Pre- and postoperative postural regulation following anterior cruciate ligament reconstruction

Abstract

There are currently no longitudinal data describing the pre- and postoperative postural regulation and stability of patients with anterior cruciate ligament (ACL) damage. Therefore, the aim of this study was to evaluate postural regulation and stability prior to and during rehabilitation following surgery of the ACL. Fifty-four physically active subjects (age: 30.5±10.9 years, 29 male subjects) were examined with the Interactive Balance System pre-, 6, and at 12 weeks following surgical reconstruction of the ACL using a hamstring tendon graft. The average period of time from injury to surgery was 27 days. Data were calculated with unifactorial and univariate analysis of variance. Significant effects were found for the somatosensory system (η2=0.115), stability indicator (η2=0.123), weight distribution index (η2=0.176), and synchronization (foot coordination) (η2=0.249). Involved side weight distribution (parameter: left) increased significantly (patients with left-sided/right-sided injury: η2=0.234/0.272). Load distribution to the heel remained stable during all three examination periods (η2=0.035 and η2=0.071), although a remarkable load at forefoot was observed. In seven out of 10 parameters partial effects were seen during the first 6 weeks after surgery. The results of this study indicated that injury of the ACL and subsequent surgical reconstructions result in postural regulation, with improvements in somatosensory system function, postural stability, weight distribution index, and foot coordination. Also, overloading of the injured side on the feet reduces significantly during rehabilitation. Thus, the initial phase of rehabilitation (weeks 1 to 6) seems to be more effective than the second period (weeks 6 to 12) postoperatively.

No significant improvement in neuromuscular proprioception and increased reliance on visual compensation 6 months after ACL reconstruction

“…The finding that sway surface area does not improve after ACLR is consistent with previous studies [ 25 ], although while using a different posturography platform and protocol, 2 studies did find balance improvements at 6 and 12 months following ACLR [ 4 , 5 ]. Nevertheless, patients who had ACLR demonstrate significantly greater sway surface area than control patients [ 4 , 5 , 12 ], suggesting that postural control is not fully restored. Furthermore, somatosensory and visual ratios are greater than those reported for control patients in a different study [ 9 ] using a similar device and protocol, suggesting that ACL tears may impair the ability of patients to use somatosensory and visual cues for balance.…”

Comparison of Postural Stability and Regulation among Female Athletes from Different Sports

“…All tasks were conducted with the subjects head in a neutral alignment (vestibular). Detailed information about the calculated parameters and used test positions can be found in previous research [14][15][16][17]. All measurements were conducted at the same time of day and in a quiet room without any distractions.…”

Postural Stability and Regulation before and after High Tibial Osteotomy and Rehabilitation

“…Patients with instability of the knee ligaments and contralateral knee OA requiring treatment were excluded, as were those with primary patellofemoral OA, bi-compartmental OA, tibial or femoral osteonecrosis and those with a history of an inflammatory rheumatic disease. The patients did not participate in the study if they were unable to perform the balance tests (posturography) owing to pain or limited motion of the lower limb [17].…”

“…It is possible that improvements in postural stability and regulation need longer than six-months to occur. In relation to other studies [17,49], we wanted to establish a more holistic approach instead of the frequently used isolated orthopedic view (flexibility, strength, pain).…”