Effect of Surface EMG Biofeedback on Quadriceps Inhibition Release During Postoperative Knee Rehabilitation

NCT07736625 | Not Yet Recruiting

• 1 other identifier: 2026-A00944-47
• Study Type: interventional
• Target: 5
• Locations: 1 country
• Sites: 1

Brief Summary

Arthrogenic muscle inhibition (AMI) is a common neurological impairment following knee surgery that limits voluntary quadriceps activation and delays functional recovery. Persistent AMI may contribute to muscle weakness, altered gait, and poorer rehabilitation outcomes. Although several rehabilitation strategies have been proposed, no complementary intervention has consistently demonstrated strong evidence for improving AMI. This prospective single-case experimental study aims to evaluate whether visual biofeedback based on surface electromyography (sEMG) improves quadriceps motor performance during standard rehabilitation. Each participant will complete eight standardized rehabilitation sessions, including four sessions with visual sEMG biofeedback and four sessions without visual feedback. The order of the two conditions will be randomized, allowing each participant to serve as his or her own control. The primary objective is to determine whether visual sEMG biofeedback improves the accuracy of quadriceps contraction, assessed by the percentage deviation from a predefined target. Secondary objectives include evaluation of motor engagement, motor control, muscle activation, perceived exertion, and pain. Between three and five adult patients presenting AMI after knee surgery will be included. Because recovery patterns are highly individualized, a Single-Case Experimental Design (SCED) with repeated within-subject measurements has been selected to characterize individual treatment responses while minimizing inter-individual variability

Conditions

Arthrogenic Muscle Inhibition; Knee Injuries; Postoperative Rehabilitation

Keywords

Surface Electromyography; Electromyography; EMG Biofeedback; Biofeedback; Quadriceps Muscle; Quadriceps Activation; Arthrogenic Muscle Inhibition; Knee Rehabilitation; Knee Surgery; Motor Control; Neuromuscular Rehabilitation; Single-Case Experimental Design; SCED

Outcome Measures

Primary Outcomes (1)

• Percentage Deviation From the Target Quadriceps Activation Level

  The percentage deviation between the quadriceps muscle activation achieved by the participant and the predefined target activation level of 80% of the maximal surface electromyography activity (EMGmax). The measure will be calculated for each contraction performed during sessions with visual sEMG biofeedback and sessions without visual biofeedback. The percentage deviation between the participant's quadriceps muscle activation and the predefined target activation level (80% of EMGmax). Lower values indicate greater contraction accuracy.

  During each of the 8 rehabilitation sessions, over approximately 3 weeks

Secondary Outcomes (5)

• Time Spent Within the Target Quadriceps Activation Zone

  During each of the 8 rehabilitation sessions, over approximately 3 weeks

• Quadriceps Motor Latency

  During each of the 8 rehabilitation sessions, over approximately 3 weeks

• Maximal Quadriceps Surface Electromyography Activity

  At the beginning of each of the 8 rehabilitation sessions, over approximately 3 weeks

• Perceived Exertion Assessed Using the Borg Scale

  At the end of each of the 8 rehabilitation sessions, over approximately 3 weeks

• Pain Intensity Assessed Using a Numeric Rating Scale

  At the end of each of the 8 rehabilitation sessions, over approximately 3 weeks

Study Arms (2)

Visual sEMG Biofeedback

EXPERIMENTAL

Participants perform standardized rehabilitation exercises with real-time visual surface electromyography biofeedback.

Behavioral: Visual Surface EMG Biofeedback

No Visual Biofeedback

ACTIVE COMPARATOR

Participants perform the same standardized rehabilitation exercises without visual biofeedback. Surface EMG signals are recorded but not displayed to the participant.

Behavioral: Standard Rehabilitation Without Visual Biofeedback

Interventions

Visual Surface EMG Biofeedback BEHAVIORAL

Participants perform standardized rehabilitation exercises while receiving real-time visual feedback of quadriceps muscle activity using surface electromyography (sEMG)

Visual sEMG Biofeedback

Standard Rehabilitation Without Visual Biofeedback BEHAVIORAL

Participants perform the same standardized rehabilitation exercises without visual biofeedback. Surface electromyography signals are recorded but are not displayed to the participant.

No Visual Biofeedback

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• AMI following knee surgery, as classified by the Santi classification system
• Aged 18 or older
• Enrolled in or covered by a social security program
• Able to understand instructions and participate in standardized rehabilitation sessions

You may not qualify if:

• Acute pain.
• Neurological condition.
• Skin lesion at the electrode site.
• Allergy to the electrode.
• Under legal protective measures such as guardianship or court-ordered protection

Sponsors & Collaborators

• Hopitaux de Saint-Maurice: lead

Study Sites (1)

Hôpitaux Paris Est Val-de-Marne - Service de rééducation orthopédique et traumatologie

Saint-Maurice, 94410, France

Location

MeSH Terms

Conditions

Knee Injuries

Condition Hierarchy (Ancestors)

Leg Injuries; Wounds and Injuries

Study Officials

• Sylvain SB BELOT, MD

  Hôpitaux Paris Est Val-de-Marne (HPEVM)

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Sylvain SB BELOT, MD

CONTACT

01 43 96 63 83; sylvain.belot@ght94n.fr

Auriane AS SLAMA, ARC

CONTACT

+33607317969; auriane.slama@ght94n.fr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Each participant will complete both study conditions: four rehabilitation sessions with visual surface EMG biofeedback and four sessions without visual biofeedback. The order of the conditions will be randomized using a predefined balanced sequence. Each participant serves as his or her own control, allowing within-subject comparison of motor performance outcomes.

Study Record Dates

• First Submitted: July 24, 2026
• First Posted: July 30, 2026
• Study Start: August 1, 2026
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: July 30, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)