EFFECTIVENESS OF CRYOTHERAPY AND TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ALONG WITH POST-OPERATIVE REHABILITATION FOR ARTHROGENIC MUSCLE INHIBITION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Introduction: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, not just among athletes but even in general population. Surgical treatment restores stability and limits progressive degeneration and long-term instability of the knee. Hence surgery is the preferred treatment for athletes and patients with physically demanding occupations. Despite the best efforts of physicians and rehabilitation professionals, often these goals are not achieved, as many patients return to normal life with lingering neuromuscular deficits and often are plagued with symptoms associated with the premature development of osteoarthritis. Quadriceps weakness is among the persistent neuromuscular deficiencies associated with ACL injury and presents a major rehabilitation challenge for patients and clinicians. Rehabilitation of the quadriceps musculature following ACL reconstruction (ACLR) often has been the subject of much debate. Materials And Methods: A total of 47 patients were included after fulfilling inclusion criteria between July 2019 to December 2021, all patients underwent ACL reconstruction using hamstring graft were subjected to Cryotherapy and TENS followed by that physiotherapy was given for early rehabilitation. Muscle thickness was measured at the intervals before surgery, 4^th week and 12^th week using ultrasound. Patients were assessed using VAS (Visual analogue score) and IKDC for functional outcome. Results: Vastus medialis and Vastus medialis obliques showed statistical significance with p value<0.05. Though other muscles did not show statistical significance it showed an increasing trend in thickness. Patients who underwent surgery within 6 months of injury had a better outcome than patients who underwent surgery between 6-12 months. Functional outcome of who underwent ACLR with isolated ACL injury showed statistical significance when compared with ACL with meniscus injury. Conclusion: Rehabilitation following ACL reconstruction has shifted from a protocol- based paradigm to a progression-based program with escalating difficulty. Early rehabilitation with additional modalities (TENS and Cryotherapy) showed better functional outcome by inhibiting Arthrogenic muscle inhibition. Early Weight bearing post ACLR plays a vital role in the rehabilitation of quadriceps muscle. Patients who underwent ACLR within short period of injury showed promising results with better functional outcome.