foot support phase on the affected side(P=0.013<0.05)were significantly decreased.2.Comparison between groupsThere was no significant difference in gait kinematics and plantar pressure between routine rehabilitation group and neuromuscular electrical stimulation group(p>0.05).The difference between the two groups showed that compared with the routine rehabilitation group,Lysholm score,isometric peak torque of quadriceps femoris on the affected side,peripheral diameter difference of thigh,range of knee flexion angle in the standing stage of the affected side,peak extension angle of hip joint on the affected side,percentage of time in the pedaling stage of front foot on the affected side,peak pressure on the outside of heel on the affected side and peak vertical ground reaction force on the affected side in the neuromuscular electrical stimulation group increased more after the intervention(P<0.05),the percentage of total foot support duration on the affected side decreased more after the intervention(P<0.05).Conclusion: Compared with routine rehabilitation,neuromuscular electrical stimulation significantly improves the knee function,quadriceps femoris strength and muscle atrophy of patients after anterior cruciate ligament reconstruction,improves the range of motion of knee and hip joints,and enhances the load bearing and buffering capacity of affected limbs,which may reduce the incidence of traumatic knee osteoarthritis and secondary injury in patients after anterior cruciate ligament reconstruction. |
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