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Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions
  1. Bertrand Sonnery-Cottet1,
  2. Adnan Saithna2,3,
  3. Benedicte Quelard4,
  4. Matt Daggett5,
  5. Amrut Borade1,
  6. Hervé Ouanezar1,
  7. Mathieu Thaunat1,
  8. William G Blakeney1,6
  1. 1 Department of Orthopaedic Surgery and Sports Medicine, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
  2. 2 School of Science and Technology, Nottingham Trent University, Nottingham, East Midlands, UK
  3. 3 Department of Orthopaedic Surgery, Southport and Ormskirk Hospitals, Ormskirk, Lancashire, UK
  4. 4 Department of Physiotherapy, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
  5. 5 Department of Orthopaedic Surgery, Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
  6. 6 Department of Orthopaedic Surgery, Albany Health Campus, Albany, Western Australia, Australia
  1. Correspondence to Professor Adnan Saithna, School of Science and Technology Nottingham Trent University Nottingham East Midlands UK; adnan.saithna{at}


Objective To determine whether reported therapeutic interventions for arthrogenic muscle inhibition (AMI) in patients with ACL injuries, following ACL reconstruction, or in laboratory studies of AMI, are effective in improving quadriceps activation failure when compared with standard therapy in control groups.

Design A scoping review of the efficacy of interventions was conducted in accordance with the methodological framework of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included ‘arthrogenic muscle inhibition’, ‘quadriceps activation following knee injuries’, ‘anterior cruciate’ or ‘knee’ combined with ‘quadriceps activation’, ‘quadriceps inhibition’, ‘corticomotor’, ‘arthrogenic’, ‘brain activation’ and ‘neuroplasticity’. Articles were evaluated for risk of bias using the PEDro (Physiotherapy Evidence Database) criteria. The overall quality of evidence for each intervention was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Data sources PubMed, EMBASE and Cumulative Index to Nursing and Allied Health Literature databases.

Eligibility criteria for selecting studies Isolated case reports and articles reporting outcomes in patients with chronic disease or major trauma were excluded. All other original research articles were included.

Results 780 potential articles were identified. 20 met the inclusion criteria. These studies provided a moderate quality of evidence to support the efficacy of cryotherapy and physical exercises in the management of AMI. There was low-quality evidence for efficacy of neuromuscular electrical stimulation and transcutaneous electrical nerve stimulation, and very low-quality evidence for efficacy of ultrasound and vibration.

Conclusions This scoping review demonstrated moderate-quality evidence for the efficacy of cryotherapy and physical exercises in improving quadriceps activation failure after ACL injury and reconstruction. These therapeutic modalities are therefore recommended in the management of AMI.

  • knee acl
  • quadriceps
  • hamstring
  • neuromuscular
  • rehabilitation

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  • Contributors All authors have given final approval of the submitted manuscript and their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have made substantial contributions to the design of the work and manuscript writing. Conceptualisation of the work was by MT, BS-C and AS. The acquisition, analysis and interpretation of data were performed by WB, AS and AB. All authors were involved in drafting the work or revising it critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BS-C, AS and MT are all paid consultants for Arthrex. BS-C also receives royalties and research support from Arthrex.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.