Quadriceps function in anterior cruciate ligament-deficient knees exercising with transcutaneous electrical nerve stimulation and cryotherapy: A randomized controlled study

Objective: To compare strength and quadriceps muscle activation in anterior cruciate ligament-deficient patients who underwent a two-week rehabilitation exercise program using TENS or cryotherapy. Design: Randomized, controlled study. Setting: Clinical research laboratory. Subjects: Thirty patients: 20 males, 10 females, 31.6 (13.0) years, 172.8 (10.0) cm, 75.8 (13.0) kg with diagnosed tear of the anterior cruciate ligament. Interventions: All patients attended four sessions of supervised quadriceps strengthening exercises over two weeks, prior to reconstruction surgery. Patients were randomly allocated (n = 10/group) to receive exercises alone, exercise while wearing a sensory transcutaneous electrical nerve stimulation (TENS) device on the knee joint for the duration of each daily session, or 20 minutes of knee joint cryotherapy immediately prior to each daily exercise session. Main measures: Normalized knee extension force and quadriceps central activation ratio were measured before and after the first supervised treatment session and within 24 hours of the last session. Results: When accounting for differences in baseline measures, there were no statistically significant group differences immediately following the first exercise session for knee extension force (P = 0.10) or central activation ratio (P = 0.30) nor were there statistically significant group differences after the twoweek intervention for knee extension force (P = 0.92) or central activation ratio (P = 0.94). Effect sizes for the change in knee extension force and central activation ratio after two weeks of therapy were all large. Conclusions: Quadriceps strength and central activation in anterior cruciate ligament deficient patients improved after two weeks of rehabilitaiton exercises, however, there were no significant differences between treatment groups.