Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain and Function Following Arthroscopic Knee Surgery: A Prospective Randomized Clinical Trial Pilot Study
Phase: NA
Conditions: Meniscus Tear
Sponsor: A.T. Still University of Health Sciences

  
   
    
    
Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on    
Postoperative Pain and Function Following Arthroscopic Knee   
Surgery: A Prospective Randomized Clinical Trial Pilot Study    
    
    
    
Study Protocol    
NCT01528228    
    
    
    
    
Principal Investigator:     
    
Kevin M. Marberry, M.D. Associate   
Professor    
Department of Surgery    
A.T. Still University – KCOM Kirksville,  
MO 65301 kmarberry@atsu.edu    
    
    
    
    
    
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

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Table of Contents    
    
    
    
1.0  Abstract       2.0  Specific Aims   3.0  Background and Significance 4.0  Preliminary 
Studies 5.0  Research Design and Methods 6.0  Inclusion/Exclusion Criteria 7.0  
Randomization Procedure 8.0  Patient Forms 9.0  Proposed Timeline 10.0   References    
    
    
Appendices    
    
A. Enrollment Form B. Physician Entered Data for Each Visit C. Preoperative Patient 
Form D. Sample Patient Pain Diary E. Timing of Data Collection Protocol F. IKDC 
Surgical Document Form  G. Outcomes Instruments (SF-12, KOOS, IKDC, Lysholm, 
Marx)    
    
    
    
    
    
1.0    
Abstract    
    
Introduction    
    
Transcutaneous Electrical Nerve Stimulation (TENS) therapy has been used for the control of 
postoperative pain with variable results.[1-9]    TENS therapy is also considered an appropriate 
non-pharmacologic adjunct to patient care in the setting of symptomatic knee arthritis.[10-28]   
Recently, orthopaedic surgeons have begun to utilize TENS therapy about the operative site in 
the early post-operative period because of several proposed benefits including pain relief with 
decreased analgesic requirements, increased quadriceps strength with decreased postoperative 
muscle atrophy.  To our knowledge, the use of TENS as an adjunct to post-operative analgesia 
in the setting of outpatient knee arthroscopy has not been extensively studied.  We propose a pilot 
study to determine the effectiveness of TENS therapy in the early post-operative period following 
knee arthroscopy for meniscectomy, synovectomy, or chondroplasty.      
    
Methods    
    
Consecutive patients meeting inclusion criteria will be randomized to one of two treatment groups: 
1) structured TENS therapy (n=10) or 2) sham TENS therapy (n=10).  Patients and the surgeon 
will be blinded to the TENS treatment group.  Patients will complete preoperative assessments of 
pain and function using standardized outcomes instruments, then complete daily pain 
assessments and reports of analgesic consumption in the early post-operative period (two weeks).  
TENS will be discontinued at two weeks post-operatively.  The surgeon will complete the IKDC 
Surgical Document Form with information from the surgical procedure.  Patients will be followed 
for a total of six months post-operatively with clinical measurements of quadriceps strength, knee 
range of motion, presence of effusion, and quadriceps circumfrence (measure of atrophy).  
Functional outcomes will be measured with KOOS, Marx, Lysholm, IKDC, and SF-12 for up to six 

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months post-operatively.  Statistical analysis will be performed using computer software and 
significance defined as p<0.05.    
    
The results of the pilot study will be used to design a multi-center prospective randomized clinical 
trial.        
    
Conclusion    
    
TENS therapy in the early post-operative period following outpatient knee arthrscopy has not been 
extensively studied.  This pilot study will provide initial information for the effectiveness of this 
widely-used clinical device.    
    
    
2.0    
Specific Aims    
    
Transcutaneous Electrical Nerve Stimulation (TENS) therapy has been used for control of knee 
pain with good results.  Documented benefits of non-pharmacologic post-surgical pain control 
using TENS include decreased opioid analgesic usage, increased muscle strength, with a relative 
lack of side-effects.[1-9]  Additionally, TENS therapy has been studied extensively for the 
nonoperative treatment of knee arthritic conditions with somewhat mixed results.        
    
Knee arthroscopy in the outpatient setting often requires a patient’s pain to be well controlled in 
order to ensure day of surgery discharge.  In the early post-operative period, pain is primarily 
controlled with a combination of modalities including cryotherapy, narcotic and non-steroidal 
analgesia.  To our knowledge, the use of TENS as an adjunct to post-operative analgesia in the 
setting of outpatient knee arthroscopy has not been studied extensively.  To this end, we propose 
the following hypothesis:     
    
Hypothesis:  Following standard of care procedures for arthroscopy knee surgery it is 
anticipated that Transcutaneous Electrical Nerve Stimulation (TENS) will provide improved 
pain relieve and improve functional outcomes.    
    
Specific Aim 1:  Determine patient’s perception of pain in the early post-operative period 
while utilizing structure TENS therapy.    
    
Specific Aim 2:  Determine the short-term (6 months) outcomes following knee arthroscopy 
while using TENS in the early post-operative period.    
    
Specific Aim 3:  Determine effect of early TENS use on quadriceps strength and tone in the 
early and intermediate post-operative periods.    
    
3.0    
Background and Significance    
    
Outpatient knee arthroscopy is considered a common procedure in the United States with more 
than 500,000 surgeries performed on an outpatient basis yearly.[29] Immediate post-operative 
pain has multiple etiologic factors including the type of surgery performed, operative time, and 
time from surgery among others.[30]   Unfortunately, these factors are non-modifiable.  Therefore, 
post-operative pain in the ambulatory setting is inevitable.[31-33]  Limiting narcotic analgesic 

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usage has several advantages and thus strategies to accomplish this goal have been proposed 
for major orthopaedic surgery.[31]    
    
TENS has been offered as an adjunct to analgesic use in the early post-operative period in a 
variety of settings.  In a prospective, randomized study, Briet and Van der Wall compared narcotic 
analgesic usage following total knee arthroplasty with and without the use of TENS therapy.  The 
authors were unable to demonstrate significant reductions in post-operative analgesic 
requirements with the use of TENS therapy following total knee arthroplasty.[1]  In a prospective 
randomized clinical trial following abdominal surgery however, Cooperman and colleagues found 
that 77% of patients receiving TENS therapy in the immediate post-operative period reported good 
or excellent results, while 33% of patients reported good to excellent pain control without TENS.[9]      
    
For the non-operative treatment of knee osteoarthritis, TENS therapy has seen mixed results.  
When compared to intraarticular hyaluronic acid, TENS therapy has shown no statistically 
significant difference in pain and functional outcome at 6 months following treatment.[15]  Law et 
al. demonstrated significant improvements in self-reported pain and ROM in first two weeks 
following initiation of a TENS therapy program for patients with osteoarthritis.  They were unable 
to detect differences in patient-oriented outcomes.[18]  Cheing et al. found that four weeks of 
TENS therapy for knee osteoarthritis resulted in improved pain measures, but the treatment was 
not statistically different than placebo ore exercise alone.[24]  In a Cochrane Review of 6 trials, 
Osiri et al concluded that TENS is more effective than placebo for the treatment of knee 
osteoarthritis.[25]  In the setting of rheumatoid arthritis, Casamiro and colleagues in a Cochrane 
Review found that TENS was effective for pain control, but a formal recommendation for its use 
was precluded by the poor design of the studies included.[17]    
    
    
    
4.0    
Preliminary Studies    
    
Preliminary data is pending.    
    
5.0    
Research Design and Methods    
    
   
5.1    Rationale for use of hand-held dynamometer    
    
The reliability and validity of hand-held dynamometry has been extensively studied and adopted 
as a means of efficiently determining quadriceps strength in the outpatient setting.[34-45]    
    
   
5.2    Rationale for use of outcomes instruments    
    
Outcomes measures have been extensively used in orthopaedic research.[46]  The KOOS (Knee 
Injury and Osteoarthritis Outcomes Score) evaluates five diminsions and is specific to kneerelated 
pathology: pain, symptoms, ADLs, sports and recreation function, and knee-related quality of life.  
The Marx Activity Level Scale consists of four questions and was designed to be a short, 
patientreported activity assessment that can be used in addition to knee rating scales and general 
health outcomes measures.  The The Lysholm knee scale was developed for the followup 
evaluation of knee ligament surgery, with an emphasis on symptoms of instability.  It consists of 
eight items (limp, support, stair climbing, squatting, instability, locking and catching, pain, 

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swelling).  It is included for historical comparison and perspective.  The IKDC (International Knee 
Documentation Committee) scale is a subjective form consisting of 18 questions.  This form is 
considered to be specific to the knee and widely used in outcomes research.  The SF-12 is a 
shortened version of the SF-36 and is a general health quality of life instrument.      
    
6.0    
Inclusion/Exclusion Criteria    
    
• 
Age 18-60    
• 
BMI ≤50    
• 
No significant joint malalignment o Neutral to 5° valgus alignment as measured on standing 
weight-bearing PA radiographs of the knee or standing extremity alignment radiographs.    
• 
No significant ligamentous instability.     
o Normal Lachman, pivot shift, varus and valgus stress tests.    
• 
No significant radiographic joint space narrowing o Joint space measurement within 10% 
in each compartment as measured by digital radiography in standing weight-bearing view.    
• 
No prior significant knee surgery o No prior ligamentous or osteotomy surgery o Prior 
partial meniscectomy is acceptable    
• 
Unilateral knee surgery    
• 
Not Worker’s Compensation    
• 
Planned knee arthroscopy for meniscectomy, chondroplasty, or synovectomy    
    
7.0    
Randomization Procedure    
    
Patients will be randomized using a block randomization scheme generated by the   statistician.  
Sealed envelopes will be used to conceal the random assignments of patients to one  of two 
treatment groups in the immediate post-operative period.    
    
 Group 1:  structured TENS therapy (n=10)    
 Group 2:  sham TENS therapy (n=10)    
    
8.0    
Patient Form (Week 1 and 2 post-operative)    
    
Patients will complete a pain and analgesic usage diary.  Additionally, patients will complete VAS 
pain questions daily and pre- and post-TENS treatment.  See Appendix D.  TENS treatment will 
be standardized and will consist of 20 minute sessions three times per day at the manufacturer’s 
recommended settings.    
    
9.0    
Proposed Timeline    
    
    
• 
Pre-study:  Patient questionnaire and database constructed.    
• 
0-3 months:  Patient enrollment begins.     
• 
3-9 months:  Data collection.  Initial data analysis of immediate post-operative pain logs.    
• 
9-12 months:  Data analysis.    
• 
12-14 months:  Pilot study completion and preparation for multi-center study.  Power 
analysis will be performed to determine the number of patients needed to enroll.      
    

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10.0  Literature Cited    
    
1. 
Breit, R. and H. Van der Wall, Transcutaneous electrical nerve stimulation for  
postoperative pain relief after total knee arthroplasty. J Arthroplasty, 2004. 19(1): p. 45-  
8.    
2. 
Lewek, M., J. Stevens, and L. Snyder-Mackler, The use of electrical stimulation to 
increase quadriceps femoris muscle force in an elderly patient following a total knee 
arthroplasty. Phys Ther, 2001. 81(9): p. 1565-71.    
3. 
Paternostro-Sluga, T., et al., Neuromuscular electrical stimulation after anterior 
cruciate ligament surgery. Clin Orthop Relat Res, 1999(368): p. 166-75.    
4. 
Wang, B., et al., Effect of the intensity of transcutaneous acupoint electrical stimulation 
on the postoperative analgesic requirement. Anesth Analg, 1997. 85(2): p. 406-13.    
5. 
Hargreaves, A. and J. Lander, Use of transcutaneous electrical nerve stimulation for 
postoperative pain. Nurs Res, 1989. 38(3): p. 159-61.    
6. 
Arvidsson, I. and E. Eriksson, Postoperative TENS pain relief after knee surgery: 
objective evaluation. Orthopedics, 1986. 9(10): p. 1346-51.    
7. 
Tyler, E., C. Caldwell, and J.N. Ghia, Transcutaneous electrical nerve stimulation: an 
alternative approach to the management of postoperative pain. Anesth Analg, 1982. 
61(5): p. 449-56.    
8. 
Neary, J.M., Transcutaneous electrical nerve stimulation for the relief of postincisional 
surgical pain. Aana J, 1981. 49(2): p. 151-5.    
9. 
Cooperman, A.M., et al., Use of transcutaneous electrical stimulation in the control of 
postoperative pain. Am J Surg, 1977. 133(2): p. 185-7.    
10. 
Selfe, T.K. and A.G. Taylor, Acupuncture and osteoarthritis of the knee: a review of 
randomized, controlled trials. Fam Community Health, 2008. 31(3): p. 247-54.    
11. 
Eyigor, S., et al., [Does transcutaneous electrical nerve stimulation or therapeutic 
ultrasound increase the effectiveness of exercise for knee osteoarthritis: a randomized 
controlled study.]. Agri, 2008. 20(1): p. 32-40.    
12. 
Cetin, N., et al., Comparing hot pack, short-wave diathermy, ultrasound, and TENS on 
isokinetic strength, pain, and functional status of women with osteoarthritic knees: a 
single-blind, randomized, controlled trial. Am J Phys Med Rehabil, 2008. 87(6): p. 
44351.    
13. 
Burch, F.X., et al., Evaluating the benefits of patterned stimulation in the treatment of 
osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with 
an independent masked evaluator. Osteoarthritis Cartilage, 2008. 16(8): p. 86572.    
14. 
Kang, R.W., et al., Prospective randomized single-blinded controlled clinical trial of 
percutaneous neuromodulation pain therapy device versus sham for the osteoarthritic 
knee: a pilot study. Orthopedics, 2007. 30(6): p. 439-45.    
15. 
Paker, N., et al., Comparison of the therapeutic efficacy of TENS versus intraarticular 
hyaluronic acid injection in patients with knee osteoarthritis: a prospective randomized 
study. Adv Ther, 2006. 23(2): p. 342-53.    
16. 
Bjordal, J.M., et al., Physical treatments have valuable role in osteoarthritis. Bmj, 2006. 
332(7545): p. 853.    
17. 
Casimiro, L., et al., Acupuncture and electroacupuncture for the treatment of 
rheumatoid arthritis. Cochrane Database Syst Rev, 2005(4): p. CD003788.    

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18. 
Law, P.P., G.L. Cheing, and A.Y. Tsui, Does Transcutaneous Electrical Nerve 
Stimulation Improve the Physical Performance of People With Knee Osteoarthritis? J 
Clin Rheumatol, 2004. 10(6): p. 295-299.    
19. 
Law, P.P. and G.L. Cheing, Optimal stimulation frequency of transcutaneous electrical 
nerve stimulation on people with knee osteoarthritis. J Rehabil Med, 2004. 36(5): p. 220-  
5.    
20. 
Cheing, G.L. and C.W. Hui-Chan, Would the addition of TENS to exercise training 
produce better physical performance outcomes in people with knee osteoarthritis than 
either intervention alone? Clin Rehabil, 2004. 18(5): p. 487-97.    
21. 
Talbot, L.A., et al., A home-based protocol of electrical muscle stimulation for 
quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol, 
2003. 30(7): p. 1571-8.    
22. 
Cheing, G.L., et al., Optimal stimulation duration of tens in the management of 
osteoarthritic knee pain. J Rehabil Med, 2003. 35(2): p. 62-8.    
23. 
Hopkins, J., et al., Cryotherapy and Transcutaneous Electric Neuromuscular 
Stimulation Decrease Arthrogenic Muscle Inhibition of the Vastus Medialis After Knee 
Joint Effusion. J Athl Train, 2002. 37(1): p. 25-31.    
24. 
Cheing, G.L., C.W. Hui-Chan, and K.M. Chan, Does four weeks of TENS and/or 
isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin 
Rehabil, 2002. 16(7): p. 749-60.    
25. 
Osiri, M., et al., Transcutaneous electrical nerve stimulation for knee osteoarthritis. 
Cochrane Database Syst Rev, 2000(4): p. CD002823.    
26. 
Yurtkuran, M. and T. Kocagil, TENS, electroacupuncture and ice massage: comparison 
of treatment for osteoarthritis of the knee. Am J Acupunct, 1999. 27(3-4): p. 133-40.    
27. 
Brandt, K.D., The importance of nonpharmacologic approaches in management of 
osteoarthritis. Am J Med, 1998. 105(1B): p. 39S-44S.    
28. 
Taylor, P., M. Hallett, and L. Flaherty, Treatment of osteoarthritis of the knee with 
transcutaneous electrical nerve stimulation. Pain, 1981. 11(2): p. 233-40.    
29. 
Hunt, S.A., L.M. Jazrawi, and O.H. Sherman, Arthroscopic management of 
osteoarthritis of the knee. J Am Acad Orthop Surg, 2002. 10(5): p. 356-63.    
30. 
Drosos, G.I., et al., Post-operative pain after knee arthroscopy and related factors. Open 
Orthop J, 2008. 2: p. 110-4.    
31. 
Sinatra, R.S., J. Torres, and A.M. Bustos, Pain management after major orthopaedic 
surgery: current strategies and new concepts. J Am Acad Orthop Surg, 2002. 10(2): p. 
117-29.    
32. 
Phillips, W.J. and B.L. Currier, Analgesic pharmacology: II. Specific analgesics. J Am 
Acad Orthop Surg, 2004. 12(4): p. 221-33.    
33. 
Phillips, W.J. and B.L. Currier, Analgesic pharmacology: I. Neurophysiology. J Am 
Acad Orthop Surg, 2004. 12(4): p. 213-20.    
34. 
Suzuki, M., et al., Reliability and Validity of Measurements of Knee Extension Strength 
Obtained from Nursing Home Residents with Dementia. Am J Phys Med Rehabil, 2009.    
35. 
Mahony, K., et al., Inter-tester reliability and precision of manual muscle testing and 
hand-held dynamometry in lower limb muscles of children with spina bifida. Phys Occup 
Ther Pediatr, 2009. 29(1): p. 44-59.    

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36. 
Katz-Leurer, M., H. Rottem, and S. Meyer, Hand-held dynamometry in children with 
traumatic brain injury: within-session reliability. Pediatr Phys Ther, 2008. 20(3): p. 259-
63.    
37. 
Bell, D.R., D.A. Padua, and M.A. Clark, Muscle strength and flexibility characteristics 
of people displaying excessive medial knee displacement. Arch Phys Med Rehabil, 2008. 
89(7): p. 1323-8.    
38. 
Lu, T.W., et al., Enhancing the examiner's resisting force improves the reliability of 
manual muscle strength measurements: comparison of a new device with hand-held 
dynamometry. J Rehabil Med, 2007. 39(9): p. 679-84.    
39. 
Crompton, J., M.P. Galea, and B. Phillips, Hand-held dynamometry for muscle strength 
measurement in children with cerebral palsy. Dev Med Child Neurol, 2007. 49(2): p. 
106-11.    
40. 
O'Shea, S.D., N.F. Taylor, and J.D. Paratz, Measuring muscle strength for people with 
chronic obstructive pulmonary disease: retest reliability of hand-held dynamometry. 
Arch Phys Med Rehabil, 2007. 88(1): p. 32-6.    
41. 
Bohannon, R.W., Hand-held dynamometry: adoption 1900-2005. Percept Mot Skills,  
2006. 103(1): p. 3-4.    
42. 
Li, R.C., et al., The development, validity, and reliability of a manual muscle testing 
device with integrated limb position sensors. Arch Phys Med Rehabil, 2006. 87(3): p. 
411-7.    
43. 
Roy, M.A. and T.J. Doherty, Reliability of hand-held dynamometry in assessment of 
knee extensor strength after hip fracture. Am J Phys Med Rehabil, 2004. 83(11): p. 813-  
8.    
44. 
Piao, C., et al., Validity and reliability of the measurement of the quardriceps femoris 
muscle strength with a hand-held dynamometer on the affected side in hemiplegic 
patients. J UOEH, 2004. 26(1): p. 1-11.    
45. 
Taylor, N.F., K.J. Dodd, and H.K. Graham, Test-retest reliability of hand-held 
dynamometric strength testing in young people with cerebral palsy. Arch Phys Med 
Rehabil, 2004. 85(1): p. 77-80.    
46. 
Wright, R.W., Knee injury outcomes measures. J Am Acad Orthop Surg, 2009. 17(1): 
p. 31-9.    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
   

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Appendix A.  Enrollment Screening    
    
    
NAME ______________________________________    
Participant ID #__________    
    
    
Question    
    
Yes    
NO    
    
Is patient age less than 18 or greater than 60?    
    
   
    
    
Did patient refuse to sign informed consent?    
    
   
    
    
Is patient BMI > 50?         
    
   
    
    
Is the patient receiving simultaneous bilateral surgical treatment?   
    
 
   
    
    
Is any knee joint malalignment present?    
    
   
    
    
Is there any significant joint space narrowing present?    
    
   
    
    
Has the patient had prior significant knee surgery?    
    
   
    
    
Does this surgery involve a worker’s compensation claim?    
   

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Are there reasons the patient will not be able to keep 
postoperative appointments?    
    
   
    
    
    
    
If any question is answered with “YES”, the patient should not be included in this study.    
    
    
   
    
Appendix B.  Physician-entered Data at each evaluation    
    
    
Participant ID # _____________________    
    
    
Time    
ROM    
(R/L)    
Effusion 
(R/L)    
Strength  
(R/L)    
Quad Circ   
(R/L)    
Other    
    
Pre-op    
    
    
    
    
    
    
    
I week    
    
    
    
    
    
    
    
2 weeks    
    
    
    
    
    
    
    
6 weeks    
    
    
    
    
    
    
    
12 weeks    
    
    
    
    
    
    

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6 months    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
• 
ROM (“3-0-135”)    
• 
Effusion (none, 1+, 2+, 3+)    
• 
Strength (lbs) using hand-held dynamometer    
• 
Thigh circumfrence (cm) measured 10 cm proximal to superior pole of the patella  Other 
comments    
    
    
Appendix C.  Preoperative Patient Form    
    
Participant ID # _____________________    
    
Thank you for agreeing to participate in this important study about the pain control after knee 
arthroscopy surgery.  Please answer the following questions.    
    
1. 
Are you currently taking pain medication for your knee?    
□ Yes    
□ No    
2. 
If yes, what medication are you taking for your knee pain?    
□  Over the counter (Tylenol, Aleve, Motrin, etc…)    
□  Prescribed anti-inflammatory medication (Celebrex, Ibuprofen, etc…)    
□  Narcotic medication (Vicodin, Percocet, Codeine, etc…)    
□  Steroid medication (Cortisone, Prednisone, etc….)    
□  Other ____________________________________________    
3. 
During the past week, how often have you taken these medications?    
□  Three or more times a day    
□  Once or twice a day    

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□  Once every couple of days    
□  Once a week    
□  Have not taken in the past week  4.  
How much pain are you having today?     
Please mark on the line where your current pain level is.    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
No  0    
1    
2    
3    
4    
5    
6    
7    
8    
9    
10    
Severe    
 
    
    
    
    
    
    
    
    
    
 Pain   
   
     
   
Pain    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
Thank you.  Please complete the surveys on the following pages.    
Appendix D. Patient Pain Diary    
    
Participant ID #: _________________    
    
Find your pain level number from the scale below. Enter the number that best represents your 
pain level for each time listed.    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
No  0    
1    
2    
3    
4    
5    
6    
7    
8    
9    
10    
Severe    
 
    
    
    
    
    
    
    
    
    
 Pain   
   
     
   
Pain    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
Time    
Pain Number   
(0-10)    
Number of Pain    
Pills since last entry  
To Do    
Complete (X)    
Surgery    
    
    
    
    
5:00 PM    
    
    
    
    

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8:00 PM    
    
    
    
    
Day 1    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 2    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 3    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM   
    
    
    
    
 
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    

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6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 4    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 5    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 6    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    

TENS in Arthroscopy    
    
15    
PI:  Marberry, KM    
kmm 4.2011    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 7    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 8    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 9    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    

TENS in Arthroscopy    
    
16    
PI:  Marberry, KM    
kmm 4.2011    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
      
    
    
    
Day 10    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 11    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    

TENS in Arthroscopy    
    
17    
PI:  Marberry, KM    
kmm 4.2011    
Day 12    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 13    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    
9:30 PM    
    
    
    
    
Day 14    
    
    
    
    
9:00 AM    
    
    
TREATMENT    
    
9:30 AM    
    
    
    
    
12:00 PM    
    
    
    
    
3:00 PM    
    
    
TREATMENT    
    
3:30 PM    
    
    
    
    
6:00 PM    
    
    
    
    
9:00 PM    
    
    
TREATMENT    
    

TENS in Arthroscopy    
    
18    
PI:  Marberry, KM    
kmm 4.2011    
9:30 PM    
    
    
    
    
    
    
    
Appendix E.  Timing of Data Collection    
    
Time    
Surveys    
Clinical Data    
Preoperative    
SF-12    
Marx    
KOOS    
Lysholm    
IKDC    
Pain VAS    
ROM    
Effusion    
Strength    
Quad circ    
    
Intraoperative    
    
IKDC Surgical Document   
Form     
Surgical Data    
1 day-14 days    
Pain VAS    
Medication Use    
    
1 week    
See above    
ROM    
Effusion    
Strength    
Quad circ    
2 weeks    
See above    
ROM    
Effusion    
Strength    
Quad circ    
6 weeks    
SF-12    
Marx    
KOOS    
Lysholm    
IKDC    
Pain VAS    
Medication Use    
ROM    
Effusion    
Strength    
Quad circ    

TENS in Arthroscopy    
    
19    
PI:  Marberry, KM    
kmm 4.2011    
12 weeks    
SF-12    
Marx    
KOOS    
Lysholm    
IKDC    
Pain VAS    
Medication Use    
ROM    
Effusion    
Strength    
Quad circ    
6 months    
SF-12    
Marx    
KOOS    
Lysholm    
IKDC    
Pain VAS    
Medication Use    
ROM    
Effusion    
Strength    
Quad circ    
    
    
    
    
    
    
Appendix F.  2000 IKDC Surgical Documentation Form Appendix G. Outcomes Instruments 
(SF-12, KOOS, IKDC, Lysholm, Marx)