Comparing the Effects of Differential and Visuo-Motor Training on Functional Performance, Biomechanical, and Psychological Factors in Athletes after ACL Reconstruction: A Randomized Controlled Trial

Abstract

Variation during practice is widely accepted to be advantageous for motor learning and is, therefore, a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable training in athletes who have undergone ACL reconstruction. Thereby, it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. Forty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n = 15), VT group (n = 15), or control group (n = 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excursion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8 weeks of interventions. Data were analyzed by means of 3 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. Significant group × time interaction effects, main effect of time, and main effect of group were found for the triple hop test and all eight directions, SEBT, HF, KF, AD, KV, VGRF, and TSK. There was no significant main effect of group in the HF and triple hop test. Additionally, significant differences in the triple hop test and the seven directions of SEBT, HF, KF, KV, VGRF, and TSK were found between the control group and the DL and VMT groups. Between group differences in AD and the medial direction of SEBT were not significant. Additionally, there were no significant differences between VMT and the control group in the triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. The findings suggest that DL and VMT training programs lead to comparable improvements in rehabilitation.

Mechanical energy flow analysis in athletes with and without anterior cruciate ligament reconstruction during single-leg drop landing

“…It appears that movement changes present in healthy participants or subjects with injuries may predispose them to further injuries based on the kinesio-pathologic model of musculoskeletal pain disorders 15 , 16 . Following a ACLR, a number of biomechanical changes influence joint motion of the lower limbs 17 . It is said that any changes made by the system as a result of pain or pathology mirror any changes in the sensorimotor system and result in systemic and predictable patterns 18 .…”

Quadriceps and gluteus medius activity during stable and unstable loading exercises in athletes. A cross‐sectional study

“…10 These specific exercises help strengthen and stabilize the muscles in the lower extremities, thereby enhancing coordination and neuromuscular control. 11 By working unilaterally, it is possible to identify and correct muscle imbalances and asymmetries in leg and trunk coordination, which is particularly relevant in the context of an anterior cruciate ligament injury and its rehabilitation. 12 Moreover, single-leg exercises challenge the body in a different way, as they require greater effort to maintain balance and stability, thereby improving proprioception and the ability to respond to perturbations.…”