Effects of Innovative Land-based Proprioceptive Training on Knee Joint Position Sense and Function in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Abstract

Background: Proprioceptive deficits are one of the most important challenges after anterior cruciate ligament reconstruction (ACLR). Objectives: The current study aimed to investigate the effects of incorporating innovative land-based proprioceptive training into the conventional accelerated land-based rehabilitation protocol, as compared to the conventional accelerated land-based rehabilitation protocol alone, on knee function and joint position sense in male athletes after ACLR. Methods: Thirty male athletes with ACLR were randomly assigned to two rehabilitation groups. The conventional therapy (CT) group (n = 15) received conventional rehabilitation for six weeks, and the proprioception training (PT) group (n = 15) received the same conventional rehabilitation in addition to 12 sessions of innovative land-based proprioceptive training. Outcomes included joint position sense (JPS) errors, International Knee Documentation Committee (IKDC) form, and Visual Analog scale (VAS). Results: There were significant differences in absolute errors (AE) (FAE = 56.81, P < 0.001) and variable errors (VE) (FVE = 60.95, P < 0.001) between the two groups. No significant differences were found in constant error (CE), VAS, and IKDC score between the two groups (P > 0.05). Both groups showed significant changes in terms of AE, VE, VAS, and IKDC after the intervention (P < 0.05). Percent changes after the intervention for AE, VE, CE, VAS, and IKDC were greater in the PT group than in the CT group, which were 70.19%, 69.22%, 66.20%, 38.50%, and 39.61%, respectively. Conclusions: Innovative land-based proprioceptive training incorporated into the conventional accelerated rehabilitation protocol offers the improvement of proprioception efficiency for individuals with ACL reconstruction, and therefore, it could be useful for clinicians when designing rehabilitation protocols to ensure the optimal engagement of proprioception.

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

“…Seven studies evaluated the effect of the addition of a motor control/proprioception training programme in the traditional rehabilitation 147–153. The heterogeneity of dose, duration and intensity of the exercises in the studies preclude describing an optimal training protocol.…”

“…Seven studies evaluated the effect of the addition of a motor control/proprioception training programme in the traditional rehabilitation. [147][148][149][150][151][152][153] The heterogeneity of dose, duration and intensity of the exercises in the studies preclude describing an optimal training protocol. Summary ► The addition of a motor control training programme (comprising training on an unstable surface (balance pad or foam roller), backward walking on an inclined treadmill and single-leg dynamic balance exercises) resulted in significant improvement in knee joint proprioception in early and intermediate phase and moderate effect at 2 years after ACLR.…”

Motor Control Changes after Innovative Aquatic Proprioceptive Training in Athletes with Anterior Cruciate Ligament Reconstruction: Voluntary Response Index Analysis

“…The objective of this study was to compare the effectiveness of innovative aquatic proprioceptive training plus conventional rehabilitation with conventional rehabilitation alone based on VRI components in athletes with ACLR. In our previous study (10), we investigated the effects of aquatic proprioceptive training only on knee proprioception, so here we intended to determine the possible effects of aquatic training on motor control changes.…”

“…Because of the unique properties of the aquatic environment, several studies have used this type of environment for treating patients with ACLR (10,(16)(17)(18)(19)(20). Most of these studies have compared the effects of land-based therapy with hydrotherapy, using similar exercises.…”

“…Accordingly, we were able to evaluate their possible effects on motor control and muscle activation patterns. However, no study used VRI analysis to assess possible motor control changes (10,16,17,20). Due to the scarcity of evidence regarding the effects of proprioception training on VRI components in athletes with ACLR, especially in the aquatic environment, it was difficult to make a direct comparison with previous studies.…”