Evaluation of proprioceptive balance results of amateur athletes following anterior cruciate ligament reconstruction: Hamstring autograft

Abstract

Aim: Anterior cruciate ligament (ACL) is one of the main ligaments which provide mechanical stability of the knee, control the anteroposterior translation and rotation movements and play a key role in neuromuscular stability. The aim of the present study is to compare the 6th month balance results on operated and non-operated sides of athletes who underwent ST/G anterior cruciate ligament reconstruction (ACL). Material and Method: The study was evaluated as a retrospective cohort consisting of patients who underwent semitendinosus/gracilis hamstring autograft (ST/G) ACL reconstruction (n=24) technique between May 2020 and October 2021. CSMI-TecnoBody PK-252 was used to determine the 6th month post-operative static balance measurements of patients. The tests were applied to both ACLR side and contralateral healthy side. Results: Compared to pre-operative levels, there was a significant improvement in the mean Lysholm, Tegner, and IKDC scores at the post-operative level (p<0.05). No significance was found between 6th month post-operative static balance results of the subjects on ACLR side and contralateral healthy side (p>0.05). Conclusion: It is seen that 6 month post-operative findings of ST/G ACLR technique show similar results with the healthy contralateral side. This result is valuable in terms of balance scores showing similar results for both sides.

Keywords

• proprioception
• balance
• postural control
• ACL reconstruction
• athletes

References

1. Furlanetto TS, Peyré-Tartaruga LA, Pinho ASD, Bernardes EDS, Zaro MA. Proprioception, body balance, and functionality in individuals with ACL reconstruction. Acta Ortopedica Brasileira 2016; 24: 67-72.
2. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y. Reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2004; 86: 515-20.
3. Anders JO, Venbrocks RA, Weinberg M. Proprioceptive skills and functional outcome after anterior cruciate ligament reconstruction with a bone-tendon-bone graft. Int Orthop 2008; 32: 627-33.
4. Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br 2000; 82: 801-6.
5. Hohmann E, Bryant A, Tetsworth K. Strength does not influence knee function in the ACL-deficient knee but is a correlate of knee function in the and ACL-reconstructed knee. Archives of orthopaedic and trauma surgery 2016; 136: 477-83.
6. Palmieri-Smith RM, Thomas AC. A neuromuscular mechanism of posttraumatic osteoarthritis associated with ACL injury. Exercise and sport sciences reviews 2009; 37: 147-53.
7. Akbari A, Ghiasi F, Mir M, Hosseinifar M. The effects of balance training on static and dynamic postural stability indices after acute ACL reconstruction. Global journal of health science 2016; 8: 68.
8. Madhavan S, Shields RK. Neuromuscular responses in individuals with anterior cruciate ligament repair. Clin Neurophysiol 2011; 122: 997-1004.

9. Machotka Z, Scarborough I, Duncan W, Kumar S, Perraton L. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 29.
10. Shaffer SW, Harrison AL. Aging of the somatosensory system: a translational perspective. Phys Ther 2007; 87: 193-207.
11. Zouita Ben Moussa A, Zouita S, Dziri C, Ben Salah FZ. Single-leg assessment of postural stability and knee functional outcome two years after anterior cruciate ligament reconstruction. Ann Phys Rehabil Med 2009; 52: 475-84.
12. Cooper RL, Taylor NF, Feller JA. A randomised controlled trial of proprioceptive and balance training after surgical reconstruction of the anterior cruciate ligament. Research in Sports Medicine 2005; 13: 217-30.
13. Kehribar L, Yılmaz, AK, Karaduman E, et al. Post-operative results of ACL reconstruction techniques on single-leg hop tests in athletes: hamstring autograft vs. hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia. Medicina 2022; 58: 435.
14. Kehribar L, Coşkun HS, Yılmaz AK, et al. Examination of ısokinetic knee strength and hamstring/quadriceps ratios in ındividuals with anterior cruciate ligament ınjury: ACL ınjured knee versus non-ınjured knee 2022; 14: 158-62.
15. Risberg MA, Holm I, Myklebust G, Engebretsen, L. Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial. Phys Ther 2007; 87: 737-50.
16. Zhou MW, Gu L, Chen YP, et al. Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction. Chin Med J (Engl) 2008; 121: 2224-8.
17. .Muaidi QI, Nicholson LL, Refshauge KM, Adams RD, Roe JP. Effect of anterior cruciate ligament injury and reconstruction on proprioceptive acuity of knee rotation in the transverse plane. Am J Sports Med 2009; 37: 1618-26.
18. Middleton KK, Hamilton T, Irrgang, JJ, Karlsson J, Harner CD, Fu FH. Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1, Knee Surger Y. Sports Traumatology, Arthroscopy 2014; 22: 1467-82.
19. Gokalp O, Akkaya S, Akkaya N, et al. Preoperative and postoperative serial assessments of postural balance and fall risk in patients with arthroscopic anterior cruciate ligament reconstruction. J Back Musculoskeletal Rehab 2016; 29: 343-50.
20. Bodkin SG, Slater LV, Norte GE, Goetschius J, Hart, JM. ACL reconstructed individuals do not demonstrate deficits in postural control as measured by single-leg balance. Gait & posture 2018; 66: 296-9.
21. Parus K, Lisiński P, Huber J. Body balance control deficiencies following ACL reconstruction combined with medial meniscus suture. A preliminary report. Orthopaedics & Traumatology: Surgery & Research 2015; 101: 807-10.
22. Howells BE, Clark RA, Ardern CL, et al. The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii Balance Board. British J Sports Med 2013; 47: 914-9.
23. Bonfim TR, Paccola CA, Barela JA. Proprioceptive and behavior impairments in individuals with anterior cruciate ligament reconstructed knees. Arch Phys Med Rehab 2003; 84: 1217–23.
24. Denti M, Randelli P, Lo Vetere D, et al. Motor control performance in the lower extremity: normals vs. anterior cruciate ligament reconstructed knees 5–8 years from the index surgery. Knee Surg Sports Traumatol Arthrosc 2000; 8: 296–300.
25. Hoffman M, Schrader J, Koceja D. An investigation of postural control in postoperative anterior cruciate ligament reconstruction patients. J Athl Train 1999; 34: 130–6.
26. Chmielewski TL, Wilk KE, Snyder-Mackler L. Changes in weight-bearing following injury or surgical reconstruction of the ACL: relationship to quadriceps strength and function. Gait Posture 2002; 16: 87–95.
27. Gauffin H, Pettersson G, Tegner Y, Tropp H. Function testing in patients with old rupture of the anterior cruciate ligament. Int J Sports Med 1990; 11: 73–7.
28. Friden T, Zatterstrom R, Lindstrand A, Moritz U. Anterior-cruciate-insufficient knees treated with physiotherapy. A 3-year follow-up study of patients with late diagnosis. Clin Orthop Relat Res 1991; 263: 190–9.
29. Kapreli E, Athanasopoulos S, Gliatis J, et al. Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study. Am J Sports Med 2009; 37: 2419–26.
30. Melnyk M, Faist M, Gothner M, Claes L, Friemert B. Changes in stretch reflex excitability are related to ‘giving way’ symptoms in patients with anterior cruciate ligament rüptüre. J Neurophysiol 2007; 97: 474–80.
31. Dyhre-Poulsen P, Krogsgaard MR. Muscular reflexes elicited by electrical stimulation of the anterior cruciate ligament in humans. J Appl Physiol 2000; 89: 2191–5.
32. Riesterer J, Mauch M, Paul J, Gehring D, Ritzmann R, Wenning M. Relationship between pre-and post-operative isokinetic strength after ACL reconstruction using hamstring autograft. BMC Sports Sci. Med. Rehabilitation 2020; 12: 1-10.
33. Fischer F, Fink C, Herbst E, Hoser C, Hepperger C, Blank C, Gföller P. Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction. Knee Surg. Sports Traumatol. Arthrosc 2018; 26: 418-425.