Determining the safety, feasibility, and effects of anodal transcranial direct current stimulation on corticospinal excitability and quadriceps performance after anterior cruciate ligament reconstruction: a randomized crossover design.

IF 0.5 4区医学 Q4 ORTHOPEDICS Annals of Joint Pub Date : 2025-01-21 eCollection Date: 2025-01-01 DOI:10.21037/aoj-24-15

Ryan Zarzycki, Anne Leung, Rebekah Abraham, Sommer Hammoud, Mattia Perrone, Shailesh Kantak

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Abstract

Background: Alterations in corticospinal excitability (CSE) to the quadriceps persist after anterior cruciate ligament reconstruction (ACLR). Centrally targeted interventions, such as transcranial direct current stimulation (tDCS), may be necessary to increase CSE and quadriceps muscle strength. The purpose of this study was to determine (I) the feasibility and safety of a single session of tDCS and (II) the effects of a single session of tDCS on CSE and quadriceps muscle performance in participants after ACLR.

Methods: This was a randomized crossover design of a single session of active vs. sham tDCS, including 20 participants (nine male) 4-6 months post-ACLR. Surgical limb quadriceps performance [peak torque normalized to body mass, rate of torque development from onset to 100 ms (RTD100), and RTD from 100 to 200 ms (RTD200)] and CSE [active motor threshold (AMT) and slope of a stimulus-response curve (SLOPE)] were measured using an isokinetic dynamometer and transcranial magnetic stimulation (TMS), respectively. Anodal tDCS (a-tDCS) was delivered over the primary motor cortex while the participant rode a stationary bike for 20 minutes. Adverse events were collected after each tDCS session. Repeated measures 2×2 analyses of variance (ANOVAs) were used to test the effect of condition and time on CSE and quadriceps performance.

Results: There were no adverse events reported and no participant drop out. There was no significant condition by time interactions for CSE (P≥0.17) or quadriceps performance (P≥0.53). There was a significant main effect of time for RTD200 (P=0.02) with decreased RTD200 post-intervention regardless of condition.

Conclusions: TDCS is safe and feasible for participants recovering from ACLR. There were no acute effects of a single session of a-tDCS on CSE and quadriceps performance measures. Multiple sessions of tDCS and/or tDCS during other tasks (e.g., during isolated quadriceps exercises) may lead to improved CSE and quadriceps performance.

Trial registration: ClinicalTrials.gov ID: NCT04504344.

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