Athletic Training M.S.

Year Approved


First Advisor

Johnson, Janet


Background/Purpose:​ With anterior cruciate ligament (ACL) injuries becoming increasingly common in individuals of all ages, it’s important to understand how to best treat the patient after surgery. The purpose of this study is to critically review and evaluate the effectiveness of Neuromuscular Electrical Stimulation (NMES) on quadriceps strength after anterior cruciate ligament reconstruction (ACLr). Problem:​ Many articles look to evaluate how effective the use of NMES is in increasing quadriceps strength after ACLr, but the current literature does not fully agree on the extent of effectiveness. Therefore, it is necessary to conduct a critical review of the literature to see what the general consensus is regarding NMES use. The question being asked is as follows: Does the addition of NMES, when utilized post-ACLr, enhance quadriceps strength? Methods: ​20 articles were found using PubMed, Google Scholar, and CLICsearch. Of those 20, 17 were randomized controlled trials, two were systematic reviews, and one was a case series. The year of publication for the studies used in this critical review range from 1987 to 2019. Studies that used NMES to increase quad strength after ACLr or total knee arthroplasty (TKA) were used to draw a conclusion. Results:​ Of the 20 articles used, 16 found that NMES was effective in regaining quadriceps strength after ACLr, while the remaining four concluded that NMES, while it would not have a negative effect on the patient, was not necessary for strengthening after ACLr. The studies that found no significant difference between groups were of lower quality compared to the studies that found a significant difference. Conclusion:​ This critical review supports the use of NMES after ACLr to increase quadriceps strength with 15 studies advocating for the use and 5 against the use of NMES. Additional research is necessary to evaluate the long term strength gains that can come from NMES use, and how it can affect return to play in athletes. Implications for Practice:​ With the goal of rehabilitation being to get the patient back to full activity, regaining function should be the main long term focus. After ACLr, patients will experience weakness and asymmetry in the involved leg. Using NMES to regain quad strength can assist in getting the involved leg back in accordance with the uninvolved leg, making the patient more functional and returning them to pre-morbid activity levels sooner.

Degree Name

Athletic Training M.S.

Document Type

Masterʼs thesis

Included in

Kinesiology Commons