Clinical study on the effect of proprioceptive neuromuscular facilitation technique on postoperative proprioception and neuromuscular control in patients with anterior cruciate ligament mucoid degeneration
Authors: Wang Haijiao , Qian Hong , Zhu Buqi , Li Youqiang , Zhao Xuefei , Huang Jingmin 
Published: September 2023

Abstract
Objective: To observe and compare the clinical efficacy of conventional group and PNF group in the treatment of anterior cruciate ligament (ACL) mucoid degeneration (MD) and to explore its possible mechanism. Methods: A retrospective case analysis method was used to analyze 34 patients (34 knees) with ACLMD diagnosed by arthroscopic surgery and pathological examination in our hospital from August 2018 to October 2020.According to the inclusion and exclusion criteria, a total of 34 cases were included, including 11 males and 23 females, aged 38-86 years, with an average age of (61.5±11.7) years, 18 cases of right knee and 16 cases of left knee. The course of disease was 3-41 months, with an average of (20.6±13.6) months. The postoperative follow-up was (15.3±1.8) months (range 12-18 months). The curative effect was evaluated before and after treatment :①visual analogue scale (VAS),②measurement of quadriceps atrophy,③Lysholm score,④proprioception function evaluation,⑤quadriceps mobilization ability evaluation. Results: Of the 34 patients enrolled, 2 were lost to follow-up, 1 was lost, and 31 completed the study. At the last follow-up, there was a statistically significant difference in VAS between the two groups at different time points (F = 411.322, P < 0.01), and there was an interaction between time and VAS (F = 7.370, P < 0.01). At different time points in the group, the degree of quadriceps atrophy in the two groups decreased gradually after treatment compared with that before treatment. However, there was no significant difference in the degree of muscle atrophy between 3 months after operation and 2 months after operation in the conventional group (P = 0.125, P > 0.05), while the difference in the PNF group was statistically significant (P < 0.01). There was no significant difference in the degree of muscle atrophy between the two groups at 1 month after operation (P = 0.114, P > 0.05), and the difference was gradually significant from 3 months after operation (P < 0.01). Comparison of different time points in the group, the Lysholm score of the two groups of patients after treatment was gradually improved compared with that before treatment, but there was no significant difference in the Lysholm score of the patients in the conventional group at 1 month after operation compared with that before operation (P = 0.999, P > 0.05), while the difference in the PNF group was statistically significant (P = 0.021, P < 0.05). The Lysholm score of the two groups at other time points was significantly different from that before operation (P < 0.01). There was no significant difference in the error value of the 15°angle regeneration test of the patients in the conventional group at 1 month after operation compared with that before operation (P = 0.150, P > 0.05), while the difference in the PNF group was statistically significant (P < 0.01). The error values of the passive angle regeneration test of the two groups at other time points were significantly different from those before operation (P < 0.01). In the comparison of different time points in the group, the evaluation of quadriceps mobilization ability of the two groups after treatment was gradually improved compared with that before treatment, and the difference was statistically significant (P < 0.05). At the same time point between the two groups, the difference of muscle mobilization ability between the two groups was statistically significant (P < 0.01). Conclusion: Both the conventional group and the PNF group can effectively relieve the clinical symptoms of ACLMD patients, reduce their pain visual analogue scale (VAS), reduce the degree of quadriceps atrophy, improve Lysholm function score, reduce the angle error of passive angle regeneration test, restore proprioception function, increase quadriceps mobilization ability, and improve knee joint function, but the PNF group is superior to the operation group. In particular, the PNF group has more significant advantages in reducing the degree of atrophy of the quadriceps femoris, improving the Lysholm function score, reducing the angle error of the passive angle regeneration test, and restoring the proprioceptive function.