STROBOSCOPIC AND NEUROMUSCULAR TRAINING IN REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

T.-J. Lin¹, C.-J. Hsu², S.-L. Hsieh², C.-M. Chang¹, C.-H. Lee¹, H.-C. Lin¹

¹China Medical University, Department of Physical Therapy, Graduate Institute of Rehabilitation Science, Taichung City, Taiwan, ²China Medical University Hospital, Department of Orthopaedic Surgery, Taichung City, Taiwan

Background: Proprioception after anterior cruciate ligament reconstruction (ACLR) cannot be fully restored. Even with training, results regarding the improvement of proprioception are inconsistent in the literature. Moreover, visual reliance effect of ACLR training program on static single leg balance have not been reported.

Purpose: The present study compared the effectiveness of therapist-supervised neuromuscular training (NMT), neuromuscular training with stroboscopic visual training (NST), and home-based rehabilitation (HBR) after ACLR in enhancing proprioception, balance, muscle strength, self-reported functional scale and visual reliance during static single leg balance.

Methods: This prospective study recruited individuals six weeks post-ACLR, who agreed to receive an eight-week exercise training program according to their group allocations (NMT, NST, HBR). The NMT and NST group received a one-on-one training with a licensed physical therapist, while the HBR group were asked to perform a training following a demonstration video online. Evaluation of outcomes were performed at pre-operation, at 6 weeks following ACLR (before training), and 14 weeks post-ACLR (post-training). Outcome measures included isometric muscle strength (quadriceps and hamstring), proprioception (knee joint position sense and threshold to detect passive motion tests), balance (static balance test and star extension balance test), and knee outcome survey-activities of daily living scale (KOS-ADLS). The Kruskal-Wallis test by time point difference (changes between post-training to pre-operation and to before training) and by group was used to explore the difference in rehabilitation outcomes. The Wilcoxon signed-rank test was used to determine the differences in significant interaction and within-group differences. Level of significance was set at p<0.05.

Results: Twenty post-ACLR individuals completed the training program in the study (NST=6; NMT=7; HBR=7). No statistical difference in categorical demographics were noted between groups (p>0.05). KOS-ADLs showed a significant difference among three groups at the change between post- and before training (p<0.05). Post-hoc showed a significant greater increase in NST than HBR (p<0.05; NST=21.50±6.06, NMT=20.43±12.46, HBR=9.57±10.56). Quadriceps muscle strength showed a significant difference among groups at the change between pre-operation and post-training (p<0.05).However, post-hoc showed no significant differences between NST and NMT (p=0.465),NST and HBR (p=0.109), and NMT and HBR (p=0.109). Visual reliance of CoP area during single leg balance showed significant difference among three groups at pre-operation and post-training (p<0.05).Post-hoc, however, showed no significant differences between groups (NST and NMT, p=0.109; NST and HBR, p=0.068; NMT and HBR, p=0.116).

Conclusions: This study confirmed that the functional score and muscle strength can be improved after the eight-week training programs. The visual reliance in single leg standing was also found to be altered through different trainings. However, with limited sample, no statistical differences among groups in the improvement of visual reliance and proprioception was observed.

Implications: The results of this study can provide a basis for training of post-ACLR individuals.

Funding acknowledgements: MOST 108-2410-H-039-010 - and MOST 110-2410-H-039-011 -

Keywords:
Stroboscopic training
Anterior Cruciate Ligament Reconstruction
Exercise therapy

Topics:
Musculoskeletal: lower limb
Sport & sports injuries

Did this work require ethics approval? Yes

Institution: China Medical University & Hospital

Committee: Research Ethics Committee

Ethics number: CMUH108-REC3-007