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

Background Rehabilitation 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. Objective To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. Design Systematic review with meta -analysis. Data sources PubMed, EMBASE, CENTRAL and Epistemonikos were searched. Eligibility criteria Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. Data extraction and data synthesis Two 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. Results Eight 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. Conclusion Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. Key messages center dot This is the first systematic review on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. center dot 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. center dot 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 number PROSPERO (CRD42020193768). (c) 2023 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.