Neuromuscular Electrical Stimulation Therapy to Restore Quadriceps Muscle Function in Patients After Orthopaedic Surgery A Novel Structured Approach

Despite evidence supporting the use of neuromuscular electrical stimulation (NMES) as an adjunct exercise modality to improve voluntary activation, muscle strength, and functional recovery after knee surgery, NMES therapy remains a clinically underutilized modality. We propose a criteria-based treatment algorithm aimed at optimizing and simplifying the clinical application of NMES therapy following knee surgery. The suggested algorithm includes a short preoperative phase for patient education (1 visit) and familiarization with NMES, followed by 2 home-based treatment phases (each lasting 3 weeks): (1) a high-intensity, high-volume phase initiated within the first few days following surgery, and (2) a high-intensity, low-volume phase. Two evaluation sessions are also incorporated, with the first following 1 week of treatment to assess the responsiveness to NMES and the second after 3 weeks of treatment to assess whether voluntary activation failure has resolved. Practical guidelines for maximizing muscle response while minimizing discomfort and fatigue, including optimal pulse characteristics, electrode size and location, knee joint position, and patient instructions, are provided.