title: Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers.
abstract: We investigated whether preoperative perturbation training would help anterior cruciate ligament (ACL) deficient individuals who complain of knee instability ("non-copers") regain quadriceps strength and walk normally after ACL reconstruction. Nineteen non-copers with acute ACL injury were randomly assigned into a perturbation group (PERT) or a strengthening group (STR). The PERT group received specialized neuromuscular training and progressive quadriceps strength training, whereas the STR group received progressive quadriceps strength training only. We compared quadriceps strength indexes and knee excursions during the mid-stance phase of gait preoperatively to data collected 6 months after ACL reconstruction. Analyses of Variance with repeated measures (time/limb) were conducted to compare quadriceps strength index values over time (time x group) and differences in knee excursions in limbs between groups over time (limb x time x group). If significance was found, post hoc analyses were performed using paired and independent t-tests. Quadriceps strength indexes before intervention (Pert: 87.2%; Str: 75.8%) improved 6 months after ACL reconstruction in both groups (Pert: 97.1%; Str: 94.4%). Non-copers who received perturbation training preoperatively had no differences in knee excursions between their limbs 6 months after ACL reconstruction (p = 0.14), whereas those who received just strength training continued to have smaller knee excursions during the mid-stance phase of gait (p = 0.007). Non-copers strength and knee excursions were more symmetrical 6 months postoperatively in the group that received perturbation training and progressive quadriceps strength training than the group who received strength training alone.
authors.affiliation: Physical Therapy Department, and Biomechanics and Movement Sciences Program, University of Delaware, 301 McKinly Lab, Newark, Delaware 19716-2591, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Hartigan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Axe
authors.forename: Lynn
authors.initials: L
authors.lastname: Snyder-Mackler
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000502:physiology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000517:prevention & control / Q000534:rehabilitation*; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control / Q000534:rehabilitation*; D011300:Preoperative Care / Q000379:methods*; D052097:Quadriceps Muscle / Q000502:physiology; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D055815:Young Adult