## 4 Discussion  
EMS was a training equipment known to improve neuromuscular functional activity by directly stimulating motor nerves and inducing muscle tetanus as a training method complementary to muscle strength development. It recently gained increasing popularity because it can be applied a topical or hole body [24,25]. It was recognized as an effective alternative approach to improving and maintaining muscle size and function, especially as diseases associated with muscle atrophy [26,27]. Hence, our study investigated if the complex use of EMS therapy and a standardized 12-week rehabilitation program for patients reduced quadriceps muscles due to ACL reconstruction would have any influence on the rapid recovery of muscular function. [PERSON] et al. [28] evaluated the complementary effect of adding electro muscle stimulation to a REP after ACL reconstruction using Kneehab. A substantial improvement in Lysholm was seen in the group using EMS compared to the group not using it in the clinical assessment findings of Lysholm and IKDC-2000. On the other hand, it was reported that there was an improvement in IKDC-2000, but there was no discernible variation in the main effect of time across the groups. In the our study, there was no interaction effect between groups in the Lysholm evaluation, but significant improvement in time was shown in EMSG, showing results consistent with previous studies. This is believed to have had a positive impact on the Lysholm score, which evaluates knee joint function in daily life, because of the rehabilitation of quadriceps femoris muscular strength and function [14,15]. On the other hand, the 12-week assessment revealed no significant differences across groups; however, the IKDC2000 examination revealed a considerable improvement in CONG. This could be because it takes three months following surgery to begin functional movements such as running and leaping, and there was no discernible evaluative disparity among the two groups. Figure 7: The rehabilitative exercise programs’ effects on isokinetic muscle function. (**A**) Compared in quadriceps femoris muscle PT. (**B**) Compared in quadriceps femoris muscle TW. control group; CONG, electro muscle stimulation group; EMSG, peak torque; PT, total work; TW. \(\#\)\(p\) < 0.05: main effect or interaction; \({}^{*}\)\(p\) < 0.05: pre- and post-test. [PERSON] et al. [29] examined the impact of early neuromuscular electrical stimulation after surgery and incorporated the EMS protocol at a 250 \(\upmu\)s pulse length and 20 Hz frequency to the general rehabilitation program to prevent muscle degeneration after ACL reconstruction. The improvement in the thigh circumference after four weeks of treatment, five days a week, for 20 min, was noticeable. In addition, the vastus medialis muscle underwent neuromuscular electrical stimulation for 4 weeks, 5 days a week, for 15 min in patients with degenerative knee osteoarthritis, suggesting that it is effective based on the fact that the thigh circumference increased significantly and the quadriceps muscle strength increased [25]. Regarding these alterations, [PERSON] et al. [30] suggested that long-term electrical stimulation of muscular neurons might turn type II fibers into type I fibers and result in type I fiber hypertrophy. The EMSG thigh circumference increased significantly in this study, as it did in the previous studies. Using a program in which multidirectional EMS was transmitted based on the vastus medialis and lateralis resulted in a notable increase in the circumference of the thigh at the 5 cm location centered on the patella compared to the general exercise group. It is believed that there is a connection between improved muscle strength as a result of a 12-week continuous exercise program and increased muscle activity of the VM and VL owing to neuromuscular adaptation [31,32]. [PERSON] et al.