Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls.
BACKGROUND
Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).


OBJECTIVE
This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.


METHODS
Cross-sectional study; Level of evidence, 3.


METHODS
This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.


RESULTS
The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests ( P = .837).


CONCLUSIONS
The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.
Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.|Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Anne
A
Fältström
Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Martin
M
Hägglund
Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Joanna
J
Kvist
D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction; D001265:Athletic Injuries / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery; D035002:Lower Extremity / Q000502:physiology*; D009068:Movement; D020127:Recovery of Function; D000068958:Return to Sport; D012916:Soccer / Q000293:injuries; D013548:Sweden; D055815:Young Adult
anterior cruciate ligament; physical therapy; proprioception; return to sports; soccer; test battery