Download PDF
Sportverletz Sportschaden 2024; 38(04): 172-180
DOI: 10.1055/a-2365-9612
Case report

Treatment of Arthrogenic-Muscle-Inhibition in patients after knee-surgery with Motion-Activated-Neuromuscular stimulation – a case-series

Behandlung der arthrogenen Muskelhemmung bei Patienten nach kniechirurgischen Eingriffen mit bewegungsaktivierter neuromuskulärer Stimulation – eine Fallserie
Christian Schoepp
1   Klinik für Arthroskopische Chrirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY (Ringgold ID: RIN39748)
,
Jörg Dickschas
2   Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, GERMANY (Ringgold ID: RIN301864)
,
Arno Schmeling
3   Sporthopaedicum Berlin, Berlin, GERMANY
,
Florian Perwanger
4   Orthoplus Bozen, Bozen, ITALY
,
Kaywan Izadpanah
5   Universitätsklinikum Freiburg Chirurgische Universitatsklinik: Universitatsklinikum Freiburg Department Chirurgie, Freiburg, GERMANY (Ringgold ID: RIN72082)
,
Arthur Praetorius
6   Klinik für Arthroskopische Chirurgie, Sportraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY (Ringgold ID: RIN39748)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Arthrogenic muscle inhibition (AMI) presents a persistent challenge in postoperative knee rehabilitation and is often resistant to standard care. This case series examines the efficacy of Motion-Activated Neuromuscular Electrical Stimulation (mNMES) in addressing AMI refractory to rehabilitation after ACL (revision) surgery, patellar dislocation, trochleoplasty, or conservative treatment of the patellofemoral pain syndrome. Eight patients who had undergone extensive unsuccessful rehabilitation received six weeks of a novel mNMES treatment regimen. Outcome assessments included patient-reported outcome measures (PROMs) and AMI classification. Results revealed significant improvements in pain reduction, knee function, and AMI reduction. Despite study limitations, mNMES demonstrated promising outcomes and could be used as an adjunct to standard rehabilitation, offering potential for enhancing postoperative outcomes in patients refractory to conventional therapy. Further research is required to validate these findings and optimise treatment protocols.

Zusammenfassung

Die arthrogene Muskelhemmung (AMI) stellt eine anhaltende Herausforderung in der postoperativen Knie-Rehabilitation dar und ist oft refraktär gegenüber der konservativen Standardbehandlung. In dieser Fallserie wird die Wirksamkeit einer bewegungsaktivierten neuromuskulären Elektrostimulation (mNMES) bei persistierender AMI untersucht, die sich nach einer VKB (-Revisions) -Operation, Patellaluxation, Trochleoplastik oder konservativen Behandlung des patellofemoralen Schmerzsyndroms entwickelt hat. Acht Patienten, die eine umfangreiche trainingstherapeutische Rehabilitation absolviert hatten, unterzogen sich 6 Wochen lang der neuartigen mNMES-Behandlung. Die Ergebnisse wurden anhand von Fragebogeninstrumenten (PROMs) und der Änderung der AMI-Klassifizierung im Prä-post-Vergleich bewertet. Die Ergebnisse zeigten signifikante Verbesserungen bei der Schmerzreduktion, der Kniefunktion und der AMI-Reduktion. Trotz der Limitationen dieser Studie zeigte mNMES vielversprechende Ergebnisse und könnte als Ergänzung zur Standardrehabilitation eingesetzt werden, um die postoperativen Ergebnisse bei Patienten zu verbessern, die auf eine konventionelle Therapie nicht ansprechen. Weitere Untersuchungen sind erforderlich, um diese Ergebnisse zu bestätigen und die Behandlungsprotokolle zu optimieren.

Keywords

arthrogenic muscle inhibition - neuromuscular stimulation - patellofemoral pain - anterior knee pain - anterior cruciate ligament revision surgery - trochleaplasty - knee pacemaker

Schlüsselwörter

Arthrogene Muskelhemmung - neuromuskuläre Stimulation - patellofemorale Schmerzen - vordere Knieschmerzen - Revision des vorderen Kreuzbandes


Publication History

Received: 16 May 2024

Accepted after revision: 15 July 2024

Article published online:
04 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Anand M. et al. Integrated 3D motion analysis with functional magnetic resonance neuroimaging to identify neural correlates of lower extremity movement. J Neurosci Methods 2021; 355: 109108
    CrossrefPubMedSearch in Google Scholar
  • 2 Bonnette S. et al. Electrocortical dynamics differentiate athletes exhibiting low- and high- ACL injury risk biomechanics. Psychophysiology 2020; 57 (04) e13530
    CrossrefPubMedSearch in Google Scholar
  • 3 Criss CR, Onate JA, Grooms DR. Neural activity for hip-knee control in those with anterior cruciate ligament reconstruction: A task-based functional connectivity analysis. Neurosci Lett 2020; 730: 134985
    CrossrefPubMedSearch in Google Scholar
  • 4 Gribbin TC. et al. Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2016; 32: 64-71
    CrossrefPubMedSearch in Google Scholar
  • 5 Grooms DR. et al. Neuroplasticity Associated With Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 2017; 47 (03) 180-189
    CrossrefPubMedSearch in Google Scholar
  • 6 Hart JM. et al. Quadriceps activation following knee injuries: a systematic review. J Athl Train 2010; 45 (01) 87-97
    CrossrefPubMedSearch in Google Scholar
  • 7 Kaur M. et al. Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2016; 46 (12) 1869-1895
    CrossrefPubMedSearch in Google Scholar
  • 8 Pietrosimone B. et al. Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31 (06) 694-706
    CrossrefPubMedSearch in Google Scholar
  • 9 Alsaleh SA. et al. Local neuromuscular characteristics associated with patellofemoral pain: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2021; 90: 105509
    CrossrefPubMedSearch in Google Scholar
  • 10 Nunes GS. et al. Effectiveness of Interventions Aimed at Changing Movement Patterns in People With Patellofemoral Pain: A Systematic Review With Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53 (12) 1-13
    CrossrefPubMedSearch in Google Scholar
  • 11 Seeley MK. et al. Anterior knee pain independently alters landing and jumping biomechanics. Clin Biomech (Bristol, Avon) 2021; 89: 105458
    CrossrefPubMedSearch in Google Scholar
  • 12 Ong MT. et al. Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study. BMC Musculoskelet Disord 2023; 24 (01) 510
    CrossrefPubMedSearch in Google Scholar
  • 13 Callaghan MJ. et al. Factors associated with arthrogenous muscle inhibition in patellofemoral osteoarthritis. Osteoarthritis Cartilage 2014; 22 (06) 742-746
    CrossrefPubMedSearch in Google Scholar
  • 14 Lepley AS, Lepley LK. Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil 2022; 31 (06) 707-716
    CrossrefPubMedSearch in Google Scholar
  • 15 Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010; 40 (03) 250-266
    CrossrefPubMedSearch in Google Scholar
  • 16 Moroder P. et al. Neuromuscular Electrical Stimulation-Enhanced Physical Therapist Intervention for Functional Posterior Shoulder Instability (Type B1): A Multicenter Randomized Controlled Trial. Phys Ther 2023;
    CrossrefPubMedSearch in Google Scholar
  • 17 Moroder P. et al. Shoulder-Pacemaker Treatment Concept for Posterior Positional Functional Shoulder Instability: A Prospective Clinical Trial. Am J Sports Med 2020; 48 (09) 2097-2104
    CrossrefPubMedSearch in Google Scholar
  • 18 Moroder P. et al. Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept. Obere Extrem 2017; 12 (02) 103-108
    CrossrefPubMedSearch in Google Scholar
  • 19 Danzinger V, Schulz E, Moroder P. Epidemiology of functional shoulder instability: an online survey. BMC Musculoskelet Disord 2019; 20 (01) 281
    CrossrefPubMedSearch in Google Scholar
  • 20 Akpinar B. et al. Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction. Arthrosc Sports Med Rehabil 2020; 2 (05) e553-e561
    CrossrefPubMedSearch in Google Scholar
  • 21 Sood I, Sen S, Arfath U. Effect of electrical muscle stimulation with voluntary contraction and taping on joint position sense in asymptomatic scapular dyskinesic patients. International journal of physical medicine & rehabilitation 2014; 2: 1-6
    PubMedSearch in Google Scholar
  • 22 Walker DL, Hickey CJ, Tregoning MB. THE EFFECT OF ELECTRICAL STIMULATION VERSUS SHAM CUEING ON SCAPULAR POSITION DURING EXERCISE IN PATIENTS WITH SCAPULAR DYSKINESIS. Int J Sports Phys Ther 2017; 12 (03) 425-436
    PubMedSearch in Google Scholar
  • 23 Uschok S. et al. Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up. Arch Orthop Trauma Surg 2018; 138 (10) 1347-1352
    CrossrefPubMedSearch in Google Scholar
  • 24 Reinold MM. et al. The effect of neuromuscular electrical stimulation of the infraspinatus on shoulder external rotation force production after rotator cuff repair surgery. Am J Sports Med 2008; 36 (12) 2317-2321
    CrossrefPubMedSearch in Google Scholar
  • 25 Sonnery-Cottet B. et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med 2019; 53 (05) 289-298
    CrossrefPubMedSearch in Google Scholar
  • 26 Schauer T. Sensing motion and muscle activity for feedback control of functional electrical stimulation: Ten years of experience in Berlin. Annual Reviews in Control 2017; 44: 355-374
    CrossrefPubMedSearch in Google Scholar
  • 27 Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 2001; 81 (04) 1725-1789
    CrossrefPubMedSearch in Google Scholar
  • 28 Reddy H. et al. Altered cortical activation with finger movement after peripheral denervation: comparison of active and passive tasks. Exp Brain Res 2001; 138 (04) 484-491
    CrossrefPubMedSearch in Google Scholar
  • 29 van Dijk H, Jannink MJ, Hermens HJ. Effect of augmented feedback on motor function of the affected upper extremity in rehabilitation patients: a systematic review of randomized controlled trials. J Rehabil Med 2005; 37 (04) 202-211
    CrossrefPubMedSearch in Google Scholar
  • 30 Ng GY, Zhang AQ, Li CK. Biofeedback exercise improved the EMG activity ratio of the medial and lateral vasti muscles in subjects with patellofemoral pain syndrome. J Electromyogr Kinesiol 2008; 18 (01) 128-133
    CrossrefPubMedSearch in Google Scholar
  • 31 Christanell F. et al. The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial. Sports Med Arthrosc Rehabil Ther Technol 2012; 4 (01) 41
    CrossrefPubMedSearch in Google Scholar
  • 32 Loudon D. et al. Developing visualisation software for rehabilitation: investigating the requirements of patients, therapists and the rehabilitation process. Health Informatics J 2012; 18 (03) 171-180
    CrossrefPubMedSearch in Google Scholar
  • 33 Zeni JJr. et al. Biofeedback to promote movement symmetry after total knee arthroplasty: a feasibility study. J Orthop Sports Phys Ther 2013; 43 (10) 715-726
    CrossrefPubMedSearch in Google Scholar
  • 34 Grooms DR. et al. Visual-Motor Control of Drop Landing After Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53 (05) 486-496
    CrossrefPubMedSearch in Google Scholar
  • 35 Labanca L. et al. Neuromuscular Electrical Stimulation Superimposed on Movement Early after ACL Surgery. Med Sci Sports Exerc 2018; 50 (03) 407-416
    CrossrefPubMedSearch in Google Scholar
  • 36 Labanca L. et al. Early Superimposed NMES Training is Effective to Improve Strength and Function Following ACL Reconstruction with Hamstring Graft regardless of Tendon Regeneration. J Sports Sci Med 2022; 21 (01) 91-103
    CrossrefPubMedSearch in Google Scholar
  • 37 Gottlieb U. et al. Exercise combined with electrical stimulation for the treatment of chronic ankle instability – A randomized controlled trial. J Electromyogr Kinesiol 2024; 74: 102856
    CrossrefPubMedSearch in Google Scholar
  • 38 Byl NN, Pitsch EA, Abrams GM. Functional outcomes can vary by dose: learning-based sensorimotor training for patients stable poststroke. Neurorehabil Neural Repair 2008; 22 (05) 494-504
    CrossrefPubMedSearch in Google Scholar
  • 39 Myles PS. et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017; 118 (03) 424-429
    CrossrefPubMedSearch in Google Scholar
  • 40 Campbell WI, Patterson CC. Quantifying meaningful changes in pain. Anaesthesia 1998; 53 (02) 121-125
    CrossrefPubMedSearch in Google Scholar
  • 41 Zatterstrom R. et al. Early rehabilitation of acute anterior cruciate ligament injury--a randomized clinical trial. Scand J Med Sci Sports 1998; 8 (03) 154-159
    CrossrefPubMedSearch in Google Scholar
  • 42 D'Ambrosi R. et al. Multiple revision anterior cruciate ligament reconstruction: not the best but still good. Knee Surg Sports Traumatol Arthrosc 2023; 31 (02) 559-571
    CrossrefPubMedSearch in Google Scholar
  • 43 Esculier JF, Roy JS, Bouyer LJ. Psychometric evidence of self-reported questionnaires for patellofemoral pain syndrome: a systematic review. Disabil Rehabil 2013; 35 (26) 2181-2190
    CrossrefPubMedSearch in Google Scholar
  • 44 Liu JN. et al. Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthop J Sports Med 2019; 7 (01) 2325967118818462
    CrossrefPubMedSearch in Google Scholar
  • 45 Dammerer D. et al. Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study. Arch Orthop Trauma Surg 2018; 138 (04) 527-535
    CrossrefPubMedSearch in Google Scholar
  • 46 Giles L. et al. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med 2017; 51 (23) 1688-1694
    CrossrefPubMedSearch in Google Scholar
  • 47 Sappey-Marinier E. et al. Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years. Am J Sports Med 2019; 47 (06) 1323-1330
    CrossrefPubMedSearch in Google Scholar
  • 48 Walsh JM. et al. The Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptomatic State after Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4 (02) e661-e678
    CrossrefPubMedSearch in Google Scholar
  • 49 Sonnery-Cottet B. et al. Arthrogenic Muscle Inhibition Following Knee Injury or Surgery: Pathophysiology, Classification, and Treatment. Video Journal of Sports Medicine 2022; 2 (03)
    CrossrefPubMedSearch in Google Scholar
  • 50 Norte G, Rush J, Sherman D. Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2022; 31 (06) 717-735
    CrossrefPubMedSearch in Google Scholar
  • 51 Nandedkar SD, Barkhaus PE, Stålberg EV. Motor unit number index (MUNIX): principle, method, and findings in healthy subjects and in patients with motor neuron disease. Muscle Nerve 2010; 42 (05) 798-807
    CrossrefPubMedSearch in Google Scholar