Use of electromyographic biofeedback in rehabilitation following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Abstract

BackgroundRehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery. ObjectiveTo synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. DesignSystematic review with meta-analysis. Data sourcesPubMed, EMBASE, CENTRAL and Epistemonikos were searched. Eligibility criteriaRandomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. Data extraction and data synthesisTwo authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences. ResultsEight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference − 1.3, 95% confidence interval (CI) − 1.74 to −0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference −6.21, 95% CI −17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group. ConclusionElectromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. Key messages•This is the first systematic review on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery.•Biofeedback intervention was found to improve knee extension and balance. There was no significant difference in Lysholm score or pain level between the biofeedback group and the control group.•Further studies are required to evaluate the effect of electromyographic biofeedback after ACL reconstruction surgery. If effectiveness can be demonstrated, this would suggest that greater numbers of patients could benefit despite the cost and lack of portability of the equipment. Systematic review registration numberPROSPERO (CRD42020193768).