Effect of acupuncture combined with rehabilitation training on walking function after arthroscopic meniscus repair

Liu Xin-rong (劉新榮), Li Qi (李旗)

1 Rehabilitation Department, the 2nd Hospital Affiliated to Luohe Medical College, Henan 462000, China

2 College of Traditional Chinese Medicine, Hebei United University, Hebei 063000, China

Effect of acupuncture combined with rehabilitation training on walking function after arthroscopic meniscus repair

Liu Xin-rong (劉新榮)1, Li Qi (李旗)2

1 Rehabilitation Department, the 2nd Hospital Affiliated to Luohe Medical College, Henan 462000, China

2 College of Traditional Chinese Medicine, Hebei United University, Hebei 063000, China

Objective:To observe the effect of acupuncture combined with rehabilitation training on walking function after arthroscopic meniscus repair.

Methods:A total of 60 cases after arthroscopic meniscus repair were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group received acupuncture combined with standard rehabilitation training, whereas cases in the control group only received the standard rehabilitation training. The energy, support torque and swing torque of the knee joints in the two groups were measured and compared before treatment, after 1-month and 2-month treatments.

Results:Before treatment, there were no between-group significant differences in the differences of energy, support torque and swing torque of the knee joints (P＞0.05). After 1-month and 2-month treatments, there were intra-group and inter-group statistical differences in these parameters (P＜0.05).

Conclusion:Acupuncture combined with rehabilitation training can increase the energy, support torque and swing torque of the knee joints of patients after arthroscopic meniscus repair and improve their walking function.

Acupuncture Therapy; Meniscus, Tibia; Gait; Rehabilitation; Arthroscopy; Randomized Controlled Trial

Meniscus tear is a common sports injury and mainly characterized by localized knee joint pain. Some patients may experience leg weakness or knee joint locking and atrophy of quadriceps femoris. Over the recent years, minimally invasive arthroscopy has been widely used in meniscus tear. Today it is attracting more and more attention because of its good effect[1-3]. In this study, we observed the effect of acupuncture combined with rehabilitation training on walking function after arthroscopic meniscus repair. The results are now summarized as follows.

1 Clinical Data

1.1 Diagnostic criteria

This was based on the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine issued by the State Administration of Traditional Chinese Medicine[4]: a history of traumatic injury, alternatively no history of obvious traumatic injury; knee joint pain and swelling following injury, coupled with clicking sounds and joint locking; tenderness on medical and lateral knee joint space; chronic atrophy of quadriceps femoris, especially on the medial side of the muscle; positive signs of McMurray test and patellar grind test; and meniscus tear confirmed by MRI exmination.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; aged between 35 and 70 years; and without gender limitation.

1.3 Exclusion criteria

Those who failed to meet the above diagnostic and inclusion criteria; having injury or fracture of cruciate and collateral ligaments; having complications of major primary medical conditions involving the liver, kidney, hemopoietic or endocrine systems; having mental disorders; and those who failed to cooperate or stick to the treatment protocol.

1.4 Statistical analysis

1.5 General materials

A total of 60 outpatients and inpatients after arthroscopic meniscus repair treated at the Rehabilitation Department of our hospital between January 2012 and December 2013 were randomly allocated into two groups, 30 in each group. There were no between-group statistical differences in age, gender and duration, indicating that the two groups were comparable (Table 1).

2 Treatment Methods

2.1 Observation group

2.1.1 Acupuncture

Points: Dubi (ST 35), Xuehai (SP 10), Liangqiu (ST 34), Zusanli (ST 36) and Xitong (Extra) [locates at 1 cun lateral to Quchi (LI 11)].

Method: After routine sterilization, Dubi (ST 35), Xuehai (SP 10), Liangqiu (ST 34) and Zusanli (ST 36) were first punctured with filiform needles of 0.38 mm in diameter and 65 mm in length. The needles were retained for 30 min upon needling sensation. After the needles were removed, Xitong (Extra) point was punctured perpendicularly with filiform needles of 0.38 mm in diameter and 75 mm in length. The optimal result can be achieved if the local soreness, distension and heaviness sensation radiates down to the buttocks. The treatment was done once a day for 2 months.

2.1.2 Rehabilitation training

Patients were asked to conduct conventional rehabilitation exercise including passive joint motion, knee joint control, stance balance and gait training. The 30-minute exercise was done once a day for 2 months.

2.2 Control group

Table 1. Between-group comparison of general materials

3 Results Observation

3.1 Measurement parameters

The energy, support torque and swing torque of the knee joints were measured using the Lokomat gait assessment system before treatment, after 1-month treatment and after 2-month treatment[5].

3.2 Results

3.2.1 Comparison of knee joint energy

Before treatment, there were no between-group significant differences in knee joint energy (P＞0.05). After 1-month and 2-month of treatment, there were intra-group significant differences in both groups in knee joint energy (P＜0.05); and there were intra-group significant differences between 1-month treatment and 2-month treatment in both groups (P＜0.05). In addition, there were inter-group significant differences after 1-month and 2-month of treatment (P＜0.05, P＜0.01). This indicates that the knee joint energy was improved in both groups after treatment and the improvement was more significant in the observation group than that in the control group (Table 2).

Table 2. Between-group comparison of knee joint energy

Table 2. Between-group comparison of knee joint energy

Note: Intra-group comparison before and after treatment, 1) P＜0.05; intra-group comparison before and after 1-month treatment, 2) P＜0.05; inter-group comparison in corresponding period, 3) P＜0.01, 4) P＜0.05

Group n Before treatment After 1-month treatment After 2-month treatment Observation 301.42±0.293.42±0.811)4)6.93±1.571)2)3)Control 301.32±0.342.78±0.531)4.52±1.121)2)

3.2.2 Comparison of knee joint support torque

Before treatment, there were no between-group significant differences in knee joint support torque (P＞0.05). After 1-month and 2-month of treatment, there were intra-group significant differences in both groups in knee joint support torque (P＜0.05); and there were intra-group significant differences between 1-month treatment and 2-month treatment in both groups (P＜0.05). In addition, there were inter-group significant differences after 1-month and 2-month of treatment (P＜0.05, P＜0.01). This indicates that the knee joint support torque was improved in both groups after treatment and the improvement was more significant in the observation group than that in the control group (Table 3).

Table 3. Between-group comparison of knee joint support

Table 3. Between-group comparison of knee joint support

Note: Intra-group comparison before and after treatment, 1) P＜0.05; intra-group comparison before and after 1-month treatment, 2) P＜0.05; inter-group comparison in corresponding period, 3) P＜0.01, 4) P＜0.05

Group n Before treatment After 1-month treatment After 2-month treatment Observation 30 53±16 171±391)4)274±771)2)3)Control 30 50±17 143±411)211±641)2)

3.2.3 Comparison of knee joint swing torque

Before treatment, there were no between-group significant differences in knee joint swing torque (P＞0.05). After 1-month and 2-month of treatment, there were intra-group significant differences in both groups in knee joint swing torque (P＜0.05); and there were intra-group significant differences between 1-month treatment and 2-month treatment in both groups (P＜0.05). In addition, there were inter-group significant differences after 1-month and 2-month of treatment (P＜0.01). This indicates that the knee joint swing torque was improved in both groups after treatment and the improvement was more significant in the observation group than that in the control group (Table 4).

Table 4. Between-group comparison of knee joint swing

Table 4. Between-group comparison of knee joint swing

Note: Intra-group comparison before and after treatment, 1) P＜0.05; intra-group comparison before and after 1-month treatment, 2) P＜0.05; inter-group comparison in corresponding period, 3) P＜0.01

Group n Before treatment After 1-month treatment After 2-month treatment Observation 30 －138±57 11±91)3)72±281)2)3)Control 30 －124±43 －41±51)34±141)2)

4 Discussion

The meniscus is a key component of the knee joint and acts to stabilize and lubricate the joint as well as reduce friction. Meniscus injury can directly affect the motor function of the knee joint[6-7]. Despite the good effect of meniscus arthroscopy, loss of certain motor functions of the knee joint may greatly affect the patients’ daily living and work. As a result, rehabilitation following meniscus arthroscopy has attracted more and more attention. Today, traditional therapy combined with modern rehabilitation training has achieved satisfactory effects in this regard[8-11].

In this study, we’ve observed the effect of acupuncture combined with rehabilitation training on abnormal gait following meniscus arthroscopy. Needling Dubi (ST 35) can remove wind, resolve dampness, dissipate cold and alleviate pain. Needling Xuehai (SP 10) can unblock meridians, resolve stasis and relieve pain. Needling Liangqiu (ST 34) can harmonize stomach qi and dredge meridians and collaterals. Needling Zusanli (ST 36) can regulate the spleen and stomach and supplement spleen qi. Needling the extra Xitong point can relax tendons. The above points combined can supplement qi and blood, remove wind and stop pain.

The study findings have shown that the parameters of the knee joint energy, support torque and swing torque in the observation group were better than that in the control group. This indicates that, compared with rehabilitation training alone, acupuncture combined with rehabilitation training can better improve the patients’ knee joint support and swing torques after meniscus arthroscopy, correct their abnormal gaits, increase their motor function of the lower limb and benefit the balance abilities of their lower limbs during walking.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Scientific Research Project of Hebei Provincial Administration Bureau of Traditional Chinese Medicine (河北省中醫(yī)藥管理局科研計(jì)劃項(xiàng)目, No. 2014188).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 25 September 2014/Accepted: 28 October 2014

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Translator:Han Chou-ping (韓丑萍)

針刺配合康復(fù)訓(xùn)練對(duì)膝關(guān)節(jié)半月板損傷術(shù)后步行功能的影響

目的：觀察針刺配合康復(fù)訓(xùn)練對(duì)膝關(guān)節(jié)半月板損傷關(guān)節(jié)鏡術(shù)后患者步行功能的影響。方法：將 60 例半月板損傷關(guān)節(jié)鏡術(shù)后患者按隨機(jī)數(shù)字表法分為兩組，每組30 例。觀察組予針刺結(jié)合常規(guī)康復(fù)訓(xùn)練治療，對(duì)照組僅采用與觀察組相同的常規(guī)康復(fù)訓(xùn)練治療。于治療前及治療1個(gè)月、2個(gè)月后對(duì)患者膝關(guān)節(jié)能量、支撐力矩及擺動(dòng)力矩進(jìn)行測(cè)量比較。結(jié)果：治療前，兩組膝關(guān)節(jié)能量、支撐力矩及擺動(dòng)力矩差異均無統(tǒng)計(jì)意義(P＞0.05)。治療 1個(gè)月及2個(gè)月后，兩組患者膝關(guān)節(jié)能量、支撐力矩及擺動(dòng)力矩均明顯改善，與本組治療前有統(tǒng)計(jì)學(xué)差異

(P＜0.05)；兩組間亦有統(tǒng)計(jì)學(xué)差異(P＜0.05)。結(jié)論：針刺配合康復(fù)訓(xùn)練可增加膝關(guān)節(jié)半月板損傷關(guān)節(jié)鏡術(shù)后患者下肢運(yùn)動(dòng)過程中膝關(guān)節(jié)能量、支撐力矩與擺動(dòng)力矩，提高其步行功能。

針刺療法; 半月板, 脛骨; 步態(tài); 康復(fù); 關(guān)節(jié)鏡檢查; 隨機(jī)對(duì)照試驗(yàn)

R246.2 【

】A

the control group only

the same rehabilitation training (same method and time) as the observation group.

Author: Liu Xin-rong, attending physician.

E-mail: tsslw110@126.com