Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study

Abstract

Background Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients.

Methods A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured.

Results The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115).

Conclusion Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.

Zusammenfassung

Hintergrund Studien haben Veränderungen im zentralen Nervensystem bei Patienten nach einer Ruptur des vorderen Kreuzbandes gezeigt. Für die Wirksamkeit von transkranieller Gleichstromstimulation bei Patienten nach einer vorderen Kreuzbandruptur gibt es keine ausreichenden Belege.

Methoden Eine Gruppe von Patienten (n=6) unterzog sich nach vorderer Kreuzbandruptur einem 6-wöchigen sensomotorischen Training während der transkraniellen Gleichstromstimulation. Die Stimulation bestand aus 20 Minuten (3 Sitzungen/Woche; 2 Wochen) über den primären motorischen und prämotorischen Kortex. Die zweite Gruppe (n=6) erhielt eine Scheinstimulation mit 6 Wochen sensomotorischem Training nach vorderer Kreuzbandruptur. Die Abweichungen des Druckzentrums in mediolateraler und anterior-posteriorer Richtung sowie die Geschwindigkeit wurden gemessen.

Ergebnisse Die Ergebnisse zeigten einen signifikanten Effekt des sensomotorischen Trainings auf die Abweichungen des Druckzentrums in mediolateraler und anterior-posteriorer Richtung (p=0,025; p=0,03) im Bein mit vorderer Kreuzbandruptur. Die Art des Trainings hatte keinen Einfluss auf die Ergebnisse. Post-hoc-Tests zeigten keinen signifikanten Effekt des Trainings in den Untergruppen (p≥0,115).

Schlussfolgerung Sensomotorisches Training führte zu einer Verringerung des Schwankens des Druckzentrums bei Patienten nach vorderer Kreuzbandruptur, aber der Zusatz von transkranieller Gleichstromstimulation, die über dem primären motorischen Kortex platziert wurde, potenziert die adaptiven Reaktionen des sensomotorischen Trainings nicht.

Keywords

Anterior Cruciate Ligament - Transcranial Direct Current Stimulation - Sensorimotor Training

Schlüsselwörter

vorderes Kreuzband - transkranielle Gleichstromstimulation - sensomotorisches Training

Publication History

Received: 23 October 2022

Accepted after revision: 09 March 2024

Article published online:
24 April 2024

• References

• 1 Meyer SE, Yamato TP, Saragiotto BT. Knee injury and ACL tear prevention programmes (PEDro synthesis). British journal of sports medicine 2017; 51 (15) 1161-1162 DOI: 10.1136/bjsports-2016-097232. (PMID: 28062466)
• 2 Walden M, Hagglund M, Magnusson H. et al. ACL injuries in men’s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. British journal of sports medicine 2016; 50 (12) 744-750 DOI: 10.1136/bjsports-2015-095952. (PMID: 27034129)
• 3 Lambert C, Ritzmann R, Ellermann A. et al. Return to competition after anterior cruciate ligament injuries in world class judoka. Phys Sportsmed 2021; 49 (03) 331-336 DOI: 10.1080/00913847.2020.1827684. (PMID: 33044870)
• 4 Ardern C WK, Taylor N, Feller J. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: Two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 2011; 39 (03) 538-543
• 5 Akoto R, Lambert C, Balke M. et al. Epidemiology of injuries in judo: a cross-sectional survey of severe injuries based on time loss and reduction in sporting level. British journal of sports medicine 2018; 52 (17) 1109-1115 DOI: 10.1136/bjsports-2016-096849. (PMID: 28446454)
• 6 Quatman CE, Quatman-Yates CC, Hewett TE. A ‘plane’ explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports medicine 2010; 40 (09) 729-746 DOI: 10.2165/11534950-000000000-00000. (PMID: 20726620)
• 7 Alentorn-Geli E, Myer GD, Silvers HJ. et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2009; 17 (07) 705-729
• 8 Tayfur B, Charuphongsa C, Morrissey D. et al. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports medicine 2021; 51 (02) 321-338
• 9 Di Stasi S, Myer GD, Hewett TE. Neuromuscular training to target deficits associated with second anterior cruciate ligament injury. The Journal of orthopaedic and sports physical therapy 2013; 43 (11) 777-792 DOI: 10.2519/jospt.2013.4693. (PMID: 24175599)
• 10 van Melick N, van Cingel RE, Brooijmans F. et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British journal of sports medicine 2016; 50 (24) 1506-1515 DOI: 10.1136/bjsports-2015-095898. (PMID: 27539507)
• 11 Ardern CL, Taylor NF, Feller JA. et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. British journal of sports medicine 2014; 48 (21) 1543-1552 DOI: 10.1136/bjsports-2013-093398. (PMID: 25157180)
• 12 Grooms DR, Page SJ, Nichols-Larsen DS. et al. Neuroplasticity Associated With Anterior Cruciate Ligament Reconstruction. The Journal of orthopaedic and sports physical therapy 2017; 47 (03) 180-189
• 13 Swanik CB, Covassin T, Stearne DJ. et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. The American journal of sports medicine 2007; 35 (06) 943-948
• 14 Grooms D, Appelbaum G, Onate J. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. The Journal of orthopaedic and sports physical therapy 2015; 45 (05) 381-393 DOI: 10.2519/jospt.2015.5549. (PMID: 25579692)
• 15 Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology 2000; 527: 633-639 DOI: 10.1111/j.1469-7793.2000.t01-1-00633.x. (PMID: 10990547)
• 16 Kaski D, Dominguez RO, Allum JH. et al. Improving gait and balance in patients with leukoaraiosis using transcranial direct current stimulation and physical training: an exploratory study. Neurorehabilitation and neural repair 2013; 27 (09) 864-871
• 17 Marquez J, Conley A, Karayanidis F. et al. Anodal direct current stimulation in the healthy aged: Effects determined by the hemisphere stimulated. Restorative neurology and neuroscience 2015; 33 (04) 509-519 DOI: 10.3233/RNN-140490. (PMID: 26409409)
• 18 Moreno FJ, Caballero C, Barbado D. Postural control strategies are revealed by the complexity of fractional components of COP. J Neurophysiol 2022; 127 (05) 1289-1297 DOI: 10.1152/jn.00426.2021. (PMID: 35353616)
• 19 Risberg MA, Mork M, Jenssen HK. et al. Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction. The Journal of orthopaedic and sports physical therapy 2001; 31 (11) 620-631 DOI: 10.2519/jospt.2001.31.11.620. (PMID: 11720295)
• 20 DaSilva AF, Volz MS, Bikson M. et al. Electrode positioning and montage in transcranial direct current stimulation. Journal of visualized experiments : JoVE 2011; (51) 2744
• 21 Liang HW, Chi SY, Tai TL. et al. Impact of age on the postural stability measured by a virtual reality tracker-based posturography and a pressure platform system. BMC Geriatr 2022; 22 (01) 506 DOI: 10.1186/s12877-022-03195-0. (PMID: 35715732)
• 22 Xu C, Wen XX, Huang LY. et al. Normal foot loading parameters and repeatability of the Footscan(R) platform system. J Foot Ankle Res 2017; 10: 30 DOI: 10.1186/s13047-017-0209-2. (PMID: 28725271)
• 23 Schabrun SM, Chipchase LS. Priming the brain to learn: the future of therapy?. Manual therapy 2012; 17 (02) 184-186 DOI: 10.1016/j.math.2011.12.001. (PMID: 22197081)
• 24 Bolognini N, Pascual-Leone A, Fregni F. Using non-invasive brain stimulation to augment motor training-induced plasticity. Journal of neuroengineering and rehabilitation 2009; 6: 8 DOI: 10.1186/1743-0003-6-8. (PMID: 19292910)
• 25 Koganemaru S, Sawamoto N, Aso T. et al. Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke. Neuroscience research 2015; 92: 29-38 DOI: 10.1016/j.neures.2014.10.004. (PMID: 25450315)
• 26 Duarte Nde A, Grecco LA, Galli M. et al. Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial. PloS one 2014; 9 (08) e105777
• 27 Kaski D, Dominguez RO, Allum JH. et al. Combining physical training with transcranial direct current stimulation to improve gait in Parkinson’s disease: a pilot randomized controlled study. Clin Rehabil 2014; 28 (11) 1115-1124
• 28 Boden BP, Dean GS, Feagin JA. et al. Mechanisms of anterior cruciate ligament injury. Orthopedics 2000; 23 (06) 573-578 DOI: 10.3928/0147-7447-20000601-15. (PMID: 10875418)
• 29 Bencke J, Aagaard P, Zebis MK. Muscle Activation During ACL Injury Risk Movements in Young Female Athletes: A Narrative Review. Front Physiol 2018; 9: 445 DOI: 10.3389/fphys.2018.00445. (PMID: 29867521)
• 30 Dauty M, Crenn V, Louguet B. et al. Anatomical and Neuromuscular Factors Associated to Non-Contact Anterior Cruciate Ligament Injury. J Clin Med 2022; 11 (05) 1402 DOI: 10.3390/jcm11051402. (PMID: 35268493)
• 31 Needle AR, Lepley AS, Grooms DR. Central Nervous System Adaptation After Ligamentous Injury: a Summary of Theories, Evidence, and Clinical Interpretation. Sports medicine 2017; 47 (07) 1271-1288 DOI: 10.1007/s40279-016-0666-y. (PMID: 28005191)