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Open Access Highly Accessed Study protocol

Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

Kathleen White1*, Stephanie L Di Stasi2, Angela H Smith3 and Lynn Snyder-Mackler13

Author Affiliations

1 University of Delaware, Biomechanics and Movement Science Program, Newark, DE, USA

2 The Ohio State University, Sports Health and Performance Institute, Columbus, OH, USA

3 University of Delaware, Physical Therapy Department, Newark, DE, USA

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BMC Musculoskeletal Disorders 2013, 14:108  doi:10.1186/1471-2474-14-108

Published: 23 March 2013

Abstract

Background

Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk.

Methods/Design

80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures.

Discussion

The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR.

Trial registration

Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317

Keywords:
Anterior cruciate ligament reconstruction; Neuromuscular training; Return to Sport