Postural Control after Anterior Cruciate Ligament Reconstruction and Functional Rehabilitation

Abstract

Total sagittal knee laxity and postural control in the sagittal and frontal planes were measured in 25 patients at a mean of 36 months (range, 27 to 44) after anterior cruciate ligament reconstruction and in a control group consisting of 20 uninjured age- and activity-matched subjects. Body sway was measured in the sagittal plane on a stable and on a sway-referenced force plate in single-legged stance, double-legged stance, or both, with the eyes open and closed. Postural reactions to perturbations in the sagittal and frontal planes were recorded in the single-legged stance with the eyes open. Total sagittal plane laxity was significantly greater in the anterior cruciate ligament-reconstructed knee (11.2 mm; range, 6 to 15) than in the uninjured knee (8.9 mm; range, 6 to 12) or in the control group (6.0 mm; range, 5 to 8). In spite of this, the patients, in comparison with the controls, exhibited normal postural control except in two variables-the reaction time and the latency between the start of force movement to maximal sway in the sagittal plane perturbations. This supports the hypothesis that rehabilitation, with proprioceptive and agility training, is an important component in restoring the functional stability in the anterior cruciate ligament-reconstructed knee.

Análise comparativa do controle postural de indivíduos com e sem lesão do ligamento cruzado anterior do joelho

“…In the studies by Zätterström et al (19) and O'Connell et al (18) no differences were seen between injured limbs and non-injured limbs and the authors believe that this fact is due to a bilateral compromising in individuals with unilateral ACL injury. In individuals submitted to ACL reconstruction, Harrison et al (8) and Henriksson et al (17) did not see significant differences as well. Care must be taken when considering the non-injured lower limb as a normality parameter, while for a rehabilitation program, the non-injured lower limb shall not be neglected.…”

“…Many methods have been used to evaluate postural control aiming to quantify this disorder for enabling a better follow-up on the evolution of surgical or conservative treatment of patients with this kind of injury. Strength platform and its adjustments are the instruments most frequently used to measure balance of individuals with ACL injury or submitted to any kind of treatment (8,10,17,18,19) . No papers describing the use of pressure sensors for that purpose, such as the F-SCAN MATT, were found.…”

“…The PC is considered as the vector resulting from vertical force reaction on the ground and the PC dislocation refers to GC acceleration (2) . Some authors believe that the PC location corresponds to the GC location (17) ; however, although the differences of concepts, everyone takes into account for evaluation purposes the point at the strength platform marked as "force center", regardless PC or GC names used. There are other authors estimating GC through "oscillation magnetometry" (21,22) or through motion analysis system.…”

“…During static posture, the key measure used to calculate balance is PC oscillation, although there is no consensus regarding its importance on ACL injuries. The most frequently used equipment for measuring PC in many pathologies, which can be found in literature, are the strength platform (12,13,14,15) or an equipment similar to extensometric platforms (8,16,17,18) . However, there are other equipment able to measure PC, such as pressure sensors.…”

Exergaming and Static Postural Control in Individuals With a History of Lower Limb Injury

“…5,7 It has been well established that rehabilitation programs focused on improving neuromuscular control, strength, and range of motion improve postural control and self-reported function in patients with chronic ankle instability (CAI), [8][9][10] acute ankle sprains, 11 and patellofemoral pain. 12,13 Although traditional therapeutic exercises have been effective in improving postural control after injury, a variety of treatment approaches can be used to improve balance after joint injury. 14 Clinicians are beginning to introduce gaming consoles, computer vision technology, and virtual reality into rehabilitation protocols.…”