Effects of electrical stimulation on lower limb function after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis

OBJECTIVE: To compare the therapeutic effects of different electrical stimulation modalities combined with rehabilitation training on lower limb function improvement in patients following anterior cruciate ligament reconstruction. METHODS: PubMed, Embase, Web of Science, Scopus, and CNKI databases were systematically searched from inception to March 2, 2026, and a meta-analysis was subsequently conducted to evaluate the included studies (PROSPERO registration number: CRD420261364272). RESULTS: A total of 11 randomized controlled trials involving 629 patients were included. Traditional meta-analysis showed that electrical stimulation combined with rehabilitation training was significantly superior to rehabilitation training alone in Visual Analog Scale (SMD = -0.596, 95% CI -0.990 to -0.202) and range of motion (SMD = 0.716, 95% CI 0.138 to 1.294), but showed no significant difference in International Knee Documentation Committee (MD = 1.931, 95% CI -3.663 to 7.526, P = 0.499). Network meta-analysis revealed that neuromuscular electrical stimulation significantly improved Visual Analog Scale (SMD = -0.837, 95% CI -1.420 to -0.254) and range of motion (SMD = 1.274, 95% CI 0.927 to 1.622) compared with rehabilitation alone, and was superior to transcutaneous electrical nerve stimulation in range of motion (SMD = -1.185, 95% CI -1.717 to -0.653). The surface under the cumulative ranking curve results indicated that neuromuscular electrical stimulation ranked first for Visual Analog Scale (92.5%) and range of motion (99.9%). No significant difference was found compared with rehabilitation alone for International Knee Documentation Committee scores (P > 0.05). CONCLUSION: Electrical stimulation combined with rehabilitation training can effectively improve Visual Analog Scale and range of motion after anterior cruciate ligament reconstruction, with neuromuscular electrical stimulation demonstrating the optimal effect, although its improvement on International Knee Documentation Committee was limited. Based on the current evidence, rehabilitation training combined with neuromuscular electrical stimulation is recommended as an adjunctive treatment protocol.