Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Hewett, Timothy E.

doi:10.1016/j.gaitpost.2012.11.001

Cited by 33 publications

(47 citation statements)

References 25 publications

(46 reference statements)

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“…Owing to these functional impairments and clinical significance, patients with an ACL-deficient knee often choose to have reconstruction surgery, and the number of reported ACL reconstruction surgery cases is as high as 350 000 annually in the USA alone. 6 Although ACL reconstruction surgery has a high success rate, younger and more physically active individuals have a relatively high rate of reinjury, 7 which ranges from 24% 8 to 29% 9 along with strength deficits, 10 reduced postural control 1112 and altered kinematics. 1314 Furthermore, a systematic review that synthesised a total of 31 studies indicated that 48% of knee osteoarthritis prevalence rates more than 10 years following ACL reconstruction surgery.…”

Section: Introductionmentioning

confidence: 99%

Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis

et al. 2016

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Objective The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. Design Systematic review and meta-regression. Data sources The literature search was performed in PubMed and EBSCO. Eligibility criteria Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. Results The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2–17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). Conclusions Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes.

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Section: Introductionmentioning

confidence: 99%

Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis

et al. 2016

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“…[6][7][8] Lower balance-error scores were found in the ACL-reconstructed population than in a healthy control group. 6 Another study reported limited single-leg postural sway ability compared with the noninvolved side and healthy control.…”

Section: Resultsmentioning

confidence: 92%

“…6 Another study reported limited single-leg postural sway ability compared with the noninvolved side and healthy control. 7 The observed joint-position-accuracy differences from the reviewed studies ranged from 0.07° to 2.20°. Although the observed joint-position-sense difference was small between braced and nonbraced conditions, this difference may have had a clinical implication.…”

Section: Resultsmentioning

confidence: 97%

“…The mean difference between the 2 groups was 0.44°, providing a comparison with the outcomes noted in this study; however, those measurements were not specific to the knee joint. Furthermore, all included studies 1-3 tested knee-joint position sense in open-kinetic-chain fashion, while other studies [6][7][8] reported deficits in balance and postural control with a closed kinetic chain. Therefore, it is difficult to synthesize the results and provide a conclusion for the clinical implication of a functional brace on joint-position sense.…”

Section: Resultsmentioning

confidence: 99%

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The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament–Reconstructed Individuals

Sugimoto¹,

LeBlanc²,

Wooley³

et al. 2016

Journal of Sport Rehabilitation

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It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients' return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions. Keywords: anterior cruciate ligament reconstruction, effect size, ACL-R Clinical ScenarioIt is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the United States. Although ACLreconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In addition, subsequent ACL-retear incidence can be as high as 24%. To assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on an athlete's return to physical activity. The common belief is that the functional knee brace provides mechanical support. In addition, some clinicians argue that external support provided by the functional knee brace may enhance afferent nerve function around knee joint, which, in turn, improves joint-position sense. Through this mechanism, those who experience ACL reconstruction maintain optimum balance ability and decrease the future risk of ACL retear. However, it is not known whether the use of a functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Focused Clinical QuestionDoes the use of a functional brace improve knee-joint position sense in individuals who have undergone ACL reconstruction?Summary of Search, "Best Evidence" Appraised, and Key Findings• The literature was searched for studies of level 2 evidence or ...

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“…The following covariates were included in the analysis and were selected due to prior literature suggesting an effect on postural control: sex [31], age [32], BMI [11], ankle injury history [33], knee injury history, [34] and migraine history [35]. …”

Section: Statistical Analysesmentioning

confidence: 99%

Evaluation of postural stability in youth athletes: the relationship between two rating systems

Howell

Shore

Hanson

et al. 2016

The Physician and Sportsmedicine

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Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport

Cited by 33 publications

References 25 publications

Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis

Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament–Reconstructed Individuals

Evaluation of postural stability in youth athletes: the relationship between two rating systems

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