SPORTS REHABILITATION IN ATHLETES WITH MENISCAL

LESIONS BASED ON ELECTROACUPUNCTURE

ASSOCIATED WITH SPORTS THERAPY Original Article
Artigo Original
REABILITAÇÃO ESPORTIVA DE ATLETAS COM LESÃO MENISCAL BASEADA EM ELETROACUPUNTURA Artículo Original
COMBINADA À TERAPIA ESPORTIVA

REHABILITACIÓN DEPORTIVA DE ATLETAS CON LESIÓN MENISCAL BASADA EN ELECTROACUPUNTURA

COMBINADA CON LA TERAPIA DEPORTIVA
Yujiao Li1 ABSTRACT
(Physical Education Professional)
Introduction: Meniscal injury is a common condition that can lead to disability due to pain and proprio-
1. Harbin normal university, ceptive failure, requiring immediate attention. Combination therapies involve advanced approaches aiming
College of Sports Science, Harbin, to accelerate rehabilitation in athletes, and electroacupuncture presents therapeutic benefits, although there
Heilongjiang, China. is still no evidence of its combination with sports therapy. Objective: This paper analyzes the performance of
sports rehabilitation in athletes with meniscal lesions using electroacupuncture combined with sports therapy.
Correspondence: Methods: The intervention in the control group was based on a traditional range of motion work, muscle
Yujiao Li strength, proprioceptive training, and other exercise therapies, while the experimental group received a 30
College of Sports Science,
min electro-acupuncture protocol three times a week for four consecutive weeks. The surrogate data (gender,
Heilongjiang, China. 150080.
age, disease course, location) are the same. Before treatment, joint activity, muscle strength, total joint scale
[email protected]
score of the LYSHOLM questionnaire, and other observational indices were measured during the 6th and 12th
week of treatment. The non-parametric statistical method and T-test were used to analyze the changes of each
index before and after treatment. After 12 weeks of treatment, the difference between the experimental group
and the combination before treatment was significant. Results: The treatment effect of the experimental group
was significantly better than the control group. Conclusion: The effect of sports rehabilitation of athletes with
meniscus injury based on electroacupuncture combined with sports therapy showed high resolutive applica-
tion value, indicating an alternative for non-surgical treatment in knee meniscus injuries. Level of evidence II;
Therapeutic studies - investigation of treatment outcomes.

Keywords: Exercise Therapy; Electroacupuncture; Tibial Meniscus Injuries; Physical Therapy Modalities.

RESUMO
Introdução: A lesão meniscal é um acometimento comum que pode gerar incapacitação por dor e falha pro-
prioceptiva, exigindo atenção imediata. Terapias combinadas envolvem abordagens avançadas com o objetivo de
acelerar a reabilitação nos atletas, e a eletroacupuntura apresenta benefícios terapêuticos, embora ainda não possua
evidencias de sua combinação com a terapia esportiva. Objetivo: Analisar o desempenho da reabilitação esportiva
em atletas com lesão meniscal utilizando eletroacupuntura combinada à terapia esportiva. Métodos: A intervenção
no grupo controle baseou-se no trabalho tradicional de amplitude de movimento, força muscular, treinamento pro-
prioceptivo e outros tipos de terapias de exercício enquanto que ao grupo experimental foi adicionado um protocolo
de eletro-acupuntura de 30 minutos de duração, 3 vezes por semana durante 4 semanas consecutivas. Os dados
de substituição (sexo, idade, curso de doença, localização) são basicamente os mesmos. Antes do tratamento, a
atividade articular, a força muscular, o escore total da escala articular do questionário LYSHOLM e outros índices de
observação foram medidos na 6ª e 12ª semana do tratamento. O método estatístico não paramétrico e teste-T foram
utilizados para analisar as alterações de cada índice antes e depois do tratamento. Após 12 semanas de tratamento,
a diferença entre o grupo experimental e a combinação antes do tratamento foi significativa. Resultados: O efeito
de tratamento do grupo experimental foi significativamente melhor do que o grupo controle. Conclusão: O efeito de
reabilitação esportiva de atletas com lesão meniscal baseada em eletroacupuntura combinada à terapia esportiva
demonstrou alto valor de aplicação resolutiva, indicada como alternativa para o tratamento não cirúrgico em lesões
no menisco do joelho. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Descritores: Terapia por Exercício; Eletroacupuntura; Lesões do Menisco Tibial; Modalidades de Fisioterapia.

RESUMEN
Introducción: La lesión meniscal es una lesión común que puede causar incapacidad por dolor y fallo propio-
ceptivo, requiriendo atención inmediata. Las terapias combinadas implican enfoques avanzados con el objetivo de
acelerar la rehabilitación en los deportistas, y la electroacupuntura presenta beneficios terapéuticos, aunque todavía
no hay pruebas de su combinación con la terapia deportiva. Objetivo: Analizar el rendimiento de la rehabilitación

Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0150 Page 1 of 5

 deportiva en atletas con lesión meniscal utilizando electroacupuntura combinada con la terapia deportiva. Métodos:
La intervención en el grupo de control se basó en el trabajo tradicional de amplitud de movimiento, fuerza muscular,
entrenamiento propioceptivo y otros tipos de terapias de ejercicio, mientras que al grupo experimental se le añadió
un protocolo de electroacupuntura de 30 minutos de duración, 3 veces a la semana durante 4 semanas consecutivas.
Los datos sustitutivos (sexo, edad, evolución de la enfermedad, localización) son básicamente los mismos. Antes
del tratamiento, se midieron la actividad articular, la fuerza muscular, la puntuación total de la escala articular del
cuestionario LYSHOLM y otros índices de observación en la 6ª y 12ª semana de tratamiento. Se utilizó el método
estadístico no paramétrico y la prueba T para analizar los cambios de cada índice antes y después del tratamiento.
Tras 12 semanas de tratamiento, la diferencia entre el grupo experimental y la combinación antes del tratamiento
era significativa. Resultados: El efecto del tratamiento del grupo experimental fue significativamente mejor que el
del grupo de control. Conclusión: El efecto de la rehabilitación deportiva de atletas con lesión de menisco basada
en la electroacupuntura combinada con la terapia deportiva mostró un alto valor de aplicación resolutiva, indicada
como alternativa de tratamiento no quirúrgico en las lesiones de menisco de rodilla. Nivel de evidencia II; Estudios
terapéuticos - investigación de los resultados del tratamiento.

Descriptores: Terapia por Ejercicio; Electroacupuntura; Lesiones de Menisco Tibial; Modalidades de Fisioterapia.

DOI: http://dx.doi.org/10.1590/1517-8692202329012022_0150 Article received on 03/15/2022 accepted on 05/31/2022

INTRODUCTION METHODS
With the social progress, economic development, the improvement Meniscus injury and its diagnosis
of residents’ living standards, and the rise of national sports, people pay Meniscus injury
more and more attention to their physical quality and health, making knee joint is one of the most important joints to complete vari-
more people join in sports. In the process of exercise, because of the ous complex movements in human motion. Because the knee joint
lack of understanding of the exercise load, exercise time and correct is located between the femur and tibia of two long lever arms of
posture, it is bound to cause sports injury in some parts of the body. human body, it is a hinge joint with shallow position, large joint
There are many franchise situations in the sports field, and the special surface, relatively less protective structure, bearing body mass and
posture caused by the special situation has become the hidden danger greater stress, and not very stable. Compared with other joints in
of many athletes’ various injuries. In daily sports training, it is often seen
the body, the knee joint is more easily injured due to its special
that athletes’ knee joint injury, especially Meniscus Injury (MI).1
structure and position, especially the meniscus, which can directly
Proprioception (PP) was put forward by Sherrington2,3 more than
affect the functional activities of the knee joint. The study and all
120 years ago. It is the feeling produced by the moving organs such as
the participants were reviewed and approved by Ethics Committee
finger muscles, tendons and joints in different states (motion or static).
(NO. 2021SU305).
Meniscus tear is the most common knee injury, which may occur
in young patients with acute knee injury, or as part of the degenerative Diagnostic method
process in the elderly. Žarko Dašić et al.4 studied and analyzed the results Clinical symptoms
of 99 cases of partial meniscectomy under arthroscope from 2005 to Mi has a history of knee injury. Pain, swelling and locked knee are
2013, and found that the treatment of partial meniscectomy has a good the three main symptoms. There are two types of injury: acute injury and
therapeutic effect on medial meniscus injury. Xiao, F et al.5,6 analyzed 47 chronic injury. The most obvious characteristic of acute injury is severe
patients with meniscus anterior angle injury under arthroscopic suture pain and swelling of knee joint gradually.
treatment. Lysholm knee joint scoring system was used to evaluate and
analyze the symptoms of preoperative and postoperative pain and lame Common specialized examination
embolism. Dariusz Boguszewski7,8 studied the effect of exercise therapy Imaging examination
on the rehabilitation of patients with meniscus injury. 23 patients aged Clinically, meniscus injury caused by trauma, joint degeneration
20-41 years were selected as the study object, and the patients were ran- and other factors is more common. According to the results of MRI
domly divided into experimental group and control group. Lin Zefeng et scan and arthroscopy, different types of meniscus injury are as follows:
al.9,10 used motion capture system to observe the motion characteristics 1 bucket handle tear:9 sagittal position often lacks normal meniscus
of the lateral discoid meniscus knee joint after the injury, and compared shape, meniscus fragments can be moved to intercondylar fossa, MRI
the difference between the lateral discoid meniscus knee joint and the shows double anterior or posterior cruciate ligament sign, while coronal
normal knee joint. This study provides an important reference value for position can identify the low signal meniscus tissue. 2 Horizontal tear:
the dynamic function of knee joint with lateral discoid meniscus injury.11,12 MRI showed that there were two or more levels of high signal shadow
Based on the above background, athletes in the field may cause parallel to tibial plateau in sagittal position, and the medial side reached
meniscus injury of knee joint due to various conditions, thus affecting the free edge of meniscus. 3 Oblique laceration: the sagittal position is
their career. In order to promote the rehabilitation of knee meniscus easy to diagnose.
injury, this paper discusses the effect of electroacupuncture combined
with sports therapy on the sports function of athletes with meniscus Treatment plan
injury.13,14 The aim is to study the rehabilitation effect of electroacupunc- the experimental group was treated with electroacupuncture com-
ture combined with exercise therapy on the meniscus injury of the knee bined with kinesitherapy, while the control group was only treated with
joint of athletes, and compare with the difference analysis of the use of kinesitherapy. Here is a detailed introduction of electroacupuncture
simple exercise therapy.15,16 therapy and exercise therapy.
Page 2 of 5 Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0150
Electroacupuncture program Remission period (3-6 weeks)
Acute stage (0-2 weeks) 1 Isometric training: straight leg raising training, knee pressing training,
Experimental equipment: electric acupuncture instrument (Huatuo), ankle pump training (the same operation procedure as acute period)
disposable acupuncture (Huatuo, 0.25 mm × 40 mm ~ 70 mm). in four directions (front, back, adduction, abduction), 20 times / group,
Acupoint selection: Quchi, Zhize, inner knee eye, calf nose, heding, 10 seconds each time, 5-8 groups / day.
2 Lower limb closed chain exercise (using the improved standing pile
Liangqiu, Xuehai, Ashi.
training): the patient stands against the wall, the knees flex painlessly,
Operation method: subjects placed their lower limbs naturally, lying
the patient pushes the wall with the back, and continues until the thigh
on their back on the treatment bed. 75% alcohol was used to disinfect
muscles can feel soft and sour, three times in the morning and afternoon,
the skin of acupoints from inside to outside, and then suitable disposable
each resting for 5 minutes.
acupuncture and moxibustion were used to insert the acupoints at a
3 Final knee extension training: the patient took the sitting position, put
faster frequency (100-150 times / min) for lifting and twisting.
a small pillow under the affected knee, maintain the knee flexion about
Frequency: 25-30min / time, 3 times / week, 2 consecutive weeks.
30 °, and then lift the heel off the bed, to the fully extended position of
Remission period (3-6 weeks) the affected knee, 20 times / group, 5-10 seconds / time, 3-5 groups / day.
Experimental equipment: the same as the first stage.
Rehabilitation period (7-12 weeks)
Acupoint selection: add Yinlingquan and Yanglingquan on the basis
1 Water sports therapy: in a constant temperature spa, patients are trained
of the first stage acupoints.
to stand on one foot, squat down, walk, cross step, “8” step, front, back,
Operation method: the operation method is the same as that of
side kick, etc. for 30 minutes / day.
the first stage, which is different from that of the first stage. The first
2 The operation procedure is the same as that in the remission period,
group is connected to Liangqiu and Yanglingquan respectively; the
which makes the training more difficult.
second group is connected to Xuehai and yinlingquan respectively; Specific operation: Pasteurized ball against the wall training - patient
the regulating frequency is 15Hz / s. Density wave is measured by the standing position, legs separated, shoulder width, back against the wall
subjects’ self-conscious comfort. with pasteurized ball, active flexion and extension of the knee joint,
Frequency: 30min / time, 3 times a week, 4 consecutive weeks. avoid pain arc, 10-15 times / group. Internal resistance training of ball
Rehabilitation period (7-12 weeks) of pasteurization - the patient sits, bends his hip and knees, places ball
Experimental equipment: the same as before. of pasteurization on the inner side of both thighs, forcefully clamps ball
Acupoint selection in this stage: add Zusanli, Sanyinjiao and Taixi of pasteurization on the inner side of both thighs, 10-15 times / group.
acupoints on the basis of acupoint selection in the previous stage. 3 Balance training: single foot standing training is the same as the re-
Operation method: the operation is the same as that in the previous mission period; single foot swing balance training (patients who can
stage, which is different from that in the previous stage, two groups of stand for 2 minutes with one foot or stand for 20 seconds with one foot
electroacupuncture wires are connected on the handle, one group of closed) can increase the difficulty of training, such as training on thick
wires is connected to Liangqiu and Zusanli respectively, the other group soft school, rubber air school, Biodex balance instrument and balance
of wires is connected to Xuehai and Sanyinjiao respectively. board, and make training groups according to specific projects.
Frequency: 30min / time, 3 times a week, 6 consecutive weeks.
RESULTS AND DISCUSSION
Exercise Therapy Program
Acute stage (0-2 weeks) This experiment was designed by blind method (single blind), ran-
1 Principle of price: in the acute stage, the patient’s knee joint should dom, pre and post control, and inter group control. According to the
be straightened under the protection of long leg steel bracket or ratio of 1:1 between the experimental group and the control group, the
kneepad to limit the flexion of the patient’s knee joint; the patient’s patients who met the criteria of inclusion and exclusion were randomly
leg should take rest, no weight bearing and no flexion and extension divided into two groups.
of the knee joint; Changes of Knee Joint Activity Before and After
2 Joint range of motion training: including active training or auxiliary
The changes of knee joint mobility before and after are shown in
training of equal length. 1-7 days after injury, it is feasible to train the
Table 1 and Figure 1. Combined with table 1 and figure 1, it can be seen
peripheral muscles of the knee: quadriceps femoris, Myxocyprinus,
that there is no significant difference in ROM between the two groups
adductor femoris, tensor fascia lata, gluteus medius and heel muscles. at the time of enrollment.
Operation procedure: After treatment, the improvement of ROM may be due to the stimu-
a. Ankle pump training: in the acute stage, the patient’s knee is mainly lation of acupuncture to promote the release of enkephalin, improve the
resting, and ankle pump training is carried out under painless condition. tolerance of the body, play a role in reducing pain, the pain can be relieved,
b. Knee training which can promote the early activity of patients. It has been proved that
Specific operation: the patient takes the lying or sitting position, slightly acupuncture and exercise therapy have obvious effect on knee joint mobility.
flexes the knee joint, presses the heel down hard on the bed for 5-10
seconds, and can complete 1000 times as much as possible every day. Changes of muscle strength before and after
c. The straight leg raising training in four directions (front, back, adduction The changes of muscle strength before and after are shown in Table
and abduction), especially the straight leg raising in front and outside, 2 and Figure 2. Combined with table 2 and Figure 2, it can be seen that
is particularly important. there is no significant difference in muscle strength between the two
c1. Straight leg lifting training: 15 times / group, 4 groups / day, after groups at the time of enrollment. In the 6 week and 12-week tests, the
the training, apply ice on the affected knee for 15-20 minutes. muscle strength of the experimental group and the control group in-
c2. Side leg lifting training (abduction training in lateral position): creases compared with the time of enrollment, and the muscle strength
15 times / group, 4 groups / day, after the training, apply ice on the of the experimental group is significantly greater than that of the control
affected knee for 15-20 minutes. group, the difference is statistically significant (p < 0.05).

Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0150 Page 3 of 5

 Table 1. Changes of knee joint mobility before and after. Table 3. Changes before and after Lysholm score.
Time Experience group Control group Time Experience group Control group
When entering 110.78±15.67 107.66±21.33 When entering 48.35±13.76 48.06±16.25
6 weeks 123.45±10.22 113.41±10.56 6 weeks 70.21±10.33 53.67±23.45
12 weeks 130.41±5.24 121.35±11.21 12 weeks 83.67±9.63 70.35±15.35

140
Experience group 100
120 Control group 80

Lysholm score
ROM evaluation value

100 60

40
80
20
60
0

40 When entering

20 6 weeks
Control group
0 12 weeks
When entering 6 weeks 12 weeks Experience group

Figure 1. Comparison of changes of knee joint mobility before and after. Figure 3. Comparison of changes before and after Lysholm score.

Table 2. Changes of muscle strength before and after. Table 4. Changes of VAS before and after pain.
Time Experience group Control group Time Experience group Control group
When entering 4.23±0.67 4.31±0.53 When entering 4.37±6.16 4.44±5.36
6 weeks 5.13±0.52 4.69±0.66 6 weeks 14.61±4.37 10.77±3.88
12 weeks 5.46±0.42 4.82±0.73 12 weeks 20.23±3.14 15.17±4.15

5.6

40
5.4 Experience group Experience group
Control group Control group
Muscle strength evaluation value

35

5.2
30
VAS evaluation value

5 25

20
4.8

15
4.6
10

4.4
5

4.2 0
When entering 6 weeks 12 weeks When entering 6 weeks 12 weeks

Figure 2. Comparison of changes before and after muscle strength. Figure 4. Comparison of changes of VAS before and after pain.

After 12 weeks of treatment, the two groups compared the mea- experimental group and the control group is significantly increased, and
surement of muscle strength, with differences. Compared with the two the muscle strength of the experimental group is significantly greater than
groups, the indexes of muscle strength measured at the time of admis- that of the control group, the difference is statistically significant (p < 0.05).
sion, 6 weeks of treatment and 12 weeks of treatment were different. From the perspective of traditional medicine, the early pain of me-
All rehabilitation training is carried out on the basis of painless, and that niscus injury of knee joint is due to the intertwined evil of blood and
is no exception for the training of muscle strength. water dampness, which soaks the knee joint and leads to the obstruction
of venation and “pain if there is no passage”, so that the knee joint has
Changes before and after lysholm score adverse activities, local swelling and pain.
The changes before and after Lysholm score are shown in Table 3
and Figure 3. Combined with table 3 and figure 3, it can be seen that CONCLUSIONS
there is no significant difference in Lysholm scores between the two With the development of society and the growing popularity of
groups at the time of enrollment. sports, sports have been a popular national activity. After treatment,
After treatment, the main improvement of the patients with me- ROM index of knee joint in experimental group increased from 110.78 ±
niscus injury is the following 8 aspects: limp, support, joint lock, joint 15.67 to 130.41 ± 5.24, while that in control group increased from 107.66
instability, pain, swelling, difficulty in going up and down stairs, and ± 21.33 to 121.35 ± 11.21. For myodynamia treatment, the experimen-
difficulty in squatting down. tal group increased from 4.23 ± 0.67 to 5.46 ± 0.42, the experimental
group increased from 48.35 ± 13.76 to 83.67 ± 9.63, while the control
Changes of pain before and after vas group increased from 48.06 ± 16.25 to 70.35 ± 15.35; For pain VAS, the
The changes of pain before and after vas are shown in Table 4 and experimental group increased from 4.37 ± 6.16 to 20.23 ± 3.14, while
Figure 4. Combined with Table 4 and Figure 4, it can be seen that there is the control group increased from 4.44 ± 5.36 to 15.17 ± 4.15.
no significant difference between the two groups in pain VAS. In the 6-week
The author declare no potential conflict of interest related to this article
and 12-week tests, compared with the control group, the pain vas of the
Page 4 of 5 Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0150
 AUTHORS’ CONTRIBUTIONS: Every author has made an important contribution to this manuscript: YL: was responsible for the writing, statistical analysis, intellectual concept and material preparation of
the whole research project.

REFERENCES
1. Ozeki N, Koga H, Sekiya I. Homeostasis and disorder of musculoskeletal system. Transplantation of synovial for small organ segmentation. IEEE J Biomed Health Inf. 2019;23(4):1363-73.
mesenchymal stem cells for cartilage and meniscus regeneration. Clin Calcium. 2018;28(3):319-27. 10. Srinivasa KG, Sowmya BJ, Shikhar A, Utkarsha R, Singh A. Data Analytics Assisted Internet of Things
2. Sun LD, Goldberg ME. Corollary discharge and oculomotor proprioception: cortical mechanisms for Towards Building Intelligent Healthcare Monitoring Systems: Iot for Healthcare. J Organ End User
spatially accurate vision. Annu Rev Vis Sci. 2016;2(1):61-84. Comput. 2018;30(4):83-103.

3. Solomon W, Holland C, Middleton MJ. Autism and understanding: the Waldon approach to child 11. Lin Z, Huang W, Ma L, Chen L, Zhang Y. Kinematic features in patients with lateral discoid meniscus
development. London: Sage Publications; 2012. injury during walking. Sci Rep. 2018;8(1):5053.

4. Žarko D, Nikola B, Miroslav K, Ivan B, Vesna B. Treatment of medial meniscus injury with partial menis- 12. Chen H, Lu Y, Tu L. Fault Identification of Gearbox Degradation with Optimized Wavelet Neural Network.
cectomy. Acta Clinica Croatica, 2015;54(3):319-4. Shock Vib. 2013;20(2):247-62.

5. Xiao F, Ding W. Divergence Measure of Pythagorean Fuzzy Sets and Its Application in Medical Diagnosis. 13. Allen T, Hollingham Z, MacWhirter J, Welsh M, Negm A, Adachi JD, MacIntyre N. Inter-rater reliability
of dartfish tm movement analysis software for measuring maximum flexion and extension at the hip
Appl Soft Comput. 2019;79:254-67.
and knee in older adults with osteoporosis and osteopenia. Physiother Theory Pract. 2018;35(6):1-9.
6. Su ZB, Zhou Y, Zhang X, Hao Y, Wang ZB. Efficacy of the arthroscopic suture in meniscus anterior horn
14. Lv ZH, Chen DL, Feng HL, Zhu H, Lv HB. Digital Twins in Unmanned Aerial Vehicles for Rapid Medical
injury. Chin J Orthop Trauma. 2015;28(10):959-62.
Resource Delivery in Epidemics. IEEE Trans Intell Transp Syst. 2021.
7. Zhou SR, Tan B. Electrocardiogram soft computing using hybrid deep learning CNN-ELM. Appl Soft
15. Fink K, Kaushal N, Gross J, Patel H, Delbello D. Bucket-handle tear of the medial meniscus in a 2-year-old
Comput. 2020;86:105778.
child. Orthopedics. 2018;41(4):e580-2.
8. Dariusz B, Iwona T, Jakub GA, Dariusz B. Evaluation of effectiveness of kinesiotaping in supporting of
16. Lourenco LM, Jiang Y, Drobnitzky N, Green M, Cahill F, Patel A, et al. Parp inhibition combined with
rehabilitation of patients after meniscus injury. preliminary report. Asian J Med Sci. 2015;6(4):61-6. thoracic irradiation exacerbates esophageal and skin toxicity in c57bl6 mice. Int J Radiat Oncol Biol
9. Zhao Y, Li H, Wan S, Sekuboyina A, Hu X, Tetteh G, et al. Knowledge-aided convolutional neural network Phys. 2018;100(3):767-75

Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0150 Page 5 of 5