{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:25:19Z","timestamp":1789683919720,"version":"4.0.1"},"reference-count":94,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Quadriceps arthrogenic muscle inhibition (AMI) represents a key impairment following anterior cruciate ligament reconstruction (ACLR), contributing to quadriceps weakness. Although transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS) have been primarily investigated for analgesia, their effects on quadriceps strength in the early postoperative period remain underexplored. Methods: This study describes a single-blinded, parallel-group randomized controlled trial investigating the short-term effects of a single high-frequency TENS session and a novel long-term potentiation (LTP) PENS protocol on quadriceps strength and related clinical outcomes after ACLR. Fifty-four participants will be randomly allocated using block randomization in a 1:1:1 ratio to one of three groups: a control group (conventional post-ACLR rehabilitation only), a TENS group (conventional rehabilitation plus a single high-frequency TENS session), or a PENS group (conventional rehabilitation plus a single LTP PENS session). Participants will receive neuromodulatory intervention during the sixth postoperative week. The LTP PENS protocol consists of five 5 s stimulation bursts at 100 Hz and 250 \u03bcs pulse width and has only been investigated once in patients with upper limb pathology, underscoring its novelty in a postoperative setting. Results: The primary outcome is quadriceps maximal voluntary isometric contraction, selected as a clinically relevant surrogate of quadriceps activation deficits associated with AMI. Secondary outcomes include pain intensity, pressure pain threshold, knee range of motion, thigh muscle perimeter, knee effusion and swelling, and self-reported function and knee-related quality of life. Outcomes will be assessed at baseline, immediately post-treatment, and 1 and 7 days post-intervention by a blinded assessor.<\/jats:p>","DOI":"10.3390\/jcm15030989","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"989","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness of Transcutaneous and Percutaneous Electrical Nerve Stimulation as Adjunct Therapies in Patients After Anterior Cruciate Ligament Reconstruction: Study Protocol for a Randomized Controlled Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2147-3053","authenticated-orcid":false,"given":"Luis","family":"Blanco-L\u00f3pez","sequence":"first","affiliation":[{"name":"Health Sciences PhD Program, Universidad Cat\u00f3lica San Antonio de Murcia, Campus de los Jer\u00f3nimos, 135, 30107 Murcia, Spain"},{"name":"Cl\u00ednica CEMTRO, 28035 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5982-3392","authenticated-orcid":false,"given":"Iv\u00e1n","family":"N\u00e1cher-Molt\u00f2","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Universidad CEU Cardenal Herrera, Campus Alfara del Patriarca, 46115 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4791-6513","authenticated-orcid":false,"given":"Juan Luis","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad de Salamanca, Campus Miguel de Unamuno, 37007 Salamanca, Spain"},{"name":"Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5443-4484","authenticated-orcid":false,"given":"Daniel","family":"Casado-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Universidad Cat\u00f3lica San Antonio de Murcia, Campus de los Jer\u00f3nimos, 135, 30107 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri\u00e1n","family":"Cases-Sebasti\u00e0","sequence":"additional","affiliation":[{"name":"Health Sciences PhD Program, Universidad Cat\u00f3lica San Antonio de Murcia, Campus de los Jer\u00f3nimos, 135, 30107 Murcia, Spain"},{"name":"Cl\u00ednica CEMTRO, 28035 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9668-9476","authenticated-orcid":false,"given":"Javier","family":"Reina-Abell\u00e1n","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Universidad Cat\u00f3lica San Antonio de Murcia, Campus de los Jer\u00f3nimos, 135, 30107 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1177\/03635465231161071","article-title":"Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study","volume":"51","author":"Willinger","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1177\/0363546514561746","article-title":"Anterior cruciate ligament function in providing rotational stability assessed by medial and lateral tibiofemoral compartment translations and subluxations","volume":"43","author":"Noyes","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"586","DOI":"10.2106\/JBJS.16.01412","article-title":"The Effect of an ACL Reconstruction in Controlling Rotational Knee Stability in Knees with Intact and Physiologic Laxity of Secondary Restraints as Defined by Tibiofemoral Compartment Translations and Graft Forces","volume":"100","author":"Noyes","year":"2018","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2928","DOI":"10.1177\/03635465231187043","article-title":"The Anterior Fibers of the Superficial MCL and the ACL Restrain Anteromedial Rotatory Instability","volume":"51","author":"Herbst","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.arthro.2024.08.018","article-title":"Decreasing Incidence of Anterior Cruciate Ligament Tears and Increasing Utilization of Anterior Cruciate Ligament Reconstruction in the United States From 2010 to 2020","volume":"41","author":"Bergstein","year":"2025","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e20161877","DOI":"10.1542\/peds.2016-1877","article-title":"ACL Tears in School-Aged Children and Adolescents Over 20 Years","volume":"139","author":"Beck","year":"2017","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.5435\/JAAOS-D-22-01020","article-title":"American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries","volume":"31","author":"Brophy","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3871","DOI":"10.1007\/s00167-021-06443-9","article-title":"ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades","volume":"29","author":"Arnold","year":"2021","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hasan, M., Berkovich, Y., Khatib, M., Yonai, Y., Ben Zvi, L., Abu Alhija, A., Shpigelman, A., and Ginesin, E. (2025). Graft selection in ACL reconstruction: Clinical and functional outcomes based on level I-II evidence. Knee Surg. Sports Traumatol. Arthrosc.","DOI":"10.1002\/ksa.70167"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1056\/NEJMcp1805931","article-title":"Anterior Cruciate Ligament Tear","volume":"380","author":"Musahl","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s00167-011-1580-3","article-title":"The anterolateral ligament of the human knee: An anatomic and histologic study","volume":"20","author":"Vincent","year":"2012","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3300","DOI":"10.1016\/j.arthro.2025.06.011","article-title":"Lateral Extra-articular Procedures with Anterior Cruciate Ligament Reconstruction: International Consensus","volume":"41","author":"Saithna","year":"2025","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1016\/j.arthro.2024.01.031","article-title":"Lateral Extra-articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Is Most Commonly Indicated for Pivot Shift of Grade 2 or Greater and for Revision Anterior Cruciate Ligament Reconstruction","volume":"40","author":"Jones","year":"2024","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Tan, S.S.H., Lim, A.K.S., and Hui, J.H.P. (2025). Comparative outcomes of anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: A meta-analysis. Knee Surg. Sports Traumatol Arthrosc.","DOI":"10.1002\/ksa.12726"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1177\/03635465241304781","article-title":"Does the Addition of a Lateral Extra-articular Procedure to a Primary Anterior Cruciate Ligament Reconstruction Result in Superior Functional and Clinical Outcomes? A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"53","author":"Kan","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1177\/03635465241309282","article-title":"Indications for Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction: A Systematic Review","volume":"53","author":"Kwapisz","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Laudet, F., Noailles, T., Lutz, C., and Hardy, A. (2025). Technical Details of Lateral Tenodesis at the Fascia Lata: A Systematic Review of the Literature. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217613"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s00402-022-04368-7","article-title":"Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid\u00ae-technique in comparison to the interference screw technique: A retrospective analysis of 200 patients with at least 3 years follow-up","volume":"143","author":"Volz","year":"2023","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2242742","DOI":"10.1001\/jamanetworkopen.2022.42742","article-title":"Optimal Timing of Anterior Cruciate Ligament Reconstruction in Patients with Anterior Cruciate Ligament Tear: A Systematic Review and Meta-analysis","volume":"5","author":"Shen","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1177\/03635465241313386","article-title":"Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated with Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up","volume":"53","author":"McAleese","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2102","DOI":"10.1007\/s00167-013-2634-5","article-title":"Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction","volume":"22","author":"Janssen","year":"2014","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1302\/0301-620X.100B3.BJJ-2017-0733.R2","article-title":"Biological augmentation of graft healing in anterior cruciate ligament reconstruction: A systematic review","volume":"100-B","author":"Hexter","year":"2018","journal-title":"Bone Jt. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1007\/s40279-022-01674-3","article-title":"Muscle Force Contributions to Anterior Cruciate Ligament Loading","volume":"52","author":"Maniar","year":"2022","journal-title":"Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Forelli, F., Moiroux-Sahraoui, A., Mazeas, J., Dugernier, J., and Cerrito, A. (2025). Rethinking the Assessment of Arthrogenic Muscle Inhibition After ACL Reconstruction: Implications for Return-to-Sport Decision-Making-A Narrative Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14082633"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5103","DOI":"10.1113\/JP282014","article-title":"Deficit in knee extension strength following anterior cruciate ligament reconstruction is explained by a reduced neural drive to the vasti muscles","volume":"599","author":"Nuccio","year":"2021","journal-title":"J. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.knee.2023.06.006","article-title":"Persistence of neuromuscular activation deficit in the lower limb at 3-years of follow-up after ACL reconstruction surgery","volume":"43","author":"Zunzarren","year":"2023","journal-title":"Knee"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1080\/17461391.2022.2056520","article-title":"Arthrogenic muscle inhibition manifests in thigh musculature motor unit characteristics after anterior cruciate ligament injury","volume":"23","author":"Schilaty","year":"2023","journal-title":"Eur. J. Sport. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/jor.24666","article-title":"Athletes after anterior cruciate ligament reconstruction demonstrate asymmetric intracortical facilitation early after surgery","volume":"39","author":"Zarzycki","year":"2021","journal-title":"J. Orthop. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.jpain.2023.03.014","article-title":"Effect of Transcutaneous Electrical Nerve Stimulation on Pain-related Quantitative Sensory Tests in Chronic Musculoskeletal Pain and Acute Experimental Pain: Systematic Review and Meta-analysis","volume":"24","author":"DeJesus","year":"2023","journal-title":"J. Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1002\/ejp.1559","article-title":"Effectiveness of percutaneous electrical nerve stimulation for musculoskeletal pain: A systematic review and meta-analysis","volume":"24","author":"Cleland","year":"2020","journal-title":"Eur. J. Pain"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1093\/pm\/pnac027","article-title":"Percutaneous Versus Transcutaneous Electrical Nerve Stimulation for the Treatment of Musculoskeletal Pain. A Systematic Review and Meta-Analysis","volume":"23","year":"2022","journal-title":"Pain Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/pm\/pnac140","article-title":"Effects of Percutaneous and Transcutaneous Electrical Nerve Stimulation on Endogenous Pain Mechanisms in Patients with Musculoskeletal Pain: A Systematic Review and Meta-Analysis","volume":"24","year":"2023","journal-title":"Pain Med."},{"key":"ref_33","first-page":"30","article-title":"Effect of ultrasound-guided percutaneous neuromodulation applied to the femoral nerve on pain and range of motion in patients with anterior knee pain: A case study","volume":"3","author":"Morales","year":"2020","journal-title":"Rev. Fisioter. Invasiva"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1590\/bjpt-rbf.2014.0176","article-title":"Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain","volume":"20","author":"Frutos","year":"2016","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1111\/j.1526-4637.2011.01215.x","article-title":"Randomized double-blind sham-controlled crossover study of short-term effect of percutaneous electrical nerve stimulation in neuropathic pain","volume":"12","author":"Raphael","year":"2011","journal-title":"Pain Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3109\/10582450903496047","article-title":"Percutaneous Electrical Nerve Stimulation Versus Dry Needling: Effectiveness in the Treatment of Chronic Low Back Pain","volume":"18","year":"2010","journal-title":"J. Musculoskelet. Pain"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"De-la-Cruz-Torres, B., Abu\u00edn-Porras, V., Navarro-Flores, E., Calvo-Lobo, C., and Romero-Morales, C. (2021). Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094877"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Bermejo, P., Torres, B., and Morales, C. (2020). Ultrasound-Guided Percutaneous Neuromodulation in Patients with Unilateral Anterior Knee Pain: A Randomized Clinical Trial. Appl. Sci., 10.","DOI":"10.3390\/app10134647"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/ner.13396","article-title":"Correct Sciatic Nerve Management to Apply Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Low Back Pain: A Pilot Study","volume":"24","year":"2021","journal-title":"Neuromodul. J. Int. Neuromodul. Soc."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Caballero-L\u00f3pez, J., Navarro-Santana, M., Almaz\u00e1n-Polo, J., Garc\u00eda-Sanz, F., D\u00edaz-Arribas, M.J., Minaya-Mu\u00f1oz, F., and Romero-Morales, C. (2025). Short-term effects of percutaneous electrical nerve stimulation on pain and muscle function in patients undergoing anterior cruciate ligament surgery: A randomized clinical trial. Front. Rehabil. Sci., 6.","DOI":"10.3389\/fresc.2025.1501703"},{"key":"ref_41","first-page":"39","article-title":"Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series","volume":"2","year":"2019","journal-title":"Rev. Fisioter. Invasiva"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1136\/bjsports-2022-105498","article-title":"Measurement properties for muscle strength tests following anterior cruciate ligament and\/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus","volume":"56","author":"Urhausen","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1002\/mus.20366","article-title":"Accuracy of predicting maximal quadriceps force from submaximal effort contractions after anterior cruciate ligament injury","volume":"32","author":"Farquhar","year":"2005","journal-title":"Muscle Nerve"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/01.j.pain.0000460353.15460.a3","article-title":"Electrical stimulation of low-threshold afferent fibers induces a prolonged synaptic depression in lamina II dorsal horn neurons to high-threshold afferent inputs in mice","volume":"156","author":"Sdrulla","year":"2015","journal-title":"Pain"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1002\/ejp.1928","article-title":"Sensorimotor effects of plasticity-inducing percutaneous peripheral nerve stimulation protocols: A blinded, randomized clinical trial","volume":"26","author":"Ortega","year":"2022","journal-title":"Eur. J. Pain"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1001\/jama.2022.21243","article-title":"Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension","volume":"328","author":"Butcher","year":"2022","journal-title":"JAMA"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s13012-015-0332-z","article-title":"Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials","volume":"10","author":"Welch","year":"2015","journal-title":"Implement Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1001\/jama.2022.21022","article-title":"Guidelines for Reporting Outcomes in Trial Reports: The CONSORT-Outcomes 2022 Extension","volume":"328","author":"Butcher","year":"2022","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"407","DOI":"10.14423\/SMJ.0000000000000131","article-title":"Declaration of Helsinki-the world\u2019s document of conscience and responsibility","volume":"107","author":"Holt","year":"2014","journal-title":"South. Med. J."},{"key":"ref_51","first-page":"254","article-title":"Ley Org\u00e1nica 3\/2018, de 5 de diciembre, de Protecci\u00f3n de Datos Personales y garant\u00eda de los derechos digitales","volume":"7","year":"2019","journal-title":"AIS Ars. Iuris Salmant."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav. Res. Methods"},{"key":"ref_53","unstructured":"Valera-Garrido, F., and Minaya-Mu\u00f1oz, F. (2016). Fisioterapia Invasiva, Elsevier."},{"key":"ref_54","first-page":"841","article-title":"The Effect of Stimulus Frequency on the Analgesic Response to Percutaneous Electrical Nerve Stimulation in Patients with Chronic Low Back Pain","volume":"88","author":"Ghoname","year":"1999","journal-title":"Anesth. Analg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S1138-6045(05)72785-4","article-title":"Escala de Aprensi\u00f3n Psicol\u00f3gica Personal (EAPP) en Fisioterapia","volume":"8","year":"2005","journal-title":"Rev. Iberoam. Fisioter. Kinesiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1177\/0964528419826103","article-title":"Immediate effects of ultrasound-guided percutaneous neuromodulation versus physical exercise on performance of the flexor hallucis longus muscle in professional dancers: A randomised clinical trial","volume":"37","year":"2019","journal-title":"Acupunct. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1111\/ner.13040","article-title":"Comparative Effects of One-Shot Electrical Stimulation on Performance of the Flexor Hallucis Longus Muscle in Professional Dancers: Percutaneous Versus Transcutaneous?","volume":"23","year":"2020","journal-title":"Neuromodul. Technol. Neural. Interface"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Gallego-Sendarrubias, G.M., Arias-Bur\u00eda, J.L., \u00dabeda-D\u2019ocasar, E., Herv\u00e1s-P\u00e9rez, J.P., Rubio-Palomino, M.A., Fern\u00e1ndez-De-Las-Pe\u00f1as, C., and Valera-Calero, J.A. (2021). Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040690"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1056\/NEJM199006073222303","article-title":"A Controlled Trial of Transcutaneous Electrical Nerve Stimulation (TENS) and Exercise for Chronic Low Back Pain","volume":"322","author":"Deyo","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/AJP.0000000000000404","article-title":"Effectiveness of Periosteal Stimulation Therapy and Home Exercise Program in the Rehabilitation of Patients with Advanced Knee Osteoarthritis","volume":"33","author":"Elbadawy","year":"2017","journal-title":"Clin. J. Pain"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.4067\/S0717-95022019000401498","article-title":"Localizaci\u00f3n Biom\u00e9trica de los Puntos Motores del M\u00fasculo Cu\u00e1driceps Femoral de Individuos Brasile\u00f1os","volume":"37","author":"Olave","year":"2019","journal-title":"Int. J. Morphol."},{"key":"ref_62","first-page":"e3882","article-title":"The Relative Location of the Major Femoral Nerve Motor Branches in the Thigh","volume":"11","author":"Page","year":"2019","journal-title":"Cureus"},{"key":"ref_63","unstructured":"CaballeroL\u00f3pez, J.J. (2025). Eficacia de la Estimulaci\u00f3n Nerviosa El\u00e9ctrica Percut\u00e1nea Enpacientes Intervenidos Quir\u00fargicamente de Ligamento Cruzado Anterior: Un Ensayocl\u00ednico Aleatorizado. [Ph.D. Thesis, Universidad Europea de Madrid]."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.2522\/ptj.20120281","article-title":"What Makes Transcutaneous Electrical Nerve Stimulation Work? Making Sense of the Mixed Results in the Clinical Literature","volume":"93","author":"Sluka","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.jpain.2012.06.004","article-title":"Increasing intensity of TENS prevents analgesic tolerance in rats","volume":"13","author":"Sato","year":"2012","journal-title":"J. Pain"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e6726","DOI":"10.1097\/MD.0000000000006726","article-title":"Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture","volume":"96","year":"2017","journal-title":"Medicine"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1111\/j.1532-5415.2007.01314.x","article-title":"Efficacy of Periosteal Stimulation Therapy for the Treatment of Osteoarthritis-Associated Chronic Knee Pain: An Initial Controlled Clinical Trial","volume":"55","author":"Weiner","year":"2007","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/j.clinthera.2013.09.025","article-title":"Efficacy of Periosteal Stimulation for Chronic Pain Associated with Advanced Knee Osteoarthritis: A Randomized, Controlled Clinical Trial","volume":"35","author":"Weiner","year":"2013","journal-title":"Clin. Ther."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Bj\u00f8rn, S., Nielsen, T.D., Jensen, A.E., Jessen, C., Kolsen-Petersen, J.A., Moriggl, B., Hoermann, R., and Bendtsen, T.F. (2024). The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113270"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"23259671221085272","DOI":"10.1177\/23259671221085272","article-title":"Effects of Leg Length, Sex, Laterality, and the Intermediate Femoral Cutaneous Nerve on Infrapatellar Innervation","volume":"10","author":"Johnson","year":"2022","journal-title":"Orthop. J. Sports Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3140","DOI":"10.1007\/s00167-016-4217-8","article-title":"Saphenous nerve injury during hamstring tendons harvest: Does the incision matter? A systematic review","volume":"25","author":"Ruffilli","year":"2017","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/036354658901700405","article-title":"Saphenous nerve entrapment at the adductor canal","volume":"17","author":"Romanoff","year":"1989","journal-title":"Am. J. Sports Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s00256-024-04814-0","article-title":"Anatomy and pathology of adductor canal (Hunter\u2019s canal)","volume":"54","author":"Mettu","year":"2024","journal-title":"Skeletal. Radiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1007\/s00167-018-5245-3","article-title":"Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction","volume":"27","author":"Almeida","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/036354658701500304","article-title":"Effect of electrical stimulation on quadriceps strength after reconstructive surgery of the anterior cruciate ligament","volume":"15","author":"Sisk","year":"1987","journal-title":"Am. J. Sports Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1055\/s-2002-35525","article-title":"Effects of Two Electrical Stimulation Frequencies in Thigh Muscle After Knee Surgery","volume":"23","author":"Rebai","year":"2002","journal-title":"Int. J. Sports Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2519\/jospt.1994.20.1.44","article-title":"Biomechanical and Histological Concepts in the Rehabilitation of Patients with Anterior Cruciate Ligament Reconstructions","volume":"20","author":"Parker","year":"1994","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"187","DOI":"10.18535\/cmhrj.v2i5.79","article-title":"Postoperative Rehabilitation of Anterior Cruciate Ligament Reconstruction","volume":"2","author":"Akhil","year":"2022","journal-title":"Clin. Med. Health Res. J."},{"key":"ref_79","unstructured":"Norkin, C.C., White, D.J., and Gonz\u00e1lez Guirado, A. (2006). Goniometr\u00eda: Evaluaci\u00f3n de la Movilidad Articular, Editorial Marb\u00e1n."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/17482960601012491","article-title":"Maximum voluntary isometric contraction: Reference values and clinical application","volume":"8","author":"Meldrum","year":"2007","journal-title":"Amyotroph. Lateral Scler."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Ogrodzka-Ciechanowicz, K., G\u0142\u0105b, G., \u015alusarski, J., and G\u0105dek, A. (2021). Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: A randomized controlled trial. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04862-w"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1515\/sjpain-2018-0012","article-title":"The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure?","volume":"18","author":"Thong","year":"2018","journal-title":"Scand. J. Pain"},{"key":"ref_83","first-page":"260","article-title":"Comparison of knee sonography and pressure pain threshold after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players","volume":"53","year":"2019","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/0269215511421029","article-title":"A randomized controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: A pilot study","volume":"26","author":"Ediz","year":"2012","journal-title":"Clin. Rehabil."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.rccot.2021.06.001","article-title":"Adaptaci\u00f3n transcultural al Espa\u00f1ol y Validaci\u00f3n de la Escala de Lysholm para evaluar la funcionalidad de la rodilla","volume":"35","author":"Torres","year":"2021","journal-title":"Rev. Colomb. Ortop. Traumatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"23259671231183405","DOI":"10.1177\/23259671231183405","article-title":"Spanish Version of the Anterior Cruciate Ligament\u2013Quality of Life Questionnaire: Translation, Cross-cultural Adaptation, and Validation","volume":"11","author":"Seijas","year":"2023","journal-title":"Orthop. J. Sports Med."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Varela-Rodr\u00edguez, S., S\u00e1nchez-Gonz\u00e1lez, J.L., S\u00e1nchez-S\u00e1nchez, J.L., Delicado-Miralles, M., Velasco, E., Fern\u00e1ndez-De-Las-Pe\u00f1as, C., and Calder\u00f3n-D\u00edez, L. (2021). Effects of Percutaneous Electrolysis on Endogenous Pain Modulation: A Randomized Controlled Trial Study Protocol. Brain Sci., 11.","DOI":"10.3390\/brainsci11060801"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1126\/science.150.3699.971","article-title":"Pain Mechanisms: A New Theory","volume":"150","author":"Melzack","year":"1965","journal-title":"Science"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/00002060-200211000-00006","article-title":"One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: Comparison of therapeutic effects","volume":"81","author":"Hsieh","year":"2002","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3233\/IES-2007-0274","article-title":"Acute effect of percutaneous electrical stimulation of knee extensor muscles on isokinetic torque and power production performance","volume":"15","author":"Requena","year":"2007","journal-title":"Isokinet. Exerc. Sci."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1007\/s00421-011-2093-y","article-title":"Atlas of the muscle motor points for the lower limb: Implications for electrical stimulation procedures and electrode positioning","volume":"111","author":"Botter","year":"2011","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1743-0003-11-17","article-title":"Muscle motor point identification is essential for optimizing neuromuscular electrical stimulation use","volume":"11","author":"Gobbo","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2147\/JPR.S181019","article-title":"Intramuscular electrical stimulus potentiates motor cortex modulation effects on pain and descending inhibitory systems in knee osteoarthritis: A randomized, factorial, sham-controlled study","volume":"12","author":"Lech","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"3","DOI":"10.18869\/nirp.jmr.11.1.31","article-title":"Effects of Intramuscular Electrical Stimulation on Symptoms Following Trigger Points; A Controlled Pilot Study","volume":"11","author":"Hadizadeh","year":"2017","journal-title":"J. Mod. Rehabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/989\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:42:46Z","timestamp":1769506966000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":94,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15030989"],"URL":"https:\/\/doi.org\/10.3390\/jcm15030989","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}