Hooks TR, Wilk KE, Reinold MM, Trapuzzano T, Barrentine SW, Andrews JR; HealthSouth Sports Medicine Center, Birmingham, AL. Trhooks@hotmail.com.

PURPOSE: Proprioceptive deficits following ACL injury and surgical reconstruction have been documented for the involved extremity and comparing this loss with the contralateral extremity. However these studies have examined these variables with subjects in non-weight bearing positions. In addition, no study has examined the periodic change in proprioception and documented the time needed to restore these deficits. Therefore, the purpose of this study was to measure the change in proprioception for the involved and noninvolved extremity following ACL injury and surgical reconstruction using a single leg stance to determine the time needed to restore proprioceptive control. SUBJECTS: Thirteen patients (8 male, 5 female, age range 17 – 35) participated in this study. All patients had suffered an ACL rupture within 72 hours of initial testing, and had no prior history of injury to either the involved or noninvolved knee. METHODS: Subjects performed single leg balance using a Biodex Stability System (Biodex Corp., Shirley, NY) with the knee flexed at 30°. The stability level systematically decreased from level 8 to level 4 during the 20 second testing period. Each subject performed, in random order, two trials for each extremity with eyes open and eyes closed. Measurements were recorded for overall balance, medial-lateral (ML) index, and anterior-posterior (AP) index. Stability measurements were taken within 72 hours following ACL injury and at 2, 4, 6, 8, 12, and 16 weeks following ACL reconstruction. ANALYSES: General Linear Model Repeated Measures analyses with post hoc pair-wise comparisons were conducted for the involved and noninvolved lower extremity for each test performed. RESULTS: A statistically significant decrease in proprioception was noted with the eyes closed as compared to open for both lower extremities for each testing parameter. Proprioceptive deficits were the highest for overall balance, followed by AP index, and then ML index for each testing condition. An overall trend toward decreased proprioception occurred throughout the 16-week testing period. CONCLUSIONS: Following ACL injury and surgical reconstruction proprioception is altered for both the involved and noninvolved lower extremities. RELEVANCE: This study demonstrates that a decrease in proprioceptive awareness occurs to a greater extent in the noninvolved extremity as compared to the involved extremity during the first 4 months following surgical reconstruction, due to the apparent resultant of a bilateral decreased normalization in proprioceptive capabilities. Based on the results of this study a rehabilitation program that includes proprioceptive training for the noninvolved lower extremity following ACL reconstruction should be implemented. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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