Changes in Dynamic Postural Stability After ACL Reconstruction: Results Over 2 Years of Follow-up

Abstract

Background: The anterior cruciate ligament (ACL) is crucial for knee proprioception and postural stability. While ACL reconstruction (ACLR) and rehabilitation improve postural stability, the timing in improvement of dynamic postural stability after ACLR remains relatively unknown. Purpose: To evaluate changes in dynamic postural stability after ACLR out to 24 months postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing ACLR were prospectively enrolled, and dynamic postural stability was assessed within 2 days before surgery, at 3-month intervals postoperatively to 18 months, then at 24 months. Measurements were made on a multidirectional platform tracking the patient’s center of mass based on pelvic motion. The amount of time the patient was able to stay on the platform was recorded, and a dynamic motion analysis score, reflecting the patient’s ability to maintain one’s center of mass, was generated overall and in 6 independent planes of motion. Results: A total of 44 patients with a mean age of 19.7 ± 6.2 years completed the study protocol. Overall mean dynamic postural stability improved significantly at 3, 6, 9, and 12 months after surgery, with continued improvement out to 24 months. Notable improvements occurred in medial/lateral and anterior/posterior stability from baseline to 6 months postoperatively, while internal/external rotation and flexion/extension stability declined initially after surgery from baseline to 3 months postoperatively before stabilizing to the end of the study period. Conclusion: Overall dynamic postural stability significantly improved up to 12 months after ACLR. Improvement in postural stability occurred primarily in the medial/lateral and anterior/posterior planes of motion, with initial decreases in the flexion/extension and internal/external rotational planes of motion.

Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study

“…[43][44][45] The presence of kinesiophobia thus may promote avoidance of complex biomechanical movements as a means of protecting the knee from further injury. [55][56][57] Brophy et al 33 observed that following ACLR in 42 patients, continued improvement in translational planes of motion was appreciated out to 24 months following surgery, while there remained largely no significant improvement in dynamic stability in rotational planes of motion at 24 months when compared with preoperative values. As such, rehabilitation should be directed at improving muscular strength and coordination in both translational and rotational planes of motion.…”

“…These included 3 translational plane assessments (medial/lateral [ML], anterior/posterior [AP], up/down [UD]) and 3 rotational plane assessments of the pelvis (left/right [LR], flexion/extension [FE], and internal/external rotation [Rot]). 33 Two additional 7 sessions of DMA testing following surgery were performed at 6-and 12 months postoperatively.…”

“…All eligible patients underwent dynamic postural stability testing on a motorized multidirectional platform (PROPRIO® 5000 Reactive Balance System, Perry Dynamics, Decatur, IL, USA) at a minimum of 2 days prior to surgery. [33][34][35] The purpose of the test is to measure balance and stability by producing simultaneous motion in the anterior/posterior and medial/lateral directions, challenging user balance and reaction ability. The PROPRIO device allows for accurate measurements of a user's center of mass when reacting to a dynamic 6 This article is protected by copyright.…”

“…Dynamic motion analysis was tested as previously described. 33 All testing was performed by a single author [initials blinded for peer review]. Using integrated software, an overall mean DMA score was calculated based on the 3 trials, ranging from 0 to 1440 points, to determine the sum of the sensor's vector moments, representing the total 3-dimensional displacement of the patient's center of mass throughout testing.…”

“…Using integrated software, an overall mean DMA score was calculated based on the three trials, ranging from 0 to 1,440 points, to determine the sum of the sensor's vector moments, representing the total three-dimensional displacement of the patient's center of mass throughout testing. 33,34 Lower scores reflect less displacement, indicative of better dynamic postural stability. The mean total time in which the patient was able to maintain both feet on the platform among the three trials at each time point was also recorded.…”