Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk

Culvenor, Adam G; Alexander, Bonnie; Clark, Ross; Collins, Natalie J; Ageberg, Eva; Morris, Hayden G.; Whitehead, Timothy S.; Crossley, Kay M

doi:10.2519/jospt.2016.6305

Cited by 47 publications

(37 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The result of the current study might have originated from bilateral impairment of postural stability following a unilateral ACL or meniscus injury [20]. Previous studies have delineated that decreases of afferent neural signal input to the central nervous system after an injury of one limb resulted in loss of motor output in the opposite limb, thus leading to bilateral impairment [32,34]. Park et al [20] denoted that there was no significant difference in postural stability between the involved and uninvolved side knees in patients with ACL tear combined with meniscus tears, and the authors also suggested that bilateral impairment of postural stability is more severe in the ACL tear combined with meniscal tear group compared with the isolated ACL tear group.…”

Section: Discussionmentioning

confidence: 88%

Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

Lee

Park

et al. 2020

Knee Surg & Relat Res

View full text Add to dashboard Cite

Background: Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods: Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anteriorposterior stability index (APSI), and medial-lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results: In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion: Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear.

show abstract

Section: Discussionmentioning

confidence: 88%

Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

Lee

Park

et al. 2020

Knee Surg & Relat Res

View full text Add to dashboard Cite

show abstract

“…Sample size was estimated from previous research 38 in which COP path velocity was compared between participants with ACLR and control individuals. Using a minimal difference of 1.3 cm/s, a group variance of 1.48, an a level of .05, and a b level of 0.8, we estimated that we would need 21 participants per group.…”

Section: Discussionmentioning

confidence: 99%

Measures of Agility and Single-Legged Balance as Clinical Assessments in Patients With Anterior Cruciate Ligament Reconstruction and Healthy Individuals

Kirsch

Bodkin

Saliba

et al. 2019

Journal of Athletic Training

View full text Add to dashboard Cite

Context Current clinical assessments used for patients with anterior cruciate ligament reconstruction (ACLR) may not enable clinicians to properly identify functional deficits that have been found in laboratory studies. Establishing muscular-function assessments, through agility and balance tasks, that can properly differentiate individuals with ACLR from healthy, active individuals may permit clinicians to detect deficits that increase the risk for poor outcomes. Objective To compare lower extremity agility and balance between patients with ACLR and participants serving as healthy controls. Design Case-control study. Setting Controlled laboratory. Patients or Other Participants A total of 47 volunteers in 2 groups, ACLR (9 males, 11 females; age = 23.28 ± 5.61 years, height = 173.52 ± 8.89 cm, mass = 70.67 ± 8.89 kg) and control (13 males, 12 females; age = 23.00 ± 6.44, height = 172.50 ± 9.24, mass = 69.81 ± 10.87 kg). Main Outcome Measure(s) Participants performed 3 timed agility tasks: Agility T Test, 17-hop test, and mat-hopping test. Balance was assessed in single-legged (SL) stance in 3 positions (straight knee, bent knee, squat) on 2 surfaces (firm, foam) with the participants' eyes open or closed for 10-second trials. Agility tasks were measured for time to completion. Eyes-open balance tasks were measured using center-of-pressure average velocity, and eyes-closed balance tasks were measured using the Balance Error Scoring System. Results For the Agility T Test, the ACLR group had slower times than the control group (P = .05). Times on the Agility T Test demonstrated moderate to strong positive relationships for unipedal measures of agility. The ACLR group had greater center-of-pressure average velocity in the SL bent-knee position than the control group. No differences were found between groups for the SL straight-knee and SL-squat balance tasks (P > .05). No differences in errors were present between groups for the eyes-closed balance tasks (P > .05). Conclusions The ACLR group demonstrated slower bipedal agility times and decreased postural stability when assessed in an SL bent-knee position compared with the control group.

show abstract

“…Following anterior cruciate ligament reconstruction (ACLR), clinical practice guidelines recommend postoperative rehabilitation to continue for at least 9 to 12 months, or until achievement of sport-speci c strength, functional and psychological criteria (67). Yet, many patients have symptoms, muscle weakness and functional de cits that persist beyond 1-year post-ACLR (8,50,61,73), which may increase the risk of reinjury, symptomatic posttraumatic osteoarthritis (OA), and worse knee-related quality of life (QoL) (13,14,23,30,48).…”

Section: Introductionmentioning

confidence: 99%

Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial

Patterson

Barton

Culvenor

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Guided rehabilitation beyond 6-months is rare following anterior cruciate ligament reconstruction (ACLR), despite high prevalence of unacceptable symptoms and quality of life (QoL). We aimed to: i) determine the feasibility of a randomised controlled trial (RCT) evaluating the effectiveness of a physiotherapist-guided lower-limb focussed exercise-therapy intervention for individuals 1-year post-ACLR with persistent symptoms, and ii) estimate the effects of this intervention compared to a trunk-focussed intervention on knee-related QoL.Design: Participant- and assessor-blinded, pilot feasibility RCT.Methods: Participant eligibility criteria: i) 12–15 months post-ACLR; ii) < 87.5/100 on the Knee injury and Osteoarthritis Outcome Score (KOOS) QoL subscale; and one of: a) one-leg rise test < 22 repetitions; b) single-hop < 90% limb symmetry; or c) Anterior Knee Pain Scale < 87/100. Participants were randomised (2:1 ratio) to lower-limb focussed exercise-therapy and individualised education, or trunk-focussed exercise-therapy and standardised education. Both interventions involved eight face-to-face physiotherapy sessions over 16-weeks, to guide allocated exercise-therapy programs. Feasibility was assessed by: i) recruitment (participants/month), ii) retention (< 20% drop-out), iii) physiotherapy attendance, and iv) unsupervised exercise-therapy program adherence (> 80% of 3 sessions/week). Knee-related QoL was evaluated using the KOOS-QoL subscale and ACL-QoL questionnaire, with between-group differences compared to published minimally important difference (MID) scores (KOOS-QoL = 10 points; ACL-QoL = 12 points).Results: 27 participants (3 participants/month; 48% men, 34 ± 12 years) were randomised. Two did not commence treatment, and two were lost to follow-up (16% drop-out). Physiotherapy attendance was > 80% for both groups but reported adherence to the unsupervised program was low (< 55% of prescribed exercises). KOOS-QoL improvement (mean ± SD) in the lower-limb focussed (23 ± 15) and trunk-focussed (16 ± 12) groups resulted in a between-group difference (mean, 95%CI) lower than the MID (7.1, -12.3 to 26.4). ACL-QoL improvement in the lower-limb focussed (20 ± 17) and trunk-focussed (22 ± 13) groups resulted in a between-group difference lower than the MID (-2.5, -18.2 to 13.2).Conclusions: A larger-scale RCT evaluating the effectiveness of a physiotherapist-guided lower-limb focussed program for individuals 1-year after ACLR with persistent symptoms is feasible. This intervention is associated with large within-group knee-related QoL improvements, but may not be superior to a trunk-focussed intervention.Trial Registration: Prospectively registered (ACTRN12616000564459).

show abstract

Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk

Cited by 47 publications

References 42 publications

Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

Measures of Agility and Single-Legged Balance as Clinical Assessments in Patients With Anterior Cruciate Ligament Reconstruction and Healthy Individuals

Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial

Contact Info

Product

Resources

About